An Inconvenient Truth

Dhanoop Dhananjayan

Is the disillusionment with Medicine as a career for real or are we

simply being paranoid? Is our generation the one destined to swallow
the bitter pill ? Seeking the answers if any….

“Medicine is the only profession that tirelessly strives to wipe out the
reasons for its own existence”

Analyze That

A prominent neurosurgeon and one of Kerala’s most respected

academicians recently remarked that the new millennium effectively
heralded the decline of Medicine as a profession .He recounted with
nostalgia the dynamic 60’s when visionaries and pioneers among
Kerala’s medical fraternity launched an ambitious programme to
nurture and establish medical education in the state where it was in
the nascent stages .The same period witnessed the birth of our
medical college, a milestone in Kerala’s health initiatives .He called the
succeeding decades the happening 70’s and the roaring 80’s when
being a man of medicine was the peak of professional and academic
achievement and the title of Dr became one of the most sought after in
society .The 90’s however saw far reaching changes in the economy
and new avenues of work and lucrative careers began springing up
demolishing the myths that Indians in cities and small towns had long
cherished about work ,pay and careers. No longer hostage to
government monopoly people were tasting the fruits of a market
economy that had made the nation wealthier and left the common
man free to taste blood in the new era of opportunity. Medicine too
was undergoing far reaching changes though a visible unease had set
in among the fraternity as private capital was seen to be undermining
constructive government interventions in the strategic health sector
.But the chain of events that began in the 90’s resulted in a rapid
erosion of the ability of the field to sustain itself as a bright career
prospect at the dawn of the new century .Degeneration had clearly set
in and the million dollar question on our minds is whether this is the
beginning of the end? From being masters of their destiny to cease
being a viable career option for India’s vibrant middle class has MBBS
come a full circle?

Show me the money

There are two kinds of doctors in the world: those who see it as a
career requiring selfless dedication and those who see it as a job that
involves prescribing medication. The first kind is becoming a rare,
dwindling species, serving in the few large public hospitals which
mostly treat the poor and needy .That specialist doctors willing to
serve in rural areas where most of our population live are almost
extinct and this has compounded the misery of a collapsing healthcare
system that swings from crookery to quackery .So the new generation
medicos who are no longer willing to sacrifice monetary benefits and
also wish to do service alongside constitute a majority. Between the
'excessive dedication' and 'excessive medication' lot lie the large
number of doctors, trying to balance the conflicts of the profession.

Medicine, is not only a difficult profession, but a lonely one. Many,

many doctors rarely take vacations, afraid of losing patients to rivals.
Many others work long, stressful hours not just because it is their duty
to attend to the sick but because consulting at three different hospitals
and running one's own clinic/s is the only way to build a name. There is
also the system of General Practitioners referring patients to particular
specialists and labs for a 'kickback'. Newly minted doctors may recoil
at the thought, but seniors see it as a standard (only borderline
unethical) practice. More troubling are the doctors who order
unnecessary tests, prolong hospital stays and generally prove
themselves unworthy of the patient's trust. These are the rotten eggs
that exist in every profession. Except, here, the guilt is compounded by
the nature of the work.

To serve without losing one's humanity, yet keep a distance in

order to preserve one's sanity. To make a good living, yet resist the
temptation to make an indecent one.
But clearly, the voice of consumerism and its attendant frills are also
audible through the ubiquitous sthethoscope. With lower pay and
difficult working conditions this balancing act is becoming increasingly
difficult. Fresh-faced youngsters who dream of taking the Hippocratic
oath one day can dispel the silly notion, for being a student of
medicine today is not what the doctor ordered any more.

From here to eternity

A career in medicine warrants one of the longest gestation periods for

any professional pursuit .The tediously long and intensive preparation
associated with the process of becoming a specialist doc is a constant
repellant for many wannabe medical aspirants.

