Dr. Prakash Chand (PC) Bhatla: Father of Family Medicine

ABSTRACT

Dr. Prakash Chand (PC) Bhatla MBBS was one of the illustrious past presidents (1975–76) of Indian Medical Association (IMA). He was a General Practitioner by vocation and a towering professional leader. He made an immense contribution to the discipline of Family Medicine – the academic discipline, medical specialty, and the knowledge domain of Family Physicians/Family Doctors within India as well as the global level. He was a brilliant human being and professional par excellence. He was probably one of the greatest leaders of the medical profession in India and a rightful successor to Dr BC Roy’s legacy. As a rare achievement, he received the Dr BC Roy National Award from the President of India twice. He received this prestigious recognition award in 1977 for socio-medical relief in India and again in 1982 for the promotion of Specialty of General Practice. He founded IMA CGP (Indian Medical College of General Practitioners), and his foundational work led to the recognition of Family Medicine as a specialty in India. Due to his efforts, Family Medicine was included in the list of recognized specialties by the National Board of Examinations (NBE) as well by the Medical Council of India (MCI). His contribution to medicine at a global level is also remarkable. He is also considered one of the founding forefathers of WONCA – World Organization of Family Doctors. He was associated with the foundation process of WONCA from the beginning (1964). The International Liaison Committee organized the first World meeting of General Practice in Montreal (Canada) in 1964 and the second meeting in Salsburg in 1966. Dr Bhatla was the convenor of the Third World Conference on General Practice in New Delhi, India, in 1968. A global representative body of Family Medicine/General Practice was launched in 1972 in Melbourne, Australia. Due to contribution to WONCA, he was elected for the first ever WONCA fellowship, the most prestigious global Family Medicine award. He was contemporary to other world leaders of Family Medicine and Primary Care such as Ian McWhinney and Barbara Starfeild. He is rightfully recognized and remembered as Father of Family Medicine. Dr Bhatla’s intellectual, professional, and administrative contribution laid down the sound background for the foundation of a Specialty body of Family Medicine in India called the Academy of Family Physicians of India. Life and work of Dr PC Bhatla continues to inspire family doctors, family physicians, general practitioners, and Family Medicine specialists across India, South Asia, and the World in the 21^st century.

Dr Prakash Chand (PC) Bhatla – The Legend: Early life

Dr PC Bhatla was born on December 28, 1919 in undivided India. He completed his Bachelor’s in Science (BSc) in 1939 from Pubjab university and earned MBBS qualification in 1944 from the same university. Thereafter, he started practicing in Lahore (Punjab, India). After partition of India (1947 – through an act of British parliament), he migrated to Delhi, the capital city of India as part of the proposed population transfer program. He started practicing as a General Practitioner in Sadar Bazar locality of Delhi and later used to live in New Friends Colony. In his routine, he worked at a clinic in the morning and spent every afternoon at the IMA (Indian Medical Association) office. Though he arrived in Delhi as a refugee due to tragic political circumstances, through grit and hard work, he quickly raised his profile among medical professionals of India to become the national president of the Indian Medical Association in 1975 [Image 1].

Image 1.

Dr PC Bhatla: Birth 29/12/1919 Death 14/02/2021: Portrait by Dr Deepshikha, Senior Medical Officer, Government of NCT of Delhi

Contribution to IMA (Indian Medical Association)

He joined Delhi Medical Association (DMA) in 1947. In a few years, he became the honorary secretary of DMA 1954–56. In 1960–61, he was elected the President of DMA. Simultaneously, he was also working for IMA Headquarters as Joint Secretary from 1956–69. He became the Hon. General Secretary of the IMA HQ from 1969 to 1975. Finally, he was elected as the President of IMA HQ in 1975–76. While holding all these offices, through his strong and influential personality, he represented medical professionals at various national and international forums. The foundation stone of the IMA House building in Delhi was laid by the first President of India, Dr. Rajendra Prasad, on September 19, 1958, and the construction of the building was started under the supervision of Dr. P.C.Bhatia, who supervised it brick by brick. With his untiring efforts, the building was completed and opened on September 6, 1964 by the then President of India, Dr. S. Radhakrishnan. His major contribution was the formation of the IMA College of General Practitioners (IMA CGP) as convener of its Steering Committee. Later, he became its Secretary, Dean, and Controller of Examinations from 1977 for about a decade. Through the IMA CGP, which is a Founder member of the World Organization of the National Colleges and Academies, (WONCA), the third Conference on General Practice was hosted by the IMA in the year 1968. He was a very popular and kind-hearted person and very successful professional leader. A General Practitioner himself, the development of Family Medicine/General Practice was close to the heart. He made Family Medicine mission of his life. After retirement from IMA, he founded and served many other institutions to promote Family Medicine discipline. The notable ones are (a) National Institute of Primary Health Care (NIPHC) and (b) Health Care Promotion Trust. He continued to organize CMEs and Seminars for the benefit of Family Physicians and Family Medicine Specialists. In short, Dr Bhatla was an institution in himself. He also wrote on spirituality and lived a contented life.

