In
my recent conversations with young residents who have graduated with an MD in Emergency Medicine and others who hold various kinds of Non
Accredited MD in EM, Certificates, Rogue Masters in Emergency Medicine or
Pseudo Diploma’s in Emergency Medicine I have come to realize the harsh truth
about what these young trained physicians visualize themselves or rather where
they are in today’s era.
We
must accept the fact, that in India the majority of jobs for physicians lie in
the private sector. When it comes to Emergency Medicine, Hospital Based
Practice is the natural course for the career of an Emergency Physician.
Keeping this economic
opportunity alive is the best a system can do to keep a specialty alive.
There
was a time that Dermatology was the last choice for majority of graduating
young physicians and today thanks to the economic growth of cosmetology and
aesthetic medicine, Dermatology has suddenly become the top field of choice for
new graduates.
There
was a time Emergency Medicine departments were called Casualty Departments.
This was in 1996 when I first saw the vision for Emergency Medicine and sowed
the seeds for its development in India. Today Emergency Medicine boats of
having many Father’s but these fathers were nowhere when I started my journey
to bring EM to India. “Success has many fathers failure has none”
Anyways,
when I started to convince the hospitals to start EM back in 1996, I was mocked
and called the “Messiah of Worthless CMOs (Casualty Medical officers).” It has been a long journey and today every
private hospital tries to canvas and market its Emergency Services. The rise of
healthcare and the demand and the brand of EM has gone up.
I
question whether the economics has become equally lucrative or not for the job
market. I will defend the later. Rogue Certifications and Diploma’s and the
modus operandi run by many organizations to conduct non accredited courses
across private hospital emergency departments led by one or two pseudo leaders
(who don’t have any experience at education) has defeated the theory of categorical
evolution of a specialty. Today these Non-accredited Programs are run by a Head
of EM (who is also mostly having a non-accredited degree) and this head
recruits up to 15 students per year by misguiding them that “One Day Their Certificate/
Masters will be recognized”. The students who join these courses haven’t made
it to conventional MD/DNB programs nor have they decided to take the
International Pathways to USA/UK. They pursue these Non-accredited programs as
an option which will add a Few Letters after their MBBS. It would be nice if
these letters had UK or USA with them. Whether these Letters really are
recognized oversees or not is another story…because what do the patients realize
anyways?
So
here we are …..We have started these mass training programs across the network
of biggest employer for EM … the corporate hospitals. These students generate
high fees and income from an erstwhile Casualty now called an ED and also cost
way less because it is now operated by a Ring Master called a “Head”. The “Head”
Safe Guards his existence by showing this Operandi as a way of productivity for
the hospitals.
I
have previously discussed how holding conferences or awarding oneself also
helps preserve this “Mirage of Image” for these leaders towards the employers
and the young physicians who they want to mislead.
What
Happens to these graduates once they gets their Diplomas, Masters Etc. The job
market is congested with leaders/ Heads or will soon get congested with these
pseudo courses. This is because the so called EM Leaders have fed an easier money
making option to the employers. There
are no jobs and if there are any, they are low paying like even less than
1,00,000 per month with an expectation that in return for the title of the “Head”
you are expected to run the the Operandi of Training which is become a Norm
across the Private Hospitals in India.
It’s
a vicious Cycle.
You do what you
are taught and what you learn, you learn wrong, you do wrong. The people who do
wrong believe that they are right and that’s why they do it !
The
Premise “INDIA NEEDS EMERGENCY PHYSICIANS” is correct!
Well
India needs Nephrologists, Cardiologists too. Why don’t we pick up all MD
Medicine Doctors who know how to do Dialysis and give them a DM/DNB in
Nephrology and so also all those who practice Diabetology a DM/DNB in
Endocrinology. This cannot happen as every specialty has to evolve and that too
with the evolution of healthcare services. By giving a viable option of cheap
labor money generating non accredited training program to the largest employer
of the specialty of EM, the growth of EM and the academic advantage to
Emergency Physicians is gone with the wind.
So
what are the options?
Critical
Care is the only one which is viable.
