What next after anaesthesia degree?

Why have I chosen an Anaesthesia specialty?

I am a second-year MD anaesthesiology resident. I do not have too many answers as to why I chose this branch of Medicine. I have always looked up to 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 come to the pain specialty. So, without having a second thought, I have chosen Anaesthesia.

What made by batchmates chose Anaesthesia?

But when I asked my batchmates, they had different answers. Some said that they did not have other options in any other clinical subjects in good medical colleges; some said that getting a job would be very easy; some answered that one does not 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 focused on MD Anaesthesia course?

During my anaesthesia study when I went through the syllabus, I was surprised to come across a lot of topics of pain management in our curriculum. In my medical college there is a successful pain clinic, but not so in many medical colleges. When I talked with my colleagues at other medical colleges, I could understand that pain management, particularly chronic pain management is not focused much on the majority of the medical colleges.

I conducted an online survey amongst practicing pain physicians. There were 75 responders. One of my questions was; ‘Did you receive any training regarding treatment of chronic pain during post-graduation?’ Only 13.3% of 75respondents were exposed to a fully functioning pain clinic.

What could be the reasons?

The possible causes are:

1. Excessive work pressure of operative cases. Faculties are engaged in operative cases.
2. Critical care cases are the most challenging. We can’t keep them waiting and it is our first priority to attend a serious patient than a patient of chronic pain who can wait.
3. Proper infrastructure, equipment and trained faculties are only a few in numbers to teach pain management to postgraduate students.
4. Promotion of this specialty by the hospital authority is lacking. 

What next after MD Anaesthesia?

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

Why think of pain management after completing anaesthesia residency?

What are the advantages and disadvantages of pain-management as 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 few hundred patients are treated at the outpatient department on each working day. I asked her, ‘What are the advantages of joining Pain Management after Post Graduation?’ She answered, ‘Pain management is an independent specialty. It does not involve emergencies. It gives the joy of having a direct interaction with patients. And most importantly, it is an upcoming branch with a lot of avenues for research.’

I talked with our honorary secretary of the Indian Society of Anaesthesiologists (ISA), Dr. Naveen Malhotra, and asked the same question to him. He answered and clarified that the management of chronic pain is an integral part of 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 clear understanding of the pathophysiology of Chronic Pain, the pharmacotherapy and interventions in the management of chronic pain. Colleges should ensure 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 should ensure that there should be a proper functioning pain clinic and PG students should be posted there towards the end of the second year or in the final year of residency. Pain management is a service to mankind and is a primary responsibility of the Anaesthesiologist to provide pain relief.’

Dr. M.D. Joshi, president of ISA almost echoed the same. 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 the most significant pain society in the country with about 3000 members. Recently it has started its academic wing named Indian Academy of Pain Medicine (IAPM) and started a fellowship course at 11 pain clinics in the country. IAPM conducts the exit exam and Dr. Khaja Javed Khan was the topper of last exit exam of IAPM in Jan 2020. I had the opportunity to speak with him. Dr. Khan said, “I decided to go ahead in this field immediately after I completed my MD. I got the opportunity to study 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 all India FIAPM exit exam and received a Gold Medal. It was 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 all MD students must think these seriously; that you 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 is a challenging clinical branch and a pain doctor enjoys the freedom of treating patients independently and get social recognition. Also, unlike core anaesthesia practice emergencies are not there.

Dr Pankaj Surange, honorary secretary of Indian Society for Study of Pain stressed the point that it is a new, very promising, and upcoming branch where there are a lot of opportunities to do something new. Moreover, like others he too emphasized that it gives the opportunity of non-dependant practice.

In my survey that I conducted among 75 pain physicians, I had similar responses. 62.7% respondents have chosen this specialty because it is an office-based individual practice not dependant on surgeons or hospitals. 61.3% loved this specialty because it is a new upcoming branch with a huge scope of doing new researches. 52% feel that there is a direct appreciation of my hard work in pain practice which is completely 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 higher authority.’ Another essential answer to this 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 most important and promising options after passing MD Anaesthesia. Doing a one-year fellowship on pain management after MD in Anaesthesia was the most important decision of Dr Javed’s career. Recently DNB board has also recognized the specialty and soon FNB in pain medicine will also be started. But more awareness of this specialty is needed.