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The Chronicles of a House Elf is an ongoing monthly series capturing the highs and lows of my working life as a junior doctor in Singapore.


And just like that, our 2-month interim posting is nearly coming to an end. Time strangely (and thankfully) feels like it’s passing slower nowadays, and the days feel longer, but not in a bad way.

I’ve been overthinking about how it’s so easy to get lost in the fast-paced lives most of us are leading, and the idea of one day looking up from our phones and hectic working lives, only to realise that a decade has accidentally slipped by and our lives haven’t really gone anywhere…or at least not in the direction that our younger, more idealistic selves may have hoped. Doesn’t that scare you sometimes?

This month’s post is centered around the idea of stagnating, both in our daily lives/work & long-term careers, and how limited career progression opportunities for doctors in the public healthcare system contributes to burnout and jadedness.

seeking fulfillment at work

I’ve been trying to find fulfillment at work, but it’s been a bit of a struggle. I’ve been in a clinic-based posting for the past 2 months, and can say with confidence that I definitely enjoy clinic-based work more than ward-based/hospital work. I love being able to connect with my patients while also helping solve their problems, as well as the autonomy & lack of hierarchy in clinics. But even then, something still feels like it’s missing.

I definitely don’t mind the work, and could do it for a few more years (for the sake of becoming financially stable and holding down a regular job like a regular adult), but do I really want to do this for the next few decades of my life, fully knowing that I will regret not having explored other potential career paths? To me, the outcome itself isn’t as important as the process, and I’d rather take a long detour and end up coming back to Medicine, than never having ventured out at all and always feeling dissatisfied.

Imagine a job that not only respects your life outside of work, but that you also don’t mind devoting a significant number of hours a week to, because you feel sufficiently fulfilled by it, in the sense that you’re able to help others while also being sufficiently stimulated by the nature of the work.

I’m not sure if you harbour similar ideals of finding a job or project that fills you with excitement and some sense of purpose, but I feel like I’m on an endless search for something like that.

I’m just curious, what would your passion projects be, if you could pursue anything without having to concern yourself with success or finances? (you can DM me or comment below)

stagnating sucks

You might think that burnout and a chill workplace are mutually exclusive, but they’re not. The problem with not feeling particularly fulfilled or challenged at your job is that you’re more likely to have feelings of burnout (like me).

Quoting Mayo Clinic, “job burnout is a special type of work-related stress — a state of physical or emotional exhaustion that also involves a sense of reduced accomplishment and loss of personal identity.”

In my current posting, the workload has been very low, since it caters to a relatively low volume of patients with straightforward (easily diagnosed and treatable) conditions. I thought I would enjoy a respite from the usual intensity of work – and to be honest, I did enjoy it for the first few weeks – but eventually, I felt tired of the repetitiveness & lack of variety of cases, and realised my learning was stagnating.

Over the past year of work, there’ve been times when I’ve been bored out of my mind, with nothing to do except watch the clock and wait for 5pm to roll around, but there’ve also been days when it was non-stop working for 12 hours straight. I can’t say I prefer one over the other, and I feel that both ‘working too hard’ and ‘not working but still stuck at work’ are only fun or healthy in moderate doses. (go on, call me a lazy and entitled Gen Z kid 🌚)

jadedness/burnout

Jadedness is a spectrum, on which I’d consider myself 60% jaded. But I’ve seen many older doctors, especially stuck in the MOPEX system for their entire twenties, at a far worse stage. They’re consistently pessimistic, do the bare minimum, and you can sense how frustrated they are at work (probably exacerbated by the lack of work-life balance). And I can see that happening to myself; the idea of ending up as a chronically burnt-out & uninspired person terrifies me.

If you look at the chart about burnout below, many doctors/peers are easily at Stage 5 – they laugh about not having a life or any hobbies, joke about feeling depressed & self-medicating, celebrate having 1 day off after 20-odd days straight of work. Yet we continue to accept such mistreatment and poor/dangerous* working conditions because we’re so used to it, and everyone around us is in the same boat, so why not suffer together?

*dangerous for both the patients and healthcare workers…I mean honestly, do you feel safe having a sleep-deprived doctor attending to you ?

Source

Work shouldn’t be about just surviving and making it through tedious week after tedious week. Work shouldn’t consume your whole life, because your employer would easily replace you in a day if you dropped dead from overwork. Medicine culture is known to be toxic in so many ways, and yet we just accept it as a rite of passage because everyone else before us did.

An excerpt from an article titled Why do physicians stay in toxic work environments?‘ hit the nail on the head:

They named this condition “learned helplessness,” or not attempting to remove yourself from a negative situation because your past experience has shown you that you are helpless.

I believe medical training teaches physicians that they are helpless. Throughout medical school and residency, you are administered shock after shock of painful experiences.

Work a 24-hour shift and complete 6 hours of documentation afterward. Shock.

Stand for 10 hours holding a retractor in the OT without taking a water or bathroom break. Shock.

Be shamed for taking a sick day. After all, you are either in the hospital (working) or you are in the hospital (because you are so sick). Shock.

