Transcript of "Career choice influences in Indian Anaesthesiologists"
Career choice influences in Indian anaesthetisiologists: A cross sectional survey Pravin Thorat1, *R.V.Shidhaye2 , Gourav Goel3, Arun K Gupta4 , D.S.Divekar5 Assistant Professor1, Resident3, Assistant Professor4, Professor and Head5 Dept. of Anaesthesiology, Rural Medical College, Loni, Professor2 Department of Anesthesiology and Critical Care, Pravara Institute of Medical Sciences, Loni India *Corresponding Author: firstname.lastname@example.org Key Words: anaesthesia, specialty, career, profession Background : Many factors influence the decision of a graduate to pursue his postgraduate studies. Method : A questionnaire was used to find out the career choice of the interns and the various practicing anaesthesiologists and their experience in this field. Results : It is shown that radiology (21%) is the first choice of postgraduate study. Practicing anaesthesiologists cite enthusiasm or commitment (50%) as their top reason for joining anaesthesiology as a postgraduate.IntroductionLarge number of factors, namely individual, the yesteryears, has widened its scope in hospitalfamilial, financial and social factors influence practice considerably in last two or three decades.undergraduate students in the selection of theirfuture career. In addition the unrealistic portrayal Clinical Anesthesiologists are experts in fields asof the medical profession in the present day diverse as intensive care, obstetrics, trauma,scenario of explosive information over the media, cardiopulmonary and airway management,sets in a complex pattern of motivation affecting perioperative patient care and both acute andtheir minds while entering medical schools. It is chronic pain management. In addition, individualknown that the medical graduates also rely on anaesthesiologists have involved themselves intheir own experience of the specialties as a areas such as research, administration andstudent to guide their career choice for teaching both at undergraduate and postgraduatepostgraduate studies1. Clinical specialties have level.always dominated the career choice for postgraduate studies. With the recent trend towards In fact recent estimates of UK Anesthesiologistsnuclear families in developing countries the career have shown that they are involved in the care ofof both earning members of the family has a about two-thirds of all patients admitted tosignificant impact on the family fabric hospital5. Despite these accomplishments,necessitating a swing towards pre and para recognition of the anesthesiologists’ vital role isclinical specialities for at least one member of the yet to be fully appreciated. Lack of recognition isfamily. The statement saying that selection of apparent not only from the general public and thespecialization is often undertaken with only the media, but also from surgical and nursingvaguest of long term career plans is probably no colleagues6-8. Another area of concern is the stresslonger true2. Major specialties tend to offer at work mainly related to lack of control, overgreater choices of place of work with greater working schedule, poor interpersonal professionalopportunities in more number of locations3, 4. relationship and increasing work overload9-11. In spite of these drawbacks it appears that recentThe specialty of Anesthesiology which was medical graduates are getting attracted toconfined primarily to the operating room (OR) in Anaesthesiology due to its wide scope of work. 43
Junior doctors are increasingly aware of the fact Interns from Rural medical college, Loni havethat Anesthesiology is one of the largest been considered to be a representative samplespecialties in the clinical workforce and that from all states of India because admissions toopportunities in it are considerable. Even for undergraduate and postgraduate studies at PIMS asenior doctors it is vital to stay abreast of deemed university is open to students from allemployment changes as the scope and nature of over the country after a competitive entrancework is changing rapidly. Increasing number of examination.female anaesthesiologists now opt for part timeworking, job sharing, and flexible working. Very Resultsfew studies on the choice of anaesthesia as a Response to questionnaire given to interns wascareer have been reported from developing hundred percent. Response to 200 questionnairescountries like Nigeria, Saudi Arabia, Sri Lanka given to the practicing anesthesiologists was 192and Pakistan12-15. (96 % response rate). This high response rate was due to the fact that questionnaires were given andThe aim of this present study is to look into the collected back personally.reasons for selection of Anaesthesiology as acareer vis-à-vis other specialties by budding Figure 1: First career choice of respondent internsdoctors during their internship training as well as for post graduationto peep into the perceptions of