PSM as a Career Option #6: 7 Strategies to Beat the 6-month itch!

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!). I have been off the blog for a while and mostly been interacting with folks over email or twitter. Until this one. I received a question on twitter, and chatted with the student for a bit. I decided to put up a rough transcript of what we talked about for this post.

This is the sixth post in the “PSM as a Career Option” series. 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?

PSM as a Career Option: #4 Will I Regret Choosing PSM if all I Want is a Clinical Branch?

PSM as a Career Option #5: Community Medicine Senior Residency in AIIMS

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 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. 

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I just had a long conversation with a recent entrant to the discipline, who was feeling a little lost and directionless after entering the MD Community Medicine course. It has been a mere six months, but they are already feeling underwhelmed, under-appreciated and losing motivation. While it usually takes a few more years for this kind of ennui to usually set in, it is not completely unheard of in recent MD entrants – something almost like a buyer’s regret. Questions start plaguing the mind. Did I make the right decision? Is there going to be a job at the end of the training? Will it pay well? Will I be respected as a member of the health profession? Should I retake the blasted entrance exams again? When will this pandemic end?

While I do not claim to have answers to any of these questions (and especially the last one), I can try to share some strategies that I have employed and which seem to have (more or less) worked for me – I am still persevering in public health, for what it’s worth. So, here goes my top seven tips (yes, like horcruxes, my bloggy wisdom comes in sevens) to counter that ennui and to figure out if PSM or Community Medicine is the right career choice for you.

Let me know if any of this makes sense. Drop your thoughts in the comments or write to me at my email. Got any strategies of your own? Add them to the list – drop them in the comments section!

1. There is an environment beyond your Department. 

A common refrain I have heard from some MD students is that they do not feel adequately inspired by the immediate environment in their respective departments. I realize that this is a serious allegation, and one I was fortunate never to experience. In fact, I had such an empowering and enabling experience at UCMS as an MD student, that I still hold those days as the gold standard against which all my educational and training experiences get compared to. However, I have heard variations on the theme – lack of role models, insipid seniors, uninspiring work experience in the department, etc etc – that many students face. While I understand there is a serious research project in this topic for IAPSM or IPHA to take up and move towards modifying the teaching-learning environment, my suggestion has always been that there is a larger environment beyond the immediate departmental milieu from which one can draw inspiration. 

One common source of inspiration is the community that we work with. There are so many stories to tell, so many problems to solve, so much human experiences to live through, that they make all the hurdles worth it. Connecting with peers across the nation through networks of IAPSM and IPHA young professionals is another way to expand your horizon. If there is a lack of inspiration immediately around you, cast a wider net!

Talk to people who have trodden the unusual career pathways. It is quite likely that most of the seniors in your medical college have followed the MD – Senior Resident – Assistant Prof. route, which is an incredibly fulfilling and challenging pathway. However, there are so many different experiences out there. You can find MD PSM folks who have worked in implementation and then gone on to lead WHO teams in Geneva; or health leaders who are championing AI/ML for vector borne diseases globally; or academics who have given up a research trajectory to trailblaze into the non-profit world; or experts who have literally built vaccine implementation pathways in India; or people who have led efforts to eliminate diseases; or researchers who have worked on intricately complex research questions, and published in incredibly high impact factor journals as very early career researchers; or … the list goes on and on. Reach out and talk to folks. See what kept them ticking – and I am fairly certain (pretty narrow 95% confidence interval) that all of them will admit to have gone through that sense of ennui and dejection at least once during their career pathways. Ask them how they beat it. Simple enough. 

2. Find out the “Top Five” things you aspire to. 

To paraphrase Cheshire Cat from Alice in Wonderland: “If you do not know where you want to go, any road will take you there…” On an unrelated note, I love that book. Every time I read it, I find something new to admire. Anyway coming back to this point. See if you can answer this question – what is/are my dream job(s)? I understand this might be a very difficult question to answer for many, and sometimes, looking through the websites of agencies you look up to (some three-letter organization that we all talk of) can help. Subscribe to DevNet job lists and see which vacancy calls excite you. Read about the research people are doing and see what sparks your fancy. Who in the news do you admire? Whose papers do you love reading? What is a career trajectory or job affiliation you aspire to? What is the public health problem that keeps you up at night? (I know, I went there, right to that cliché!)

