India is perhaps is the unique country of world where a lot of systems of medicines are practised under authorization by the Government. Besides, Modern Medicines or Allopathic System of Medicine; which is mainstream system of patient care many other complementary medical practices such as Ayurveda, Homeopathy, Siddha, and Unani, are also practised. Ayurveda clinical practices form the biggest compartment among the AYUSH practices as complimentary medicines. Currently, with nearly 500 teaching and training institutes including 140 Post Graduate Institutes of Ayurveda in country and over 4.5 Lakh registered Ayurveda practitioners, the Ayurveda clinical services have outreach to even remotest human habitations in the country. These clinical practices are undertaken from state run institutions, charitable establishments to even private facilities and include both outpatient and indoor hospital services. There is no doubt that these Ayurveda institutions not only have established their importance in primary health care of society, in fact they share a major component of public health care in the country. The dependability of the masses on the services of the Ayurveda institutions and clinics is huge compared to other systems of AYUSH. It is also an established fact now that institutions managed by institutionally trained Ayurveda practitioners have far outnumbered the services of traditional Vaidyas now. Even the clinics and establishments of traditional Vaidyas are presently being run by institutionally trained Ayurveda doctors. The efforts of National Commission for Indian System of Medicine earlier Central Council of Indian Medicine have gone a long way in providing uniformity in teaching and training of students of Ayurveda institutions both at under-graduate and postgraduate level. The periodic review of curriculum of teaching and training has made the syllabus need based. Further postgraduate courses too have contributed a lot in nurturing the needs of specializations. Research too is contributing in evidence basing of Ayurveda practices. With regulated admissions, talent too is involved in teaching and training of Ayurveda. Few leading institutions are also constantly involved in upgrading the clinical skills of Ayurveda clinicians through Continued Medical Education, Reorientation, and Hands on Training Programmes. This along with upgraded patient care services to the level of NABH in State as well as private institutions are contributing a lot in image building of Ayurveda as well as an attraction of patients to Ayurveda institutions for disease management. However, in spite of this bright picture of Ayurveda in country, the challenges for Ayurveda practitioners are immense and need to be redressed at desired levels. Ministry of AYUSH, Government of India, through its regulatory bodies, have assured uniformity in teaching and training of Ayurveda, including postgraduation. Trans India avenues for Ayurveda education are also available, where in students of one State can get enrolled into other State colleges of their choice. However, when it comes to practice the regulation of specific states are different. While some states bodies permit pure Ayurveda practice others have allowed integrated practice of medicines. It is an established fact that in most of the ayurvedic colleges, the hands on training of the integrated system of clinical practices is not satisfactory and as such in the States where integrated practices are allowed the newly passed ayurvedic graduates get attracted to allopathic/modern hospital for training and associated monetary gains and needless to say get involved in practice of modern/allopathic medicine. This they practise in their clinical practises also on priority. Another challenge for Ayurveda practice is that most of the postgraduates coming out of ayurvedic institutes opt for teaching assignments in ayurvedic colleges in the absence of other stable jobs. Very few of them opt for self-employed clinics. The challenge for graduates is different. In view of absence of respectable job offer, they wait for same or start with a small clinic. The lack of availability of standard treatment protocols and exposure to evidence based medicine, poor diagnostic potential to rationalize the treatment as per disease pathology makes them shaky in management of diseases. Their capacity to interpret the investigations is also limited, which sometimes leaves the patients unsatisfied. Those struggling in their clinical career have little to fall back upon on experts for opinion and further they have minimum chance to get knowledge through regular Hands on Reorientation training to improve their clinical practices. Young Ayurveda graduates fail to get acceptance by masses due to their nontraditional approach to the traditional medicines. Most of the people prefer traditional Vaidyas engaged in Ayurveda practices as a family tradition, irrespective of their knowledge. Some of these practitioners are often recognised for prescribing remedies for few specific disorders, which sometimes may be questionable. Shrinking base of classical Ayurveda medicines and their cost benefits often attracts the Ayurveda practitioner to patent Ayurveda products of big or small pharmaceutical houses, to be used the way they are propagated, sometimes not even knowing their pharmaceutical constitution. Failing to thrive on their routine practice, some of these Ayurveda practitioners get engaged sometimes in unethical medical practices for momentary gains. Another challenge for ethical Ayurveda practice arises from unsubstantiated claims by certain individuals and institutions in the management of refractory diseases and terminal diseases through Ayurveda drugs and procedures in social media. Be it television channels, newspapers, or other communication channels like internet services U-tube, Instagram, Face book, etc., a lot of stuff is available to attract unsuspecting patients to seek remedy of their refractory ailments at high cost. Many unsuspecting patients fall prey to these dubious propaganda. Sometimes, a sincere Ayurveda practitioner is also expected by patients to assure such therapeutic outcomes, which in fact are not achievable. Without effective regulation of such claims by the law enforcing agencies such therapeutic claims often lower the reputation of Ayurveda practitioners in eyes of educated society. Ayurveda practitioners desirous of working in high impact areas of system like Kshar Sutra, Panchakarma, etc., face challenge of high investment in the beginning with good dividends later-on. These workforce and space intensive clinics carry a high cost of establishment which sometimes is a challenge of well-intended and qualified Ayurveda doctor to begin with keeping in mind, the fact that today’s most of Ayurveda students come from lower middle class families. Poor referral facilities is an another challenge for Ayurveda clinician. Any patient requiring higher treatment facility from a clinic of Ayurveda practitioner often lands with hospital of modern system of medicines and is lost for further follow-up there. The efforts of the Ayurveda practitioner in the early management of disease are rarely appreciated by the patient. Lack of empanelment of the Ayurveda clinics, hospitals by private and public enterprises for reimbursement of treatment costs, nonauthorization for medical certificates, and denial for establishment of diagnostic facilities, etc., in Ayurveda clinics too are challenges for successful Ayurveda practices even for postgraduate specialist of Ayurveda. In addition to these, there are other challenges for Ayurveda practitioners across the country and based on the state of other medical facilities available in the area. It is high time that Union and State Governments come up with mutually acceptable guidelines on clinical practices of Ayurveda practitioners. Ayurveda practices should be recognized as primary facility for health promotion and wellness. Ayurveda practitioners should be empowered with evidence-based treatment guidelines in high impact health care areas so that they can not only serve the society but also have a decent earning from their practices. Finally uniform guidelines to empower Ayurveda practitioners for managing primary emergencies should be area of interest of authorities. This only can help talented Ayurveda practitioners to face the healthcare challenges of modern times successfully.
Y. K. Sharma (Thu,) studied this question.