Gandaki Medical College
Teaching Hospital & Research Centre (P) Ltd.

Career of Medicine by Digvijay S Timilsina

Why work at all:

Before I discuss the pros and cons of medicine as a career, I consider it worthwhile that prospective doctors decide why any work is needed. When I ask this question, the common responses are:

  1. Name, fame and money.
  2. Feeling of being useful.
  3. Social service.
  4. Fulfilling my pride.
  5. Achieveing my desires etc.

Now all these have a common theme and that is satisfaction. Satisfaction is needed to be happy. To be happy the basic requirements are only two.

Humility: This is concept that acknowledges that I am not perfect. There will be someone or something superior to me in this world. This is the prime reason why believers are happy. They have acknowledged the superiority of God over themselves. This generates some kind of humility. Humility is the foundation for happiness. This acknowledges the right of others to speak differently from us. It ensures that we encourage and actively support people who think and act differently from us. It teaches us to celebrate diversity. It teaches us not to establish superiority on others based on different thoughts, education and social standing. Above all education must teach us to accept our mistakes. It should teach us honesty, integrity and dependability.

Usefulness: The other feeling that can generate happiness is the belief of being wanted and useful. Its to fulfill the need of this criteria that we need to do some work. We can firmly conclude that we all work because we want to feel useful. This gives us satisfaction and then we are happy. Any enterprise that serves others will give more of this feeling.

Why learn:

If the purpose of working was to feel useful and thence happy. The purpose of learning can be simply put as to prepare ourselves to do better in what ever we do. The target being to enhance competence so that more can be achieved. This will mean we can feel more useful. The most common cause of failure is performing beyond competence. We can only succeed when we perform inside our competence limits. Learning will increase competence and reduce the chance of failing. As succeeding will generate in us a feeling of usefulness rest assured failure will do the stark opposite.

Learning also means that it brings about change in behavior. If change in behavior or thoughts cannot be demonstrated after learning, we should critically question the utility of learning. The behavior change established after training and education should be predictable and measurable to some degree.

Criteria for a dream career

  • Opportunity to serve: Allows you to help people.
  • Action: Doesn't tie you to a desk all the time.
  • Respect: You are an important part of your community.
  • Security: Allows you a good living with a secure future.
  • Excitement: Changes daily, so it's hardly ever boring.
  • Mobility: You're in demand wherever you choose to live.
  • Flexibility: Gives you lots of career options from the same education base.

When we consider the criteria for a dream career I must say that Medicine scores very high on all of them.

What do doctors do?

Most doctors' professional lives are filled with caring for people and continuously learning more about the human body. Every day in communities around the country, doctors work in neighborhood clinics, hospitals, offices, even homeless shelters and schools to care for people in need. Physician researchers are at work today developing exciting new treatments for cancer, genetic disorders, and infectious diseases like AIDS.
Academic physicians share their skills and wisdom by teaching medical students and residents. Others work with health maintenance organizations, pharmaceutical companies, medical device manufacturers, health insurance companies, or in corporations directing health and safety programs.
People with medical skills are in demand just about every where.

Getting in Medical School is not easy:

It takes hard work and commitment to make it to medical school. You must be extremely motivated. No one attains the level of devotion these entrance examination demand unless the motivation comes from inside. I am yet to see a student achieve these levels of success with forced study.

I am obliged to look for the following when selecting a candidate:

  • Finest minds
  • Most motivated students.
  • Strong and demonstrated interest in working with people.

There are many sources for motivation

  • Peer pressure.
  • Parental counseling.
  • Educational literature.
  • Biographies / Role models.

Choose whatever suits you. I personally think that a prospective medical student will need them all. The major problem is most countries just cannot produce enough doctors that the nation needs. The projected incremental need for MBBS for Nepal is at 5000 per year. In the coming 10 years the most Nepal will produce is 2000 per year.
This stream is a very long road. You will need training for about 15 years

  • MBBS 5 – 6 years.
  • Masters +3 years.
  • Sub specialist training + 3 years.
  • Settling down average + 6 years.

Total of 18 years after 10+2. Basically you begin work at 36-40 years of age.