One thing that could be a distraction in this step is if you are not able to sharply define the role you aspire to. For example, you may think you want to work in WHO or want to do administration – but that does not actually help you define the specific skills you need to develop (see points 5 and 6 below). The more sharply you define this “dream job”, the easier it will be for you to frame the pathway to get there. For instance, you can aspire to be the program manager for neglected tropical diseases in WHO SEARO. Or you can desire to be the Chief Operating Officer of Fortis Hospitals. Or you could want to be an Epidemiology Advisor to Medecins Sans Frontieres or Doctors Without Borders. The clearer the goal, the easier it is to chart the way to get there. 

I admit it might seem a little shallow to chase a job profile, but sometimes, when we feel a little lost and directionless, looking at a target can help in reigniting the need to connect to the work. What would you have to do to get there? It sets a goal and perhaps helps overcome the ennui that can become overwhelming at times. It is quite easy to get into the rut of the daily grind – and having a target can sometimes help beat that. 

3. Read about public health legends, their trials, travails and triumphs. 

In line with the previous tip, sometimes, it is hard to find an idol, a beacon, a figure to aspire to, an individual to inspire. If you are in that zone, read about the public health greats. One of the books that always inspires me (and that I keep recommending and gifting to folks) is “Mountains Beyond Mountains”, Tracy Kidder’s biography of Paul Farmer. Another one is the former MSF President James Orbinsky’s legendary book “An Imperfect Offering”. There are many many more… you can surely find a book suited to your interests. Reading these books provides a glimpse into the struggles that these greats had to go through, and how they kept themselves motivated and connected to the work. 

Dr. Madhukar Pai, one of my real life public health idols, maintains a living list of global health books. Whenever I am replenishing my Amazon wishlist, I go check it out. With over 200 books, the list is likely too huge to be read by any one person, but it does have some amazing recommendations and you can find interesting books to read from this crowdsourced and expert curated list.

4. Build your own community of support. 

One thing I have been eternally grateful for is the lasting friendships I have built wherever I have trained.  Whether it be my friends from my MBBS days, or the small cohort of public health minded folks that came together during my MD training, or even the small nucleus of social justice, health equity advocates that I have been connecting with during my PhD training of late, I have been fortunate to come in contact with people who inspire me every day.

It is very important to find people who have similar thoughts about health, medicine and the world. Honestly, they don’t need to be in Community Medicine/PSM. Some of my closest confidantes are health management folks, qualitative researchers, internal medicine people, health economists, pediatricians, and systems researchers. We are bonded by our common nerdy appreciation for health, justice, equity and sometimes, even history! 

How does one build these communities of support? Some you will meet through common platforms of discourse – at a conference, for example. Many others will be through serendipitous connections. Following hashtags on twitter, following facebook or insta trends can sometimes bring you more than your daily dose of memeological satisfaction.

These networks usually grow organically and slowly, but need to be nurtured and sustained once they do grow. Investing in such friends is worth it. It also opens up many opportunities to collaborate! Is the Internal Medicine fellow doing something or seeing something in the clinic that piques your interest? See if you can get together and write about it, or design a small research project to explore those problems/ideas. Building these communities of trust have helped me through some seriously confusing times, times when I had felt my career had stalled and I was stagnating in the profession. 

5. Identify core areas of interest and develop a “Theory of Change” for your career. 

Now that you have identified the heroes you aspire to emulate or job profiles you wish to land, you need to figure out what you need to do to get there. Yes, there are certain things that you will need to learn during your MD training to pass the exams, that will never again be of any use in your life. But we all need to get through those issues, so no point complaining about them. Aside from those minutiae, what are the things you need to do to get to where you want? Take a piece of paper and start working backwards. In 5 years after MD, I want to be at X position. For that, after my MD, I would need to acquire X, Y and Z experiences. For that, I would need to work with A, B or C organizations. To land those jobs, I would have to cultivate networks linked to the M field. To be proficient at these jobs, I would need to learn P, Q, and R things as an MD resident. Talk to people in those roles or on the trajectory to those roles and see how you can better prepare yourself. 