Mayur Prakash , who scored 92 per cent in the PCB group, says
medicine is definitely not a lucrative career option any more. ``We
shall be spending over 10 years to become doctors and will end up
with ridiculous salaries. People from the middle class cannot afford to
invest so many years in medical education,'' he points out. He says he
could secure a master's degree in business administration in two years
flat. This coupled with a three-year bachelor's degree is a far cry from
the 10 years it takes to become a doctor.

Ajit.P.V who has dismissed the MBBS option despite his performance in
the CBSE exam. ``This profession is just not worth the effort. An MBBS
degree is useless today. One has to opt for post-graduation,'' he
explains. “Students, and often parents, thus feel the investment in
medical training is just so much money and time wasted. ``

The queues of anxious students lining up for admission forms for the
MBBS course have wilted this year and the reasons they cite are
marked by a sense of disillusionment .Even prominent coaching
institutes in Thrissur and Pala cite drastically dropping enlrollment
levels in their flagship PMT coaching programmes. ``One woman said
she did not know why her daughter wanted to waste so many years
and become a doctor. She said she'd rather put her money in UTI
bonds,'' says Dr S M Sapatnekar, Assistant Director of Medical
Education and Research. This, says Dr Sapatnekar, sums up the
attitude of both parents and students he interacted with during the
course of the CET admission period.

The period when he studies clinical medicine is easily one of the most
enjoyable time in a doctor’s life .This is partly because on completion
of his degree he is constantly under parental and societal pressures
besides from his better of peers to rake in the income. The stipend that
fresh interns earn at hospitals makes a part time job at McDonald's
appear lucrative. The period after MBBS is a period of indecisiveness in
the life of every medico. Many of us will be wondering what to do
next!?! Most of us will be trying to get into MD/MS specially medicine,
surgery, orthopedics, pediatrics & Radiology. Year after year the level
of competition goes on increasing making it tougher getting a seat in
the subject of our choice leading to frustration .Most doctors who do
not successfully breach the barrier are left in no man’s land.

The long course has no buzz .The lack of buzz around medicine is
evident from the fact that even a sneeze at the Indian Institutes of
Technology or Indian Insitutes of Management reverberates in the
national media. In contrast, medicine hits the headlines only in the
context of exorbitant fees being charged by private medical colleges.

Serving the people is all very fine but when you are 27,post-graduate
and still dependant on your parents,i guess it pinches. So, yes, the
'noble profession' hangover remains a key motivator for those seeking
careers in medicine. However a few years down the line, cynicism sets
in. Don’t we, the privileged folk who made it to a medical college,
deserve better.

Medicine and engineering have long been the two 'most wanted'
careers for middle class India. Slowly and steadily, though, engineering
seems to be gaining ground. Four years of engineering study at a
decent college fetches you a well-paying job. Or one can choose to go
abroad for further studies with a good possibility of financial aid and a
quick job. Five and a half years of basic medical study -- even from the
best institution -- gets you nowhere.

My question is why states Sharmil ,a medical student ,why should

medicine school graduates be willing to watch others whiz past them
while they struggle indefinitely?“Most of my friends who took
engineering have been happily placed with MNC’s even with average
academic credentials while the so called cream slogs it out here till the
end of time.”

Let's not compare apples with oranges by saying, "not all MBAs/
engineers get good jobs." Those who get into top ranking colleges
certainly do, unlike their similarly brilliant MBBS counterparts .For
reasons such as these, even doctors are dissuading their kids from the
profession. And that's a fact.

Says Abdul Sattar who had a top rank in the engineering entrance yet
opted for Medicine, " At least in Kerala ,after reading interviews of all
the toppers ,in 10th and 12th i couldn't find many wanting to join the
medical stream. ,all future aspiring corporate tycoons or software
engineering etc .I have a younger brother on the verge of making the
'ultimate' career decision: medicine/ engineering? The choice is clear
and unambiguous now. Eight out of 10 folks today cannot avoid the
temptation of the get-settled-quick draw of engineering/ MBA Doctors
still enjoy a great deal of 'respect' in society. But is that going to be
enough to motivate future generations of bright young people to join
the profession?."

