India detects around 15 lakh new cancer cases every year, adding a patient load comparable to the population of a city like Nashik. At the same time, the country already faces a significant shortage of oncology specialists.
However, a recent development under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) has raised serious concerns within the medical community. Several states are excluding hundreds of experienced, fellowship-trained oncologists in the private sector from treating patients under the scheme.
Importantly, these doctors are not being excluded because of inadequate clinical experience or training. Instead, authorities are enforcing eligibility rules that require National Medical Commission (NMC)-recognised super-specialty degrees, such as DM (Doctorate of Medicine), MCh (Magister Chirurgiae), or DrNB (Doctorate of National Board).
New PMJAY Eligibility Rule Bars Many Cancer Specialists
As a result of this rule, hundreds of oncology specialists have become ineligible to treat PMJAY patients, despite having years—often decades—of clinical experience.
Doctors say the rule overlooks an important reality: formal oncology super-specialty courses were limited or nonexistent until a few decades ago. During that time, fellowships at reputed cancer institutions served as the primary pathway for doctors to train in oncology.
Even today, many postgraduate doctors pursue two- or three-year fellowships at leading cancer centres to gain hands-on expertise in areas such as:
- Head and neck oncology
- Gynaecological oncology
- Haemato-oncology
- Paediatric oncology surgery
Surat-based oncologist Dr. Hemish Kania, who compiled data on the issue, said more than 300 fellowship-trained specialists across multiple states have been affected. Many of these doctors have served as department heads, medical directors, academic teachers, and senior surgeons, treating cancer patients for decades.
Shortage of Cancer Specialists in India
As reported by TOI, the policy change has sparked concern because it coincides with India’s already limited oncology workforce.
Currently, the country has:
- Approximately one medical oncologist per one million people
- Only around 4,000 oncosurgeons nationwide
Therefore, excluding even 300 trained specialists from PMJAY-linked care could significantly reduce treatment access, particularly in Tier-II and Tier-III cities where private insurance coverage remains limited.
For many economically disadvantaged patients, government health insurance schemes such as PMJAY are the only means of accessing cancer treatment.
Fellowship-Trained Doctors Face Practice Restrictions
Several fellowship-trained oncologists have reported being unable to treat PMJAY patients despite extensive training at India’s leading cancer institutions.
For instance, Dr. Ravi (name changed), a 42-year-old general surgeon from Uttar Pradesh, completed a three-year fellowship in head and neck oncology at Tata Memorial Hospital, Mumbai. He returned to his hometown in 2021 to address a critical shortage of cancer specialists.
However, he now finds himself barred from performing surgeries on PMJAY patients.
According to him, four out of six private-sector cancer surgeons in his city are fellowship-trained and now face similar restrictions. Consequently, PMJAY patients must endure longer waiting times for treatment.
Dr. Ravi also questioned the policy’s disregard for training from prestigious institutions such as:
- Tata Memorial Hospital, Mumbai
- AIIMS, New Delhi
- Gujarat Cancer Research Institute, Ahmedabad
- Regional Cancer Centre, Thiruvananthapuram
- Dr. B. Borooah Cancer Institute, Guwahati
Despite the rigorous training offered by these centres, their fellowships currently carry no weight in PMJAY eligibility decisions, doctors say.
Impact on Doctors in Private Hospitals
The rule appears to affect private-sector specialists more severely than those working in government hospitals.
For example, Dr. Arun (name changed), a doctor from Patna, said he remains eligible to treat PMJAY patients because he works in a government hospital, where at least one team member typically holds an NMC-recognised degree.
However, many of his batchmates working in private hospitals in Patna and Kochi can no longer operate on PMJAY patients.
Doctors also report that their names have been removed from the HEM 2.0 portal, the National Health Authority’s digital platform used to manage PMJAY services. As a result, some hospitals have begun terminating contracts with these specialists, since they can no longer generate PMJAY claims.
Dr. Kania warned that the situation could worsen if other government healthcare schemes, such as the Central Government Health Scheme (CGHS), adopt similar eligibility rules.
