SUBSPECIALTY IN MEDICINE. IS IT WORTH ALL THE TROUBLE (OR TROUBLES)?

Continuing education never ends in Medicine. Learning is a life long process. The day you finish your first degree be it MD or MBBS, you have to think about postgraduate education. The day you finish your second degree or masters, you have to think about subspecialty or fellowship training.

Subspecialty training or fellowship training is a different ballgame if you want to compare to masters programme. At this point of time, most of us is settling down with many commitments either personal or family.

To even start thinking of a subspecialty training is already a major decision. You have to start looking for training centres either locally or in other foreign countries. Usually in many centres, there will be at least 2 or 3 years of waiting list, unless you have close contact to the training consultant. Even after you have secured the place, it might be difficult to secure a working visa for you in the particular country for you to work. Even after you have secured both the training centre and working visa, some of you may not be able to secure any scholarship for the fellowship training. I have a colleague who took a MARA loan to do her fellowship. She is still paying the loan now.

After all these troubles, then it came to the time for you to go for your fellowship. The scholarship is usually not enough to cover your living expenses for the whole duration of the studies. You need to fork out your live savings for the studies. Sometimes you have to spend your credit card up to the limit and do the payment later. One of my colleague spend to the limit, two of his credit cards while doing his fellowship. The credit card payments were only settled after 2 years later on. Comparing to a non medical personnel who did masters or PhD overseas, we don't have the luxury to do odd jobs to cover for our living expenses overseas. This is because you usually work the whole day and sometimes doing on calls, without pay. If you compared to your colleague in Singapore, they were usually given a bigger scholarship. Their scholarship were given by the Ministry of Human Resources. As a comparison, 5 years ago, our scholarship to France is Euro500, whereas their scholarship is Euro1500, a Euro1000 difference. Now, if you go to Europe, you will get around Euro1500 per month if your bring your whole family together (maximum 4 children will be paid allowances).

Then, your wife or husband may have to take unpaid leave or resign from his or her job. This is another loss of income, which will deprive you of your spending power while you study. Then, your children, who need to go to school in a foreign country. It is fortunate for them, if you are doing your fellowship in an English speaking country such and UK or Australia. They can go to the country's public school. The fees are usually cheaper or free. If you are doing your fellowship in a non English speaking country, you may have to opt for International School. With the current scholarships that were given to us, we can never afford International School. Only if you work with Malaysian Embassy, you can afford International School. If you can't afford it, would your children miss school for a year?? That is for you to decide.

After the long one year of fellowship, you came back to your current employer or university. With it, you were confered a Fellowship or etc, etc. But with it, you also carry unpaid credit card bills, bank loans, your children missing school in Malaysia and your wife not working for a year. Your house would surely be in a mess, after leaving it for a year.


One year gone, you missed the CLA5 (Penilaian Tahap Kecekapan 5) and you miss the boat for your promotion. Your colleagues who graduated the same year with you got the promotion earlier since he didn't missed the CLA5. Will you get any extra increament?? NO. Will you get recognition for the work you have done?? NO.

So, the question is, is it worth all the troubles???? This is a difficult question to answer. For me, a big YES. However since I dare not sacrifice my children's education and I can't afford to spend a lot of money for overseas fellowship, I have done my fellowship locally. I still need to spend a lot of money for weekly traveling from Kuantan to KL and also spending for the house rental. The scholarship of RM1000 (RM900 + RM100 extra COLA) is not enough to cover it all. You have to sacrifice something to get something else. The extra amount of money I spent is peanuts if compared to others who had spent doing fellowship in France, Turkey, UK or Australia.

Why do doctors still go for their fellowship, with all the troubles and suffering for them and their families?? I can list some and others can add more.

a. Personal satisfaction: If you like to do something, you will go for it, no matter how big the obstacle is.

b. To be better: In a more challenging world now, being a generalist is not an option. In the past, when you passed as a doctor, you resign and opened your GP clinic after 3 years. Your clinic will be prosperous. However now, you may not survive 2 years if your open a clinic.

c. For promotion purposes: As I mentioned above, you won't get your immediate increament or extra allowances after you finish your fellowship. However, it could become a platform for your promotion. In a university setting, if you planned or decided to apply for a Professorship (VK7) in 5 years time, it would be easier for a subspecialist. You will receive specific cases for your subspecialty. From there, you can collect and have a database of your specific patients and cases. With the databases, you can conduct trials, studies, publish papers, give talks, conduct conferences, conduct courses, becoming consultants to other centres and etc. All of these will give you extra points for your promotion.

d. To start a new service in your current centre: No subspecialists in your current area of expertise is available in your current centre and you want to give something to the public. It is quite noble I think.

d. Greener pasteure (not sure if it is a correct spelling): Some people use this as a platform to go to private. In a competitive world now, being a subspecialist increase your value in private hospitals. You can command more salary and cover more hospitals and doing specific cases if you are a subspecialists. However after saying all these, please remember that the public is paying for you subspecialty training. Please give them at least 5 years of wonderful service and then resign. The 5 years will increase your skills, add value to your work ethics, satisfy the public service. Lastly, please still do come and give 'amal jariah' to the public hospitals after leaving.

Lastly, please make sure you pay your WIFE and CHILDREN handsomely after all these troubles. They are the ones who suffered a lot when you did your training, doesn't matter whether it is locally or in another country.