MiM Mail: Intern Regretting Specialty

Hello MiM!

I love your blog! It's been amazing reading everyone's stories and I hope I can get some insight or advice. I am currently a FM intern at my desirable location because I am near both my and my husband's family. We have a beautiful 5 month old daughter who is the light of my life. Since the match I've been regretting my chosen specialty. I came out of medical school loving a competitive specialty and was too discouraged to go through with it and under family pressure to come home for the baby's sake. I thought I had to do what's right for my family and return home where we can get some help and my daughter could be in a loving environment. My husband is a teacher and wasn't happy at our med school location. He was over the moon about coming home I couldn't disappoint him... But now I regret everyday I'm in this specialty.

Things I like about FM is the variety such as derm, pediatrics, and psych. Things I don't like about FM is I hate chronic health conditions. I don't like to be responsible for managing diabetes with kidney failure and liver cirrhosis plus 30 medications. My personality is much suited for a more specialized area. I don't know what to do. I want to switch into something else but I have no idea what. I would love to do dermatology but it is so highly competitive that I doubt I would get in. I also don't think my family will be willing to relocate for me to pursue options to get in such as a research fellowship. Other areas I'm interested in is pediatrics, EM, and psych. I know I know it sounds like I should do FM but I just can't take the "bread and butter" of it.

General pediatrics sounds better to me then general practice because kids don't generally have so many chronic health conditions for me to manage and I love working with kids. I didn't consider it in med school because of parents but now I am one and totally get it!! EM also sounds perfect on paper but the lifestyle scares me (nights,weekends, holidays) high burnout rate, and life/death pressure. Psych was a great rotation in med school but I know how emotionally draining patients can be. Also none of these residencies are available in my hometown and would require moving. Should I do what's best for my family? Try and stick it out? Or ultimately try and pursue something that will make me happy? I'm so conflicted because I know moving would be hard on all of us :((( and I'm scared to make things harder on my husband and me.

Any insight or advice is appreciated! Thank you!

Sincerely,
Regretful Resident

MiM Mail: Paediatrics training vs. family medicine

To the mothers in medicine team!

I'm a doctor working as a second year paediatrics registrar with a new baby and was hoping you might be able to give me some advice- I have struggled with choosing a career path for the last six years since I graduated from medical school- I generally don't like very stressful jobs but on the other hand, have always really enjoyed complex, interesting patients I've seen whilst working in hospitals.

At the moment, I'm a second year paediatrics trainee (and have yet to sit the exams for the college of physicians). I have a twelve week old baby and am contemplating going back to work where I will need to do three more years of training after my exams, of largely shift work (nights, evenings, weekends). If I do the training part-time, I would need to spend six years (and thats without having more children, which my husband and I would both like).

For these reasons, I'm considering changing careers to general practice (family medicine where I will be able to finish training in 18 months (or 3 years part-time and can say goodbye to shift work forever!). I think I will miss hospital-based medicine (and just getting to see children) but I think it might be more family friendly? Any advice from people with similiar dilemmas in the past, and how they decided what was best, would be really appreciated!

MPAS

MiM Mail: Why the disparity in advice to prospective doctors?

Dear Mothers in Medicine,

There seems to be a disparity in the advice given to prospective doctors. Sometimes the tone is tense, heavy, and almost bitter. Warning people of the commitment, the intensity, the sacrifice of medical school and residency. And other times the thread takes a completely different tone and instead offers encouragement and suggestions for making it work, and the reassurance that more and more people are finding ways to get through those grueling years with a family.

As I try to work out the cost benefit analysis for myself, I'm curious how much of these perceived sacrifices and other costs are specialty based or otherwise dependent on the choices of the student. For example, yes, the financial cost of medical school is significant, but there are scholarships, there are repayment for service programs, and there are ways to mitigate the costs. What impact does the choice of specialty have on the stressors of residency?

How often are medical students able to get a residency near their medical school so they do not have to move their family?

Currently, my kids are 1, 4, and 5. To put the next 10 years into medical school means my kids may pay a steep cost during their childhood, and I'm not sure how much benefit they will receive. From their standpoint, I'm concerned this next step for me could be particularly hurtful. But I want to focus on primary care, which I suspect could be a milder journey, and therefore ask less of my family.

My husband is 100% on board. Wholly and completely. His work allows significant flexibility but insignificant pay. So he's happy to move with me and make this work. I just need to figure out what we'll be asking of the kids before we move forward.

Any insight for me?
Thanks.

MiM Mail: PCP to PM&R?

I am an older mom to a one and only, fabulous, wonderful little boy. I had a career in human services before medical school. I completed my internal med residency. I have worked as a PCP for about a year and, frankly, it's awful! I like my patients. I chose to work in an underserved area with a lot of folks who are newcomers to the United States and I really like this part of the work. I feel like all I do is tap on the computer instead of really dealing with the human being in the room with me.

I had never heard of PM&R in med school. The more I hear about it and read about it, the more I feel like it might be a good match for someone like me. (You know, someone who likes to talk to patients, take a history, do an actual physical exam, maybe have time to do a procedure....)

Does anyone have any suggestions about residency training? It doesn't sound like the PM+R residency would be that much worse than the schedule of an attending PCP. I am able to sacrifice salary due to a very type A doctor dad in the picture. (In that way, I am very, very lucky.)

Thanks!

MiM Mail: Not excited by the OR anymore

Hello all,

I was a huge fan of this forum as a woman in medicine, and now I am a brand new mother to a sweet 1 month old baby girl.

