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.
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
Drawbacks1.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
Wednesday, March 12, 2008
by Liang Zhen Chang and Kok Yee Onn, m2sEver wondered what anaesthesiology is about? Or what anaesthetists are like? Pulse interviews eminent A/P Ong Biauw Chin and Dr Yao Che Lin to find out that the field of anaesthesiology is a close knit community doing tough and sometimes unrecognized work, where long hours of boredom means you’re doing your job well in the OT and where a cross roads of physiology, pharmacology, intensive and pain care means opportunities in an evolving field. Pulse sheds light on anaesthesiology…
*A/P Ong is a senior consultant and teaching professor at SGH and NUS respectively, Dr Yao is a consultant at SGH and is understudying A/P Ong.Pulse: Pretend you're talking to the layman. How would you put across your job scope to him succinctly in a sentence.Dr Yao: I put you to sleep before surgery, keep you alive during surgery, and ensure you have minimal pain after surgery.
A/P Ong: The anaesthetist basically makes sure the patient is alive during surgery. We help make it possible for simple and complex surgery to be done. Some anaesthetists also specialise in the areas of pain and intensive care!
Pulse: What's your daily timetable like? Is it hard juggling family/private life with working life? Exactly how busy or how free can you get on a good or bad day?Dr Yao: Working hours are generally from 8am to 6pm during weekdays, with about 6 calls a month, including 1 Fri, 1 Sat, 1 Sun a month. Only a superwoman can juggle family, work and social life. An ordinary person like me has to give up something. Unfortunately, social life is the first to be sacrificed. On good days, I may be able to bring my 2 children to for an afternoon ice cream treat. On bad days, they are already asleep by the time I get home, and still asleep when I leave for work the next day.
A/P Ong: Time is totally unpredictable! On a bad day the surgery may take more than 12 hours for example during the instance when it took 100 hours to separate the Siamese twins. On a good day when patients decide not to come, it could be totally free, on bad days, life can be unusually hectic! Most of us try not to make appointments on weekdays or weekends when we are on call because we can never predict when we are going to end. Surgery may not end on time or become more complex than planned. I guess most of us juggle private life, family and work to the best of our abilities.
Pulse: What is the one most memorable moment you've encountered through your practice as an anaesthetist?Dr Yao: Patients come and go. The most treasured times are the ones spent with colleagues. When we are trudging through a bad call at 5am in the morning, when sharingour joys and woes, when someone is willing to give up a precious weekend to cover a sick friend's on callduties...
A/P Ong: I guess that would have to be the separation of the Siamese twins because it was historical. But most of all, the team of anaesthetists worked together for a really long time and till today we remain friends. The friendship and camaraderie is very important to me.
Pulse: It is often asserted that anaesthetists 'have an easy life while waiting for money to roll in'. How true do you think this statement is?
Dr Yao: First time I am hearing this! The only time this happened was during my schooling days when my parents provided pocket money, holiday allowance, petrol subsidies, permanent car loan etc.
A/P Ong: Do come and join us as part of the anaesthesia team for 6 months and judge for yourself! I can think of easier ways to see money rolling in than risky anaesthesia work! Most anaesthetists are masters of controlling stress and looking perfectly cool and calm even when everything is falling apart!
Pulse: What qualities and traits do you think make good anaesthetists? What advice do you have for aspiring anaesthetists?Dr Yao: Borderline obsessive compulsive disorder, selective hearing loss, preferably X-ray vision and in-built fingertip ultrasound capability as well. The only advice I can give is: you must have a passion for what you want to do. If you don't, you will definitely need extra painkillers and discipline boosters throughout your career.
A/P Ong: The best advice is do come and do it for 6 months and decide if you really like it. Passion is crucial and can only tell when you are here doing it!! Talk to seniors and get honest down-to-earth advice for yourself! Qualities include the ability to make quick and sound decisions, ability to work as a team and multi-task, being meticulous, able to handle acute stress and plenty of stamina!! A bit of liking of physiology, physics, pharmacology and statistics helps too!
Pulse: What is one thing you dislike and one thing that you like most about your job and why?
