Surgical, anesthesia and obstetrics (SAO) workforce production capacity in India: a retrospective analysis of postgraduate and subspecialty training spots

Background We assessed the SAO production capacity of India i.e., the number of postgraduate (PG) and subspecialty (SS) surgical training spots per 10 million population across multiple specialties and subspecialties at national and state levels. Methods A retrospective secondary data analysis of PG and SS SAO spots across 36 states for 2018 was conducted using data from the National Health Profile (2019) and census-based population projections. The number of PG & SS SAO spots per 10 million population were calculated, across the states and type of SAO specialty. The ratios of PG spots per 100 MBBS (Bachelor of Medicine and Bachelor of Surgery) spots and SS spots per 100 PG spots were also calculated. Results There were a total of 13,793 PG and 1350 SS SAO spots available across India, leading to densities of 104.60 and 9.90 per 10 million people, respectively. The PG spot density was higher for General Surgery (23.56), Anesthesia (24.81), and OBGYN (21.55). The SS spot densities were higher for Urology (1.90), Neurosurgery (1.86), and Cardiothoracic and Vascular Surgery (1.83), The spot density was geographically uneven. For every 100 MBBS spots, there were only 20 PG SAO spots, and for every 100 PG SAO spots, only 9 SS SAO spots were available. Conclusion India’s SAO workforce production capacity is limited and inadequate to meet Lancet Commission on Global Surgery (LCoGS) SAO workforce targets by 2030. Hence, scale-up of SAO training capacity needs to be carried out with attention to reducing disparities.