PSM as a Career Option #7: Finding the right job after MD PSM/Community Medicine – A 7-step Guide

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, 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 is the seventh 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

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

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. 

---

After my previous blog post, I talked to a friend who is still in training, and whose opinion I hold in very high regard. He suggested I take the next step and write about how to approach the process of finding a job for PSM graduates who are at the beginning of their third year of MD or in their Senior Residency and are looking for jobs. He also suggested an idea that I am toying with – of creating a series of videos, simply talking to folks about their career choices and working in the discipline. Being the lazy person that I am, of course, I am yet to overthink the heck out of it, so I do not know if I will go ahead and do it, but it does seem like an idea worth pursuing. Also, he assures me that blogging is dead and that video is the new medium, but, honestly, for what its worth, I write on this blog more as a sounding board to air out my ideas and thoughts, without any regard for monetization or SEO or all those things.

Anyway, that being said, I have had these discussions about finding jobs or choosing between jobs with many friends and juniors and I have come to realize that I am perhaps the worst person to talk about these things. I have an inordinately high threshold for risk, and am very willing to jump from one safe, conventional option to a more uncertain, unconventional one, if it appeals to me intellectually. For instance, after my MD, I managed to get Senior Residency positions in several very highly regarded institutions, including UCMS, my alma mater. But I chose to not join any of those and instead went to work in PHFI, an incredible fulfilling choice! When I moved from PHFI to ICMR, I prioritized the fact that at ICMR I would have the ability to lead my own projects (compared to working as a research staff in PHFI). I prioritized that, and overlooked a major pay cut – something all job-hunters are advised against. For me, the promise of the professional and personal fulfillment at ICMR more than compensated for the loss in income.

Again, after settling down and doing some fun, impactful work in ICMR-NICED in Kolkata, I jumped ship to go work with a mentor in New Delhi, who was bringing in disruptive innovation to the ICMR way of thinking. I jumped in without having a clear understanding of what the position entailed. Yet another advice that all job-hunters should heed – “Look before you leap!” I bypassed that because after talking to the mentor/boss, I was convinced that more than the job, he was invested in me being successful in the kind of work I wanted to do. He promised me an extent of autonomy and independent thinking otherwise difficult to find in more hierarchical settings. Again, a choice that was counter-intuitive, but one for which I am much better off today.

Tracking back to my PG entrance days *shudders with horror*, I chose to study PSM over other more conventional, clinical options, like surgery, ObGyn, etc. – a choice that a lot of my well-wishers were unable to understand. Now that I am a decade into my public health life, I have a lot of thoughts about this choice, and maybe someday, I will write about it. Anyway, all these disclaimers being out of the way, here are my strategies for preparing yourself for the job market once you are done with your MD training or Senior Residency in PSM or CM. Take it or leave it, but do realize that these are very personal opinions, and can be entirely off target. As always, my bloggy wisdom and He Who Must Not Be Named’s survival analysis, both come in sevens!

1. The major categories of jobs

While this may be a bit of an oversimplification, the major categories of jobs that one can land after MD or SR-ship in PSM include the following:

1. Academia: The usual SR to Assistant Prof to Professor route. Not going to elaborate more on this because this is perhaps the most well-known career pathway.
2. Research: Public health research, working with agencies like the ICMR institutes, PHFI, CHRD SAS, George Institute, etc. just to name a few. There are many large, medium and small sized government and non-government bodies working on public health research.
3. Implementation NGOs: These represent on-the-ground jobs, executing project or program deliverables, often working on the delivery or M&E of public health programs. Some common employers in this field include JHPIEGO, CHAI, CARE, PATH, and so many others.
4. Multilateral agencies: WHO, UNICEF… these agencies can hire for national or international services on a wide range of jobs. Starting from roster of consultants to line staffing, these positions are some of the most coveted jobs for most public health students.
5. Government agencies: Like the state or central public service commissions. These may often result in jobs as General Duty or Specialist Grade Medical Officers. There is also the option of working in health administration after completing the Community Health Administration MD degree – now this is something that I have absolutely no idea about. I learnt about it when a few seniors working in this arena were kind enough to share their perspectives after my last post.
6. Program implementation: Just what it says. You can work in various capacity in implementing public health programs, either working directly with the program or with other NGOs or agencies involved in program implementation. For instance, one of the young global health leaders from India, a contemporary public health colleague, started off working with an NGO that was associated with public health service delivery and policymaking in the field of malaria.
7. Private sector: Often in pharmaceuticals or hospital administration. I personally do not have a lot of experience about these positions, so I would love to hear from folks who are working in these sectors.
8. Humanitarian health: An emerging trend, the most popular recruiter in India is MSF or Doctors Without Borders. Nationally, I have heard excellent things about Doctors For You.
9. Clinical public health: Also known as Family Medicine. Jokes aside, very few MD programs in PSM actually give us good training in performing a clinical role. We do run community clinics, but rarely have the mentorship and rigor needed to learn evidence based care. Some people end up taking more courses (like the diabetes course from PHFI or some other certificate courses from the BMJ group, IGNOU, etc. None of them are actually MCI/NMC recognized, to the best of my knowledge) and branching into general practice. My personal opinion is – if this is the workflow that calls out to you DO NOT pursue a career in PSM. Go choose a different, clinical discipline that can better equip you to build the clinical skills you need to serve your patients the best. The Academy of Family Physicians of India website has a lot of great resources and networks you can look up to understand more about the career opportunities and pitfalls in this field.
10. Public health entrepreneurship: Honestly, the newest of all these categories, this remains a fairly unexplored terrain. Off the top of my head, I know of at least two people who have branched out into this exciting, high risk-high reward workflow.

