Career poll: if you weren't a doctor, what would you be?

Since beginning my clinical rotations as a medical student, I have been exposed to so many interesting, dynamic jobs within health care that I never knew existed such as Recreational Therapy, Occupational/Physical Therapy, Respiratory Therapy, Doula, Midwife, Lactation Consultant, Clinical Social Worker, the list goes on and on.

As someone who regularly follows MiM guest posts and who talks to many premedical students, I always find it interesting that exposure to other fields in medicine is so lacking. There are so many different ways to become a health care provider and though Doctors are among the highest in the hierarchy, without a diverse group of providers we not only fail to provide the best service to our patients, but we often fail to address core issues that determine health outcomes. 

With that said, for the physicians around:

• if you weren’t a doctor what medical professional would you be or would you choose a completely different field?

And for those in training:

• what other careers in medicine have you researched, considered, or shadowed in? What did you think?

My answers:

• If I hadn’t become a doctor, I would be a Recreational Therapist with a focus on alternative methods such as massage and reiki or a Doula/Health Coach/Life Coach/Interior Decorator
• Prior to my training, I didn’t really spend time shadowing Nurse Practitioners or Physician Assistants but should have. I will be entering academic community pediatrics in an urban setting and the overwhelming majority of my mentors and folks whose careers inspire me are Pediatricians. However, if I was interested in more community or rural medicine, pursuing a career as a  Nurse Practitioner or Physician Assistant would have been a possible alternate route to providing primary care with much less debt and better work-life balance.

In between promise and fatigue: here's to the end of residency

“Tell your heart that the fear of suffering is worse than the suffering itself. And that no heart has ever suffered when it goes in search of its dreams.”

“Before a dream is realized, the Soul of the World tests everything that was learned along the way.”

“Every search begins with beginner’s luck. And every search ends with the victor’s being severely tested.”

I can see the end of residency. My schedule is set. I know that June 23 is my last official day of my pediatric residency. I am standing on the edge: the edge of my time as a “trainee” and the beginning of my time as an Attending Pediatric Physician. As one of my closest mentors says, “Medicine is about delayed gratification,” and she is so right because I can feel the end of training, it’s palpable. It stands looming in the distance. I see the promise - the chance to continue to create the career that I have envisioned for so long. One committed to the underserved, adolescents, and new families. One committed to medical student education and helping to forge a path in medicine where the marginalized student feels less alone. One committed to enhancing trainees understanding of health literacy, compassionate care, holistic care. One committed to clinical excellence and rigor.

I can feel the promise of creating a career where I can share more of the child-rearing responsibility with my husband. We have had the chance this year to experience up to 2 consecutive months of me having a “regular” or non-Ward schedule and it has been amazing (family dinners, weekend outings, dates, sleeping in). My Attending friends tell me that this is how life can be post-residency and that I have to work hard to get a schedule that allows us to feel more like a regular family. Interviews have been going very well, but none has felt quite like “the one.” I can feel “the one” coming though and am giving myself until April to keep searching and networking.

But I can also feel my fatigue. It also stands looming and sometimes sneaks in for a jab or two. The tight pull of my neck as I continue to type into our electronic medical record. The beginnings of a tension headache as I work on licensing applications during Zo’s nap time. I can feel my strain and my friends’ strain as we begin conversations about our final residency rotations with “I am soo over this!” Invariably all of our texts, phone calls, and in person conversations include our “being over” being on call, covering in the wards, and Interns doing crazy things. Then we laugh and talk about how a friend who is a new Attending has told us something wonderful about his or her life.

As my Residency Director said, “You’re not supposed to love residency” because it’s not a permanent job, it’s just a big hulking stepping stone.

As I always do when I am straddling a new transition, I have begun to re-read selections of "The Alchemist." This book has been with me since the first time I read it in 2004 as a fourth year undergraduate awaiting medical school acceptances. This road has had its share of suffering. Times where I felt failure was imminent. I fought on. In spite of a few very low points, I have experienced joy beyond what I ever could have imagined. Providing excellent patient care, figuring out diagnoses, being hugged and hugging amazing families and assisting them during their lives’ lowest points. I have experienced the joy of getting married to an amazing man that I now call my own and together we welcomed to the world an outgoing, rambunctious little boy that amazes us every day. There isn't a day that we don't pause, smile or laugh out loud and shake our heads at his silliness and love for life.

As I stand on the edge of my most recent life’s transition, I foresee some suffering, some testing, and a whole lot of joy. While I welcome luck, I also know that I have been fortified by life’s challenges and know that you can experience fatigue and promise simultaneously and it still bring so much joy.

Here’s to the end of residency!!!

Quotes above are from Paulo Coehlo's "The Alchemist," 1993.

MiM Mail: Missing life before kids

I am a family doctor in southern Ontario but previously worked in remote northern Canada for 3 years. Up north, I worked in full-scope practice, including OB, ER, home visits, hospitalist, fly-in communities, medivacs and nursing station phone support. When I became pregnant, I could not have my job modified to have a healthy pregnancy. I was concerned about extremely bumpy boat rides to get to and from clinics, helicopter transfers, working in very cold environments, nearly being flooded, stray dog attacks, dust, bugs, and not having safe shower or tap water in certain fly-in communities. I had asked to not work nights but was told this was not an option due to lack of staffing.

Sadly, I left the community I had intended to stay in all my life. I moved near my extended family in southern Ontario. We bought a farm, and my husband stays at home with the baby and farms. We have the wonderful support of 4 grandparents. We now have a very happy toddler and another baby on the way in the summer.

Down here, I run my own clinic four days/week. I am doing walk-in clinics on the weekend. Although I enjoy it and have a very reasonable schedule, I am growing antsy to do more. I find that down here, even the simplest issues are referred to specialists. Compared to the north, people are not very sick when they see me. I enjoy being home with the baby, but only for a few days a week. I am happier working as a physician the rest of the time. I miss the action and adventure of northern medicine. I keep looking at job openings in the north and trying to figure out how this could work. What I always seem to conclude is what is best for me isn't best for my family.

The things that are keeping me from going back up north? Well, for one, I am 16 weeks pregnant. I plan to have two kids, so after this one, pregnancy won't be a limiting factor, but breastfeeding will. My husband doesn' t want to move north, as there are no farming options for him there. He has farm animals that require daily care, so even doing locums and bringing him with the kids isn't possible. I could go alone, but that would be very stressful on a baby and toddler.

Maybe I should just stay put and accept the current situation. I just feel like my skills are being lost for every year I don't use them. I would love to hear some advice or suggestions from others.

MiM Mail: Advice for non-traditional mom

Hello and thank you for your blog! I am wondering what advice you might give for a slightly older mom considering medicine after the baby-phase. My husband and I are both teachers at an international school and we are looking to transition to living back in the States near our families. I am considering applying for medical school for the fall of 2016 and have completed all the prereqs, taken the MCAT, and have all my letters of rec on file.

We have four children, ages 12, 10, 5, and 17 months. I would start medical school with my oldest beginning high school and my youngest being three years old. I am in my late thirties, and investing in a career in medicine would combine my pure love of science with a passion for extending the tremendous care-giving roles I have had over the years.

