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series of blog posts that could function as a repository for such future queries (till such time as the content becomes outdated).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.

This is the fourth in a series of ten posts. Read the previous posts here:

PSM as a Career Option: #1 Why Choose PSM?

PSM as a Career Option: #2 Is Delhi the Best Place for Doing MD in PSM?

PSM as a Career Option: #3 What do we Learn in MD PSM and does it Help Later in Life?

Will there be any regrets if one is interested in a non-surgical clinical branch and ends up in PSM?

AND

Can one still practice as a GP after doing MD? I went through the websites of few institutes which offer fellowship programmes but none of them had MD (PSM) in the eligibility criteria. IGNOU degrees, I’m told, help neither clinically nor add weight to resume. Correct me if I’m wrong, sir.

This is an extremely personal sort of an issue and I believe I shall be generalizing far too much if I offered a blanket answer for this. I can, however, provide anecdotal evidence to support what is largely my personal opinion. From the little that I have seen, I can say, that this is an issue that cuts both ways, the proverbial double edged sword.

Unfortunately, the truth of the matter is that a large proportion of the students who end up choosing PSM or Community Medicine only do it as a back up resort. There are several people I know who have voluntarily taken up the subject ahead of other “more clinical branches”, but we are a minority. I know of people who were forced into doing PSM for one reason or another though it was not their first choice by a large distance, yet, who ended up falling in love with the subject and committing to a career in it. I also know of people who picked up the subject voluntarily, of their own free will, and ended up regretting it every single day – going as far as contemplating quitting the field altogether.

There are stories on the both sides, and as I have said before, the opportunities as a PSM MD are no worse than any other discipline. However, the real issue lies with the person who is concerned. If they are totally interested in a non-surgical clinical branch (like I was), settling for PSM might not be the best idea. As your question clearly indicates, for you, “ending up in PSM” is not quite a desirable outcome. If you see yourself as a clinician, doing OPD work and daily clinic work day-in-day-out, then, by all means, pursue your dreams. Believe in yourself, back your abilities and study for another year and see if the PGMEE Gods are kind to you!

If, however, you think that you have the skills that could make you a good student of this rather oddball subject, and you are ready to live with the choice, then pick up PSM and commit yourself to it. There is nothing worse than “settling for” a subject, and then not being committed to excel at it. Whatever the choice, once it is taken, there is no need to rethink it or rehash the past; the best way forward is to “accept” the situation and make the best of it.

I know a lot of students are wary of dropping a year, especially those who have already dropped one or two years prior. The uncertain nature of the PG entrance exams virtually guarantees that every year you drop, you start from square one. In my eyes, preparing for PG exams is a process which has a particularly strong Markov Property!* But the game of life is a long, complex one. If you have a dream, then by all means, you should chase it. At least you would not die wondering, and you would not live the rest of your life regretting the fact that you picked the wrong subject to spend your life with. The main reason why people burn out or end up with a mediocre and dissatisfying career pathway is that they keep resenting their choice instead of embracing it, and moving on with their lives.

A lot of posts on the forums are negative when it comes to picking PSM as a career option. There are several very vocal critics of the subject, and some of them are students of the subject. Always listen to these people very closely, because they might give you a hint of what can be the worst case scenario you might get stuck in. Remember this: nobody will hold a gun to your head and make you pick the subject. It will be your choice. This is what you are being compelled to do! And you should focus on being the best, making the best of it. Cribbing and crying and regretting picking up PSM despite having a “non-surgical clinical” dream is a waste of time.

As for being a General Practitioner, you are eligible to practice medicine if you have an MBBS degree and are licensed by the state council and/or the Medical Council of India. I am not sure which fellowships you are talking about, but after an MD in PSM, there are no chances of doing DM or other super specialty training. Although I have been hearing about the impending announcement of DM courses in areas like epidemiology and health economics and such for the last couple of years, I have never actually seen any concrete evidence of these being anything but rumors.

If you are hell bent on making it work as a private practitioner, there are several other workarounds. One thing that PSM MD course virtually guarantees is that you shall have a lot of free time on your hands. As a PG student of PSM you shall be the envy of your colleagues in the clinical branch – at least your quality of life will be something they shall yearn for. While they are pulling insane 48/72 hour shifts in the OTs and wards and emergencies, you are virtually free by 4 PM (and even earlier, in most places). You could utilize this time to land an MRCP degree or do a certification course like one of the courses offered by PHFI (like the certificate course in evidence based management of diabetes) or take any number of short courses or distance learning courses to boost your CV and your learning. It is true that unless a course is MCI recognized (which almost none of these courses are), there are no tangible benefits except for the bit of vanity an additional degree offers, and the expertise that might result from intensively doing a well-planned course. There are a lot of IGNOU degrees that one would be eligible for, but, once again, as you have pointed out, they might just be a waste of time as, from what I have heard, all you do is pay them for the money and eventually sit for the exam and hopefully, pass it. Investing time in an MRCP degree could be a much more viable alternative, if you are picking PSM solely to land up with the tag of an “MD” and then plan to set up your own practice. Personally, I would strongly disapprove of this route because there is so much to do in the subject and so many opportunities just waiting to be exploited, settling for just the MD tag would be a sad outcome!

At the end of the day, as a private practitioner, your commitment is to your patient. Whether or not you are a good doctor, and have the clinical knowledge or skills to help your patient is not determined by your MD PSM status. I know several doctors, who are excellent clinicians and have very busy practices, although they are “just” MD in PSM! If you invest time and energy in yourself, you can do whatever you want to! But if you cannot handle living in the dark shadow of a clinical hangover that does not get mitigated by your day to day work, it is better you not choose this discipline, and fight for another year.

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!

 Markov Property:

Wikipedia explains this quite well:

In probability theory and statistics, the term Markov property refers to the memoryless property of a stochastic process. It is named after the Russian mathematician Andrey Markov.^[1]

A stochastic process has the Markov property if the conditional probability distribution of future states of the process (conditional on both past and present states) depends only upon the present state, not on the sequence of events that preceded it. A process with this property is called a Markov process. The term strong Markov property is similar to the Markov property, except that the meaning of “present” is defined in terms of a random variable known as a stopping time. Both the terms “Markov property” and “strong Markov property” have been used in connection with a particular “memoryless” property of the exponential distribution.^[2]

The term Markov assumption is used to describe a model where the Markov property is assumed to hold, such as a hidden Markov model.

A Markov random field^[3] extends this property to two or more dimensions or to random variables defined for an interconnected network of items. An example of a model for such a field is the Ising model.

A discrete-time stochastic process satisfying the Markov property is known as a Markov chain.