A 1000 mile journey

[TowardsHome]

I have been lurking around these forums for the past few months. Was neither articulate enough nor confident enough to make a meaningful contribution. I think now is the time to start a journal of my R2I thoughts , aspirations and dreams. The sharing of the tale might clarify the thought process, unburden the heart , evoke suggestions from the fellow R2Iers, the end of the day help lighten/complete the R2I journey

About Me/family :

Living in United States since the past 8 years. Was a post graduate for the past 7 years and have been working as a faculty in a good medical university for the past 1 yr as a clinician/educator. My wife works part time as a primary care physician and we have a 4 year old daughter

Background:

Born and spent 28 years of my life in Andhra Pradesh. Went to medical school, completed post graduate training in Hyderabad . As soon as I completed my post graduation , started working in a corporate hospital while contemplating career direction. The shocking reality of debased medical practice and exploitation in that particular hospital made the choice clear. ( More about that in a separate post )

Life in United States
Professional life in United States has been nothing short of an academic dream come true. I was fortunate enough to have worked with some great color blind mentors here who helped me become what I am today. After finishing residency in a good university setting, went on to secure a competitive fellowship and an advanced fellowship . I took up a teaching job at a reputable University on the west coast. Feel liked and valued in present position. In the process, wife completed an internal medicine residency and has found her balance between part time practice and taking care of our 4 year old.

Immigration Status: Permanent residents since 1.5 years

Reasons to contemplate returning to India :
Do I need a reason to go home ? Probably not. But given the uphill journey, I need to be clear in my mind about the motivating factors

1. Parents: I feel that my parents have made lot of sacrifices to ensure that we grow up comfortably. When I wanted to leave to United States at 28 years of age , my mother sent me with her entire provident fund ( retirement fund ).My parents came over in turns, helped us take care of our little one when we were busy with our residencies . Being close to them in their golden years is the best way we can repay them for the sacrifices they have made all their lives for us .I have no doubt that my kid will have a blast with both sets of her grand parents .Over the past decade I have noticed the slow morphing of these extremely resilient individuals to completely dependent individuals who would not like to leave us for a minute when we visit them once a year . I have never seen my patients cry through out the 35 years of my life . Now tears are regular occurrences at airport send offs

2. Sense of belonging: There is no doubt that life in United States has nothing been exceptional to me professionally. Met and worked with living legends in the field who reinforced the values of respect and professional dedication but personally, there has been a growing sense of emptiness inside. Lot of my friends have done very well adapting to life in United States. They have learnt to follow the NBA, Monday evening foot ball, go kayaking . I still hang on to cricinfo, TV 9 is my favorite ,R2I india blogs are a favoritie past time. Some times I wonder at the lengths I go to inorder to replicate a feeling of ?India ? in my sorroundings.

Factors that make this journey challenging

1. Finances: Being in post graduate training for seven years ( working for 54 k a year ), we have little savings. This year we were able to save upto around 80k . Do not know what a comfortable cushion is that can smoothen the initial bumps we expect
2. Career prospects : Both of us have excellent jobs here and combined we have started making around 300 k an year from the last year onwards .Each time we visited India, our honest enquiries for positions in hospitals were met with cold apathy at the best .Comparing this to the situation here, where every meeting I go to, I atleast encounter one or two division chiefs trying to explore my? interest ?in their division .We are ready for pay cuts, but unemployment is an entirely different issue. Neither we have the financial resources nor the networking to set up some thing on our own. At the present moment this is the biggest challenge facing us. Any guidance is deeply appreciated

More challenges to be contd..

Please feel free to comment, criticize, advise , counsel or remove if found useless

[R2I-2010]

1. Parents: I feel that my parents have made lot of sacrifices to ensure that we grow up comfortably. When I wanted to leave to United States at 28 years of age , my mother sent me with her entire provident fund ( retirement fund ).My parents came over in turns, helped us take care of our little one when we were busy with our residencies . Being close to them in their golden years is the best way we can repay them for the sacrifices they have made all their lives for us .I have no doubt that my kid will have a blast with both sets of her grand parents .Over the past decade I have noticed the slow morphing of these extremely resilient individuals to completely dependent individuals who would not like to leave us for a minute when we visit them once a year . I have never seen my patients cry through out the 35 years of my life . Now tears are regular occurrences at airport send offs

Go home while there is still a time. Even though it's not too late for me yet I wish I knew 5-10 years ago that time really never comes back neither does it wait for anyone.

