Even as India continues to focus on strengthening its primary healthcare, a new study highlights a significant shortage of trained family physicians, particularly in rural areas. The first-ever national survey of family medicine practitioners in India, conducted by the Academy of Family Physicians of India (AFPI) in collaboration with Indian and international academic partners, paints a concerning picture of an overstretched healthcare workforce and an inadequate system to support it.
Published in PLOS Global Public Health, the study—titled The landscape of family medicine in India – A cross-sectional survey study—gathered responses from 272 family physicians across 28 states and union territories between November 2020 and March 2021. The findings highlight the role that family doctors play in India’s primary care landscape, while also highlighting the serious mismatch between the country’s health needs and the current medical training infrastructure.
A Vital but Underrecognized Role in India’s Healthcare System
A family doctor is a trained medical professional who provides comprehensive, continuous, and person-centered care across all age groups and health conditions. Serving as the first point of contact in the health system, they manage a broad range of health issues, coordinate specialist referrals, and build long-term relationships with patients—making them essential for delivering accessible, cost-effective, and preventive care that strengthens the overall health system. Family physicians are increasingly recognized as central to achieving Universal Health Coverage
In India, however, family medicine as a specialty remains underutilized and poorly integrated into the broader healthcare system. Despite being officially recognized in 1984, the field has struggled to gain traction, with training programs limited in number and geographic reach.
The survey reveals that nearly 89 percent of family physicians currently provide outpatient care, while over half also deliver inpatient services (68.2 percent), emergency care (55.8 percent), and even palliative care (61.7 percent). Additionally, many offer home visits and telemedicine services, underscoring their versatility and community-rooted practice.
Significantly, 39.3 percent of respondents reported working in rural areas—a proportion notably higher than the national average of physicians in such locations. These doctors frequently deliver essential services often unavailable in rural India, including minor surgeries, fracture care, and even spontaneous vaginal deliveries. In low-resource areas where specialist services are scarce or non-existent, family physicians often serve as the first—and sometimes only—point of care.
Gap Between Need and Capacity: A Broken Training Pipeline
India’s population, now exceeding 1.4 billion, needs a robust cadre of generalist physicians to anchor its primary care system. According to healthcare policy estimates, India will require at least 15,000 trained family physicians annually by 2030 to meet the demands of its aging population and shifting disease burden. Yet the number of recognized postgraduate seats in family medicine remains shockingly low—just around 700 per year.
Of the 272 survey respondents, 61 percent had completed full-time in-person residency programs such as the Diplomate of National Board in Family Medicine (DNB-FM), while 39 percent had undergone part-time, blended, or distance-based training—most of which are not officially recognized by India’s medical regulators. The Christian Medical College (CMC) in Vellore alone accounted for the vast majority of these non-traditional programs.
This reliance on unaccredited training programs reflects both a demand for skill-building among general practitioners (GPs) and a failure of the formal system to provide adequate postgraduate opportunities in family medicine. According to the study, many doctors pursuing part-time training did so years after completing their undergraduate medical degrees, signaling a strong grassroots demand for upskilling among India’s existing GP workforce.
Strengthening Primary Care: Benefits of FM Training Evident
Regardless of the type of program—full-time or part-time—doctors reported that postgraduate training in family medicine substantially enhanced their confidence, scope of practice, and ability to manage undifferentiated patients and complex health needs. Those with full-time training were somewhat more likely to report improved confidence levels, reduced referrals to specialists, and increased procedural skills such as inpatient care and anesthesia.
Crucially, the study found that postgraduate FM training contributed to a more team-based, multidisciplinary approach, with over half of respondents indicating they regularly work with non-physician health workers such as nurses, lab technicians, and community health workers. These collaborations are vital in rural or underserved regions where healthcare human resources are scarce.
The findings also challenge the assumption that doctors with specialty training are unlikely to remain in primary care. Nearly half (48.3 percent) of surveyed family physicians were working in primary care facilities, including private clinics, community health centers, and government-run primary health centers. This suggests that with the right training and support, physicians are willing and able to anchor frontline care.
A South-Heavy Training System and the Need for Geographic Equity
The survey also sheds light on the skewed geography of family medicine education in India. Most full-time and part-time training programs are concentrated in the southern states of Tamil Nadu, Kerala, and Karnataka. Tamil Nadu, particularly CMC Vellore, dominates part-time blended training. While this regional concentration has produced well-trained professionals, it raises concerns about equitable access to training across India, especially in the northern and northeastern states.
Interestingly, although many part-time programs were based in Tamil Nadu, the hands-on training for these programs occurred across 24 different states, revealing a decentralized but fragile ecosystem that relies heavily on a few institutional pioneers.
Barriers in the Public Sector: Why Most Family Physicians Work Privately
Another striking finding is that more than 60 percent of respondents work exclusively in the private sector. While this may reflect broader trends in India’s healthcare labor market, it also points to the underutilization of family physicians in the public sector. Government-run community health centers (CHCs) currently prioritize specialist roles such as internal medicine, pediatrics, and obstetrics, but face severe vacancies. Integrating family physicians into CHCs could be a cost-effective and scalable way to fill these gaps, given their broad skillset.
Experts, including those in AFPI have called this a missed opportunity warning that India risks becoming a country of specialists without a strong primary care backbone, further calling this model unsustainable, especially in rural and underserved areas.
A Call for Scale, Standardization, and Recognition
The authors of the study stress that the time for policy action is now. They recommend several key reforms including:
- Expand postgraduate FM seats, both in full-time and flexible blended formats.
- Integrate family medicine into undergraduate medical curricula to build early awareness and interest.
- Recognize and accredit quality part-time and distance-learning programs, especially those targeting in-service general practitioners.
- Incentivize government recruitment of family physicians, especially in CHCs and rural PHCs.
- Support faculty development to grow the pool of trainers and mentors for future cohorts.
The authors argue that building a critical mass of well-trained family doctors is not just a workforce issue—it’s a public health imperative. Without action, India may continue to rely on an overstretched specialist system ill-suited to managing the growing burden of noncommunicable diseases, mental health challenges, aging populations, and the continuing threat of pandemics.
The AFPI-led national survey offers the most detailed snapshot yet of family medicine in India—and the message is clear. Family physicians are already playing an essential, often underappreciated, role in India’s health system. With the right investment, policy support, and educational reforms, they can form the backbone of a stronger, more equitable primary healthcare system.
The clock is ticking. As India moves closer to its 2030 health targets, ensuring the scale-up of family medicine must become a national priority—not an afterthought.
References:
The landscape of family medicine in India – A cross-sectional survey study : https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0004107
Family doctor crisis hits India, 15K needed annually: https://medicalbuyer.co.in/family-doctor-crisis-hits-india-15k-needed-annually/