I have hesitated to go down this road because of the tremendous financial investment as well as the time required, but I have loved my various experiences in health care throughout my career up to this point. I would love any personal advice on whether this path is worth it!

Thanks,
Sara

I Don't Know How To Dress Myself

And I know I'm not the only one...

I was thrilled to see a physician-mom address this in the Atlantic: The Clothes Make The Doctor, by Anna Reisman. In this thoughtful and humorous piece, she describes how she met with a potential new primary care doc, and was put off by the sharp-dressed woman's stiletto heels and expensive suit. She then explores how physicians should ideally dress, and thus, present themselves.

She hit on a perennial topic of discussion and debate amongst my colleagues, both male and female. Male colleagues bemoan that they are expected to wear a collared dress shirt and tie, day in and day out. But female colleagues complain that they have no real "dress code", and thus, no guidance, on how to dress for patient care.

In my office, which is an all-female practice, the "work uniform" runs the gamut from: clean and pressed white coat over smart dress suits and heels, to dress suits and sensible shoes without the white coat, to business-casual with or without the white coat, and then, to me.

I'm usually in whatever Bargain Basement Clearance Store pants with less-dirty knit top and scuffed sensible shoes I can match when I get dressed in the dark at 5:30 a.m, with a reasonably clean white coat pulled over it all, like a disguise. I can't remember the last time I ironed anything; I think it stretches back a decade or more. I buy all permanent press or knit clothing. If something needs to be dry-cleaned, it's a once-a-year piece. Sweaters, slacks, scarves- they all must go into the washer and dryer, or be relegated forever to the back of the closet. This all is, I feel, most practical. Who has time to fuss over clothes?

I also LOVE a bargain. And while there are women who can browse Nordstrom Rack or Marshall's or TJ Maxx and put together respectable, even snazzy, professional outfits, I am not one of them.

Still, I can't let go of my old habits. In medical school, we had an informal group of women about the same size who met occasionally to "swap": everyone brought a bag of clothes they didn't want, all higher-quality stuff, and we had a party as we tried on each other's stuff. Everyone left with a "new" item, and the leftovers went to charity. If someone I knew suggested this today, I would so totally be there!

I even found my wedding dress, a 100% silk designer ball gown with an impressive train, for $250.00 at the Filene's Basement Run Of The Brides Traveling Sale, back in 2008. I considered it the find of the century, a total coup, and I told anyone who seemed like they cared how much I had spent.

I still have had no qualms with rooting through school fundraising secondhand clothing sales, and leaving with large bags of the clothes of people who are probably my neighbors.

I think some of my reticence on spending money on clothes stems from the fact that I've gone up and down ten sizes within the last five years. Yes, there were two pregnancies in there, but the ballooning waistline was not due to gravidity. It was due to the fact that I gained an unbelievable amount of weight with each pregnancy, on the order of sixty pounds, EACH TIME. Three months after my second baby, my daughter, was born, I realized that I had even GAINED weight while breastfeeding. My BMI was over 30. I was OBESE.

Then, with a two-year-long concerted effort at a low-carb diet and exercise when I could get it in, I lost fifty pounds. Babygirl is now almost three years old, and I've kept the weight off for almost a year.

Despite being back to my pre-pregnancy weight and size for this long, my closet is still filled with a mishmosh of sizes, and alot of "more comfortable" pieces, like Ponte slacks (read: knit pants). A friend and colleague recently pointed out to me, in a humorous way, that Ponte slacks are in the same category as yoga pants. Meaning, not acceptable work attire.

Unfortunately, in order to dress well, one needs two things: Time, and Style sense.

I know I will never have the time or inclination to study fashion magazines or follow style blogs. And for some reason, when I see someone who I think is dressed really well, meaning, how I'd LIKE to dress, I can't seem to replicate their look (probably because of my clothing care learning disability.)

But, I still want to look like a real, respectable, clean, practical yet SOMEWHAT stylish physician. Someone who is aware that it's almost 2015, but who is also willing to kneel down on the exam room floor to look at a patient's diabetic foot ulcer.

I know, I know. Time to grow up, learn how to iron, make the dry cleaners a regular weekly errand.

I also need a personal shopper. I have seen this mentioned on prior MiM posts (that I cannot locate right now), and people have suggested Macy's, as they offer those services free of charge. Of course, to take advantage of that requires several things: Making an appointment, taking some time, and investing in attire.

Sigh. With two children under age five, a working husband who travels alot, and boards study on the agenda every day, these things are not likely to happen anytime soon.

Tomorrow will dawn, and I will likely be pulling on a wool blend turtleneck, my black slacks with a little elastic in the waist, and Danskos.

But I will be comfy...

-Genmedmom

MiM Mail: Anesthesiology or psychiatry?

Hi everyone!

As many others have shared, MiM has been such a valuable resource to me since embarking on the path to a career in medicine. Now, I have a more direct question for you all. I have been considering specialties, and while I still have plenty of time to decide, the pressure to make arrangements for research this summer and beyond is weighing on me, especially because I'm interested in two very different fields for obviously different reasons: anesthesiology and psychiatry. 

Anyway, some background first… I am a first year medical student and my partner is a fourth year, currently interviewing for residency. He is pursuing ENT and has mentioned interest in the possibility of pursuing a head and neck fellowship eventually… We have no children yet but starting a family is a huge priority and we both envision a timeline within the next 5 years (i.e., during medical school or residency for me). 

Because family life is extremely important to both of us, and it’s already becoming clear to me that his field will be a lot less flexible in this regard, I’m seeking any advice on deciding between the two specialties above. I know that balancing family life in a two-physician family is going to be extremely difficult regardless and so I am willing to make some career decisions to account for that. It seems that both anesthesiology and psychiatry can make for good lifestyles eventually (though with drastically different levels of compensation) but is there more I should know? Are the residencies drastically different? Is the difference in salaries going to be too stark if pursuing manageable hours (or even “part time”)? I know both can be flexible, but are those lower hour positions more realistic in one field? Anything else I’m missing?

I should also note that because we’re both from, and hope to remain in, a relatively undesirable area near what is considered a highly underserved area, I would seriously consider the NHSC scholarship if I chose to pursue psychiatry. I could also earn an MPH in one year at no cost through my medical school’s MD-MPH program which is something I have also considered (my pre-medical school studies were based in the social sciences).

Thanks so much!

T

MiM Mail: Middle of career life crisis

I feel like I am in the middle of a career-life-crisis.

I am a mother to an almost-3-year-old, and a 9 month old. I am an OB/Gyn. And, I love being both.

After residency, I joined a large private practice. Even after I had my son, I was fairly happy with my schedule. I worked about 3 1/2 days a week in the office, one day on call per week, and one weekend on call per month. But, I thought it was a pretty good life for an OB-Gyn. I sometimes missed holidays, wedding anniversaries, and important family events, but realized that those things came with the territory. After all, babies don't take holidays from coming into this world.

