Dilemma of a medical professional: To return or stay put

[ukr2blr]

About me/family:

About 40 years old. Came to the UK in 2002 and have been a consultant paediatrician the last 5 years in a reputed university hospital. Wife works as an IT project manager over the last 5-6 years. 4 year old daughter who has just started a good school.

Life in the UK

Professionally have done well. Completed my higher specialist training. Got a good academic fellowship and am currently in a clinical and academic role. Feel liked in present position. Wife is not an engineer and had to change her career but has over the last 5 years settled well in project management role in the healthcare set up.

Immigration Status: UK citizens in the process of OCI acquisition

Reasons to return to India:

I guess my reasons are not as different to many in the forum.
1) Personal: Sense of belonging to India. To provide a much wider experience to my daughter while she is still young.

2) Parents: I feel that my parents have made lot of sacrifices to ensure that we grow up comfortably. When I left for the UK at 25 years of age, my parents sent me with their provident fund ( retirement fund ). My parents came over in turns, helped us take care of our little one when we were busy with our jobs. 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 her grand parents .Over the past decade I have noticed the slow morphing of these individuals to dependent individuals.

3) Would like to contribute back to the Indian society. Would like to join/set up an organisation where the cut back system is not followed/ limited to a minimum.

Challenges:

1) Can I build my practice in India given the state of affairs? I have been in contact with many corporate hospitals over a period of time (almost every 2 years) and their response has been apathetic to say the least. The best response that I have got this year has been after direct contact with the CEO?s. Although I do not have a concrete offer yet a couple of them look promising. Will be meeting people on my next visit to India. Getting a job is one thing establishing a practice is another.

2) Wife?s job: Career opportunities for my wife have grown over the last 3-4 years in the UK and she is due for another promotion soon. Not sure whether she would be able to get a comparable IT project manager job in India (she is not an engineer). This currently is an important limiting factor as there seems to be some positive response for my job but none so far for her.

3) Kid education: Currently has just started school in one of the good private schools in the city But I do not think she would have a difficulty in getting admission in a good school in Bangalore.

4) Finances: Have some in the saving pot. Have a house (parents) and 3 others (currently rented) in Bangalore. Given the next biggest expense is the kids education we both would need to be in well paid jobs for the next few years.

5) Work life balance: I am sure that my work life balance would be affected. Here able to have at least 3 of 4 weekends off. In Bangalore weekend off would be limited to Sundays only (perhaps 3 of 4). However will have a host of relatives and friends whenever I am free.


More challenges on the way?

Please feel free to comment, advise, counsel

[killbill pandey]

About me/family:

About 40 years old. Came to the UK in 2002 and have been a consultant paediatrician the last 5 years in a reputed university hospital. Wife works as an IT project manager over the last 5-6 years. 4 year old daughter who has just started a good school.

Life in the UK

Professionally have done well. Completed my higher specialist training. Got a good academic fellowship and am currently in a clinical and academic role. Feel liked in present position. Wife is not an engineer and had to change her career but has over the last 5 years settled well in project management role in the healthcare set up.

Immigration Status: UK citizens in the process of OCI acquisition

Reasons to return to India:

I guess my reasons are not as different to many in the forum.
1) Personal: Sense of belonging to India. To provide a much wider experience to my daughter while she is still young.

2) Parents: I feel that my parents have made lot of sacrifices to ensure that we grow up comfortably. When I left for the UK at 25 years of age, my parents sent me with their provident fund ( retirement fund ). My parents came over in turns, helped us take care of our little one when we were busy with our jobs. 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 her grand parents .Over the past decade I have noticed the slow morphing of these individuals to dependent individuals.

3) Would like to contribute back to the Indian society. Would like to join/set up an organisation where the cut back system is not followed/ limited to a minimum.

Challenges:

1) Can I build my practice in India given the state of affairs? I have been in contact with many corporate hospitals over a period of time (almost every 2 years) and their response has been apathetic to say the least. The best response that I have got this year has been after direct contact with the CEO’s. Although I do not have a concrete offer yet a couple of them look promising. Will be meeting people on my next visit to India. Getting a job is one thing establishing a practice is another.

2) Wife’s job: Career opportunities for my wife have grown over the last 3-4 years in the UK and she is due for another promotion soon. Not sure whether she would be able to get a comparable IT project manager job in India (she is not an engineer). This currently is an important limiting factor as there seems to be some positive response for my job but none so far for her.

3) Kid education: Currently has just started school in one of the good private schools in the city But I do not think she would have a difficulty in getting admission in a good school in Bangalore.

4) Finances: Have some in the saving pot. Have a house (parents) and 3 others (currently rented) in Bangalore. Given the next biggest expense is the kids education we both would need to be in well paid jobs for the next few years.

5) Work life balance: I am sure that my work life balance would be affected. Here able to have at least 3 of 4 weekends off. In Bangalore weekend off would be limited to Sundays only (perhaps 3 of 4). However will have a host of relatives and friends whenever I am free.


More challenges on the way…

Please feel free to comment, advise, counsel

About Me/family


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


More challenges to be contd..

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

The above two posts look very similar . You guys brothers ? Just kidding.


