The everyday Punjabi word for a class at school is ਜਮਾਤ (jamāt). A child in the first grade is in the first jamāt; a classmate is a ਜਮਾਤੀ (jamātī). The word came into Punjabi from Arabic, where jamāʿa means a gathering, an assembly, a body of people brought together, and in its older senses it still carries that weight: a jamāt can be a congregation or a party of travellers. I like the word because it describes a class honestly. A class is a gathering, and unlike most gatherings it is assembled with its dispersal already scheduled. Everyone in it knows the date on which it will end.
My pre-medical years at Khalsa College in Amritsar, from 1994 to 1996, were spent in a jamāt of that kind, and a pre-medical class is, almost by definition, a group of young people studying physics, chemistry and biology with an eye, at least for the moment, on a small number of the same doors. At that stage no one in the room was a doctor, and no one was not a doctor. Everyone was pre-something. The labels that would later be attached to each of them, by employers, by families, by reunions and by their own retellings, had not yet been issued. For two years, the class was simply the class.
What a class shares while it lasts is more than a room. It shares a syllabus, which is a stranger and more intimate thing than it sounds. For two years a group of people read the same chapters in roughly the same order, learn the same diagrams, are puzzled in the same places and examined on the same days. Their knowledge, for that short time, is nearly interchangeable. A question one of them cannot answer is very likely one another can, and the exchange happens without anyone keeping account. Later in life almost nobody shares a syllabus with anybody. Colleagues in one profession read different journals and forget different things; friends in different professions do not share even a vocabulary. For many of the people in it, a pre-medical class is the last time they will know roughly what everyone around them knows. Some of the warmth with which such years are remembered may come from that: less from youth or setting than from the brief experience of an ignorance held in common and lifted together.
The title of this essay sorts them anyway. Friends who became doctors, and friends who did not: the phrase divides a whole class by a single credential, and puts the credential first. I have kept it because it names, more exactly than a gentler title would, the habit of mind the essay is about. Seen from the far side of a profession, a class easily comes to look like a field from which some people were harvested into medicine and the rest were left standing. The essay is an attempt to look at that habit and refuse it, which means starting with what it hides.
One ground rule, stated once. No one from those years is named or described here, no one’s road is narrated, and no one’s reasons are guessed at. That is not modesty for its own sake. It is part of the argument, and I will come to it near the end. What follows concerns the shape of divergence, the places where roads part and the stories told about them afterwards, not the particular road of anyone who sat in those rooms.
Two Roads, Really About the Same #
Robert Frost’s “The Road Not Taken,” first collected in Mountain Interval in 1916, is among the most misremembered poems in English. It is quoted at graduations as a hymn to choosing the road “less traveled by,” and its last line, “And that has made all the difference,” is offered to the young as a blessing on boldness. Read the poem through and it says something else. The traveller stands where two roads part in a yellow wood. He looks down one as far as he can. Then he takes the other, which has “perhaps the better claim, / Because it was grassy and wanted wear.” And at once the poem takes the distinction back:
Though as for that the passing there Had worn them really about the same,
And both that morning equally lay In leaves no step had trodden black.
The roads were really about the same. The difference arrives only in the final stanza, and it arrives in the future tense: “I shall be telling this with a sigh / Somewhere ages and ages hence.” It is the later telling, not the morning in the wood, that turns two equal roads into the one less travelled and the one not taken. The poem is not about a bold choice. It is about the story a person will tell, years afterwards, to make a nearly arbitrary choice look like a destiny.
There is a history behind the poem’s irony, and it makes the poem sadder. Frost said in later years that he had written it with his friend Edward Thomas in mind. On their walks together in Gloucestershire in 1914, Thomas would choose a path and then regret the one they had not taken. Frost sent him the poem from America in 1915. Accounts of how Thomas took it differ. What is not in doubt is that he enlisted that summer, and that in April 1917 he was killed at Arras. Two friends had walked the same lanes, arguing gently about paths; within three years one of the roads led to France and did not come back. The poem that teased a friend for his regrets became, in hindsight, a poem about a divergence more absolute than either man could have foreseen on those walks.
