Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Participant Selection
2.3. Data Collection
2.4. Data Analysis
2.5. Ethics
3. Results
3.1. Participants’ Characteristics and Analytical Themes
3.2. Practice Hurdles in Public Sector Health Facilities
3.2.1. Security
“Why would I put my life in danger by anesthetizing a patient who is already in shock with insufficient blood in hand and a mob of patient’s family outside theatre ready to rip me off in case of his demise”.(QH5)
“Government has appointed a few police sergeants outside each hospital which cannot control violent and angry attendants—especially when there are hundreds of them out there. So, in peripheral setups, best is to take non-serious or ASA 1 [American Society of Anaesthesiologist Classification] cases. I know it’s not good for patients, but it’s not good to risk healthcare team lives either”.(DH2)
“There is no check and balance anywhere, just we don’t have lame excuse to refer it to some other hospital. So, we save patients life while peripheral workforce prefers to save their own”.(TH2)
3.2.2. Gender Inequalities
“When I was an MCPS student 20 years back, I used to get 3 k for a case, and immediately used to go for it, but now after being an FCPS having 20 years of experience why would I go for 5 or 10 K for case where surgeon having equal qualification is getting in 100–500 K. Even, I have to start before him and finish after him due to pre- and post-ops—so why don’t I spend quality time with my family instead?”.(TH8)
“Transport facilities must be provided to female staff in every hospital especially in night shift when moving alone in local transport or private taxis is generally not considered safe in our country”.(TH7)
3.2.3. Experiential Seniority Outranking Qualifications
“Government made rules to move every MCPS and DA consultant to peripheral hospitals and FCPS/MS consultants to stay in tertiary care and train other residents. But unfortunately, in many tertiary care hospitals DA consultants are leading […] and FCPS consultants have to work under them, which creates chaos, ultimately leading FCPS consultants to give up and move out of the system. So, the differentiation in status according to specification of degree is inevitable now”.(TH1)
“In several teaching hospitals, despite having numerous consultant anaesthesiologists in country, non-consultants are given authority and only support underqualified people like themselves. [This] creates challenges for more qualified professionals who ultimately leave the system due to the harsh and exhausting work environment”.(TH4)
3.2.4. Pay and Incentives
“I am getting the same pay as any government officer in bank, taxation or teaching in school with same pay grade. What’s the point in working so hard, attending 24-h calls, working on all public holidays, disasters, pandemics when you can’t provide your family a better lifestyle or education than others?”.(DH3)
“If not for all doctors, at least consultants should be offered housing, transport facilities, clubs and specific schools for children, or at least special quota seats for healthcare professional’s families along with their regular salary. This could overcome our workforce deficiency, as nobody wants to move out of their native country if they can get the best for their families here”.(DH5)
3.2.5. Evening Privatization of Public Hospitals
“It was common practice in the past in the biggest tertiary care hospitals […]. Richest people would opt for state-of-the-art private wards in government hospitals as they were reliable”.(TH3)
“Autonomous hospital bodies have the legislative authority to start private practice, but they do not want to take responsibility, as evening private practice needs cleanliness, up-to-date or at least decent waiting venues etc. Although 30% of income received from private patients goes to management for maintaining these things, they are not willing to burden themselves”.(TH10)
3.3. Private Sector Health Facilities Obstacles
3.3.1. Inadequate Salary and Facilities
“Private sector is making a fool of the public by making modern buildings, interiors, reception private rooms etc., but as the public can’t enter operating rooms, the situation is grave there. Insufficient and out-dated monitoring and equipment, lack of proper sterilization, even drugs sometimes. So, complication rates are 60–70% more than in government hospitals…”.(DH4)