Jokes aside, this is a serious dilemma .Medical practice in India is a difficult and different beast. You will listen to perspectives and counter perspectives .Take all of them into account. At the end, remember - every one has a unique set of circumstances personally and professionally that might have led to failure or success. For every "success" cited , there are two who could not make it work . The logic applies the other way round too.

Advantages of Practice In India

1. I do not know the practice model in UK, I cannot comment about the paper work/regulatory BS. In India , you do not have to deal with much of that , though most of the corporate hospitals have some sort of EMR.In India , labor is cheap , so you probably will get scribes/equivalents even if the culture spreads

2. Social/Personal - You know that already , I will not comment


Disadvantages/Limitations

1. Hours and Life Style: This is going to be a shock coming from Great Britain, especially if you are the primary bread winner and expect salary as the predominant component of annual income. 6 to 6.5 day work week is the norm especially in the metro. People expect cell phone numbers, especially in Hyderabad.

2.Distrust: You are the point of sale in India and enough idiots have screwed the system , there is a fair amount of distrust . Expect second opinions when you recommend common procedures . All said and done, in the West predominantly , this is not the issue . Every surgical consent is held in a video-taped room in many corporate hospitals in Hyderabad. There is enough anger in the system that physicians tend to be held responsible for negative outcomes irrespective of the cause . This is prevalent in the West , but probably more in India as the corporate system seems bent on screwing the common man . People are not idiots ,but they also have few choices and the helplessness irritates people

3. Corporate BS: Bangalore might be better than Hyderabad ( my experience is restricted to Hyderabad) : Corporate Hospitals are held by individuals/families and given the mushrooming , health care margins are wafer thin. "Referral fee " is alive and kicking in Hyderabad and each year I go , it actually becomes more formal and legitimate . You will be a part of the system if you are employed there . Make no mistake about that

4.Income : In India , physician income follows the 80-20 rule . 20% of physicians make 80% of income. If you are in the 20% , you are going to be okay . This is a contrast to relatively uniform salaries which tend to aggregate around the median in the West for majority


This has been my experience. I have been trying to go back for 3 years. Each year I spend 8 weeks (all my vacation) shadowing my Indian colleagues in Hyderabad and this is what I have gathered .There are lot of people practicing in India who hopefully will contribute. Expect each of the points to be countered by people practicing in India . And that is the point of forum, perspective and counter perspective - you should know as many perspectives as possible

KB Pandey's perspective : It is not easy, but if your heart is set on it, go for it. Go for it expecting challenges and see what happens .Preferably set up some thing on your own. For that you need to have a cash cushion . No place for rose tinted glasses nostalgia either personally and professionally. Hard reality is tough and brutal.

[rajradio]

About me/family:

About 40 years old. Came to the UK in 2002 and have been a consultant paediatrician the last 5 years in a reputed university hospital. Wife works as an IT project manager over the last 5-6 years. 4 year old daughter who has just started a good school.

Life in the UK

Professionally have done well. Completed my higher specialist training. Got a good academic fellowship and am currently in a clinical and academic role. Feel liked in present position. Wife is not an engineer and had to change her career but has over the last 5 years settled well in project management role in the healthcare set up.

Immigration Status: UK citizens in the process of OCI acquisition

Reasons to return to India:

I guess my reasons are not as different to many in the forum.
1) Personal: Sense of belonging to India. To provide a much wider experience to my daughter while she is still young.

2) Parents: I feel that my parents have made lot of sacrifices to ensure that we grow up comfortably. When I left for the UK at 25 years of age, my parents sent me with their provident fund ( retirement fund ). My parents came over in turns, helped us take care of our little one when we were busy with our jobs. 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 her grand parents .Over the past decade I have noticed the slow morphing of these individuals to dependent individuals.

3) Would like to contribute back to the Indian society. Would like to join/set up an organisation where the cut back system is not followed/ limited to a minimum.

Challenges:

1) Can I build my practice in India given the state of affairs? I have been in contact with many corporate hospitals over a period of time (almost every 2 years) and their response has been apathetic to say the least. The best response that I have got this year has been after direct contact with the CEO’s. Although I do not have a concrete offer yet a couple of them look promising. Will be meeting people on my next visit to India. Getting a job is one thing establishing a practice is another.

2) Wife’s job: Career opportunities for my wife have grown over the last 3-4 years in the UK and she is due for another promotion soon. Not sure whether she would be able to get a comparable IT project manager job in India (she is not an engineer). This currently is an important limiting factor as there seems to be some positive response for my job but none so far for her.

3) Kid education: Currently has just started school in one of the good private schools in the city But I do not think she would have a difficulty in getting admission in a good school in Bangalore.

4) Finances: Have some in the saving pot. Have a house (parents) and 3 others (currently rented) in Bangalore. Given the next biggest expense is the kids education we both would need to be in well paid jobs for the next few years.

5) Work life balance: I am sure that my work life balance would be affected. Here able to have at least 3 of 4 weekends off. In Bangalore weekend off would be limited to Sundays only (perhaps 3 of 4). However will have a host of relatives and friends whenever I am free.


