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Old 01-21-2008, 10:29 AM   #1
dershing
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Default Long letter from a trainee neuro surgeon

anyway like dershing, who by the way is my primary school classmate, i'm 32,
been working for 8 years since graduation, finished my basic surgical
training(MRCS= membership for royal college of surgeons) and Masters of
Medicine(singapore), and am now in my advance training to be a neurosurgeon.

anyway to start with medicine.... the course application alone is painful,
every year 5000+ to 7000+ applicants, 500-700 shortlisted for the
interviews, 2 to be exact, and only 200 chosen.(was 150 previously, then
goverment realised that's not enought doctors! but this is a stop gap
measure, and will only affect the newer doctors, namely yourself and others
to follow, i'll explain later). Firstly if you have any dreams of making big
bucks and all that, please DON'T do medicine. SERIOUSLY. for the hours that
we work per week vs pay, it kinda sucks. you only do it if you feel like
making a difference in someone else's life. it's an adrenaline rush like no
other sometimes. stock brokers play with money, which can be made and lost
easily, we play with lives, where every decision WILL make a difference, and
once lost(life that is), it's GONE! if you cannot take stress, then don't do
it too! i've seen breakdowns and attempted suicides in medicine, esp final
year students.

BUT to let you know, as you progress up the seniority level life actually
gets much better. and all the suffering you put up with earlier kinda makes
sense after a while, cos it'll help you make better choices and understand
more of how the hospital runs and so on.

ok so life starts when you enter medical school. this is nothing like
biology at A level, everything you've learnt is USELESS and you have to
basically learn a whole new language. when you hear 2 doctors speaking it
sounds like greek to the layman, but a lota information is transmitted in
all the lingo. From anatomy to physiology to Biochemistry in year one, to
COFM, Microbiology in year 2, then the clinical years from 3 to 5 where you
study pathology, pharmacology, medicine, surgery, O&G and paediatrics. if
you survive all that and make it to the final year exams, we expect you to
function like a houseofficer would(i've assisted in the exams about 4 years
running so i know what they ask hehe). if you pass that THEN you start
housemanship, which can be considered the 6th year of training. you're now a provisionally registered doctor, can prescribe medicine, drugs(like
morphine!) and give MCs(VERY IMPORTANT), but being provisionally registered

you cannot sign death certs and take consent for procedures. but you're
supposed to learn in this training year.

life for a HO sucks, start work at 7am, usually end by 7pm if you're lucky.
7am you come and update the list of patients so that your team can start at
8am sharp, update the blood results and any new referal letters from the day
before so you can update the team you're in. usually the team consists of
houseman(HO), Medical officer(MO), Registrar, and Associate consultant or
Consultant or Senior consultant as the last line. you report upwards in that
order. 7-9 am is the ward rounds whereby you see all the patients with your
seniors, they order all the changes, like bloods, blue letter referals,
small procedures like lumbar punctures, central lines etc. you're not
trained in all this during medical school days cos all you do then is
accquire knowledge. the HOUSEMAN time is when you learn, or have to learn as much as possible, cos once you're a medical officer your registrar would
expect you to be able to do simple procedures like chest tubes and those
mentioned above. So after the round about 9 or 10 or later, you DO the
changes that were ordered, discharges, and the rest. if you're lucky can
make it for lunch, otherwise changes are utmost priority! lunch after. later
in the afternoon, you clerk new cases, review the answers from blue letters,
chase up any earlier blood results, and wait for your team to do the evening
round. then you do the changes for the evening round(if any, but usually a
LOT!) and when all's done you go home. there's no fixed time when you go
back but it's quite simple, finish changes= go home.
SO the hospital cannot be left unattended after working hours, so that's
where night calls come in. a call is when you're the team on take that day,
all new admissions go to you, and you need to clerk and order investigations
for all the new A&E admissions. it comprises the houseofficer, medical
officer, registrar, which are all stay in, and the consultant who is usually
at home sleeping. on average there are 6-8 calls a month, and depending on
the place your're in you don't nesessarily get to go post call, that means
after a bad call, at 7am you start you usual day and end like any other day.
whether you get to sleep or not, that's your problem. my worse was 10 calls
a month, i was either on call or post call or pre call, and you walk around
like a zombie. on average you work everyday unless your boss lets you off
during the weekend.

specialist training depends on yourself, broadly after you graduate you get
a MBBS(singapore) so you're a doctor, but not a specialist, you can do GP
work, but cannot call yourself a specialist and are not registered as one in
the Singapore Medical Association. there are MANY specialist training
available, from medical based like renal, cardiology, gen med, to surgical
based like orthopedics, general surgery, cardiothoracic surgery,
neurosurgery, transplant, hand and recon surgery, plastics surgery and so
on. you apply for a place in the basic specialist training once you're an
MO, or going to be one, and depends on the interview whether you get chosen for it or not. once you finish your basic training, which comprises several exams of different formats, and complete the minimum amount of time, then you can go on to become an advanced trainee, or registrar. once you complete your advanced tranining, you're a consultant or associate consultant.

