Going part-time

I have been a little MIA here since I've joined the chaos that is being an attending!

I was once told that the first year of being an attending would be the hardest. That is quite the understatement.

I was going through so many changes this past summer. I moved out of San Diego, a place that has been home for 14 years. I joined my husband in Los Angeles and after 2 years of long distance, we are finally under the same roof! Little C started her new school. It was basically a lot of change. It was all good but with any transition, it is never smooth sailing.

Fortunately, all that stuff mentioned above went pretty smooth. Kids are so resilient. Little C had a best friend by week 2 and by the second month, she was completely adjusted. It is definitely nice seeing my husband's face in person and not via FaceTime! But it turned out, the hardest transition was my new role as an attending.

I joined a private group. I remember posting on this website about what to ask in a job interview. To sum it up, I was way too excited that I was actually getting a job that I forgot majority of the advice given to me and signed a contract without really knowing what I was getting myself into. I had a sense of what the group would be like but I went along with their assumption that as my first year out of training that I would want to jump right in, make a lot of money and be on the full-time schedule, which included a lot of weekend call and evening shifts.

Initially, it didn't seem horrible compared to residency and fellowship. But my biggest dilemma now was how do I juggle being an attending and a mom without my own mom? My mom has been more than a grandma the past 4.5 years since little C was born. She was her primary caregiver for 2.5 years and the following 2 years of my long distance with my husband, she was available for every single sick day, call, evening shifts and weekend obligations. But I wanted to hold true to my promise that she would be a grandma once I became an attending. I think I really burnt her out the past almost 5 years and I think it was starting to put a dent in our relationship so this was new territory for me.

I found an incredible nanny to help with picks ups and drop offs but I was often very frustrated as to why I was working this hard and still not getting the work life balance that I thought I would ultimately have once I became an attending. I grew very unhappy, bottled it all up inside and did something I never thought I would do.

I quit.

But the most surprising twist of all was that my resignation wasn't taken and instead I was asked what would be my ideal schedule. I was shocked. I didn't expect such encouragement and flexibility. It took some convincing because I didn't think I deserved this kind of special treatment being so fresh out of training but it turns out, there were many people in the group who had different contracts that accommodated their lifestyles.

I thought I would let the group down if I didn't work the regular full-time schedule. I thought I was selfish asking to be taken out of the call pool and to only work from the hours of 8-5. But trying to quit ended up being the best decision ever. I got my dream schedule. I finally have time to work out for the first time in 5 years. I have the luxury of dropping off and picking up little C from school on Tuesdays and Thursdays. And the idea of second child is exciting now, rather than terrifying!

I feel like I can finally breathe now after 6 years of holding my breath and just trying to survive during residency and fellowship. I finally did it. I got my work-life balance. It's never perfect but I can work with this. So my take away lesson from all of this is don't be scared to ask for what you want, preferably without having to go through an almost resignation like myself!

this little wiggly squirming miracle in my belly

I just stopped on the MiM website when it dawned on me, I haven’t posted in 3 months?!? What in THE world?

I realized it’s because I’ve been holding my breath for the last few months. Putting all of my energy into cooking up a healthy baby. Doing my dag-on best to not stress and submit to this process of life after loss.

I posted in August that we are welcoming our second child. This little baby is now about the size of a butternut squash, just shy of 29 weeks and the third trimester. It wiggles and flips, squirms and dips all of the time. I’m in love.

I’ve been holding my breath. The first 12 weeks I fretted every time I used the bathroom with a prayer of “please no blood, please no blood, please no blood”. And there wasn’t any blood! 4 early ultrasounds later I knew this one was a strong one with a heartbeat like it’s big brother Zo (many thanks to the sweet Ultrasound Tech at my hospital and at my obstetrics office who let me see the baby’s heart beat so many times and hugged me as I cried each time). It’s been strong since it made its first appearance with my linea nigra at 3 weeks.

Balancing part-time work with a first grader and tenure track husband is no small feat. I am so thankful that pursuing medicine has afforded me with the ability to work part-time and still live quite comfortably. I am able to eat delicious, healthy food, attend prenatal pilates class weekly., see a chiropractor for my aching back and hips twice a week as prescribed, volunteer at Zo’s school, be the Parent Teacher Association Co-Secretary, and have days every week to myself with my favorite Netflix series (Supernatural season 4 of 28 and She’s Gotta Have It!). Though I am exhausted at the end of my office days seeing pediatric patients, I am so thankful for those days. I get to see my patient grow. They get to see me grow. And I am now getting advice from everyone about welcoming another baby into our world. I love my staff. I love my patients.