A pre-medical class comes to its yellow wood at the end of its course. Admission to medical colleges in India has long turned, for most seats, on competitive examinations and the merit lists drawn from them, and the seats have always been fewer than the students who want them. A list is published. Some names are on it and some are not. Some students who could have taken a seat choose another course; some who wanted medicine try again; some discover, with relief or with grief, that they wanted something else all along. My own road ran on to the Sri Guru Ram Das Institute of Medical Sciences and Research, where I studied for the MBBS from 1997 to 2002. That is the one road in this essay I can describe, and I mention it only to say where I am standing when I look back.
From that standpoint, the roads look very different from how they looked in the wood. The story told with a sigh, ages hence, says that some people were always going to be doctors and others had other paths in mind. On the morning itself, for many students at such a fork, the roads may be really about the same: separated by a few marks on a single paper, by a form submitted or not submitted, by a family’s circumstances that year, by a preference that might have gone the other way in a different month. Frost’s traveller knew this on the morning and expected to forget it. Most of us do forget it, and the forgetting has consequences for how we see the people who walked the other way.
Way Leads On to Way #
Frost’s poem has one fork, and the single fork is part of its charm and part of its falsehood. Lives rarely divide at one place. They divide through a long series of smaller forks, most of which are not recognised as forks when they are passed: which subject came easily, which teacher was encouraging, which relative had gone before, which city had a seat, which year a family could spare a son or daughter, which course was full. Frost knew this too; it is why the poem contains the line about how “way leads on to way.” The fork remembered later, the merit list or the admission letter, is usually only the most visible of them, the one with a date and a document attached, and so it is given credit for the whole divergence.
The same is true on the near side of the line. Friends who became doctors sounds like a single category, and it is not. Those who entered medicine in the same year went on to diverge from one another almost as widely as from everyone else: into surgery and psychiatry, villages and cities, hospitals and clinics and laboratories and offices, long careers and short ones, contentment and its opposite. Two physicians who sat in the same pre-medical class may, thirty years on, share less of their working lives than either shares with a classmate who became a schoolteacher. The credential that seemed at eighteen to divide the class into two clean groups turns out to be one fork among many, decisive in its season and much less decisive afterwards than the story told about it suggests.
Chill Penury #
The great English poem about lives that did not become what they might have become is Thomas Gray’s Elegy Written in a Country Churchyard, published in 1751. The speaker stands among the graves of a village’s poor and thinks about what the earth contains:
Full many a gem of purest ray serene The dark unfathomed caves of ocean bear: Full many a flower is born to blush unseen, And waste its sweetness on the desert air.
Some village Hampden may lie there, Gray suggests, some “mute inglorious Milton,” some Cromwell “guiltless of his country’s blood.” They did not become what they might have, and Gray names the reason with an exactness that still stings. “Knowledge to their eyes her ample page / Rich with the spoils of time did ne’er unroll; / Chill Penury repressed their noble rage, / And froze the genial current of the soul.”
As an account of hidden constraint, this is close to the truth, and it applies far beyond an English village. Any class that is sorted into professions is sorted partly by forces that have nothing to do with ability or desire. Money is the plainest: fees, books, the coaching that some families can buy for an entrance examination and others cannot, the years of study a household can afford to wait through before a son or daughter earns. Then there are obligations that do not appear on any form: land that needs someone to work it, a parent who falls ill, a business that will pass to whoever is at home, an expectation that one child will stay near. There is opportunity, which depends on where one lives, what one has heard of, and who has already gone ahead. And there is chance, which governs more of every life than the people living it like to admit, including the chance of a good or bad day on the morning of an examination.
All of this is real, and none of it can be read off the outside of a life. Gray’s poem is generous because it insists that obscurity is not proof of emptiness. But it is worth noticing what the generosity costs, because the same cost is waiting for the physician who looks back at his class.
The first cost is that Gray decides, on behalf of the dead, what they might have been, and he chooses the measures of his own world: a statesman, a great poet, a general. The village becomes, in his eyes, a nursery of unrealised fame. It does not occur to the poem that a man might have been a fine farmer and wanted nothing else, that his ambition, if he had one, might have run in a direction Gray had no word for. When the poem does turn to their wishes, it supplies them: “Their sober wishes never learned to stray; / Along the cool sequestered vale of life / They kept the noiseless tenor of their way.” The poet knows they were sober. He knows they never strayed. He heard none of it from them.