Today
Critical Care has been able to safe guard the job & Salary economics for
its constituents, thanks to the structured growth of this specialty in India. CCM
and its structured growth is in a way one of the deterrents to growth of EM
because all that is expected from the EP is wheel the patient to critical care.
The hospital makes more money if patient lies critical in the critical care
unit rather than be stabilized in the ED.
This
has given rise to idea that Emergency Physicians can handle critical care or
rather emergency physicians are critical care physicians anyways. These
students are made to believe that they are getting an Post Graduation in Critical Care with
a Title of EM.
Critical
Care is a vast, labor intensive, high knowledge specialty which needs intense
training. When you go to a CCM Meeting you realize the different sub specialties
in CCM from Neuro to post-surgical critical care, trauma critical care,
toxicology critical care etc.
In
India Specialties like anesthesia, chest medicine and internal medicine have
made inroads into CCM. Physicians who have training in CCM even today work hard
to gain knowledge and very few boast that they know all the sub specialties in
CCM well.
I
have heard EM Leaders make callous statements like “what do critical care guys
do ?” “Just give inotropes, antibiotics and monitor outputs from GI GU and feed
via NG Tube/Peg Tube”
This
is wrong and a total disregard for a specialty which is so crucial to
healthcare. CCM Experts do much more and
definitely know tons more than emergency physicians. EM Physicians are expected
to be trained in handling all emergencies. In India they are definitely not trained
in Peads EM. They can arrogantly boast
and lie to themselves and others but fact is they are not trained…that’s the
truth. When these misguiding leaders continue to misguide these young physicians
that CCM is EM and EM & CCM are one specialty…..
I would call upon CCM Specialist to be cautious. There may be chance that Rogue
Mafia will now invade CCM Centers with a Cheap Labor Hiring Operandi like they
have done in EM.
There is a big myth being floated to start
EICU (Emergency ICU) so that money can be generated by labelling an area in ED
and calling it an ICU. I have confirmed news that these model has started.
I
would call upon CCM to safe guard its specialty by cracking down on these
rogues. There are many failed Intensivists who have found home in Emergency
Medicine. Their hospitals have given them leadership positions to head their Casualties
where they too run the Training Operandi.
They
need industry support to run these marketing campaigns like Conferences and
Award Syndicate. The money is in Critical Care, so guess what……start floating the
idea that EM and CCM is one…start training programs to match this myth and
encourage graduates to work in CC Units and make CCM their future. Even
conferences on EM in India now have partnerships and sessions on Critical Care….
A step to infiltrate a Structured Specialty.
In
all these mess……We forgot why we were here…, we were here to provide EM Care to
our patients, we started this specialty when CCM was already in existence and
now we are coming a full circle to say EM is same as CCM. Yes Emergency
Physicians can undergo more training (up to 3 Years) to gain adequate knowledge
to staff a CCM Unit but to lead a CCM Unit it will be years. CCM is vast and a
lot needs to be learnt. It is the same way Now days Heads of EM are appointed
as soon as they confirm that they can operate the modus operandi ….and they
always know CCM is there to back them up…
I urge my
fellow interested youngsters to question all those who offer to guide them,
check their credentials, ask around, talk to different people, explore whether
you will have a good job career, don’t get emotional, you have worked too hard
to be misguided by a few who are there because their job Is to generate cheap
labor and safe guard their positions……
I want all who read my blog to understand that speaking the truth, hearing the truth and accepting the truth is better than to live in a False Reality....there will always be an explanation and a perspective.... the fact is ... is that perspective REAL ?
I believe in the truth and if its the truth.... its Real...I do not deter but I just speak it out !
The future is better when the present is good….and when it involves many then a few cannot reap its fruits…and if few are reaping its fruits …… many are not getting and will not be getting what they deserve……..That’s oppression by false motivation….
I believe in the truth and if its the truth.... its Real...I do not deter but I just speak it out !
The future is better when the present is good….and when it involves many then a few cannot reap its fruits…and if few are reaping its fruits …… many are not getting and will not be getting what they deserve……..That’s oppression by false motivation….
Till then the patient continues to seek Emergency Care……..expecting
the best, trusting what is being handed
out…..well there is always Critical Care to back the ED anyways !