“Crisis in the mind of a student of Community Medicine”

“Crisis in the mind of a student of Community Medicine”

The discussion starts with queries, suggestions, comments posted on Modern Community Medicine, a group on facebook social network in September. As a student, teacher and practitioner  of Community Medicine/Public Health I decided to write down few lines from my own perception and little experience gained during post-MBBS period(January,2003-September,2011). I would definitely like to share with budding Community Medicine Specialists and the greats in this field.

First of all I would like to declare that, I am a proud “MD degree holder” in Community Medicine. To me Community Medicine in India has gone beyond the age of sanitation awakening, vector control...It is progressing towards a new horizon of Advanced Community Medicine Teaching (Academics), Health System Strengthening, Health System Administration & Management, Health System Research & Development etc. Today, large numbers of the Community Medicine(CM) experts are produced in India with respect to increased demand generated for them, than ever before. As a student of Community Medicine we have to raise ourselves and our quality to meet the above demands and prepare ourselves during post graduate training. I believe along with others that “A community medicine specialist without valid field experience will never make a good academician”.

 Let’s have a SWOT analysis with respect to deeply concerned career prosperity and identity crisis in Community Medicine. I am doing with Weakness(W), Opportunity(O) and Threats(T) first later we’ll go with Strength(S). Let’s examine these four real statements of professionals related to this discipline.

“…I am a first year post-graduate student of Community Medicine. From the day I joined in this subject I have listened stories stating the dilemma which a MD(community Medicine) faces. Even I am not able to explain to people what branch of medicine I am in. I had a tough time with an old woman of my village explaining this. So I finally ended up as a polio doctor who conducts pulse polio…”

“…if I am not convinced with my subject, I surely am not in a position to convince anyone else. I feel very uncomfortable and painful to learn that WHY we still do not have enough courage to speak about the subject which is going to earn bread and butter in the coming years...”

“…I have always felt that PG students from our branch feel a kind of insecurity. The reason for that can be unawareness regarding scope of our subject and availability of opportunities outside medical colleges after completion. It is very difficult to believe that Community Medicine is not a non clinical subject. PGs from other clinical branches do not have any doubt about their future and are very clear in their mind…”

“…what for the community medicine is? More precisely what for Modern community medicine is? It deals with UG/PG teaching only...research...consultancy (WHO/UNICEF/anyNGO) or management/administration(of health programme)..!!?? And still searching for answers...!!...”

I would like to address the crises/concerns arising in the mind of a 1^st year students of Community Medicine in getting due recognition in public life. An Identity crisis arises first. After taking this degree what specialist they will be called unlike cardiologist, gynaecologist, surgeons etc. How they will tell/explain a common man about their specialty? Not only the new comers into this discipline but also some elder degree holders still nurture the identity crisis in their mind.

Start of thinking and telling yourself and to others that you are going to be/are a “Community Medicine Specialist” only and only who will prevent the disease itself before it attacks a man by help of prophylactic drugs, vaccines, health education, preventive measures, preventive health check-ups and investigations. The way of taking help of polio tag is unacceptable and discouraging. Doesn’t it produce a sense of “Impersonation”? Once it made me laugh a lot when one of my wife's friend used to think that I was a polio doctor when I was a SMO in UP. I told my wife to tell her that “I am more than a polio doctor”. Still that lady rings my phone from UP for medical advice for ailments in her children. So raise yourself, rise above the identity crisis. Always try to find the best possible answer to your problems. Ask your peers and seniors for a solution. Eat, drink, talk and sleep with COMMUNITY MEDICINE and raise the standard and quality of this discipline.

