Mradul Varshney

My Notebook !!
It is said that Hunter's moon is one of the brightest moon, when the moon appears larger and more orange. Here is my attempt to capture on my phone.

It was a cloudy day here.. 

And the clouds were hiding the moon. 

But eventually the moon came out of the clouds illuminating the clouds with it's brightness. 

Recently NBE or the National board of examination started a new post graduate diploma course , the Post MBBS diploma in eight subjects, namely Radio-diagnosis, Obstetrics and gynecology, Pediatrics, ENT, Ophthalmology, Respiratory Medicine, Family medicine and Anesthesia. NBE is also credited to run post graduate degree courses named DNB aka Diplomat of National Board in few private and government hospitals. These DNB hospitals are accredited by NBE itself and are our of the purview of MCI or recently known as NMC (National Medical Commission). 

Why start a diploma course?
In the last few years , we saw that MCI started converting all diploma courses run at various medical colleges to degree. The rationale being add one more year of training and you get a specialist doctor who can treat as well as teach. As per the norms , a diploma holder is not eligible for faculty position in medical educational institutes. 

But again NBE thought that start diploma again because we need more specialist doctors to cater to ever expanding Indian population. But why diploma?? Why not degree? It is may be because, NBE has set the minimum guideline to start a diploma course at any hospital at a significantly lower level than a regular post graduate degree course so as to accommodate almost all small hospitals in the list of eligible institutes where these diploma courses can be run. 
If you don't know, NMC has a certain guideline for institutes where a post graduate program can run. These guidelines are made to ensure enough patient load and variety of cases available at the hospital along with facility for treatment and specialists to treat such cases, so that a post graduate trainee can acquire sufficient skills to manage cases once he completes the training. Unfortunately the hospitals which are selected for these diploma courses, lack all the infrastructure and facility for a post graduate training.
So is it good to have these diploma courses?

It is good on one hand that we will get more specialist doctors to cater to the rural population. But my main concern is training at these centers. The centers which are selected for the diploma courses are mainly the district hospitals of the tier 2 cities. These district hospitals have been running to cater mainly to OPD patients and less critical indoor patients. These hospitals refer more critical patients to nearby medical college hospitals or other tertiary care hospitals. So to say, these hospitals work as referal centers for CHCs and PHCs and cater to mostly less critical patients only. Similarly these hospitals lack equipment and infrastructure too. Many investigations and superspeciality departments are not available in these hospitals. Medical science needs working together and many sick patients need higher investigations or reference to some super specialty department. There is also lack of proper teaching faculty in these hospitals, as these hospitals are mainly run by medical officers. 

So few questions still remain to be answered. 
Is it sensible to make specialist doctors with incomplete training?
Will these doctors, able to handle cases in periphery better than a MBBS doctor and the refer rate will decrease ?

Traditionally Doctors are not considered Entrepreneurs in classical sense and usually medicine is considered an all occupying work and hardly leaves any space for anything else. Several factors can be thought to contribute to this perception. To start with the usual impression of a medico in society in general is someone who is risk averse and deals with facts rather than imagination. While as an entrepreneur you need to have that rebellious, risk taking instinct along with an ability to foresee, the so called vision.


All this while Healthcare was filled with gaps in delivery and challenges, while so called traditional managers and investors are usually naive to the deep healthcare centric problems. This has lead to the change in the Doctor’s mindset in last few years. Now we see more and more Doctor’s rising to the opportunity and utilizing their innate skills of medicine and capability to work under stress. Rise of the Doctor-Preneur is inevitable as we doctors see gaps in system which need to be addressed by someone from inside the system. Rise in IT sector specially ecommerce and virtual reality now attracts young Doctors to look for parallel models in healthcare. Telemedicine, role of wearables, electronic health records, social networks, tele-education, ePrescribing, Practise management; list of IT applications being tried in healthcare appears endless.

Read this artcle written by Dr. Sumer Sethi on his blob: Doctors and Entrepreneurship - Sumer's Radiology Blog

Rural healthcare in India has been a real concern, still in 2017. Due to many reasons, government has failed to implement proper healthcare facility in most of the rural areas. Doctors always become the easy target whenever there is discussion about lack of healthcare facilities in rural India. Govt. and authorities quickly blames doctors that they don’t want to work in villages and bla bla. 
In india around 50000 doctors graduate every year and at least 30% are from rural areas themselves. The irony is even doctors originally from rural India doesn’t want to work in villages for long time, so there must be some reason why this is happening. Most Medical Officers either stop attending the PHC/CHC or leave the job altogether. 
After working in periphery for few months and talking to many doctors who are working and trying to work in villages i found out that many doctors are willing to work in villages and also start working there but due to a number of factors they lose interest in continue working in villages. The reasons are numerous but i tried to list a few most contributing.
Read full post at: Why doctors lose interest in working in villages? – Medico's Space