training

Type of Training – Residency (MDGP program)

Length of Training – 3 years

Year Family Medicine established – 1982

Number of family medicine residents graduating each year – unknown

Number of institutions that offer family medicine – 7 training centers

practice

Number of family doctors – unknown

Physician to population ratio – unknown

DALY: 29,514/100,000 individuals (due to all causes)

Life Expectancy:

• Females 2017: 72.0 years

• Males 2017: 69.0 years

Mortality rate 2017:

• Males: 167 per 1,000 male adults

• Females: 125 per 1,000 female adults

Infant Immunization-HepB3: % of 1-year-old children recieved: 90%.

College of Family Physicians (Y or N):

• No

training

The undergraduate medical education is a MBBS program that includes six years of medical school along with a one-year internship (Allison, 2018). During the MBBS program, the first two years is spent on the basics, and the next four years involves clinical training (Allison, 2018). Some medical schools like the Patan Academy of Health Sciences have emphasized on a community health and primary care perspective from the start (Allison, 2018). Three medical schools are government funded and the rest are all private, hence the syllabus of what is taught to students depends on whether the medical school is private or government funded (Allison, 2018). From medical school onwards, the training received by students is specialist oriented and this trend is also observed in general hospital system (Ackerman, Lani).

Residency training is available but it is not mandatory (Ackerman, n.d.).  The first residency program was established in 1982, and was known as the Calgary Nepal project that was introduced in collaboration with Tribhuvan University Institute of Medicine in Kathmandu and the University of Calgary, Canada (Ackerman, n.d.).  All applicants for this residency should have completed an MBBS or equivalent medical course, and an internship (Ackerman, n.d.).

The MDGP program is different from the family medicine programs in North America, the approach of the program aims to train generalists rather than primary care professionals (Allison, 2018). The MDGP residents receive training for anaesthesia (both general and spinal), basic operation, crash C-section, orthopaedics, basic fracture management, paediatrics, dermatology, and dentistry (Allison, 2018; Lewis et al., n.d.). The purpose of the MDGP program is to train healthcare professionals capable of providing a wide range of services at a district hospital when there are no specialists available in the area (Lewis et al., n.d.). This program was not highly desired in the past, however now the trend is changing (Allison, 2018). The residents are taught through rotations along with some didactic elements (Allison, 2018).  The MDGP program also involves a research component in the form of a Masters thesis (Allison, 2018). The MDGP graduates are well respected due to the well-rounded knowledge they have, which they gain during the in-depth generalist training they undergo (Allison, 2018). The Nepal Medical Council oversees the continuing certification (Allison, 2018). Physicians seek continuing certification even though there are no fixed requirements for it (Allison, 2018).

Currently, the seven residency training centers in Nepal include Tribhuvan University Teaching Hospital, Kanti Children’s Hospital, Maternity Hospital, Patan Hospital (all in Kathmandu), Western Regional Hospital, United Mission Hospital, and District Hospital (Ackerman, n.d.).

practice

In Nepal, the term used for a ‘family doctor’ type of care is either MDGPs or general practitioners, the difference between the two is that a MDGP has completed a three year MDGP program, while a general practitioner has completed the MBBS and set up a practice right after graduating with no additional training (Allison, 2018).

MBBS graduates after successfully completing the licensing exam can start to practice medicine (Allison, 2018). The MBBS graduates provide service by working as primary healthcare providers (Allison, 2018). It is known that those who work to provide service in remote hospitals are able to get better opportunities for residency later on (Allison, 2018).

In the villages, a health assistant who has completed grade 10 and has received 2 years of training or a certified medical assistant who has completed grade 10 and had received 10 months of training practice, manage health and sub health posts (Ackerman, n.d.). There are over 2000 doctors registered with Nepal Medical Council, out of which approximately 245 are specialists, 28 are dental surgeons, 551 are general medical officers who are medical school graduates without residency training, and 91 are public health administrators (Ackerman, n.d.).

Nepal has seven provinces with a lot of primary healthcare centers and district hospitals, in addition to a few private hospitals (Allison, 2018). There is no gatekeeping role because the MDGPs provide care to everyone that visits them. In the cities, the generalists compete with specialists to see patients (Allison, 2018).  Patients don’t have an allegiance to a particular doctor and would visit three to four doctors (Allison, 2018).

MDGPs and general practitioners have a solo practice mostly, except in remote district hospitals (Allison, 2018). There is a certain degree of a team-based practice in remote district hospitals, since they are isolated and it is the doctors who also manage the hospital at the same time (Allison, 2018).

Nepal has a vertical disease oriented model of primary care that does not have a major preventative focus (Allison, 2018). Currently, there is a lack of strong public health presence. Mass screenings are performed, but this is not the responsibility of the MDGPs (Allison, 2018).