PMJAY Exclusion of Fellowship-Trained Oncologists Threatens Cancer Care Across India
India detects approximately 15 lakh new cancer cases annually, a patient load equivalent to the population of a major city like Nashik. Despite this staggering burden, hundreds of experienced and fellowship-trained oncologists in the private sector are being systematically excluded from treating patients under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY). This exclusion is not based on inadequate training or lack of experience but stems from their lack of National Medical Commission (NMC)-recognized super-specialty degrees such as DM (Doctorate of Medicine), MCh (Magister Chirurgiae), or DrNB (Doctorate of National Board).
Veteran Oncologists Rendered Ineligible Despite Decades of Experience
Doctors affected by this policy shift emphasize that until recent decades, fellowships were the primary pathway into oncology, as formal degree courses did not exist. Even today, securing a two- or three-year fellowship at renowned cancer hospitals like Tata Memorial Hospital, AIIMS Delhi, or Gujarat Cancer Research Institute remains prestigious, providing hands-on training in specialized areas such as head and neck surgery, gynae-oncology, haemato-oncology, and paediatric oncology surgery.
Many of these now-ineligible oncologists have advanced to become department heads, medical directors, teachers, and senior surgeons, each accumulating decades of experience treating cancer patients. Dr. Hemish Kania from Surat, who compiled data showing over 300 affected doctors across states, revealed that some barred specialists have even taught oncology to DM or DrNB students. This eligibility shift is particularly alarming given India's severe shortage of cancer specialists, with roughly one medical oncologist per million people and only about 4,000 oncosurgeons nationwide.
Impact on Patient Access and Healthcare Equity
The exclusion of these 300 trained specialists from PMJAY-linked care could significantly reduce access to cancer treatment, especially in smaller cities where private insurance penetration is low. This disproportionately affects poor patients who rely on government medical insurance. For instance, in a Tier-II city with only six onco-surgeons, four of whom are fellowship-trained, PMJAY patients face longer waiting times as these experienced doctors are barred from operating on them.
Doctors report that their names have been removed from the HEM 2.0 portal used by the National Health Authority (NHA) to manage PMJAY, leading hospitals to terminate contracts because these specialists can no longer generate PMJAY claims. Dr. Kania warns that PMJAY may set a precedent, with other government schemes like CGHS potentially adopting similar eligibility criteria.
Historical Context and Regulatory Confusion
The genesis of this problem dates back to before 2018, when the erstwhile Medical Council of India (MCI) sought to address the shortage of oncology teachers. Between 2002 and 2010, there were very few DM and MCh seats in medical and surgical oncology. In 2011, Dr. K S Sharma, former academic dean of Tata Memorial Centre, helped frame a plan to expand fellowship programs at reputed cancer hospitals to fix the teacher shortage.
These fellowships, while not MCI-recognized, held sanctity and allowed MS or MD post-graduate doctors with two years of experience in dedicated cancer hospitals to be regarded as teachers. Many trained fellows took up teaching posts in public cancer institutes, with some later moving to smaller cities to establish independent practices.
However, in 2020, the MCI was replaced by the NMC, which issued guidelines requiring oncologists to hold recognized degrees without mentioning fellowships. The Rajasthan Medical Council's September 2023 directive, which mandates that specialty claims be backed by MCI or NMC-recognized qualifications, became the basis for debarring fellowship-trained oncologists from PMJAY in that state. Interestingly, NHA guidelines do not include the NMC-recognition clause, creating regulatory confusion.
Inconsistencies and Calls for Resolution
Doctors highlight glaring inconsistencies in the current policy. For example, post-graduate dentists are permitted to operate on oral cancer patients under PMJAY, while general surgeons with advanced oncology fellowships are not. NHA CEO Dr. Sunil Kumar Barnwal stated that the NHA empanels hospitals, not doctors, with qualifications decided by the NMC. Efforts to contact NMC chairman Dr. Abhijat Sheth were unsuccessful, though doctors who met him reported being directed to approach the NHA.
State authorities have asked doctors to obtain written clarification from both NHA and NMC, but no such clarification has been issued, perpetuating the deadlock. Medical associations, including the Indian Medical Association, have taken up the issue, arguing that the rule cannot be applied retrospectively. The Indian Association of Surgical Oncology advocates extending eligibility to trained oncologists from premier institutions with fellowships or at least two years of training in such centers.
Dr. Rudra Acharya of IASO emphasized, "Given the rising incidence of cancer and the long waiting list in government cancer institutions, the eligibility clause needs to be revised." Dr. Sharma has engaged with the NHA, which seeks NMC certification for past fellows, and it is learned that the NMC is considering recognizing fellowships. If state authorities do not respond, affected doctors may resort to legal action in high courts.
