The “Dr” debate masks a larger crisis in allied-health education

By Dr P K Gupta* 

India’s allied-health professions have long operated in a fragmented landscape of universities, hospitals, State authorities and private institutions, each with its own nomenclature, curriculum and standards. The National Commission for Allied and Healthcare Professions Act, 2021 was meant to correct this by creating a unified national framework for education, professional regulation and institutional recognition. Few dispute the need for such oversight. The real question is whether standardisation is quietly becoming synonymous with longer courses, additional internships and new professional titles—changes that risk masking deeper gaps in clinical training, institutional capacity and affordability.

The country has seen a steady expansion in the duration of allied-health programmes even as the MBBS degree has remained broadly stable for decades. Physiotherapy, occupational therapy, optometry, laboratory sciences, radiography and various technology programmes have grown from short hospital-based certificates or diplomas into four- or five-year degrees with compulsory internships. This shift has brought some benefits: stronger scientific foundations, clearer professional identity and better mobility across States. But these gains do not automatically justify stretching nearly every programme to the length of a medical degree. A course becomes stronger through competence, not through the mere addition of semesters.

Duration should follow the actual skills required for safe practice. The essential questions are practical: what procedures must a graduate perform independently; how many supervised cases are needed to master those skills; what level of diagnostic reasoning is appropriate within the profession’s scope; and whether institutions have the patients, departments, equipment and trained supervisors to teach those competencies. The Act’s competency-based approach is sensible in theory, emphasising early clinical exposure, skill laboratories and measurable outcomes. The danger lies in institutions meeting the prescribed number of years without providing the clinical ecosystem those years were meant to contain. Regulation then becomes a measure of time served rather than competence acquired.

Clinical education cannot be separated from patient care. A physiotherapist cannot learn rehabilitation from lectures alone. An occupational therapist cannot understand functional assessment without treating patients. A laboratory professional cannot become competent without supervised work across a range of specimens. A radiographer or technologist cannot be trained safely without functioning departments. Yet many programmes are offered by stand-alone institutions without a medical college or teaching hospital, relying instead on distant affiliations that provide limited supervision and too few opportunities to perform procedures. An extra internship year cannot repair years of inadequate clinical exposure; it simply adds cost, delay and frustration while producing graduates whose qualifications are longer but whose skills remain uncertain.

The Commission’s own curriculum framework acknowledges this risk, placing responsibility on institutions to ensure appropriate affiliated hospitals, supervision, logbooks, transport and reasonable stipends for interns. These cannot remain aspirational guidelines. They must become enforceable conditions of recognition. Clinical training should begin early and continue throughout the programme, with theory and practice reinforcing each other. In many disciplines, a well-designed three-year degree with continuous supervised training may produce a safer graduate than a nominally longer programme with weak patient exposure. Higher-risk professions may reasonably require four or five years, but duration must be justified profession by profession rather than imposed uniformly.

The economics of prolonged education cannot be ignored. Every additional year adds tuition, living expenses and lost income. In private institutions, fees often run into several lakhs annually, excluding accommodation, equipment and transport. While more than eight crore individuals filed income-tax returns in 2024–25, filing a return does not mean a family can afford five years of private professional education. Course length is therefore an equity issue. Regulators should impose an extra year only when they can identify the competencies it adds and verify that institutions can teach them. Where internships are full-time and productive, students should receive stipends rather than be charged another year of tuition for work performed in hospitals.

The debate over the “Dr” prefix for physiotherapists and occupational therapists adds another layer of complexity. In academic history, “doctor” is not exclusive to medicine, but in clinical settings the public commonly interprets it as referring to an MBBS-qualified practitioner. The dispute is therefore not merely about prestige; it concerns patient understanding, scope of practice and accountability. The NCAHP curricula recommended the prefix with statutory suffixes such as PT and OT. Subsequent objections, withdrawals and court rulings—including the Kerala High Court’s 2026 decision allowing the usage, now under appeal—have left the matter unsettled. Whatever the final outcome, safeguards are essential: suffixes must be displayed prominently; no title should imply authority to prescribe modern medicines without legal sanction; and scopes of practice must be clearly defined and communicated. The solution lies in precise regulation, not ambiguous titles or denial of legitimate professional expertise.

India needs a larger, better trained and more respected allied-health workforce. The NCAHP can help achieve this, but its success should not be measured by how many programmes become four- or five-year degrees or by the prestige of professional titles. The real measure is whether graduates can perform their work safely, whether students receive adequate clinical exposure, whether education remains accessible beyond affluent families, and whether patients can clearly understand who is treating them and under what authority. Regulation must prevent weak institutions from selling duration in place of training. Competence must precede course length, clinical responsibility must follow demonstrated skill, and professional recognition must never come at the cost of affordability or patient clarity.

---

*Contact: guptapradeepkumar698@gmail.com