In the first-ever national survey assessing the structure of family medicine in India– The landscape of family medicine in India - A cross-sectional survey study, researchers uncovered not only a drastic shortage of family physicians but also the underlying reasons behind it — and how this shortfall is impacting the overall healthcare delivery model.
Family medicine is often regarded as the backbone of a healthcare system. It goes beyond basic primary care by offering a comprehensive, continuous approach that integrates medical , social and economical aspects of a community. A family physician acts as a crucial link between the individual and the healthcare system. They not only diagnose and treat patients but also perform minor office-based procedures, provide palliative care, offer community health services, conduct home visits, Telemedicine and cater to people of all ages, genders, and medical conditions.
However, this specialty remains under-recognized in India, and its declining relevance poses a potential threat to community-level medical care.
Globally, the terms Family Physician and General Practitioner (GP) are often used interchangeably. In the Indian context, however, there’s a key distinction: a GP typically refers to an MBBS doctor providing primary care without postgraduate training, whereas a family physician has undergone specialized postgraduate training in family medicine.
And this distinction lies at the heart of the problem.
Family medicine was officially recognized as a specialty in India in the early 1980s by the then Medical Council of India (now the National Medical Commission). Despite this recognition, only a limited number of medical colleges across the country offer dedicated training programs in the field.
While several training pathways in family medicine exist, only two are recognized as full-time postgraduate qualifications by the National Medical Commission:
Doctorate of Medicine in Family Medicine (MD-FM)
Diplomate of National Board in Family Medicine (DNB-FM)
Other options such as the Postgraduate Diploma in Family Medicine (PGDFM), Master’s in Family Medicine, etc are part time or distance learning programs and often lack regulatory standardization. Some physicians also opt for international qualifications like the MRCGP (International) offered by the Royal College of General Practitioners, UK, which is comparable to global standards in family medicine training.
Traditionally, general practitioners have managed most of the country’s primary care needs. However, this trend is declining due to two key reasons:
Lack of academic credibility for GPs without postgraduate training.
Increasing preference among young doctors for more specialized, popular fields like internal medicine, pediatrics, and surgery.
Family Physicians in India
The first MD in Family Medicine (MD-FM) training program in India began at the Government Medical College in Calicut in 2012. From 2015 to 2020, the college offered only 2 seats per year, resulting in just 10 trained family physicians during that period. Out of 286 government medical colleges, only seven offer the MD-FM program, while among 276 private institutions, only 39 offer DNB-FM, with a total of just 110 seats available annually. Most postgraduate Family Medicine courses are concentrated in three South Indian states—Kerala, Karnataka, and Tamil Nadu. This is reflected in the distribution of fully trained family physicians, the majority of whom currently practice in these states. Overall, accredited Family Medicine training seats account for only slightly more than 1% of all postgraduate medical seats in India.
According to the survey, 62% were working in the private sector, 52% in the government sector, and 16% were engaged in both. Interestingly, those with full-time FM training were less likely to serve in the government sector compared to those who underwent part-time training. Regarding services provided, 88.9% of respondents offered outpatient Family Medicine services, while others were involved in hospital-based services such as emergency care, inpatient management, and more.
Community Health Centres (CHCs) are designed to be primary care centers staffed with specialist doctors providing disease-specific care. Ideally, each CHC is assigned a medical specialist, gynecologist, pediatrician, and surgeon. However, due to inadequate infrastructure, lack of resources, and their remote locations, many of these posts remain vacant. Family physicians—trained in minor surgical procedures, childbirth, chronic disease management, and pediatric care—can effectively fill these gaps. Their broad training equips them to address diverse healthcare needs in under-resourced settings.
Family physicians are uniquely trained to work in remote areas with limited resources while maintaining a strong focus on community health and well-being. In the absence of qualified family physicians, rural populations often turn to untrained or quack practitioners. This can result in harmful outcomes, especially for poor and underserved communities that cannot afford or access care in urban centers.
A family physician provides comprehensive, continuous primary care to individuals and families. Without them, patients are often forced to seek specialists even for minor ailments, leading to longer waiting times, higher healthcare costs, and inefficient use of specialist services. Moreover, without proper triage and referral systems at the primary care level, specialist clinics become overburdened.
Currently, the MBBS curriculum in India does not give adequate focus to Family Medicine, despite it being an integrative specialty that encompasses various medical domains. As a result, aspiring family physicians often have to practice without formal training, given the scarcity of FM training seats. Additionally, many part-time FM training posts are not officially recognized, creating uncertainty among young doctors about whether to pursue the field.
In contrast, many countries have well-established postgraduate training programs in Family Medicine (also known as General Practice) to strengthen primary and community healthcare. The Medical Council of India must recognize this gap and take necessary steps to integrate Family Medicine more effectively into medical education and workforce planning.
References:
1. Gupta, Archna, Raman Kumar, Ramakrishna Prasad, Sunil Abraham, Nisanth Menon Nedungalaparambil, Paul Krueger, Carolyn Steele Gray, Megan Landes, Sanjeev Sridharan, and Onil Bhattacharyya. “The Landscape of Family Medicine in India – A Cross‑Sectional Survey Study.” PLOS Global Public Health 5, no. 1 (January 29, 2025): e0004107. https://doi.org/10.1371/journal.pgph.0004107.
(Rh/Dr. Shubham Halingali/MSM/SE)