About two years ago, we moved to our home state to be closer to family. In doing so, I changed career paths. I now work as an OB hospitalist, doing about seven 24-hour shifts per month. It's a different role than I ever thought I would have. I see patients in the hospital that have no physician and take care of OB emergencies when their on call physician cannot make it to the hospital in time. In short, I still get to deliver babies and help women in emergent obstetrical issues, which is very rewarding. And, I get to have a lot of time with my children. Now, for example, when we sign up for a 2 week swimming class, I only miss a couple classes, whereas before, I would have only made it to one class. I get to go to the park, the zoo, the mall carousel, and all the daily little things that a lot of mothers in medicine have to miss out on.

I feel guilty even saying this, but when I first transitioned to this job, I definitely had to adjust to being at home so much. I felt guilty at times, because there were definitely moments when I (and my son, for that matter) felt bored. I would call my sisters and ask what they do each day with their kids. But, now, we have gotten into our groove. We have play dates, learning activities, favorite fun spots, and of course, naptime. So, before I know it, the day has passed and we are on to the next. And, just when motherhood starts wearing me out, it is time for me to go to work the next day. And, actually, it is a nice break to get away and have some career time. My 3 year old son asks every morning if I am a doctor or a mom. With this job, most days I spend "being a mom", and only some days do I spend "being a doctor".

So, what's the problem? One of the reasons I went into OB/Gyn was the hospital-office balance. I loved forming long-lasting relationships with patients that continued throughout life stages, multiple pregnancies, and through difficult diagnoses. There is something about delivering someone's baby that bonds you to them. You become important to them. It almost feels like you should be invited to sit at their table for Thanksgiving dinner. And, now, I don't have that relationship. So, I keep looking at job opportunities and wondering if I should return to private practice so that I can have relationships with my patients like I had before. The thing is, that if I make that career jump back to traditional OB/Gyn private practice, I will be giving up a lot of time that I have with my kids. So, I worry that I would end up in a "grass is not always greener" situation. I'm not as familiar with the business aspects of medicine, but to the best of my knowledge, it is difficult to keep a practice afloat (paying overhead, salaries, benefits, malpractice) in the OB/Gyn world and work only part time, so full-time it would be.

I know you guys can't decide my future. The truth is, that getting it all in writing is actually helping me process it all. But, any advice would be nice. Is it possible to have a part-time OB/Gyn practice? Should I just count myself blessed that I get so much time with my kids, even though my particular position as an OB/Gyn is not quite as fulfilling as it once was? How do I not feel guilty thinking all these thoughts?

Sincerely,
Confused mommy doc

Journal Club: Women in academic medicine

In March, the Annals of Internal Medicine published a study by Jolly and colleagues  demonstrating that women in academic medicine -- those holding K grants, or career development awards -- do more domestic work than do their male counterparts. There are a lot of reasons: more women had working spouses than did men in the same position, but that didn't explain the whole difference. The article itself is quite interesting, but the editorial that went with it (accessible by same link) -- written by two women in senior academic roles -- was what really got my attention. They suggest that the differences are really a matter of choice, and that disparities are not as disturbing as the study authors suggest.

They ask: "...is the fact that talented women may choose to shift a few hours from research to their family roles until the youngest child is in high school a threat to academic medicine? We certainly do not think so."

I think the perspective of these very successful editorialists is one of hindsight rather than foresight: we made it work, in traditional or non-traditional ways, and so why are you so worried about a few hours here and there? The answer is that we won't have the jobs we love if we can't make it by the standard criteria -- these being acquisition of grant funding, publishing papers, and providing patient care. I certainly appreciate, and have taken advantage of, the flexibilities of my research time -- but flexibility is an illusory concept. The hour I spend (or that my husband spends -- I think this equally applicable to both genders in many ways) taking the kids to school or getting home earlier is at some price, either in late nights or in projects unfulfilled.

You can see my response, written with two colleagues in similar positions (we are all women with K grants, patient care responsibilities, and families, trying to make it in academia) with the original article.

What is fascinating to me about the dialogue that goes on in these letters is the span of decades of women's perspectives that are included among the letter writers. This is a pesky problem and it won't go away soon.

Dena

Birthday Call: from zero to 60 and then somewhere in the middle in mere hours

40 minutes into my commute to work, I had a pseudo-melt down. As I sang “Happy Birthday” over the phone to my three-year-old, I lost it. I realized that I hadn’t kissed him on his birthday, I’d forgotten my lunch and during a 28 hour call the cafeteria food begins to make me nauseous, and that I was exceedingly anxious about all of the changes our lives will encounter over the next few months.

Needless to say, I’m in the call room after a deluge of discharges, awaiting our next transfer, feeling the urge to write and release this tension.

My Little Zo is three today. Three years ago, on this day, I birthed a fabulous little human being into the world. He’s helped me grow in countless ways. I’ve learned to let go. I’ve learned to give my all in the moment and then pass things off to someone else (to hubby O, to my parents/in-laws, to the wonderful ladies at daycare, to his Pediatrician). I’ve learned that keeping your own kid alive and occupied means breaking lots of rules (my infant slept on his belly after weeks of sleepless nights, my 2 year old ate yogurt and spinach smoothies or oatmeal for dinner on picky-eating nights) and that I am so much more capable than I ever thought imaginable. I’ve realized what’s important (playing legos and dinosaurs before bedtime and leaving my notes until he’s gone to bed, sleep, couple time, giving my all at work and not worrying about my child since he’s taken care of at all times).

In less than a year, I’ll be an Attending and yet another goal will have been achieved. I have had a few successful telephone interviews and I have my first in-person interview in October with a community health system affiliated with my medical school. This morning when I was sobbing, a great friend, KJ, who is now a Pediatrician in private practice gave me her pep-talk. We have these at least once every few months. She tells me about all of the little and big victories she has in her life after residency. She has weekends off and time to be with her boyfriend and her dog. She tells me about her quirky colleagues and her amazing patients. She tells me how different things will be in a few short months.

So, on Little Zo’s third birthday, I went from zero (dragging myself out of bed after an exhausting month on inpatient service during asthma season), to 60 (sobbing in the Starbucks parking lot), to somewhere in the middle. I am thankful for three years of motherhood. Thankful that Zo is vibrant, healthy, active, super-smart, and super-sweet (when he’s not biting or hitting). Thankful for only 3 more days on inpatient service before 2 months of elective and that I've been able to do great work this month and keep folks' babies alive and healthy! Thankful for friends like KJ who understand the struggles of residency-based medical practice. Sad that I wasn’t at home snuggling Zo and our visiting family members. And hopeful of life after residency.

Happy birthday to my little roaring dinosaur - Mommy loves you!

Say What?!? Time to find a job!

It’s that time of the year. Career preparation time. I am applying for community pediatric jobs in the D-M-V (Washington DC-Virginia-Maryland) area and it feels surreal. Medical school in the area was extremely enjoyable and our family hopes to return and lay some roots (is it weird to really want to be on House Hunters?!?).

What didn’t happen:
- I didn’t get Chief Resident. I was pretty bummed out for several weeks, but I think it’s for the best. My mentors reminded me that I pretty much have all of the skills I would have been able to obtain (leadership, administrative) and if I am totally honest with myself acting as an Inpatient Attending for several weeks and crazy hours is not my cup-of-tea! I’m all about outpatient medicine and am ready to have regular hours, my own patients, and more time with my family. No pseudo-residency-with- poor pay increase for me.

