EDITORIAL

                                           

Pediatrics as a subspecialty: A downward slide?

During a teaching session, the demonstrator quizzed my daughter, a final professional MBBS student, about her preference for post-graduation course. Her colleagues were amused and stared her in disbelief when she uttered pediatrics as her choice for the PG course. Being the daughter of a paediatrician her reply was quite natural. But the bewilderment of her colleagues seems quite surprising to me. I remember my graduation days. When it came to make a choice I had to go for the pediatrics, not because I loved this specialty but simply by 'peer pressure''. Honestly speaking, I was fascinated by cardiology and neurology during my UG clinics. It used to be great pleasure to unravel the mysteries of heart sounds and cardiac rhythm. Listening to cardiac murmurs and assigning a particular valvular lesion indeed used to fascinate me. The excitement of clinching the site of the lesion in a CNS case based purely on neurological examination was simply great. Though it is almost a different proposition altogether now a days with the advent of echocardiography and CNS imaging techniques that have almost relegated these clinical exercises to redundancy now. I used to find pedaitrics quite a ‘disordered’ branch where you need to struggle to restrain an irritable baby first before proceeding any further.

But, at that time, pediatrics was the most sought after branch. There was no competitive examination for postgraduate courses. Once you secured a decent standing based on your UG performance, you knew in advance what specialty you would be joining later. No wonder, the first top three students opted for pediatrics and I also had to give in to the temptation of leading a successful and a comfortable, hassle-free life. And I must confess, I have not had to repent my decision till date. It has been an exciting journey, and quite a fulfilling experience so far.

 

 

So, I was baffled by the current thinking of the present generation of medicos. Pediatrics is not considered a lucrative proposition nowadays. Radiology, dermatology, pathology and other minor branches are the most sought after specialities now. Even Ophthalmology and ENT are getting preferences over the child health subject. Pediatrics as a subspecialty has lost its pre-eminence, and is being pushed to lower rungs. This scenario seems quite universal all over the country. The reasons may not be difficult to fathom. I was going through a graphic posted on a social media site depicting comparative analysis of physicians’ compensations in the USA. And, quite to my surprise, the pediatricians were pegged at the bottom. Orthopedicians and radiologists were the highest earners followed closely by cardiologists and anesthesiologists. Even family practitioners, internists and psychiatrists are earning more than the pediatricians. This data emanated from US, a country where the burden of infectious diseases have been reduced considerably low, thanks to universal immunization. The scene in our country is much different. Pediatric infections still constitute a major chunk of morbidity and mortality. Vaccination rates are very dismal. Public health is in ruins. I doubt if any such comparison on doctors' earning is available from India. Yet, the trend even here seems to be similar to that in the western world.

The profitability and earning potential may be just one consideration. The ultra-demanding nature of the specialty coupled with unpredictability and unsure outcomes at times, makes general pediatrics not so attractive a proposition today. The attitude and mindset of today's generation of medicos may be another reason. Gone are the days when the budding medicos used to feel some obligation to their community, a sense of allegiance to ethics and Hippocratic oath, and have passion to do charity. Today's medico is a restless, desperate and over ambitious soul who hates to play the waiting game. Reflecting the general attitude in the whole society, the important parameter of success is monetary gain which they wish to achieve in a shortest possible time. It is time for a fast buck and a fast lifestyle. The advent of private medical institutions and subsequent huge expenditure incurred may be the reason behind their unusual hurry to earn and recover the expenses. It is wrong to presume that this trend is a feature of the pass-outs of private colleges. Those from premiere government institutions have just the same outlook.

But why should earning potential and ease of life ought to be the only deciding criteria? More so, in a nation like India - a country having almost highest mortality figures on child and neonatal deaths in the globe, topping almost all the charts on burden of key infectious diseases; having some of the highest figures on malnutrition and anemia; featuring in the bottom of child rights issues. This growing apathy of budding medicos is worrisome. India needs the sharpest brains to bring 'out of the box' solutions to its burgeoning child health woes. A diversion towards non-clinical specialties may not only dwindle the status of pediatrics as a premiere subspecialty but, more importantly, may shift our valuable resource material from our current social/national needs and aims.

-Vipin M. Vashishtha