You are led to believe that this is just the price of admission to becoming a doctor. If you really want to become a physician you must find a way to endure these painful situations. You just have to put your head down and power through your training. There is no way out but through.

article by Chelsea Turgeon, MD

Tell me this doesn’t sound like pretty much all of us, when we shrug off working yet another 6 or 7-day week, or go post-call after nearly 30 hours straight spent at work, or have to compete to take Annual Leave in departments with poor manpower? Or when senior doctors tell you that they had it worse in their time and that we should be grateful for our salaries (a grand $3-4k!!), as if suffering is the prerequisite to becoming a goOd dOcToR.

I just want to remind those of you who might be working too hard for an employer who doesn’t respect your time or sufficiently value your contributions, that your life outside of work is precious and worth setting firm boundaries for!! As seen on the AntiWork subreddit:

Residency + career progression (or there lackof)

Another nail in the coffin is the local Residency system. Comparing 2 countries with toxic medical cultures, American medical graduates are almost guaranteed Residency/training positions, but here in sunny Singapore, you’ll have to fight for it.

If you have time and want to gain a better understanding of the issues plaguing the long-term career prospects of junior doctors in my generation (ever since the Residency system kicked into place), I encourage you to read Running on Empty, an excellent opinion piece by a fellow local medical blogger.

But to briefly summarise, there’s low morale among junior doctors and poor long-term career prospects due to the constraints of a small healthcare system like Singapore.

  • There’s simply not enough space for all local & foreign medical graduates to receive specialty training. What was once a basic entitlement has become yet another round of competition for limited training spaces in an increasingly-competitive residency system (following the US’ Residency system).
  • In the past, Singapore followed the UK’s system and trained its specialists via traineeships (Basic & Advanced Specialist Training), which meant if you worked in a specialty for X number of years and passed the required exams, you would have a guaranteed place on the career ladder. You’d go from Medical Officer to Registrar, Associate Consultant, Consultant, and eventually Clinical Professor.
  • The old training process directly resulted in an oversaturation of upper positions in the public healthcare sector, compounded by the fact that many 60/70-year old doctors are still working, so there’s insufficient slots for younger doctors to be promoted. (yes, doctors have insanely long shelf lives)
  • Not all doctors who complete residency nowadays are even guaranteed Associate Consultant jobs. Some remain ‘stuck’ as Registrars – working bad hours with stressful calls and lower pay.
  • After becoming a Resident, your life doesn’t get easier: the rat race, overwork, and constant fight to prove oneself continues, with some residencies/specialties boasting rising dropout rates over the years.
  • It’s even worse for those who aren’t in residency, or failing year after year to get into a highly competitive residency (a very common occurrence given the sky-high competition). You’ll get stuck in the MOPEX system for 4-5 years, where you may be randomly assigned to departments (which you may or may not have chosen) which are lacking manpower. Most people I know of in this route are merely waiting for the 5-year bond to end before they flee to the private sector, and not many stay on in hospitals afterwards. So there’s really not much hope for meaningful career progression for non-residents, as much as hospitals tout various career paths like the Hospital Clinician scheme, etc.

It’s a bit of a chicken & egg scenario – I’m not sure if I became increasingly jaded with the system when I realised just how competitive getting into specialist training (Residency) was, or if I was already sure of not wanting to specialise and just used this as a bonus ‘push’ factor to justify why I didn’t want to apply for anything.

Anyway, a handful of my friends/PGY2s will be starting their residency training in July, and I’m excited for them! They’re all in Family Medicine or Internal Medicine, the 2 residencies which have the largest pool of trainees and tend to accept doctors fresh out of Housemanship. On the flip side, I know of many more who applied to various specialties (some have tried for 3+ years) but didn’t get accepted…

If I really did feel sufficiently passionate about any specialty, I might be able to hold on for another 5-6 years and put my body through 80-hour work weeks, in spite of the sacrifices required. But personally, since I have minimal interest in hospital-based specialties and don’t want to wreck my own health & sanity, I’m choosing to tap out of this system earlier to gain practical experience in fields I’m interested in exploring (both within and outside of Medicine) and slowly figure out my own career path.

It’s scary to walk down this uncharted path, but it’s better to have tried and failed, than to have spent my twenties stagnating.

what’s next + a temporary hiatus of this series

I’ll be spending a few months travelling and trying to figure out the rest of my life before starting in a new job, but I’m preparing a massively personal 3-part series that I’ll hopefully be posting the same time next month (y’know, the usual 25/26th).

To my fellow MOs (and some HOs) starting your new postings in July, all the best and may the odds roster be ever in your favor!

My junior doctor series will resume in October, with exciting new updates. Until then, be sure to follow my Insta or like my Facebook page to stay up to date with my other posts & life/travel updates!

And here’s my song rec for this month, Turn by The Wombats:

They say the best memories are the ones that we forget
Like listening to Drake at your best friend’s swimming pool
Floating anti-clockwise in a red mushroom
Maybe it’s the crazy that I’d miss
It won’t get better than this

xoxo,
Faith

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If you’re interested in exploring my blog, click here for an index of all the posts I’ve ever written (travel, musings, doctoring), or check out my most read series below:

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