It was way back in January 2000 that the Union health ministry first received the proposal for a Bachelor of Rural Medicine and Surgery (BRMS), a degree specially designed to address the shortage of medical practitioners in rural India. The degree had its critics, and alternative proposals?like the National Rural Health Mission?won the day, back then. But as the challenge remained formidable, the Union health ministry announced in January 2010 that the Medical Council of India (MCI) would be crafting the syllabus for a BRMS course that would run into 3.5 years (as opposed to the 5.5 years that a conventional MBBS course demands). Both the health & family welfare minister and MCI have been talking up BRMS since then. Now, the Planning Commission?s high level expert group on universal health coverage has also given the course its backing, and projected that all districts with more than 5 lakh people will have BRMS colleges by 2022. Intended to be delivered entirely at rural sites, with qualifying practitioners practising only in rural areas for the first 10 years after they qualify, and with their training focused on villages? health problems, the BRMS course can really address India?s rural-urban healthcare divide, wherein around 80% of our doctors cater to only 20% of the population.
This problem is not unique to India by any means. Shortage of doctors in rural areas is severe even in Japan, which boasts a cheap, successful and universal health insurance system. In the US, only 9% of doctors practice in the rural areas where 20% of the population lives. Germany has seen the number of practising physicians increase by 50% in the last 20 years, but the 550 empty rural practices today are still expected to be joined by another 7,000 in the next decade, because country doctors are retiring without replacements. In the face of young doctors? seemingly universal desire to stay in the cities in which they are trained, the BRMS scheme does seem a promising model to counteract the acute rural healthcare shortfall. With proper quality safeguards, let?s get this innovative framework moving.