Then this education is not cheap. The average expenses borne by a student in tuition fees is as follows

  • USA ~ 150,000 USD.
  • UK ~ 100,000 Pounds.
  • Nepal ~ 30,00,000 NRS.

REMEMBER: Even if you are a scholarship student tax payers have paid you fees. Debt will be incurred by the family, institution or the nation for each doctor produced.

Source: American Medical Association website.

As we can see that the debt for medical education is increasing with each passing year. It is estimated that over 80% of graduates carry educational debt. The median debt burden for graduates of public medical institutions has risen to $100,000 while that for private school graduates has increased to $135,000. 25% of students with educational debt report principle in excess of $150,000 and a significant minority reports debt as high as $350,000. Medical education debt was 4.5 times as high in 2003 as it was in 1984, growing well beyond the consumer price index. Over the past twenty years, median medical school tuition and fees have increased by 165% in private schools and by 312% in public schools. Between 2002 to 2003, students saw some of the largest tuition increases in history. Private school tuition increased by 5.7% while public school tuition increased by 17.7%. Keeping these figures American Association of Medical Colleges came out with this report
“In recent years, physician incomes have increased only slowly, and in constant dollars, the amounts have trended slightly downward." Therefore, while tuition and debt continue to outpace inflation, physician incomes continue to lag far behind. This has made medical education less and less affordable to students and their families. It also ensure that most doctors will be in financial stretches right from the beginning of their career. The most encouraging part is most doctors report a very high degree of happiness inspite of a state of minimal savings.

Presently Nepal is facing a downturn in the economy. We can assuredly expect some tightening of budget. Funding for medical education will be compromised especially in the public sector. Rescinding of scholarships will follow. Increases in tuition, mid-year and retroactive tuition hikes is the expected fallout. Only private sector can fill the gap between the requirement of medical graduates and their production.

Preparing for Pre Medical Entrance Test:

Most students preparing entrance to medical education will burn themselves out before the D day arrives. The major challenge is balancing the need to pass XII board and to prepare for the PMT in about 18 months (12 months for XII grade and 6 months preparation). Success is directly proportional to the amount of hard and smart work invested in. Time does not stretch. It will be 18 months for every body. Applying Preto principal 80% of focused work will yield 20% results and 20% of focused work will yield 80% results. That is where the smart work comes in. The most common cause of failure is performing beyond competence. We must increase our efficiency and competence to succeed. As stress burn out and fatigue before the D day are the reasons of most falures I will spend some space of my article on this issue. Burnout is well recognized, and has a high cost for the individual, for colleagues and for the quality of service that patients get.
Doctors are more vulnerable than comparable professional groups to alcoholism, drug abuse and suicide.

  • Stress leads to arousal
  • Person selects a coping response
  • If effective, relaxation of arousal
  • If ineffective, arousal increases, resulting in strain
  • Unresolved stress leads to burnout

First time hit:
This will be very difficult and rewarding. Some ground rules will be needed.

  • Select a subject (physics, chemistry, biology) you find easy to understand. Make a thorough revision.
  • Select topics from your comfortable subject that are easy to understand. Make a thorough revision.
  • Now, take up the remaining two subjects you find more difficult to follow. Study them.
  • From your difficult subject, select easy topics. Revise them.
  • From your comfortable subject, select difficult topics. Study them.

This makes clear that you must break up the monumental tasks into small units for achievement. Achieve your easiest goals and proceed to progressively difficult ones. Then you will have left about 20% task undone rest will be completed. Beginning form the difficult task ensures that you accomplish very littlie in the end.


  • Revise class X (science subjects) and class XI chapters during holidays.
  • Select topics from X and XI chapters that are usually covered in PMTs .
  • Make separate registers for each of the three subjects (physics, chemistry and biology) and make notes under those topics. Gain a thorough understanding of the topics.
  • After that, get to your class XII syllabus. It's clear that the XII syllabus forms the basis of all PMTs.
  • With this effort, you will cover 80 per cent of the class XII syllabus. So, during your vacations you could prepare for PMT. Select frequently asked topics in PMT from all the three subjects of class XII. Gain in-depth knowledge of these topics.

