Shortage of cardiothoracic surgeons ails government hospitals in T.N.

At least 300 patients at government hospitals across Tamil Nadu are waiting for cardiothoracic surgeries, with the waiting time ranging from 1.5 to 3 months. Among the 36 government medical college hospitals, their affiliated institutions and standalone super speciality centres in the State, only a handful have cardiothoracic surgery (CTS) departments, and not all are full-fledged units with adequate staffing, resulting in delays in performing life-saving interventions.

Reliable sources in the Health Department and inquiries with doctors across the State showe that several patients have been waitlisted for surgery (except in cases of emergencies) at a number of government hospitals. Though officially acknowledged, the shortage of cardiothoracic surgeons in T.N.’s government health sector remains unresolved.

Not enough surgeons

Presently, Rajiv Gandhi Government General Hospital, Government Stanley Medical College Hospital, Tamil Nadu Government Multi Super Speciality Hospital, Omandurar Estate and Kalaignar Centenary Super Speciality Hospital in Chennai; Government Rajaji Hospital, Madurai, Coimbatore Medical College Hospital, Mohan Kumaramangalam Medical College Hospital, Salem and Tirunelveli Medical College Hospital have operating centres but not all have a full strength of surgeons. The Institute of Child Health (ICH) and Hospital for Children in Chennai is the major centre for paediatric cardiac surgeries.

Officially, the government medical colleges at Thanjavur and Tiruchi have sanctioned posts of cardiothoracic surgeons but these are either non-functional or understaffed with no surgeries conducted for the past four and three years respectively. “Out of 39 tertiary care centres, only nine (including ICH) have CTS units. At least 50-60% of the 70 sanctioned posts for cardiothoracic surgery are vacant,” the source said.

Patient volume high

A doctor noted that the volume of patients is high as people from at least four to five districts are being referred to these centres, but they are unable to cater to all patients owing to a shortage of hands. In Chennai, at one of the centres, doctors said the average waiting period for patients requiring surgery is two to four months. Some patients have had to wait for two months after being admitted for valve replacements. Similarly, in another hospital, patients had to wait for 1.5 months after admission.

“Cardiothoracic surgery involves long operating hours but the remuneration remains poor. The government needs to act immediately to fill at least 50% of the vacancies,” a surgeon said.

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Lack of equipment

Another doctor said that not all CTS departments are fully equipped. For instance, one of the major government hospitals that has a CTS department does not have a functioning Intra Aortic Balloon Pump, a widely-used mechanical circulatory support device that improves coronary perfusion to keep the heart pumping to aid from any cardiogenic shock.

“One cardiothoracic surgery takes at least four to five hours. In many government hospitals, surgeons also handle the post-operative care of patients, as we do not have the concept of intensivists here,” the surgeon said. The government sector also lacks the concept of cardiac anaesthetists to handle pre- and post-operative patients, another doctor noted. A hospital official acknowledged that there was definitely a dearth of CTS surgeons. “Some surgeons, however, are ready to operate in the second shift if more anaesthetists and theatre staff are allotted,” he said.

Instead of starting new hospitals, the State government should focus on equipping existing institutions with adequate staff, doctors said.

Poor remuneration

A senior doctor said that delays in regularisation and poor remuneration has forced a number of Non Service Post Graduates, who had completed their MCh in CTS and worked in government hospitals to fulfil bond requirements, to quit after the bond period. “Some are willing to work in the government sector. They are paid around ₹70,000-75,000 here, but corporate hospitals pay cardiothoracic surgeons ₹2-3lakh,” he said.

State health officials could not be reached for a response.