Career Advice For Doctors

People often ask me for career guidance and career advice. Sometimes, I wonder why.

Here is my story...

My return to clinical practice has been rather sudden. Well, not really.

I had last practiced medicine in a hospital setting in Ireland in 2006. My last post was as a senior house officer in paediatrics. I hated paediatrics. I almost died during that 6 months posting and I told myself, I was never going back.

I am not saying that paediatrics is an awful specialty, it is just that the experience confirmed what I already sort of knew beforehand, I knew that I did not want to be a paediatrician.

The reason why I took up that post was because of the opportunity. At that point in time, my ultimate career choice would have been emergency medicine.

I enjoyed working in the emergency department much more than any where else in the hospital, but I would get a bit worked up whenever a paediatric patient came through the door, even though this was a very unlikely situation in Ireland where healthcare for adults and children are segregated.

Even so, when working in a smaller hospital like St Columcilles in Loughlinstown, we did encounter a few children and even (*horrors*) babies. So I thought it was a good idea to spend some time in paediatrics, learning the basics. It was a nightmare, but it was also very valuable experience.

I remember being depressed the first few weeks, even crying in front of my husband in the evenings. He would ask what was wrong, and I told him I hated paediatrics. But he advised me to keep at it and that I will learn a thing or two from the posting. He was right. Looking back, I am glad that I did not quit.

Taking a break from practising medicine to lecturing physiology, at that time in 2007, seemed like one of the best decisions in my life. It was so nice to have a normal nine to five job, no weekends, no on-calls, no unsocial hours. No sick patients to attend to, no emergencies or life-threatening situations that needed to be managed, just lectures that in theory could always be rescheduled if necessary.

It was difficult though, because it was the first time I lived in Kota Bharu. It took me awhile to get used to the place, perhaps around 6 months, before I could genuinely be happy again.

I am not saying Kota Bharu is horrible, but like paediatrics, it just wasn't my cup of tea.

Of course as muslims, we must always believe in blessings in disguise. Had I known what KB was like beforehand, I would have never said yes to my hubby's proposal of pursuing his training in USM.

So there we were in KB with no extended family support as neither of us were Kelantanese. The kids were still small, my eldest was four and the second was 2.5 years old.

We had a new maid from Indonesia. I had no real experience with Indonesian maids as my late sister in law was the one baby-sitting our children back in Dublin. My hubby was busy with his MMED or plastics masters program. The decision to join the physiology department might not have made sense to others, but it did to me.

Luckily, I came back from Ireland with the MRCP, so I joined USM as a medical lecturer. Life consisted of preparing and giving lectures, conducting problem-based learning sessions and simulated clinical skills teaching at the clinical skills lab. Lunch break was a full two hours. I could go home and fetch the kids back from kindy, then return to the office in the afternoon. It was such a contrast to practising full time.

After a year or so our daughter was born. Our maid also decided to end her contract to return to Indonesia so we hired a new one.

I had promised the then Dean Prof Aziz Baba, that I would pursue a PhD in physiology if he let me join the physiology department. It didn't materialise because about two years later, as planned, we moved back to KL for hubby's training in HKL. I was the happiest girl in the world. Tears ran down my cheeks and I felt that I was finally back where I belonged. I even secretly promised myself I would everything possible to remain here and not go back to KB.

I took unpaid leave to accompany my spouse. We had bought a condo in KL a year or two beforehand in preparation for this period in hubby's training. Kids settled in a kindy nearby. The condo was a stones throw from HKL. After six months, my late dad passed away. We decided to move back to PJ to keep my mum company and sell off the condo.

I had already started lecturing part time in USIM as they were short of staff and even had a vacancy, but due to the 'gentlemens agreement' between deans of medical schools, I could not be offered the post. I had to let go of my USM post first.

I guess it was a blessing in disguise again as I started to look elsewhere for a job. This was the second time in my life I had 'nothing to do' and after two months, I was starting to go crazy. (The first experience was right after graduating while waiting for work to start).

I attended an interview with SEGi and was offered a job as a physiology lecturer. I called up a friend to ask her opinion about SEGi as she had worked there before. Instead, I found out about an opening in Taylors and passed my friend my CV.

Taylors University had a better offer and I took it up. I resigned from my USM post.

I have a lot of good things to say about Taylors University as an employer and in many ways I did enjoy the two years I spent there. I also had the opportunity to pursue my MBA, something I had always wanted to do ever since graduating from medical school, with 50% employee fee discount.

While we were in KB, I ventured into a business opportunity but things did not work as planned. I realised I needed to learn more about business and enrolled for MBA right after hubby completed his MMED.

I will write about the MBA in another blog post.

In Taylors, I was the physiology lecturer of a new medical school. The campus was brand new and award-winning. It was a stones throw away from my mums house in PJ. Work was similar to that in USM but the pay better and lecturers had to only spend 5 hours on site. We had 40 days annual leave, annual bonus and increments, life was generally good.

Our eldest son started primary school that same year in 2010 and I was grateful to have a mum to supervise the maid while I was at work. Hubby though, only came back during the weekends.

