Consider this while choosing a medical speciality


A doctor should follow his interest and passion when it comes to choosing a speciality to go into. — AMITA SEVELLARAJA

When I entered medical school, I was determined to become a specialist.

I thought running a maternity home would give me independence, and so obstetrics and gynaecology (O&G) was one of the specialities I thought I would pursue upon graduation.

In fact, I remember a senior of mine, who, even before entering medical school, had decided that he wanted to be a neurosurgeon.

And indeed, he is now a successful neurosurgeon in private practice.

The medical school curriculum and learning was tough, and many of us were just struggling to pass exams while trying to enjoy university life with whatever minimal time we had left.

Our objective was to pass one examination at a time until we graduated.

So, while I still harboured the ambition of becoming an independent specialist, as a struggling medical student, this became a fleeting and increasingly distant thought.

Once I graduated and became a houseman, I worked mainly in two disciplines, i.e. O&G and medicine.

After that I had a short stint in surgery before becoming a medical officer in a small district hospital in Mersing, Johor.

I studied for the Part 1 examinations for both the Membership of the Royal Colleges of Physicians (MRCP) for medicine and the Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) for O&G.

Later, I chose to do O&G and I have not regretted this decision, having been in this speciality since 1988.

You, as a young medical officer, may have to make a decision as to which speciality you would like to go into.

Many choose specialities based on their interest in particular fields.

Others follow their role models, who may be family members or a doctor under whom they have trained.

Specialists in private practice can be divided into two categories: frontline specialists and supportive specialists.

A frontline specialist is a doctor who has direct contact with patients.

These are the specialists whom patients look for to seek treatment.

Examples of these specialities are:

  • Medicine and its subspecialties (general medicine, cardiology, endocrinology, rheumatology, etc)
  • Paediatrics
  • Surgery and its subspecialties
  • O&G

Meanwhile, supportive specialists are those who support the frontline specialists.

Patients don’t seek them out.

Examples of these specialities are:

  • Anaesthesia
  • Pathology
  • Radiology

From one point of view

Radiologists, who specialise in diagnosing injuries and diseases through medical imaging, fall into the category of supportive specialist. — FilepicRadiologists, who specialise in diagnosing injuries and diseases through medical imaging, fall into the category of supportive specialist. — Filepic

As an experienced private practitioner, allow me to give you some insights as to which category you might want to choose to practise in.

Here are some of the advantages and disadvantages of the two different categories.

The first advantage of being a supportive specialist is that you don’t have to go out and spend time “marketing” for patients.

You can just focus on your job.

And when you complete your duties for the day, you are free and need not think of work.

As a frontline specialist, however, you not only have to do your job as a doctor, but you also have to spend time promoting yourself.

This may include giving lectures, going out to meet general practitioners (GPs), and being active on social media and in professional or civil societies, so that other doctors and the public will be aware of you.

A considerable amount of time can be spent on doing this.

This is time taken away from your family and your own leisure.

The management of your hospital will never value this time spent, even though it also helps bring patients to their door.

The second advantage of being a supportive specialist is that you can take time off and no one will notice it.

Your patients will not miss you, and when you come back, you can slip back into your routine without any loss of income.

The frontline specialist will not be able to take extended leave as he might lose his patients to his competitors if he is not around for a long time.

The third advantage of a supportive specialist is that you can easily move to another hospital or town if you wish without much loss of income.

A frontline specialist who has invested her time and energy in a particular hospital or town will find it difficult to move from her existing hospital because she has created a large following – an asset that she will find difficult to give up.

If she moves, she will have to start all over again in the new hospital.

For this reason, many frontline specialists remain in the same place for a long time.

The fourth advantage of a supportive specialist is that you can get immediate income upon joining a private hospital.

Let me explain how this works.

Most hospitals have a system where patients and frontline specialists do not choose their supportive specialists.

Patients are sent or assigned to them on a rotational basis.

As such, a new supportive specialist will get patients as soon as he joins the hospital.

From another point of view

Surgery is an example of a frontline speciality where the doctor faces the patient directly. — Photos.comSurgery is an example of a frontline speciality where the doctor faces the patient directly. — Photos.com

Now, let’s look at what might be considered the disadvantages of being a supportive specialist.

The first disadvantage is that the hospital can bring in another doctor in your speciality at any time, thus diluting your workload and income.

The same can also happen to a frontline specialist, but because patients often look specifically for a particular frontline specialist, it is more difficult for the hospital to divert patients to the newcomer.

So, the income of a frontline specialist is more secured than that of a supportive specialist.

The second disadvantage is that in some hospitals, frontline specialists can request for the services of particular supportive specialists.

In this system, frontline specialists can, at times, take advantage of the supportive specialists.

For example, a new anaesthetist may feel the need to always be ready to support the surgeons when called upon, even if he is on leave or not on call, and regardless of whether it is day or night.

In order to establish himself, he has to be available to the surgeons at the times when his senior colleagues are not keen to do the case, especially when the surgery has to be done at odd hours.

The third disadvantage of being a supportive specialist is that it is much easier for the hospital to terminate your services if there are any disputes.

As a supportive specialist, you are dependent on the hospital for your patients.

Your replacement can easily take over your duties without much problem.

I have personally seen this being done to an anaesthetist whose contract was terminated because the hospital management had a dispute with him.

For frontline specialists, the management will think twice before terminating their services as when such a specialist leaves, some of their patients will follow them to their new place of practice, causing the hospital a loss of income.

So, if you are a supportive specialist, you need to be more accommodating to the hospital management and frontline specialists in order to survive in private practice.

Follow your passion

Most of us choose a speciality because of passion.

We want to be in a speciality that will drive and inspire us, even on our worst days.

This article is merely to make you aware of the difference between these two categories of specialists.

These are well known facts to all private practitioners, but rarely openly talked about.

Knowing the advantages and disadvantages of each category will give you a better understanding of where you stand when you select a speciality and decide to move into private practice.

Dr S. Selva is a consultant obstetrician and gynaecologist, and fertility specialist, in private practice in Melaka. This is the 10th article in a weekly series about surviving private practice in Malaysia. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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