“In the private sector, not only are wages lower but also qualifications give you no edge. If they want to give an anaesthetist 5,000 for a case they would get one, whether it’s some OTA [Operation Theatre Assistant], HO [House Officer], MO [Medical Officer] or technician. They would give you no preference or better wage for your qualification, which not only reduces quality of anaesthesia but also reduces opportunities for skilled personnel in-country”.(DH8)
3.3.2. Surgeon Dependency
“The worst thing in Pakistan’s private sector for anaesthesiologists is surgeons. You can practice only if you are connected to some surgeon who can call you for his surgery on his terms. If anaesthesiologists are directly collaborating with hospitals instead of surgeons, only then could checks-and-balances be kept”.(QH4)
“With my more than 19 years of experience in this field, I can assure that the only thing to overcome this issue is to make a rule that anaesthesiologists should meet with patients two days before surgery, for pre-operative assessment and rapport-building or patient get to choose an anaesthesiologist himself instead of the surgeon or hospital. This is the only way this malpractice could be reduced”.(QH1)
3.3.3. Lack of Out-of-Theatre Practice
“Chronic pain management is a definitive branch of anaesthesia, but it has no scope in private practice as fellow consultants of oncology or ortho would never refer them to any anaesthesiologist. They think they can handle everything by themselves”.(DH6)
3.3.4. Lack of Surgery Categorisation
“Strict legislations are required for private sector as they take anaesthetists for granted. Not every anaesthetist is capable of handling any case or any kind of complication, so they must be called according to the type of surgery”.(QH7)
4. Discussion
4.1. Implications for Policy and Practice
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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ID | Job | Gender | Age (in years) | Experience (in years) |
---|---|---|---|---|
TH1 | Anaesthesia consultant at teaching hospital | Male | 42 | 10 |
TH2 | Anaesthesia consultant at teaching hospital | Male | 54 | 15 |
TH3 | Anaesthesia consultant at teaching hospital | Male | 37 | 7 |
TH4 | Anaesthesia consultant at teaching hospital | Female | 36 | 5 |
TH5 | Anaesthesia consultant at teaching hospital | Male | 59 | 28 |
TH6 | Anaesthesia consultant at teaching hospital | Male | 44 | 11 |
TH7 | Anaesthesia consultant at teaching hospital | Female | 35 | 6 |
TH8 | Anaesthesia consultant at teaching hospital | Female | 55 | 24 |
TH9 | Anaesthesia consultant at teaching hospital | Male | 48 | 18 |
TH10 | Anaesthesia consultant at teaching hospital | Male | 50 | 19 |
DH1 | Anaesthesia consultant at DHQ hospital | Female | 31 | 2 |
DH2 | Anaesthesia consultant at DHQ hospital | Female | 36 | 3 |
DH3 | Anaesthesia consultant at DHQ hospital | Male | 40 | 6 |
DH4 | Anaesthesia consultant at DHQ hospital | Male | 51 | 18 |
DH5 | Anaesthesia consultant at DHQ hospital | Male | 45 | 9 |
DH6 | Anaesthesia consultant at DHQ hospital | Female | 42 | 5 |
DH7 | Anaesthesia consultant at DHQ hospital | Male | 37 | 8 |
DH8 | Anaesthesia consultant at DHQ hospital | Female | 33 | 4 |
QH1 | Anaesthesia consultant at THQ hospital | Male | 52 | 19 |
QH2 | Anaesthesia consultant at THQ hospital | Male | 48 | 5 |
QH3 | Anaesthesia consultant at THQ hospital | Male | 34 | 1 |
QH4 | Anaesthesia consultant at THQ hospital | Male | 41 | 6 |
QH5 | Anaesthesia consultant at THQ hospital | Male | 37 | 5 |
QH6 | Anaesthesia consultant at THQ hospital | Female | 42 | 4 |
QH7 | Anaesthesia consultant at THQ hospital | Male | 32 | 1 |
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Shahbaz, S.; Zakar, R.; Fischer, F.; Howard, N. Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives. Int. J. Environ. Res. Public Health 2022, 19, 13427. https://doi.org/10.3390/ijerph192013427
Shahbaz S, Zakar R, Fischer F, Howard N. Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives. International Journal of Environmental Research and Public Health. 2022; 19(20):13427. https://doi.org/10.3390/ijerph192013427
Chicago/Turabian StyleShahbaz, Sumbal, Rubeena Zakar, Florian Fischer, and Natasha Howard. 2022. "Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives" International Journal of Environmental Research and Public Health 19, no. 20: 13427. https://doi.org/10.3390/ijerph192013427