[sureshr30]

You need to get past the Job challenge in India. Otherewise your combined 300k salary in US will make you doubt your R2I thoughts. Its actually a non starter in my opinion. Both of you have worked hard to get to this salary level and you need to cash in for atleast a few more years of this good salary before any R2I thoughts. In the meantime please bring your parents over to the US for frequent trips.

[TowardsHome]

[QUOTE]

You need to get past the Job challenge in India.

Thank you for the reply. What you say is true. I feel like for some reason, I am not approaching this "job search " in the correct fashion. If you go by the official protocol , you get to meet some bottom feeder MBBS graduate ( aka RMO )who derives immense pleasure in making you wait and then tell you that " even though they are not hiring at present , they will consider you, given the expertise and will pay a princely sum of 50k re per month".If you meet the head honcho for your speciality, he is passive aggressive about how phoren doctors cannot adapt to Indian conditions and how he "plans " to do all what we do in phoren in the next 6 months. He will make sure you are reminded about how XYZ from phoren did not even unpack before he R2Aed

This year I plan to ask my US mentors to put me in touch with some genuine thought leaders in my field in India and see what they advise

Thank You very much for your reply

[TowardsHome]

[QUOTE]Go home while there is still a time. Even though it's not too late for me yet I wish I knew 5-10 years ago that time really never comes back neither does it wait for anyone.


Thank you , I agree with your assessment that this is a time bound process. If you procrastinate enough, neither there is a need nor there is a will to return at that point. We will be left with could have, should have, would have, after the 2nd round of drinks for the rest of life

[okonomi]

......
Please feel free to comment, criticize, advise , counsel or remove if found useless

home is where you are peaceful and find yourself with something called "Chi". A well appreciated blog writer here called "Chi" better than the vague notion of belongingness.
Link: http://www.r2iclubforums.com/forums/showthread.php/10388-KRV%E2%80%99s-Sandbox?p=413396#post413396
You probably already found out that where you belong is where you are appreciated. As others had suggested, bring parents to where you belong. Moving the mohammed to the mountain is just one option....

[TowardsHome]

Okonomi, that was a great post. Thanks. The question I have for you" is Chi is an indivisible particle or are we allowed to have a home Chi and work Chi?":confused:

[okonomi]

Okonomi, that was a great post. Thanks. The question I have for you" is Chi is an indivisible particle or are we allowed to have a home Chi and work Chi?":confused:

You know that it was not my (blog) post. RRK, the admin of this forum is a great fan of that blog post author KRV. I can see why he could be. "Chi" seems to be the peaceful feeling that one could have when there are no troubles and the world around you is at peace.
From the very little you had posted about your experiences in visits to desh (aka India), you doubt whether you'd have that "Chi" thing at work, if you ever moved there. Are you thinking that the home-Chi could have an overwhelming effect to overcome the shortage at work ? I have no idea; but having "Chi" seems to be more like being pregnant. You have it or you dont. Even a small amount of discomfort with your peace can gnaw away at the total you.
What I know from the problems posed to this forum is that everyone has a different set of home issues, that is so special. Home-Chi would indeed be different. Some have moved to India to retire; that is a technique to avoid the work-Chi and therefore cancel its effects on peace.

However, what I know is that "Inertia" is a great life-force, and in America I had learned this: "if it ain't broke, don't fix it".

[TowardsHome]

Challenges contd..