I love this little wiggly squirming miracle in my belly. Here’s to 10 more weeks of us being conjoined. Please stay healthy. Please stay healthy. Please stay healthy. You are so strong. You are so strong. We love you so much. We love you so much. We love you so much.

MiM Mail: How to ask for part-time?

I'd love for advice on the topic below. Thanks MiM!

I recently started my first attending job (anesthesiologist). I interviewed at many hospitals and ran the exhaustive lists of pros and cons with my husband before accepting a position at a large, academic tertiary care hospital near extended family. My reasons for picking this position were many, but a large part was the better work/life balance it seemed to offer over the private practice model (some private groups were regularly working 80 hours/week!).

Fast forward to now, when despite this being my best option, I'm still working 60 hours a week, my husband is still working full time, we are struggling to manage the day-to-day shuffle of having two kids. It's just as exhausting as residency! I need to cut back my hours for my own mental health and for my family, but how? I'm the newest attending. I'm the youngest attending. I'm female. I fear the "mommy track" label that will come with it, despite the fact that I will still be working more than 40 hours/week. I also resent the massive pay cut to work what any other professional would call full time.

I can get over all of my misgivings, but I'd love advice from people who have had this talk with their bosses. When is acceptable to ask? How long do I have to wait? How did you do it?

Thanks, ladies!

MiM Mail: Looking for a part-time pediatrics residency partner

I am a mother of soon to be three boys in search of a part-time residency in Pediatrics. I am willing to live anywhere in the continental United States to make part-time possible. I read encouraging comments from mothers on your blog who did part-time or know someone who did. I was also encouraged by an article I read from the AAP on part-time and how open programs are to it. It listed benefits of mental health, productivity and job satisfaction. However, I seem unable to find a program amenable to it. I applied to all of the programs that advertise having part-time/shared positions. I've been offered a few interviews but when I ask about part-time, I don't get very encouraging replies.

One woman wrote that she similarly got denied until she found a partner willing to split time with her. I am looking for such a person and would love it if we could find each other. My dream is to be a doctor but I do not feel the sacrifice of three solid years of working horrific hours is fair to my family. I hope there is another person out there seeking the same and we can help each other fulfill our dreams and personal goals in this way by sharing a position. If you would like to discuss further, please send an email with your contact information to mothersinmedicine@gmail.com.

Thanks in advance,
J

What Does "Lean In" Mean? Whatever You Want It To.

Genmedmom here. You'd think that as a doctor and a mother and a blogger with a focus on work-life balance, that I'd have been psyched to read Sheryl Sandberg's Lean In. Truthfully, I dreaded reading it.

I figured I'd have to read it sooner or later, given what I do, and I wasn't looking forward to it at all. From the bits and pieces I'd heard about it, I assumed that it must be a pushy, finger-wagging manifesto designed to make me feel more guilty that I already felt.

But I felt guilty NOT reading it. So one day, when I ordered a bunch of books on Autism (our son is autistic) and a few Barbara Brown Taylor essay collections, I also ordered Lean In. It sat on my bedside table for about a month. The other books got read (I read a lot), but Sheryl's smiling face looked up at me night after night, book closed, waiting.

Finally, one night, after the kids were down and charts were done and my brain needed some book reading for an hour or so, I realized I had nothing else to read but smiling Sheryl. I very reluctantly opened it...

And she had me at the second paragraph of the introduction.

She describes how she gained seventy pounds in her first pregnancy, and suffered from brutal nausea the whole time; how she struggled with simply walking, and realized that Google needed to have pregnancy parking close to the building, for all pregnant employees. So she made it happen. Wow.

Flashback to my pregnancies, where I gained, yes, seventy pounds, and felt awful, and struggled with simply walking... Like many employees of my big city hospital, I park at a garage about a mile away, and walk in. For my first pregnancy, my manager gave me a handful of parking passes that I used in the last ten days. That was great, but it was the last ten days, and there weren't any for my second pregnancy. I remember waddling painfully to and fro...

The point of her sharing the anecdote is to illustrate that she didn't realize how helpful pregnancy parking would be until she experienced it for herself. She wondered how no one brought it up before:

"The other pregnant women must have suffered in silence, not wanting to ask for special treatment. Or maybe they lacked the confidence and seniority to demand that the problem be fixed. Having one pregnant woman at the top- even one who looked like a whale- made the difference".

