India’s vanishing clinicians: Is technology a panacea?

Zachary Jones, Senior VP, Portea Medical, outlines steps that needs to be taken to tackle the growing talent gap in the Indian healthcare sector and suggests that technology can help to some extent

India is in a tough bind. Demand for healthcare workers is set to explode due to both domestic and international trends but the country’s ability to produce more healthcare professionals has seriously lagged demand. In fact the MCI has actually decreased the number of allowed seats for MBBS-level doctors in an effort to ‘preserve the quality of medical education.’ FICCI estimates that over the next ten years, India will need to double its number of doctors, triple its number of nurses, and quadruple its number of paramedical staff. To make matters worse, these estimates are likely to be conservative.

The number of Indian seniors is set to grow from 100 million currently to 240 million by 2050. This demographic boom is being met by a quickly developing senior care industry, heightening the need for nurses and paramedical staff. Also, historically healthcare spend in India has grown slower than the economy as a whole. This is sharp contrast with its emerging market peers where spend growth has outpaced economic growth by around two percentage points. Given the shortfall in healthcare infrastructure in India, this seems unlikely to continue. Both these trends will exacerbate clinician supply shortfalls.

Internationally, the recent healthcare reforms in the US, including the Affordable Care Act (popularly referred to as ObamaCare), will greatly expand the number of Americans that are insured and create an even greater need for foreign-educated healthcare professionals. Presently the US produces far too few healthcare workers to meet its demand. This combined with an across the board ageing of populations in developed countries should create attractive career opportunities outside India for many Indian clinicians.

The talent gap in India can be narrowed via three approaches: task shifting, creating more attractive career paths and a more extensive use of technology in healthcare delivery.

Task shifting

Indian clinicians tend to be ‘jacks of all trades,’ performing many tasks that in developed markets are the responsibilities of more junior clinicians or support staff. This is the result of a number of factors, but largely hinges on poor clinician training, overly defined roles, and a lack of paramedical staff. By fixing these challenges, lower-end tasks can be shifted from senior medical professionals to more junior team members or non-medical staff, freeing up bandwidth to see more patients.

• Clinician training tends to be extremely variable — There are a number of excellent clinicians in India, but unfortunately, a degree doesn’t necessarily equal clinical competence among support staff. As a result, senior clinicians must do much of this lower-end work themselves. The Indian government should take a more proactive role in policing clinician quality.
• Overly defined roles – The Indian healthcare sector could benefit greatly if it were more open to upskilling nurses into roles between those of a doctor and a nurse. In the West, these nurse practitioners have been critical in addressing the shortfall of primary care doctors.
• Creating a strong pipeline of paramedical staff — Many of the tasks that today are done by nurses can be safely and effectively done by nursing aides. By shifting these responsibilities to nursing aides, nurse time can be freed up allowing them to see more patients.

Creating a large group of trained paramedical staff is of the utmost importance and something that we have been able to do successfully at my company, Portea Medical, by replicating US training modules in India. The Government of India through its National Skills Development Corporation (NSDC) has done valuable work in providing access to funding for companies focused on this space.

Creating a value proposition for clinicians

According to McKinsey, 50 per cent of trained medical professionals in India don’t work in the healthcare sector having either emigrated abroad or taken higher paying/ lower stress jobs outside of the healthcare field. The private sector needs to do a better job of creating a career path for clinicians and providing attractive incentives. The government should also look at better ways to recoup the investment it has made by training clinicians at taxer-payer expense in public schools. These could include periods of mandatory service in India before going abroad, service in underserved areas, and minimum periods of service in the healthcare sector before accepting a role in another sector.

Using technology to make healthcare less people dependent

Technology is likely to be a panacea for the healthcare space in India because one of its strengths is automating low-end processes and removing the human element from service delivery. The most exciting applications are in remote monitoring, where “Internet of things” enabled devices can monitor patients in real time eliminating the need for most clinician involvement in the home or hospital setting. The developments in this sector are exciting including smart ECGs, BP apparatuses, and pulse oximeters among many others, which allow hundreds of patients to be remotely observed by a single nurse. This technology already exists and the challenge is around deploying these devices in India in a cost effective way.

Thankfully, the near-term answer to India’s human capital challenge isn’t dependent upon the government’s efforts to build more degree granting institutions. Rather, more extensive use of technology in patient care and a greater availability of trained support staff should allow India to pioneer a less clinician-dependent approach to healthcare delivery.