the chronicles of a House Elf: my 7th month as a House Officer in Singapore + why I’m not doing a residency + the virtues of ‘lying flat’

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This is part of an ongoing monthly series capturing the highs, low (and everything in between) in my life as a freelance doctor working in Singapore. If you’re interested in finding out about medical/non-medical careers or getting answers to doctoring-related questions, check out my Chasing Careers series!

7 months in, and I’m running out of things to write about. I’m sure all of you are sick of hearing me gripe about the 7-day work weeks and being on call for 30-odd hours – and frankly I am too – but it’s not like I’ll be able to quit this lifestyle anytime soon (5 years and 5 months to the end of my government bond; oh joy).

Anyway, I’m drafting this while chilling at a beach bar on annual leave, which feels like the epitome of zen, so perhaps this month’s blogpost will seem less salty and more optimistic. We’ll see.

In this month’s post, I’ll be shedding some light on the residency/postgrad training programme (for the benefit of my non-medical followers), my reasons for not applying for it, and how it ties into my newfound ‘lying flat’ approach to life.

why I’m not doing a residency

The residency system provides postgraduate medical training in various specialties, allowing doctors to become accredited specialists after completing 5-6 years of training. It’s a system that originated in the USA, and was adopted by Singapore in the recent past.

In the USA, it’s practically a given that all graduating doctors will be automatically matched to a residency programme and receive training to become a specialist, even if it’s not in the field they picked as their #1 choice (which also sucks). For residency in Singapore however, it’s closer to the Hunger Games, with limited training spots available across the various specialties and aspiring trainees having to wait a few years before being able to secure a spot in more competitive/high-paying specialties such as Orthopedics, Eye, ENT, O&G, etc.

I knew of a Medical Officer with children of schoolgoing age, who waited 7 years before being accepted into the Eye residency programme; there was another Orthopedics resident who began her training when she was almost 40. Even traditionally less-competitive specialties such as Internal Medicine and Family Medicine still have an acceptance rate of ~50% (don’t quote me; a few existing residents gave me this approximation).

If or once you do get into the residency programme, it’s a whole new can of worms (or can of opportunities, depending on how you view it). On top of our regular gruelling working hours, residents have to study for difficult postgraduate exams (AFTER WORK, the horror!), meet various requirements such as completing X number of surgeries/procedures, teach juniors/undergraduates, host journal clubs, participate in research projects, as well as do multiple menial administrative tasks & paperwork. It’s a huge and significant time commitment, especially in your late twenties/early thirties.

When I first entered med school as an idealistic teen, I harboured dreams of being either a Psychiatry or Emergency Medicine resident, but quoting Les Miserables, ‘life has killed the dream I dreamed’. After burnout hit me real hard in M3/Year 3, I woke up to the reality that postgraduate training would not make me more fulfilled or happier, and that I am still more than capable of having a great career as a doctor without devoting the remainder of my twenties to a residency.

Basically, my reasons for not choosing any residency are:

  1. I don’t want to be married to my work. I want a life.
  2. I’m not passionate enough to spend 5-6 years in training.
  3. The current competitiveness & long residency wait times don’t seem like worthwhile time investments.

Personally, I’m more passionate about lying flat – having freedom and a good work-life balance – and am not sufficiently interested in any particular specialty to feel like such sacrifices will ever be justifiable. Different strokes for different folks I suppose.

‘lying flat’

I’ve previously written a whole post about the origins & essence of the ‘lying flat’ movement and why it resonates so greatly with me, which you can read here. But to summarise, it’s a way of life spawned by the disillusioned and overworked Chinese youth which caught on internationally, and as a disillusioned and overworked youth myself, I naturally gravitated towards the values it embodies.

To me, lying flat means choosing to live life at my own pace and on my own terms, instead of being pressured by societal expectations of career progression, material wealth, home ownership, marriage/settling down, etc. It means I’m prioritising freedom and my own wellness over all else.

