Shortage of anesthesiologists and nurse anesthetists in the country

With the expansion of hospital infrastructure in Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), the opening of new operating room facilities in the district hospitals, and the introduction of new services, the need for anaesthetic human resources is increasing.

According to WebMD these specialists give you medicine to prevent pain and, if necessary, make sure you sleep through your operation procedure.

Anesthesiologists don’t just work in the operating room. They also give pain relief if you have an ongoing condition like back pain or cancer. And after surgery, they sometimes help you control pain after you get home, too.

As per the JDWNRH Report 2021, the government is expanding the number of health facilities with operating room facilities, and also new hospital constructions are being carried out, especially in JDWNRH. The Department of Anesthesiology must plan its human resource requirement in the coming months to meet the demands.

The Department of Anesthesiology is facing a lot of challenges. The facilities providing anaesthetic services in the country are increasing but the number of General Duty Medical Officers (GDMOs) willing to undergo residency in anesthesiology are lesser. It is unknown why there are fewer doctors willing to take up anesthesiology when compared with specialization in other fields of medical practice.

The Royal Civil Service Commission has also relaxed some rules to encourage general doctors to enroll in an anesthesiology residency, but still the response from the general doctors has been lukewarm.

However, a very few doctors have opted for specialization, and this has marginally increased the pool of Anesthesiologists in the country.

With the limited number of anesthesiologists in JDWNRH, it has become imperative for the government to recruit more anesthesiologists from other countries even though it is expensive. There are seven expatriate anesthesiologists including four in JDWNRH working in the country at present

The Chief HRO of the Ministry of Health said there is a shortage of anesthesiologists as well as nurse anesthesiologists in the hospitals. The ministry is exploring mobilization of funds, and the government has proposed to hire five more expatriate anesthesiologists from Myanmar, which is yet to be confirmed.

Currently, there are 15 anesthesiologists in the country including expatriate and retired doctors with a special pay package on contract.

 In the Eastern regional referral hospital in Mongar, nurse anesthesiologists are managing there.

JDWNRH has seven anesthesiologists. There are six GDMOs undergoing anesthesiologists, four in Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) and two in Bangkok.

The health ministry is not able to send nurses for anesthesiology training due to a lack of funds since the anesthesiology course takes a year and there are no courses available for nurses in the country.

The official also said two slots for anesthesiology course was announced this year, but there was only one taker in KGUMSB.

The JDWNRH report stated that nurse anesthetists have been the backbone of anaesthetic services in the country for the past two decades, and will also be for the next two decades or so. To provide operating services at the district hospitals and also the regional and national hospitals the nurse anesthetists cannot be phased out for the next two decades.

Therefore, it is imperative that the government send a batch of nurses for nurse anesthetists training as soon as the situation permits. The nurse anesthetists will provide anesthetic services at the regional and district hospitals for various emergency procedures for which they are trained.

The Department of Anesthesiology in JDWNRH is also standardizing the anaesthetic equipment supplied to various health facilities in the country. Health facilities with operating room facilities should have standardized equipment depending on the types of cases they provide anaesthetic services. This is being done to ensure that standard anaesthetic equipment is supplied to various health facilities to enable optimum utilization of expensive medical equipment.

The anaesthetic staff, especially in the district hospitals, are not able to update their knowledge and skill. It is essential that the staff are provided with training to enhance their knowledge and skills to provide safe anaesthetic services through regular continuing medical education, and attending workshops, and seminars on Anesthesiology. This is an important responsibility of the department and the department is trying its best to upgrade the knowledge and skill of its staff.

Meanwhile, the Department of Anesthesiology, JDWNRH oversees the human resource requirement of the whole country and ensures that standard anaesthetic services are available in the district and regional referral hospitals. This department will put up long-term and short-term training proposals to the Ministry of Health, like sending 12 nurses for training as nurse anesthetists (2 batches) in the coming five years.

This is being proposed in line with the opening of new operating room facilities in the district hospitals and the new constructions in JDWNRH.

The department will put up the need to continue recruiting and retaining expatriate anesthesiologists till there are adequate anesthesiologists in the country.

The department will also take up more residents if general doctors are willing to take up residency in anesthesiology. The department will liaise with the, JDWNRH and Ministry of Health to provide CME to all staff.

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