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December 16, 1999


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It's One Hell of A Life

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Dr Balamurali K Ambati and Dr Jayakrishna Ambati

A young Indian-American entering medicine is as commonplace as a doctor with a white coat. Previously, we examined the phenomenon of our community's youth going to India for medical school.

In this space, we would like to consider the very choice of medicine as a career, a question that should be addressed on both an individual and a community level.

The driving force for many of our youth to enter medicine is likely parental influence. In turn, this stems from our parents' experiences in India, where there were two sure tickets to financial security: medicine and engineering.

Since the first generation's arrival in the US, they have seen that doctors in this country have the greatest median income, financial security, and prestige of all the professions. There is a pervasive psychology in the Indian community that medicine is the ideal "default" profession. The logic is that any child with a level of intelligence sufficient to get through college and medical school will almost certainly go on to make a six figure income.

Given that illness is untied to the health of the economy, doctors will never have to face unemployment. Finally, doctors will always be admired in society. What other line of work can match that level of comfort, security, and respect? Further, we have seen many parents who could not be doctors in India push their kids into medicine.

Moreover, parents who have seen other families' children express desires to become artists, rock stars, or athletes naturally become protective and reactionary, applying pressure to go into a "safe" occupation.

Coupled with our community's premium on education, specifically the sciences, this makes the desire to see one's children become doctors a potent force. This is not to deny that many of our young people have a genuine desire to help other human beings or interest in the life sciences, but when a large plurality or even majority of our college youth have premedical majors, surely there are cultural or family factors at play.

Both of us chose to enter medicine for the opportunity to heal and the challenge of discovery. Our parents were instrumental in guidance and support, no more, no less. Our time in medicine has given us the chance to help people mend their wounds, see clearly, and come to terms with loss. It has presented us with challenges of fundamental biomedical questions that we can tackle head-on and the ability to unlock the door to future advances.

It has helped us blossom into citizens capable of serving our community to our fullest. In the brief time we have been doctors, we have witnessed sea changes in the practice of medicine. Managed care has made time a commodity and finances a pressing concern for all. It has eroded autonomy and corroded the patient-doctor bond.

Still, our daily satisfaction has not diminished. Medicine is a wonderful field, but it asks, it demands, much of anyone who enters it.

Is medicine the best individual choice for so many of our youth? The rewards of medicine are indeed great: essentially guaranteed financial security aside, the satisfaction of assuaging suffering and the daily intellectual challenge are unmatched by most other fields. But there is a steep price to pay in the pursuit of becoming a doctor, whether or not one succeeds in getting an MD.

We have seen many a youth founder on the shoals of their parents' surrogate dreams, crashing in a vain quest to do well enough in college to enter medical school, squandering year after year in research or ancillary training in desperate orbit trying to land in a medical school, or exiling themselves to a foreign school.

Medical school and residency are a long and arduous road; almost all personal time is usurped by academic and clinical responsibilities. Massive debt and low pay weigh on the mind of almost every young doctor. Family life can be postponed indefinitely. For 7-14 years after college, the flower of our youth has little time or money to experience life.

Even after training is completed, doctors work longer hours than anyone else. This takes a great toll on families; in two-doctor households it is all too common for children to not get the love and attention they need to prosper. This should not discourage kids from being doctors, but merely place things in perspective.

On a community level, is it good for so many of our youth to become doctors? Again, a plethora of doctors enhances the prestige and financial resources of the Indian community. However, there are serious consequences for our children and community as a group if so many of our youth go into medicine.

With Indian-Americans already comprising 10 per cent of medical school students, medical schools have begun raising admission standards for Indian-Americans relative to other ethnic groups. More importantly, is it not desirable for our community to make inroads into all facets of American life? Would it not help our community to have young Indians become lawyers, teachers, journalists, politicians, marketers, financiers, software designers, businessmen, engineers and scientists?

Just as a temple cannot stand on a single pillar, the vibrancy of our community depends on having members in a panorama of professions. It is time that we all realize that there are many avenues and opportunities in this country to make a living and make a difference.

Over the past decade, our family has conducted free weekly academic classes for middle- and high-school students, thus witnessing the growth of several hundreds. Not surprisingly, many of our students have gone on to medical careers. But others have excelled in unrelated fields.

One such example is Sanjiv Agashiwala, who went on to study business and then launched a highly successful career as fashion designer Sandy Dalal. Now this is not a clarion call to the catwalk.

That would be as foolish as the near-universal exhortation to medicine that confronts our youngsters. But it should serve as an example that hard work and aptitude can be rewarded handsomely in fields other than medicine.

Life is too short to wile away as a jaded miscast consumed by ennui and resentment. The imposition of medicine as a career out of fear of insecurity and the burden of community expectations serve no one in the end. As someone once said, "Winning the rat race doesn't change the fact that you're still a rat."

Most Indian-American youngsters enjoy the luxury of pursuing their true calling, unburdened by the pragmatic fears of livelihood faced by their parents and grandparents. This opportunity should not be squandered on either whimsical hobbies or on fulfilling parental dreams.

Parents have a solemn duty to guide and minister, to point out to kids that they cannot always do what they like, but should try to like what they do, to show that hobbies and fancies do not a career make.

Open communication and honest advice on the opportunities and challenges of the world are great gifts. Rather than wrap their children in a cocoon of vicarious hopes, parents should unleash the potential of their children.

Parents should neither be dacoits of dreams nor silent spectators, but instead cultivate innate inclinations and guide with wisdom.

Medicine is a divine calling and a great career, for those who are meant for it. The choice to enter it should at its core be a desire to heal, even at great personal sacrifice. The wings that a medical career can be are not achieved by imposing the albatross of community expectations on the backs of our youngsters.

To be sure, medicine is financially secure; but, to be honest, business and law are probably far more lucrative for the truly entrepreneurial. Not everyone has the right mix of scientific analytic skill, capacity for memorization, dedication, humanism, discipline, and sheer guts that medicine requires.

Just as well, there are better options than medicine for talented young people with other inclinations and capabilities. Believe it or not, there are other stable, productive, and satisfying professions. Youth should be able to choose, in conjunction with their parents, the profession that best matches their talents and abilities. With the right combination of support and dedication, our youth can be trailblazers in any field they choose to pursue.

Dr Balamurali K Ambati and Dr Jayakrishna Ambati are in the Department of Ophthalmology of Harvard Medical School. They thank Ambati M Rao and Gomathi S Rao for insightful discussions.

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