Why do so many MBBS graduates from AIIMS write the USMLE and migrate to the US?

Hi, I am currently a faculty of Psychiatry and I went to the US in 2010, after taking Step 1, did 6 months of electives over there, cleared CS examination, and then came back to India, studied for PG entrance examination, and stayed back. I did MBBS from UCMS, Delhi and we had a pretty strong culture of going to the US over there (not sure how it is nowadays). The reasons for going to the US remain pretty much the same whether you are a graduate of AIIMS, UCMS, MAMC, or Manipal. I will talk about a few important ones-

1 Disenchantment with the system- Many students feel disenchanted with the Indian medical system, as they see the overworked residents in the hospitals, who are often ill-treated by the consultants and senior residents. Students feel that this is their future and get demotivated. Most of these students have no idea about how things work in the US. But imagine that it would be better.

2 Money- A large number of students compare the residency stipend in India (Rs 30K-Rs 75K per month in India) and compare it with the residency stipend in the US (USD 3,000) and reach the conclusion that doctors in the US earn so much more.

3 Tougher PG entrance examination- Many students believe that getting residency in the US is much easier than cracking the tough Indian PG entrance examination, and hence the move.

4 Discouragement by seniors- Most of the students take advice from residents and senior residents in their colleges, and these residents are usually unhappy. They often tell the students how useless and unrewarding it is to become a doctor in India. The students get discouraged and look for the options, and USMLE is the obvious option that comes to their mind.

5 Unrealistic expectations of life in the US- A large number of students imagine that life in the US is all rosy and happy. For many, Hollywood movies work as the benchmark. They believe that life in the US would be similar to what they see on screen.

Let me explain why all these reasons are flimsy and not based on facts

1 The Indian Medical system is definitely broken. Residents are overworked for sure. Consultants are usually mean and not so nice. But American residency is no cakewalk. An American resident works harder than an Indian resident (except probably the first year of Indian residency). Rounds in their wards would start at 7:30 or 8 in the morning, and in surgery wards, even at 6:30. The amount of documentation that they do is just mind-boggling. And then, most of the Indians doing residency in US are under pressure to do some serious research work, if they want to have a shot at the fellowship. Not only that Indians get to know that one way of getting a green card earlier (and not wait for 10 years) is to have an exceptional academic record and publish loads of research papers. So they have to work pretty hard. It’s simply untrue that residency in India is tougher than residency in the US.

2 Money- Comparison of stipends is naive, one remains a resident for 3 years only. But to be fair, the money that a US doctor earns is almost always more than what an Indian counterpart would earn. But there are two important points to be made here. The earnings of an Indian doctor in the private sector are pretty decent, most of the medical students seriously underestimate the earnings of doctors in India. Please do not look at the salary of your medical college professor, that not a representative sample. More importantly, money is important to buy stuff and services. And even with more money, people are not able to afford a cook, a chauffeur, a maid and a nanny in US, whereas you can have all of that while earning one third of your counterpart in US. US doesnt have cheap labour, India has it. We dont have to do the dishes and cook the food, there you dont have much of a choice. People dont realize it, but life is so much easier back home.

3 After teaching for PG entrance exams, for so many years, I can say one thing for sure. If one studies properly for 1 year, he/she will definitely clear the PG entrance in India. USMLE is tricky. Indians usually do good in Step 1 and Step 2 CK. But CS is tricky, I have seen many bright students flunking the CS (which reduces the chances of a good residency significantly). The interviews can be tricky and, the whole Matching process is tricky. Most importantly if you are not able to get a good rank in the Indian entrance, you can always pick a diploma or a nonclinical seat, but you dont have that option in US. You can pick family medicine over there but even that is not a cakewalk. Some of my batchmates, have still not gotten into residency.

4 Discouragement by seniors – I usually get angry when I see a demotivating post written by a senior doctor, for the simple reason that they don’t present the entire picture. Of course, there are problems in the Indian medical system, but it’s not all bad. As a psychiatrist, I see so many MBAs and Engineers in their 40s or 50s, anxious about layoffs and losing their jobs, I am yet to see one doctor with the same problem. A doctor in India may or may not become rich, but he will never be poor. You will always make enough to meet your basic needs. It’s true that there is the risk of violence, and we all read about the cases of violence against the doctor by unruly patients, but what about those majority of patients who are nice, respectful, and thankful. An image has been created in the minds of young docs that all patients are hooligans, I disagree, most of the patients are still very respectful towards the doc. And while it’s true that the violence against doctors is a menace that must be dealt with as strictly as possible, let’s not create a rift between patients and doctors because of few antisocial elements.

5 Life in US is not all rosy, in fact you will never feel like a first-class citizen over there. The vast majority of Americans are amazingly nice people, but every now and then, you will meet someone who will in a subtle way remind you that you are not one of them. You will always be aware of the brown colour of your skin, more so when you are out of the hospital. You will try to speak like them (not becuase you want to show off, but becuase your patients wouldnt understand you unless you twist your tongue in a certain way for atleast some words), you will try to develop a liking for Halloween and Christmas (but in your heart you would always miss Holi and Diwali), you will try to develop a liking for baseball and basketball (but you would always be checking the cricket score), you will try to be like an American but India won’t leave you.

So why I came back, you ask. For all these reasons. After spending almost 6 months I started asking myself this question, why the hell am I here. I couldn’t give myself a good answer. So, I decided to go back. I appeared for the CS exam about 5 days before I returned to India. I had decided that I would not pursue USMLE any further and had no motivation to clear CS, but I knew if I flunked CS, people would say that I went back because I couldn’t pass the exam. And that was not acceptable to me. I used every iota of energy in my body for like 2 weeks, prepared for CS, and of course, cleared it. And left the US, on my terms.

It’s been 10 years. I have not regretted coming back to India even for a single day. In fact, I am so proud of my younger version who had the spine to call it quits and come back.

P.S. These were my reasons, many of my friends have settled in the US and are pretty happy, some of them who settled over there and are not so happy. I guess it varies from person to person. But the crux of the matter is that going to the US is not such an obvious choice. And staying back in India is not so bad.

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