What has happened:
- started talking to my Academic Advisors about my interests in community pediatrics
- had a few outstanding people offer to serve as references (Clinic Director, Chair of our Peds Heme-Onc Department, Mentor, etc . . .)
- written and revised my cover letter
- written and revised my Curriculum Vitae (CV)
- gotten considerable feedback from my Clinic Director, Academic Advisor, family and friends including an amazing sorority sister who's a Lawyer who cut my cover letter up so much that I basically rewrote it and it's soo much better
- started regularly visiting the PracticeLink and Pedsjobs websites
- registered for the AAP National Conference in San Diego in October

What I still have to do:
- finish reading “Lean In” (loving this book, so enlightening and inspiring. I’m all about leaning in!)
- send out my cover letter and CV to personal contacts in the area letting them know I’m ready to “discuss employment opportunities” (loving the sound of that)
- actually find some jobs to apply to
- go to the AAP Conference’s career fair and professional development sessions and dazzle some program/practice reps and learn about interviewing and contracts
- finish the last 11 months of residency
- start work as a Pediatric Attending Physician (woo-hoo!)

Alright practicing physicians - any suggestions? Anything you see missing in my list above? In applying for jobs after Residency what mistakes did you make? What do you wish you’d done differently?

Guest post: Making a career shift to leadership

A few months ago, when I was contemplating a shift in direction in my career, I happened to google 'women leaders in medicine'. Among the websites and blogs that google search generated was 'womenmdresources', and through that, the 'mothersinmedicine' website. Reading through current and old posts was like finding a community of friends I had not known existed. In fact, one of the first blogs I read was from 'anesthesioboist' and the post was about her experience with her child having surgery at Boston children's where she had been a resident. I found myself smiling as I recalled a very similar experience at the very same hospital some years ago with my son needing surgery for a fracture while I was a resident there! It made me feel connected to this entire community out there of women in medicine, especially the unique community of mothers in medicine.

Fast forward a few months, I have made the career shift, which involved going from being a staff anesthesiologist at a small community hospital to being the chief of my department at another small community hospital. It required a lot of thought on my part and discussions with my husband to go after this opportunity especially with one child being almost ready to go off to college in another year and another entering the tween diva stage. Did I want to take on this challenge at this juncture of my career (and challenge I knew it would be) especially with my husband's job needing him to be traveling for most part of the week? It would have been so much easier to stay where I was and go to work and come back home and not have to deal with all the issues involved with taking over the running of a department.

10 years ago, when I was finishing my residency with 2 young kids, if I had had a crystal ball, I would never have seen myself in a leadership position down the road. I thought I would be content with a staff position in a small department, enjoying my work, but leaving it at the hospital when I left in the evening and focusing on my kids and family. And that's what I did. However, few twists and turns in the last few years changed my direction and I feel now, for the better.

I had had some experience with the running of a group without the title of chief in a previous job so I knew the trials and tribulations it would involve.

Ultimately, we decided I could not pass up on this opportunity. That previous experience had whetted my appetite to be in a position to be able to make some changes, to problem solve. I had found it very satisfying when I was able to make some changes to make processes run smoother than they had.

And so here I am, 2 weeks into this new role. It has been a challenging couple of weeks. And I find myself looking forward to more.

-Anesthesia Mom

Do you have 5 year plan?

When asked this recently, I fumbled.  Actually, I tossed back the answer, asking the asker to mentor me through getting such a plan.  It wasn’t even someone who knew me well and it had been asked in a fairly casual way.  Regardless, I was not able to answer the question.  But if I were to answer it, the answer would be, “No I do not.”

I feel like my personal plan is on track, I have some goals which essentially these include some family fun and fitness.  But in the professional arena, I don’t have a 5 year plan like others do.  Do others have a 5 year plan? 

I have quite an accurate 5 day plan.  My calendar is reasonably organized.  I'm a list writer, whether on paper or on a smartphone (actually, both) and an avid list crosser-offer.  Sometimes I'm tempted to add things just so I can cross them off again once completed.

Flash back 5 years ago, I don’t think I actually had a career plan to get to where I am now, though I am where I want to be.  I was "finished" with the relatively more well-defined years of college, med school, residency, public health school, educator-leadership program, (can you say "perpetual trainee" or more generously "life long learner"?).  Career-wise, I think that mostly things have come to me through plenty of hard work, but admittedly with some luck, good timing, and strong collaborations.  Now I’m trying to think about what will come next.  Not that I’m at a mid-life crisis per se, but just that if I try to map out what’s coming up, what should happen, what I’d like to do or explore professionally, I’m just not sure.  I feel like I can (and do) help others along with theirs, but not sure of my own at this point.  In academia there are peaks, valleys, plateaus and mountains to climb.  I am hoping I can find the right trail.  The journey is still interesting, made more interesting by taking part in mentoring others, even as I continue to pave my own way.  I have a vision of what I might want to do but I'm not sure how to get there or if it's feasible.  I continue trekking onward. 

Do you tend to let things happen and see what unfolds along the way, or do you have a plan?

the world's longest adolescence

I've been undergoing more frequent bouts of financial incontinence of late. I bought five sweaters in a recent end-of-season sale and a side table from Serena and Lily that is made of carved wooden swans. My husband describes this purchase as the Most Ridiculous Thing We Own. 

I can feel the end is in sight. I am almost done with my training, after which I will be making several times more money than I ever have before.  

Saturday morning I went to a financial planning seminar for graduating medical residents and fellows. After a brief introduction, the speaker guided us through a program he had developed specifically for medical trainees to calculate exactly what income was required to develop and maintain the life we projected to lead with our future salaries. 

I don't know what my salary is going to be next year. I am looking at positions that vary over $130,000 between them, adjusted for part time vs. full time, and private vs academic. So I entered a figure somewhere in the middle. It's even more difficult to project my husband salary as he owns his own company with a salary that varies month to month. He's gone months without a salary at all, which I've always thought taught us to live beneath our means. 

Beneath our means, but perhaps not beneath our expectations. 

It took about 90 minutes to complete the program.  There were a few numbers I didn't know how to estimate - like the expected rate of inflation and expected rate of return on our investments. There were some shocks along the way - the projected cost of a 4 year state education for my 1 year old son is $360,000 if tuition costs continue to climb. I entered the tuition cost for two kids at the most expensive elementary and high schools in the city, the cost for two weddings, and my medical school debt. I figured in the cost for a standard 3 bed, 3 bath house in our community with a 20% down payment. The program included costs I hadn't thought of before, like the cost of an accountant, orthodontia x 2, and home owners' insurance. It calculated the estimated yearly expenditure of feeding and clothing two kids. I felt pleased to enter the amount we've manage to save in retirement and savings accounts. 

I got to the end.

-$118,455

OMG. 

That's the amount of yearly income we lack in order to meet what I thought were fairly modest goals. 

I've heard medical training as the world's longest adolescence. I've never felt it to be as true as I do now, starting down the last few months of my training and still uncertain of what I am going to do next year. 

After a collective gasp, our speaker smiled and admitted to a slight "glitch" in his program - while the program took into account the rate of inflation, it did not adjust the physician salary for that rate of inflation. In other words, the cost of every itemized expense would go up, but our purchasing power would go down with time. 