The book continues in this style, outlining the significant challenges women face in today's workplace, dotted with personal anecdotes and shared stories, humor, and problem-solving suggestions. There's plenty of data, but it's not boring. I was surprised at the praise, validation and encouragement for women at all angles of leaning in, including those who work part-time or stay at home. There is very little by way of exhortation; actually, I had to search for anything:

"I have written this book to encourage women to dream big, forge a path through the obstacles, and achieve their full potential. I am hoping that each woman will set her own goals and reach for them with gusto."

I actually enjoyed this book, and strongly recommend it to any woman considering a career in anything.

So, why did I dread reading it? Why did a book described everywhere as "an inspiring call to action" sit gathering dust on my bedside table for a month?

Well, as an internist who works part-time and mother of two young children, I've been exhorted, invalidated, even attacked. So, I assumed Sandberg's book would be another attack. It's not every day, but I'm sure I'm not the only part-time physician who has encountered this, the face-scrunching and "So, how does THAT work?" or a "Don't your patients get frustrated that you're not fully available?" kind of thing.

The attack most famous came from a senior female physician. I remember how sick I felt when I read anesthesiologist Karen Sibert's Op-Ed "Don't Quit This Day Job" in the New York Times (June 2011). In this essay, she doesn't just frown upon women working part-time in medicine: she crushes them. Worse, she crushes the aspirations of those considering medicine as a career:

"I recently spoke with a college student who asked me if anesthesiology is a good field for women. She didn’t want to hear that my days are unpredictable because serious operations can take a long time and emergency surgery often needs to be done at night. What she really wanted to know was if my working life was consistent with her rosy vision of limited work hours and raising children. I doubt that she welcomed my parting advice: If you want to be a doctor, be a doctor....You can’t have it all."

The death blow, however, was to people like me,

"Patients need doctors to take care of them. Medicine shouldn’t be a part-time interest to be set aside if it becomes inconvenient; it deserves to be a life’s work."

The... what do you call this? It wasn't an implication or an accusation, it was a sound dismissal of MY life's work. I have a small panel of patients, commensurate to my four clinical sessions per week. I work in a warm, nurturing environment, in a group practice of all part-time female internists. We have excellent clinical support staff. We enjoy great flexibility in our hours. We also are also regularly evaluated and rated by our patients, as well as our hospital, on various criteria ranging from patient satisfaction surveys to outcomes data comparisons between practices, and we perform extremely well.

I also have two small children, ages two and three, a working husband who is a wonderful partner, and family close by. I'm almost always home for dinner, and enjoy most weekends with my family. Yes, we carry pagers and are on call for ourselves Monday through Friday, with weekend calls shared, and there are occasional calls at less opportune times (bathtime, bedtime..). And, with the advent of the patient portal, where patients can communicate with providers online (kind of like email), they can send me a message basically anytime. But overall, clashes between work and family are few and far between.

My gut sense is that what I have going works. Most of my patients are working women, and I'm open and chatty about being a working mom (can you tell?). My kids' photos are up in my exam room, regularly updated, and patients eagerly ask about them, just as I inquire about their families. We trade stories. I receive solidly positive feedback from patients and colleagues alike. (I feel weird putting it on paper, all this positivity, but isn't that what we women do, is downplay our achievements?)

THIS is my "leaning in". I do not aspire to be a department chair, to publish in the peer-reviewed literature (though I have), or to have my own office with puffy leather chairs. I have made the considerable achievements of graduating from medical school, surviving residency, and thriving in a highly regarded primary care practice. I want to be a good doctor and a good mother (and to write about it!) I believe that you CAN have all this, because I do.

That is the beauty of the message from Sheryl Sandberg: "leaning in" isn't a one-size-fits-all formula. As in the quote above, she hopes that women set their own goals and reach for them.

Sandberg also talks about how women need to help other women achieve their goals. I agree with that, and it starts with pregnancy parking! It also includes calmly ignoring even senior female docs like Karen Sibert when they try to force a one-size-fits-all, my-way-or-the-highway approach onto a career path as variable and malleable as medicine. Sandberg discusses the phenomenon of senior women not only being unhelpful, but even hindering the progress of the up-and-coming women:

"Critics have scoffed at me for trusting that once women are in power, that they will help one another, since that has not always been the case. I'm willing to take that bet. The first wave of women who ascended to leadership positions were few and far between, and to survive, many focused more on fitting in than on helping others. The current wave of female leadership in increasingly willing to speak up. The more women attain positions of power, the less pressure there will be to conform, and the more they will do for other women."