Another big challenge in R2Ing atleast as far as my profession is considered is fear of failure . Incapacitating fear that we may not be able to replicate the professional success we had abroad, fear that we may not stand a chance in the complex labyrinth of referrals, kickbacks, percentage dealings.In the past few years we expected corporate medicine to become more transparent, meritocratic and imagined that this process would be accelerated by the anticipated medical tourism boom. Nothing of that sort happened ,corporate cabals grew stronger, senior physicians continue to exploit juniors in tune with the malignant hierarchy. The depressive trends continue . But I still want to go back and lead a fulfilling professional life . Is this possible ? There is only one way to find out, and I shall find out

"The truth is that our finest moments are most likely to occur when we are feeling deeply uncomfortable, unhappy, or unfulfilled. For it is only in such moments, propelled by our discomfort, that we are likely to step out of our ruts and start searching for different ways or truer answers.”
― M. Scott Peck

[rajradio]

I have been lurking around these forums for the past few months. Was neither articulate enough nor confident enough to make a meaningful contribution. I think now is the time to start a journal of my R2I thoughts , aspirations and dreams. The sharing of the tale might clarify the thought process, unburden the heart , evoke suggestions from the fellow R2Iers, the end of the day help lighten/complete the R2I journey

About Me/family :

Living in United States since the past 8 years. Was a post graduate for the past 7 years and have been working as a faculty in a good medical university for the past 1 yr as a clinician/educator. My wife works part time as a primary care physician and we have a 4 year old daughter

Background:

Born and spent 28 years of my life in Andhra Pradesh. Went to medical school, completed post graduate training in Hyderabad . As soon as I completed my post graduation , started working in a corporate hospital while contemplating career direction. The shocking reality of debased medical practice and exploitation in that particular hospital made the choice clear. ( More about that in a separate post )

Life in United States
Professional life in United States has been nothing short of an academic dream come true. I was fortunate enough to have worked with some great color blind mentors here who helped me become what I am today. After finishing residency in a good university setting, went on to secure a competitive fellowship and an advanced fellowship . I took up a teaching job at a reputable University on the west coast. Feel liked and valued in present position. In the process, wife completed an internal medicine residency and has found her balance between part time practice and taking care of our 4 year old.

Immigration Status: Permanent residents since 1.5 years

Reasons to contemplate returning to India :
Do I need a reason to go home ? Probably not. But given the uphill journey, I need to be clear in my mind about the motivating factors

1. Parents: I feel that my parents have made lot of sacrifices to ensure that we grow up comfortably. When I wanted to leave to United States at 28 years of age , my mother sent me with her entire provident fund ( retirement fund ).My parents came over in turns, helped us take care of our little one when we were busy with our residencies . Being close to them in their golden years is the best way we can repay them for the sacrifices they have made all their lives for us .I have no doubt that my kid will have a blast with both sets of her grand parents .Over the past decade I have noticed the slow morphing of these extremely resilient individuals to completely dependent individuals who would not like to leave us for a minute when we visit them once a year . I have never seen my patients cry through out the 35 years of my life . Now tears are regular occurrences at airport send offs

2. Sense of belonging: There is no doubt that life in United States has nothing been exceptional to me professionally. Met and worked with living legends in the field who reinforced the values of respect and professional dedication but personally, there has been a growing sense of emptiness inside. Lot of my friends have done very well adapting to life in United States. They have learnt to follow the NBA, Monday evening foot ball, go kayaking . I still hang on to cricinfo, TV 9 is my favorite ,R2I india blogs are a favoritie past time. Some times I wonder at the lengths I go to inorder to replicate a feeling of “India “ in my sorroundings.

Factors that make this journey challenging

1. Finances: Being in post graduate training for seven years ( working for 54 k a year ), we have little savings. This year we were able to save upto around 80k . Do not know what a comfortable cushion is that can smoothen the initial bumps we expect
2. Career prospects : Both of us have excellent jobs here and combined we have started making around 300 k an year from the last year onwards .Each time we visited India, our honest enquiries for positions in hospitals were met with cold apathy at the best .Comparing this to the situation here, where every meeting I go to, I atleast encounter one or two division chiefs trying to explore my” interest “in their division .We are ready for pay cuts, but unemployment is an entirely different issue. Neither we have the financial resources nor the networking to set up some thing on our own. At the present moment this is the biggest challenge facing us. Any guidance is deeply appreciated

More challenges to be contd..

Please feel free to comment, criticize, advise , counsel or remove if found useless

welcome home. parental love is a one way stream, no matter what you do it cannot be returned back it is the most unconditional thing known to man(or woman). I can fully understand what you feel. Last week my dad a little hypertensive encephalopathy and had to be admitted. I felt that someone was chocking me for the entire 10 hours while he was recovering while I was wringing my hands.

