Surgical, anesthesia and obstetrics (SAO) workforce production capacity in India: a retrospective analysis of postgraduate and subspecialty training spots

Abstract

Objective: To assess the SAO production capacity of India i.e., the number of postgraduate (PG) and sub-specialty (SS) surgical training spots per 10 million population across multiple specialties and subspecialties at national and state levels. Methods: A retrospective secondary data analysis of PG and SS SAO spots across 36 states for 2018 using data from the National Health Profile (2019) was conducted. The mid-year 2018 populations were obtained from the census-based population projections. The number of PG & SS SAO spots per 10 million population were calculated and divided based on the type of program (diploma, MD/MS & DM/MCh) and type of SAO specialty to investigate SAO workforce production capacity in each state. Ratios of PG spots per 100 MBBS spots and SS spots per 100 PG spots were also calculated. Data was wrangled using Google Sheets, analyzed in JASP v0.16.0.0, and visualized using Datawrapper. Results: There are a total 13793 PG and 1350 SS SAO spots leading to densities of 104.60 and 9.90 per 10 million people, respectively. PG spot density for General Surgery (23.56), Anesthesia (24.81), and OBGYN (21.55) were comparable and were much higher than Orthopedics (14.64), Ophthalmology (11.96), and Otorhinolaryngology (8.08). SS spot densities were greater for Urology (1.90), Neurosurgery (1.86), and Cardiothoracic and Vascular Surgery (1.83), followed by Plastic Surgery (1.52), and Pediatric Surgery (1.27). The average density was significantly lower for PG SAO specialties than non-SAO specialties (p=0.001) whereas there was no significant difference in densities for SS . For 100 MBBS spots, there were only 20 PG SAO spots while for 100 PG SAO spots, there were just 9 SS SAO spots available. The distribution of spots was geographically uneven with about two-thirds of spots concentrated in 10 states/union territories. Conclusion: Annually, India can produce only about 24 General Surgeons, 15 Orthopedic Surgeons, 12 Ophthalmologists, 8 Otorhinolaryngologists, 25 Anesthetists, 22 OBGYNs, and 10 sub-specialist surgeons per 10 million population. The distribution of spots is inequitable across the states. Hence, scale up of surgical training capacity needs to be carried out with attention to reducing disparities.

Achieving Surgical, Obstetric, Trauma, and Anesthesia (SOTA) care for all in South Asia

“…For instance, to achieve the target density of 20 SAO specialists per 100,000 population by 2030, Bangladesh, India, and Pakistan would need 40,288, 291,824, and 47,710 more SAO specialists compared to 2015 ( 140 ). Additionally, the training spots should be equitably distributed ( 141 ).…”

“…A shortage of pediatric SOTA care workforce is associated with greater neonatal, infant, and under-5 child mortality (115). Moreover, data from India depicts that pediatric surgery contributes to only 0.7% of the total subspecialty training spots (118). This depicts a lack of training capacity that can contribute to the continuation of workforce shortages in the future.…”