On being a freshly passed dermatologist in the time of pandemic

I sat one morning in my balcony with my recently issued MD marksheet, hardly two weeks old, in my hand. The precious document proudly declared: “Passed MD with Distinction in Dermatology, Venereology and Leprosy.” I could not but help wonder what sort of future awaited me. After all, dermatology is a much coveted and sought-after discipline, as one is told at the start of the postgraduate course.

As I flipped through the pages of the newspaper and navigated through the job advertising websites, I was rather excited to see plenty of advertisements and opportunities for medical professionals, particularly in premier institutes and hospitals throughout India, with most of them offering handsome emoluments at the first glance. Sadly, on looking at them in greater details, I realized that most of the vacancies are not for dermatologists; rather they are reserved for other disciplines such as medicine, surgery, anaesthesiology and pulmonology. For the very few institutes that do have a vacancy for a dermatologist (which are usually numbered as if in binary numerals – either 0 or 1), the competition is cut-throat, to say the least. For example, the author is aware of 17 postgraduates applying for a single seat in a premier institute of North India.

To add to the already complicated picture, most private practice clinics and hospitals demand good hands-on experience in the field of cosmetology, such as familiarity with lasers, hyfrecators and other sophisticated devices. Most of these are beyond the curriculum of many Indian colleges, as a result of which, the newly passed postgraduate is forced to spend a considerable amount of time learning these vital soft skills before they can confidently engage in private practice. In one way or the other, fellowships in these fields have become mandatory, though opportunities for these are again, limited. Some of these courses may even burn a hole in one’s pocket. Starting a private clinic with an expensive setup is also beyond the affordability of most freshly passed postgraduates.

The current pandemic situation has aggravated the problem more: Most vacancies that had once existed in dermatology before the pandemic have been siphoned away to cater to the disciplines greater in need during the pandemic. The author’s experience (also shared by other colleagues) is that dermatology is usually regarded as an “optional” or “ancillary” subject by many clinicians in other disciplines. The argument offered is that dermatology patients are usually not sick enough to justify a very important status for the subject. While this may be true to a limited extent, life-threatening dermatological emergencies are frequently encountered in many hospitals irrespective of the situation of COVID pandemic. There are many dermatoses that have been assuming epidemic proportions in India (e.g., dermatophytosis¹), partly due to dearth of well-qualified dermatologists. The pandemic with shutdown of dermatological services in many places has only aggravated the problem.

Another point to ponder is that the present curriculum of MD which although makes two publications mandatory, does not offer enough chances to hone one’s writing skills, as a result of which, many newly passed postgraduates face difficulty in publishing academic papers. Publishing papers can put one in an advantageous position in job hunting.² Organising frequent workshops at the postgraduate level on scientific writing, could encourage postgraduates to contribute more to the existing literature beyond the two mandatory publications, and above all, inculcate a habit of publishing which could offer a distinct advantage in terms of employment.

Creating more seats at senior residency level for dermatologists, training them in the tidbits of cosmetology, with inclusion of cosmetology in the postgraduate syllabus and sensitising physicians from other disciplines about the vital role dermatologists play in patient care is the way forward. More importantly, freshly passed dermatologists can be offered training and employed on emergency basis for the management of the pandemic situation, as our recent experience in the country suggests. Only then will unemployment among freshly passed dermatology postgraduates significantly decrease.

The mobile in my hand beeped. It was a message from one of my colleagues from another discipline in high demand in the current scenario. He had just got an exciting offer from one of the most prestigious institutes of North India. I longingly looked at the distant mountains from the window of my room. The mist in the Himalayas was slowly clearing up, and the bright sun was slowly rising above the horizon, clearing the darkness on its way. A big fish jumped out of the water in the Ganges, making a full circle before diving back, as I walked back to my daily chores, confident of landing a job as soon as possible.

(The author is a recently passed postgraduate from AIIMS, Rishikesh)