In general, some broad categories of competencies we should develop during our MD training are in epidemiology, biostatistics, some aspects of healthcare management and program implementation, some basic concepts of health economics, an ability to think critically and, most importantly, an ability to express oneself eloquently, both in writing and speech. While there are many, many resources that outline the basic skills one should acquire during a Master’s level training in public health some of the stuff on Dr. Madhukar Pai’s Teachepi site is a very good starting point. Having a clear goal can be incredibly helpful in setting this path. 

I realize this is easier said than done because I, myself, have been putting off doing this for a while. But yeah, I hope to walk the walk soon after I finish talking the talk… 

That being said, a lot of our career pathways are shaped by serendipitous encounters and chance occurrences. Some of these cannot be planned and manufactured. However, planning allows you to stay focused and create excellent competencies in certain fields. That cannot hurt! To be honest, I got my career start when my MD guide facilitated a conversation with someone who would end up being my first boss. It was a chance encounter, but the fact that I was gearing up for an epidemiology role and building my epidemiology skill set was instrumental in ensuring I landed the job right out of my MD residency training. 

6. Find out what motivates you and see if the profession offers those rewards. 

While you are charting out your career pathway and building your stairway to heaven, see if these things actually interest you. You will be surprised to learn that although you greatly admire the final outcome, you may completely hate the journey you need to take to get there. For instance, you might love the profile of the researcher scientist who publishes in the big journals, but you could end up hating the logistics of doing research. You might love the profile of the Director of a WHO division, but completely hate the political and diplomatic burden that comes with it. This is where setting a clear goal, as mentioned before, can be of help. 

7. Find a mentor. Easier said than done. 

While I keep this at the end, this is perhaps one of the most important (and difficult) things to do. Good mentorship is often sorely lacking in our training programs. I, for one, am absolutely indebted to the teaching and non-teaching staff of UCMS, without whose unflinching support I would perhaps be a lot more lost than I am now. I still feel like I have not been able to live up to the amazing mentorship, support and kindness I received during my MD training, and honestly, it is one of the factors that keeps me striving for more. 

One encouraging thing is that the IAPSM has started a program to connect young and early career Community Medicine professionals with established mentors in the field. This is an incredibly insightful effort and one which is fulfilling a major lacuna in our training system. However, I would like to point out, that in the aftermath of the pandemic, the world has become much smaller. It is much easier to get on zoom call or a google meet or a WhatsApp chat and connect with people who would have been spatially and temporally beyond our reach only a few years back. It is much easier to use social networks to connect With folks that inspire us or whose work we admire. So, finding mentors is perhaps not all that difficult, especially if one is also open to finding peer mentors!

I do realize that a lot of what I have written above is contingent on individual motivation and drive. While that is an important factor, it is also a good investment in building a skill set – perseverance, persistence and patience – which is essential to succeed in the field. 

So if you have the six-month, or one year or ten-year itch – remind yourself that there are incredible people who have taken the same journey as you, who have achieved amazing things, improved the lives of millions of people in indescribable ways. There is no reason why we cannot tread in their footsteps. They have left footprints that we can follow, even as we feel that we are “forlorn and shipwrecked”. 

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This is my first post in a while. What got me back to writing on the blog after a long hiatus was the realization that people still read my posts and reach out to me. It is so humbling to see that something that I do/did as a pastime is helping (or not) so many people even so many years down the line. I have been suffering from somewhat of a blogger’s block, debating whether my voice – as a person and as a professional – has changed too much to justify writing on this blog, which is now over 12 years old. I did start writing this as an intern! Maybe this will be the start of writing here again. Let’s see…