How to Become a Pediatric Endocrinologist?

Amongst all the sub-specialty in Pediatrics, the pathways for pediatric endocrinology are least known, at least that's my opinion. I hardly knew prospects about pediatric endocrinology during my graduation days.

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One of the several reasons is that the field was mostly occupied by adult endocrinologists looking after the children. But this has changed a lot in recent years with more and more Pediatricians trained in endocrinology are taking over the role for good.

Honestly, I feel most of us, comparatively have lesser ideas on why and how to choose Pediatric endocrinology for subspecialty training and what are the future aspects of it.

Q: Can we start with why you choose pediatric endocrinology as a career option after Pediatric training?

I always wanted to pursue specialty training after my Pediatric residency. I was fortunate to work in and get exposure to almost all specialties during my residency.

It was not until the last 3 months of my residency when I decided to do Pediatric Endocrinology. During my posting in Pediatric Endocrinology, I started loving it and later decided to pursue further training.

I feel it is a very challenging branch and I enjoyed it both during my training years and now as a consultant. You have to be very meticulous and alert while dealing with children having endocrine disorders and it suits my personality trait.

It seems to be a complex branch at the start, but with the right approach and training, it can be simplified. It excites me every time I succeed in helping a child with an endocrine issue.

Very few of us know about Pediatric endocrinology training in India. Can you explain the training pathways?

So there are two ways to pursue specialty training in the branch.

1. DM in Pediatric Endocrinology, which is being offered at PGIMER Chandigarh. It is the only institute in India with a DM in pediatric Endocrinology. It is a 3-year course and was started in 2018.
2. Fellowship courses are being offered at many institutions including government and private. The fellowships at medical colleges are offered via university. Tertiary care corporates and private institutes also offer institutional fellowships that are not affiliated with any university.

Can you compare these training opportunities?

Well, if you are aiming at a degree or a course recognized by NMC then the only option is DM. Until the date, none of the fellowships are recognized by NMC. But this might change in the future given the changing trend of Paediatric endocrinology in India. The training opportunities will definitely increase. But at least for now, DM can fetch you a better position in the future.

However, the learning opportunities are similar if not better in many of the centers offering fellowship. The majority of the fellowship programs are being run by Pediatric endocrinologists with long and wide experience in the field, who have been trained at higher centers out of India.

This gives an opportunity to inculcate the tangential thinking and approach needed for the complexities.

The majority of fellowships are of 2 years duration, which is quite a sufficient and adequate time when compared to other subspecialty training like FNB.

What precautions one must observe while choosing the training institute for this branch?

Of course, since the training process is not uniform, one must be cautious while making their choice about the training institute.

I will try to consolidate this, under 6 major things.

1. Clinical work- Government institutions have a plethora of clinical patients. But one must remember, when it comes to endocrinology, work-up is super-important. Some government programs do offer support but that is only for treatment and not the diagnosis.
   
   Since in India, the patients have to spend from their pockets. You may not be able to get the whole picture of the patient including clinical, biochemical, radiological, and genetics.
   
   Private hospital programs may have the advantage of detail and thorough work-up but the classical cases are less compared to the government ones. Also, the overall workload is usually not as high as a government setup. So while deciding one must try to look for a balance.
   
   
2. Teaching- This is extremely important and one should never overlook it. Interaction with the mentor during case discussions and seminars helps to clear the mind and thought process of a mentee.
   
   There is no standard protocol of teaching so one should enquire individually at institutions from the previous passed fellows and mentors about teaching.
   
   
3. Research- In my opinion Endocrine is one heavily research-oriented branch. One must look at this aspect seriously. This area is many times ignored in different training programs of India. So, highly advisable to enquire about the scope of research at the institution, you wish to apply to.
   
   Few institutions in India do provide good opportunities for research in pediatric endocrinology. 
   
   
4. Laboratory facilities- Understanding how different biochemistry assays are done plays a pivotal role in an Endocrinologist’s clinical practice. The trainee should have exposure to at least once a month or fortnight sessions in the biochemistry lab.
   
   
5. Other Sub-specialty- Inter-disciplinary management of patients is important as holistic management of patients requires all sub-specialties to work together giving the patient the best possible care. Therefore better to be in a place where most of the other sub-specialties are well established and running.
   
   
6. Stipend- Unfortunately for endocrinology there is no governing central body so far and the stipend is decided by the training institute. One will have to enquire at individual institutes. However, in DM the stipend is fair.

What are some good places for training Pediatric endocrinology in India?

Several places are offering Pediatric endocrinology training in India. Some of the good training centers are

1. HCJMRI & Jehangir hospital- Pune
2. IGICH, Bengaluru
3. Regency hospital, Kanpur
4. SGPGI, Lucknow
5. Wadia Children’s Hospital, Mumbai

DM in Pediatric Endocrine is available at PGIMER Chandigarh as we discussed earlier.

What are the training options outside India? Can you name few good institutes outside India for further training?

Well, there are many options in the USA, the UK & Australia.