Founding forefather of WONCA – World Organisation of Family Doctors: Contribution at global level

According to Dr David Game, President of WONCA (1983–86), ‘Dr PC Bhatla had a very strong influence on the early development of WONCA. He represented IMA in WONCA (World Organization of National Colleges and Academies) in General Practice/Family Medicine from 1964 to 1976. The International Liaison Committee organized the first World Meeting in Montreal (Canada) in 1964 and the 2^nd World Meeting in Salzburg (Austria) in 1966. Dr Bhatla was the convener of the 3^rd World Conference on General Practice in New Delhi, India, in 1968. The Delhi conference announced that ‘It will also consider the question of a World Federation/Association of National Colleges/Academies and Equivalent Organizations of General Practice’ (WONCA). Dr Bahtla drafted a constitution proposal for such an international body. However, in Delhi the WONCA leaders agreed to discuss this matter further at the 4^th World Meeting to be held in Chicago (USA) in 1970. Here, it was agreed to proceed with the formation of The World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA). The WONCA organization was formally inaugurated at the 5^th World Meeting held in Melbourne, Australia (1972). Dr Bhatia was designated as the chairman of the Membership Committee of the Interim Council of WONCA. At the WONCA inaugural meeting, in 1972, Dr Bhatla spoke about the need to educate general practitioners in providing preventive and curative treatments, in being health educators and counselors, and in motivating and educating people and communities about health. Dr Bhatla said in his speech “Every national health program, including the Family Planning Program, should include the involvement of general practitioners. Education and motivation of the community has to be done on a personal basis. And who is nearer to the community than the family doctor?” He became Speaker (Chairman) of the General Assembly in 1976. Dr David Game paid tribute to him as one of the ‘founding forefathers of WONCA’ on the demise of Dr Bhatla in 2001 [Image 2].[1,2]

Image 2.

Dr PC Bhatla at inaugural conference of WONCA, Melbourne, Australia, 1972

Dr. PC Bhatla Seminal Papers

Dr Bhatla wrote a series of papers on Family Medicine/General practice from sixties to nineties, which were published in the Journal of Indian Medical Journal (JIMA). The intellectual contributions are available in the print archive of JIMA (Kolkata office). These papers define the early family medicine body of knowledge in India in the modern times. These papers are listed below for the benefit of the readers. These papers also reflect his intellectual contribution to the laying foundation of Family Medicine, especially in India [Image 3].

Image 3.

Dr Raman Kumar, National President, Academy of Family Physicians of India, presenting portrait of Dr PC Bhatla’s to Prof. Dr. J.A. Jaylalal, National President, Indian National Association (2020-2021) and Hon Secretary General Dr Jayesh Lele at National Headquarters of Indian Medical Association, New Delhi

1. General practice/family medicine as a speciality. Bhatla PC. J Indian Med Assoc. 1985 Apr; 83(4):135-8. PMID: 4078336 No abstract available

2. Residency programme in family medicine/general practice. Bhatla PC. J Indian Med Assoc. 1983 Nov; 81(9-10):179-85. PMID: 6674362 No abstract available

3. General practice/family medicine as a speciality. Bhatla PC.J Indian Med Assoc. 1985 Apr; 83(4):135-8.PMID: 4078336 No abstract available

4. General practitioner--institutional and patient relationship. Bhatla PC. J Indian Med Assoc. 1972 Dec 1;59(11):486-91. PMID: 4656365 No abstract available.

