If there is one branch of medicine that requires more skill than most others, it is paediatrics. Besides the usual medical knowledge, a paediatrician, or a child specialist, must also gently handle young patients, some of whom are not even old enough to speak.
The ideal paediatrician, says Dr KK Kalra, medical superintendent at Chacha Nehru Bal Chikitsalaya, New Delhi, “understands children and loves them, is a keen observer, dedicated, and listens to parents with patience. S/he is playful with children, full of humour, and treats them with empathy.”
In the West, a paediatrician treats children up to the age of 18; in India, the age ceiling is 14. There is one noticeable gap in a paediatrics student’s education in this country, says Dr Kalra. “The study programme in India does not take care of the (children’s) socio-psychological aspect fully. This is taught in more detail in the West.”
Paediatricians are in great demand — Dr Kalra rates it among the top five or so medical disciplines in terms of work opportunity. Most multi-speciality hospitals these days have a paediatrics department. “Now, exclusive paediatric hospitals for treating all types of medical and surgical cases are opening around India,” he adds.
Almost 17,000 doctors are enrolled with the Indian Academy of Paediatrics, and nearly 1,400 paediatricians are produced annually. But more are needed, “almost three times as many”.
For independent practice, “typically, six to seven years of work after MBBS is required”, says Dr Kalra. This includes a stint in a state or a private hospital.
To be a doctor of medicine in paediatrics, one needs an MD degree after MBBS. But paediatric surgery is a super-specialisation. Earning an MS degree following MBBS makes one a general surgeon. Three years’ further training makes one a paediatric surgeon. “It is a complex branch, as every organ (in a child’s body) is in miniature and it is an art performing surgery with the tiny instruments,” says Dr Rajiv Chhabra, consultant paediatric and neonatal intensivist, Artemis Health Institute, Gurgaon.
A big part of the job is also psychological. “Kids are far more intelligent than what we think. Therefore, they should be advised (on their health) as one would advise an adult,” says Dr Chhabra.
And children should be told if they are sick. “Children have every right to know about the disease and the treatment,” states Dr Chhabra. “It affects the psyche of a child if he comes to know that his well-wishers have been lying to him. It is definitely a good practice to let them know what a doctor is planning to do.”
What’s it about?
A paediatrician can be a doctor of medicine or a surgeon, treating children up to the age of 14. Paediatric surgery is a super-specialisation, and it needs extraordinary skill, as patients can be as young as newborns with tiny organs that can only be operated on with equally small surgical instruments. A paediatrician needs to work on young patients’ minds as well — winning their trust, getting them to understand that they are unwell and need to follow the doctor’s advice, encouraging them to talk about the symptoms, etc. A qualified doctor can work in a state or private hospital for a few years before setting up independent practice, which is fairly easy to establish
Clock Work
A typical day for a middle/senior level pediatrician could be like this:
9 am: Reach hospital/private clinic
9.30 am: Start seeing children in outpatients department or speciality clinic
12.30 pm: Lunch
1 pm: See patients admitted to hospital or those coming to the clinic
4 pm: Spend an hour going through latest research in medical journals
5 pm: Do some tele-consultation
6 pm: Take some emergency calls/go on visits
8 pm: Finish for the day
A paediatrician who is a teacher spends about an hour daily on training fellow juniors
{{/usCountry}}A paediatrician who is a teacher spends about an hour daily on training fellow juniors
{{/usCountry}}The Payoff
In the government sector, the pay per month is about Rs 50,000 (beginner); Rs 60,000 (middle-level); and Rs 1 lakh (senior). In the private sector, the corresponding packages are Rs 35,000-40,000; Rs 60,000-Rs 1 lakh; and Rs 1 lakh to 5 lakh. In private practice, a doctor’s earning depends on his reputation
Skills
. Love for kids and understanding of their behaviour
. Good listening skills and keen observation
. A playful manner around children
. A big reserve of patience
How do i get there?
Take science with biology in Plus Two. After finishing school, take the written entrance test (state- or institute-specific) to enrol for MBBS at a medical college that is well-known for paediatrics. These are usually centres of excellence in other fields as well. Certain medical colleges overseas are considered good if someone were to practise abroad. Becoming a paediatric surgeon means three years of extra training after becoming a general surgeon. This amounts to six years’ study after MBBS
Pros & Cons
. Fairly good pay from the start and easy to establish practice
. A very satisfying job if you like children
. Greater than usual risks if the patients are very young
. Parents may panic often, resulting in many emergency calls
Institutes & urls
In India
. Postgraduate Institute of Medical Education & Research, Chandigarh
http://pgimer.nic.in
. All India Institute of Medical Sciences, Delhi
www.aiims.edu
. Maulana Azad Medical College, Delhi
www.mamc.ac.in
. Lady Hardinge Medical College, Delhi
www.du.ac.in
. Christian Medical College Vellore
http://home.cmcvellore.ac.in
. Institute of Child Health, Chennai
. Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry
www.jipmer.eduhttp://ich.tn.nic.in
. BJ Wadia Hospital for Children, Parel, Mumbai
No website
In Britain
. Great Ormond Street Hospital for Children
www.ich.ucl.ac.uk
In North America
. Children’s Hospital Boston
www.childrenshospital.org
. Children’s Hospital of Michigan
www.childrensdmc.org
. Massachusetts Hospital
http://www.mgh.harvard.edu
. Children’s Hospital of Philadelphia
www.chop.edu
. Hospital for Sick Children, Toronto, Canada
www.sickkids.ca
In Australia
. Royal Children’s Hospital, Melbourne, Australia
www.rch.org.au
. Westmead Children’s Hospital, Sydney, Australia
www.chw.edu.au
. The University of Western Australia School of Paediatrics and Child Health
www.paediatrics.uwa.edu.au
You get established quite early on
A senior doctor talks about this discipline
What is the overall scenario in paediatrics in India?
There is a demand-supply gap as far as paediatrics is concerned. That is why we have one of the highest infant mortality rates in the world. One must also note that paediatrics is a branch of medical science that is driven by passion rather than financial rewards.
A paediatrician gets established early on because there are not many super-specialities at this stage in India.
What advice do you have for aspiring pediatricians?
As with any other branch of medicine, one should be hard-working, passionate about the subject. It is a rewarding branch in terms of job satisfaction. But it also requires a lot of patience as (very small) children can only express themselves by crying.
As for career opportunities, the super-speciality at this stage is neonatology, paediatric intensive care. If someone wants to do super-specialisation in other branches, then they have to do DNB courses or be part of an adult training programme or do these courses outside India where fellowship programmes are available — places like the US, UK, Australia and Canada.
How do you interact with very young patients?
A doctor must have a very keen eye for observing symptoms. Talk to a child as you would talk to an adult. Most of the diseases nowadays are lifestyle-related, and if a child is guided towards healthy habits, s/he will follow that always.
Dr Rajiv Chhabra, consultant paediatrician and neonatal intensivist, Artemis Health Institute, Gurgaon Interviewed by Sanchita Guha