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Journal of Indian Association of Pediatric Surgeons, Vol. 10, No. 3, July-September, 2005, pp. 135-136 Editorial Isn't it time to get started? Pathak IC Emeritus Professor, Department of Pediatric Surgery,
PGIMER, Chandigarh, India Code Number: ip05033 Nearly 4 years ago, a symposium entitled ′Pediatric Surgery - a growing or a sinking specialty′ was organized during the 27th Annual Conference of the Indian Association of Pediatric Surgeons (IAPS) in September 2001 at Thiruvananthapuram. The symposium was convened by Dr. Basak, the then President of the IAPS at the request of many members of the IAPS ′to look at the problems of pediatric surgery and how our association has to be involved to overcome the problems.′ A number of members spoke at this symposium and its proceedings were duly published. [1],[2],[3],[4],[5],[6],[7] As far as I am aware, there has been no appraisal or a follow up of the suggestions made at this symposium. However, the Presidents of IAPS during the last 4 years have stated that they approached the Medical Council of India (MCI), Ministry of Health, Planning Commission, and even the P.M.O. appraising the authorities of the problems faced by the specialty. [8],[9],[10] None of the speakers at this symposium believed that the specialty was sinking. All of them, however, agreed that it was not growing. Many of the speakers voiced their concerns about the lack of job opportunities, comparatively low financial gains, and the poor image of the specialty, lacking glamour. Insufficient volumes of work and under utilization of their capabilities were other concerns. What are the ground realities? It is true that there is a dearth of job opportunities. There are only 25 medical institutions in the country, which are recognized to impart postgraduate training leading to the degree of M. Ch pediatric surgery. There may be other medical colleges, which have independent departments, or units of pediatric surgery, but their number is not large. The rest of the medical colleges and institutions numbering nearly 200, do not have any trained pediatric surgeons on their staff. Teaching of pediatric surgery and care of surgical conditions of the children in these colleges is managed by general surgeons. Although no statistics are available, there are very few districts or civil hospitals in the whole of the country that have trained pediatric surgeons on their staff. The recognized training centers produce 30-40 pediatric surgeons every year. The present strength of the members of our association is 710, according to the IAPS directory 2003. Most of the trained pediatric surgeons who are not in the academic institutions or state hospitals have therefore no option but to enter private practice. Most of these trained pediatric surgeons concentrate in metropolitan cities or state capitals. Very few have ventured into smaller towns for reasons such as lack of infrastructure and support from medical colleagues. In metropolitan and big cities there is a lot of competition with not enough cases to support a large number of pediatric surgeons, thereby leading to despair and frustration. There are reasons for an insufficient surgical workload at these places. During the past three decades, there has been a gradual but steady encroachment by organ and tissue specialists cornering a sizeable chunk of pediatric surgical work. Most of the trained pediatric surgeons have never ventured in the fields of cardiac or neurosurgery and many others have shown little interest in endoscopy, laparoscopy, minimal access surgery, transplantation, or oncology. Many of the training centers in the country, I believe, do not provide comprehensive training in areas that are being handled now by urologists, plastic surgeons, neurosurgeons, endoscopists, and laparoscopists. How many pediatric surgeons does the country need? As far as I know, during the past four decades, there has been no attempt to make a survey or have an estimate of the number of surgeons the country needs. It has been suggested that the country needs 2000-4000 pediatric surgeons.[4],[11] These figures have been arrived at on the basis of Western statistics. Considering that we have less than 700 practicing pediatric surgeons, most of whom seem to be unhappy with their lot, it would be fair to ask if the country needs less or more of pediatric surgeons. A wide range of suggestions were made by speakers at the symposium 2001 to tackle the various ′problems′such as lack of job opportunities and varying standards of teaching, and training centers of the country. As far as job opportunities are considered, most of the speakers suggested that all medical colleges in the country should have independent departments of pediatric surgery and the teaching of pediatric surgery and the surgical care of children should be carried out only by trained pediatric surgeons. State governments of the country should also have trained pediatric surgeons at the district and civil hospitals. Both these conditions, if fulfilled, will not only create the desired job opportunities but also create the demand for more trained pediatric surgeons. It was further recommended that each state should have at least one referral hospital, which should have well-equipped neonatal center with intensive care facilities. The training centers imparting postgraduate training should have uniform standards as far as curriculum, equipment, staff, and infrastructure are concerned and should have facilities to impart training in organ-based specialties, endoscopic, and laparascopic surgery. It is well known that majority of neonates with congenital anomalies come from poor families, who are not in a position to afford private health care. Even in governmental set up, the cost of neonatal surgical care is quite high. Welfare steps like ′Treatment of Children Deformities Act 2001′of the American Congress, which requires that group health insurance plan should be available in our country also.[6] It is almost 4 years that we were made aware of the ′problem′that our specialty suffers from. Is it not time that IAPS took up the responsibility of taking note of all the infirmities that bedevil the specialty and took timely action to tackle them? IAPS Presidents, howsoever motivated, cannot achieve much single handedly, while holding the office for a year or two. Our first priority should be to see that all medical colleges in the country have independent departments of pediatric surgery. All our energies should be focused on this issue in the first instance. It is a historical fact that independent departments of Pediatrics existed in nearly all medical colleges ever since the 1950s and 1960s of last century, and when in the early 1990s M. C. I. was considering changes in curricula, pediatricians had little difficulty in getting pediatrics an independent status with a separate paper and examination in the subject. To take up the various suggestions and recommendations made at symposium 2001, I suggest that the IAPS executive constitute a number of committees without any further delay; the committees should not only deliberate on the various issues but also recommend action to be taken up by the IAPS executive and other influential members of our association. References
Copyright 2005 - Journal of Indian Association of Pediatric Surgeons |
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