Repost from an old blog post, because it is the time of the year when emails from confused would-be PSM/Community Medicine MDs start trickling into my inbox…
Each year, around the time of AIPG counseling, I get a fair number of emails asking about PSM as a career option. These question are mostly from students who have not really considered PSM as a career option, and hence, do not have the information or evidence needed to take an informed call. I usually try my best to provide what I think is my evidence based opinion (yeah, that is an oxymoron right there!). This year, I received an exceptionally well worded email, articulating the questions in a very cogent and coherent manner, and I thought that I could use my responses to frame a series of blog posts that could function as a repository for such future queries (till such time as the content becomes outdated). In the subsequent posts, I shall try to make the case for, and against, joining PSM as a career option, based on the questions posed to me this time around. Hopefully these shall help clarify your doubts, and if not, feel free to write in to me!
Disclaimer: Please note that I am not liable for the outcomes of any decisions (whether positive or negative) that you have taken based on the information I provide in this blog. This is my studied opinion and for all practical purposes, they may be off base and totally wrong. Please do not judge everything I say here to be the ultimate truth.
Q1. Why choose PSM? Like a person interested in Surgery says the scalpel gives him/her the chance to be a ‘savior’ or a person interested in Emergency Medicine says it gives some sorta high to be doing the procedures, why choose PSM?
Also, are there any qualities that a doctor requires to make a good epidemiologist?
PSM is a rather new branch and is yet to find a footing in the traditional medical system. Whilst the concept of preventive medicine and public health, or epidemiology, have been around for a while now, it is only of late that the global community is awakening to the possibilities these disciplines present for us. Unfortunately, in India, in my opinion, the system has not matured to the point where the competencies of a Preventive Medicine specialist can be fully harnessed.
The question “why choose PSM” is difficult to answer because, in all honesty, few people, if any, choose the subject. I made the call to pick PSM ahead of some other options (in the spirit of full disclosure – I was not making it to my first choice subject, Internal Medicine, in an institute of my choice, making me consider alternate routes). In fact, we need some sort of assessment to see why people are picking whatever disciplines they are picking (not just PSM) and what are their hopes, dreams, aspirations going in, and whether they are being fulfilled in the long run.
One thing that can be said is that the career options are no worse in PSM than in other disciplines, though one has to travel off the beaten tracks in order to appreciate the width of the opportunities afforded by the subject. It gives an easy life – there are no night duties, no emergency hours, work hours are decent – some things which get really important when it comes to striking a good work-life balance (something which is getting harder to achieve for some of the more competitive clinical fields).
In addition, it provides an avenue for training in a number of multidisciplinary fields like biostatistics, epidemiology, policy making or even grants administration, making a career in research very viable. It gives you an opportunity to work in the development sector, and get into the emerging field of CSR driven activities, public health related activites (jobs or funding may even be sourced from primarily non-health stakeholders) and international aid.
With a greater emphasis on research as a critical competency for evidence based medicine practice, it may not be an overstatement to say that in the coming days, a PSM specialist would be an integral part of clinical decision making teams.
That said, the biggest obstacle remains within the discipline itself. The inability of the PSM fraternity to look beyond the defined boundaries is restricting. I shall give an example from my life – despite landing an amazing job with immense potential for career growth and academic excellence, when I was offered the position of Senior Resident in a government hospital (actually, it was the University College of Medical Sciences, my alma mater!) I was actually in a major quandary – because, very few grads actually venture out into the vast unknowns! Although I did take the step and chose to turn down the really lucrative offer of Senior Residency in a leading government hospital, and arguably, one of the best academic PSM departments, (and therefore, closed the option of going into Academic PSM in most places in India) I must say I have had a lot of indecision plaguing me over it. It feels good to finally acknowledge this, because, despite being the kind of person who does not hold back from taking calculated risks, this felt like a major gamble… one can only hope it works out in the longer run.
Another thing that I perceive about the discipline is that there is a MASSIVE sense of identity crisis. Are we a clinical branch or not? Are we public health specialists? Are we supposed to be included in the policy making discussions? What role should we play in a hospital? Should we be a part of patient care process? If so, in what capacity? What is our spectrum of professional competency now that MPHs and Family Medicine grads are coming out a dime a dozen? Is it just one of the “dead weight” disciplines which private colleges grind their teeth and bear for MCI’s sake or can we actually become a profit-making entity? And over and above all – what is the name of our subject? Is it Preventive Medicine, or Preventive and Social Medicine (alternatively Social and Preventive Medicine), or Community Medicine, or Community Medicine and Family Medicine?
To answer the second part of the question, what makes a good epidemiologist, let me explore a more fundamental question – Is there anything in the way we are training PSM MDs today that makes them indispensible? For example, the USP of an anesthesia MD is that they are, and ONLY they are, equipped with the skills and knowledge to administer anesthesia. So, what is that skill which a PSM MD, and ONLY a PSM MD, can bring to the table? In my opinion, none. None of the skills that I have outlined in the previous response are the sole expertise domain for a PSM MD. I know this makes for a very controversial point and a lot of people will throw brickbats my way for saying this, but my feeling is that, as a recent PSM MD, I have not acquired any training in course of my MD from one of the best institutes for studying PSM, that cannot be mastered by doctors from other disciplines. To be honest, most of the policy making and public health work today are being done by people NOT from the PSM fraternity. At the national level, the policy discourse and a major public health organization is led by a cardiologist. Most of the advanced work in vaccines and child health are being led by pediatricians. In fact the Indian Academy of Pediatricians, through their vaccine policies and their journal, Indian Pediatrics, has done more for the public discourse of health related issues than has the PSM organs.
I am not saying that the PSM associations have not done anything at all, but I have felt that there could have been more coherent contributions to the public health domain from the subject experts.
So, I guess what I am trying to say is that you do not HAVE to be a PSM MD in order to be a good epidemiologist, or a great biostatistician. In fact, some of the best epidemiological minds I know of belong to people who have specialized in Microbiology, Pediatrics, Internal Medicine and Pathology! In my opinion, there is, at this moment, no particular field which is the sole expertise of PSM MDs. We are still, in large measure, a discipline of “Jack of all trades, master of none”. Unfortunately, I do not see any of that changing any time soon.
To summarize, life in PSM might be a bit different compared to the typical clinical discipline, but prospects wise, it is not all that different a ball game. So, you may choose PSM as it gives you a great quality of life, but prepare to be surrounded by mediocrity. You may choose PSM as it gives you the option of branching out into super interesting areas (like health economics, social determinants of health, global health, international health, research, funding and grants management, community interventions including clinical trials, and many more!) but prepare to be able to take a risk and walk the path less trodden. You may choose PSM as it gives you opportunities to do meaningful research, but prepare to slog very hard to find funding support for that, and to acquire skills that make you a good researcher. You may choose PSM because it is still an emerging subject and you can leave your mark on it, be a name to remember, but be prepared to suffer an identity crisis before you establish your identity.
If you have any queries regarding picking up Preventive Medicine/Social and Preventive Medicine/Preventive and Social Medicine/Community Medicine as a career option, please consider dropping me an email or leaving a comment in the box below!