That didn't seem right. Of course my salary would go up, perhaps to cover the gap between the estimated salary and the projected cost of our lifestyle. And then he made what I think was the most striking point of the presentation. The partners he left in private practice anesthesia in 1993 are making the same salary now as they were 20 years ago. 

OMG x 2. 

It is unlikely that physician salaries are going to go down, but it is highly likely that, with the restructuring in health care underway, salaries won't go up with inflation. I've heard that said before but didn't think too much of it. Now seeing a dollar amount placed on what had seemed like conjecture has given me pause. And in that pause seeped a now recurring frustration. 

How is it that I started med school a few short weeks of my 22nd birthday, I will graduate when I am 33 and I still can't decide what I want to do next year? What is in the best interest of myself, my family, and the longevity of this career I've been working for since I was 21? 

During my ongoing job hunt, I received the unwelcome advice to "not make any decisions based on money alone", which does seem like sound advice and in keeping with the best interest of my young kids, who would benefit from a mother who is around more, and my career should I decide on an academic path over the more lucrative private route. But in that room I started to re-appraise the relative benefit of the options ahead of me. If I work part time in academics, does that mean my kids don't go to college?

The exercise served to broaden what had been a frustration specific to not knowing myself to include the more generalized frustration that I don't know anything. 

And it put to rest any lingering consideration I'd had on the idea of a third child. 

Should I go to medical school?

I have gotten several emails though my blog, some from people who found me through Mothers in Medicine, asking me for advice. I am so touched that people reach out to me. I used to answer these emails individually. I have not answered the last handful, for many reasons.

Most of all, these reasons are personal. Intern year is much different than fourth year as a medical student. I have had a lot more demands on my sleep schedule, my time, my emotions, and my responsibility. I haven't been blogging much in general.

I also did not match last year, and have spent most of this year questioning my dreams. I don't want to rain on anyone's parade with some sort of bitter reply. Which, I wouldn't necessary give, but I have to be honest in my answer. Being a single mother in medical school and residency isn't a piece of cake. But, being a single parent in this world isn't a piece of cake, either, and being a medical student and / or resident isn't a piece of cake. Foregoing medical school isn't necessarily the answer to any of that.

Here is some general advice I will share with parents, single or otherwise, who are facing decisions about medical school and residency. These answers cover a mishmash of frequently asked questions that come up in comments and emails. I looked it over, and I use the qualifier "very" a lot. I usually avoid that word, thanks to my father's influence. He told me to edit by replacing every "very" with "damn", and then to edit out the profanity. I have left them in, because this topic is very damn very challenging.

For single parents or parents whose partner will not be available for child care:

You will need to have a very, very flexible, very solid support system. For clinical years and residency, you will be expected to change what time you come and go on a moment's notice. The rotation you are on most likely will change every four to six weeks, and the demands, time wise, may change day to day on certain rotations. These hours can be as early as 5 am or even earlier, and you can be expected to stay way past midnight, even all night. Some of these times you can plan for, and some you can't. Living near family is very, very important for those of us who can arrange for that. It definitely can be done without family, but please keep in mind the expense and issues with screening and turnover of caregivers.

For people who are facing custody issues, possibly moving for residency, lack of familial support in their particular area:

I feel for you. Coparenting arrangements are very, very difficult. Depending on a lot of factors, you may need to be willing to move for residency, especially for certain specialties or even for some of your rotations. This may involve moving to a place your ex doesn't want you to move to, or moving to a place away from familial and / or social support. The judge may not look to kindly upon you leaving town with a child or children to a place where you know no one and will be working 80 hours a week, including nights, no matter how much you love your kids and parent well. And, there is a reason for that. Is it doable? Yes. Is it a good idea? Depends. Keep this in mind before embarking on medical school. This is one reason I wish I had done ARNP midwifery instead of medical school, occasionally. I wouldn't have to do the match for obstetrics residency. I had reasons not to go the nursing route then, and those are still valid.

For people trying to decide between nurse practitioner, midwifery, physician, and other avenues of the medical profession:

I really stumbled into medicine without a full understanding of how involved the process was, when it came to board exams, residency match, etc. I am still not fully informed on what it takes to be most of the other options available. Please research the nitty gritty, and you will still be surprised by the reality of how the sausage is made. I found studentdoctor.net. With all of its problems (and there are MANY), it is a decent place to find out practical details of many steps of medical school, from pre-med through fellowship and beyond, if you can fish through the trolling, bragging and nonsense.

As for whether or not you can handle it...sigh. I think we can all handle a lot. I think there are times at work, even at 4 am, in which I am exhilarated, and so happy that I chose my path. There are times when I am with my kids that are quality times, and everything seems to work out. There are times in which I feel completely overwhelmed, where I cry at work, and then cry at home because these kids who I wanted to desperately to spend time with when I was stuck at the hospital are bickering with me and with each other, and all I want to do is send everyone to their rooms. No matter what happens this March when I find out if I match in obstetrics or family practice, I will be happy as a physician. I will also have regrets. I think this will apply to anyone, no matter where their choices lead them.

For people who are older:

I was not the oldest person in my medical school. I am not the oldest person in my residency program. I think it is more of an issue with your peers than with your professors and attending physicians, who may be your age. They don't think they are less skilled, and may identify with you more readily than they do younger students. Some people may say it's a waste of investment of a medical school spot or residency spot that a younger person who would give more back deserves more. People say this about women in medicine, too, and that we want to go pop out babies and work part time when we are done with training. All these people can, um, stuff it.

For people who have a history in the "natural" birth community, i.e. doula, midwife, or are just crunchy types looking into medical school:

There is definitely room for us in all aspects of the medical community. I was pleasantly surprised by the diversity in my medical school and in the medical community. One of the first events I participated in for medical school was a social event at a bar, and one of my classmates, a massage therapist, was a few sheets to the wind and offering to balance my classmates' chakras in a wobbly kind of way. I sat next to a grandmother who caught her own grandchild at a home birth all of my second year.

However, medical school is long. Residency is long. It is a grueling, intensive slog. Make sure you are doing it to become a physician. If you want to be a doula, be a doula. I will not be a doula or a lay midwife if I am an obstetrician, or even if I am a family practitioner. It is not worth the effort to go through all the extra training, and the infrastructure is very inflexible and unforgiving. You potentially will be choosing battles constantly, and need to know your place as a matter of respect and experience and survival. Does that mean always stuffing it?  No. But, it means often stuffing it.


If there's anything I missed, please add it in the comments.

MiM Mailbag: Should I stay or should I go?

For my entire life I knew I always wanted to be a doctor, that was never a question.  At the age of 5, I declared I wanted to be a pediatrician, when the bossy know-it-all older sister of mine demanded I have a career in mind.  Since that time, I have had many experiences, working in a veterinary, dental and "human" hospital setting and ultimately chose medicine as my career.  I was a straight-through kind of girl.  College, med-school, residency, boom, boom, boom.  That being said, I always had someone telling what, when, are where, that is, until 4th year.