Dr Yao: I need instant results, good or bad; which I can get most of the time. Hours can be unpredictable, and yes, so is my input output schedule.
A/P Ong: I like most the fact that we are in contact with many different disciplines and that we can keep pace with new developments in various fields of both surgery and medicine since we need to know both of these areas well enough to manage the patients well. What I don't like I guess is having to see and explain things to "well" patients coming for "not so essential" surgery especially when they demand perfect results.
Pulse: Where do you think anaesthesia is headed in the near future? Also, there was some mention that the mechanisms of some anaesthetic drugs are not known and if someone can prove it; they might win a Nobel prize? Could you give an example or elaborate on this enigma?Dr Yao: There are many postulations on the mechanism of anaesthesia. Anaesthesia may one day be not just a supportive field to surgery, but also as a therapeutic entity by itself. But again, who knows, we may come one full circle and go back to the days where surgery can be conducted without anaesthesia.
A/P Ong: Anaesthesia has a wide open future because it is one of the gateways to pain specialisation since many techniques used are relevant to pain. We are also one of the gateways to intensive care because the discipline and rigours are very much the building blocks of intensive care medicine. Anaesthesia also opens the field to teaching and education in areas like physiology, pharmacology and some important life saving procedures like maintaining airway, intubation and also invasive line setting. Up to this day the actual mechanism of anaesthesia is not known and only postulates are given. This would be an exciting area for research.
Pulse: We've read reports about traditional Chinese acupuncuture exerting the same effects as conventional general anaesthesia would. For example, in Bernard Lown's 'The Lost Art of Healing', he mentioned that he observed an open heart surgery done with acupuncture and without general anaesthesia. How do you think acupuncture fairs up against anaesthesia?
Dr Yao: Have you not watched Wong Fei Hung in Once Upon A Time in China? He could use acupuncture to anaesthetize a patient for surgery, albeit a regional technique! I cannot wait for the day acupuncture is integrated into anaesthesia. It would most certainly give us a more marketable edge over our Western counterparts.
A/P Ong: This is an interesting area. However, in general it is accepted that other drugs like ketamine need to be used to supplement acupuncture as "the only form" of anaesthesia. This is different from using acupuncture as a pain treatment modality.
Pulse: What is the training/ career path like? How many openings are there per year and how many apply?
A/P Ong: You need to have preferably completed 6 months of anaesthesia before you decide on embarking upon anaesthesia as a career. The basic training that ensues lasts at least 36 months and you have to pass the part I and II exams. After that is advanced training which is 24 months minimum plus an exit exam to pass before specialist certification. In general, we take in about 12 basic trainees every year. You can do your training and sit for the part II without being a "trainee" as long as you keep a satisfactory log of your cases which is the same as that of the trainees. However admission to the advanced specialist training programme is a prerequisite for certification as a specialist. Singapore is a recognised training centre for the Australian and New Zealand College of Anaesthetists and therefore you can sit the FANZCA Part I and II exams here as well.
The career path: stay as anaesthetist in the restructured hospital and subspecialise if you wish eg cardiac, paedaitrics, neurosurgery, etc and/or go into the private sector. You can also choose pain specialty, intensive care or even perioperative medicine. One can also take on teaching full or part time and/or research in either the basic sciences or the clinical areas. There are certainly other non medical options including patient safety, administration etc that you could choose to go into as well.
Pulse: What are some of the unique pros and cons of anaesthesia?Dr Yao: We will always look young due to our oxygen-enhanced work environment. But if you cannot take the stress, you will have the coronary arteries of a ninety-year-old!
A/P Ong: The unique pros are that you can branch out to many other areas and also keep in touch with state-of-the-art developments in both medical and surgical fields. The unique cons I guess would be the unpredictability of time, the high risk and therefore high litigation that comes with the risks. The lack of patient contact and dependence on surgeons could be a con but could potentially be a pro as well!!
Pulse would like to thank Prof Ong and Dr Yao for allowing us to interview them. We are sure that you readers have learnt alot more about anaesthesia that you probably didn't know before!
Anaesthesiology at work
