Medical PG courses: Moving towards super speciality
If you are sick, nowadays it’s easy to find a specialist than a general physician. Do you know why? A basic MBBS degree plus an MD/MS is just not enough. Graduates aspire to become super specialists rather than remain just general physicians (GP).
“With the advancements in the field of medical sciences, highly specialized training is the need of the hour. It has led to increasing demand for super specialized contributors,” says Dr Sanjeev Lalwani, Registrar of AIIMS, New Delhi.
Dr. Sanjeev Lalwani,
Passion for speciality
You must have a burning passion for the speciality you choose. Dr. Pankaj discovered his true calling during his rotatory MS internship at Sir Sunderlal Hospital, a teaching hospital affiliated to the Institute of Medical Sciences, Banaras Hindu University. At the emergency wing, he found that most of the cases were related to road accidents that result in head injuries in 90 percent of the cases. A keen observer, Dr Pankaj was always in awe of his senior neuro specialists who handled such cases with finesse. This prompted him to pursue MCh in Neuro Surgery from GB Pant Institute of Postgraduate Medical Education & Research or GB Pant Hospital, associated to Maulana Azad Medical College, Delhi
“I have assisted 400 neuro-surgeries in last two years as the course gives more relevance to practical component,” says the third year MCh student. He feels lucky, getting unique opportunities here. “It’s the only public hospital in the country that trains neuro surgeons to perform endovascular coiling and endovascular embolization surgeries,” says Dr Pankaj, whose day commences with 2-hour theory class followed by visits to operation theatre, OPD and respective wards. He assists and performs surgery under the guidance of professors.
In keeping with the trend, hospitals too are slowly evolving as super specialized or multi-speciality centres. The speciality hospitals are perceived as delivering higher quality treatment.
When Dr. Usha Kumar joined Lady Hardinge Hospital in 1990s, 95 percent of surgeries were open surgeries. After gaining an advanced diploma on endoscopy surgery from Germany, she is now more into laparoscopic advanced surgeries. Today she uses ultrasonic wave energy to seal vessels; morcellater that can remove tumour of any size from uterus and ovaries. “Gynae endoscopy surgery has become sub speciality in Gynaecology. Earlier everything was handled by one doctor to conduct deliveries, infertility treatment or other surgeries. Now many doctors specialize in one area. It helps in minimizing the chances of complications.
The idea is to move towards greater perfection in patient treatment,” says Dr. Usha Kumar, Senior Consultant & Gynae Endoscopic Surgeon, Max Superspeciality Hospital, Saket, which attracts a number of patients from abroad, especially from Dubai, UAE, Nigeria and Afghanistan. “Various factors attract foreign patients to India - lack of gynae endoscopic experts and high cost of surgeries in some countries,” she reveals.
Dr. Usha Kumar,
Senior Consultant & Gynae Endoscopic Surgeon,
Increasing need for specialists
The number of cancer patients is increasing worldwide. “In the coming years, lifestyle diseases including cancer will be the biggest challenge. So there will be greater demand for oncologists,” says Dr Meenu Walia, the first DNB Medical Oncologist of India. She is currently the Director of Max Oncology Centre at the Max Hospital, Patparganj. The job, if it can be called that, is very strenuous but quite satisfying as well. “The most satisfying moment for me is when your patient comes out of deathbed...and one day walks into your OPD 5 years later and says I am alive because of you,” she says. Oncology deals with cancer management. The three career branches under oncology are medical oncologist, surgical oncologist and radiation oncologist.
Dr Meenu Walia,
Director of Max Oncology Centre,
Max Hospital, Patparganj
Patient care is nowadays more of teamwork, no longer dependent on a single speciality. Dr. Balaram Airen, Head of Cardio-Thoracic Sciences Centre, AIIMS emphasizes the need of multiple specialists. “Most of the surgeries are through cardio-pulmonary bypass that controls the function of heart and lungs by a machine. Here the support of cardiologist, cardiac anaesthetist, cardiac radiologist, cardiovascular pathologist, nuclear medicine specialist is inevitable,” says Dr.. Airen.