The second cost was pointed out by William Empson in Some Versions of Pastoral in 1935. The famous stanza about the gem and the flower, he observed, works by making a social arrangement look like a fact of nature. A gem in an ocean cave and a flower in a desert are not wronged by their obscurity; nothing can be done about either. By setting the poor beside them, the poem quietly suggests that nothing can be done about the poor, and its melancholy consoles the reader for an injustice it declines to name. The sigh replaces the question of who built the cave.
Gray himself, to his credit, complicates his own portrait a stanza later. The lot of the villagers, he writes, did not only circumscribe “their growing virtues, but their crimes confined.” An unlived life of eminence is also an unlived life of the harms eminence can do, and the man who never became a Cromwell also never waded through slaughter. The point is easily overlooked, and it matters here. To look at a classmate’s road and see only the medicine that was not reached is to assume that the profession is pure gain, and that the life which missed it missed nothing but good.
The temptation for a physician looking back is to stand in the churchyard of his own class and see mute, inglorious doctors. The phrase people use is kinder but carries the same assumption: he could have been a doctor. It is offered as a compliment and can land as an insult, because it measures a whole life by a road it did not take. Constraints were real. Their weight in any one life is known only to the person who carried it, and sometimes not entirely to him.
The Word Merit #
The lists that sort a pre-medical class are called merit lists, and the word carries more freight than it seems to. In 1958 the British sociologist Michael Young published The Rise of the Meritocracy, a satire written as though by a historian looking back from the year 2033. The word meritocracy had appeared in print only two years before, but it was Young’s book that made it current, and he used it in order to warn against the thing it named. A society that sorted people rigorously by tested ability and effort, he suggested, would be fairer in one sense and harsher in another. Under older forms of inequality, those at the bottom could tell themselves, often truthfully, that they had never been given a chance. Under a meritocracy they would be told that they had been given their chance and measured, and those at the top would come to regard their position as simply what they deserved. Young lived long enough to see the word he had made famous as a warning adopted as a compliment, and to protest about it.
A merit list is an instrument of the kind he worried about. It is also, it should be said, a protection. Where admission could otherwise be bought or inherited, a ranked list based on a public examination is a real defence of the student without connections, and it is not a defence anyone should be quick to give up. The difficulty is not the list. It is what the list teaches when it is mistaken for a verdict on persons. A rank measures performance on certain papers on certain days, and the word merit quietly stretches it into a judgment of worth. Those above the line learn to read their place as earned; those below it are invited to read theirs the same way. Neither reading survives a careful look at how any list is made, but both tend to survive the decades, and both colour how a class sees itself when it meets again.
The Short and Simple Annals #
In the same poem Gray asks that “Grandeur” not hear “with a disdainful smile / The short and simple annals of the poor.” Annals are records kept year by year, and the word is exact. Some lives produce long annals and some produce short ones, and the length has less to do with their worth than with the kind of work they contain.
Professional lives are unusually well documented. A physician’s road leaves a trail of certificates, registrations, appointments, examinations passed and titles conferred, each dated and stamped, and each easy to report. That is part of what professions are: systems for producing credentials that can be checked. The documentation is useful, and it creates a distortion. Lives that run through institutions generate paper. Lives spent farming, keeping a shop, teaching in the same school for thirty years, holding a family together through illness, or caring for an ageing parent generate much less, even when they contain at least as much skill, judgment and endurance. The short annals are not necessarily the thin ones. They are the ones whose substance did not pass through an office that issues certificates.
Every way a class remembers itself tilts toward the long annals. A reunion is a gathering, like the class itself, but it is a gathering that has acquired a scoreboard. The people who come are, disproportionately, the people who are comfortable being asked what they do. The news that travels between reunions is news of the kind that can be announced: a promotion, a practice, a new appointment, a child’s admission. Steady contentment is not news. Neither is a quiet decision to put family before advancement, or the slow mastery of a trade, or ten years of looking after someone who could not look after himself. These are the achievements that make lives bearable for the people around them, and they have no announcement form.
Biography and memoir have the same tilt, and this site is not exempt. A memoir is organised around the author’s road, and the people who appear in it tend to appear where they touch that road: as companions, rivals, teachers, foils. A classmate who did not become a doctor enters a doctor’s memoir, if at all, as the person on the other path, which is to say as a point of comparison in somebody else’s story. That is a small injustice, and it is built into the form. The least a writer can do is notice it.
