For an Indian medical graduate, choosing specialty after MBBS is most often, if not always, harder than choosing his/her spouse. With more than 30 specialties to choose from, and most of them not being introduced thoroughly at the undergraduate level, things only get harder as time for final decision comes. I also was not different.
I come from a family where I am the first doctor in not just my own lineage but from two villages my parents come from. No one even in my faraway relatives had become a doctor before me, so by default knowledge of medicine as a career field was a completely alien concept for us. Once I somehow entered the medical college, in the initial years of MBBS I thought as I hate to read much and have a good enough physique to powerlift stuff around, Orthopaedics would be the best option for me, but the lack of diagnostic thrill and extremely hectic work life of a surgeon turned me away from it.
During the final years of my MBBS, my interest turned towards the most hyped branch of medicine, the Internal/General Medicine. It was having everything I wanted, great diagnostic thrill of Sherlock, very wide knowledge base, and a lot of prestige. I worked very hard from 3rd year onwards to fulfill that dream. I had 2 amazing friends in hostel, Suman and Vishnu, them and constant grind of coaching videos and mcqs became my world for next 2 years. Like any other Aiimsonian, my plan also was to get back into Aiims somehow, but the path to Internal Medicine in Aiims is not an easy one. You have to come into the top 100 of the country out of odd 70k people. A very peculiar type of training and I will say a good amount of luck is needed to grab that position.
I gave my first INI-CET exam at end of internship in Nov 2020. I specially remember that I still had many unfinished subjects and attempted only 140 questions out of 200, even then, the result was pretty surprising for me as I had achieved ~5500 rank which was pretty astounding for an unprepared first attempt. That superiority complex crept into me knowing that I secured a better rank than a lot of my seniors who had already taken one or two drops, but little did I know destiny had multiple reality checks in store for me in the near future.
I took the drop in 2021 and because of COVID-19, NEET PG had been shifted to the latter part of the year. I faced May INI-CET and to my utter disappointment and surprise after around 6 months of extra hard work with complete preparation, I got ~8500 rank. I was completely disheartened, I couldn't comprehend how that happened, with incomplete preparation i had got 5.5k but now after completing everything I dropped to 8.5k? I gathered myself again somehow thinking it was just bad luck and restarted my studies with even more strength.
Comes September 2021, that infamous NEET PG exam finally happened after multiple delays. By this time I was running on fumes, constant grinding for more than 3 years was showing its sign on me. I was getting nauseous even by seeing the books, which continues to this day somehow. Even with all the energy drain I kept preparing till last day and gave the exam, which according to me went pretty good. I remember my friends asking me how much rank I was expecting in that exam and I replied by saying that it can be anything below 10,000 depending on my luck, but even with the worst luck ever i could have in my life, it should not slip below 14-15,000. Maybe the God was checking my balance sheet of past bad karmas that time when he heard my saying that. I got 14251 rank!
The dreams of General Medicine were almost slipping, as with that rank I could have got DNB only and that too in the most peripheral locations of the country and even getting that would be requiring a pinch of luck which I definitely was missing that year. I still had one chance left, the Nov INI-CET exam, I gave that and got an unpleasant surprise yet again, my rank came 5500! After one year of extra hardwork, mammoth leap in knowledge, hours of grinding, constant good ranks in mock tests, I was somehow standing exactly at the same place from where I had started one year back. It felt like all that sweat and hardwork was for nothing, I was extremely heartbroken.
Give your best and whatever be the result later you won't regret it.
This everyone says but no one tells that when you have not succeeded after sacrificing everything and giving every ounce of yourself, you start to question your own abilities. The failure after your best efforts is the worst kind of failure, as you don't know what more to do, it completely shatters your self-confidence and puts a big dent on your ego.
I was at the boundary rank of 14k, with previous year medicine rank going upto 18k I was sort of in a safe zone but I realized that every year as the DNB was getting popular, there was a negative shift in General Medicine by 3-4,000 rank. So I was again in a dilemma on whether I should continue to study or not. Seeing me frustrated and unable to make a decision, my parents stepped up and decided to go for an educational loan for PG just in case I misses the DNB by any chance. Finally that sigh of relief came as I stopped my preparation after around 3 years and started my detailed analysis of the counselling process.
