PM-JAY and Oncology in India:
Progress, Policy Shock, and the Need for Balance
A Surgical Oncologist’s Perspective
Over the last decade, oncology care in India especially in Gujarat has undergone a profound transformation. Much of this shift has been driven by government-backed schemes, culminating in Pradhan Mantri Jan Arogya Yojana (PM-JAY).
As a practicing surgical oncologist working across metro as well as peripheral centres, I have witnessed this transition closely from a highly centralized, overburdened system to a more distributed, structured, and accessible oncology ecosystem.
However, recent developments suggesting that MD-qualified oncologists may no longer be eligible for PM-JAY empanelment have created significant concern within the medical community. Particularly in cities like Ahmedabad, where a large number of experienced clinicians fall into this category, the implications are substantial.
This moment requires not reaction but reflection, balance, and system-level thinking.
Where We Started: The Pre-PM-JAY Reality
Around 2015–16, before PM-JAY and during the Ma Yojana era, cancer care for economically weaker patients was largely dependent on government institutions like the Gujarat Cancer and Research Institute.
Long waiting lists were the norm, hospitals were severely overburdened, and delays in surgery and treatment were common.
Outside this system, oncology care was available only at selected corporate hospitals, which were financially out of reach for most patients.
As a result, many patients underwent cancer surgeries in small nursing homes, ENT or general surgery setups, and low-resource environments with basic infrastructure. These setups often lacked ICU backup, multidisciplinary planning, and standard oncological protocols. The patient journey was fragmented, and outcomes were inconsistent.
What PM-JAY Changed: A System-Level Transformation
The introduction of PM-JAY marked a turning point not just financially, but structurally.
Cancer care began to decentralize, expanding beyond metro cities into districts such as Mehsana, Patan, Palanpur, Himmatnagar, Surat, Rajkot, Bhuj, and Navsari. Patients no longer needed to travel long distances for treatment.
Large private hospitals also began participating in government schemes. This brought advanced operation theatre infrastructure, ICU support, and standardized surgical oncology care to patients who previously could not afford such facilities.
Treatment pathways became more structured. A biopsy diagnosis increasingly led to direct referral to a cancer centre, reducing delays, unnecessary intermediate procedures, and fragmented care.
Multidisciplinary oncology also saw significant growth. Tumor boards and integrated care models became more common, allowing patients to receive evidence-based decisions and combine modality treatment surgery, chemotherapy, and radiation within one coordinated system.
At the same time, increased awareness reduced the role of middlemen. Patients began approaching cancer centres directly, minimizing referral exploitation and reducing repeat or suboptimal surgeries in smaller setups.
Impact on Patients
The most significant beneficiaries of PM-JAY have been the patients.
Access to treatment improved, financial burden reduced, waiting times shortened, and treatment compliance increased due to proximity of care.
Importantly, patients in Tier 2 and Tier 3 cities could now receive treatment closer to home, often while continuing their daily lives. This led to lower dropout rates and better overall outcomes.
Impact on the Oncology Ecosystem
PM-JAY also catalysed systemic growth across the oncology ecosystem.
There has been a visible expansion of oncology centres across regions, along with the growth of DNB and structured training programs. Young surgeons are now getting better exposure, and there is a clear shift towards specialised, protocol-driven oncology care.
This transformation has strengthened the future workforce of oncology in India.
Impact on the Oncology Ecosystem
PM-JAY also catalysed systemic growth across the oncology ecosystem.
There has been a visible expansion of oncology centres across regions, along with the growth of DNB and structured training programs. Young surgeons are now getting better exposure, and there is a clear shift towards specialised, protocol-driven oncology care.
This transformation has strengthened the future workforce of oncology in India.
The Current Policy Shift: Understanding the Intent
The move to restrict empanelment to DM/MCh/DrNB-qualified oncologists is not without rationale.
Oncology today is highly specialised, protocol-driven, and outcome-sensitive. There is a legitimate need to standardise care, ensure quality, and reduce variability. From a policy standpoint, this shift aims to align Indian oncology care with global standards.
Where the Policy Risks Missing Ground Reality
However, policy must remain grounded in real-world constraints.
India already faces a shortage of trained oncologists. Excluding experienced MD/MS practitioners may reduce the available workforce and create access gaps, especially in non-metro regions.
Experience versus qualification is another critical concern. Many MD-qualified oncologists bring 20–25 years of experience, have managed large volumes of cancer patients, and have contributed significantly to care delivery and training. Ignoring this experience risks losing valuable clinical expertise.
The impact on rural and semi-urban areas could be particularly severe. Smaller towns may face a healthcare vacuum, forcing patients to travel again, increasing treatment delays, and potentially reversing the gains achieved through decentralisation.
The Core Issue: A System Design Challenge
This is not a conflict between superspecialists and experienced doctors.
It is a balance between standardisation and accessibility both of which are essential and cannot be compromised.
The Way Forward: Practical, Balanced Solutions
The answer lies in refining the system, not reversing progress.
A transitional empanelment pathway could allow experienced MD/MS oncologists to continue under PM-JAY through case volume validation, outcome-based assessments, and periodic credential reviews.
A tiered oncology care model can help differentiate between early and complex cases. Basic or early-stage cancers may be managed by experienced practitioners, while advanced cases are referred to superspecialist centres. This ensures both access and quality.
Structured referral systems are equally important. Clear guidelines must define which cases can be managed locally and when escalation is necessary, preventing both overtreatment and delays.
Expanding oncology training is another key step. Increasing DrNB and MCh seats, expanding fellowships, and introducing skill-based certification pathways will help bridge the workforce gap.
Finally, rationalising PM-JAY packages through periodic revision and realistic costing of advanced procedures is essential for long-term sustainability.
Final Perspective
PM-JAY has already transformed oncology in India from centralised to decentralised, from unaffordable to accessible, and from fragmented to structured. The current policy shift aims to improve quality. However, without flexibility, it risks compromising access.
Closing Thought
Healthcare policy must not choose between access and excellence. It must design systems where both coexist.
Because for a cancer patient, delay is not policy, access is not optional, and quality is not negotiable.
Dr. Bhavin Vadodariya
MS, DrNB Surgical Oncology
Head & Neck Cancer Surgeon
Ahmedabad