Care work deserves a particular word here, because it is the work most often hidden by the short annals and the work most familiar to a physician from the other side. Much of what keeps sick people alive and dignified is done by people who hold no credential for it: the son who arranges his life around a parent’s appointments, the daughter-in-law who learns to manage a feeding tube, the neighbour who checks every evening. Physicians see this work constantly, and know how much of a patient’s outcome depends on it. It would be strange to honour it in patients’ families and fail to see it in the lives of the people one studied beside.
The Road Not Taken by Me #
There is another story a physician is tempted to tell about the class he left, and it is about himself. It comes in two versions, and both are flattering in their way.
In the first, he was always going to be a doctor. The choice, seen from the far end of a career, looks less like a choice than a calling, and the other roads in the wood fade into scenery. This is Frost’s sigh turned into a creed. It is comfortable because it makes a life feel inevitable, and an inevitable life cannot have been a mistake. It is also untrue in a specific way. It erases the contingency that the morning in the wood contained, and with it the people for whom the same morning went differently. If one’s own road was destiny, then the others’ roads were the absence of destiny, and the condescension follows by itself.
In the second version, the physician conjures the life he would have had on another road and finds it more interesting, or freer, or happier. The writer he might have been, the scientist, the man who stayed. This version flatters in reverse. It romanticises an alternative that never had to survive a single ordinary Tuesday, and it borrows, without permission, the lives of the classmates who actually took those roads, as though they were the author’s unlived drafts. They were not. They were their own lives, with their own disappointments and their own Tuesdays.
Frost’s traveller knew the essential fact about counterfactuals: “knowing how way leads on to way, / I doubted if I should ever come back.” The other road cannot be walked later to see where it went. There is no control group for a life. Even the person who stood at the fork is no longer available to ask, because he has changed. In a study published in Science in 2013, Jordi Quoidbach, Daniel Gilbert and Timothy Wilson measured the personalities, values and preferences of more than nineteen thousand people between eighteen and sixty-eight, and asked them how much they had changed over the past decade and how much they expected to change over the next. At every age people reported that they had changed a great deal and predicted that they would change little. The authors called it the end of history illusion: each of us regards the present as the moment at which we have finally become who we will be.
The finding bears on a pre-medical class in an unexpected way. The eighteen-year-olds who stood at that fork each believed, more or less, that the person choosing was the person who would live with the choice. Neither the ones who became doctors nor the ones who did not were right about that. The students who sorted themselves, or were sorted, in the 1990s have since become people they could not have predicted, on both sides of the line. To judge any of those lives by what an eighteen-year-old wanted is to hold them to a contract signed by someone who no longer exists.
Each Supplementing the Other’s Memory #
The novel that understands reunions best ends with one. In the last chapter of Gustave Flaubert’s Sentimental Education, published in 1869, two old school friends, Frédéric Moreau and Charles Deslauriers, sit by a fire in middle age and, in the words of an early English translation, “proceeded to summarise their lives.” Flaubert gives the verdict in a sentence: “They had both failed in their objects—the one who dreamed only of love, and the other of power.” They try to explain it. Frédéric suggests that he never kept to a straight line; Deslauriers says he had too much logic and his friend too much sentiment. “Then they blamed luck, circumstances, the epoch at which they were born.”
That is the first thing old classmates do when they meet: they render verdicts, on themselves and each other, by the measures they set out with. Flaubert lets the verdict stand. These two did fail, by the standards of their own youth. But he does not end there. The friends begin to say to each other, “Do you remember?” They recall the school at Sens, the playground and the chapel, the masters and the boys, and at last a misadventure from the holidays of 1837, a visit to a house of ill repute, bouquets in hand, from which Frédéric fled in confusion almost as soon as they had arrived, with Deslauriers obliged to follow because Frédéric had the money. They tell the story at length, “each supplementing the narrative where the other’s memory failed.” And when it is finished Frédéric says, “That was the best time we ever had!” Deslauriers agrees.
