DNB or MD/MS?

Over the past several years, many people have asked me whether they should join DNB or MD. Some days ago, one of my juniors in MBBS also called me up for advice – he wanted to join a DNB course in Nuclear Medicine, and he was apprehensive about the pass percentages after the three year course. I gave him a standard answer that I give almost anybody who asks me same question!

This incident gave me the idea to explore in my next blog. My thoughts here are good only for medicos in India. I have no idea what is the system elsewhere!

So here it is:

Doing an MD/MS is certainly better when

1. you get it in a single (or at most two) attempts at the PG entrance exams and
2. get it in an academically decent institution and
3. get the subject of your choice.

The biggest advantage that seems to be clearly visible to everyone is, the vast majority of guys doing an MD/MS clear their final exams in one go!

But how many people taking PG entrance exams satisfy all the three conditions above? I would say, only a handful!

Consider this –

Out of the thousands who appear for PG entrances, only a minority percentage qualifies in their first attempt. A first attempt could mean a preparation time for anywhere between a couple of months to a year. Another attempt could take the preparation time to two years!

Next, out of the minority who qualify in their first attempt, only a handful get into a good academic institution. The rest end up in places without enough facilities or patients or good teachers or good academic activities. Let us face it guys, even if you say that these type of institutes still produce good PGs, it is solely due to the hard work of the PGs; the institute doesn’t give them much! And most of such postgraduates do end up learning a lot of their subject during their senior residencies in better places, after completing their PGs. So, places which do not qualify as good institutes are as bad as places offering DNB but not qualifying as good institutes. Several of those joining these colleges do so because they have no other choice – not out of their own sweet will!!

Finally, a tiny miniscule of the people fall into the group that satisfy the above two conditions and also the third one – that is getting into a subject of their own choice!

The very vast majority either

1. doesn’t clear the PG entrances in its first attempt or
2. doesn’t get a good institution or
3. doesn’t get the subject of its choice!

So what is the scenario like for the vast majority?

The vast majority ends up toiling hard for two or more years, getting into a second hand college and compromises on its subject choice, settling down for the second or third choice!

What is the point that I want to make?

Well, let us take the instance of a regular PG entrance exam taker. He completes his internship, and then ends up preparing for the entrance exam on an average for 2 years, before he qualifies in any of them. All this time, he either works at a hospital part-time for a pittance, or doesn’t work or earn anything at all! For two years on an average he reads and re-reads all the subjects in medical science, many of which may not be relevant for the PG course he joins later. Then he finally clears an exam, but is still not happy as he couldn’t get the subject he wanted. He either decides to try again or join another subject, which was not there in his wish list earlier! He finishes the course in 3 years, finally. So now he is a postgraduate 5 years after his internship (average) in a subject he didn’t initially plan for, and likely from a college he hadn’t planned to join.

Compare with a person joining DNB. The DNB entrance is easy to clear – so our man gets through within 6 months. He gets to join in the subject of his choice – there are plenty available! Admitted, he may not get a good institution, but in most cases, the DNB institution cannot be worse than the MD/MS institution that he would have joined, if he had cleared his PG entrance. He spends three years in his DNB and then spends another two clearing the final exam. This is what people fear the most – not being able to clear the final exam in one attempt! I will come to it later. After his initial three years and before clearing DNB final exams, he studies only his own subject, and he works and earns in the meantime in his own specialty! So after 5 years he is a postgraduate, in a subject he wanted to, with the requisite work experience as well!

So, come on, let us list the relative strong points of DNB and MD/MS:

1. You spend about 5 years in both MD/MS and DNB (from start of preparation for entrance to clearing your final PG exam).
2. Out of those five years, 3 are spent in pursuing your course. In MD/MS, the other two years are spent in preparation for the entrances, with the subjects studied only distantly related to your postgraduate course activities or your job thereafter. In DNB, you spend the other two years preparing for the final exam of your own PG subject, which keeps making you better and better at theory till you pass!
3. In addition, the initial 2 years spent in preparation for MD/MS entrance are spent holed up in a library or a rented and shared apartment, sometimes shelling out money for the rent and for any coaching one might take. There are very few who can boast of getting through PG entrances while getting some work experience as well! On the other hand, the two extra years after a DNB course is usually spent working in the same specialty somewhere and gaining practical experience as well as earning some money.
4. You rarely get the subject of your choice in MD/MS, and if you do, you compromise on the college. You, more often than not, get a subject of your own choice in DNB, and the average DNB institution is never worse than the average MD/MS institution.
5. Getting through an MD/MS entrance is usually a fair and square game (not counting management quota donation seats and stray instances of question paper leaks). But with DNB, recommendations and connections work a lot along with donation/fees money.
6. The internal examiners in MD/MS know you very well! This, surely, is an advantage in your final exams. But the other side of the coin is that you might get to be at the receiving end of a long standing grudge from your examiner if you are not able to please him/her in all possible ways! In DNB, there is hardly any partiality as all the candidates are unknown to the examiners. Only your depth of knowledge of the subject and good luck count. The examination itself is considered more uniform all over the country as the candidates never know what possible cases might come in their exam, unlike in MD/MS. The downside of this is it takes a lot more to convince the examiner that you are good at your subject!

There can be a few more minor points in and out of favor of either DNB or MD/MS. But finally, if you ask me for my opinion, I think DNB is worth everyone’s try and in most cases joining a DNB program available at hand scores over further attempts at PG entrances!