There was a time when Current & Contemporary Greats of Community Medicine (Our beloved respected teachers) were called as “Jack of all Trades, Master of None”.  Actually it was not the problem with the system at all.  If you look deep into the subject matter of Community Medicine  you will find that our beautiful discipline overlaps and intersects with other disciplines like Paediatrics (in early neonatal care, infant growth, immunization,childhood nutrition and illnesses etc:eg. nothing but Preventive Paediatrics), Obstetrics & Gynaecology(in antenatal care, maternal health and nutrition, safe pregnancy and maternal survival:eg nothing but Preventive Obstetrics & Gynaecology) and Public Health(Health system management, health system strengthening, health system researches, national health program operation, health policy formulation etc: eg. nothing but Practical/Field Community Medicine).To conclude that the subject itself makes/metamorphose us into a “Five Star-Expert/a Jack/a Master of trades. Because a MD in Community Medicine knows about Reproductive & Child Health/ Occupation Health/Health Management & Administration/ Disease Epidemiology/ Teaching Technology/ Health Policy/ Immunization/ Nutrition science/ Conducting Research. Simply talking we deal with preventive aspects of every clinical subject. Then how and why should we be tagged “Non Clinical”??? Now we have to rise above this “identity crisis” by only introspecting the subject matter of this discipline. It demands in that manner. We have to look after the preventive health of human from womb to tomb along with health system’s needs as policy maker, planner, manager, administrator, researcher etc. We have to play these multiple roles destined to us. And Community Medicine is all about these. We have to ward off all the inferiority complexes nourished in our mind. The PG teachers would have to play, impinge and enrich into the minds of PG students of this branch of Medicine.

Now let’s go to Opportunity(O).Many years back, role of the professional with MD in PSM/CM/SPM was viewed as Medical Teacher in Medical Colleges only and it was a very traditional thought and choice. That scenario no longer exits and persists. Time has come for experts in the Community Medicine to play active role as Policy Advisors/Planners, Program Managers/Technical Consultants (Surveillance Medical Officer/TB Consultant/Maternal Health Consultant etc), Researchers in the field of public health. Also there is scope to see beyond the Government Sector & International Agencies. The experts need to expand their role in large Voluntary and the Private sectors as well.

The opportunities for a MD is of broad and multi spectrum. Just after completion you have these options on your “Career Plate”.

Classification of Opportunity

(A) Teaching (in a Government or Private run Medical Colleges/Public Health Institutes like PHFI, AIIPH etc).

(B) Non-Teaching/Public Health Consultancy (with State/Central Governments, UN Agency like WHO,UNICEF,UNFPA  etc &  Other Private sectors etc).

Next question is “What do you like to see yourself after 3 years of obtaining the MD Degree?”

The answer may be (a) A full time Academician or (b)A full time Public Health Consultant.

If your answer is (a) there are 2 Options from me.

Option 1: Join directly as Senior Resident/Tutor/Assistant Professor in Community Medicine. Later on if your department gets involved in Project/Research works, you could accumulate and acquire field experiences.

Option 2: * Try to join with an agency mentioned in classification under (B) which either needs professionals with MBBS only/MD/MPH. Work there for 2-3 years only not more. Return to join/start the career of teaching(A community medicine specialist without valid field experience may not make a good academician).

*Ensure that during sacrificing 2-3 years with agencies you must not cross the age limit to start the career as Senior Resident/Tutor/Assistant Professor in Community Medicine.

If your answer is (b) there are 2 Options from me.

Option 1: **Directly join with an agency mentioned in classification under (B) which either needs professionals with MBBS only/MD/MPH. Do not hesitate the hard and harsh Field Work/Field Travel. After  2-3 years opt for better jobs.

Option 2: Join directly as Senior Resident/Tutor/Assistant Professor in Community Medicine. Work for 3 years, get as many as papers published as 1^st/2^nd author. Then join with agencies as consultants preferably in that posts which need MD/MPH.(To me it is a safe choice because if at all you need to return back to teaching your past experience of 3 years in teaching will protect your position as Assistant Professor)

**Remember always that the experience-years accumulated in public health field is not considered as teaching experience.

The fresh MD degree holder with 2-3 years of public health field experience just after their MBBS will always remain ahead of others.

Threats(T) include  (i) Competition from MPH degree holders during recruitments for the post of consultants (iii) Preferences for MBBS degree holders with >3 years progressive experience by agencies(ii) Increased PG seats in mushrooming Private and Government medical colleges which increases competition for the posts of SR/Tutor/Assistant Professors. You have to keep it in mind always.

As a Community Medicine Specialist I always dream to run my own clinic under name of  “Immunization & Preventive Health Clinic” whether I am working as a Teaching Faculty or a Consultant. It is yet a dream to come true.

The beauty with MD(Community Medicine) is that your movement can be bidirectional eg. “ Teaching”‹-› “Consultancy”. Widely available career options are always for you. Let’s call ourselves “Community/Preventive Medicine Specialist”. Start fly to the land of opportunities. Wish all of you good luck always…

I am leaving the scope to you to find out the Strength(S) of this discipline throughout your professional career.