I finally had the chance to choose what I wanted, where, I wanted, etc and I found it totally overwhelming.  Before medical school, in college, I spent a lot of time in OR's and doing clinical research.  I was for sure I was going to be a surgeon.  Within the first month of medical school, I had an OB shadowing experience and fell in love.  Since that point, I continued clinical research in OB and had a fascination with the pathology, physiology, and academic side of OB.  I did my surgical rotation 3rd year and hated it- except peds surgery which I thought was amazing.  I then did OB, enjoyed the surgery part, but was less than charmed by the OB lifestyle, attendings' attitudes, and inherent "risks."  I then did peds, loved the patients and parents, especially low risk, "pleasant" growth and development outpatient issues, but truly disliked inpatient and the "medicine" behind peds. 

Then began the indecisiveness, peds ob peds ob, I weighed it back and forth a million times, ultimately deciding I would miss the children in my life too much not to do peds and regret the "lifestyle" of OBGYN and malpractice of surgery and deliveries if I chose OB. I didn't even know if I liked surgery, given that as a medical student we were lucky if we even got to gown and scrub much less try our hand on the instruments.  Like many others, I was told, "If there is anything else you like, don't pick this."  So, there was something else I liked, and I didn't pick OB.  I thought, "How will this choice affect my future life and family?" 

I am now an intern at a top program, I got my first choice, interviewed everywhere I applied, and even got married and graduated medical school. With each "celebratory" experience I had this sinking feeling that I had sold myself short.  That I chose what I "thought" would be better.  Chose what would be a "rosier life" where everyone looked happy and ate dinner with their children at night.  But deep down as much as I tried to convince myself that I was happy, I was never really "sold" on academic  pediatrics.  Do I love reading peds articles and treatments? NO.  Did I feel sad when I unsubscribed from the ACOG listserve because it was like a slap in the face each month when I got their mailings? YES.

So here I am, August of my intern year thinking, OH GOD, what did I do?  I did inpatient for a month, NOT a good fit.  I am doing ER now and like the pace, but cannot see myself in that ADD environment for my life, and I only like the quick, "This is a cold you will be fine," not the trached, g-tubed chronic kids because frankly, they break my heart.  I just cannot get the gusto to pick up a peds journal and read the stuff, I have no interest in antibiotic choice for pneumonia, differentiating between nephritic and nephrotic syndrome on a CMP or UA.  I just don't think I love pediatric medicine, but it makes me sad to think of leaving the patients, happy attendings, and lifestyle behind. 

My husband and I laid out a beautiful plan: work hard for a year or max 2 in residency then have a baby and finish in three quick years, BUY a house and become real people with 2 real salaries and get rid of the med school debt.  I want this plan.  I like this plan, the banker and the happy, smiley little pediatrician wife.  The only problem is, I am not sure I can be that person,  Looking toward the next 2.8 years of residency looks like a long lonely road- 3+ months in a chronic care facility, LOTS of months on the floor for heme onc, neurology, and chronic GI patients.  I want to like it, and there are some things I do like, but I am not sure I can fall in love with the medicine, more with the idea of it all.

I have felt a strong calling to switch to OB but every time I get close to doing it, I back away and convince myself not to.  But am I crazy to leave peds at a top program for a specialty I am not sure is right?  It seems so shiny and exciting but is it?  Will I feel better or think, oh no, why did I leave peds?  Is it work the risk?  Should I just stick it out, finish peds, then do a second residency if I really feel that I need/want to?  Is a second residency even a feasible option? 

I don't like being the girl who cries all the time with a charmed life, being tormented by the coulda shoulda woulda bug.  But I don't want to be the mom who wakes up in 10 years thinking "why did I switch?"  or better yet "why didn't I?"  I don't want to be the ONLY unhappy pediatrician anyone ever met because I was wishing I was something else.  

Now, in the midst of intern year, I am trying to sort out- do I hate pediatric floor medicine and is that why I didn't like my first month?  Was it just bad chemistry with my seniors and that made everyone unhappy? Do I hate pediatric medicine but like the patients? Should I give it the old college try and stick out a whole year before I make a hasty decision and switch because once I apply to switch, I am locked into that and out of this?

What is hardest for me in making this decision as that I love the children and the families. I love making them smile, laugh, and feel well.  I love reassuring the parents, and it breaks my heart thinking of leaving them now.  Truly breaks my heart. But academically it is just not there for me.  I want to be that person, but I am concerned that I cannot get up enough interest to learn it all. Are most days in gen peds outpatient clinic happy and well or are they chronic, and labs test follow-up kind of stuff?  Are the NP/s and PA's taking all of the pleasant easy patients away?

I am scared to switch and the uncertainty it brings.  What if I don't like the OR?  What if I have terrible hand eye coordination.  What if I am scared and don't actually like the OB setting?  I have heard that pediatric gynecology exists, but how many of these are sweet chubby babies and how many irresponsible teens?

If I leave peds, that will delay everything, life, children, etc.

I stand in limbo- should I stay or should I go?
 

Can Women Have It All? Depends On How You Define All.

I just finished the just profoundly awesome article Why Women Still Can't Have It All by Anne-Marie Slaughter, in this month's Atlantic. This is the article that has all the buzz going about professional women and work/life balance.

It has taken me a full week to finish this article, reading in bits and snatches before work, between patients and after work. I finally got through all 6 pages. Totally worth it. She says what I have been feeling and trying to voice to the women coming up the ranks of training in medicine.

Though I disagree with one fundamental point. She feels that most women can't Have It All, and by All seems she means breaking into the higher echelons of their professions, making the highest possible achievements. I agree with her on this.

My feeling is that All can mean something else. All, to me, means achieving total personal and professional fulfillment. And this does not have to mean being the CEO/ Secretary of State/ Department Chair/ Nobel Prizewinner.
When I am asked advice by pre-meds or medical students considering a career path, I hedge my response based on their answer to my questions-- "Do you have or want to have a family? And do you want to spend time with them?"

There are few professions that require as much schooling as medicine. It took a long time for women to get into those schools, to break into the profession. Women now comprise 50% or more of the students entering medical schools. However, we still don't see many women in positions of power in medicine or in certain subspecialties. While women in medicine has been a long time coming, women in power positions in medicine, and women  in certain subspecialties, may be a long time coming yet. The basic reason? The paths to those positions mean too great a sacrifice at the expense of a family.

I wish I could say to any of these incredibly bright, hardworking, determined women that "Hey, with enough brains and hard work and determination you go anywhere in medicine!" But that's bull, and Anne-Marie Slaughter says so in the pages of the Atlantic.

But they can have it All.

If All means achieving personal and professional fulfillment, of finding that elusive work/ home balance, then I'd say, it's entirely possible, but think it through very carefully. Look to the future- Look to the women who are working and practicing doing what you want to do. What kinds of positions are available? Is anyone working part-time? Are family values promoted and respected? Would you be expected to be at work and working endless hours? Is there a lot of call? Would you need to go into the hospital unexpectedly? Etc etc.

If women have or envision having a family someday, I ask them to think really hard about the kind of life they imagine. What kind of a partner do they or will they have-- is this someone who can stay home when the baby is sick/ it's a snow day/ there's an unexpected holiday/ they are sick? What kind of partner and mother do they want to be-- do they want to be present, participating, reassuring, enjoying family dinner, tucking in? If so, can that vision fit with the lifestyle of the specialty they're considering?

