“I have had dreams and I have had nightmares, but I have conquered my nightmares because of my dreams,” says Joan Salk, an American virologist and medical researcher who developed one of the first successful polio vaccines. Do you have dreams? Are there nightmares that come with that dream?
Be it the difficulty of achieving our goals, the occupational stress or the temptation to give up, many of us fear a mishap in deciding our career choices. Now, allow me to share with you my dream of becoming a doctor and the realities that follow. Join me as I examine questions such as: To what extent am I willing to give back? Will I earn as much as I wish to? Will I be able to handle death?
Why do I want to be a doctor?
The initial motivation for wanting this career path is most definitely attributed to my fascination with the complicated mechanics and intertwined systems of our body. Not just that, I want to incorporate this passion of mine into my future career.
As someone who is considering medicine as a career choice, I wanted to expose myself to more opinions and practices of the scene. Hence, I signed up for many healthcare outreach webinars and enrichments. One of the doctors' speeches particularly stood out to me. He asked prospective medical students to consider if they have been keeping up with the medical findings of the current pandemic as one of the many measures to determine if they are suited for medicine.
Of course, I could defend myself with many reasons: I didn’t have enough knowledge to appreciate the new findings, I didn’t have the resources to keep up with the medical scene and I simply did not have interest in infectious diseases. However, two things were clear, one being: medicine does not only involve Biology. And the other being: studying and practising medicine involves life-long learning which needs one to proactively read research papers, take the effort to keep up-to-date with the latest information, question the information and apply them to your circumstance.
Reflecting upon this, I contemplated whether I am really suited for the medicine pathway. Life-long learning is definitely a practice that I would like to exemplify, however, if I am not able to start reading research papers now, will I be able to do it one day? I recognised that it is difficult for one to dive into the unknown and start looking at those tedious writings with mind boggling jargons. However, this road block should not stop me. I must then put in the effort to be in a situation where I can overcome this barrier, to achieve this tiny milestone. For me, I threw myself into the unknown sea of H3 Biology. Amongst straight A students which I inevitably find myself inferior to, with the right mindset, I believe it would be the best learning opportunity.
I wish to have a fulfilling and meaningful career. To me, this satisfaction can be derived from alleviating the dreadfulness and pain of others that are physically unwell. After all, we become the most vulnerable when faced with a life and death situation we have no control of.
As a child, do you remember when everyone in class had to share their ideal career aspirations? Being a doctor is arguably one of the most common choices. Truth be spoken, being a doctor is not the only way to help patients, but it is labelled as one of the most prestigious ways.
As Ali Abdaal, a Cambridge University Medicine Graduate, puts it: On average, a doctor is able to save only 8 lives throughout their entire medical career. In comparison, donating $3000 to the Against Malaria Foundation would, on average, save 1 life. So, other higher paying jobs may allow one to ‘make a difference’ of greater impact than that of a doctor by, for example, funding research of rare illnesses or less aggressive medical treatments to manage common diseases, namely cancer.
Furthermore, allied health workers which includes, but are not limited to, Occupational Therapists, Physiotherapists, Dieticians, Podiatrist and Medical Social Workers, are equally important in a patient’s recovery journey. Allied health workers mostly assist patients in their recovery. For example, for a middle aged patient who has just undergone a major lower limb related injury and needs a walking stick, an Occupational Therapist would visit his house to identify possible hazards like sharp edges, glasswares, and loose wires, which may block the path of the patient. A physiotherapist would aid the patient in recovering mobility. Whereas, a medical social worker may step in to advise patients in settling financial debts from the healthcare treatment. The observable impact of making a difference as an allied healthcare worker is equally visible and sometimes even, faster and more guaranteed.
Last but not least, our nurses are the most apparent glow of warmth within cold, white-washed clinical rooms. Nurses’ job scope requires them to not only administer medication and assist patients in dressing, bathing and mobility but also update family members about patients’ medical conditions and console them. However, nurses often have to fill in the gaps of an understaffed hospital and recently, even bear much of the brunt of the increasing trend of violence inflicted on healthcare professionals. Most upsettingly, nurses are commonly looked down on by the public, such that one of the goals of the campaign - Care To Go Beyond, by our Ministry of Health is ‘raising the profile of nursing’. Little does the public know that nurses are essential gatherers of information critical in uncovering health conditions. Nurses are also arguably the ones who leave a more lasting impact on the mental well-being of patients and their families. So, as the prospects of nursing seem to be improving, along with its prestige, will more people consider nursing as a profession?
