Paediatrics!
Wednesday, March 12, 2008
by Tan Ying Cong Shea Ryan, m3
Paediatrics has come a long way in Singapore from its formal establishment of the NUS Department of Paediatrics in 1962 to the opening of KK Women’s and Children’s Hospital in 1997, which enabled the setting up of several subspecialty divisions. While the management of acute infections was by far the main paediatric workload in the 60s (gastroenteritis alone accounted for almost 20% of all admissions), paediatrians today treat a diverse range of conditions with asthma, congenital heart disease and cancers being more commonly treated nowadays.
I caught up with Dr Lynette Shek Pei Chi from the Children's Medical Institute NUH as well as Dr Angelin Tan, a private consultant paediatrician, to find out more.
I caught up with Dr Lynette Shek Pei Chi from the Children's Medical Institute NUH as well as Dr Angelin Tan, a private consultant paediatrician, to find out more.
1) What is the typical work of a paediatrician like?
Dr. Shek: Like most doctors, our day begins very early at about 7.30 a.m. when the whole department meets to discuss cases. Training doctors present cases to senior paediatricians. This has been the practice in my department for many years and I think that this is very helpful as we all learn from each other. After that, the work depends on the career path the paediatrician has chosen. For most general paediatricians, this means seeing patients in the wards and clinics. For myself, I have chosen to spend time in research, so I have fewer such clinical duties. Regardless of the emphasis, we all spend time teaching medical, dental and post-graduate students through bedside teaching, lectures and example!
Dr. Tan: I would say there are 2 main kinds of clinical workscopes: that of the neonatologists and the general paediatricians cum subspecialists. The Neonatologists deal with the pre-mature babies and provide different levels of care depending on how premature the baby is. It can be really hard work and intensive, getting calls from O&G in the early mornings on premature deliveries so most neonatologists tend to be guys though on the whole most paediatricians tend to be female.
2) What are the more pertinent pros and cons of the specialty that a houseman should consider before he decides to specialize in paediatrics?
Dr.Shek: The first and most important thing is - one must love children. We spend the majority of our time at work, and if you can't enjoy being with your patients, it is harder to look forward to a day at work. General paediatrics is very much like general practice for children as one looks after coughs and colds as well as vaccination of healthy children. That may not appeal to doctors who prefer the “excitement” of surgical disciplines. Most paediatric departments are small, so everyone knows everyone else such that there is almost a family feel to being a paediatrician. I can’t think of any cons, that is why I chose the discipline.
Attractions
- Hospital and community based approaches needed
- Range of skills needed for children from prematurity to adolescence
- Dealing with young patients in the context of people around them (parents, extended family, peers, school)
- Opportunity to take part in large multidisciplinary teamsLarge number of different career paths possible
- Not overspecialised: all paths require some skills of a generalist
- Variety of challenges ranging from acute illnesses to chronic diseases
1.Heavy service commitment with sleep deprivation
2.Emotionally demanding
3.Little scope for private practice
3) Is paediatrics becoming increasingly competitive with the falling birth rates in Singapore?
Dr.Shek: I think the need for specialists in all fields is increasing as medical technology increases. So the answer is no, the field is not becoming increasingly competitive.
Dr.Tan: Yes, I feel in the private sector its becoming increasingly competitive with many younger paediatricians coming onto the scene. In my time, each medical cohort only had about 100 students, now its more than doubled and there’s a paediatric clinic covering every part of Singapore.
4) What is the training/career path like?
After the houseman year, one has to undergo at least 3 years of basic training followed by 3 years of advanced training. The final year of advanced training is usually spent in sub-specialty training.
5) How is the transition to private practice? What are the main differences between working in the private and public sector for paediatrics?
Dr. Tan: There are about close to 200 paediatricians in Singapore and I would say about 50% are in private practice. Like every private practitioner, to get enough patients, we need to keep up with general paediatric services on top of any subspecialties we may have. In the instituitions it’s a bit different as the subspecialties see more cases. Nowadays, there’s a big shift towards ambulatory paediatrics as well
6) What is the salary range like?
Dr.Shek: The salary of doctors working in government practice is fairly structured. As medical officers and registrars, the salary is not unlike that of doctors in other disciplines. As consultant paediatiricans, one can expect to earn about $8,000 to $10,000 per month.
7) As a lady doctor, how hard did you find it to juggle family/personal life and work?
Dr.Tan: Haha, having had 5 kids of my own I can tell you that it was not easy but it can be done! Early in your career, with your BST, AST and Specialist training your life revolves around work and family life, I don’t recall having much of a personal life. If you choose to set up a private clinic, the first few years are very hectic too. Nevertheless, its all about prioritizing and I remember working hard during my lunches and night shifts to finish work ahead of time so I didn’t bring any work home. But as you progress in your career it gets easier and now I can think of picking up hobbies I never had time for. The key is to choose doing what you like so you enjoy work. I look forward to seeing all my patients! That’s very important for a doctor.
“I look forward to seeing all my patients! That’s very important for a doctor.”
- Dr. Angelin Tan