More challenges on the way…

Please feel free to comment, advise, counsel

i work most days and I enjoy it so can't compare qol. But 4 houses in Blore with nhs pension and starting life as a pediatircain and wife can easily find a job in it. You have a fairly good career ahead in India. Unlike in uk periatrics is very popular in India.

[sumachechi]

OP
Are you a general paediatrician with academic experience? Your best bet could be to attach yourself to a better quality private hospital and have your own private practice along with it. Check out Dr Girish HC in CloudNine hospital Bangalore. Nice guy, discuss options with him.
If your attitude is right, and you are willing to be patient, you should do well

[dbs]

#OP,

There is obviously a solid base you have in India, both financially (3 rentable prop) and family. You have the stated desire to give back to your parents. That should stand you in good stead.

You do have the professional background for a successful life in India.

The only unknown factor (to us, you would obviously know) is your aspirations for life. What is important for you and what you would not tolerate.

UK has its ups and downs, I lived there for 14 years. Weather can be unkind at times. Missing family and friends can be irksome. Not being able to celebrate Holi by drenching your friends (and their wives) is sorely missed. Some family events, weddings are enjoyed thru skype, face book and emails. But not a bad life overall.

India has disadvantages as must have been pointed out to you already. Proximity to in-laws (perhaps not in your case) is sometimes a non-negotiable factor.

Rest depends on you. What is more important and what is less important and can be done without. You must have a merc or can you do with a Honda. Can you live with some of your privacy curtailed. Only you can decide. Some of these things are easy to brush aside from a distance but the proof of the pudding is when you live it. If you have the right attitude then you can cut it. I have a bad attitude and can not help criticizing everything but when I am inside the bedroom with aircondtioning on and DW by my side, ALL IS WELL.

[ukr2blr]

Thanks kill bill pandey for all the advice and experience that you have penned down. Many of the hospitals in bangalore have a version of EMR. Having said that most hospitals in the UK are implementing EMR/have implemented EMR in some shape or form (including my own). So I do not anticipate that this would be an issue. Having an EMR has its benefits and its challenges which can be another post altogether.

You have listed a good number of disadvantages most of which I agree. I do not think there are any/many corporate hospitals that do not work on a percentage basis or have the 'referral system' that you have talked about. It is also interesting to note that many people who have returned from the west and who have set up things back home have pretty much assimilated themselves to the mainstream practice. So I guess as an organisation I would not have much say in it but may try and limit it in my practice although the money may be less in the first few years.
Did not know the 80-20 rule! But see what you mean.

Unfortunately as things stand I cannot set up things on my own and as one of my friends had said 'you go home to be near your dear ones but do not expect the same practice as the west'

[ukr2blr]

Dear Sumachechi,

Thank you for your response. I am a neonatal consultant with an academic interest. I will be looking at some of the corporate hospitals when I go to Bangalore next and perhaps will have the chance to meet Girish in Cloud nine as well. There have been a few of my friends who have returned back to Bangalore over the last few years (although only one is a neonatal consultant). While some have settled down within a year or so others have taken a longer time to settle down in terms of their practice. They all though agree that the personal satisfaction that they get from their patients/parents is immense and equally have highlighted the difficulties that they have faced (includes unprofessional behaviour from their own support team, nurses, juniors).

OP
Are you a general paediatrician with academic experience? Your best bet could be to attach yourself to a better quality private hospital and have your own private practice along with it. Check out Dr Girish HC in CloudNine hospital Bangalore. Nice guy, discuss options with him.
If your attitude is right, and you are willing to be patient, you should do well

[ukr2blr]

Thanks rajradio. I had read through your diaries and also some others and must congratulate you on your achievements over the past few years. Unfortunate as it may seem we are not able to take out the NHS pension anymore as the QROPS scheme has been stopped for NHS pensions. Equally the 3 houses do give a decent side income but will not substitute our necessity to work. Given that I will need time to establish my practice we feel that it is necessary that both of us have got to work at least for the initial few years.

i work most days and I enjoy it so can't compare qol. But 4 houses in Blore with nhs pension and starting life as a pediatircain and wife can easily find a job in it. You have a fairly good career ahead in India. Unlike in uk periatrics is very popular in India.

[R2I_wish]

It is slightly easier if u have indian postgraduation degrees like MD, DM neo. If not it takes time to adopt to indian clinical conditions. Also FRCPCH, CCT is seen commonly nowadays, u will have to find ways to differentiate yourself from others. You may also need to meet OBGyns and impress upon them to send sick neonates. Giving or receiving kickbacks is entirely upto u. Many people I know dont do it.

Are u prepared to do some gen paed?. Because eventually u may have to. Including vaccinations and treating URI and D& V, Which in UK you wouldnt.

Sent from my GT-I9082 using Tapatalk

[ukr2blr]

Thanks R2I_wish. I agree that in India one would have to do general paediatrics along with any other sub-specialty that one might have. I do not know of anyone yet who does not do so. This though means that specialists may be the first port of call for many people and hence one would have the coughs colds etc. So I am keeping my expectations low but perhaps there is also a chance to develop a collaborative way of practice. I guess unless we go we would not know.