Beds don’t treat patients: Doctors do. And they are in short supply. Here’s what to do

Leading epidemiologists predict that by the end of the year India will have millions of Covid-19 infected patients, vastly higher than present numbers. Let us prepare for the worst and pray for the best. Thanks to the early lockdown by the government we got two months to prepare for the Covid onslaught. Today we are debating about exporting PPEs and ventilators, rather than struggling to import them a couple of months ago. Our attention should now shift towards reducing mortality, especially in rural India.

The first round of the Covid battle was won by doctors and nurses working mainly in government and some private hospitals. They did a phenomenal job at a very early stage of the pandemic. Today these doctors are tired and burnt out. Both private and government hospitals treating Covid patients are desperately short of young specialist doctors and nurses, not beds, as media projects.

Who can take care of sick Covid patients? The ideal doctor to do so in the ICU is an MBBS doctor who has worked in a critical care unit for at least two years. They should be less than 50 years old and fit. They should have the skill to insert monitoring lines into blood vessels and maintain vitals. Some of them should be experienced enough to paralyse a patient, insert a tube into the lungs to ventilate. These are extremely skilled jobs. A minor mistake can endanger the patient’s life or their own lives. It’s not true that every doctor can look at the cardiac monitor in the ICU, diagnose and treat.

To manage 1,000 private and government hospitals with over 200 beds for a year we need at least 50,000-75,000 young MBBS doctors who, after internship have gained experience in medical ICU or surgical ICU or coronary care unit, accident and emergency rooms. A 200-bed Covid hospital will need at least 50-75 specialist doctors, 500 nurses to cover 6-hour shifts, weekly off and sickness leave since a few of them will get infected.

How to get 50,000 young trained specialist doctors for Covid ICUs? Generally ICUs need 20% of doctors who are trained in the critical care unit/ anaesthesia or emergency rooms. 80% of the doctors should have the knowledge to interpret the data from the cardiac monitor, biochemical and haematology results, and act on them. Medical talent can be tapped from these sources:

1) About 25,000 young medical specialists who have completed three years of training in clinical specialties in teaching hospitals under MCI or DNB banner and are waiting for the final DNB or MD, MS exams. Most of these skilled doctors are currently jobless since they do not have a postgraduate degree. According to Dr Manoj Gupta, ambassador of DNB Doctors Association, most of these doctors will be happy to serve Covid patients in district hospitals for a year if exempted from the exams.

2) About 3,000 doctors who underwent a fellowship programme for 2-3 years after internship as intensivists in large private hospitals and acquired great skills. According to Dr Dhruva Choudhury, president of Indian Society of Critical Care Medicine, most of these specialists will be delighted to work in Covid hospitals in districts provided the Medical Council of India (MCI) recognises them as “intensivists”.

3) About 1,200 young medical specialists who after internship spent 3 years working in emergency rooms, resuscitating critically ill patients and certified as emergency medicine specialists under the Society of Emergency Medicine. Most of them will be happy to work in Covid hospitals for one year provided MCI recognises them as emergency medicine specialists.

4) About 1,700 young specialist doctors who after the internship spent 2 years in large heart hospitals and gained experience in non-interventional cardiology and coronary care units. According to Dr Rajesh Rajan, chairman of Association of Clinical Cardiologists, most of them will be delighted to work in Covid ICU for a year, provided their diploma degree is recognised by MCI.

5) About 90,000 Indian doctors who are trained in Russia and China couldn’t clear the Indian exit exam. Good number of them are working as physician assistants in critical care units across India. If we can choose about 20,000 brightest young doctors and make an offer to work as junior doctors in Covid hospitals for a year in return for exemption from exam, we’ll get an adequate number of junior doctors to tide over the crisis.

6) There are about 2 lakh final year nursing students who finished training waiting at home for the final exam. Most of them will be happy to work in Covid hospitals provided they are exempted from the final exam and recognised as ICU nurse practitioner on additional 1 year of ICU service.

Healthcare industry is rigidly regulated, which only recognises degrees even with basic skills. For example, any doctor who spends 10 years working full time as an anaesthesiologist post-MBBS, and acquires great skills but without “MD in anaesthesiology” degree, is legally not allowed to anaesthetise patients independently.

However, the aim should be to create a large floating skilled workforce of doctors and nurses who can be deputed where Covid peaks, especially to protect rural India. The Covid crisis has clearly demonstrated that government job or money will not attract MBBS doctors, postgraduate degrees will. This offer can be entirely optional. In exchange for their service to Covid patients if MCI as an exception recognises their skill, a few thousand precious lives can be saved.