Abstract
Background: Medical specialization is an understudied, yet growing aspect of health systems in low- and middleincome countries (LMICs). In India, medical specialization is incrementally, yet significantly, modifying service delivery, workforce distribution, and financing. However, scarce evidence exists in India and other LMICs regarding how medical specialties evolve and are regulated, and how these processes might impact the health system. The trajectory of emergency medicine appears to encapsulate broader trends in medical specialization in India – international exchange and engagement, the formation of professional associations, and a lengthy regulatory process with the Medical Council of India. Using an analysis of political priority setting, our objective was to explore the emergence and recognition of emergency medicine as a medical specialty in India, from the early 1990s to 2015. Methods: We used a qualitative case study methodology, drawing on the Shiffman and Smith framework. We conducted 87 in-depth interviews, reviewing 122 documents, and observing six meetings and conferences. We used a modified version of the ‘Framework’ approach in our analysis. Results: Momentum around emergency medicine as a viable solution to weak systems of emergency care in India gained traction in the 1990s. Public and private sector stakeholders, often working through transnational professional medical associations, actively pursued recognition from Medical Council of India. Despite fragmentation within the network, stakeholders shared similar beliefs regarding the need for specialty recognition, and were ultimately achieved this objective. However, fragmentation in the network made coalescing around a broader policy agenda for emergency medicine challenging, eventually contributing to an uncertain long-term pathway. Finally, due to the complexities of the regulatory system, stakeholders promoted multiple forms of training programs, expanding the workforce of emergency physicians, but with limited coordination and standardization. Conclusion: The ideational centrality of postgraduate medical education, a challenging national governance system, and fragmentation within the transnational stakeholder network characterized the development of emergency medicine in India. As medical specialization continues to shape and influence health systems globally, research on the evolution of new medical specialties in LMICs can enhance our understanding of the connections between specialization, health systems, and equity.
Highlights
Medical specialization is an understudied, yet growing aspect of health systems in low- and middle-income countries (LMICs).[1]
Consistent with other health policy analyses in LMICs,[34] we find that the idea of emergency medicine specialization, rather than the policy community actors themselves, seems to have primarily motivated action on the part of regulator, perhaps due to the fact that the regulators were medical professionals and shared similar normative beliefs as those in the EM network
In this paper, we outlined the trajectory of a recent medical specialty in India over the last several decades, and examined the factors that influenced the development of policy for that field
Summary
Medical specialization is an understudied, yet growing aspect of health systems in low- and middle-income countries (LMICs).[1]. Of new medical specialties in high-income settings.[4,5,6] Specialization is a feature of many professions, with professional bodies being comprised of ‘segments’ based upon mission, methodologies, clients, and interests.[7] Focusing on the formation of medical specialization, Leeming[6] and Döhler[5] categorize influencing variables as follows: (1) conceptual and technological innovation; (2) intra-professional competition driven in part by market forces; (3) social and political factors; (4) structural and organizational aspects of academic medicine and health service delivery. The evolution of medical specialties in high-income settings, in the nineteenth and early twentieth century, was lengthy, complex and at times contentious.[4,8,9] Scholars have highlighted the roles of multiple stakeholders (notably national professional associations) and the importance of international exchange, Key Messages
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
