Dr. Tomaš Kasal is a successful orthopedic surgeon who has chosen his country over a million euro income in the West. In order to give our readers some idea what he contributes to his field and to his patients, we spoke to Dr. Kasal at his chosen place of practice, Prague’s Na Homolce (Homolka) hospital.
Can you describe briefly the field in which you work, and some of the current trends involved?
Orthopaedy and bone traumatology are medical fields that are developing very rapidly in this country, and every year new techniques and new instruments emerge for curing fractures and endoprothesis. One problem presented by such a developing field is keeping up-to-date with all the data – it is nearly impossible for one person to be continually and comprehensively informed. Today the most important breakthroughs and trends typically relate to computers and equipment or instruments used during operations. While some machines didn’t even exist five years ago, today there are computers that can direct the operation itself.
How do you coordinate your work and personal life?
It’s difficult. I have two children – boys, one and there years old – and we are expecting a third baby. We don’t know the gender yet, it will be surprise. My wife is an art historian. I try to spend as much time with my family as possible, while at the same time performing medicine on high level.
What does a typical day look like for you, when you have an operation?
We have to be at in the hospital by 7am. The first thing we do is go and see all our patients and make notes in a clinical record and prescribe medication for upcoming day. Then is a “X-ray round” when we evaluate the previous day and the results of treatments. Then there’s a 15-minute meeting with the chief physician to go through the previous and upcoming days, and then at 8.30 the surgeries start. We have from three to seven surgeries per day, typically finishing in the late afternoon… it depends on what types of surgery.
What percentage of your surgeries are already routine?
I cannot say about some surgeries “this is just a routine.” Every patient is unique, and the fact that you have done a certain operation 200 times, doesn’t mean the 201st time may not be completely different. Actually, the more operations you do, the less you can say it is just routine. As your practice grows, so does your demureness and humility. If you have performed an operation four or five times, you can start to believe that it’s just a routine. But if you have done it a thousand times, you learn that it is not a routine at all.
Do you leave your work “behind the door” when you leave the hospital?
Usually yes… if the day is successful and the operations are good. But if something fails, it is difficult to dismiss it.
Did you ever think about working somewhere other than Homolka?
The years I was doing my internship in the clinic were pretty hard… there was a lot of work, we had to study materials and publish articles too. There was almost no time for a private life and family. After time, I had some experience and a good position and I was thinking about going to work abroad, but then came the offer from Homolka, and I decided to accept it. I am satisfied here and I don’t want to go abroad… also because of the needs of my family.
What gives you the greatest satisfaction at your job?
I don’t want to be sentimental, but the biggest satisfaction is when a patient comes and is happy with the result of our work. Generally, we can say this is the mission of this job, but I don’t like to use this expression. To be a doctor is a job like any other one, one that should be appropriately paid too. For me it is also a business – I studied it, made a certain investment in it, and I am doing this job because I want to help people. On the other side, I have my family and my own life. In the Czech Republic, the word “mission” still has the meaning of that kind work that is satisfactory in itself, so why should you want to be paid for it?
Can you describe the time you spent in London?
I was there to get practice in the Royal National Orthopaedic Hospital in Stanmore. But the situation of foreign doctor is a bit complicated there. The English doctors won’t allow a foreigner to cure their patients… especially not in a private hospital, but even in the state hospitals they are afraid that the foreigner could prove that he is better than the “locals”. So I was allowed to assist during operations, but I could not conduct my own operations.
The biggest difference between practice in Prague and in London is probably the different level of skills. There are two groups of surgeons in London: the heads of surgical teams are usually doctors in their 50s, and they are highly qualified and very good. The other doctors that assist them during the operation are between 30 and 40 years old and their skills, at least in comparison with Czech doctors, is significantly lower.
How many patients do you see per week?
In the outpatient clinic it is around 130 to 150 people per week, if I don’t operate. And when I operate it is about 10 to 12 people per week, but it depends a lot on the types of surgery. It could be eight people one week and 17 the next one.
Is it possible to have a private practice in addition to the position at Homolka?
I haven’t thought about it, but the possibility is there… some of my colleagues do this. If my time possibility allowed, I wouldn’t be against it. But I have a full workload with my job at the moment, so it isn’t a question I need to solve now.
This may be a rude question, but – what kind of money can a good surgeon can make here?
I earn 27,000 crowns a month, plus something for extra shifts… but that extra isn’t very well paid.
Why did you leave London with a potential income in the millions of pounds per year?
It isn’t just about money, there are always more factors – roots, family, etc. My father, who is a pretty successful businessman, says that everything is a question of money; you can buy everything or any service.