Despite knowing this information, will I be considered blinded by ‘prestige’, if I still prefer to be a doctor while claiming to aim to ‘make a difference’? In my opinion, one would not be considered blinded by prestige if possessing the heart to serve is but one of the many reasons for choosing a career as a doctor because the job scopes are ultimately different.
Points to consider when pursuing the career of a doctor: Is this really what I want?
Long working hours, poor mental wellbeing, negative net worth especially within the first few years into practice… With evidence of the hardships one may face in the healthcare industry, why do some Singaporeans still choose to become and remain a doctor? This can be a rather daunting question with no definite answer for those considering a career as a doctor.
In my opinion, having an interest in the career and the heart to serve is only one side of the coin when deciding if the career is right for them. The other side of the coin, that may arguably be more important, is steeling oneself to face the hardships one has to bear in this profession. I have heard many doctors tell prospective medical students that the career comes with a huge emotional baggage. However, it was the sense of fulfilment and meaning they found in their career that kept them going. Here are some of the points I have considered:
What does giving back to society mean to me?
Coined by Joan Tronto, the Ethics of Care explores, for instance, the relationship between caregivers and care-receivers. “It is important to realise that we are receivers as givers of care, acted upon as well as agents,” he spoke. However, in some of today’s healthcare systems, caregiving has become a technical system that finds itself wrapped with capitalistic gains. This may just be the root cause of the increasing violence between caregivers and care-receivers.
Some say that in healthcare, to put it bluntly, how the patient feels is all that matters. In my opinion, “serving” has always seemed so focused on the receiver. To me, “giving”, “helping” and “empathising” better represent the job of a doctor.
Some may also feel that doctors who complain about their long hours are merely entitled people with a prestigious high paying job complaining about a job they have chosen. Personally, I believe that no matter how high the pay, it cannot relight the flame of passion in burnt out workers, compensate for persistently poor mental health or its impact on their loved ones. Neither can it quantify the ethical weight or impact of their decisions. Every job has its own stresses, hence it is unfair to compare the stresses of each job when they do not have clear common grounds for comparison. I remember when an allied health worker was asked for his reasons for choosing his career instead of becoming a doctor, he said he knew he would not have been able to cope. He believed in the need to take care of himself before being able to help others. Indeed, our heroes in white capes are just like you and I. Therefore, I feel that it is still essential to reframe the way we view doctors today.
Will I earn as much as I wish to?
Some may have the preconception that being a doctor ensures a path to riches. In my opinion, this notion may be related to the high level of educational achievement the job requires as proof of one's capabilities. This is an especially entrenched mindset in Asian culture: We assume that one must score well in examinations and achieve high levels of certification in order to earn a comfortable living.
In reality, on average, a Singaporeans’ median monthly salary is $4056 and $5265 in 2020 for adults aged 25 to 29 and 30 to 34 respectively. For doctors, after 5 years of medical school, 1 year as a house officer and 3 years as a medical officer, the average pay is $4000 to $5000. Looking at these figures, it seems that the starting salary for doctors is on par or slightly above that of average Singaporeans for the first few years of work. Afterwards, as majority of doctors do not choose to specialise, their pay may stay stagnant if they remain in the public sector.
For the doctors that decide to specialise it would take at least another 6 years to earn as much as $10,000 which is significantly higher than the average peak median monthly salary of Singaporeans, who earn only $6435 at the age of 4o to 44. With this data, being a doctor seems to indicate a better salary than the average Singaporean.
However, we also have to keep in mind the number of hours doctors work. From the personal recount of the junior doctor featured on RICE Media, after factoring in the total amount of hours he worked, his pay could be equal or less than that of a bubble tea maker. There are many factors of consideration such as whether some doctors choose to open their own clinic, or whether they choose to leave the public sector to join the private sector. Therefore, the salary of doctors may not be as high as it seems, especially for the amount of effort put in to become and work as a doctor.