Faced with stiff competition from other technical careers and lack of
incentives to offer ,medicine today is a pale shadow of its former self
and is finding it tough to attract the finest talent and the brightest
minds .Whether it can recover from this state of being nobody’s child ,
only time will tell.

Greener Pastures
Indian doctors are renowned worldwide for their skill and expertise
.The west has always been always represented a shining economic
paradise for Indian medics .In fact during the near past Britain’s
healthcare services was supposed to have been dominated by the
Khans ,Patels and Mehtas. However with serious immigration issues
and shrinking employment spaces doctors are no longer welcome in
many western nations .The widely publicized law in the UK reserving
jobs for the natives and clamping down on Indian doctors have left
thousands of these medics deprived of their livelihood .The US too has
imposed curbs to prevent oversupply of foreign doctors .A panel
apponted by the U.S congress even expressed fear that "one day all
classical textbooks will be edited by Indians, if the current inflow is not
checked"

Appear for United States Medical Licensing Exam, a necessary

prerequisite for Indian medical graduates seeking a residency post in
that country. After clearing USMLE steps 1 and 2, you need to actually
go to the US and give the Clinical Skills Assessment examination,
where you have to examine mock patients in a stipulated period of
time.
The entire process is long, difficult and expensive. Also, getting a
residency post is not easy or certain .Compare this to the one step
GMAT or GRE taken by engineers and the contrast becomes all the
more clear.

Searching for the answers

But we also need to remind ourselves that 15 years back, even

engineering wasn't a great paying profession. There were few
government jobs and little private sector. Then came people like
Narayanmurthy of Infosys who with his global low cost delivery model
created private organizations that created huge demand for
computer/software engineers and we all know the rest is history.

Why can't the Indian doctors create world class private medical
infrastructure which is cheaper compared to the west so that patients
world over want to come to India for treatment? In my opinion this is
the surest way to prosperity for doctors in India. What you are telling is
already happening in hospitals like MIOT and Apollo where a new
concept of "health tourism" is emerging But care should be taken to
regulate these ventures and use the wealth generated to subsidise
rural healthcare for the poor. But again, only few hospitals can invest
the money needed for this infrastructureTrue that "Medical Tourism" is
on the rise but we need venture capitalists to set up our infrastructure
just like IT so that we can sell our products to the world. Clinical
research, it is being said, may be the next big thing. Especially if India
can convince the West to outsource its clinical trials here. Hospital
management courses are becoming popular. Yet, neither is attracting
medical graduates in a big way.

The new scenario has been the proverbial dark cloud with the silver
lining .The medical fraternity has produced some truly brilliant
administrators and entrepreneurs who have combined expertise with
crisis management to potent effect in their respective fields .In fact our
very own Dr.V.Venu who is currently tourism secretary and 25th batch
alumnus is credited with transforming Kerala into one of India’s most
sought after tourist destinations. 1% of IIM Ahmedabad's class of 2006
lists its background as 'medicine'. That is just about three students, but
it was unheard of until recently. But why not ? If 17-year olds who
joined engineering can later realise this isn't what they want to do for
the rest of their lives, the 17-year olds who similarly opted for medicine
should be free to make the same choice. In that sense, unlike any
other graduates, doctors still have a great deal of pride in their skills.
They also give it up less easily than engineer/ MBAs who will happily
sell shampoos or manage hedge funds, with no love lost for their
original subjects. Just for that, I salute the unsung, underpaid,
unwilling-to-give-up young doctor. Aapka number aayega, zaroor
aayega.

Not unless we put medical education under a scanner, diagnose what's

ailing it and figure out a holistic form of treatment. As a professional
community, we should rise up to the challenge and seriously do
something about this or medicine will lose its aura soon .All said and
done there are no easy answers .The future for India’s physicians is full
of uncertainty—but also full of opportunities. Tomorrow's doctors
should not be unemployed; rather, they should be redefined. As
Dickens famously put it it is the best of times and it is the worst of
times.

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