The ending is often read as Flaubert’s last and bleakest joke: two lives so empty that their high point was a schoolboy failure. That reading is fair. There is another inside it. In the summary of their lives, the friends are rivals and judges, each measuring the other’s failure against his own. In the shared memory they are collaborators. Neither can tell the story alone; each holds pieces the other has lost. What their friendship actually contains is not a comparison of outcomes. It is a memory of a time before outcomes, held in two heads and complete only when both are present. The best time they ever had was the time before the sorting.
Friendships that survive divergent roads seem to survive on that second footing, not the first. They have obstacles. Professions acquire vocabularies, and a physician’s speech fills up with abbreviations and a manner of describing bodies that can make ordinary conversation feel like a consultation. Schedules part: night duty against early fields, clinic hours against school terms. Geography parts people too.
Medicine adds a strain of its own, so ordinary that it is easy to miss. Once a friend becomes a doctor, he becomes a resource. At weddings and on the telephone the questions begin: a parent’s tablets, a child’s fever, a pain that has gone on too long. Most physicians answer gladly, and the questions are a form of trust. But they can change the shape of a friendship without anyone intending it, because the expertise flows one way. The friend who farms is seldom asked about soil or weather by the friend who practises medicine; the friend who teaches is not consulted about how children learn; the friend who keeps accounts is not asked what he has learned about money and fear. A friendship across the line seems to last best when the asking runs in both directions, when the physician remembers that the other person also became expert in something, by a road with fewer certificates, and wants to hear about it.
Some friendships do not survive these things, and that is not always a failure. People are allowed to drift. But where a friendship does last across the line between those who became doctors and those who did not, it has usually stopped asking the question on which the line was drawn.
Punjabi has a word for the kind of companion such a friend becomes. A ਹਾਣੀ (hāṇī) is an age-mate, someone of one’s own years: in the phrase ਹਾਣ ਦਾ (hāṇ dā), “of the same age,” the measure is time lived, not rank achieved. Two people can be hāṇī whatever their credentials, because what they share is a calendar. The word does not ask who did better. It asks only who was there at the same time, and it is a better description of what a classmate is than any list of what each one became.
Unnamed #
I said at the beginning that no one would be named here, and that the reason was part of the argument. It is this.
A memoir has an appetite for people. The quickest way to make an essay like this one vivid would be to invent, or half-invent, a few classmates: the brilliant one who became a farmer, the one who failed the examination twice and became an excellent pharmacist, the one who now runs the family’s business and is happier than any doctor in the class. Sketches like that are the stock of reunion speeches and of a certain kind of memoir, and they are almost always unfair. They turn a person into an illustration in somebody else’s moral education. They assign reasons the person never gave. They put a life, without its owner’s consent, in the service of the author’s point that every life has value, which is a strange way of honouring it.
A life belongs in an essay like this only with its owner’s consent, and so nobody from those years appears here. That absence should not be read as estrangement, and it is not a judgment of insignificance. The lives in question are, for the most part, private lives, and they belong to the people living them. Medicine has a long habit of keeping other people’s stories in trust; it would be odd for a physician to suspend the habit for the companions of his own youth. A classmate’s road is his own to narrate, in his own words, to whomever he chooses, and the fact that it diverged from a doctor’s road gives the doctor no special rights over it.
A harder objection remains. Even the generosity of the preceding pages can be read as another form of authority. A physician who announces that the lives of those who did not become doctors are also worthwhile has positioned himself, once again, as the person whose approval matters: the examiner who passes everyone, but who is still the examiner. Gray’s elegy has the same structure. The poet grants the villagers their dignity, and the granting is his.
I do not think there is a way to write about this subject that escapes the objection entirely, but there is a way to take it seriously. It is to refuse the role of certifier altogether. Not your life was also worthwhile, which still holds the pen, but your life is not mine to grade. A physician’s training includes, at its best, a discipline of not passing judgment on how patients choose to live, and of offering what medicine can offer without requiring that they live as the physician would. The same discipline, turned toward a class of thirty years ago, means describing the general shape of divergence, the constraints and the stories, and then leaving the particular lives alone.
No Single Ranking #
What remains, when the verdicts are set aside, is the jamāt: a gathering assembled for a while and then dispersed, as it was always going to be. Its members went on to medicine and to many other things, by roads that were sometimes chosen, sometimes assigned and often both, and they became people none of them could have predicted at eighteen. Some of their lives are long in annals and some are short. By the measures they set out with, some of those lives will count as failures and some as successes, and both judgments are less interesting than the lives.