Personally, pay is an important, but not the most important factor I am considering. Nevertheless, the pay of a doctor per month is comparable or more than that of an average Singaporean. Hence, since it matches my interest, the pay is, I feel, enough to convince me, one who hasn’t entered the field, that I can have a future with financial stability in this career pathway.
Dealing with death
How do doctors deal with patient death? Is it healthy to feel attached to their patients? Most doctors will say there is a need for balance in this attachment. As a doctor they need to empathise with their patient’s situation, and feel for them in order to adequately support their family members. Most of the time, over-attachment to patients occurs when they see the shadow of a loved one in their patient.
A story I heard from a doctor during my experience in NHMed 2021 (organised by HC Med Soc) stuck close to me. In the paediatric ward, a child unfortunately passed on. Later in the day, one of the doctors saw her young daughter wearing a similar hair clip to the child that passed on. The thought of the possibility of losing her own daughter suddenly overcame her, causing her to break down.
Having not gone through it myself, I cannot imagine and will not fully understand the emotional burden such traumatic experiences have on doctors. In many healthcare settings, healthcare providers sometimes go for counselling sessions themselves, and I feel that only with an adequate support system, will I be able to ride through this tide if I ever have to face it.
Dealing with burnouts – Is this the lifestyle I want?
Working long hours on end and the possibility of being called back to work even on “off-days” leave doctors without the privilege to even arrange dinner plans. A 2017 study published in the Singapore Medical Journal noted that 8 out of 10 doctors feel emotionally burnt out and struggle to find work life balance. That’s why doctors spend their little time off very wisely — with their families, catching up on sleep or indulging in their hobbies. Even though such negativities are the realities of a medical career, it all boils down to each person’s priorities. Therefore, prospective medical students, it is a good time to reflect on whether you can fall within the 2 out of 10. Personally, this issue is one of the most important deciding factors which I have pondered on for ages, yet to come to a final conclusion.
When I think about having to spend hours on end studying all that science, I know for a fact that the medicine pathway can be draining and even dreadful. I wonder if I will be able to manage my time if I were a medical student given that life as a JC student is already an extremely rocky one.
As I progress in my medical career, will I still have time for my loved ones? What about my other aspirations and enjoyment? For sure, learning about the human body gives me adrenaline. However, together with stress and endless piles of work to keep up with, will there still be fulfilment and interest left to savour in this career or will i just be running on fuel? Can studying about the human body be just a hobby? Or perhaps I can consider a career as an allied health professional whose working hours are shorter and less unpredictable. The system can put up many guidelines to protect the doctors from overwork but who would ignore ethical obligations and put work aside when they know a patient is in need? These thoughts bombard my head and spin me into a headache everytime I open up this Pandora's box.
Some time ago, in an attempt to erase these thoughts that were becoming overwhelming, I thought to myself: I will study life science instead. To my surprise, I had this sense of relief, as if an invisible weight was lifted off my chest. It was a great feeling. However, every time I doubt myself, the world just somehow throws back many other things to ignite this thought of wanting to contribute as a healthcare worker again. For example, giving me the courage to little by little overcome my fear of seeing people in pain and feeling helpless. These thoughts may or may not resonate with you, because everyone’s fears, concerns and experiences are different. However, when life gives you lemons, make lemonade. Don’t be afraid to face your fears, and grow into someone beyond yourself, happily and patiently.
Us in Hwa Chong
At the age of 17-19, we ponder our life decisions, most to no avail. We want to achieve great things, we want to earn a lot of money, we want to find a career we like and we also want to enjoy the many other entertainments of life. Personally, I plan to read more books written by doctors, The Unseen World by Jonathan Reisman being the next on my list. My journey of pondering and learning about this career is just beginning.
So, what do you think? Is being a doctor in Singapore a worthwhile career?
Word count: 3415 words
Written by: Tan Xuanmin (21S78)
Edited by: Goh Yu Le (21S79), Tran Vu Phuong Uyen (21A15), Caroline Ong Wan Ting (21A10)
Photographs provided by: https://pin.it/17G9Yt0
Appendix
Medical hierarchy/ path from a medical student onwards -
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