Another blessing in disguise, I can relate to single parents. I understand their struggles because at one time, I faced them too.

Having children in primary school was something that I needed getting used to. I wished I was better prepared but I am thankful for the experience all the same.

Working as a physiology lecturer again allowed me time to spend with my children, send them to Kumon and swimming classes, even though I had a hired a van to fetch them from school. I am so grateful for being able to work and spend time with my kids.

Two years later I decided to return to clinical practice. I joined an organisation which will remain unnamed. The patients were mostly customers, who came for health screening, I was back to working full days and even weekends. Thankfully, we did not work nights.

In the beginning, I was required to travel to their center in Cheras, which was about half an hours drive one way from PJ. I left home early, often while it was still dark, in order to get shaded parking. I loved the training for ultrasonography that went on for about one and a half months, although it was a stressful period due to the travelling. That was my first experience with the infamous Klang Valley traffic jam.

After six months, I left because there were things that I was not happy with that myself and colleagues had tried to change but couldn't.

I had taken two breaks from my MBA course and with encouragement from my hubby, decided it was time to complete the course. For the dissertation, I decided to look at the general practice clinic as a potential future business venture, and as part of my research, I worked in a few different practices seeing real patients, mostly, I would say about 85-90% had upper respiratory tract infection or acute gastroenteritis needing a medical certificate to get time off work. It was not a very intellectually stimulating experience but again, I learnt a lot. I also completed my MBA just before our 4th child was born.

I decided, both from gut feeling and from my own research, that it was not an opportune time to open a general practice clinic.

I came across a vacancy in Perdana University and applied while I was pregnant and working on my dissertation write up. I attended an unofficial interview a few days before delivery. When my baby was six months, I started working full time again, but this time as an assistant professor in internal medicine.

Teaching has always been one of my interests and it was great to do that again. I missed teaching. I did not miss hospital medicine.

Not much has changed since I last left. Patients were still non-compliant to medication, reluctant to stop smoking nor exercise. There were a few new medications and some small changes to the management of certain conditions but overall, everything else was the same.

What was new though, was commuting daily from PJ to KL. I had never worked in the heart of KL before. Oh my God, the traffic was insane. Luckily we did have some flexibility in working hours to be able to avoid the worst of it. It was a great privilege to work with American colleagues in medical academia and to have HKL as our teaching hospital. I learnt so much during the few months I was there. I have a lot of good things to say about Perdana University Graduate School of Medicine. I am a believer in the advantages of a graduate medical program due to first hand experience.

While I was busy at my new job, our eldest child sat for his UPSR last year. Our first experience and a lot to learn from as well. Another subject for a separate blog post.

I then found out that there is a private university with as their teaching hospital based in Kelantan. It took me some time to decide to apply. The boys were getting bigger and in need of their father.

As it turns out, I am now back in KB as an associate professor in internal medicine, teaching in the hospitals here.

In Kelantan, compared to KL, we have to state the source of water that patients consume in the history, due to the risk of leptospirosis. The patients are mostly Malay, and speak Kelantanese, so I often need my local students to do some translating. In KL there were patients of various races and many non-nationals too. A lot of Nepalese patients were admitted with acute coronary syndrome.

Currently, I only work 20 hours per week as per contract agreement. When the dust has settled, I plan to pursue further training in dialysis management for our new business venture. We also have a few other business ventures in the planning stage.

My maid is the same maid as seven years ago when my daughter was born, after my second Indonesian maid. The first Indonesian maid returned home after finishing her contract as her children had started school. We know her much better now and trust her to take care of the kids when we are not around. The kids (the two older ones) are now big enough to be able to tell us if anything is wrong. So even though we have no extended family support here, we can cope. I am also not a stranger to KB.

In contrast to patients in Ireland, they are not that different except for:
Fever and rash signifies dengue rather than meningitis, although meningitis could still be one of the differential.
Fever in an unwell patient much always make one think of dengue.
Fever and potential exposure makes leptospirosis high on the differential list.
Thalassaemia is common, though almost as unheard of in Ireland as cystic fibrosis or inflammatory bowel disease is in Malaysia.
Pulmonary tuberculosis is so rampant that there were always newly diagnosed patients in Ward 26, HKL, who were placed at the last cubicle with the bed facing the window. No isolation, no positive pressure ventilation, patient may not wear the N95 mask all the time.

In a nutshell, there is no simple career advice.

I come across a few different types of people through out my life.

The first type is the one who knows what they want, and go out and get it. My husband is like that. He made his mind up early on that he wanted to become a surgeon. His first job as an intern was in plastic surgery and he fell in love with that. The rest is history.

The second type is like me, we are not really sure what we want.We have some idea of what we like and what we don't like but the rest is mostly a grey are. We need to go out and explore things, try new things to see what works and what doesn't, and in the process, hopefully, discover the path that was meant for us.

For women, more than men, family is an important factor to consider when making career choices. I choose to work and have a family, I don't want to sacrifice either one. The challenge lies in finding the right balance, equilibrium.