5. Responsibilities of general practitioners. Bhatla PC. J Indian Med Assoc. 1990 Dec; 88(12):335. PMID: 2074349 No abstract available

6. Surgical services by generalists in rural areas. Bhatla PC. J Indian Med Assoc. 1990 May; 88(5):140-1. PMID: 2280078 No abstract available

7. Group practice. Bhatla PC. J Indian Med Assoc. 1978 Nov 16;71(10):264-7. PMID: 756892 No abstract available

8. Occupational health and safety and general practitioners. Bhatla PC. J Indian Med Assoc. 1989 Jul; 87(7):167-9. PMID: 2621354 No abstract available

9. Some common problems in general practice Bhatla PC. J Indian Med Assoc. 1967 Dec 16;49(12):566-71.PMID: 5594218 No abstract available

10. A plea for research into general practice.Bhatla PC.J Indian Med Assoc. 1968 Nov 16;51(10):519-22.PMID: 5715240 No abstract available

11. Primary health care: a commitment to honour. Bhatla PC. J Indian Med Assoc. 1988 Feb; 86(2):25-7. PMID: 3397552 No abstract available

12. Health and lifestyles. Bhatla PC. J Indian Med Assoc. 1996 May; 94(5):174-7. PMID: 8855570 No abstract available.

Role in creating post-graduate Family Medicine (DNB FM) residency program in India Legacy in India

Dr PC Bhatla through his foundational work established IMA CGP (Indian Medical Association College of General Practitioners). The first step of academic specialty family medicine was initiation of FCGP (Fellow College of General Practitioners) examinations. The curriculum of FCGP was adopted as the curriculum of MAMNS (Member National Academy of National Sciences) in Family Medicine. In 1983, the National Board of Examinations (NBE Currently NBEMS) was created by the government of India through an amendment in the MCI (Medical Council of India) Act. It was due to efforts of Dr PC Bhatla that NBE included Family Medicine in the list of specialties. Later the MCI (Medical Council of India) also recognized Family Medicine as a distinct specialty and included it as discipline within its Postgraduate regulation. The DNB Family Medicine qualification and residency training underwent various stages of evolution and changes since then. The fellowship of IMA CGP (FCGP) was the stepping stone towards evolution of a full-time residency program in Family Medicine in India. FCGP was awarded both on the basis of examination as well as on the basis of experience. FCGP examination was based on a prescribed curriculum that was prepared under supervision of Dr Bhatla. The earlier original curriculum booklets of NBE contained the Family Medicine post graduate curriculum. This curriculum was a copy of the FCGP curriculum. The Family Medicine DNB program since then has undergone major reforms and experimentation since 1983 till now. Initially, the eligibility examination was completion of a prescribed CME hours and experience. Later, NBE initiated DNB part 1 examination toward eligibility to admission to full time PG program. Initially FCGP was considered equivalent to DNB part 1 examination [Images 4-6].

Image 4.

Workshop on Present and Future of Family Medicine as and Specialty: Hand Written notes by Dr PC Bhatla (Courtesy Dr SK Bansal)

Image 6.

Workshop on Present and Future of Family Medicine as and Specialty: Hand Written notes by Dr PC Bhatla (Courtesy Dr SK Bansal)

Image 5.

Workshop on Present and Future of Family Medicine as and Specialty: Hand Written notes by Dr PC Bhatla (Courtesy Dr SK Bansal)

Family Medicine Training Program in India and specialty organization of family medicine: Seeds of developments

Presently, DNB FM is a full-time residency program offered at the accredited institutions. Presently, all admissions to DNB Family Medicine programs are conducted through the common National Eligibility Entrance Test for Post Graduation (NEET PG). The first MD Family Medicine program was initiated in 2012 at Calicut Medical College, Kerala, and currently Family Medicine is a popular clinical specialty among NEET PG aspirants.

Dr SK Bansal, one of the first-generation family medicine post graduates in India, recalls that he qualified for the FCGP examination in 1980. The convocation FCGP was organized in 1983 in Delhi, where he had the opportunity to meet Dr PC Bhatla. Dr Bhatla encouraged him to enrol in the recent DNB Family Medicine program. Dr Bansal visited the office of NAMS (National Academy of Medical Sciences) near AIIMS New Delhi, where the NBE office was located and enquired about the course. He was guided there, and he became one of the first-generation DNB (Diplomate National Board) Family Medicine in 1985. However, the council of NAMS was reluctant to admit DNB Family Medicine-qualified persons to be admitted as members. Dr Bhatla pursued this matter with the NAMS officials and finally gates opened [Image 7].

