By this recent trend of superspeciality seats going empty shows that there is something going really wrong with the medical higher education policy.
Amongst the surgical branches, the ones which are majorly impacted are CTVS surgery on the top, followed by paediatric surgery and plastic surgery.
Amongst the medical branches, cardiology on the top, followed by critical care, nephrology and gastroenterology. Below is my analysis of possible causes of this trend:
Widespread prevalence of unreasonable service bonds by the state governments for candidates joining super specialty seats:
To join a super specialty seat there is already requires so much sacrifice which is made by the candidates on economic, family and personal front but by bringing the draconian service bonds into picture it becomes all the more difficult and counterproductive to join a superspecialty.
Government colleges in different states ask students to sign bonds to serve in their hospitals for a minimum of three years and a maximum of 10 years after finishing the course. For instance, Tamil Nadu wants a candidate to work in the state for 10 years; only then a candidate can practice on his own freely. Already the average age at which a candidate joins is 32-35 years, by the time a candidate finishes his bond service, he would be approaching the age of retirement or would in a grip of some lifestyle disease having wasted all the happy years of his/ her youth.
Inhuman working conditions and impossible number of work hours with all the responsibility
With no regulations on work time for resident doctors in place, in most states the residents have to do duties ranging from 24 to 48 hours at a stretch and monthly number of working hours ranging from 400-500 hours, which is highest amongst any of the developed or developing countries in the world. Owing to lack of specialist doctors, superspecialty residents have to virtually bear all the workload in these specialty institutes or departments with all the responsibilities. Family responsibility and personal mental and physical well being tends to be totally neglected for the whole 3 years.
The specialties affected more are the ones which are more physically demanding or are perceived to be with low scope
Specialties like CTVS and Pediatric Surgery are perceived to be more physically demanding. CTVS is mostly concentrated in big cities because of a costly setup (requirement of heart lung machine, ECMO machine etc), hence also contributing to lesser new job opportunities compared to other branches.
Whereas with Paediatric surgery the issue is different, it is in a gray zone where in a lot of patients can go to a General surgeon or a super specialist as per the system involved. Corporate hospitals also do not support Paediatric Surgery as it is not so lucrative for them. Most of the Government Medical Colleges also do not have a Paediatric Surgery departments. Hence greatly limiting the opportunities for a freshly passed out graduate. However, gradually the demand of Paediatric Surgeons is definitely on a rise in Tier 1 and Tier 2 cities.
Similarly for plastic surgeons there are not many positions in corporate hospitals compared to Urology, Surgical oncology, Gastrointestinal surgery or Neurosurgery. One reason for this is a lower case loads and the practice is mainly dependent on referrals from general surgeons, oncosurgeons, orthopedic surgeons and pediatric surgeons. You have to work under the shadow of a senior surgeon for few years in corporate hospitals before you can kick start your own practice.
Comments
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Jithu George Kanipayoor Now a days government is increasing PGSS seats indescrimately.Here in our state ,there is about 20 pediatric surgery seats (Mch).Suppose if 20 surgeons are passing put each year with Mch ,is there any proportional vacancy in either government or private sector ?Are the number of job opportunities increasing each year ?Hence most of the seats are left vacant, a kind of natural correction .
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Manjunath Subramanyam Jithu George Kanipayoor agreed , but across the country definitely scope is there , the councils / MOH has to provide the infrastructure which is lacking .Fir example in KIDWAI there is no definitive PRS department , it’s a premier cancer institute , today it’s the era of sub specialty group practise but where do we stand , I hope it’s the same scenario in many centers . How can we expect things to change !
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Murali Guntoju Number of pg or ss seats have increased as per population demand, but employment has not increased at the same ratio. People are afraid to take few branches as the salaries paid in these branches has decreased and also the no of specialists increased.
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Manjunath Subramanyam The scope is huge and tremendous , but right administration is what matters I believe , ex Kidwai doesn’t have definitive PRS department , today it’s the era of sub specialty practise , it can be turned into another CHANG GUNG , but who and how , it …See More
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Anirban Kundu Well said Sandeep, but of late we’re also noticing a trend where 6 years DNB super specialty seats are being filled up, at least in CTVS. Perhaps this is owing to the relative uncertainty regarding PG admissions in broad specialty courses, and the candidate plumps for a super specialty course so as to stave off any future uncertainty.
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Skanda Shyamsundar There’s only one main reason for this. The name’s Bond. Education Bond!
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