General Practice (Family Medicine) - My way forward

Since I started studying Medicine in 2014, many people kept asking me this question "What do you want to specialise in?" I had always found it a difficult question to answer. As a matter of fact, I found every specialty interesting in its own way. Choosing a particular specialty would mean that I would be out of touch with the other specialties. It would be quite boring if I could only do one specialty.

I was also told "Don't be a GP (General Practitioner). There are already too many GPs in our country, it's useless to become one. You should become a specialist instead." I never agreed with that statement. I firmly believed that as long as you genuinely want to contribute to the society, all doctors including GPs and specialists play a very important and noble role.

In fact, I found the job of GPs really great from my observations. General Practice is very broad. Being the first point of contact for patients, GPs get to see cases of all specialties. This is certainly more interesting than doing a specific specialty. I also value work-life balance very much. I could see that GPs have better work-life balance compared to doctors in hospital-based practice.

In 2017, I understood for the first time that General Practice is actually a specialty on its own, which is also known as Family Medicine. We can specialise in General Practice, and I started considering it. I was aware that it's extremely competitive to get into a Master's programme for Family Medicine at public universities in Malaysia. Therefore, I thought of taking the Membership of the Royal College of General Practitioners (MRCGP) exam instead.

In Year 3 of medical school, I performed particularly well in the General Practice rotation compared to other hospital-based rotations. I also found myself learning much more efficiently in General Practice settings compared to hospital settings. During my Electives in Year 4 of medical school, I chose to do General Practice. Meanwhile, many of my friends had little interest in General Practice.

Later, I found out that the MRCGP exam can only be taken as part of a General Practice specialty training programme in UK; it cannot be taken in Malaysia. I then had a change of plan. I thought of taking the Membership of the Royal Colleges of Physicians (MRCP) exam instead. Unlike MRCGP, the MRCP can be taken in Malaysia as a standalone qualification. MRCP is an exam for Internal Medicine rather than General Practice, but it’s fairly common for GPs in Malaysia to take MRCP. Just like General Practice, Internal Medicine is very broad and encompasses many specialties.

As I gained more and more clinical exposure, I found out the brutal realities of working in hospitals, including bullying, heavy workload, long working hours and having to regularly miss out on meals and sleep. I realised that hospital-based practice is deeply incompatible with my own values, and I increasingly became disillusioned with clinical practice as a whole. Seeing how bad hospital-based practice is made me convinced that General Practice wouldn’t be much better. Consequently, my interest in General Practice faded, and I decided not to do clinical practice at all.

After graduating with my medical degree in August 2020, I was fortunate enough to get a Teaching Fellow post at my medical school. I enjoyed the Teaching Fellow post so much and it totally felt like a paradise. In May 2021, I firmly decided to be a Medical Lecturer in the long term. A Medical Lecturer post would require Malaysian Medical Council (MMC) Full Registration, which in turn requires completing House Officer training. Despite knowing how challenging and stressful House Officer training is, I went ahead with it, fuelled by my strong determination to be a Medical Lecturer.

I started House Officer training at Kluang hospital in August 2021. The extreme stress and endless challenges further reinforced the fact that hospital-based practice is not for me at all. I found out that Medical Officers (MO) in hospitals have to routinely work continuous 33-hour on-calls lasting from 8AM till 5PM on the next day, making it even more stressful than House Officer training. Therefore, I set my minds on quitting clinical practice to be a Medical Lecturer as soon as I completed House Officer training.

In October 2022, I discovered that the RCSI-UCD Malaysia Campus (RUMC) offers a General Practice specialty training programme known as the Malaysia-Ireland Training Programme for Family Medicine (MInTFM), which incorporates the Membership of the Irish College of General Practitioners (MICGP) exam. This provides an alternative route for joining General Practice specialty training in Malaysia apart from the very competitive Master's programmes at public universities.

In January 2023, MMC announced that moving forward, only doctors on the National Specialist Register (NSR) would be allowed to practise as Medical Lecturers. That would mean I must complete specialty training before I could become a Medical Lecturer. I considered joining RUMC's MInTFM programme. Later, I found out that we are only allowed to join the MInTFM under the Ministry of Health's Hadiah Latihan Persekutuan (HLP) scholarship; self funding isn't allowed. Only MOs working with the Ministry of Health are eligible for the HLP.

In October 2023, MMC reversed their decision that only doctors on the NSR can be Medical Lecturers. Of course, I was overjoyed. Following that, I scrapped my plans to join the MInTFM. In December 2023, having obtained my MMC Full Registration and Annual Practising Certificate (APC), I applied for a Medical Lecturer post at my medical school. Unfortunately, my application was unsuccessful due to my lack of a postgraduate qualification.

After completing House Officer training in January 2024, I had no choice but to proceed to working as a MO in Internal Medicine at Kluang hospital. Although I had a high degree of theoretical interest in Internal Medicine, the 33-hour on-calls, heavy workload and long ward rounds were totally unbearable for me. I desperately wanted out of it to become a Medical Lecturer.

In June 2024, I got transferred to Klinik Kesihatan Sundar in Sarawak. That was my first time working in a General Practice setting. Sundar is a very secluded village. Although the work there was quite fun and relaxing, I was deeply troubled by the extreme isolation and difficult life at that place. I couldn't enjoy the job or appreciate General Practice, and I was constantly stressed and frustrated. After taking and passing the MRCP Part 1, I applied for Medical Lecturer posts at multiple universities, but all were unsuccessful.

Eventually in October 2024, I was transferred to Klinik Kesihatan Ibu dan Anak (KKIA) Limbang, another General Practice setting. KKIA Limbang is a total paradise, with supportive work environment, manageable workload and no on-calls, in the nice town of Limbang. I enjoy my work here so much and I make sure to show my fullest enthusiasm and dedication in my work. I always put in my time and efforts to communicate properly with every patient to address their concerns and expectations. I realised that managing patients in General Practice settings is so interesting and rewarding.

I finally understood that General Practice is my true calling and I want to keep doing it in the future. With that, I set my minds on applying for RUMC's MInTFM programme. After my application was shortlisted, I took the Clinical Entrance Test on 21 January 2025 and attended the interview on 20 February 2025. On 26 February 2025, RUMC informed me that I was successful in the application. However, I may only join the MInTFM in July 2026, due to the fact that I am only eligible to apply for the HLP in the following year.

It marks a very significant milestone in my life, as this is my first time receiving an offer for a specialty training programme, even with the delayed start. I will still go ahead with completing the MRCP and the Diploma in Child Health (DCH), as they too are very valuable for GPs. I look forward to my future career in General Practice (Family Medicine).