Being a Pediatric Cardiologist in India – A clarion call

It started with an anonymous email [Appendix 1] from an affected new-generation Indian pediatric cardiologist, which stimulated us to conduct a web-based survey[1] among the aspiring new entrants to pediatric cardiology in India. The survey was an eye-opener to the struggles and perceptions of the young generation of the pediatric cardiology community in India.[1] The accompanying editorial[2] detailed the possible causes and suggested solutions. The survey and the editorial resonate with most pediatric cardiologists in the country across generations and garnered more comprehensive discussion and comments on being a pediatric cardiologist in India. The amount of discussion through email and other social media platforms was overwhelming. In the current issue of the Annals of Pediatric Cardiology, we have a mini-symposium[3] addressing the issue with comments from some of the established and emerging leaders of the field. Dr. Tharakan gives beautiful insights into the history and evolution of the field of cardiology and pediatric cardiology in the country. Dr. Rajesh Sharma discusses the importance of handling the job crisis and training issues facing pediatric cardiac surgery and advocates for a holistic approach. The other authors highlight the challenges for the field, the potential reasons, and the prospects.[3] In the letter to the editor section, Zheleva and Rajasekhar[4] advocate for a refreshing health population-based policy approach to training pediatric cardiologists, intensivists, and pediatric cardiac surgeons. They suggest engagement with the state and central governments to develop health policies and plans that will address the needs of the patient population. We must understand the demographic trends and evolve a population health approach to create a specialized workforce and develop infrastructure and systems. In the other letter, Handa A[5] critically appraise the issue and offer different perspectives about why he chose pediatric cardiology in India, his expectations, and possible solutions to this complex issue. From the above discussions, it is clear that we should consider a new approach. Table 1 summarizes the actionable points for revamping the specialty in a resource-limited environment. Most actionable points need advocacy with the various state and central governments. The Pediatric Cardiac Society of India (PCSI) has established a task force for advocacy with government agencies, including the insurance regulator. However, it is time-consuming and requires perseverance. Other issues, such as reforming the curriculum and exit examination, may be initiated soon. Another significant focus should be on discouraging pediatric cardiac interventions from being done “everywhere by everyone.”[6,7] PCSI should propose appropriate guidelines for this. However, the most significant bottlenecks are creating pediatric cardiology centers in various states and ensuring an adequate number of people trained in pediatric cardiac surgery.[8] Some of the proposed actions are idealistic and may take time to implement. However, we need to put in a formidable effort collectively.Table 1: Suggested measures and actionable points to improve the standards and satisfaction of young pediatric cardiologists[ 2 ]“As a person acts, so he becomes in life. Those who do good become good; those who do harm become bad. Good deeds make one pure; bad deeds make one impure. You are what your deep, driving desire is. As your desire is, so is your will. As your will is, so is your deed. As your deed is, so is your destiny.” – Anonymous, The Upanishads It is really time for action now to redefine our destiny for the sake of millions of children born with congenital heart disease in India.