Why are doctors protesting in India?
On December 11, thousands of doctors from across the country went on a day-long strike to register dissent.
On December 11, thousands of doctors from across the country went on a day-long strike to register dissent against the Government of India’s new rules allowing Ayurvedic doctors to practice minor surgical procedures. The rules that were passed on November 19th by the Central Council of Indian Medicine, stated that the post graduate scholars of Shalya and Shalakya must be trained to independently perform 58 minor surgeries. Doctors and medical students across the country have been protesting against the new rule, saying that they strongly oppose ‘Mixopathy’. Ayurvedic practitioners, however, have emphasised that the IMA should not call this mixopathy, but an integrated system.
No to Mixopathy
Mixopathy is the term used commonly by the doctors practicing modern medicine, referring to the possible integration of alternative medicines like Ayurveda or Homeopathy with modern medical science.
“We respect Ayurveda, and we believe that further research in it must be promoted. However, we strictly say no to mixopathy. Just allowing Ayurvedic doctors to directly use allopathic medicine or procedures is not going to help develop this alternative medicinal practice,” says Dr Avinash Bhondwe, Maharashtra State President, Indian Medical Association (IMA).
Doctors under IMA’s umbrella had also protested across the country a few years ago when the Government had allowed Ayurvedic and Homeopathic doctors to prescribe allopathic medicine.
“The rules have included 58 surgeries, which include General Surgery, Urology, Surgical Gastroenterology, ENT, Ophthalmology, and Dental medicine, and Ayurvedic names have been given to those. These are not the surgeries from Sushrut Samhita, those were different. The CCIM should explain with proof that each of these procedures mentioned in the ancient Ayurvedic Surgery are equivalent to the modern Medical Surgical Nomenclature as mentioned in the Notification. They won’t be able to do it,” Bhondwe adds.
The doctors have demanded that the amendments must be withdrawn and the medical boards must stop promoting mixopathy. IMA’s reasons for opposition are simple. The National Medical Commission (NMC) regulates the surgical branch of modern medicine. The CCIM has included the 58 surgeries in Ayurveda syllabus without taking permission from the NMC. Thus, after the said PG course in Ayurveda, the students will be awarded a Master of Surgery (MS) degree in Modern Medicine. The doctors and medical students feel that this could mislead people.
Difference in Training
Emphasising on the years and efforts MBBS students put into training for surgeries, Bhondwe says, “In allopathic medicine, students first learn the anatomy of the human body. Then they learn biochemistry, pathology. Then those who have a higher score in the MBBS examination get into training for surgery, where they conduct hundreds of surgeries under the guidance of senior doctors. After that, when they get into their specialisation, they learn more complex surgeries.”
Along with the intrinsic details of this training, the IMA Maharashtra President also states that the students in Ayurvedic medicine programme do not have much exposure. “Number of surgical patients in Ayurvedic hospitals is very less, so the students don’t see as many patients as an MBBS doctor,” he says.
“We are not saying that the Ayurvedic doctors/students are not capable, but they are not trained for surgeries in their learning system,” he adds.
"Untrained persons practicing sophisticated surgical procedures which require years of training under modern medicine is a grave threat to public health," states the IMA in its public statement on the issue.
“As MBBS students we get to watch and experience surgeries from the second year of our MBBS course itself,” says a second year MBBS student at BJ Government Medical College.
He adds, “We have had surgery postings since second year, so until we finish our internships, for four years, we have a good experience and exposure to different types of surgeries. That is not the case with the BAMS students. In fact, they also don’t study anatomy, dissections, pathology as detailed as we do. Due to this, there are good chances that in case there is a major complication in any of these surgeries, the Ayurvedic surgeons might not be able to resolve it, and would in the end, need an allopathic doctor.”
Most of the 58 surgeries, out of which 39 are general surgery procedures and 19 are related to Eye, Ear, Nose, Throat, Head, Oro-Dentistry surgeries. As per IMA, most of these surgeries are conducted by super-specialist surgeons, for which they pursue studies and experience for almost eight years of actual experience, right from the first year of MBBS.
Protests to Continue
From December 2, the doctors and medical students have begun various protests to oppose this move by the CCIM.
In Maharashtra, along with the doctors registered with the Maharashtra Medical Council, students from 36 Government and Private Medical Colleges in Maharashtra studying MBBS actively on behalf of IMA's wing of Medical Students Network (MSN), junior doctors pursuing PG through the Maharashtra Resident Doctors Association (MARD) and the Junior Doctors Network (JDN), a wing of IMA have been agitating against the new rules. Nationwide, 6 lakh IMA members from all over India, including postgraduate and postgraduate medical students of modern medicine, have supported the protest.
On December 11, the doctors were on a symbolic strike from 6 am to 6 pm, where they did not see any patients except for emergency cases and COVID-19 patients. “If nothing happens, we will go to the Supreme Court to challenge this notification,” Bhondwe said.
Bridging the Doctor-Patient Gap
‘If you want more doctors, increase the number of medical hospitals and the number of seats at the hospitals’ is what the doctors have stated. “They say we do not have enough surgeons. Then we should have more government medical colleges, and increase the number of seats there. That way, we will be able to train more and efficient surgeons,” the MBBS student said.
The uneven ratio between the doctors and the patients was also the reason when the Homeopathic, as well as Ayurvedic doctors, were allowed to prescribe allopathic medicines. However, even then, doctors practising modern medicine had opposed, instead asking the Central Government to boost advanced research in alternative medicine.
"India has a robust modern medicine system and Indian doctors are skilled and affordable. 550 odd medical colleges are turning out around 1,00,000 doctors every year. There is only a lack of political will and investment to expand and strengthen services. States like Tamil Nadu and Kerala have employed MBBS doctors in PHCs on a permanent basis and deployed them gainfully 24x7. Around 1,50,000 young MBBS doctors are unemployed at any point of time trying their chances at PG NEET. Mixopathy for cheap labour will be a cruel joke to these young doctors,” statement issued by the IMA Headquarters on December 13th stated.
What Ayurvedic Practitioners are saying?
Ayurvedic practitioner Vaidya Prashant Tiwari, who is also an invitee advisory member of Ministry of AYUSH, has alleged the IMA of misleading people by calling this approach mixopathy. “It is an integrated system, where the people will get more options to choose from. They could also get alternatives to surgeries. We could combine conventional as well as unconventional medicine,” Tiwari said.
He also said that as opposed to the rumours, not all BAMS doctors will be performing surgeries. The good colleges that offer MS degrees will train Ayurvedic doctors in surgical procedures. Here, they will also get exposure to patients. And anyway, if we don’t allow Ayurvedic doctors to perform any surgeries in the first place, how will the students get exposure?” he questions.
Tiwari also adds that the IMA has misinterpreted the notification, and now misleading people.