If you want to do a short 3 months or 6 months fellowship in Pediatric Endocrinology then ESPE (European Society of Pediatric Endocrinology) gives you a scholarship for that. Similarly, a diabetes fellowship by ISPAD (International Society of Pediatric & Adolescent Diabetes) provides a good opportunity for short-term learning.

If you need formal training in the USA you need to go through their program of USMLE and then complete Pediatrics Residency followed by a 2 years fellowship program.

For the UK you need to have MRCPCH with a national training number. Then at level 3 of your training (ST6 to ST8 i.e. from the 6th year of residency), one can undergo CCT training (specialty training). The other way around to UK training is through Medical Training Initiative. The MTI post duration range from 1 to 2 years.

In Australia, one needs to have basic training in Pediatrics (3 years ) and then can apply for specialty training in individual institutions as oversees specialist short-term training (FRACP, maximum of 2 years). If accepted by an institution they need to apply for AMC (Australian Medical Council) license and then can do their respective fellowship.

Can You mention a few good institutes abroad for endocrinology?

A few good places to mention in the UK are

1. Great Ormond Street Hospital, London
2. Alder Hey Children Hospital, Liverpool
3. Royal Manchester Children's Hospital, Manchester
4. Bristol Royal Hospital for Children, Bristol

The Options in Australia are

1. Royal Children's Hospital Melbourne
2. Sydney Children Hospitals Network
3. The Children’s Hospital at Westmead

Can you describe a typical day during your training period?

The routine usually started with morning rounds of in-patients, including dynamic simulation tests and workup of patients. I use to have 4 clinics per week, 2 evenings and 2 mornings.

There was one dedicated diabetes clinic per week. In the afternoon times generally were focused on patient and carer counseling and educating parents with diabetes and any other complicated endocrine disorders.

There was twice-weekly formal teaching for us. The rest of the time was working in a biochemistry lab, understanding how things are done and learn to interpret them.

I also got the opportunity to work on different projects as a part of the research.

What are the employment and economic prospects for pediatric endocrinologists in India?

Honestly, as a dedicated and exclusive Pediatric Endocrinologist, the employment opportunities are more in a corporate hospital, This provides the setup, lab, quick turnaround time, and also support from other subspecialties which are quite essential sometimes.

The next option is establishing your setup. It has its own perks but at the same time, it is not in every-ones capacity. While in metro or bigger cities you can be associated with more than one place, this gives a good patient pool and opportunities to spread your coverage.

Money prospects are not like an intensivist, neonatology, or general pediatrician but it will lead you to a comfortable life. You don't need to have sleepless, heart-pounding nights. In my opinion, it's a very comfortable and satisfying branch. Also, you are always free to some general Paediatrics if you would like to. You don't need to have sleepless nights

Medical Colleges are not yet open to employing Paediatric endocrinologists as full-time pediatric endocrinologists yet. But the trends are changing as they are with other sub-specialties as more and more Paediatric residents opting to work in subspecialties than general. You can start working in Pediatrics Department & develop your division of Pediatric Endocrinology if you want to be in teaching places.

What has been the most rewarding part of being a pediatric endocrinologist?

I feel in the majority of endocrine disorders there is a treatment. It’s like there is a way out and you can remarkably improve the life of a child. There are hardly any situations with a dead-end. The treatment is specific and targeted.

If you are confident about the diagnosis. The treatment part is very rewarding. The other thing is, in endocrinology, the response can be measured. The happiest part is watching a child get better and quantify the outcomes.

Dealing with adolescents is interesting and relishing. When you transition them to adult endocrinologists you feel you have been a part of their journey in life.

Are there any shortcomings in particular?

Of course, these are, as in any branch of medicine. The branch and associated courses are still not well recognized by Indian Medical Council. The waiting time to get settled is slightly longer. The monitory prospects are not as high compared to other branches until you plan to settle in a metro. But then there is always a side. The times are changing.

Do you think the adult endocrinologist are overlapping with you guys in terms of patients?

Yes, they do. In this India, everyone is allowed to practice the way they want. It is up to the individual doctor and the way they identify their capacities. But with more and more legal infrastructure building, this might change in the future.

In some corporates, there are already mechanisms to keep a check on this.

I personally feel an individual needs to be a Paediatrician before being a ped endocrinologist. The field needs a thorough understanding of how kids grow and develop.

However, it is also the choice of patients and their parents but with more and more Paediatrics endocrinologists coming up, the awareness amongst parents is changing and soon we will see changing trends in terms of the patients we cater to.

1. Paediatric Endocrinology information
2. BSPED-UK GRID posts in Paediatric Endocrinology

1. How and why - Neonatology
2. How and why - Pediatric Hematology-Oncology

Author

Nikhil Lohiya | DNB(Pediatrics), Fellowship in Pediatric Endocrinology

Nikhil has completed Pediatric residency from Mehta Hospital Chennai and trained in Paediatric endocrinology from HCJMRI, Jehangir Hospital, Pune with further training from Alder Hey children’s Hospital, Liverpool, UK. He is currently working as Consultant Pediatric Endocrinologist at Growth, Development & Endocrine Center, Nagpur, MH