As a 12^th standard kid, just having completed a battery of qualifying tests and secured a spot in medical school, I thought the biggest decisions in my life with regard to my career were behind me. Boy was I wrong! I assumed that since I was among ‘the chosen few’ to make it to medical school the rest of my career would pan out pretty neatly. With a little hard work, an ounce of patience and some street smarts I could see myself two decades on, driving that fancy car, basking in the admiration of my contemporaries and sleeping easy at night knowing I had done my share of good deeds for the day. While dreaming, I failed to factor in the trials and tribulations of landing a medical residency and then surviving it!  

Getting to America was a long, laborious and expensive process which took meticulous planning and an equal amount of hard work.

Surprisingly, as one nears the end of medical school all the doubts kick in. You discover that finishing medical school was the easy part as you are now looking at a panorama of new choices. Was medical school the right choice? I was barely eighteen when I made it, how informed a decision could it have possibly been? Too often, young South Asians stray into the profession because ‘Daddy said so’ or because of a lack of options.

Asking Yourself Why you Want to do Medicine

During training, which generally extends into a person’s thirties, doctors are paid a pittance in India. I found the idea of being financially dependent through these years, unappealing.

Apathy towards engineering, disdain for the arts and commerce are unfortunately why young Indians tend to gravitate towards medicine. An advantage our American counterparts have over us is that they are required to graduate college before they make a decision as difficult as this. Four years of college gives you a lot more perspective. Years of studying, hard work, 80 hour weeks, 30 hour shifts, and measly wages for what seems like eternity —you really have to want to be a doctor to take the plunge. I believe it’s a fair price the profession asks of you, considering you are in the business of saving peoples’ lives. Nonetheless, I like to believe I was among the fortunate few to have chosen medicine for the right reasons.

Finding your specialty

Surprisingly, as one nears the end of medical school all the doubts kick in. You discover that finishing medical school was the easy part as you are now looking at a panorama of new choices. Was medical school the right choice?

Having completed medical school and vanquished lingering demons of self-doubt, the next task was to decide what field of medicine I wanted to pursue during my residency. This is probably among the easier decisions you will make. Invariably, by the time one graduates and has experienced, as a student and an intern, virtually every field of medicine through the interesting (albeit challenging) rotations through various departments, one tends to form a personality type. The slicing and dicing surgeonesque persona, an adrenaline junkie who feels at home in the ER, or perhaps the more intellectually inclined Internal Medicine specialist (I happen to be the last, so do pardon the bias) are all distinct characteristics medical students develop during their formative years.

In addition to your intrinsic preferences, the lifestyles and salaries that a specialty commands, is like night and day. However, the intense competition for the few residency slots often make people forgo their preferences and settle for the next best choice, or sometimes even for anything that might be available. It is generally at this stage when most Indians weigh in on whether to continue post-graduate medical studies in India or try to secure a medical residency abroad.

Flaws of the Indian Medical System

Apathy towards engineering, disdain for the arts and commerce are unfortunately why young Indians tend to gravitate towards medicine. An advantage our American counterparts have...is that they are required to graduate college before they make a decision as difficult as this.

The Indian medical education system has many flaws including a terrible shortage of training centers for doctors. Barring a handful of world-class government training hospitals that are accessible to everyone, most teaching hospitals are out to make a quick buck at the expense of medical students. Much like the sale of cattle, residency seats are auctioned to the highest bidder with absolute disregard for merit.

The regulatory system is dysfunctional because the people in government who are in charge of regulation often possess interests in the private colleges that benefit monetarily from the sale of these residency positions. What remains, is a handful of post-graduate seats in a few good government centers that are up for grabs to the thousands of graduates pouring out from medical schools all over the country. Add to that, reservations, quotas, affirmative action, call it what you may, and the odds of getting into a good college are even less. Another grouse I had with the Indian medical education system was the poor wages paid to junior doctors. During training, which generally extends into a person’s thirties, doctors are paid a pittance in India. I found the idea of being financially dependent through these years, unappealing.

