internal medicine in USA vs INDIA.

[royalmedicus]

hi doctors,

it always makes me so surprised to see that the branch of internal medicine has always been and it is still the most desirable in India but at the same time in the usa its the least paid, least respected and the least desirable branch.

in india medical toppers` choice is internal medicine and IM docs are seen as heads who orchestrate patient`s treatments, while in USA IM is kind of reserved for FMGs [with exception of top programs.] and IM docs are seen as dumping ground for the problems and paperworks of patients which other specialists dont want to do. more interestingly i never heard the word PRIMARY CARE for IM docs in india but in usa they are just little above NPs and PAs with the title of PRIMARY CARE PHYSICIAN.

when i began walking on usmle path, i got this info from my usa friends and online forums, i am just baffled.
why do you think such a extreme contrast exists?

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[docontherocks32]

Well, for starters , it comes down to the money to be earned. In general, surgical branches earn more which makes them more desirable.

When you have a student loans to pay off, you would want to earn as much as possible, as soon as possible.

Then comes the factor of lifestyle that you want to live. A medicine doctor would be attending calls even at night where as some branches like dermatology, radiology are more relaxed with the working hours and the type of work you do during these working hours.

Medicine is really vast. In case one doesn't pursue a fellowship, internal medicine demands one to master a great amount of knowledge, which is a difficult task. In the US, it is acceptable to fall back on PubMed, Uptodate and other references, while in India, Internists are expected to know everything by heart ( which is actually a dumb thing, which many of the good institutions in India have started realizing).

But another thing that I'd like to point out is that your premise is not completely correct. While it is true that some of the toppers have started taking medicine again over the past few years and that the medicine seats in premier institutes like PGI and AIIMS are filling at top ranks, most toppers are not taking medicine. Radiology, Dermatology and Orthopedics is more sought after by most of the toppers.

. We have a network of Primary Health Center (PHC), under aegis of Community Health Center (CHC, a secondary care hospital) and Government hospitals (tertiary care centers). The problem is that most people don't want to go to a PHC or CHC to work, as the location is in rural areas and the pay is not increased relative to the poorer quality of life there. However, doctors are posted there (government jobs assuring help in getting a quota in residency). Also, the residency in preventive and social medicine is supposed to be akin to family medicine in some ways. Whether it works is another debate altogether. You seem to be an Indian MBBS graduate, its surprising that you're not aware of all this.

 

[royalmedicus]

Well, for starters , it comes down to the money to be earned. In general, surgical branches earn more which makes them more desirable.

When you have a student loans to pay off, you would want to earn as much as possible, as soon as possible.

Then comes the factor of lifestyle that you want to live. A medicine doctor would be attending calls even at night where as some branches like dermatology, radiology are more relaxed with the working hours and the type of work you do during these working hours.

Medicine is really vast. In case one doesn't pursue a fellowship, internal medicine demands one to master a great amount of knowledge, which is a difficult task. In the US, it is acceptable to fall back on PubMed, Uptodate and other references, while in India, Internists are expected to know everything by heart ( which is actually a dumb thing, which many of the good institutions in India have started realizing).

But another thing that I'd like to point out is that your premise is not completely correct. While it is true that some of the toppers have started taking medicine again over the past few years and that the medicine seats in premier institutes like PGI and AIIMS are filling at top ranks, most toppers are not taking medicine. Radiology, Dermatology and Orthopedics is more sought after by most of the toppers.

. We have a network of Primary Health Center (PHC), under aegis of Community Health Center (CHC, a secondary care hospital) and Government hospitals (tertiary care centers). The problem is that most people don't want to go to a PHC or CHC to work, as the location is in rural areas and the pay is not increased relative to the poorer quality of life there. However, doctors are posted there (government jobs assuring help in getting a quota in residency). Also, the residency in preventive and social medicine is supposed to be akin to family medicine in some ways. Whether it works is another debate altogether. You seem to be an Indian MBBS graduate, its surprising that you're not aware of all this.

thanks for the reply.
no, i am not indian mbbs graduate but have been to india for quite a long time after completing medical school somewhere else.
everything you said is true but i know it already, still i cant find the valid reason for such an extreme contrast.

 

[Medstart108]

Well Internal Medicine is becoming more competitive recently. This is I believe due to the competitiveness of fellowships.

 

[royalmedicus]

This is I believe due to the competitiveness of fellowships.

but not for the internal medicine itself, right?

 

[Medstart108]

but not for the internal medicine itself, right?

Well because people want to do these competitive fellowships like GI and Cardiology, more competitive and top students are competing for internal medicine (because IM is a pre-req) and they are squeezing out other students.

 

[Medstart108]

but not for the internal medicine itself, right?

Its also true that internal medicine though in the US as a field in and of itself is not really viewed as prestigious or something difficult to obtain by americans. Specialties like cardiology, GI are more prestigious especially cardiology.