How the Policy Issue Began
The roots of the current problem date back to the early 2000s, when India faced a severe shortage of oncology teachers and specialists.
According to Dr. K. S. Sharma, former Academic Dean of Tata Memorial Centre, the number of DM and MCh seats in oncology remained extremely limited between 2002 and 2010.
To address this shortage, the erstwhile Medical Council of India (MCI) expanded fellowship programs at major cancer hospitals. Although these fellowships were not formally recognised by the MCI, they were widely considered credible training pathways.
At that time, MCI introduced a provision allowing MD or MS doctors with at least two years of experience in dedicated cancer hospitals as senior residents or fellows to serve as teachers in oncology. This arrangement helped bridge the shortage of specialists and educators.
Many fellowship-trained oncologists subsequently joined public cancer institutes and later moved to smaller cities, where they built independent oncology practices.
Transition from MCI to NMC Changed Eligibility Criteria
The regulatory landscape changed in 2020, when the National Medical Commission (NMC) replaced the MCI.
Under the new guidelines, oncologists must hold NMC-recognised super-specialty qualifications. However, the guidelines do not mention fellowships, creating uncertainty about their validity.
In September 2023, the Rajasthan Medical Council directed that any claim of specialty must be supported by an MCI- or NMC-recognised qualification. Subsequently, the Rajasthan State Health Authority used this directive to exclude fellowship-trained oncologists from PMJAY procedures.
Officials in Gujarat have also indicated that NMC-recognised qualifications form the basis for listing oncologists under PMJAY.
Confusion Between NHA and NMC Guidelines
Interestingly, doctors argue that National Health Authority (NHA) guidelines themselves do not explicitly require NMC-recognised super-specialty degrees.
One oncologist from Vadodara, who completed a head and neck oncology fellowship at Tata Memorial Hospital two decades ago, noted that NHA guidelines still allow ENT specialists and general surgeons with oncology fellowships to perform surgeries under PMJAY.
This discrepancy has led to confusion and inconsistent implementation across states.
When contacted, NHA CEO Dr. Sunil Kumar Barnwal clarified that the NHA empanels hospitals rather than individual doctors, while doctor qualification standards fall under the NMC’s jurisdiction.
However, doctors who approached NMC officials report being redirected back to the NHA, leaving the issue unresolved.
Concerns Over Policy Inconsistencies
Doctors have also pointed out certain inconsistencies in the eligibility rules.
For example, postgraduate dentists are currently allowed to perform oral cancer surgeries, whereas general surgeons with advanced oncology fellowships are being excluded from treating PMJAY patients.
This disparity has further intensified calls for policy review.
Medical Associations Call for Policy Revision
Leading medical bodies, including the Indian Medical Association (IMA) and the Indian Association of Surgical Oncology (IASO), have taken up the matter with both the NMC and NHA.
Experts argue that the new rule should not be applied retrospectively, especially to doctors who trained before formal oncology degrees became widely available.
IASO representatives have proposed that eligibility be extended to oncologists who have completed fellowships at premier cancer institutions or undergone at least two years of specialised oncology training.
Dr. Rudra Acharya of IASO emphasised that revising the eligibility criteria is essential given the rapidly increasing incidence of cancer in India and the long waiting lists at government cancer hospitals.
The Road Ahead
Dr. K. S. Sharma has also raised the issue with the National Health Authority, which has reportedly asked the NMC to certify fellowship-trained oncologists. Sources indicate that the NMC is currently considering recognition for certain fellowship programs.
Meanwhile, state health authorities have advised doctors to seek written clarification from both the NMC and NHA. Until such clarification is issued, the deadlock continues.
If the issue remains unresolved, affected doctors may ultimately approach the High Court to challenge the policy.
Given India’s growing cancer burden and the shortage of oncology specialists, healthcare experts believe that revising the eligibility criteria is critical to ensuring timely access to cancer treatment for PMJAY beneficiaries across the country.