Few in Singapore have attempted a career like Professor Wong Tien Yin. A President Scholar in his younger days and a graduate of the National University of Singapore (NUS), Professor Wong also has a MPH and Ph.D in epidemiology from the Johns Hopkins University, USA. He is currently the Provost's Chair Professor, Medical Director at the Singapore National Eye Centre (SNEC) as well as the Vice-Dean of Clinical Sciences at the Duke-NUS Graduate Medical School.

As one of the early "clinician scientists" in Singapore (before the term was more widely used), Professor Wong is an ophthalmologist who specialises in retinal diseases. His clinical and research work focus on diabetic retinopathy and age-related macular degeneration, both of which are major causes of blindness globally. To date, he has published more than 900 peer-reviewed papers in various journals including Nature, the New England Journal of Medicine and the Journal of the American Medical Association.

Recently, Professor Wong was conferred the President's Technology Award, one of Singapore's top scientific honours which serves to recognise the contributions of outstanding individuals in science and technology. Working with two other awardees, the team developed a suite of novel ocular image analysis technologies which allow doctors to detect and track the progression of three major eye diseases that cause blindness. These systems have been applied in the populations of Singapore, USA, Europe, Australia and other Asian countries.

Join us as Professor Wong talks to Synapse Magazine about the challenges he faced in his initial journey. He also describes the characteristics and skills required to be a successful clinician scientist and the need for more Singaporean youths to pursue this career path.

Your involvement in research has been exemplary, can you share with us your beginnings in the field of science?

It was all rather incidental. We do not do scientific research because we are brought up to be interested or have a strong desire to do so in schools. In the late 80s and early 90s, medical school was all straightforward clinical training. I started doing research only after medical school because getting a training position in ophthalmology was competitive and some senior people suggested writing a paper.

My first publication was a review paper. Although the review did not require original data, writing it involved heavy reading as I needed a thorough understanding of the literature. It was difficult as I was clueless. Furthermore, there were no online resources like PubMed at that time. Hence, I frequented the libraries in the SNEC and NUS to look at resources stored in CDs and old journals. Sometimes, I even wrote to people to get the appropriate papers.

It eventually took two years before the paper was published in a top U.S. ophthalmology journal. However, when the paper came out, I felt a strong sense of achievement. Furthermore, it also helped me identify knowledge gaps which eventually became ideas for future projects.

At a point in Singapore's history when the career path of a clinician scientist was unknown, what were some of the challenges you faced? Do these challenges remain relevant today?

It was difficult and I struggled to do both science and medicine in my early career. When I was attending scholarship interviews for my Ph.D overseas, I remember the interview chair from the Public Service Commission (PSC) asking me, "You are a doctor, why should we fund you to do a Ph.D overseas? Why don't you concentrate on doing what doctors do in the hospitals?" I did not get the scholarship and eventually took no-pay leave from MOH to pursue the Ph.D. I remember at Hopkins when me and my wife had our first child, my wife asked me why are two trained doctors living like this when we were buying a second-hand pram. That challenge is no longer present. Today, any doctor with the desire and intention to do a Ph.D will be fully supported.

There was also no concept of "academic medical centers (AMCs)" back then. The two larger hospitals, SGH and NUH, were very clinically orientated, and research was not part of their agenda. Funding and facilities for research were limited. Career pathways for clinician-scientists were non-existent. Many of these challenges have disappeared because Singapore has shifted from a basic healthcare model, where we follow others and best practices overseas, to a knowledge-creation and learning healthcare model. We desire to be Asia's medical hub and our country's residents depend on us to generate evidence for the best diagnoses and treatments. Because of this paradigm shift, you need innovation and research in the healthcare setting. Hence, the context, culture and motivation for Singapore's healthcare has changed.