prospectiveanaesthesiologists entering the field and also learnfrom those who are already established in thefield, as to the limitations of this career choice tomake it more attractive in the days to come.Deliberating on the reasons put forward by theinterns and on the perceptions of prospectiveanaesthesiologists would help to suitably modifyundergraduate and postgraduate curricula to makethe specialty more competetive in comparing withother clinical specialities.Materials and methodsA questionnaire was given to MBBS medicalgraduates of Pravara Institute of Medical Sciences(PIMS) during their internship training, from Figure 2: Reason for selecting anaesthesiology asMarch 2006 to November 2007. A different a first career choice by respondentquestionnaire was given personally to practicing anaesthesiologistsanesthesiologists at National and State levelAnesthesiology conferences and CME with arequest to return them duly filled in, insisting thatit would only take a short time to complete it.Questionnaire to interns related to their first threechoices for post graduate studies and to find outthe reasons for opting for anaesthesia as a firstchoice by some of them. Practicinganesthesiologists were asked to mention reasonswhich contributed to their choice of anaesthesia asa career assuring all concerned that confidentialityand anonymity would be maintained. Respondentswere given a list of choices from which they hadto choose one or more. 44
1. Enthusiasm or commitment: what I really 9. It provides immediate gratification in ones want to do and be. (26% -50) work. 90%2. Self appraisal of own skills and aptitudes. 10. It enables the clinician to perform invasive (15% - 29) procedures. 54%3. Perceived working experience of jobs 11. There is little post operative liability. 10% undertaken so far. (6% - 11) 12. No need for any personal setup or clinic.4. Hours or working conditions. (5% - 10) 100%5. Experience of chosen subject as a student. 13. It is a career with immediate earning (10% - 19) potential. 90%6. Promotional prospects. (5% -10) 14. Satisfaction observed by interacting with7. Particular teacher or department. (4% - 8) other anesthesiologists. 54%8. Domestic circumstances. (4% - 8) 15. Fascination with the work in ICU and9. Inclination before medical school. (4% - 8) CCU’s. 72%10. Advice from others. (7% - 13) 16. No direct contact with the patient on O.P.D11. Future financial prospects. (20% - 39) basis. 72%12. Other reasons. (7% -13) 17. Any of your relatives is an anesthesiologist and you are influenced by their job. 37%Figure 3: Reasons for choosing anesthesiology 18. You are influenced by a particular teacher.as a career among interns 37% 19. You think that anaesthesia is a very easy Percentage wise distribution of Questions for Interns subject that just involves spinal and general anaesthesia and few short procedures. 54% 120% 20. You feel that the work is interesting and 100% 99% 98% stimulating and provides adequate level of 100% 90% 90% 90% responsibility. 81% R e s p o n s e in % a g e 81% 81% 80% 73%72% 72%72% 21. You feel that it is a dangerous and risky job. 18% 60% 54% 54% 54% 54% 45% 22. You are impressed by the work of an 37% 37% 37%37% 36% anaesthesiologist in the OT when you went 40% to see other surgeries. 99% 18% 18% 20% 10% 9% 23. You feel that life and death of a patient 0% depends on the anaesthesiologist. 36% 0% 24. You think that there is a marital disharmony 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 in the life of anesthesiologists. 18% Question Number 25. You feel that it is a thankless job. 9% 26. You think that the surgeon gets more importance as compared to an1. It involves the clinical application of anaesthesiologist. 98% Anatomy, Physiology and Pharmacology. 27. Other Reasons: 0% 81%2. There is adequate time off. 54% Table 1: Age and gender wise distribution of 3. There is diversity of training experience. practicing anaesthesiologists 45% Age wise Age in years No. of respondents distribution4. Prestige associated with the institution. 37% 25 to 34 135 ( 70 % )5. Interest developed during internship. 73% 35 to 44 36 ( 19 % )6. It is a profession with high value of 45 to 54 15 ( 8 %) satisfaction. 72% 55 to 64 4 ( 2 %) > 65 2 ( 1 %)7. The value of anesthesiologists is increasing Gender wise Males 104 ( 54 %) day by day. 90% distribution8. It’s easier to obtain a post graduation degree Females 88 ( 46 %) in this field. 37% 45
