Twelve Years of Doing Good Work for the Wrong Reasons

Dr. Kavitha Subramaniam completed her MBBS in 2008 and her MD in Internal Medicine in 2012. For the following decade, she practised at a mid-sized private hospital in Chennai, managing wards, consulting in outpatient clinics, and occasionally covering emergency admissions.

By any clinical metric, she was excellent. Her patient satisfaction scores were consistently high. Colleagues valued her clinical reasoning. Juniors sought her out for guidance. She was, in the language of the institution, a "valuable resource."

She was also, by 2021, burning at a rate she was no longer able to manage.

"Burnout is the wrong word for what happened to me, or at least it's incomplete. Burnout implies you were on fire and ran out of fuel. What I experienced was more like I had never had the right kind of fuel. I was working very hard at something that did not use the best parts of me. And medicine is a field where you cannot do it half-heartedly — the stakes are too high. So I was pouring everything in and getting back less and less."

The specific form of her discomfort was instructive in retrospect. She was not tired of helping patients — she still cared about individual outcomes. She was exhausted by the narrowness of the clinical frame: treating one patient at a time, within a system she could see was flawed, without any means of influencing the system itself.

When a cholera outbreak in a periurban area of Tamil Nadu sent a wave of preventable cases through her ward in 2021, she spent a week treating patients and the months afterward unable to stop thinking about the public health failures that had caused the outbreak. She wrote a three-page note on system-level interventions. Nobody asked for it. She sent it to her hospital's medical director. He thanked her for it and filed it somewhere.

"That was the moment I understood that the clinical setting was not where my instincts were pointing. I was looking at the system, not the patient. I needed to be in a role where that was actually the job."

The Decision Point at Forty

By the time Dr. Kavitha contacted Dheya in early 2022, she had already been circling the question of career change for two years. She had attended a short-term health management course, read extensively about public health careers, and had one informational meeting with an official at the Tamil Nadu State Health Mission that had been energising but inconclusive.

What she lacked was structured support for making the transition — someone who could help her map her specific strengths to specific opportunities and build a credible path from clinical practice to policy, without the two-year MBA she could not afford to take and did not want to pursue.

She enrolled in Dheya's Destination Mastery programme, designed for mid-career professionals navigating significant career pivots. The programme begins with a full RAPD assessment and a three-session debrief with a senior mentor.

Her mentor was Dr. Rajiv Menon, a public health specialist with fifteen years of experience across government, academic, and international development contexts before joining Dheya's network.

The RAPD Debrief: Naming What She Already Knew

Dr. Kavitha's RAPD results showed a dominant Directive orientation — high across all sub-dimensions: agenda-setting, systems influence, decision-making under uncertainty. Her Analytical dimension was also strongly elevated. Her Relational and Practical scores were present but clearly secondary.

The profile, Dr. Menon explained, describes someone who is driven by defining problems, influencing the conditions that create them, and making decisions at a systems level. It is the profile of a policy architect, not a frontline practitioner — though the clinical experience provides irreplaceable domain knowledge.

"When Rajiv described the Directive profile to me — the need to work at the level of systems and conditions rather than individual cases — I had the same feeling you have when someone puts glasses on you and you realise you've been squinting for years. That's what I am. I've always been that. The question was whether I could build a career on it."

The Analytical dimension, Dr. Menon noted, is a strong complement to the Directive in health policy contexts. Effective health policy requires both the drive to define and implement change and the rigour to build evidence-based arguments for it. Clinical medicine develops both, but applies neither at the system level.

Mapping the Transition: Three Realistic Pathways

Sessions four through six of the Destination Mastery programme were structured around identifying and evaluating specific career pathways. Dr. Menon mapped three routes:

Pathway 1: Health Policy Roles in Government or Multilateral Organisations. Positions at state health missions, national health authorities, WHO, UNICEF Health Section, or USAID health programs. These roles require public health credentials for most senior positions, but entry-level consulting and technical advisory positions are accessible to clinicians with relevant experience. Timeline to meaningful role: 12–18 months, depending on whether a public health certificate (a 6-month program, not a two-year degree) was pursued in parallel.