In January last year, when we were M5s selecting our House Officer postings, I had some sadistic peers deliberately choosing tough postings for the sake of learning (spoiler alert: most are regretting it now, because Housemanship itself is already tough enough, regardless of hospital), but my like-minded friends were scouting around for the postings with the best work-life balance. I can’t say my year has been all rainbows and sunshine (although it currently is), because some degree of suffering is to be expected during Housemanship, but my quality of life is above average for a House Officer solely because I chose relatively chill postings.

A key tenet of the anti-work movement, a close cousin of the lying flat movement, is that you’re absolutely and utterly replaceable at work, so there’s honestly little to no incentive in you staying beyond your designated working hours or going the extra mile to impress your bosses. And since I’m being paid an average of $8-10/h, there’s even less of an incentive to do so. Personally, as long as my patients are faring well and I’ve completed all my work for the day, I try to be out the door at 5pm on the dot.

In contrast, if I had decided to undertake a residency, I would have had a pile of additional responsibilities and invariably ended up pulling longer working hours or studying late into the night after clocking out of work, which isn’t something I want at this stage in life. I’ve already studied hard for too many years and lost too much time to learning things that didn’t fully interest me. I’m still interested in lifelong upskilling & learning, just not necessarily in medical-related things.

how the past month has been

My 3rd month in KTPH Medicine has been yet another enjoyable and comfortable month, with time passing at a comfortable speed. Much like the story of Goldilocks, my previous workplace was ‘too hot’, but this place is ‘just right’ – nothing is too stressful, the pace of work is efficient yet doesn’t give the feeling of being rushed, everyone is friendly, and there isn’t a strong sense of hierarchy here.

I’m surprised at how much my mental wellness and subjective quality of life (objectively, all doctors are more overworked than the average person and have a poor QoL) has improved over the past few months, and I’m actually feeling sad at the thought of having to leave the bosses, coHO/MOs and nurses here behind when I rotate to my third & final posting in the end of December.

Many of the MO/Medical Officers (the next tier of seniority above HO/House Officers) in my department were former HOs in KTPH IM as well, and chose to stay on for years because they enjoyed the good work-life balance and great culture here. Some signed on as Resident Physicians (a position for more senior MOs) to work in the department long-term, for additional career and salary progression.

If you’re a future House Officer wondering which hospital and posting would be good to ease yourself into Housemanship, I strongly recommend the postings in this hospital (IM/Ortho/Surg). I don’t think we’re allowed to spend a full year in 1 hospital, but a lot of my current fellow HOs are staying on in KTPH for a second posting.

my future plans

As my longtime readers know, I’ve dreamt of migrating since I was 11 years old, and all my decisions since then – including becoming a doctor – have been geared towards reaching that dream. I wrote about my reasons for wanting to migrate in a 2018 post (which you can read here), and I’d love to hear if any of you share similar dreams or thoughts as me!

I’m still 5+ years away from migrating, after completing the government bond I signed with M0HH, and while it still feels rather far away, I’m already a lot closer than I was back in secondary school, when I had inspiration boards filled with pictures of all the places I dreamt of travelling to or maybe settling down in.

In retrospect, I’m not sure why I thought being a doctor would be the easiest way to migrate…I should probably just have studied a random degree abroad and found a job there instead. But oh wells, hindsight is 20/20 and my government bond costs half a million dollars.

In the meantime, I’ll continue to live life to the fullest here, upgrade myself by attending additional medical & non-medical courses, travel as much as possible (which is tricky since we only have ~21-24 days of Annual Leave), and save up for my big move.

My inner circle is aware of which country I’m planning to head to, but circumstances may change and international medical licensing issues may always throw a spanner into the works, so I’ll share more details publicly once it becomes more certain.

Soon enough (or at least before I turn 30), I’ll reach my dream, and maybe some of you/my loyal readers will stick around till then to celebrate with me!

My song rec for the month is Elvis Song by Maisie Peters, a full-on sadgirl song:

I’m thinking ‘bout
Late nights in the old arcade
Drinking cheap wine as Elvis plays
Singing “You were always on my mind”
I was yours and you were mine

Happy Black Friday shopping and merry almost-Christmas; check back on Christmas day for next month’s post! I’m off to enjoy the rest of my Annual Leave and the weekend, ciao! Be sure to follow my Insta or Facebook page to stay up to date with my latest posts and life updates.


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