The Central Council of Indian Medicine, which is a statutory body set up under the AYUSH Ministry to regulate Indian systems of medicine, issued a gazette notification allowing Postgraduate (PG) Ayurvedic Practitioners to receive formal training for a variety of general surgery, ENT, ophthalmology and dental procedures.
The Central Council of Indian Medicine directed amendments to the Indian Medicine Central Council (Post Graduate Ayurvedic Education) Regulations, 2016, which allowed postgraduates students in Ayurveda undergoing ‘Shalya’ that is general surgery and ‘Shalakya’ which deals with eye, ear, nose, throat, head and neck, oro-dentistry to perform 58 specified surgical procedures.
This attracted opposition from many allopathic professionals. It was condemned by the Indian Medical Association (IMA) as a mode of allowing mixing of systems of medicine by using terms from allopathy. But later, the AYUSH Ministry subsequently 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, and the amendment merely added clarity and definitions to the 2016 regulations concerning post-graduate Ayurveda education.
In 2019, Lok Sabha passed National Medical Commission Bill (NMC). This bill allowed for the formalisation of proposals to induct mid-level care providers — Community Health Providers — in primary healthcare in India, who would serve at health and wellness centres across the country, and focus on primary healthcare provision, with a limited range of medicines allowed for them to use for treatment of patients.
Mid-level care providers or MLPs are not practising doctors, they are health workers trained at a higher education institution for at least 2-3 years. They are authorized to work autonomously to diagnose, manage and treat illness, disease and impairments, as well as engage in preventive and promotive care.
The main aim of providing MLPs is to improve the overall healthcare sector, especially in rural areas but this comes along with strict rules and regulations, training, certification, and standards.
The issue that allopathic doctors raise is that this practise would result in uneven standards of medicine because even though the postgraduate Ayurvedic surgical training is not short-term, it is difficult to determine if the outcome of both a formal three-year course of surgeries conducted in Ayurvedic medical colleges and hospitals will have the same standards and outcomes as allopathic institutions require explication and detailed formal enquiry, in the interest of patient safety.
On the other hand, this can prove to be helpful for Indian healthcare system as there is a shortage of allopathic doctors in rural areas, even after repeated efforts of the government to encourage doctors to practice in rural areas through rural bonds and quota for those who have served in rural service in postgraduate seats. Availability and accessibility of MLPs can bridge this gap.
The AYUSH streams are recognised systems of medicine, and are allowed to independently practise medicine. There are special medical colleges who offer both undergraduate and postgraduate training, including surgical disciplines for some systems, such as Ayurveda. But there is a difference in approach in the systems of medicine and models which allow for cross-pathy. 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.
