PROFILE: Wai-Ching Leung

With the risk of specialists becoming superseded by subspecialists and superspecialists, it might seem imperative that doctors enter their chosen specialty early in their careers. Wai-Ching Leung did not, however, follow this “conventional wisdom”

After my house jobs, I obtained experience up to junior registrar level and passed the relevant membership or fellowship examinations in paediatrics, ophthalmology, general practice, and psychiatry. Although I enjoyed the experience in each of these specialties, I decided to broaden my clinical experience, rather than limiting myself to a single specialty at this stage. Many colleagues warned me of the negative perception among senior medical figures of such career moves and of the dangers of being a “rolling stone,” but I felt that the experience in one specialty often enhanced my understanding in others. I did come across a few supportive consultants, however, and a consultant psychiatrist single handedly guided me to success in my preparation for the Faculty of Public Health Medicine part I examination. Soon afterwards, I entered public health medicine training with the hope of finally becoming an academic in a single specialty. By this time, most of my fellow students who graduated in my year were already applying for consultant posts.

If my strength seemed to lie in passing examinations, subsequent events proved otherwise. Some considerable time after I started public health medicine training, I discovered that none of the projects I was involved in was suitable for the Faculty of Public Health Medicine part II examination. Inevitably, this weakness led to a record of in-training assessment (RITA) form D (that is, need for targeted training)—the first time such a form was issued to a post-part 1 trainee in the region. Although the resulting constructive actions and support I received led to success in my part II exam soon afterwards, conflicting official views about my academic training needs complicated matters further. When I was eligible for the certificate of completion of specialist training (CCST), in October 2000, my academic achievements were insufficient for me to pursue an academic career, and this situation has recently been exacerbated by official educational objectives being radically rewritten.

During this rather lengthy period of turmoil I received much advice—some informal, some strictly official and imposed—of varying quality. From this, I learnt many lessons about the importance and nature of good career guidance. Firstly, the quality of advice is not necessarily associated with the official positions the advisers hold. Secondly, nobody can advise on all matters, and good advisers know their limitations; we often simultaneously act as advisers on some matters but need advice ourselves on others. Thirdly, an adviser's openness, impartiality, and willingness to acknowledge potential conflicts of interests are paramount. The real difficulty for those seeking advice lies not so much in finding willing advisers but in picking out the good ones. Finally, good advice can make a tremendous impact on the career, morale, and psychology of the recipient.

These reflections encouraged me to share any worthwhile experience and insights I might have gained, and I first began to write BMJ Career Focus articles in December 1999, when my trainer's genuine commitment to career guidance began to restore some order to the chaos I was in. What did I base my articles on? Over the past 10 years or so, I have studied for four masters degrees—in law, mathematics, business administration, and education—two by distance learning, one by self study, and one by day release, and three were preceded by relevant undergraduate study or followed by vocational studies and experience. This was made possible by the sacrifice of many evenings, weekends, and annual leave, together with appropriate time management. Life outside work and study was somewhat restricted, though not abolished. I certainly struggled at times, though having my personal interest and curiosity as the motivating force—as opposed to the need to satisfy committees—made the work a pleasure rather than a chore. None of these degrees seems to have a medical slant. For example, I obtained a general LLB (bachelor of laws), and my masters degree was in criminology and family law; my MMath degree consists of a combination of pure and applied mathematics as well as statistics; and my MEd degree was mainly in applied linguistics. I find it helpful, however, to apply these disciplines to medicine, and I take an active interest in medical education, medical law, and medical statistics.

What are the pros and cons of such an unusual career path? There are clear financial disincentives, long periods of insecurity, and considerable delay in ascending the career hierarchy. Furthermore, many doctors in senior positions still view unconventional career paths with deep scepticism. I believe, however, that knowledge or experience across specialties and disciplines outside medicine adds value to our work, whatever we do. In my case, for example, it will add to my contribution to an integrated undergraduate medical curriculum and health service research. More importantly for me, however, it enhances my personal satisfaction and enthusiasm for my work and minimises the risk of burnout. I certainly would not recommend others to follow my footsteps, but I do urge you to have the courage to deviate from conventional wisdom if necessary in order to fulfil your inner wishes.

LI>Loefler ILP, Turnberg L. Are generalists still needed in a specialised world? BMJ 2000;320:436-40. http://bmj.com/cgi/content/full/320/7232/436.