MUMBAI: In a shocking representation of the lack of essential healthcare, the largest chunk of doctors in the country do not hold the MBBS degree (bachelor of medicine, bachelor of surgery) — a basic prerequisite to practice modern medicine (allopathy). Instead, they have degrees of alternative medicine like ayurveda or homeopathy , but they may still be prescribing a significant portion of allopathic medicines.Data culled from the physician census by market research firm, IMS Health says that the non-MBBS general physicians (GPs) charge the lowest — possibly because of their low qualification, experts point out, while the super-specialists like the oncologists and neurologists occupy the top rung, in terms of consulting fees.The physician census, covering 120 cities (metro and non-metro) across the country with nearly four lakh doctors, confirms the huge dearth of quality healthcare professionals, and worse, this situation is not illustrative of rural areas at all.When contacted by TOI, an official of the Indian Medical Association (IMA), a body representing healthcare practitioners, said it has urged the government to bring in laws to prevent quacks from practicing. Corroborating the census findings, the IMA says on its website that quacks are increasing in the country, both in urban and rural areas, and an estimated 10 lakh quacks are practicing allopathic medicine, out of which four lakh belong to practitioners of Indian Medicine (Ayurvedic, Sidha, Tibb and Unani).It further divides quacks amongst three basic categories— quacks with no qualification whatsoever, secondly, practitioners of Indian Medicine (Ayurvedic, Sidha, Tibb, Unani), Homeopathy, Naturopathy, commonly called Ayush, who are not qualified to practice modern medicine (allopathy) but are practicing modern medicine, and lastly, practitioners of so-called integrated medicine, alternative system of medicine, electro-homeopathy, indo-allopathy etc terms which do not exist in any Act. Only practitioners who hold the MBBS degree, and registered with the Medical Council of India or the state medical council can practice modern medicine (allopathy).IMA has also urged the government to bring in an anti-quackery law to curb unqualified and unlicensed people from taking up medical practice in the country, IMA national president Dr K Vijayakumar told TOI, adding "we are demanding an increase in the undergraduate and post-graduate seats in medical colleges to fill the gap".Says Amit Backliwal MD IMS Health South Asia: "Access to good quality healthcare is a significant challenge in India. A key issue in getting access, according to an earlier IMS study is availability of healthcare workers, diagnostic facilities and delivery of care of a standard quality. The significant variations and disparities in number of doctors across cities, high burden on tertiary care physicians especially more prominent in smaller towns, along with mismatch in healthcare indicators to inadequate presence of healthcare infrastructure and manpower, all lead to an extremely fragmented, chaotic and poor state of healthcare in India".The disparities in consultation charges exist across doctor specialities as well as towns and cities, with factors like qualification and high cost of living, driving this trend.While general physicians, dentists and consulting physicians are at the bottom, the top rungs are occupied by the super specialists like oncologists, neurologists, cardiac surgeons and nephrologists – whose fees are 4-5 times that of the general physicians. In the middle lie doctor specialties like pediatricians, gynecologists, ENTs and ophthalmologists who charge 2-3 times more than general physicians. Predictably doctors from mega metros charge a premium over doctors from smaller cities; on an average a consultation with Mumbai doctors is 20-40% costlier than the all-India average doctor fee. Factors like higher cost of living, high disposable incomes, advanced treatment facilities, and higher repute of doctors drive this trend.