Dear Sir,
I read with interest the survey[1] and the accompanying editorial[2] concerning the plight of newer-generation specialists trained in Indian pediatric cardiology, which were published in the Annals of Pediatric Cardiology. I have summarized my thoughts as a fresh graduate of pediatric cardiology in India.
WHY PEDIATRIC CARDIOLOGY IN INDIA?
Passion over money
Most pediatricians who have chosen pediatric cardiology have done so because of their passion for this fascinating specialty. I believe no one has chosen the field for quick and easy money. Even newly graduated pediatricians get an excellent salary.
Love for pediatric cardiology
I knew many colleagues who were so passionate about pediatric cardiology, “AND THIS LOVE AFFAIR IS ADDICTING.”
CHALLENGES OF PEDIATRIC CARDIOLOGY TRAINEES IN INDIA?
Challenge over easy life
During the postgraduate period, the students usually have the least exposure to pediatric cardiology, except for a few apex institutes in our country. Even the knowledge of basic electrocardiogram and the general approach to congenital heart disease (CHD) is lacking during pediatric residency. Honestly, even senior pediatricians do not have an interest in or knowledge of pediatric cardiology, which is translated into their students. Just imagine preparing for a branch to which they are least exposed. Most have worked in pediatric cardiology centers for at least 1–2 years to crack the entrance examination. The major challenge starts after getting the Doctorate in Medicine (DM) seat in pediatric cardiology. In this vast sea of cardiology, students are trying to avoid being drowned and, at the same time, trying to swim against the tides. On the other hand, most pediatricians are well settled, usually within 5 years of passing their MD (Doctor of Medicine) Pediatrics.
Competition/interaction with cardiology fellows
With all due respect and no offense to anyone, all the cardiology fellows and post-DM fellows are interested in interventions like atrial septal defect device closure and patent ductus arteriosus device closure without contributing to the essential pediatric cardiology work such as wards, emergency, and outpatient services. This hampers the opportunity for pediatric cardiology fellows.
WHAT DO WE WANT AS PEDIATRIC CARDIOLOGY FELLOWS?
Equal recognition as senior resident cardiology
Cardiology fellows start doing temporary pacing and pericardiocentesis even during their first 6 months, while pediatric cardiology fellows have limited exposure. Even the consultants feel comfortable asking cardiology fellows to do these procedures in children. This even hampers the little opportunity that can be provided to pediatric cardiology fellows.
Permanent positions in academic institutions
The sad state of affairs is that even the apex institutes where high-quality work has been done for a long time do not have new posts for pediatric cardiologists.
Work on a temporary job-A triple-edged sword
Till he gets a permanent job, a pediatric cardiologist can work temporarily without job security even after completing DM. This is a triple-edged sword. On the one hand, they are getting trained. However, the downside is that a lack of job security affects the mindset after some time. Moreover, it affects the juniors’ opportunities.
Consider pediatric cardiology more than device closure
Most of the young cardiologists feel that pediatric cardiology is nothing more than device closures. This is the irony. Device closures are only one part of the pediatric cardiology. Pediatric cardiology is infact such an extensive and fascinating culmination of hemodynamics, anatomy and clinical findings.
HOW TO IMPROVE THE SITUATION?
Improve pediatric cardiology exposure during MD pediatrics: It should be made compulsory during MD. Most of the institutions do not have pediatric cardiology exposure. Their students should have at least 2 months of good training in academic institutes
Adequate posts in government and private institutions
Easy access to training in electrophysiology (EP) and fetal cardiology: Considering the usual challenges of pediatric cardiology, it is impossible to imagine a pediatric cardiologist spending 2 years on an EP/fetal cardiology fellowship. Short-term, regular 3–6 months of training in these specialties should be readily provided in India and abroad with the help of mentors
Indian Pediatric Cardiology League: Like Indian Premier League in cricket (IPL), which has revolutionized cricket in India, where even small players benefit in addition to big shots, the same scenario should be created in pediatric cardiology with the help of mentors and the government
Encourage pediatric cardiac surgeons: Pediatric cardiology and pediatric cardiac surgery go hand in hand. Few cardiac surgeons chose pediatric cardiac surgery as an option, considering the challenges of a long learning curve. Surgeons should be encouraged to select pediatric cardiac surgery as a career
Line needs to be drawn: Our country’s senior pediatric cardiologists are responsible for drawing a line between cardiology and pediatric cardiology. I do not know about the line level, but a line is necessary at some level
Create systems: There are many pediatric cardiac patients and pediatric cardiologists. A system should be created that benefits both. Setting up a pediatric cardiology care center and government insurance schemes could be a way forward.[3,4]
CONCLUSIONS
The seniors in our field are responsible for creating a system with the government’s help where passionate pediatric cardiology lovers get well-deserved and satisfying opportunities.
I dream that all pediatric cardiac patients get timely and appropriate treatment regardless of economic status. ERADICATE EISENMENGER SYNDROME. Moreover, pediatric cardiology would become the most preferred super-specialty.
Kehte hain agar kisi cheez ko dil SE chaho… to puri kainaat usse tumse milane ki koshish mein lag jaati hai.
THE SAME IS TRUE WITH ME AND PEDIATRIC CARDIOLOGY.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
I am indebted to my seniors and mentors who have taught me to remain afloat in this vast sea of pediatric cardiology and swim against high tides without drowning.
REFERENCES
- 1.Sachdeva S, Dhulipudi B. Current career perspective of pediatric cardiologists in India. Ann Pediatr Cardiol. 2023;16:201–3. doi: 10.4103/apc.apc_121_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
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