When I was interviewing for jobs four years ago, I had just come out of a research fellowship, and I knew that life wasn't for me. Very competitive, getting those grants. I also saw women MDs who aspired to be Heads of Something, or Experts in Something Else, and I knew I didn't want to do that either. I knew I wanted to focus on family as my priority, and to work part-time at a clinical practice with a good "vibe": supportive, flexible, mom- friendly.

I had to really search. I hired a professional job headhunter guy. He kept sending me listings. Some places wanted me to work 10 clinical sessions a week! Others had 1 week of call a month. Ugh.

Now, I'm a part-time internist, with two little kids. I was lucky to have found work in a small, progressive practice, 5 sessions a week, with 1 week of call every 3 months. The vibe? Well, just this morning, I met with my practice head and explained our situation:

Our two-year-old isn't talking. He's been diagnosed with severe delays in receptive and expressive communication, as well as some cognitive delay. He's eligible for all kinds of services. We'll be taking him to speech therapy and group therapy at least... and before that, he needs hearing testing, a developmental eval, etc. We'd also like to get him into some other activities to help him start communicating. This will all take some time, and time involves rearranging my work schedule. Like, dropping my Friday afternoon clinic.

My boss was great. There was no issue here. The support was 100% there.

All, to me, is where I am. Yes, I had to search this place out. Yes, there is tweaking here and there. I'll be glad for a promotion and a raise when it comes. I'll be glad for some adjustments to my schedule; a decrease in clinical time and an increase in admin time. Work sometimes edges into home, and home into work; I think that is natural and inevitable. But I consider all of that to be fine-tuning of an otherwise really excellent arrangement.

Can All be as easily achieved in all the areas of medicine? I don't think so, not yet. So my advice to those making their way up the ranks is to think about what will bring you personal and professional fulfillment, and to work towards a healthy work/ home life balance.

It may be that practice arrangements like mine in medicine are few and far between, but I see them popping up here and there in primary care. Where they are not, then shift work, as in Emergency or Hospitalist work, may be far more inviting to the aspiring physician-mother.

But maybe someone is driven to be the Head of a Department or the Expert in Something, and they feel they will not be happy or fulfilled until they have made the achievement; AND they want to have a family.... In that case, I think the choice of a partner, living close to extended family, and a very organized schedule could help... Personally, I don't believe that these external professional achievements give one true life satisfaction. I think many of us start off thinking they do, and hope they do, but then realize, they don't. Family does.

My way of seeing this: I was trained to do a hard job that I loved. I also wanted to have a strong, healthy family. So for me, I chose carefully. Now, I am doing the job I trained to do and that I love, I do it well, in a great hospital and positive environment. I also spend alot of quality time with my two little kids and my husband and my extended family. "Alot" to me is what I need. I get the time I need with my family.

So I feel very lucky. I have it All. I think we all can, even in medicine, but it takes looking to the future, thinking hard, being honest, and choosing carefully.

Guest Post: A comment from a daughter

This was left in our comments section. We think it is worth sharing.


Being the 18-year-old daughter of an OB-GYN about to leave for college...I want to tell you all something, and I hope that it will mean something to you. Whether you forget it, remember it, hate it so much that you yell at me in comments afterward, or love it so much that you post it on your refrigerator, I think it just needs to be said. I am terribly sorry for intruding on this site, and I do not remember even exactly how I found it. Still, I am glad that I did for the sake of this message. I only wish I could post it on the main page, however intrusive that may be, and that you all might understand the message even if I don't articulate very well (and I know I often do not when I try to sort through my thoughts). The OB-GYN in my family is my dad...but I think that it has less to do with which parent is the doctor in the family and more to do with how much we, the children, can't help but love our parents.

My dad was the head of the department at a hospital down here for 7 years. He worked even more then than now. He had wanted kids for years but waited because my mom wanted to work on her career a little more and settle (she was a bit wild and decided to quit her job [special ed teacher] after my older brother [1st baby] was born.)

Growing up, I don't remember much time with him. ...but I remember that we'd lovingly pack up a little of everything we had for dinner and put it on a plate, cover it in plastic wrap, and only then would we serve ourselves the food, so that he could "share" dinner with us, even though some nights he wouldn't be home until long after we were sleeping.

I remember him forgoing eating that dinner we saved some nights--no matter how hungry he was after being held late, or even if he only got there by rushing home for a short stop while he was on-call--so that he could give us three our night-time baths and tuck us in (we all fit in one bed back then, WITH him to tell us a story of growing up so far away in NYC up north, of all places!)

I remember that waiting eagerly for the time when his one day off a week after his on-call night would be "my" day, and I could spend time with him one-on-one. (We took turns, though I admit I was impatient for mine.)

I remember throwing tantrums and getting upset, with him yelling and me yelling...and looking back on it, I realize that I was just a little kid being a little kid, and he was just my exasperated father trying to get me to behave after a 36-hour day of being on-call and scared for my brother with one of his famous, crazy, one-oh-six-degree-Fahrenheit-breaking-point fevers keeping him worried while some poor mother cursed at him while birthing her baby and apologized afterward, crying and laughing, saying she didn't mean it while hugging a wriggling red baby with silly hair.

I remember eating a snack at 5PM and taking my shower early when I was just a little bit older to hold myself over while we waited for him to get home at 8PM before eating dinner and rushing off to bed.

I remember my dad taking time off work to come meet up with us for a week of vacation up north to visit some family. Then he’d have to fly back for work, spawning memories of the miserable, lonely phone calls we and my mother had with him while we were driving back, visiting more family all the way down the coast back to home.

I remember my dad getting in his scrubs to take us to the doctor and explaining everything he discussed with said doctor to us in words we could understand--whether it was the optometrist, the pediatrician, or the radiologist, respectively.

I remember crying because I thought my dad couldn't make it to my award ceremony, spelling bee, or school play; I also remember various feelings of relief, satisfaction, and sometimes more crying when my mom would video tape it and I'd watch it with him later, or when I'd see him rush in--still in scrubs--from the back in the middle of the competition, or when my teachers snuck him in backstage even though I had already calmed down because they knew I'd be so relieved and happy that he had made it after all.

I see now that my dad is overworked, overstressed, doesn't exercise well enough (not that he has much time to hit the gym, with my grandmother with Alzheimer's living with us and also requiring tons of care), and that he has always, always been there for me, loved me with all his heart (and these things count for big-brother and little-sister, too!), and has always wished he could have even more time with all of us (and still does, especially with my brother away at college).