Tough Battlefield for Residencies Abroad

Years of studying, hard work, 80 hour weeks, 30 hour shifts, and measly wages for what seems like eternity — you really have to want to be a doctor to take the plunge.

Given the obstacles in India, a large number of medical students predictably flock to greener pastures abroad. That having been said, landing a residency abroad is not easy. The UK, which for many years was a happy hunting ground for Indian doctors has all but slammed shut its doors to young Indians for the past two years. New regulations require all EU passport holders to be considered for any position before the spot can be given to a non-EU passport holder. This measure sprang up to tamp down unemployment among their own doctors in the face of stiff competition from doctors from the subcontinent.

Australia is another option, but the system for foreign doctors in Australia is not structured. As a result, not many foreign doctors put their eggs in that basket. Singapore is now emerging as a destination for young doctors, though in many ways, it remains unexplored territory.

That leaves the United States which has traditionally exerted a pull on young South Asian doctors. However, there are caveats to taking the American route for your medical studies. For starters, residency programs prefer medical students who graduate from American medical schools as they are familiar with the US medical system. Therefore, foreign medical graduates need to build up their CVs with strong clinical experience and/or research, again preferably in the US. Despite having all this on a resume, foreign students still find themselves at a disadvantage when competing with US medical graduates.

The Pull of the US for International Students

Invariably, by the time one graduates and has experienced, as a student and an intern, virtually every field of medicine through the interesting…rotations through various departments, one tends to form a personality type.

After weighing all my options, or lack thereof, I concluded America was probably my best shot. The desire for quality education and financial independence drove my decision. Residents get paid USD 40,000 to USD 55,000 during training and substantially more once they finish. For all these reasons and more, there are droves of doctors like me from all over the world, who compete for limited positions, so I harbored no illusions that it would be an easy ride.

Getting to America was a long, laborious and expensive process which took meticulous planning and an equal amount of hard work. Multiple exams, endless days and nights spent researching programs, corresponding with seniors, uncles, aunts and anyone who had gone through the process, a forest worth of paperwork, two trips to the US preceded by a perfunctory visit to the friendly neighborhood consulate official, crisscrossing America in the middle of a winter that the Al Gore mafia called the worst ever to attend a dozen or so interviews (for a tropic born and bred first-timer like me -20 degrees can take its toll), dissecting the Internet for cheap airline tickets and hotel rooms — all this while trying to maintain my sanity, knowing that for some of us this entire process was going to be a fruitless exercise.

The long wait

The Indian medical education system has many flaws…Barring a handful of world-class government training hospitals that are accessible to everyone, most teaching hospitals are out to make a quick buck at the expense of medical students.

It was almost two years after it all began when I finally got news that I had been accepted to the Good Samaritan Hospital Internal Medicine residency program in Baltimore. I moved to Baltimore in June and started my residency training a few days later. I have made some friends, interacted with inspirational doctors and teachers and helped patients. Six months into the program, the easy part was getting used to the long hours, weekends at the hospital and waking up at 5.30 am (a luxury I can afford only because the hospital is just five minutes away!).

I am still coming to grips with my furniture-less apartment, the indispensable nature of Google Maps and the art of ironing shirts (I have new respect for my dhobi back in India). The hunt for an affordable second-hand car in this supposedly slumped market is an ongoing endeavor. Cooking is one exercise I have steered clear of thus far, and with it, breakfast and dinner, thanks largely to the free lunch I’m entitled to at the hospital. There are the occasional days which leave me frustrated and disgruntled, but as I leave the hospital on those exasperating days, I can’t help but smile to myself as I see the shiny Mercs lined up in the ‘reserved’ doctors’ parking lot!

Dhruv Joshi is doing his medical residency in Internal Medicine at the Good Samaritan Hospital in Baltimore.