Lately there has been a clamour to start new associations and societies representing virtually any and every small facet of cardiovascular and thoracic sciences. The aim and purpose for these societies is not clear. Proponents say that knowledge has exploded exponentially and a generalist cannot keep pace, so moving forwards, subspeciality development is a necessary must. Naysayers maintain that these associations are egocentric trips of a few brains, who are either mistakenly just copying the western model of over-specialisation, which is still not relevant in India, or more disparagingly, label it as an effort in one-upmanship to propel their careers and stay in lime light.

Leaving this divisive, and rather controversial, debate for a later opportune moment, I grant the primacy and need for sub-speciality evolution, but with a caveat—majority of us still practice a wide variety of procedures, which at best can be divided into very broad major categories of adult and paediatric cardiac surgeries, thoracic surgeries and vascular surgeries, and thereafter any further subdivision is irrelevant and inappropriate for a developing nation like India. ‘Science’ must address the aspirations of the ‘Society’ that it serves. In India, and in fact the entire developing world, the need is for more homogeneity in availability of basic cardio-vascular-thoracic services in tier 2 and 3 cities, rather than delving into niche arenas. The latter may serve the surgical fraternity on an individual basis, but it is the former which will bring societal gains.

Moreover, both the industry and the surgical audience find it difficult to cope up with these new dawn societies, cropping up virtually dime a dozen. The societies are not self-sustaining financially and rely heavily on the industry to sponsor their activities. However, the pharmaceutical and the device industries have neither the capacity, nor the will, to finance them. This becomes all the more pertinent given the recent governmental activism, vigilantism and oversight into the industry-medical profession interaction and cooperation, labelled, not without a reason, an unholy ‘Nexus’. They even compete with the overarching parent body, in our case, the Indian Association of Thoracic and Cardiovascular Surgery, for a share from the common pie of limited and fast-dwindling industry-sponsored resources. Thereby, these societies virtually strike at the very basis of the parent body and make one wonder about the existential import of these latter guardian bodies.

To justify their existence and relevance, each sub-speciality association has to per-force have its conference and other activities. The end result—a busy practicing surgeon is caught in this onslaught of meetings and conferences, so much so that, unable to keep pace, he develops a kind of inertia, or what may be labelled ‘Conference Fatigue’. This leads to poor attendance in actual presentations and discussions, even if one is registered for the conference. That’s the naked reality of most conferences today—delayed starts because of empty halls, unethical lures like early bird prizes to attract audience to morning sessions (at least lunch attracts most delegates to pre-lunch sessions), listing musical bonanzas and ‘Gala-nites’ as the conference highlights, and commissioning half a dozen panelists and chairpersons, hoping against hope that at least they will form an audience for the sessions preceeding and succeeding their own sessions!

Pari passu with ‘Zoom/videoconference fatigue’ becoming a definitive diagnosis, and sooth to say, may be in due course even meriting an International Classification of Diseases nomenclature; fatigue associated with physical in-person congresses too is an equally pivotal reality. One has to concentrate not only on the science being presented, but also on the style, manner and tenor of the presentation, the body language of the presenter, his/her demeanour, facial and hand gestures and modulations, and language—its syntax, pitch and pronounciation. Processing of all these verbal and non-verbal cues entails energy expenditure and takes a heavy toll on the so-called passive listener, or the audience, leading to unappreciated fatigue and exhaustion—both mental and physical. Not to be underestimated is the role of the venue—its environs, temperature, humidity, conditioning of the air, ambient lighting, the seating arrangements, the audio–video quality etcetra, all contributing their two pence to the overall end result, so much so that the whole effect is much more than the sum of the parts. Even though the role of each of these factors may seem trivial in genesis of physical affirmity, the ‘Gestalt’ is much more complex and telling. It may even have far reaching consequences including, but not limited to, influencing patient-care adversely. How many times, after returning from a conference, does one feel a need for a holiday, just to recoup the lost energies, vigour and sanity!!

As such, the glean and the sheen of our annual conferences has lost out in the recent past, something which can only get accentuated in the times to come, unless we take some proactive measures. The least the parent association can do is not to accord any kind of recognition to these sub-speciality associations or their activities. Instead, the parent body can create councils, task forces or working groups for the legitimate aim of development of various sub-specialities, and leading lights in their respective fields should be commissioned with a view to these tasks. Forbye, adequate representation should be given to various sub-specialties in annual conferences. Unfortunately, as it has been for the last 25 years, coronary artery disease seems to have hogged all pre-eminence and other sub-specialities were relegated to the backyard. If equal importance is given to all fields, then we may be able to assuage the ruffled feathers to some extent and dissuade our members from either creating or joining these associations. Consequently, it may even provide a sigh of relief to the stressed and beleaguered industry.

We all, individually and collectively, thus need to take a pause, ponder and debate certain questions of fundamental import—do we need to have separate standalone associations, with their elaborate hierarchical edifices, for all sub-specialities? Wouldn’t they be duplication of effort and wastage of scarce resources, besides weakening the respective parent bodies? Has ‘United we stand, divided we fall’ lost its relevance?

Trying to figure out the prevalent opinion in the fraternity on the index subject matter, a PubMed Central Advanced search using the MeSH words and phrases ‘Cardiac sub-speciality Associations’, ‘Cardiac Societies’, ‘Super-specialisation’, ‘Demerits of separate sub-speciality associations’ and ‘Should cardiac sub-specialities be developed as independent verticals’ yielded zero results. Friends, if these matters cannot shake you off your inertia of expressing and penning down your views, then one wonders—what would?

Please speak out.