Image 7.

Dr Bhatla’s letter in support of Family Medicine to NAMS (National Academy of Family Sciences)

The initial batch of DNB-qualified persons initiated a movement to further consolidate the training program and develop the specialty knowledge base. They formed an association called AFI, Association of Family Medicine Specialists of India, under leadership of Dr SK Bansal of Rourkela, Orissa. Dr Radha Krishna Murthy (Bangalore, Karnataka), Dr Jitendra Kumar Singhvi (Kota, Rajasthan), Dr Sarojini Panchatnam (Ellore, Tamil Nadu), Dr Pradeep Kumar Mohan (Ambala, Haryana), Dr Pankaj Kanji Mehta (Mumbai, Maharashtra), Dr Subramanyam A.V. (Nellore, Andhra Pradesh), and Dr Birbal Chandra Kar (Champaran, Bihar) were the other leaders of API movement. In the era of typewriter and post offices, a total of 66 persons joined the formal membership of AFI. Dr Bhatla supported this initiated and patronized AFI [Image 8].

Image 8.

Dr Bhatla’s dream for a specialty body in Family Medicine letter to Dr SK Bansal (Courtesy Dr SK Bansal)

Many Family Medicine-trained doctors were active with local city based Family Physician Associations in different parts of India under the banner of FFPAI (Federation of Family Physicians Association of India) including Dr BC Rao of Bangalore. FFPAI was founded in 1986 as an umbrella body of GP units in different cities of India. GPA, General Practitioners Association of Mumbai, is one of the oldest associations of Family Physicians/GPs in India and celebrated 50 years of foundation in 2023. A few like Dr Naresh Chawla of Delhi pursued leadership positions within Indian Medical Association and IMA CGP. He became the President of Delhi Medical Association (DMA) and Vice President of the Delhi Medical Council (DMC). IMA CGP continues to exist with a GP-based IMA member, operating from Chennai, India. However, most of the members of FFPAI and IMA CGP were retiring without any replacement. They were the successful generation of general practitioners who won the trust of the general population of India. The development of the Family Medicine discipline continued to remain challenged for several decades.

Barriers to Family Medicine: Early Era of Independence

In spite of the Bhore committee (1946) report recommendation and Alma Ata declaration (1978) for comprehensive primary care, India opted the path of ‘Selective Primary Care - Diseased based vertical programs’ under the influence of Rockefeller Foundation and WHO. The Rockefeller Foundation sponsored in 1979 a small conference entitled “Health and Population in Development” at its Bellagio Conference Center in Italy. The conference was based on a published paper by Julia Walsh and Kenneth S. Warren entitled “Selective Primary Health Care, an Interim Strategy for Disease Control in Developing Countries” in the New England Journal of Medicine (NEJM). For several decades, India’s choice of public health model was based on Selective Primary Care (Disease-based Vertical National Health Programs). The selective primary care model continues even today and is manifested through tens of disease focused vertical national health programs. The medical education system also aligned with the selective primary health care model and established the Department of Community Medicine in order to feed the vertical disease-based program while ignoring the comprehensive primary care model. It is to be noted that in spite of being the largest medical education system of the word, Indian medical schools do not have mandatory departments of Public Health or Family Medicine. This choice was based on the Indian policy inclination of seventies and under influence of global health organizations.[3]

Also, due to the persistent non-cooperation of the Medical Council of India (MCI), regulatory body of medical education in India, Family Medicine could not be mainstreamed and it never became a discipline/specialty for MBBS training in India. At the cost of Family Physicians/Family Medicine, Specialty and Sub Specialties were promoted at all medical colleges in India. MCI remained a specialist and hospitalist monopoly and continued to act so. Family Medicine/Family Physicians/General Practitioners/Family Doctors were totally disfranchised from the medical education system of India for several decades. As an outcome, the profession of Family Physicians/Family Doctors came to a decline in India.[4]

After the economic reforms of the 1990s, the economy of India has been rapidly growing and currently positioned among the top five in the world. There is growing recognition for high-quality primary care for the general population amid growing per capita income and improving infrastructure. The Government of India has pledged to make India a developed country by 2047, the centenary year of India’s freedom from British colonialism. It is high time that the long pending aspiration of a high-quality primary care and health care delivery system is developed in India. Family Medicine has been mandated by the current government though National Medical Commission Act 2019.[5]