Practicing MCQ

Solving MCQ is the backbone of getting into medical school. To become more efficient here you pick a MCQ book that you want to solve. Before any revision of theory for that subject begin your attempt to answer the MCQ. Give reason why you chose a particular response and why you rejected others for each question. Record these reasons in a register. Check your score. You will not need to revise the answers for the questions you scored correctly even without revision. You will keep getting them right in the future. Now begin concentrating on the questions you marked wrong. Revise your wrong reasons and start correcting your deficiencies. Your first go through the book will be very slow but the next time when you have to rely on your register only the speed picks up very encouragingly. With this method you do not waste time in relearning what you never forget anyway and concentrate on your weaknesses.

Who is suited for career in medicine:

Now this is as the Principal and CEO of a medical college. I will take students who score very high academically and fulfill most of my other requirements.

  • Perfectionism
  • Need for control
  • Exaggerated sense of responsibility
  • Difficulty asking for help
  • Excessive, unrealistic guilt
  • Suppression of feelings
  • Difficulty taking vacations and enjoying leisure time

Enough intellectual ability to do the job. Honesty, integrity and conscientiousness, must be at the heart of good practice. Helpfulness and willingness to cooperate come close behind. The personal welfare of the profession is another consideration. This is the kind of person I would be very happy to enroll in my school.

Selectors point of view focuses on

Getting the right policy for admission to medical school is a balancing act. We have to be fair to society by choosing people with the potential to be good doctors. We also have to be fair to the applicants—that diverse group of people who for many reasons want to set out on the long road to a medical career.

The job of the selector is not easy. Selection is not an exact science. We must use what evidence we have to ensure that we do our best by all concerned. There is widespread agreement that we should select future doctors on wider criteria than scores of academic success The aspects of individual merit that are most relevant to admission to medical school are hard to define. There is a strong case for the relevance of general intelligence. For most complicated tasks, intelligence is a good predictor of achievement. Selection based on previous scholastic success, essentially as a surrogate for intelligence, has generally served medical schools well. The predictive capacity of previous scholastic achievement, however, fades with progression through the course. Intelligence is multidimensional, and greater emphasis could be placed on some of its forms for example, emotional intelligence. The personal welfare of the profession is another consideration. Doctors are more vulnerable than comparable professional groups to alcoholism, drug abuse and suicide. This is why we need emotionally intelligent and robust candidates.

Stability over adult life. This is one character profile that I put very high demand on. Its not easy to predict stability over adult life. Long-term studies of stability of personality characteristics have shown that personality traits exhibit high test-retest correlations over intervals of 6 to 45 years. At the highest managerial level IQ accounts for almost 70% of performance variability. So in demanding evidence of high IQ (even in the form of exam results) we have got something right. Predictability can be improved by including some measure of other factors.

Further factors consistently found to add to prediction of performance are integrity and conscientiousness: these do not correlate with IQ.

Additional predictability doe not come from the number or nature of outside interests; years of education adds little to predictive validity; and the number of courses a person has been on is of no value (so much for how we measure ‘continuing professional development’). Previous job performance adds to prediction for those already in the profession, but adds nothing at entry. Some of these results are counter-intuitive: this is because IQ overlaps with other things. So a quick learner will have good performance in a previous job which will correlate so highly with IQ that it adds little to predictive validity. Although virtually all students are high academic achievers at school, from the top 0.4%to the top 10%, school and medical exam scores do correlate, with contribution to variability reported between 16%and 58%.

There are some non academic predictors of academic failure1,2,3

  1. Inadequate proficiency in English.
  2. Minority community.
  3. Female gender.


  • Medicine is a near perfect career.
  • It is very demanding.
  • Getting in, passing, performing and passing on the knowledge all are your job.
  • Medical schools will be required to produce excellent professions and very able social leaders at the same time else they shall not be doing the right thing.


  1. Cariaga-Lo LD, Enarson CE, Crandall SJ, Zaccaro DJ, Richards BF. Cognitive and cognitive predictors of academic difficulties and attrition. Acad Med1997; 72:S69 -S71
  2. Huff KL, Fang D. When are students most at risk of encountering academic difficulty? A study of the 1992 matriculants to US medical schools. Acad Med1999; 74:454 -60
  3. Strayhorn G, Frierson H. Assessing correlations between black and white students' perceptions of the medical school learning environment, their academic performances and their well-being. Acad Med1989; 64:468 -73