The Central Council of Indian Medicine, a statutory body set up under the AYUSH Ministry has allowed postgraduate (PG) Ayurvedic practitioners to receive formal training for a variety of general surgery, ENT, ophthalmology and dental procedures.
Debate over Ayurvedic surgeries
- The Indian Medical Association (IMA) decrying it as a mode of allowing mixing of systems of medicine by using terms from allopathy.
- The debate revolves Ayurveda doctors allowing ‘Shalya’ (general surgery) and ‘Shalakya’ (dealing with eye, ear, nose, throat, head and neck, oro-dentistry) to perform 58 specified surgical procedures.
- The AYUSH Ministry has clarified that the ‘Shalya’ and ‘Shalakya’ postgraduates were already learning these procedures in their (surgical) departments in Ayurvedic medical colleges as per their training curriculum.
Broader issue
- The broader issue is the feasiblity of short-term training equip them to conduct surgeries and if this dilutes the medicine standards in India.
- As such, the postgraduate Ayurvedic surgical training is not short-term but a formal three-year course.
- Whether the surgeries conducted in Ayurvedic medical colleges and hospitals have the same standards and outcomes as allopathic institutions requires explication and detailed formal enquiry, in the interest of patient safety.
Why such a move?
- The shortage and unwillingness of allopathic doctors, including surgeons, to serve in rural areas is now a chronic issue.
- The government has tried to address this by mechanisms such as rural bonds, a quota for those who have served in rural service in postgraduate seats.
- However, it would probably still continue to fall short of enough trained specialists in rural areas.
Are there any restrictions on Ayurveda practitioners?
- As of now, no such restriction exists that limits non-allopathic doctors, including those doing Ayurvedic surgical postgraduation, to rural areas.
- They have the same rights as allopathic graduates and postgraduates to practise in any setting of their choice.
Is it sensible to allow Ayurvedic surgeons to only assist allopathic surgeons, rather than perform surgeries themselves?
- The AYUSH streams are recognised systems of medicine, and as such are allowed to independently practise medicine.
- They have medical colleges with both undergraduate and postgraduate training, which include surgical disciplines for some systems, such as Ayurveda.
- There is, however, a difference in approach in the systems of medicine, and hence models, which allow for cross-pathy.
Various risks associated
- An apprenticeship model for Ayurvedic surgeons working with allopathic surgeons might fall into a regulatory grey zone.
- It might require re-training Ayurvedic practitioners in the science of surgical approaches in modern medicine.
- Even then, there might be a limit to what they are allowed to do. Any such experiment can put patient safety in peril, and hence, will need careful oversight and evaluation.
Can this lead to substandard care?
- Many patients prefer to receive treatment exclusively from AYUSH providers, while some approach this form of treatment as a complement to the existing allopathic treatment they are receiving.
- For invasive procedures, like surgery, the risk element can be high.
A matter of rights
- Patients have a right to know and understand who their surgeon would be, what system of medicine they belong to, and their expertise and level of training.
- There should not be a difference in quality of care between urban and rural patients — everyone deserves a right to quality and evidence-based care from trained professionals.
Way forward
- We need to explore creative ways of addressing this gap by evidence-based approaches, such as task-sharing, supported by efficient and quality referral mechanisms.
- The advent of mid-level healthcare providers, such as Community Health Providers in many States, is also an opportunity to shift some elements of healthcare (preventive, promotive, and limited curative) to these providers, while ensuring clarity of role and career progression.