Academy of Family Physicians of India: Taking forward the work of Dr. PC Bhatla

Due to the push of National Health Policy 2002 and National Rural Health Mission (2005), the concept of Family Medicine gained momentum in the new millennium. Now there are full-time residency programs offered across India through NBE. However, the progress was slow. There was a requirement to build academic scholarship, promote research, and upgrade practice standards and standardization of training programs at undergraduate and postgraduate levels. There was a need for a paradigm shift in India from ‘Specialist teaching/training GPs’ to ‘Family Medicine faculty teaching/training family physicians’. There was a need for a new academic body representing Family Medicine in India. The Academy of Family Physicians of India was founded in 2010 by Dr Raman Kumar (Founder, National President - author of this paper) and Dr Vandana Boobna Agarwal (National Secretary) with the support of Dr Sudha Kumari, Dr Rakesh Prasad Shahi, Dr Navneet Gill, Dr Paritosh Tiwari, Dr Santosh Lional Thomas, and others. All were recently qualified full-time residency-trained Family Medicine experts. AFPI has rejuvenated the Family Medicine development in India through conferences (FMPC, National Conference on Family Medicine and Primary Care) and other academic activities. Strategic advocacy has led to inclusion of Family Medicine discipline in the National Medical Commission Act 2019. AFPI has a membership base in all states across the country. AFPI has also become a full member of WONCA (World Organization of Family Doctors). In 2015, AFI organization initiated by Dr Sk Bansal was merged with the Academy of Family Physicians of India (AFPI) during FMPC Conference Delhi. The story and journey of AFPI are to be discussed in a separate paper.

Remembering Father of Family Medicine: Dr PC Bhatla Memorial Oration Award

In recognition of the contribution of Dr PC Bhatla, AFPI (Academy of Family Physicians of India) instituted an oration award in his memory in 2022. The first oration award was conferred to renowned public health leader of India Dr K Srinath Reddy. Dr Reddy delivered the first oration at FMPC 2022 Hyderabad. At the beginning of his talk, Dr Reddy remembered his interaction with Dr PC Bhatla as an student at AIIMS, New Delhi. Dr Reddy had the opportunity to work for Dr PC Bhatla as a rapporteur for one of his meetings [Image 9].

Image 9.

Dr K Srinath Reddy: Delivered 1^st Dr PC Bhatla Memorial Oration at FMPC Hyderabad in 2022 (Dr. K Srinath Reddy with Dr Raman Kumar, Founder and National President, Academy of Family Physicians of India at FMPC 2022, Hyderabad Conference)

Dr PC Bhatla holds an exceptional record of being recipient of Dr BC Roy National Award by the President of India bestowed in recognition of contribution of medical professionals. Dr PC Bhatla was awarded Dr BC Roy National Award in 1977 for socio-medical relief in India and again in 1982 for the promotion of Speciality of General Practice. He was admitted as Fellow of IMA College of General Practitioners and conferred Fellowship of the Royal Australian College of General Practitioners in 1972. In recognition of his contribution to WONCA, he was awarded the first fellowship of WONCA, the most prestigious award in 1976 in Toronto. The Indian Medical Association has also instituted an award in the name of Dr PC Bhatla in 1979. Dr PC Bhatla Award is open to members having membership of IMA for at least 10 years and of the IMA CGP for at least 5 years life membership.

He was contemporary to other world leaders of Family Medicine and Primary Care such as Ian McWhinney (Canada) and Barbara Starfeild (USA). Dr Bhatla’s intellectual, professional, and administrative contribution laid down the sound background for the foundation of a Specialty body of Family Medicine in India called the Academy of Family Physicians of India. Life and work of Dr PC Bhatla continues to inspire family doctors, family physicians, general practitioners, and Family Medicine specialists across India, South Asia, and the World in the 21^st century. His colleagues and contemporaries remember him as a warm and friendly personality. He was always supportive of newcomers to the professions. He was charming and affectionate. Currently, seven medical colleges in India offer 3 years training MD Family Medicine. All new AIIMS institutions across are planning to start MD in Family Medicine. A total of 59 institutions under NBEMS are offering DNB three-year program, whereas 106 institutions across India are offering two-year full-time diploma in family medicine. It is a journey in progress, but the fruits of hard work of Dr Bhatla are now being realized. He is rightfully recognized and remembered as Father of Family Medicine.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.