As you will note, some of these categories are not water-tight and will have overlap with other categories of jobs. As intersectoral professionals, that is something which is very likely to happen in our professional lives, so don’t sweat it. Also, this list is entirely based on personal opinions and not a strict and systematic analysis (not beyond anything I have done in course of my job searches, anyway) of job profiles. Did I miss any major categories of jobs? Let me know! I am working on a more in-depth post describing the workings of these nine categories of public health jobs and hope to drop it some time next week. Stay tuned in to catch it.

2. What is your ikigai?

Given the wide spectrum of jobs available, the next question is: What kind of a job will give you a sense of joy and fulfilment? That is where the concept of Ikigai comes in. This concept basically states that there is a slim overlap between jobs that you are good at, that can pay you for subsistence, are good for the people or society in general, and you are passionate about. If you can find a job that lands bang in the middle of the cross-section of these attributes, you have found your ikigai. Unfortunately, as great as it sounds, I find myself wondering if such jobs truly exist.

Let me know if you feel like your job lands in the sweet spot and I would love to pick your brain about how you got into it!

3. Who are you? What is your risk appetite?

One thing I have noted is that those who made forays into the more unconventional career trajectories had to take a fair amount of risk to get there. Speaking for myself, I can say that at several critical junctures in my career, I chose to branch out and take the less trodden path – certainly a risky move. I was speaking with a much more risk averse friend a few weeks back, and we were going through some of the job opportunities they had before them. An incredibly talented individual, I remain convinced that they would reach incredible heights of success in whichever field they chose. However, they had the amazing insight of recognizing that they were risk averse when it came to job choices and preferred the certain over the blurry. Whilst I would often go the other way, in speaking with them, I realized that the quantum of risk one is willing to take will often help in making decisions.

One thing goes without saying – the deeper one goes into their career, the more risk averse they become. This is only natural. So, do the crazy things early, I would say. Want to launch a start-up? Be an upstart and start it up in your MD final year (ahem, risky advice that can backfire during the MD final vivas, for sure – if you get my hint!). Want to join Doctors Without Borders and go work as an epidemiologist tracking outbreaks or describing the epidemiology of nodding disease in South Sudan? Make it your first job application! Want to explore working in rural, underserved areas of India? Go find a position with Jan Swasthya Sahyog when you graduate.

Whatever you do, start with understanding who you are and how you can get to your ikigai!

4. Scoping the job market

One thing that I keep mentioning, and which also found its way in my last PSM as a Career post, is knowing more about your dream job(s). In this post, I would also add that temper your dream jobs with a bit of the reality. Get a good sense of the kind of positions that are out there, for which you might be a good fit. Subscribing to job boards can be a good starting point. LinkedIn can also be helpful.

5. Creating a peer-support group

One thing that has really come up and become a big source of information on upskilling oneself and keeping abreast of the current job and market trends is leveraging the power of social media and messaging apps such as WhatsApp and Telegram. Make sure you are on the groups which are more active and have a more enriched cache of academic discussions. Fostering smaller peer support groups can also be of great help, especially if you are not great at keeping up with the firehose of information that the social media today can be. These groups are hard to develop, as it may be difficult to nucleate a small, dedicated, and like-minded group of friends and contemporary professionals. One reason that makes it more difficult to maintain these kinds of support systems is that you all will end up competing for the same jobs quite often. But, if you can manage to transcend these (petty) competitive rat races, it will prove to be a helpful tool in the toolbox that is your public health professional career.

6. Reality bites

One thing that I did not sometimes take into account when making my own career choices were the constraints of reality. Unfortunately, they have often caused a lot of heartache and heartburn for me. So, assess where you stand. Do you have a lot of dependent family members, and your immediate physical presence is essential for them? Then maybe moving for a couple of years to South Sudan to work with Doctors Without Borders is not for you. Are you paying off a home loan or an educational loan or have some other financial obligations in the form of an EMI every month? Then job pay may become more important than a lot of the other “soft” perks. Another issue that often constrain us is the so-called “two-body problem”. An issue for those of us who are already married or about to be married, an ideal job also comes with geographic constrains for both spouses. Personally, I was in a long distance relationship for a fairly long time, as we both were working through our own career pathways. This is not something I would recommend – for obvious reasons – but I also recognize that the world today is much smaller, and work from home is a more acceptable alternative. Whatever be your considerations, the older we grow, the more our reality pulls us in a direction. Knowing these pulls will prevent the occurrence of shearing forces in life and career.

7. Warning signs

And last, but surely not the least, be on the lookout for warning signs about a job you are targeting. Speak to people who are working there, or better still, worked in that position prior to you. Why did they leave? What was the working condition like? How were the colleagues? How was/were the boss/es? How does the institute leadership treat early to mid-career employees (which we are most likely to be)?

With LinkedIn gaining a lot of momentum, it would not be very difficult finding folks who are currently, or were in the recent past, affiliated to your prospective employer. Reach out to them, drop them a message saying you are interested in talking to them about their job and pick their brain for advice on succeeding in the position. Of course, be wary of what you speak, who you are speaking to and what dynamics there are – you do not want to trigger unwanted red flags or work cliques.

One key thing is to work conscientiously during your MD training or Senior Residency to develop a strong grip over the core competencies of epidemiology, biostatistics, and program management, and developing a niche area of interest. This will define your professional identity and help you find the right path forward. ALso, to be honest, a lot of the decisions I took in my short career could have easily backfired and landed me in trouble. Instead, most of them tended to work out – and I am thankful for having the good fortune to experience that. So whilst there is a definite role in preparing and planning, the X-factor (call it what you will) still has some role to play! Have any comments or words of wisdom to share? Feel free to drop them in the comments below!