However, what remains is the challenge of doing well in both science and medicine. Science is getting more competitive while medicine is becoming more specialized and knowledge-intensive. With only 24 hours in a day, you cannot be broad clinically and excel in your science at the same time. To do well, you need to be extremely good at your science while being well-versed in a focused clinical area. For example, if you are doing breast cancer research, you can only be a breast surgeon, not a general surgeon. There is just not enough time to compete in terms of the clinical volume.

Being a clinician scientist is a difficult and uncertain route. You do not know if you will succeed. I do not see many young people taking this route of balancing research and clinical work. Most people will want a comfortable and safe career which provides a good work-life balance. Fewer feel a mission to push the boundaries of medicine and be part of the broader Singapore ambition to succeed as a thought centre and leader. Unless that ambition and capability are present, the challenges for someone to take this route are still quite significant, despite the investment and support.

It is often said that mentors can make or break your mind set to do research. Who were some of these mentors in your career and how have they guided you?

Many clinician scientists attribute their success to the people who helped them along the way. When I look back at my career, I agree with this philosophy. Most of my career happened in serendipity. It was through the advice and guidance of my mentors that I got to where I am today.

I had the fortune of meeting many mentors. These include Professor Arthur Lim, Professor Donald Tan, my previous director at both the Singapore Eye Research Institute (SERI) and SNEC, as well as Dr. Vivian Balakrishnan when he was the director of SNEC. There were also overseas mentors whom I met during my fellowship training, MPH and Ph.D. They were Professor Alfred Sommer and Professor James Tielsch from John Hopkins Bloomberg School of Public Health, Professor Ronald Klein from the University of Wisconsin, Professor Paul Mitchell from the University of Sydney and Professor Hugh Taylor at the University of Melbourne. These were very senior people who would, at different stages of my career, be interested in my career and work. They provided directions at very critical decision points. Following those advice shaped how my entire journey moved along.

The culture for doctors to do research is still adolescent at best in Singapore. How do you think younger students can be encouraged to take up research roles?

Singapore needs people to take on roles that enhance the ability of medicine to be competitive globally, especially in the Asia Pacific region. These include not just clinical roles, but broader academic roles in research, teaching and leadership. In countries which have a long tradition of research culture and achievements, there is a strong representation of researchers as role models. As compared to these countries, Singapore is young. Therefore, we need to build up research role models so that people can aspire to be like them.

Many young people look at senior professors and view their achievements as unattainable. But we need to remember that there is nothing special about myself or other successful researchers in Singapore. We came from the same "soil" and the same schools. Most of the students pursuing medicine are top students. Back in high school, they have done well and always wanted to do more. So why shouldn't they do more in medicine? If we tap into their ambition, perhaps we can spur them to achieve more, taking up research roles in the process.

What do you think are some skills which are crucial to a successful clinician scientist?

Firstly, clinician scientists need to be focused. They have to persevere in terms of asking an important question and looking at methods to find the answers. Secondly, formal training is a necessity. Many clinicians see research as a part time business. Given their status as doctors, they assume they should be able to do research. I will encourage serious clinician scientists to have a PhD. Without it, they will not be competitive. Thirdly, clinician scientists must love writing. If you struggle with writing a paper, you should seriously consider against being a clinician scientist. The idea of a paper being a "publish or perish" piece of work is still very true. Without the ability to write, you will face an extreme difficulty in communicating your work. Finally, a very good emotional quotient is necessary as clinician scientists have to collaborate with people. They need to understand the different needs of their collaborators and exchange ideas freely. Most importantly, they need to share the risks as well as the achievements, publications and glory when the time comes.

It seems that you have quite a lot of work to juggle. How important do you think a work-life balance is?

I do not profess that I have a good work-life balance. Someone previously told me that work-life balance is overrated and it is true. You have to love what you are doing. With that mind set, work in the work-life balance becomes a part of life. Even though you may be working, you will end up with an interesting and enjoyable journey. I think that is the way to look at it instead of separating them up.

Finally, what advice will you give to the youths of this generation who are interested in pursuing medical research?

Aim high and dream big. You do not get success by being tentative and cautious. Take risks and you will eventually be rewarded.