Career in Palliative Care: The future is already here – time to reckon

Dr. Abhinav Singh, Patna

Introduction

A trained palliative physician is a precious and rare professional in India. Care of terminally ill or those suffering from incurable disease is like a ship in an uncharted sea, seeking some guidance by the light thrown by the palliative care providers. Despite rapid socioeconomic progress there are limitations and challenges in providing palliative care. One of the major challenges is shortage of trained palliative care professional. Due to this shortage, training programme in palliative care needs more attention. This shortage of demand and supply can be assessed from the fact that about 1% of population is able to avail palliative service (1).  Less than 1% of medical colleges are providing specialised training for same and in most palliative care as specialised department is non-existent.

Current scenario for training:

Palliative care is naïve to Indian medicine. Unlike other disciplines of medical sciences viz internal medicine, surgery, radiology, obstetrics and gynaecology, psychiatry etc post graduate training is not provided by all medical colleges in India. Medical council of India (MCI) recognised Palliative Medicine as specialised branch in 2010(2).  First post graduate training programme was started in second year of second decade of this century at Tata Memorial hospital, Mumbai.  The first batch exit exam was conducted in 2015 (2). After one year of exit of first batch of Tata Memorial Hospital first batch admission in post graduate programme was commenced in AIIMS, New Delhi. At present these two institute are providing post graduate degree.

There are many institutions and organisations nurturing palliative care providers. Institutional Fellowship in palliative medicine is provided by Christian Medical College, Vellore (3). Training is onsite one-year residency programme.  One of the benefits of training at institutions like Christian Medical College, Vellore, Tata Memorial Hospital,Mumbai and AIIMS Delhi is exposure to diverse group of patients. These institutes care of patients from all over India, adding to versatility of patient disease and complications.

Many training programmes are now grappling with the challenge of teaching and assessing judgment and linking it with practice. These programmes are run by Non-government organisations like Pallium India, Kerala and Karunashraya, Bengaluru etc (4,5). These centres provide introductory workshop & training through onsite training for few days to week. Pallium India is providing certificate course in palliative care. Introductory courses are also conducted time to time by many organisations. Many organisations are promoting courses in collaboration with Indian association of palliative care (IAPC).

There is distance learning MSc programme conducted by Cardiff university. Earlier contact programme was conducted in Bengaluru. After change of University policy, it is mandatory to attend in campus programme at Cardiff.  Scholarships funding course fee, travel and accommodation in United Kingdom to attend compulsory residential teaching for full 3year duration of programme is available.

Indian College of Palliative Medicine (6):

For integration and promotion of palliative care education in India, Indian association of palliative care is considering for starting Indian college of Palliative Medicine. It aims to develop education system for specialisation of palliative medicine. It is planned as three level specialisations. Level 1 as palliative care sensitization/awareness education program. Teaching at level 2 will be for generalist palliative medicine education. Level 3 specialisation from this course will help physicians to become Specialist palliative medicine practitioners.

National health policy and Palliative Care (7):

National health policy, 2017 denotes important change from very selective to comprehensive primary health care package for palliative care.  “Health and Wellness Centres” will be providing comprehensive primary health care. As a result, need for palliative care provider will be more in coming days.

For accelerated achievement of neonatal mortality targets and single digit stillbirth rates through improved home based and facility-based management of sick new-borns need for palliative care provider in paediatric age group at district level hospitals is proposed.

Also, as per the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, it is mandatory to provide solutions which is community centred and meet the health needs of geriatric patients. The policy recognizes the growing need for palliative care for geriatric illnesses and advocates the continuity of care across all levels.

As a part of comprehensive primary health care across country government is willing to collaborate with private sector through health and wellness centre. Partnerships with special emphasis for palliative services is under consideration. Overall national health policy is providing new platform for the palliative care provider to grow, flourish and serve needy.

Prospects for Palliative Care provider:

In country like India where less than 1% of population is able to assesses Palliative care has vast potential to grow as career.  Many well-established specialities have more competition and less opportunity. Contrary to which palliative care has less competition and more opportunity to work. Being Naïve in the medical world, gives ample opportunity for growth. In end remember “rare gem is always precious” and palliative care provider is one of those gems in world of medical sciences.

References:

1. Rajagopal MR and Joranson DE. India: opioid availability – an update. J Pain Symptom Manage 2007; 33:5: 615-622
2. Salins N. Specialist palliative medicine training in India. Indian J Palliat Care 2015:21:257
3. Prospectus of Christian medical college Vellore http://www.cmch-vellore.edu/SITES/Education/prospectus.pdf

4.Official website of pallium india   https://palliumindia.org/courses/

5. Official website of The Bangalore Hospice Trust (BHT)- Karunashraya https://www.karunashraya.org/
6. Salins N. The Indian College of Palliative Medicine: A concept in evolution. Indian J Palliat Care 2017;23:353-4
7. National health policy 2017 , https://mohfw.gov.in/documents/policy

Author: Dr Abhinav Singh is palliative physician from Patna, Bihar. He completed one-year fellowship in palliative medicine from Christian Medical College, Vellore. He is member central council, Indian Association of Palliative Medicine.