Medical Education Medical Practice

The Great Indian Fellowship Scam

Author: Dr Deepthi N.S.

“There will be no formal hands on surgical training, however during this time you will be allowed to perform some steps under supervision” – this is an excerpt from a very reputed institute offering a post graduate fellowship programme to young doctors. There are many things wrong with this statement. Firstly a post-graduate fellowship programme is and should always be about hands-on training and not merely “observation” and “assistance” during surgeries. With the “observation” and “assistance” having already been completed during the post graduate training any sensible senior doctor would agree that Fellowship is about acquiring the much coveted skills and not merely being a spectator. The current trend in training makes one wonder what the future holds when these senior surgeons themselves would require life-saving procedures and the current batch of young doctors would then be in a position to only “observe”.

In a country with 0.7 doctors for every 1000 patients (WHO standards requiring 1 doctor to every 1000 patients), with their career graphs kept at a negative slope by the so called premier institutions’ training programmes, when can this young post graduate doctor be expected to practice independently ?

“In the event of the candidate leaving the course by discountenance or otherwise and thus failing to complete course- 1) The fee paid by the candidate will not be refunded and 2) The stipend drawn by the candidate from the institute during the period of the fellowship programme is to be paid to the institute”- reads yet another shocking extract from another premier institute’s online website. Is this a fair deal being offered to the candidate considering most fellowship trainees will be in their 30s with families to support and might encounter unforeseeable circumstances? The stipend, would come as no surprise to you falls into the lower middle class bracket, and in no way can keep the family afloat, considering most trainees move cities for their fellowship programmes. Fellowship programmes are scattered scantily and randomly across the various cities of India, take down rent from an already low stipend, chances for a decent lifestyle and mental health are slim to none. The tradition of ‘treats’ and ‘gifts’ from the junior most doctor (practiced not only during fellowship but right from internship) also does not help the trainee to achieve financial freedom and adds to the stress of an already tight budget.

The above point also highlights a very grim situation where the fellowship programmes are so scarce that this is probably the reason why young doctors sacrifice financial freedom for acquiring skills, questionable skills considering the above examples. A common phrase used within the medical community is “fellowship is nothing but glorified residency”. It holds true to the fact that low wages, derogatory attitude of some senior surgeons’ and no hands-on don’t make it very different from a residency programme. Burnout is inevitable and the question to ask here is who pays the price in the end? Is it that senior surgeon who failed to be a flag bearer of true leadership and now regrets it on his deathbed or the patient who looks up to all doctors being hands of God?

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