whether you get your training post depends on the number of applicants and
places available, hot jobs like ortho or plastics usually have a long
waiting line of several years, made worse by the influx of the 200+ batch of
doctors, now you see why i said it affects you and others around your year.
my time we were short of docs BIG time, getting reg jobs was not the
problem. this is if you want to become a specialist. if you're not
intersted, then after your bond of 5 years you can leave to be a GP or do
some admin job, but without a specialist degree, you're just a plain doctor,
cannot do much other than GP or admin doc or leave the profession. the main
difference is as a GP you're paid more at the start, but it stagnates after
a while unless you're a dam good buisnessman. as a specialist, you're paid
shit when you're training, but at consultant level it's good pay for least
work, cos you've got a bunch of Regs, MOs and HOs to do your bidding,
hehehe.

advanced training takes anywhere from 3 to 5 years depending on
subspeciality chosen. in the begining, it's quite a LOT to learn, but you
get the hang of it after a while.....
what a week is like after HO life depends on wat speciality you choose. but
it comprises of rounds, clinics, Operating if you're in a surgical field,
CME training, calls etc. but more responsibility as you go up the ladder, so
you do less leg work basically.

the main difference in private and public sector is the PAY. but don worry
yourself about that, cos that's too far away to see for now. once you decide
your career path( i mean specialist training) then you worry about private
or public AFTER you've passed your advanced training. hehe

if you cannot take all this, then give the job to someone else who can....
there are lotsa dysfunctional houseofficers nowadays, they are great at
studying, but cannot think on their feet or apply what they learnt into
their practise. what i cannot stand is a student who can study great, but
cannot think like a doctor and problem solve. for your basic or advanced
training, don't worry about your medical school grades so much, your regular
appraisals once you start work is much more important. you don't need to be
the brightest spark to be the best surgeon, but it helps HAHHA.

inspite of all this, it's a great job, no regrets, work hard, play hard.
some ups and some downs, but when the patients thank you, it's genuine!

if you want after your A's you can approach the hospital to do a observer
stint and see how things function.
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Old 03-05-2008, 10:58 PM   #2
sparky
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Thanks for the sharing It was really informative!

However I am currently having problems obtaining job shadowing experience at hospitals. Do you know of any hospitals offering observer stints, particularly in gynaecology & obstetrics?
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Old 03-22-2008, 12:50 PM   #3
LockT31W
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i have a friend who's currently in Monash now and wants to return to Singapore to be a paediatrician after graduation. how hard is it to enter specialist training for that field here in Singapore if you're an overseas grad? should she do her specialist in Australia instead?
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Old 04-01-2008, 08:47 PM   #4
michelly89
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Wow thanks for sharing all that information! I knew the road to becoming a doctor was hard and this pretty much confirmed whatever expectations I had.

I guess my biggest concern now should be the whole application process, but I really want to look beyond that. I went for the NUS open house fully aware of what the application process was like and knowing how tough it would be to get into medicine, so all I really wanted to know was the opinion of med students of what a good doctor should be like. How do you go about finding out if your personality matches what you aspire to be? What was it like, studying medicine? What was it like as a house officer? To my disappointment, the first person I spoke to said something like, "shouldn't you be more concerned about getting into medicine first?" So I guess reading this really answered quite a bit of the questions that I felt were unanswered on that day.

So yes, thank you! Now I have one more pressing question -- how do you go about finding out if you can think on your feet and solve problems "like a doctor"? At our tender age of 19, I don't think a lot of us has had the opportunity to experience thinking on our feet in a high-stress setting, apart from answering questions in the Q&A section of the oral presentation for PW.

And finally, if we are rejected in this round, or if we aren't quite sure yet about being a doctor, there is a 'longer' route to eventually becoming a physician via the NUS-Duke Medical School which only accepts graduates right? Or does the school just focus on producing physician-scientist/researchers as opposed to practitioners?

Last edited by michelly89; 04-02-2008 at 12:10 PM.
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Old 10-18-2008, 11:11 PM   #5
melsonchun
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Great Insights
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Old 02-11-2009, 09:39 PM   #6
sockmui
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Default more information

Heya! Thanks for sharing with us! Helps me clear a lot of my doubts. Anyway, I found this info online about the career of a doctor. Quite useful to me. It might be useful to some of you too!

http://www.lokun.nhg.com.sg/career.html
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Old 01-20-2010, 09:11 PM   #7
cheyenne
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thank you so much for the info!!! i am rather worried though that i might not be able to get in
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