INDIA’S HIGH hypertension and diabetes burden, leading to cardiovascular diseases, has been a cause of global concern. Official data now shows the country could also be headed for a critical shortage of cardiovascular surgeons and cardiologists.
Of the 552 seats that remained vacant in around 30 disciplines after admissions were completed to the 1,907 superspeciality medical seats last year, 104 were in cardiovascular and thoracic surgery and 55 were in cardiology.
Last year was the first time that a common entrance examination, NEET SS, was conducted for masters in surgery and doctorate courses, followed by centralised counselling.
According to Dr Shiv Choudhary, professor and HoD, Department of Cardiothoracic and Vascular Surgery, AIIMS, the pattern of cardiothoracic and vascular surgery (CTVS) and cardiology gradually falling off the map has been visible for some time. The centralised counselling may have merely shone the light on a simmering problem, he says.
“CTVS is not the speciality of choice, it has a long incubation period. While a urologist may be ready to practise on his own at 30 years, for CTVS where the training is long and hard, it could be 45 years. The average work day for a resident could be 18-20 hours. There are very few well equipped centres because it is both expensive and manpower-intensive to run a CTVS Centre. What is more, after such a long and arduous training, a CTVS surgeon would probably get Rs 20,000 per surgery while a gastrointestinal surgeon would make Rs 50,000 from a gall bladder surgery,” says Choudhary.
Given India’s CVD burden, we are already short of cardiovascular doctors, both clinicians and surgeons, says Choudhary.
He estimates the CTVS requirement to be about 8,500 against the current 1,200-1,500 doctors. “There are just 48 centres training doctors in CTVS. Some years ago, while I was part of a UPSC board that needed to choose 22 surgeons for government postings, I chose all six who appeared for the interview from the 14 applicants. In the end, just two joined,” he says.
According to Dr K S Reddy, former head of the Department of Cardiology, AIIMS, and President of Public Health Foundation of India, there are quality and faculty issues in medical colleges.
“Not many have enough case volumes for effective training, whereas for DNBs (Diplomate of National Board) run by private hospitals, that is not the case. So many students prefer to opt for a DNB. It is also no doubt a very strenuous training programme. There is also a faculty shortage. The Medical Council of India has not accepted the equivalence of DNB so this means DNB holders cannot teach. But as we roll out the National Health Protection Mission, the shortages will only get more pronounced when more and more people are able to opt for treatment they were earlier missing out on,” says Dr Reddy.
The faculty shortage in fact has spawned a vicious cycle — people do not come because there are not enough centres, there are not enough centres because there are not enough trained faculty members.
The Ministry of Health is in the process of tweaking the exam format to ensure such huge numbers of vacancies do not remain. For one, from the 2018 NEET, students will appear for speciality wise examinations rather than the broad speciality format of last year. More importantly, a student can opt for only two specialities, unlike last year when students had the option of “blocking” as many seats as they wanted and not vacating them till the last date of counselling was over.
Last year’s NEET counselling also got mired in court cases, causing delays that perhaps affected the final intake, officials say. Andhra Pradesh had cited Article 371 to deny seats to outside students — it was finally settled in court.
Says Dr Vinod Paul, Member (Health), NITI Aayog, till a few years ago, heart doctors were considered “glamorous” and the superspecialities much in demand. “Now people just want it easy, they have become selfish. You have to be very determined to pursue these disciplines,” says the former AIIMS professor.
An update on the cardiovascular disease incidence of India, published in the journal Circulation in 2016, said: “The Global Burden of Disease study estimate of age-standardised CVD death rate of 272 per 100,000 population in India is higher than the global average of 235 per 100,000 population… Premature mortality in terms of years of life lost because of CVD in India increased by 59%, from 23.2 million (1990) to 37 million (2010).”