My dad works a hard and difficult job with terrible hours because he feels it's his calling. Even when it's very difficult, there's a certain joy in it for him, in the miracle, as I'm sure you all understand. His partners are also loving parents with the same kinds of challenges of having families and careers--and all but two of the six others are women, a mother/doctor group may be interested to hear. However, I also realize that my dad works so hard also because...he loves us. Not only is he giving other people the chance to have the wonders he has, but the hard work he does makes sure that my mother can care for us and her slowly dying mother with Alzheimer's, despite those difficulties (our other grandma also lives with us, but is perfectly sound of mind, if not of eyesight). He keeps food on our table so, though things with insurance companies have made things more difficult over the years, we have never worried about food as many Americans now do--including ones nearby, ones in my school, or friends that I visit. We have never wanted for clothes to wear, a place to live, or even "extras" like a second car to drive--meaning we never had to walk the just-over-a-mile road to our school, but that we could go by car (since we're too close for bus). We have the luxury of a really cool PS2 that was an incredible gift for the three of us years ago and still serves us remarkably well for its generous age--not to mention an assortment of games we've "collected" through the years; I might add that those came mostly from birthday and holiday gifts from "Mom and Dad" that I'm sure my parents bought with the money my Dad works hard to earn.

I've lived a very privileged life full of experience and love, and I feel blessed to have had both of my parents. They are strong people who have raised me remarkably well, so I feel I have the great advantages of knowing right from wrong, the importance of learning and respect for others, and the much-forgotten value of courtesy and good manners. (And that those last two count even when things are bad or you're in a bad mood. We're all only human, but so's everyone else. Then again, I’m sure he sometimes wishes his patients taught their children that way, or lived it themselves, too...)

On behalf of children everywhere with doctor parents who worry, fret, and guilt themselves over the time they have to spend apart from their children...I want you to know that we love you, and even if it's hard when we're little to understand what you do, or why you're gone so long sometimes (though we tend to vaguely grasp even then the idea that "work" is very hard and busy and keeps you away even though you love us very much and wish all the time that you were here with us), we're proud of you and love you very much. We do our best to understand and accept these struggles with you, and we see better while looking back from older ages all of the sacrifices and difficulties you've endured for us, and just how much you've always loved us--and at all ages young to old, we love to hear you say it on nights when you're around to tuck us into bed.

Contributions to my career

As working mothers, we often focus on how we can manage to not allow our "with-kid(s)" status to affect our work. We overcompensate to prove we do as much work as the next *man* and we play ourselves into guilt cycles if we are either away from work or away from our kids (which is the case almost constantly).

I say, baloney. Being in medical school and residency has taught me much about medicine; however, being a mother has taught me a lot about myself. And that has furthered my ability as a physician far more than I ever expected. I have, therefore, decided to make a list of all the things I have learned by being a mother, which have made me a better doctor:

1) I recognize a temper tantrum for what it is, whether it comes from a child or an adult.

2) I realize that I may make good decisions that are not popular. I don't need to apologize for them.

3) If I subscribe to the "if you want something done right, do it yourself" adage, I will be doing everything for everyone all of the time. Then by definition, no one else will never learn to do it right because they will have no experience.

4) My daughter is being raised to be unapologetically bright without the influence of gender stereotypes. I should be no different.

5) Consistency is a vital skill.

6) Hand-washing must be frequent and thorough. This may seem obvious to anyone in medicine, but 2 kids with gastroenteritis brings this issue home with a vengeance.

7) I leave work at the end of the day only to begin the even more difficult job of managing kids and a household. So does my husband. We are partners after all, and our relative value units have to be equal (we have a joint checking account). If I expect him to pull down his share at home, I have to pull down my share at work.

8) My life is crazy enough right now, I can't imagine how empty I'll feel once my beautiful kids go off to college. I appreciate that I have this great career of mine.

Protected time

For awhile now, I've been in a subclinical funk about work. Don't get me wrong, I love my job and what I do, but over the years in my present position, I've been acquiring more and more responsibilities but not more time or support to do them. Some of it, I'll admit, is self-inflicted. I've taken on a bunch of research projects and mentoring, all important for my academic career and all things I've been told I should be doing. Other responsibilities have insidiously appeared on top of what I already do, or have mushroomed out of existing roles.

I've been wanting to say something to my boss.

My feelings, though, of disgruntlement have waxed and waned. One day I came into work, so fired up by my thoughts of injustice on the commute in, I furiously scribbled a list of Things I Do as ammunition.

I need more protected time.

But, things were busy that day and the list got pushed under a million other things, and by the time I remembered, the fire had smoldered and I thought, it's not that bad.

Another thing was holding me back.

Among my colleagues, I am the only one with children.

I've always feared that saying something about wanting a decreased workload or other dispensation would automatically trigger the - oh, that's the (weak) mother talking. At times, I feel like I need to prove myself as extra-productive to counteract such thoughts. Look! I can do all of this despite having kids!

Yet, the last couple of days were so overwhelmingly hectic that I again felt that need to have The Talk with The Boss. I talked it over with my husband and he agreed: I was doing too much, especially now while I was still nursing my son. But, do you think I should even mention family issues? I really didn't want to. Yes, it is part of the equation but it's not a part I'm willing to admit to my work (male) superior.

So, I sat down with The Boss and explained what I felt. I went over my projects and significant responsibilities, and asked for more protected time.

Which I was granted.
(Where's the Staples' That Was Easy button when you need one?)
I wish sticking up for myself was easier, and that I didn't feel such hesitance due to my mothering identity. Maybe I would feel the same way, even if I didn't have children...women tend to be not as good negotiators when it comes to our jobs.

The extra protected time, though, is a serious boon. I'm glad I said something.

The train

By the time I started medical school, the drive to succeed had impregnated my dura mater. It had always been all about getting the best grades, doing the best extracurriculars, getting into the best college, logging the best pre-medical school research, and finally, getting into the best medical school.

I went to a medical school that has the reputation of being ultra-competitive. It's easy, in that environment, to only know one direction: up. Of course I would continue on my trajectory, get the best grades, do the best extracurriculars, get into the best residency. Of course I would put career first for now. How would a family help me achieve? (I also was not married at that point, but still.)

When I heard the same lecture as Fizzy's OB, the one about rates of fertility declining after age 30 and rates of chromosomal abnormalities increasing, I have to admit, I, and I'm sure a good percentage of my female classmates, had a small identity crisis. I remember having conversations with my female classmates and friends about how would we balance the pulls to start a family and career. I remember feeling confused and frustrated and conflicted. As much as I wanted to succeed academically, I wanted to be a mother too. Maybe more so.

Nevertheless, I pushed on and got into that hard but glorified residency. Along with me, several of my female medical school classmates did as well.

Deborah* was one of my residency class who went to medical school with me. She was a serious student with a long history of overachievement. I was honestly surprised when she got pregnant during residency and even more surprised to learn she was planning to take a non-academic "cushy" job after finishing (that younger me felt threatened by the word 'cushy').

"I'm getting off the train," she confided to me.

Yes, I realized, I was on the train, sitting in one of the passenger cars, speeding ahead to some unknown destination. How did I get here? Do I want to get off? (I don't know; Not yet.)

Now, with my second child just being born, I've been thinking about the train. After residency, I transferred to a slower train (probably a local). The transfer itself was a bit unsettling: going from a modern, shiny, speeding express one to a bumpier, older, slower model, but I've grown to like this train. I'm still enjoying the scenery going by, and I've taken advantage of its multiple stops. I like the promise of a career destination. But, I also wonder if, in the future, I'll ever want to get off entirely and whether I could ever be okay with that. Or whether I'd ever regret not going faster.

*name changed