Doctor? Scientist?
Realised something - which is important:Lives of doctors in the US and the lives of doctors in Singapore are very much dissimilar.
I don't know why I didn't realise this earlier - actually I have some of the information at hand but maybe I am just too willing to accept the rosy picture and conveniently ignore the reality.
The current reality is this: Singapore is short of doctors. Whereas the US has plenty.
Logical conclusion: if I am licensed to practise, will my boss (i.e. the Government of the Republic of Singapore) let me spend 75% of my time in the lab? Will I only have 2 cases in a morning to see or 13 cases a week to evaluate?
Hell no. I guess after all those work I would not even have the energy to read journals. Let alone all the planning, management, mentoring, problem solving, networking, etc etc etc. I know where my limit lies.
The medical school in Singapore is already over-capacity. Duke-NUS is only taking in that many students. To make up the numbers MOH still needs to source doctors from outside Singapore.
If the situation remains this way for the next 10 years - the problem is unlikely to alleviate with an expanding and greying population - there is no way a clinician scientist is going to have a good life. Unless A*Star says to MOH, NO YOU CAN'T TAKE AWAY OUR RESEARCHERS (in caps and bold) - under the current leadership this is extremely unlikely.
We can only count on the US professors in A*Star to do their job for this situation to turn towards our side. Not likely - because Singapore is not the US. If our healthcare system is supported by a whole bunch of overpriced medical insurance plans and we constantly have people like Howard Hughes, Andrew Carnegie, etc. we will be able to afford to train doctors and put them in labs only. Unfortunately, BUT fortunately for our people, our system is not like that. I don't want that to change.
(Economists please correct any factual or assumption errors - leave a comment.)
If I am the Government, I will deploy my resources to benefit the population the most, and the immediate need of the population is front-line health care. NOT research - putting you in a lab you might come out with something great in 10 years, but if I deploy you to the max now I can fulfill the needs of 40 patients a day. 40 x 52 x 5 x 10 - that is a huge amount of patients. The risk might be lower to just buy solutions from other people than to come out with the solutions ourselves - we may not even succeed in coming out with these solutions in the first place. At least, in that case, the taxpayers will not doubt where their money went to.
No wonder Prof Ren told me: if I intend to hold a MD, a PhD in Singapore would be good enough (he said 'Singapore provides excellent PhD training'). He also says that my decision should be based on whether 'I want to spend more time in the clinic or in the lab'. Of course his is a perspective from Singapore - initially I don't really understand it but now I think I do.
It seems like in Singapore, if you are a doctor licensed to practise, research is secondary, not primary. It seems to me - the reason why they are providing resources to train MBBS/PhDs is that they need these clinicians to bring what the basic/applied scientists developed into the hospital, develop it further and then inject it into the IV lines. It is not fully expected that they will come out with things the basic/applied people come out with. They want these doctors to have a PhD so that they can have the formal training to equip them with the ability to understand the language of basic/applied science, so they can actually function effectively when carrying out the translation because they don't have to learn-as-they-go.
The Government needs them to complete the sequence of biomedical initiatives (no wonder A*Star says that this is 'Phase 2' of their biomedical initiative) - from the DH5a that I clone my lentivirus vector in to something that can enter someone's IV line and cure him - and Singapore's clinical researchers are at the end of this spectrum only or at best, mostly.
(Not a very good strategy in my opinion, if you have limited resources. Look, 3 - 5 MBBS/PhDs a year with heavy clincal duties is not going to make a lot of difference. If they really want A*Star to become something like the NIH, they need a whole group of committed people with the enough experience and the right perspectives. And whoever funding must be committed too, and all these are long-term commitments. I am willing to be there if I can contribute and if they want me - if they want me.)
This is not the only role a MD/PhD plays in the US. MD/PhDs are dotted all across the spectrum. They can be as clinically inactive as they want; Bert Vogelstein, M.D. is not actually practising anymore, from what I understand.
I don't think practising medicine can be secondary to lab in Singapore if you are licensed to practise. Thus, if I were to become a successful scientist, I have to do what a scientist does. My post-doc years are all in Singapore - thus I need to get my PhD training from a great mentor outside Singapore.
I will continue to gather information, and track changes in Singapore. In the meantime, it would be more wise to look out for more opportunities in the basic medical sciences. Haha and, history :)
Labels: Policy and Politics, Studies and Career