A plural account of those lives would need more measures than any credential supplies: usefulness to others, steadiness, skill, kindness, the care given to people who could not repay it, work done well that no one inspected, joy. No single scale ranks lives along all of these, and the attempt to rank them by one, by the presence or absence of a degree, tells us mainly where the person doing the ranking happens to stand.
A plural account has a failure of its own to guard against, and Empson’s objection to Gray applies to it as well. To say that every road led somewhere worthwhile can become a way of not noticing the roads that were closed unfairly: the student who could not pay for what others paid for, the young woman whose family would not let her travel to the city where the seat was, the boy who left a course because a harvest failed. Those were not alternative paths freely taken. They were losses, and some of them were injustices that a better arranged system could have prevented. Refusing to rank lives does not require pretending that nothing was taken from anyone. It requires a distinction between the worth of a life, which is not mine to grade, and the fairness of the gate it passed or did not pass through, which is everyone’s business. The first calls for respect. The second calls for repair: cheaper routes, more seats, doors that depend less on money and on where one happens to be born. A physician who looks back at his class with real generosity owes it both.
Frost’s traveller, looking back, will tell the story with a sigh and claim that the road made all the difference. Flaubert’s old friends, looking back, decide that their best time was a Sunday evening before anything was decided. Between them they describe the two temptations of anyone who looks back at a class: to make the divergence into destiny, and to make the time before it into the only time that counted. Neither does justice to the people involved. The roads were about the same on the morning they parted, and they have since led to lives whose worth does not depend on which way they went.
The title of this essay will stay as it is. Some friends became doctors, and some did not. That is one true thing about each of them, among a great many others, and it was never the order in which they should be listed.
Evidence and Editorial Note #
Documented findings. Public biography relied on: pre-medical studies at Khalsa College, Amritsar, 1994–1996; MBBS at Sri Guru Ram Das Institute of Medical Sciences and Research, 1997–2002. Robert Frost, “The Road Not Taken,” quoted from Mountain Interval (1916; Project Gutenberg text). Thomas Gray, Elegy Written in a Country Churchyard (1751), quoted from the Project Gutenberg text of Selections from Five English Poets. Gustave Flaubert, Sentimental Education (1869), final chapter, quoted from the anonymous early English translation printed in M. Walter Dunne’s edition of Flaubert’s works (Project Gutenberg, volume 2): the summary of lives, “Then they blamed luck, circumstances, the epoch at which they were born”, “each supplementing the narrative where the other’s memory failed”, and “That was the best time we ever had!” Jordi Quoidbach, Daniel Gilbert and Timothy Wilson, “The end of history illusion”, Science 2013;339:96–98 (PubMed abstract): more than 19,000 people aged 18 to 68. Standard reference knowledge: Frost’s friendship and walks with Edward Thomas in Gloucestershire in 1914, Frost’s later statements that the poem had Thomas in mind, Thomas’s enlistment in 1915 and death at Arras in April 1917; William Empson’s reading of the Elegy in Some Versions of Pastoral (1935), paraphrased; Michael Young, The Rise of the Meritocracy (1958), its satirical use of “meritocracy” and his later protest at the word’s adoption as praise, paraphrased, with the word’s first known use in print by Alan Fox in 1956 (Wikipedia, “Meritocracy”); admission to most seats in Indian medical colleges by competitive examination and merit list; the Punjabi words ਜਮਾਤ, ਜਮਾਤੀ, ਹਾਣੀ and ਹਾਣ ਦਾ, and the Arabic origin of jamāt. Vendor representations. None.
Recollection and tradition. Beyond the public biography, the essay asserts no remembered scene, conversation or classmate. No person from the author’s years at Khalsa College is named, described or given a trajectory, and the examples of possible roads are general, not drawn from anyone’s life. The kinds of classmate sketched in the section on privacy are named only as the stock figures such writing tends to use, not as real people.
Analysis and forecast. The readings of Frost, Gray, Empson and Flaubert, the account of how credentials lengthen some lives’ records and shorten others’, and the refusal to rank divergent lives are the author’s interpretation and ethical preference. Independence. This essay is not sponsored by any institution, company, health system or technology developer.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.