Dr. Sandeep Vaishya, an alumnus of AIIMS, is one of the best-known neuro-surgeons for brain and spine surgery in India. “Our hospital specializes in three broad areas – brain surgery, spine surgery and function neuro surgery. A nuero surgery involves 10-15 types of procedures in the brain. We do a lot of minimal invasive surgeries and installation of good technology brings out better result,” says Dr. Vaishya, currently working as Director Neurosurgery at Fortis Hospital, Gurgaon. The patient undergoing neurosurgery receives care and support from neurosurgeon, neuro-anaesthetists, neurologists, a neuro-monitoring team and the neuro-critical care team.
Eligibility & selection process
After PG degree (MD/MS), one must opt for post-doctoral three-year DM (medical) or MCh (surgery) degree that allows you to specialize in a specific area. In total, you devote a minimum of 11 years to become a specialist. Every year prominent institutes like AIIMS, PGIMER, University of Delhi and CMC Vellore conduct All India DM/MCh entrance exam.
The AIIMS MCh entrance exam consists of 100 marks, comprising 80 marks for theory and 20 for departmental assessment. Ask Dr. Airen how do you assess a candidate? “We have a spot exam where we keep clinical objects for the candidate to analyse. For instance, a student must be able to identify metal valves we use for replacement. In the viva voce, we try to gauge their IQ and passion for the subject,” he said.
The structure of super speciality courses recognized by Medical Council of India differs from institute to institute. The main reason is that the exposure to number of patients and variety of diseases may vary between private and government hospitals.
Popular super specializations
As you narrow down the field of work, you understand the problem in greater detail. According to Dr. Lalwani, some of the popular super specializations at AIIMS comprise endocrinology, neurology cardiology, gastroenterology GI surgery, Urology and Neurosurgery.
Dr. Vikas Kumar Keshri chose AIIMS for pursuing MCh Cardiothoracic and Vascular Surgery. “The training on cardiothoracic and vascular surgery is at par with centres of excellence word wide. The institutes gets referral from centres all over the country and handles with expertise, the rarest of rare cases,” says Dr. Keshri, who works as Associate Consultant, Mission Hospital, Durgapur, West Bengal.
In a private hospital a doctor can earn almost 5 to 10 times of their counterpart in the public sector. Most private hospitals take an ‘X’ amount from the client fee. The senior resident employee at an institute like AIIMS can expect a salary of around Rs. 80,000. Under state government, it could come down to Rs. 35,000 to 45,000. “Your working hours is unlimited in a private hospital as compared to fixed hours of a government hospital,” says Dr. Usha.
Is super specialization a must?
Many doctors argue that governments should not venture deep into this field, as it is not very cost effective. With limited resources, hospitals should have clear priorities. The aim of the government should be to meet the primary and secondary healthcare needs of each citizen rather than invest its resources on costly tertiary healthcare facilities – in fact only a small percentage of patients require it and this can be adequately taken care of by subsidized contributory health insurance schemes. “The medical healthcare system is in the form of a pyramid. The base is formed by general physicians (broad), followed by specialists (intermediate) and top is by super specialists (Tip). Only 5 to 10 percent patients need super-specialized treatment,” informs Dr. Rakesh Kumar, Additional Professor, Department of Otorhinolaryngology, AIIMS, New Delhi. In the same breadth Dr. Anil Chauhan, Principal, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda adds, “With the cost of providing super specialist care to a patient, hundreds of patients can be provided primary healthcare.”
Super-speciality hospitals will continue to grow in India fuelled by patients with deep pockets and also because of the rapid growth of medical tourism. The challenge is to ensure that they grow outside the big metro cities so that they can be accessible to all patients. Super-specialists in medical colleges have the potential for improving the capacity of medical officers in the field by executing short courses for management of stroke, acute myocardial infraction, trauma and so on. Dr. Chauhan sees a bigger role for super specialists to augment the country’s healthcare resources. “Super-specialists should become consultants helping to design programmes and guidelines for the state to improve the capacity to manage patients at the Primary Health Institutions (PHIs) like Community Health Centres (CHC) and District Hospitals (DH),” he says.
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