Rheumatology practice and training in India – A perspective from rheumatology consultants
Durga Prasanna Misra1, Vinod Ravindran2, Aman Sharma3, Anupam Wakhlu4, Vir Singh Negi5, Ved Chaturvedi6, Vikas Agarwal1
1 Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
2 Centre for Rheumatology, Calicut, Kerala, India
3 Department of Internal Medicine, Clinical Immunology and Rheumatology Services, Postgraduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Rheumatology, King George's Medical University, Lucknow, Uttar Pradesh, India
5 Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
6 Department of Rheumatology and Clinical Immunology, Ganga Ram Institute for Postgraduate Medical Education and Research, Sir Ganga Ram Hospital, New Delhi, India
Dr. Durga Prasanna Misra
Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: We surveyed rheumatology consultants regarding their perceptions about rheumatology practice and training in India.
Materials and Methods: A structured questionnaire was administered during two national rheumatology meetings to evaluate practice settings and demographic characteristics of patients seen. We also assessed perceptions regarding junior doctors, auxiliary health professionals (AHPs), ancillary facilities (daycare, intra-articular injections, musculoskeletal ultrasound [MSKUS]), and possible government-driven strategies for improving rheumatology care delivery.
Results: The response rate was 56% (70/125); 68 complete responses were further analyzed. Most respondents were in the private sector (56/68), had been in practice for a mean of 11.5 (±8.4) years, attended to a mean of 150 (±91) patients every week, a majority of whom were educated upto intermediate level and belonged to the middle class. About 60% had junior doctors to assist them in care delivery; 82.5% (52/63) felt that junior doctors had limited competence in managing rheumatic diseases. More than 90% felt the need for AHPs in the clinic, although less than one-half had access to such personnel. Most utilized ancillary services like intra-articular injections (97%), daycare facilities for infusions (92%), and MSKUS (71%). More than 90% respondents felt that government-funded programs for the management of rheumatic diseases, coupled with a structured referral system, would be useful.
Conclusion: Rheumatology practice in India may improve by better training junior doctors in skills related to rheumatology at the undergraduate and postgraduate internal medicine levels. The development of specialist AHPs may help enhance service delivery. Government programs for community management of rheumatic diseases and management guidelines suited to the needs of a developing economy majorly reliant on out-of-pocket expenditure for healthcare are significant areas for development.