August 2008 | St. John’s Reunion, Orlando, FL
I would like to thank the NA alumni for inviting me to do this talk and sponsoring my trip. Special thanks to Raghavendra and Marian who made this possible.
All talks should begin with a disclaimer and here are my disclaimers:
- Any statements regarding the CBCI, St. Johns management etc are accidental.
- Any references to person/persons are purely coincidental.
- Finally, I am not trying to convince you that you should go back to India.
So what am I going to do? Over the next 20 minutes I am going to describe my experiences transitioning from an academic institute in the US to an academic institute in India. I will first describe my background, then try and debunk certain myths about the possibilities in India, and finally present some harsh realities. My goal would be to give you a sense of how one might approach transition.
Regarding my background, having graduated from St. Johns in 1993 I wanted to get training outside India for several reasons.
- Not good enough for Indian exams
- Exposure to different thinking
- Get some research experience
Coventional wisdom at the time went this way “Arre baba! What better way than to go to the phoren?” And my approach was very consistent with the postgraduate entrance exam style multiple choice queries:
d) All of the above
So, I joined the University of Illinois for a residency in Internal Medicine
This is what the University of Illinois looks like these days…..At the time I was there, UIC was known as the University of Indians and Chinese……I want you to pay attention to the elevated train that runs in front as this is where many a chain snatching takes place among the Indians.
Back in India however, we are never too far behind in catching up with US fads so here is the spot that Dr. Mary Olapally had her chain snatched at the St. Johns staff quarters.
I did my fellowship training at the Univ of Minnesota……here is a nice picture of the views we would get from the 14th floor of the building that hematology department was located in.
After my training, there were a few career options available to me….I could
Join UIC Chicago – as an Assistant professor
135,000/-; lab; tech; 300,000 start up funds
Join Medical College of Georgia – as an Assistant Professor
150,000/-; lab; 300,000 start up funds
Join Rockefeller/Cornell – as an Assistant professor
100,000/-; no lab of my own; no start up funds; 90% research protection
Share space, technician
Mentor: Barry Coller, M.D. – David Rockefeller Professor of Medicine and Head Laboratory of Vascular Biology, Rockefeller University Hospital
One of the key points I want to stress, especially for some of the younger folk here who are still in training or getting into training programs is to focus on finding a good mentor that will help you get established in the beginning of your career. This I believe is the single most important step towards establishing an academic career in the long run compared with other potential distractions such as salary or start up funds.
So, I decided to go with good mentorship and took a dual appointment with both Rockefeller (where I did research; bottom right) and Cornell (where I did my clinical work; bottom left)
In addition to good mentorship, I gained tremendously from the environment that the Rockfeller offered: Rockefeller University is associated with 23 Nobel laureates in medical and allied medical fields. Additionally, I became a physician scientist which is a mixture of a clinician and a researcher. I also appreciated the fine art of translational research where one takes findings from the laboratory bench and tries to apply it to the patient at the bedside.
So you may wonder why one would want to change such an environment and life and go back to India. To answer that you would have to ask what is it that we want.
Teaching/ practice/ research
- Administration and management
I wished to be an academic physician involved in teaching, research and clinical practice and thought that it would be very challenging and ultimately satisfying to attempt an academic career in India. The paucity of persons with my skills in India would also make my life relatively uncomplicated (at least by way of reduced competition).
There are several reasons motivating my transition to an academic center in India…..
- Selfish desires
- Practical reasons
Selfish desires and practical reasons are somewhat less interesting to discuss at such a forum and that is why I am going to share with you some of the inspiration that motivated my transition.
This (below) was the path to my clinic at Cornell from the lab at Rockefeller.
On the way, I would pass this painting in the passage way and wonder who it was till I stopped one day and read the sign.
The sign reads: Ida Scudder MD, Cornell University College of Medicine class of 1899, Founder, Christian medical College and Hospital for Women, Vellore India.I was very inspired by this young Cornell graduate who at a very early stage in her life and career chose to do something very challenging and out of the box.
