Family medicine requires specialized postgraduate training to deliver holistic care across all ages and conditions—critical today as chronic illnesses like diabetes and hypertension surpass infections as India’s leading health burden
Published Jul 07, 2025 | 7:00 AM ⚊ Updated Jul 07, 2025 | 7:00 AM
Synopsis: A new national survey published in PLOS Global Public Health reveals that Tamil Nadu, Kerala, and Karnataka are driving India’s family medicine training, underscoring regional disparities in primary healthcare education. The study, based on responses from 272 family physicians, highlights the specialty’s growing importance amid India’s rising burden of chronic diseases and the need for holistic, long-term primary care
Three southern Indian states are single-handedly shaping the country’s family medicine workforce, according to a national survey that highlights both the progress and glaring regional disparities in India’s primary healthcare training infrastructure.
The study, published in PLOS Global Public Health, surveyed 272 family physicians across India and found that Tamil Nadu, Kerala, and Karnataka collectively account for the vast majority of family medicine training and practice in the country.
Family medicine, a medical specialty focused on comprehensive, long-term primary care for individuals and families, has become increasingly vital as India faces a dramatic shift in its disease burden.
Unlike general practice, family medicine involves additional postgraduate training that equips doctors to provide holistic care across all age groups and medical conditions. This comprehensive approach is particularly crucial as chronic non-communicable diseases like diabetes, hypertension, and kidney disease have overtaken infectious diseases as the leading causes of morbidity and mortality in India.
Family physicians serve as the first point of contact for patients, enabling early detection and management of these chronic conditions while coordinating care across multiple specialties, a role that becomes essential when patients require long-term, continuous healthcare management rather than episodic treatment.
The study findings reveal concentration of medical expertise in the south, raising urgent questions about healthcare equity and training accessibility in other regions.
Most striking is the dominance of a single institution: the Christian Medical College (CMC) in Vellore, Tamil Nadu, which alone has trained over 95 percent of all part-time family medicine graduates in India.
However, only 19.4 percent of these graduates completed their hands-on training in Tamil Nadu, indicating that the state’s institutions are effectively serving as national training hubs while students gain practical experience in their home regions.
The institution’s reach extends far beyond state borders, with its distance learning programs training doctors across 24 different states, creating what researchers describe as a “hub-and-spoke” model of medical education.
“This is the first study to survey family physicians in India nationally,” the researchers noted. “While we surveyed our respondents nationally, we found that most FM training programs exist in three southern states – Tamil Nadu, Karnataka, and Kerala – and, as expected, most family physician respondents work in these three states.”
The survey’s findings points to a critical healthcare infrastructure gap. Despite family medicine being recognized as a medical specialty since 1984, India had only 110 full-time training seats available nationwide in 2023, with just seven government medical colleges offering MD-FM programs. In contrast, southern states have pioneered innovative blended learning approaches that combine distance education with hands-on clinical training.
The three southern states were among the first to adopt and promote family medicine as a distinct medical specialty focused on comprehensive, long-term primary care for individuals and families. Their early adoption has created a ripple effect across the country, with Tamil Nadu-based institutions now training doctors who return to practice in their home states.
Tamil Nadu accounted for 20.9 percent of full-time trainees, followed closely by Karnataka (20.9 percent) and Kerala (14.6 percent). Delhi, despite being the national capital, accounted for only 7.6 percent of full-time trainees.
The survey found that most family medicine-trained physicians work in Kerala, Karnataka, and Tamil Nadu, followed by Andhra Pradesh, West Bengal, Maharashtra, Telangana, and Uttar Pradesh.
The study’s findings demonstrate that postgraduate training in family medicine significantly enhances healthcare delivery capabilities. Trained family physicians showed increased confidence in managing complex clinical situations and were more likely to provide comprehensive services including emergency care, hospital inpatient services, and home visits.
Particularly noteworthy is the impact on rural healthcare delivery. Nearly 40 percent of surveyed family physicians practiced in rural settings—significantly higher than the national average for all doctors. This finding is crucial given India’s ongoing struggle to provide adequate healthcare in rural areas, where specialists are scarce and healthcare infrastructure remains underdeveloped.
“Family physicians self-report providing various surgical-based procedures as part of their practices,” the researchers observed. “Interestingly, we found several associations suggesting that family physicians who work rurally were more likely to offer various procedures. This suggests that the family physicians sampled are providing services based on the needs of the communities in which they work.”
The survey also revealed that 91.5 percent of respondents had some form of teaching role, including training undergraduate medical students and non-physician health workers. This teaching component extends the impact of family medicine training beyond individual practice, creating a multiplier effect that strengthens the broader healthcare system.
The concentration of family medicine training in southern states highlights a critical need for national expansion. The current training capacity falls far short of India’s healthcare needs, with family medicine accounting for just over 1 percent of all accredited postgraduate training seats in the country.
“The current number of DNB-FM and MD-FM programs alone will not be able to produce enough graduating family physicians,” the researchers warned. “It is estimated that just over 1% of all accredited postgraduate training seats in India are in FM.”
The study also identified a significant population of practicing general practitioners seeking additional training. More than one-third of survey respondents had completed their family medicine training through part-time programs, many after working as general practitioners for years. This finding suggests both a demand for upgrading existing healthcare providers and a practical pathway for rapidly expanding the skilled primary care workforce.
The survey’s findings come at a time when medical experts are increasingly advocating for the return of family physicians in India’s healthcare system. The concept, once common in Indian households, has largely faded as patients increasingly prefer direct consultation with specialists.
Dr Rajeev Jayadevan, former IMA president from Kochi, emphasises the importance of family physicians in modern healthcare delivery. “In all developed nations, a family physician or general practitioner occupies a key position in healthcare delivery,” he explains. “A regular family doctor knows all the members of the family and understands the social, economic, and health-related issues of the entire family, and is able to guide them over a long period of time.”
The shift in disease burden toward chronic non-communicable diseases has made family physicians even more crucial. “With pressure from demographic ageing, rapid urbanisation, and globalisation of unhealthy lifestyles, chronic non-communicable diseases have overtaken infectious diseases as the leading cause of morbidity, disability, and mortality,” he noted, an independent physician in Bengaluru.
He explains the holistic approach that family physicians bring: “Family medicine physicians are trained to address the most common medical needs of a patient, irrespective of age and gender. The focus of a family physician is the patient as a whole. Not just physical illness, but also wellness of the patient.”
Dr Sujith Vasudevan, a family physician continuing his father’s legacy in Kerala’s Kochi, describes his role pragmatically: “We are like glorified traffic policemen. We watch people and direct them where to go so that they don’t end up in trouble.” He notes that in cities like Mumbai, many celebrities refuse to see any other doctor unless referred by their family doctor.
