What Next after Anesthesia PG?

Why have I chosen an Anaesthesia specialty?

I am a second-year MD anaesthesiology resident. I don’t have too many answers on why I chose this branch of drugs. I have always followed my father like most other kids. My father is a practicing pain physician who did his MD in Anaesthesia, a university topper, who left his successful Anaesthesia practice to return to the pain specialty. So, without having a reconsideration, I also have chosen Anaesthesia.

What made my batchmates to choose Anaesthesia?

But once I asked this question to my batchmates, and they had different answers. Some said that they didn’t got other options in the other clinical subjects in good medical colleges; some said that getting employment would be very easy; some answered that one doesn’t have direct responsibility of the patient after perioperative period. But not so surprisingly, none of them took up anaesthesia as a gateway to the specialty of pain management like me.

How much chronic pain management is emphasized on MD Anaesthesia course?

During my anaesthesia study once I went through the syllabus, I used to be surprised to return across tons of topics of pain management in our curriculum. In my medical college there’s a successful pain clinic, but not so in many medical colleges. Once I talked with my colleagues at other medical colleges, I could understand that pain management, particularly chronic pain management isn’t focused much on the bulk of the medical colleges.

I conducted a web survey amongst practicing pain physicians. there have been 75 responders. one among my questions was; ‘Did you receive any training regarding treatment of chronic pain during post-graduation?’ Only 13.3% of 75 respondents were exposed to a totally functioning pain clinic.

What might be the reasons?

The possible causes are:

  • Excessive work pressure of operative cases. Faculties are engaged in operative cases.
  • Critical care cases are the foremost challenge. We can’t keep them waiting and it’s our first priority to attend to a serious patient than a chronic pain patient who can wait.
  • Proper infrastructure, equipment, and trained faculties are only a couple of in numbers to show pain management to postgraduate students.
  • Promotion of this specialty by the hospital authority is lacking.

What next after MD Anaesthesia?

When asked, the majority of my batchmates were curious about continuing practicing core anesthesia in surgeries. Some opted for tougher super-specialties like neuro or cardiac anaesthesia. Some were curious about labour analgesia, but none talked about chronic pain management.

Why consider pain management after completing anaesthesia residency?

What are the benefits and drawbacks of pain management as a super-specialty compared to other subjects? I took interviews of some important personalities in pain management in India.

I asked this question to Prof Dipasri Bhattacharya, Head of the Department of Anaesthesia, Critical Care & Pain Management at R G Kar Medical College. She runs a bustling & fully functioning pain clinic since 2011, where a couple of hundred patients are treated at the outpatient department on each working day. I asked her, ‘What are the benefits of joining Pain Management after Post Graduation?’ She answered, ‘Pain management is an independent specialty. It doesn’t involve emergencies. It gives the enjoyment of getting an immediate interaction with patients. And most significantly, it’s an upcoming branch with tons of avenues for research.’

I talked with our honorary secretary of the Indian Society of Anaesthesiologists (ISA), Dr. Naveen Malhotra, and asked an similar question to him. He answered and clarified that the management of chronic pain is an integral part of the MD anaesthesia curriculum. He told, ‘The MCI revised current PG curriculum and included Pain Medicine and Critical Care, and clearly states that a PG student should have a transparent understanding of the pathophysiology of Chronic Pain, the pharmacotherapy and interventions within the management of chronic pain. Colleges should make sure that Students spend enough time in pain clinics which has dedicated faculties of pain, has case presentations in chronic pain management. The onus is on the HOD, that they ought to make sure that there should be a correct functioning pain clinic and PG students should be posted there towards the top of the second year or within the final year of residency. Pain management may be a service to mankind and may be a primary responsibility of the Anaesthesiologist to supply pain relief.’

Dr. M.D. Joshi, president of ISA almost echoed an equivalent. He emphasized that the MD Anaesthesia curriculum empowers an anaesthesiologist to practice most pain interventions and management of chronic pain is an integral part of MD.

Indian Society for Study of Pain, an Indian chapter of the International Association for Study of Pain is that the most vital pain society within the country with about 3000 members. Recently it’s started its academic wing named the Indian Academy of Pain Medicine (IAPM) and began a fellowship course at 11 pain clinics within the country. IAPM conducts the exit exam and Dr. Khaja Javed Khan was the topper of the last exit exam of IAPM in Jan 2020. I had the chance to talk with him. Dr. Khan said, “I decided to travel ahead during this field immediately after I completed my MD. I got the chance to review at DARADIA Pain Clinic & Hospital for my pain fellowship. I got excellent exposure, training, and insight into this subject for one year. I secured the highest marks in FIAPM exit exam and received a trophy. it had been a difficult decision, but I left core anaesthesia practice.’ Dr. Khan ensured that he was delighted to be a full-time pain doctor.

I also talked with Dr Ipsita Chattopadhay, a current pain fellow at RG Kar Medical College, Kolkata. She said that each MD student must think these seriously; that you simply can have their own individual & independent practice, work-life balance, varied and interesting work, challenging pain interventions & scope of researches.

Dr Karthic Babu N, chairman of the Indian section of World Institute of pain said that this branch may be a challenging clinical branch and a pain doctor enjoys the liberty of treating patients independently and obtain social recognition. Also, unlike core anaesthesia practice, emergencies aren’t there.

Dr Pankaj Surange, honorary secretary of Indian Society for Study of Pain stressed the purpose that it’s an alternative, very promising, and upcoming branch where there are tons of opportunities to try to do something new. Moreover, like others, he too emphasized that it gives the chance of non-dependant practice.

In my survey that I conducted among 75 pain physicians, I had similar responses. 62.7% of respondents have chosen this specialty because it’s an office-based individual practice, not dependant on surgeons or hospitals. 61.3% loved this specialty because it’s a new upcoming branch with an enormous scope of doing new researches. 52% feel that there’s an immediate appreciation of my diligence in pain practice which is totally lacking in anaesthesia practice.

How to increase awareness of pain management? I asked this question in my survey. 60% answered, ‘Pain clinic at medical colleges must be properly functioning with surprise visits from the upper authority.’ Another essential answer to the present question was, ‘Organizing more classes, workshops, and seminars in chronic pain management in medical colleges.’

So, most seniors agree that practicing pain management is one of the foremost, important and promising options after passing MD Anaesthesia. Doing a one-year fellowship on pain management after MD in Anaesthesia was the foremost important decision of Dr Javed’s career. Recently DNB board has also recognized the specialty and shortly FNB in pain medicine also will be started. But more awareness of this specialty is required.

Interesting facts:

In an interview among pain physicians, 13.3% of 75 respondents told that they were exposed to a totally functioning pain clinic during their post-graduate training.

All others pain physicians joined pain management fellowship programs privately after MD anesthesia.

“Management of chronic pain is an integral part of MD anaesthesia curriculum..” Honorary secretary of the Indian Society of Anaesthesiologists (ISA), Dr. Naveen Malhotra

Other facts:

62.7% of pain doctors have chosen this specialty because it is an office-based individual practice not dependant on surgeons.

61.3% loved this specialty because it is a new upcoming branch with a huge scope of doing new works.

52% feel that there is a direct appreciation from patients after pain relief which is lacking in anaesthesia practice.