An unfortunate recent trend in Indian healthcare has been the derecognition of a number of radiology training centers by the National Board of Medical Examiners, including some prestigious ones which have been conducting radiologist training for over 20 years. This has resulted in a decrease of about 40-50 seats or radiology graduates per annum, by one estimate, which is approximately 20% of the total number of training positions that exist. In a country that is desperately short of radiologists, this is a retrograde step that is nothing short of appalling. We need to train many more radiologists, not less. The rationale for such a decision also escapes logic. Ostensibly it is related to the theory that radiology can only be taught in a hospital environment and so the accreditation is now inextricably linked to the number of beds (200) that the institution must show in order to receive radiology accreditation. In other words the postulate is that standalone outpatient centers (and of course teleradiology centers, perish the thought!) cannot train competent radiologists, even if they perform hundreds of thousands of radiologic procedures a year and have greater radiologist staffing, clinical and training material than hospital based departments.
The reality of course, is that there are outpatient imaging centers that provide suboptimal radiologist training, just as there are hospital based departments that do the same. Regardless, the quality of radiologist training does not depend on the bed strength of the hospital but on the teaching commitment of the faculty and the management. As the number of diagnostic centers increases in response to the needs of our growing population, the percentage of practising (and potentially teaching) radiologists that work at outpatient centers will necessarily increase. Removing these radiologists from the ranks of teaching radiologists will further diminish an already scarce resource.
Further, the teaching material generated at such centers is not insignificant. While these centers may not be performing studies such as invasive angiographies, the majority of outpatient studies including plain xray, ultrasound, CT, MRI and even PET-CT are currently being performed at outpatient imaging centers covering the vast majority of radiologic procedures. For those specific training
needs that can only be met at hospitals, there is always the option to have the residents rotate through a hospital, as used to be the case.
In the setting of teleradiology centers such as ours, the same applies. We see studies from 20 countries and a variety of clinical environments , which gives us access to a huge and unique teaching database. We have a large and experienced team of radiologists who are keen and excited to teach. We conduct regular CME both live and online, have a teaching website, portal and e-lecture program that are of a unique nature and critical in todays environment. To not accredit us for radiologist training seems a travesty of the current system.
In general, the response of the National Board is similar to the exaggerated responses seen in the past to other suspected or real violations.
Classic among these are the PNDT act which in the attempt to curb the illegal activities of a few, imposes harsh restrictions on the many. Similarly the effective shutting down of all clinical research for drug development in the country is another sad knee jerk response to the unfortunate misdeeds of a few.
What is needed is to ensure that existing training programs function optimally, rather than to just shut them down.
Better enforcement of the existing regulations, rather than escalation of the regulations to draconian proportions, is essentially the need of the hour.
Otherwise the baby will truly be thrown out with the bathwater.