Pathway 2: Health Policy Consulting. India's health policy consulting sector — firms working with state governments, donors, and international health organisations on program design, evaluation, and implementation — actively seeks physicians who can combine clinical credibility with analytical capacity. Entry is typically through contract-based technical assistance roles, building to independent consulting. Timeline: 6–12 months to first contract engagement.

Pathway 3: Health Journalism and Communication. A less direct route, but one that several physician-writers had taken: building a public voice on health policy issues through writing, contributing to policy publications, and developing a reputation that leads to advisory roles. Slower to monetise but effective for physicians who combine the analytical and relational dimensions strongly.

Dr. Kavitha was drawn to Pathway 2, with elements of Pathway 3 as a supporting strategy for visibility.

"Rajiv pointed out that in health policy consulting, nobody hires you because of your MBBS and MD alone. They hire you because you have a demonstrated point of view on health systems. The writing was not a side thing — it was how I would build the reputation that would make the consulting credible."

The Eighteen-Month Transition

The plan Dr. Menon and Dr. Kavitha built was layered:

Months 1–4: Continue clinical work part-time (three days per week), begin writing for health policy publications. Target: two published articles on health system design topics, at least one in a peer-reviewed journal or a recognised policy publication such as The Wire Health or Scroll Health.

Months 5–8: Complete a 6-month online Certificate in Public Health from a recognised institution (TISS or NIMHANS programs). Begin attending health policy forums, PHFI events, and state health mission consultations as a participant.

Months 9–12: Make first consulting approaches — short-term technical assistance for NGOs working in health program evaluation, building practical policy experience alongside clinical credibility.

Months 13–18: Reduce clinical work to on-call only, focus full-time on consulting pipeline. Target: first independent contract of at least ₹6 lakh annual equivalent.

The writing component produced earlier results than expected. Dr. Kavitha's first essay — a 1,800-word analysis of the gaps in Tamil Nadu's primary healthcare infrastructure, published on a policy platform in the fourth month — was shared widely in health policy circles and led directly to an invitation to a UNICEF consultative workshop on maternal health program design.

"That workshop changed everything. I was in a room with people who were doing exactly the work I had been thinking about for years. And they were looking at me like I belonged there. That was the first time I felt that I was in the right place."

Where She Is Now

By the time this case study was written, in early 2026, Dr. Kavitha had been working as an independent health policy consultant for 22 months. Her practice had grown to include:

  • Three active state government contracts (Tamil Nadu, Kerala, Telangana) in primary healthcare and maternal health program design
  • Two international development organisation retainerships (one with a Geneva-based global health foundation, one with a multilateral development bank's South Asia health team)
  • A monthly health policy column with a national English daily, reaching an estimated 180,000 readers
  • Annual billing in FY2025: approximately ₹42 lakh

She maintains a once-a-week clinical session at a community health centre — not for income, but, she says, "to stay honest. You cannot do health policy credibly if you've completely lost touch with what happens in a consultation room."

She was asked whether she regretted the twelve years in clinical practice before making the shift.

"Not for a moment. Everything I know about how health systems fail people, I learned at the bedside. The clinical years are not wasted time — they're the credential that makes the policy work credible. What I regret is that nobody helped me see earlier that my particular combination of strengths pointed somewhere specific. I could have found this fifteen years ago. But finding it at forty is infinitely better than not finding it at all."

What Physicians (and Other Professionals) in This Position Need to Know

Career drift in medicine is underreported and undertreated. The culture of clinical work does not make space for the admission that one's professional identity may be misaligned with one's role. The personal and financial investment in medical training creates a sunk-cost pressure that is difficult to think clearly through. And the absence of structured support for mid-career pivots in professional fields leaves many physicians — and lawyers, engineers, academics, and other credentialed professionals — spending decades in roles that do not use the best of what they have.

The Destination Mastery programme is Dheya's specific offering for this cohort: professionals in their 30s and 40s who have significant domain expertise and a growing conviction that they are pointing in the wrong direction.

Explore the Destination Mastery programme →

Dr. Kavitha's case is not a story about escaping a difficult career. It is a story about finding the version of contribution that matches who you actually are — and then building the path to get there.