Discussion patients. But no association was found betweenSenior anaesthesiologists from UK have this perception of interns and their selection of thewitnessed a time in UK when there were not specialty as a career. According to 90% of internsenough applicants for anaesthesia training posts the demand and value of anaesthesiologists isand some Regional Health Authorities did not increasing day by day due to disproportionateadvertise new posts at the Senior Registrar level increase in the number of surgeons from differentbecause they were afraid that they would not be surgical fields as compared to the number offilled with suitable applicants16. Since that time, anaesthesiologists.things have changed substantially for the better. Safety of anaesthesia with modern anaestheticFrom the data assimilated, there appears to be a agents and drugs has not only increased but alsogeneral trend when assessed at both years 1 and 3 has provided the anaesthesiologists with greaterfollowing qualification that anaesthesia is control over the patients in pre, intra andbecoming more popular 16. There is a huge gap postoperative phase. After sucessful surgery thebetween need and supply of qualified anaesthesiologist is not bound to the patient andanaesthesiologists in India as well and all gets immediate gratification in majority of cases.presently practicing anaesthesiologists are This fact was realized by 90% of interns whooverworked. Shortage of anaesthesia practitioners considered immediate earning potential of thisin rural, tribal, hilly villages of India where nearly profession with a respectable income as a very60% of our citizens reside is much more acute. attractive proposition. 81% of interns wereReported figures from Government of India show attracted towards the specialty because of directshortage of nearly 6000 anaesthesiologists and clinical application of knowledge of anatomy,only 30% of the population has satisfactory access physiology and pharmacology and they felt thatto proper anaesthesia services of which 80% are the work was interesting and stimulatingurban beneficiaries 17. providing an adequate level of responsibility. 73% developed interests during internshipThe aim of this survey was to assess the indicating teaching during anaesthesia posting ofexpectations and perceptions of interns as well as internship was good. Even today there are someto find the reasons for selection of this speciality myths and ignorance regarding the specialty asand fulfillment of their desires of currently revealed by the fact that more than half the internspracticing anaesthesiologists about various thought anaesthesia is a very easy subject withaspects of the specialty. routine and repeated adminstration of the same drugs for spinal and general anaesthesia. 18 %In this study anaesthesiology as a career was thought that the profession is a dangerous andindicated by 11% interns and subjects like risky job dealing with all the medical emergenciesSurgery, Paediatrics, and Opthalmology were less arising unexpectedly at odd times and in situationsappealing. Main reason cited was minimal which are quite critical.monetary investment for setting up anaesthesiapractice where as specialities like Surgery, One of the reasons for not choosingMedicine, Gynaecology and Paediatrics need not anaesthesiology as a career is lack of recognition.only a huge initial investment but also have a Large number felt that it is a thankless job and thegreat competition from others already in the field key role of an anaesthesiologist is not appreciated.with uncertainity of good returns. Most interns Credit due to an anaesthesiologist for many good(99%) were very much impressed by jobs done is not given to him/her on manyanaesthesiologists work in operation theatre. An occasions. On the contrary he/she is blamed byanaesthesiologist is the team leader in the surgeons and others for untoward, unavoidableoperation theatre without whom the surgeon complications arising in operation theatre whichcannot commence the surgery. 98% of the interns are beyond his/her control. On occasions whenfelt that the surgeon gets greater importance as surgeries last for longer duration than expectedcompared to an anaesthesiologist by the patients and are performed at odd hours the workingbecause of the nature of the job and greater schedule of an anaesthesiologist gets totally upsetexposure of surgeon pre and post operatively to and becomes erratic. Anaesthesiologist may be 46
compelled to miss some important social anaesthesia technicians or assistants. These stepsgatherings and family functions, which at times will enhance the public image and create aleads to marital disharmony, stress and favorable public opinion of anaesthesiologists.psychosocial breakdown. In our study 9% felt that Utilization of the facilities of “information andit is a thankless job and 18% thought that there is technology” in publishing about anaesthesia,a great possibility for marital disharmony in the anaesthesia related problems and in givinglife of an anaesthesiologist. instruction in the management of disasters will go long way in raising the image of the speciality 17.The main reason cited for selection of thespeciality by practicing anaesthesiologists was To attract more and more students towards thisenthusiasm and commitment followed by good specialty, undergraduate teaching should be madefinancial prospects by 50(26%) and 39(20%) more interesting. Interns