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Call from the heart

India requires a large number of cardiologists to contain a virtual epidemic of cardiovascular diseases afflicting two crore people. Rahat Bano reports.

education Updated: Aug 04, 2010 10:34 IST
Rahat Bano

India is not in the pinkest of health. A 2008 study in the British medical journal Lancet said India would have 60 per cent of the world’s heart disease cases by 2010. An estimated 70 million cases will make India the world’s cardiovascular disease capital by 2025. Cardiovascular diseases already cause nearly one-third of all deaths in the country.

Dr V K Bahl, professor and head, department of cardiology, All India Institute of Medical Sciences, says, “To take care of this large population of patients we require a very large number of well-trained cardiologists who can diagnose the disease, treat it medically and are well versed with latest innovations in interventional procedures.”

Cardiologists are the first port of call for most heart patients. They diagnose and decide whether the person requires an angioplasty and stenting (placing a small steel mesh-like structure in an artery) or surgery, for which s/he is referred to a cardiac surgeon. Earlier, all cardiac patients used to go under the knife — for bypass surgery. But now non-surgical solutions have come up. Then, cardiologists examined the patients, diagnosed the ailment and prescribed medicines (in line with their qualification - MD and DM). Now they perform non-surgical invasive procedures as well.

Says Dr Bahl, “With the widespread use of intervention procedures carried out percutaneously (non-surgically), the role of cardiologists has expanded tremendously as they now not only treat patients with medicines but also open narrowed and diseased coronary and other vessels, such as renal, carotid and peripheral vessels, with balloons and stents.” Cardiologists treat narrowed valves by balloons and can replace valves non-surgically. They treat disorders of cardiac rhythm by placing pacemakers and ablating abnormal pathways by radiofrequency ablation. (Ablation is a procedure done to cure the rhythm disorder of the heart). They can also treat various congenital diseases by putting devices to close holes present in the heart from birth.

Dr SS Bansal, the only cardiologist from India who was awarded a fellowship of USA’s Society for Cardiovascular Angiography Interventions in 2009, adds, “Now most cases can be handled by cardiologists due to the widespread availability of drug-coated stents, when the chances of recurrence are very low.” According to Dr Bansal, who is managing director, Metro Heart Institute, Faridabad, hardly 20 per cent of the cases now call for surgery. “Eighty-per cent of cases with blocked arteries can be handled by cardiologists.”

Opening up a blocked coronary artery by stents in the first few hours of chest pain due to a heart attack is “the most dramatic and life saving procedure carried out by cardiologists.” This makes them a saviour of millions worldwide. Do you have it in you to be one of them?

What's it about?
Cardiology is a branch of medicine which deals with diseases of the heart and vascular systems. The heart diseases include coronary artery disease, congenital heart defects, valvular heart disease, hypertension and cardiomyopathy. Cardiologists are different from cardiac (cardio-thoracic and cardio-vascular) surgeons in that they don’t perform surgery. However, today, cardiologists carry out various non-surgical invasive procedures as well

Clock Work
A cardiologist’s average workday at AIIMS:
8 am: Academic session
9 am: Go for a round to see patients in the wards. Perform diagnostic and interventional procedures like echocardiography or angioplasty
1.30 pm: Grab a quick bite for lunch
2-7 pm: Work in the out-patient clinic - general cardiology and specialist clinic like pacemaker, hypertension and heart failure
7 pm: Evening round for admitted patients and those who have undergone various therapeutic procedures
8 pm: Read journals to keep abreast of recent advances in the field.
In teaching institutes, they also guide research projects

The Payoff
In the government sector, the salary is as per fixed pay-scales. In the private sector (which accounts for 80 per cent of healthcare in India) in Delhi/NCR, a fresh DM in cardiology can make about Rs 1.5 lakh a month while the top-most cardiologists’ pay packages range from Rs 1 crore to Rs 2 crore per annum

Skills
. A very caring and positive attitude
. Dedication to this demanding profession
. Good inter-personal skills to deal with patients as well as their families
. Willingness and capacity to digest large amounts of knowledge and keep learning

How do i get there?
. Opt for science (physics, chemistry and biology) at the plus-two level
. Do an MBBS programme (four-and-a-half-year) plus compulsory one-year internship training
. Three years as junior resident in internal medicine to qualify as MD (internal medicine)
. Go for a three-year DM programme or even the DNB in cardiology and you become a cardiologist

Institutes & urls
.
All India Institute of Medical Sciences, New Delhi
www.aiims.edu
. GB Pant Hospital, New Delhi
http://health.delhigovt.nic.in/Hospitals/GBP/default.html
. Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
www.sgpgi.ac.in
. Christian Medical College, Vellore
www.home.cmcvellore.ac.in
. Sree Chitra Institute of Medical Sciences & Technology, Thiruvananthapuram
www.sctimst.ac.in
. Postgraduate Institute of Medical Education and Research, Chandigarh
http://pgimer.nic.in

Pros & Cons


.

Immensely satisfying work — life-saving nature of work earns you loads of respect in society


.

Top cardiologists in the private sector rake in big money


.

Takes several years to become a cardiologist and then you have to update your knowledge and train yourself continually in life


.

You have to be on call 24 hours a day


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Demanding, long hours, especially in large teaching hospitals

We need a large number of cardiologists

A senior cardiologist talks about the current scenario

What’s the heart disease scenario in India?
India is a vast country of a billion-plus people of diverse religions, cultures, castes, languages, social strata etc. And as if to replicate this diversity, we have a whole gamut of cardiovascular disorders afflicting our country. Today, we find ourselves in the midst of a large cardiovascular epidemic. With 32 million affected persons, we are already the diabetic capital of the world. By 2025, with an estimated 70 million cases, we will have the unfortunate distinction of being the cardiovascular disease (CVD) capital of the world as well. Even today, CVDs account for 29 per cent of all deaths in India. By 2015, the estimated loss to our national income from CVD is projected to rise to $54 billion. In addition, rheumatic heart disease is still rampant and continues to strike the young in their most productive years. Our ever-increasing population base has ensured a large burden of congenital heart disease cases as well.

What’s the demand and supply of cardiologists in India? How many cardiologists per, say, 1,000 heart patients, do we have in India? What’s the ideal ratio?
To take care of this large population of patients we require a very large number of well-trained cardiologists who not only can diagnose the disease, treat it medically but are also well-versed in the latest innovations in interventional procedures. Every year, about 27,000 doctors graduate from Indian medical colleges. But, more than 75 per cent of Indian doctors are based in cities, whereas about 70 per cent of patients in the country are village-based. According to government of India figures, the doctor-population ratio was a sparse 1:1722 in 2005. As far as super-specialisation is concerned, the situation is grimmer — we are still far away from achieving the ideal patient-doctor population ratio in India.

What does it take to succeed as a cardiologist?
No doubt you have to be well-qualified and trained from a reputable institute to succeed as a cardiologist as is true for any professional. The field of cardiology is challenging to the extent that now even amongst cardiologists there are cardiology specialists — interventional cardiologists (treat coronary and other heart disease percutaneously by balloons and stents), non-invasive cardiologists (have skills and training in diagnostic procedures like echocardiography), paediatric cardiologists (specialise in congenital heart disease), electrophysiologists (manage heart rhythm disorders by pacemakers, devices and radiofrequency ablations).
But more important is being a passionate, caring and honest human being.

Dr V K Bahl Interviewed by Rahat Bano