As I was going through the previous years' trends, I got to know the existence of many branches I had never heard of before like Nuclear Medicine, Palliative Medicine, and yeah, Family Medicine. I tried to understand what each branch was and what it does. When I was starting on Family Medicine I thought it's a new name for PSM only but when I delved deeper into it, I realized it's the most hardcore clinical branch I could ever dream of. It was matching all my criterias like vast knowledge base, the thrill of diagnosis, independency, and most importantly it was a end branch, so there was no need to specialize which I always hated.
As I learned more about it, it was a holistic branch that deals with the person having the disease and not the disease in a person. You see not just adults but a whole family, you see kids, husbands, their wives, grandparents, and everyone, and this branch makes you competent enough to deal with almost anything thrown at you with ease. It deals at primary and secondary level of care, in which falls the majority of the patients, so your customer base is extremely huge. In Western world, these are the doctors who are the first line of contact for a Patient to the healthcare, so being called The Gatekeepers of Healthcare, and it is their responsibility to seek for specialist consultation when they deem it necessary. They are the ones to whom the patient consults the most and this repetitive pattern turns into a interpersonal relationship of trust. The doctor who is treating you, your small kid, and your pregnant wife at the same time becomes like a Health leader of that family and guides them in taking major health decisions of their life.
I even saw the first timers opportunity in this branch. As it is comparatively new in India, the slate is completely clean, whatever I do here in this branch will go far and wide and will be much more recognized than what I do in any other old super saturated field. The efforts I'll need to put for a similar impact would be much lesser in Family Medicine than any of the old branches. Obviously, the old branches give you the cushion of security and predictability, but Family Medicine overcompensates it with opportunities, adventure, and extremely wide knowledge base.
But as every moon has a dark spot, Family Medicine was not different. Even with Family Medicine doctors having the capability to decongest the overloaded hospitals of the country and decrease the healthcare spending by billions, Govt of India has yet to appreciate their role in Healthcare and job opportunities in Govt and private sector are limited as of now. This was not a problem for me as I never wanted to work under someone and have always wanted to do my own independent work.
The other major problem was of prestige. Family Physicians all over the world have to suffer this prestige issue, as not being an organ specific doctor, you end up being a Generalist Specialist among your colleagues and while your patients will be giving you utmost respect, you will be getting looked down by your own colleagues. This was the only issue I was having, I don't actually care much about any other problem but self-respect and ego are very dear to me. My gut had already indicated what I needed to do but this prestige issue didn't let me reach a final decision for a long time.
To make my decision concrete I discussed about it with everyone I could find, my parents, friends, practising Family Physicians, other Physicians, my neighbour's dog and what not. Everyone was extremely supportive of that decision but left the responsibility to take the final decision to me only. Unable to make a decision, at the end of November, I sat down and made a comprehensive pros and cons list on Family vs Internal Medicine tackling minute-to-minute detail covering from practical, financial to future and emotional aspects of it. After hours of brainstorming that day I finally decided to take up Family Medicine. It was very hard to overcome that prestige issue in me but I realized that satisfaction of treating huge variety of patients and getting their respect will be much more important for me than anything else, and when your patients respect you everyone else follows the same. That deep intuitive feeling also played a role in my decision, it reminded me again and again that it is Family Medicine(FM) which is meant for me.
Comes the day of counselling, my rank was pretty great from FM perspective, I could easily grab the top FM institute of the country, Sir Ganga Ram Hospital. I was sure of getting it in the first or second round, and after living 5+ years in Patna, I wanted to be near to home, so I just filled 3 choices in counselling, all in Delhi-Sir Ganga Ram Hospital, St. Stephen's Hospital and Maharaja Agrasen Hospital. In first round, I got St. Stephen's Hospital which was upgraded to my first choice Sir Ganga Ram Hospital in second round. With all the ugly twists and turns for over a year, I was finally where I was meant to be and I am extremely happy to be where I am.
Now while writing this article in second year of my PG and looking back, it seems like it was all the play of destiny, if all that had not happened, I would not have had landed here. I was thinking to directly talk about what FM is and not talk about my journey, but I realized there are innumerable people like me who are still going through the hardships of securing a PG seat.
This article is dedicated to all the hardworking doctors of this country working hard against all odds to pass this hurdle of PG examination. I know your journey is going tough and you feel suffocated sometimes, but don't worry, keep working hard and one day you'll reach your destination, it might not be where you want to be right now, but it'll surely be where you are meant to be.