J writes:

I am now in the process of applying to the match. I have been very sure in the past that I really want to go to the US for residency training, but recently I have been having some mixed feelings. Perhaps it is the fear of leaving people whom I am comfortable with, leaving my family and my Malaysian lifestyle- and venturing into a relatively unfamiliar place.

If you do not mind me asking, what was your motivation to continue training in the US after you completed medical school? Have you ever considered staying back in Malaysia and begin work as a house officer?

Well, there is no one simple answer. Indeed, on occassion I sometimes ponder those questions even now. The objective answers are simple: training in the US provides a clear-cut, probably faster, pathway to becoming a specialist. 3 years after graduation, you can be a pediatrician, or internist. 5 years after medical school you could be a general surgeon, or nephrologist, or a silly endocrinologist (well, 6 for me including that research year). It's a very well organized curriculum; you spent time doing rotations only relevant to your scope. No pediatrics for someone going into adult rheumatology. No OB for a psychiatrist. Specific, one could say almost to a fault. Tunnel vision. But with that, comes efficiency and expertise. By the time I completed training I had treated hundreds of thyroid cancer patients. Countless thyroid biopsies and ultrasounds. You know from the start of a program that you WILL finish in a specified time unless you screw up. And, if one trains in an academic institution, the research and scholarly experience can be priceless, one that may be lacking in many hospitals elsewhere. So, objectively, the reasons are simple. It's fast. From what I understand this is not the same in Malaysia. No guarantees on how long one has to work before you get into a Masters program. If you even get into one. Obviously, I speak as a naive outsider as I have no basis for comparison. But, I do know that many of my classmates who went back have not yet completed their specialty training. One of my juniors who trained in the US subsequently returned to Malaysia and is now an Assistant Professor at one of the teaching hospitals. And she's also the superior to one my IMU classmates who did not pursue training overseas. Understandably, he's frustrated- he is academically 5 years ahead of her, but is lightyears behind in academic standing.

However, as we all know, life is not objective. And so J, your concerns are valid. The truth you will have to face is this: when you pursue this path, there will be sacrifices. In every imaginable way. Things that we often take for granted. But often the most precious: family, friends. Our way of life. The birthdays, social gatherings, the Chinese New Year celebrations I've had to miss. The sickness, and not being there when family and friends are ill. Even the funerals I've had to miss. You will leave familiar territory, a culture and country that may frustrate you with its shortcomings but still one you hold dear to your heart, to join a totally foreign world. One that at times seem so sterile, financially rewarding, efficient and friendly, yet lacking in the warmth, depth and substance to which you have grown accustomed. And needless to say, you will miss the food, terribly.

You will close some doors, never to return. You may say goodbye to a woman with whom you had yearned for a future. To friends whom you have known since you were a toddler, some you may never ever see again in your lifetime (outside of Facebook).

Yes, there will be sacrifices.

But the truth is, with one door that you close, you open others. And it is my strong belief that it is only by stepping into the unfamiliar, the unknown, that we are able to grow and develop. And for most, we are resilient enough to adapt to our new lives, to cherish it and eventually to call this our new home if we so choose.

Have I ever considered returning? Yes, up until my postgrad year 4 I was certain I'd return to my native Malaysia. Have I ever pondered how I'd be had I returned? All the time. I fantasize about the ease of which to find satay at 10 PM. To easily join friends for a meal. To have our children play together. To show Alli where her daddy grew up, the things he used to do.

Do I regret staying? Not even for a fleeting moment. When I look at the loves of my life (and no, I'm not referring to the Porsche) and the family I've gained calling this home, everything makes sense.
J, only you can decide what is right for you. Only you can decide if it is worth it. Good luck.