Rejoinder: The 'Dr' debate is settled; Parliament settled it

By Aditya Sharma* 

Dr P K Gupta's recent article (The 'Dr' debate masks a larger crisis in allied-health education, Counterview, 1 August 2026) on the use of the "Dr" prefix by physiotherapists reads, on its surface, as a balanced take on a genuinely difficult question. But a closer look shows that it revives a set of arguments that were put before Parliament during the drafting of the National Commission for Allied and Healthcare Professions Act, 2021 (NCAHP Act) — and that Parliament's own Standing Committee considered and rejected. This response draws on the Committee's 117th Report and the text of the Act itself to lay out why.

Does "Dr" Really Confuse The Public?

The article claims that in clinical settings, the public "commonly interprets" the title "Dr" as meaning an MBBS-qualified doctor. In India, this doesn't hold up. Practitioners of Ayurveda (BAMS), Homoeopathy (BHMS), Unani medicine (BUMS), and dentistry (BDS) have used the "Dr" prefix for decades, a usage recognised both by their respective statutory councils and by the Clinical Establishments (Registration and Regulation) Act, 2010. Indians routinely encounter "Dr" attached to practitioners who are not MBBS-qualified. No data is offered to support the claim of widespread confusion, because there isn't much evidence for it.

The article also notes that the Kerala High Court's 2026 ruling allowing physiotherapists to use "Dr...PT" is "now under appeal" — a phrasing that implies the matter is legally unsettled. It isn't. A High Court judgment is binding law within its jurisdiction unless and until it is stayed or overturned; an appeal alone does not suspend it.

It's also worth noting what Parliament actually decided on this point. The Indian Medical Association (IMA) told the Standing Committee that "paramedics should not prefix 'Dr' to their name and if they violate this they should be punished accordingly." The Committee didn't adopt that position. Instead, the resulting Act and the competency-based curricula developed by physiotherapy professionals themselves recommended "Dr" with the statutory suffix "PT" — a call made by domain experts, not imposed from outside.

"Allied Health Professional" Or "Healthcare Professional"?

The article repeatedly describes physiotherapists as "allied health professionals," but the Act draws a sharper line than that phrase suggests. Under Section 2(d), an allied health professional is an associate, technician, or technologist trained to support diagnosis and treatment under someone else's plan, requiring a minimum of 2,000 training hours. Under Section 2(j), a healthcare professional is someone who studies, advises, researches, supervises, or independently provides preventive, curative, rehabilitative, or therapeutic services, requiring a minimum of 3,600 hours over three to six years.

Physiotherapy training in India runs to roughly 5,280 hours — 4,320 hours of coursework plus 960 hours of internship — which places it well inside the "healthcare professional" category. The Standing Committee recorded these figures in detail, and its 31st Report separately noted that physiotherapists complete a "four and a half years degree course" before entering government service.

The Act's own Schedule describes a physiotherapy professional as someone who undertakes "comprehensive examination and appropriate investigation," and provides treatment covering diagnosis, screening, and treatment — not simply someone executing another professional's instructions.

Independent Practice, Not Medical Supervision

The article's framing leans toward the idea that physiotherapists should work under medical supervision. That position was explicitly considered and set aside by the Standing Committee. Its 117th Report states plainly:

"Addition of 'under the supervision of a modern medicine doctor' in the Schedule would place the allied and healthcare professionals under the shadow of the medical doctors... The other suggestions submitted by IMA need not be included."

The IMA had argued that physiotherapy "remains medically directed services... executed under medical supervision" everywhere in the world. The Committee rejected this. Section 14 of the Act gives every registered professional the right to provide services within their defined scope and to charge fees for them; Section 15 bars unregistered practice. The framework Parliament settled on is one of independent practice within defined boundaries, not subordination to medical sign-off.

The pay parity question tells a similar story. The 31st Report recorded "a lot of dissatisfaction" among physiotherapists and occupational therapists over stagnant pay scales, and recommended revision "according to their qualifications and duration of the course." Parliament has, on this evidence, treated physiotherapists as professionals whose training justifies parity — not as a subordinate category.

Prescribing and "task shifting"

The article's line that "no title should imply authority to prescribe modern medicines without legal sanction" sounds uncontroversial, but it quietly assumes prescribing must remain solely a medical function. That assumption doesn't match either the Act or international practice.

The Act defines "task shifting" (Section 2(w)) as moving specific tasks to allied and healthcare professionals suited to them, as part of reorganising the health workforce. The Standing Committee endorsed this explicitly as one of the Bill's core objectives. Extended-scope physiotherapy, including limited independent prescribing, has been standard practice in the United Kingdom since 2013, and exists in Australia and parts of the United States as well; the WHO has repeatedly backed task shifting as a way to address workforce shortages. Framing prescribing as an unmovable medical monopoly is a contested position, not a neutral fact — and it's one Parliament weighed and moved away from. The Act's own Schedule, notably, includes "diagnosis" and "screening" within physiotherapists' statutory scope.

Are course durations really "inflated"?

The article suggests course lengths are being padded without justification, floating "a well-designed three-year degree" as an alternative. But physiotherapy degrees in India have run four to four-and-a-half years for decades — this isn't a new development tied to the NCAHP Act. The curricula themselves were designed by physiotherapy experts, not administrators, and the Standing Committee's own recommendation was to strengthen clinical training and internship components, not shorten them.

Naming The Pattern

The Standing Committee's report contains a section that speaks directly to articles like this one. It observes that functions once handled by parents, teachers, clergy, and social workers have steadily been redefined as medical functions, and attributes much of the resulting imbalance to what researchers at the Public Health Foundation of India call "medical dominance" — reinforced through professional autonomy, control over health economics, and the collective influence of medical associations. The Committee noted this has real effects: it lowers the standing of allied health professionals in public perception and contributes to low morale within the profession.

Read against that backdrop, several of the article's moves — questioning the "Dr" prefix on grounds of confusion that the Indian record doesn't support, casting physiotherapists as executors of others' treatment plans, treating prescribing as inherently medical territory, and describing expert-built curricula as duration inflation — track closely with positions the IMA placed before the Committee and that the Committee declined to adopt. The article also doesn't disclose Dr Gupta's professional background, which seems relevant given how closely the piece's arguments mirror one side's submissions.

Where This Leaves Things

The NCAHP Act was the product of extended parliamentary scrutiny — 31 stakeholder groups and individual experts, heard over seven sittings. The Standing Committee's report lays out the competing arguments in detail and explains why it landed where it did. The Act, the resulting expert-designed curricula, and the Kerala High Court's ruling together form the current legal and professional landscape.

None of this means the article's underlying concerns about training infrastructure and affordability aren't worth discussing — they are. But those concerns don't need to be bundled with arguments that were already raised, examined, and set aside during a legislative process that took input from all sides.

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*Contact: sharmapuru008@gmail.com