So, read the book, and either make your way up, or reach a hand down. Set goals and "lean in" any way you choose, because only you know what is right for you, and if it's right for you, it's all right.

And I'm interested to hear what others think of smiling Sheryl's book.

Guest post: Choosing part-time work in emergency medicine

First I want to tell you all how grateful I am to have found your site.  I now check it regularly and see it as my "lifeline" to others who have been through (and are going through) a lot of my own struggles and joys of being both a mom and a doctor.   I am a part-time practicing Emergency Physician 6 years out of residency.  I live in the Midwest.  I have two children, a 9 year old girl and a 4 year old boy.

For a while now I have been wanting to write something about choosing to work part-time.  I have been inspired by all the great posts from the other MiMs, so here is mine:

I am a part-time ER doc.  It is something that has taken me a while to feel proud to admit.   I love being an Emergency Physician, and I know that there is nothing else in the world I'd rather (and am meant to) do.  BUT....I am also a mom.  I had my daughter right before intern year started, and nothing could have prepared me for that experience.  I think I must have deluded myself in thinking that it would somehow be doable to juggle the responsibilities of both a newborn and intern year.  Without my husband it would have been impossible. I missed out on so many moments with my daughter during her first few years!  Do I regret this?  I guess in a way I do, but I know that if I didn't miss out on those moments I would not have been able to succeed in this career I love, and would not be able to support my family financially as I do now.  I want to tell all you other MiMs out there--nine years later, my daughter has NO recollection of the first 3 years of her life, she has NO idea that I was gone for most of those years, and despite all those missed moments we have a very close relationship. 

I started working full time after residency to pay off debt and our mortgage, but I cut down to 80% when my son was born.  This has allowed me to continue to support my family and enjoy our life by going on vacations, going out to eat, and spending time as a family.  But after a few years the time had come to decrease my hours even more.  Being in EM for so many years has taught me one thing:  life is short, and you never know when it is your time--time to get sick, time to become injured, time to die.  I know that there is a lot of controversy and stigma out there about "part-time docs", but in the end this is a personal, not a socioeconomic decision.  I have dedicated 13 years of my life to medicine.  After 3 years of residency and 6 years of practice I am confident in my skills and knowledge.  It is now my children's turn to have my focus and attention. They will only be this small and will need me this much for so long.  It is their time.

Goat farming, return to residency or the status quo?

I work two days a week, and I'm home with the kids for three. Apart from a full-time stint when Pete took a ten-week parental leave in 2005, I've never worked more than three days a week since I finished residency five years ago.
You might assume that if I've maintained the same pattern for years, I must have found the perfect balance, requiring little review.
But a typical week of end-of-day comments to Pete looks like this:

• Monday: "I've been thinking of doing another residency. What would you think of staying home for three years?"

• Tuesday: "Let's move to the Island and take up organic goat farming. Think how much the kids would love it."

• Wednesday: "Work's been great lately. Maybe we should pick up another day of daycare and increase my work to three days a week. We could use the extra cash to pay for a cleaner and meals."

• Thursday: "I've been thinking maybe I should be home full-time while the kids are this young. These years will be done before we know it."

• Friday: "Why don't you apply to medical school? You could go into family medicine, and we could share a practice. One of us could always be home with the kids."

• Saturday: "I'd love to throw myself into work full-time, even just for a year or two."

• Sunday: "Our current arrangement really is ideal. I'm so grateful that I get to spend this much time with the kids. What other career would offer this flexibility?"

These suggestions, and many others, are never offered out of dissatisfaction, but out of creative optimism. An afternoon seeing prenatal patients makes me want to return to the clinic the next morning. But a morning spent hunting for crabs at the beach with the kids makes me wish for a long, uninterrupted string of just such days.
I don't consider the constant consideration of alternatives pathological. For one thing, when you're a physician mother, being yanked in several directions is the norm. For another, I think it's healthy to live with intention, frequently reviewing one's choices.
Before getting a new haircut, my personal rule is that I must want that cut for seven consecutive days. I apply the same basic principle to life changes. When rapidly cycling through ideas, best to sit tight with the status quo, unless an option eventually emerges as the better one.
My fantasy pendulum swings equally in both directions - increasing time at home and at work. The average of all ideas I toy with is exactly what I'm doing now.
Looks like for the foreseeable future I'll continue seeing patients on Tuesdays and Fridays, and spending the rest of the week sharpening pencil crayons and picking berries in the woods.