should get activelyrespectively. This is quite understandable at a involved in routine clinical work likeyounger age when one is bubbling with energy preanesthesia checkups, investigations,and looking forward to a safe comfortable future. preparation of the patients and actual anesthesiaEarlier studies have shown anaesthesilogists in techniques. Interns may be given the tasks ofgeneral have a “introvert” personality which is perioperative monitoring under constantreflected by 29 (15%) of anaesthesiologists who supervisions and they should be introduced toregarded self appraisal of own skills and aptitudes labour analgesia, chronic pain management andas their reason for taking up this career. Individual ICU procedures during their anaesthesia termself experience as a student was another important postings. A major step to reduce the shortage ofreason but factors like promotional prospects, anaesthesiologists will be to increase the numberinfluence by a teacher or a department, domestic of post graduate seats.circumstances, inclinations before medical schooland advice from others did not seem to have much From the lessons learnt from this study more andinfluence to choose this career. Turner et al 18 more budding doctors need to be attracted to thefound more than 50% of medical graduates specialty by increasing current popularity of theindicated enthusiasm/commitment and specialty which would help not only to overcomeanticipated hours /working conditions to have a the shortage but also attract talented younggreat deal of influence on career selection. doctors to a speciality with bright futureInclinations before medical school, domestic prospects.circumstances, influence of a particularteacher/department and future financial prospects It is felt that more multicentric studies on largerwere rated influential by less than 20 % of those numbers would help in drawing final conclusionschoosing anaesthesia. and taking suitable remedial measures.Raising the profile of the anaesthesiologist, both Referencesamong the public and fellow health professionals 1. Allen I. Doctors and their careers. London:is the responsibility of existing anaesthesiologists Policy Studies Institute, 1988.which should be considered as one of the top 2. Vaughan C. Career choices for generation X. BMJpriorities. Public awareness of anaesthesia 1995; 311:525-6.services and anaesthesiologists is far from 3. Nunn JF. Development of academic anaesthesia in the UK up to the end of 1998. Br J Anaesthesiasatisfactory even now. This is basically due to the 1999: 83: 916-32fault of anaesthesiologists in marketing 4. General Medical Council Education Committee.themselves. They should constantly try to make Recommendations on Basic Medical Education.the public aware of the importance of their work London: GMC, 1980by establishing pre anaesthesia clinics, patient 5. Simpson P. Possible realistic and practicalcounseling, pain clinics, and trauma and critical solutions to the problems of implementing thecare areas so that there is more exposure and European Working Time Directive (EWTD) inbetter patient contact. In addition they should 2004.promote paramedical courses for training http://www.rcoa.ac.uk/docs/solutionsewtd.pdf 47
6. Le May S, Dupuis G, Harel F, Taillefer M-C, 13. Famewo CE, Bodman RI: The choice of Dubé S, Hardy J-F. Clinimetric scale to measure anesthesia as a career by undergraduates in a Saudi surgeons satisfaction with anesthesia services. University. Middle East J Anesthesiol; 8: 179-85, Can J Anesth 2000; 47:398–405. 1985.7. Garcia-Sanchez MJ, Prieto-Cuellar M, Galdo- 14. Karalliedde LD, Senanayake N, Aluwhihare AP: Abadin JR, Palacio-Rod MA. Can we change the Attitudes of the 1984 Medical graduates of the Sri patients image of the anesthesiologist? Rev Esp Lanka to anaesthesia. Med Educ; 20: 60-63, 1986. Anestesiol Reanim 1996; 43: 204–7 15. Khan FA, Hamdani GA. Factors influencing the8. Hennessy N, Harrison DA, Aitkenhead AR. The choice of anesthesia as a career in a developing effect of the anaesthetists attire on patient country. Middle East J Anesthesiol. 2007; attitudes. The influence of dress on patient 19(1):149-57. perception of the anaesthetists prestige. 16. Editorial II. Careers in anaesthesia. 2005; 95 (3): Anaesthesia 1993; 48: 219–22. 284–69. Dickson DE. Stress (editorial).Anaesthesia 17. Presidential address – 2006. Indian J. Anaesth. 1996;51:523-4 2007; 51 (1) : 10 – 1210. Seeley HF. The practice of anaesthesia- a stresser 18. Turner G, Goldacre MJ, Lambert T, and Sear JW. for the middle-aged? Anaesthesia 1996; 51: 571-4 Career choices for anaesthesia: National surveys11. Kam PCA. Occupational stress in anaesthesia. of graduates of 1974-2002 from UK medical Anaesth Intensive Care 1997;25:686-90 schools. Br.J.Anaesth 2005 95:332-338.12. Akinyemi OO, Soyannwo AO: The choice of anaesthesia as a career by undergraduates in a developing country. Anaesthesia; 35: 712-15, 1980. 48