You have a very good synopsis of Indian medical scene. the corporate sharks will have u( and me) for breakfast in a minute. So in my opinion here is the dos and donts.

Donts:

1. Do not believe what any corporate hospital tells you....it aint gonna happen. At the time of interview just nod your head and keep thinking...ok what is my back up plan B or plan C.

2. Do try to form a team of folk who are like minded.

3. Read this forum carefully its very informative. If I were you I would spend the next 10-15 days rummaging through this forum. every thing is there.

4. Do not think your 80k is going to last very long in India.its like pissing in the ocean and checking for urine titres( inflation in India is mind boggling), pardon my francois..feeling a little laissez-faire today.

So for the good part.

1 I do believe it can happen(return) inspite of all the headwinds. The first and foremost is remind yourself its india....India of 2011. Not the one you left 8 yrs ago. Its also not america. ask yourself if people brazenly pissing on the walls ticks you off? these are very important questions. I put a chest tube in someone, when removed and threw it in trash the nurse was carefully picking it out to reuse it. So I grabbed it from her hand and cut it to small smithreens, and stared her like I could kill her. Just be very oblivious to the crap around you.

2. There are some super kool physicans on the forum.....some of them R2I all of them very happy. Their names are sumeet, cabo, ihaveadream(planning to R2I), drpavan( planning to), man, sumachechi. Each of them are fantastic. That apart there are many UK and US returned MDs in HYD that you can try to contact. If u are going there I can give you more data like phone numbers.

3. If you are in anyway related to oncology, university of pittburgh is taking over the managment of a very large hospital in HYD( not mine), since they actually have an American guy at the helm they may try to understand our thoughts better, so if you have a set timeline we could talk to them.

4. Like we tell domestic abuse patients...make a mental note of an escape route. R2I to MDs can get a little abusive, this escape can come in various forms
a) keep your GC and take a rentry.
b) make lot more money for a 2-3 years and then attempt it, as then you'll the financial cushion.
c) add some surgical or in office skill to your and wife's skill set, the general thought process in India, why should I pay for talking to a MD, he is not doing anything to me? see if you or the wife can do anything in diabetes.
d) keeping the house in US, schmoozing your current boss, so on and so forth.

5. Spend time but just enough time to pick up what you need from the forum. If you post too much or think too much it becomes like a "nach basanti naach" with little kalia watching the performance while you try to avoid the broken bangles( were you too young for sholay?:)). basically, there is a lot of arm chair pass me the samosa kinda tea and biscuits judgement that'll confuse you. there will be all sorts stupid logic put forward to prevent you from something really basic..go back to where you home country is.

Ill add a couple of links when i get some time. hope this helps.

next time when you want to explore the job option try using some jugaad. just ask around and see if the chairman of some hospital Can be reached using some weird contact, usually its a small world. If you have a niche speciality contact the drug reps in us and ask for the contact details of their branch, india. lastly, be very humble and be willing to step back a little when you can(throw in some 'sirs' when MBBS guy eating pan is is interviewing you) this is going to be the hardest part. An orthopedic surgeon trained in liverpool in joint surgery was told by the chariman of the largest orthopedic hospital in chennai that the chairman dint like him because he was sittng cross legged ( on the chair), so it was percieved disrespectful. Always remember these guys have not been outide india but you have seen both sides of the pond.

rk

added later: you ll see bribery and cheating all around, you ll have a friend, he calls you, u ll go to find out he does nothing for a living and his father is a motor vehicle inspector(govt scale 10k). he has just thrown a party at taj krishna. If you come back and feel like putting your fingers in your mouth and throwing up India is not for you, if you are going to enjoy and order a couple of long island ice teas on friends tab india is for you......pls make sure what you are getting into. I personally( have been called out) dont care about all that.....so I go home. Some nihilistic narcissism is also needed to R2I.

i am not trying to preach or sermonize here, if you dont like any part of it or as a whole.....just tell me i ll delete, my role is to share my feelings not to preach you.

http://www.r2iclubforums.com/forums/showthread.php/21112-Starting-a-Medical-Practice-in-India/page9

http://www.r2iclubforums.com/forums/showthread.php/3160-pm071-My-R2I-Diary-to-Delhi?p=400612#post400612