Another major source of inspiration I feel is that of a role model. Several clinicians at St. Johns are inspiring role models. There is George D'Souza who has set up an excellent academic chest medicine program. Dr. Srinivas in psychiatry who is involved in a lot of collaborative and basic research. Others are Dr. Phadke a pediatric nephrologist and Cecil Ross who is involved in hematology. However, the role model that inspires me most is Dr. Prem Pais who successfully manages to practice, teach, do research, publish, and encourage other faculty to attempt all of the above. He has also been a wonderful mentor to Dr. Denis Xavier, my classmate who should have been at this meeting today but was unfortunately not able to attend.
While it is all very well to be inspired, there are always harsh realities and hurdles to consider. For instance what does your spouse wish to do? Do you have children and what age are they at? What are your salary needs? What is your definition of quality of life? How do you view professional satisfaction? All of these realities are not easily addressed but need to be thought through in a deliberate manner. After deliberating for a while I joined St. Johns as:
- Associate Professor of Medicine and Hematology in the Department of Medicine
- My salary dropped from $$$$ to $
- Living quarters changed from a Manhattan 3BR to a Koramangala 2BR with enough land to start a plantation
- Importantly, Anita, my wife joined St. John’s
- The kids: settled easily in a new school
- Finally, our dog did not have to go through quarantine!
I guess I was very fortunate that my wife felt the same way about returning to India.
You are probably wondering if the headlines read American dream turns in to Indian nightmare but no, that not quite true
There are the usual hurdles and dealing with them effectively helps make your task easy.
- Getting a job
Academic vs. corporate
- Negotiating your contract
- Obtaining certification
Karnataka Medical Council
Medical Council of India
- Acceptance by co-workers
The following principles kept me sane:
- Making a clear choice between academic and corporate medicine.
- Understanding that contract negotiation is something that does not occur in an Indian academic medical center.
- If you aim for academic medicine, then register your degree with the local state body and eventually with the medical council of India
- Acceptance by coworkers can sometimes be difficulty but usually occurs with time.
- Understanding that you may have to tough it out for the first few years till you get accepted by your new colleagues.
So the big question is: how am I doing? I am having fun. Like the picture of this kid who is visiting the lab suggests….I am enjoying my self tinkering around.
But let’s get to the specifics:
I get great satisfaction in contributing to minor changes in the teaching program by using newer methods and focusing on an inquiry style of learning.
I also mentor MD candidates, a visiting hematology fellow from the University of Melbourne, and students in the lab, all of which I really enjoy.
Finally, I am conceptualizing a training program in hematology which is challenging but fun.
I believe strongly in investigator initiated research and have focused on anemia which is a significant problem in India. The focus of my research has changed a little to suit my environment but as is evident, there is funding available in India. My only difficulty is that insufficient time is devoted to this aspect of my work.
Although the amount of funding may seem substantial, only achieving the stated endpoints of these research grants would be the best way of determining ones success and I am hopeful that we will get there.
Clinical care takes a large portion of my time: and this is how my time is spent
- Medicine department
Grand rounds 2/week
Call 1/3wks; Sunday rounds 1/5
- Time commitment 100%
Practically – 75%
- Protected time 16% (1 day/week)
Part of my administrative work involves fund raising and I want to bring your attention here to the generous contribution of the Kaliath family foundation that has instituted an award for research in hematology. I am hopeful that it will help build capacity in hematology research at St. Johns.
It isn’t only rosy though, I do suffer from angst, especially with regard to the absence of the concept of mentoring, especially in the research fields and a lack of adequate mentors. Incentive based practice is another of my major concerns as it takes away the focus of a busy clinician from teaching and research. In St. Johns it has served to destroy the very fabric of the institution.
I also miss life in New York and the wild NA alumni bashes….shown below is a pillar of the NA chapter supported by two equally strong pillars of the NA chapter.
However, the institution and the gulmohurs keep my spirits afloat and help me realize that this transition is one of the best career decisions that I have made in my life. While it is still too early to make a judgment on whether this transition is a success, I am hopeful that one day in the future I will be able to do that.