I have completed the 4th year of a plastic surgery residency at a competitive and busy program, and am currently taking a research year to have more time with my daughter. My husband is in medicine as well.

I am writing because when I decided to go into surgery (albeit plastics, which is a little bit less demanding), I had not even met my husband and did not think I wanted kids. Obviously my priorities have changed.

Since becoming pregnant, I have been strongly considering a change in specialties or leaving medicine altogether. My new priority is being a mom, being present, and being focused on my daughter's upbringing. Plastic surgery demands long hours to build a practice, rigorous call, and exhausting surgeries that take a lot out of me by the end of the day.

I know switching would mean lengthening my training at this point since I only have 2 clinical years (and probably fellowship) after this research year. But I can't help but think this will be so much better for us in the long run. It makes me a little sad since I have invested so much in my surgical training already, but I don't know if I would be happy continuing on this track. I am not looking for an "easy specialty" since there is no such thing, just one that better fits my priorities. Otherwise, what other options are there outside of medicine?

I liked PM&R when I was a medical student and found it uplifting since you got to see patients' long term progress. I also liked emergency medicine for the immediate feedback and fast pace (the same thing that drew me to surgery initially). I think I need to bite the bullet and find something with more of a fixed schedule that allows me to focus on my family when I am at home, rather than being a slave to my pager. I am just not excited about the operating room anymore, especially given all of my life changes. I have never loved surgery the way some of my colleagues do, and this confirms it.

Any thoughts or advice would be so helpful.

Thank you!

To be or not to be.....a generalist

Hello MiMers!

I'm nearing the end of my Family Medicine residency and am struggling with the age-old question: To be or not to be?....a generalist.

I've always loved the variety and scope of FM. To me, there is such great appeal of being a jack-of-all-trades kind of doctor. I love being the first point of care, collaborating with specialists, seeing new and unfamiliar problems, and flying by the seat of my pants. Growing up in Canada and being surrounded by a culture of Family Medicine has undoubtedly shaped my love for general practice.

That being said, after countless hours of studying, rotations, patient care, and hard work, I am sometimes weighed down by the questions, "What am I GOOD at? What's my area of EXPERTISE?" Sure, there are the things that I see everyday and feel pretty comfortable with: Diabetes, high blood pressure, back/shoulder/knee pain, asthma, preventive care to name a few. But this always comes with the knowledge that I'm not necessarily an EXPERT in those fields. Can I really be giving my patients the best care for their problems if I'm not an endocrinologist (diabetes)? orthopod (shoulder pain)? pulmonologist (asthma)? Could I give a thoughtful, professional-level lecture on any of those subjects?

I've been seduced many times during residency into doing a fellowship. At one point, I've seriously considered a fellowship in geriatrics, OB, EM, sports med, palliative care, dermatology and HIV/AIDS (to name a few). But I can never seem to commit myself to narrowing down to one subject. I find myself getting back to the same fear of getting pigeonholed into one area and losing my ability to be a generalist. It is quite a humorous mind-loop that I get into time and time again.

Ladies, lets discuss. What do you love about being a specialist? Or a generalist? I'd love to hear your thoughts.

Sincerely,
HulaMed

MiM Mail: How happy should you feel in residency about your specialty?

I am a third year psychiatry resident and a mother to a precious 21 month old little girl. I often find myself wondering how happy I should feel as a resident in my specialty. I was very ambivalent about choosing a specialty and considered family medicine and pediatrics as well. I ultimately chose psychiatry because I felt it would be less stressful and offer a better lifestyle. I also tend to not believe in myself and wondered if I could handle the rigors of those other specialties. As a resident I often wonder if I made the wrong choice. I don't hate my specialty but often find myself wondering if my personality would have been a better for the aforementioned specialties. Sometimes i feel "too nice" for psychiatry and I despise emergency psychiatry and the legal aspects of the field. I have thought about finishing psychiatry and then completing another residency but I just don't feel that I have the stamina for that and want to work part time as soon as possible. I'm just wondering if others have struggled and ultimately found happiness in their field? I'm hoping my feelings are related to burnout and don't indicate I will never find fulfillment in psychiatry.

MiM Mail: Choosing a specialty when you like a lot and love nothing

Hello MiM,

I am new to your blog but have recently spent countless hours reading past posts to hopefully gain some insight (and to avoid studying for step 2). I am a MS4 who just finished 3rd year rotations and am desperately trying to figure out what I am going to do with the rest of my life. Honestly, I did not have that "Ah-ha" moment in medical school when I found something I absolutely loved and knew it was what I was destined to do. I liked most of my rotations, of course some more than others, but nothing blew me away, and I am very disheartened by this.

Right now I am trying to choose between applying to Ob-Gyn and Internal Medicine. Very different, I know. But I like Ob a lot - dealing with relatively younger, healthier patients, working with just women (mainly), and being a surgical and medical specialty is appealing. It was definitely my favorite rotation of third year. However, I never pictured myself as an OB and to be frank, I am quite terrified of their perceived lifestyle. I am 27 years old, married to my high school sweet heart and love of my life, and my family is everything to me. We do not have any kids yet, but definitely want 2 or 3 in the (near) future. My mother was a stay-at-home super mom who never missed a school function or dance recital. Obviously, choosing a career in any field of medicine means that that won't be me; however, I feel if I become an Ob-gyn it will be that much more difficult. I really like delivering babies, but am I still going to like it when I am 45 years old at 3am or when I am missing my child's school play?

If I chose internal medicine, I am basically saying "I haven't decided what to do yet" and it gives me an extra year to put off the decision. Internal medicine has so many different fellowships that I feel I will be keeping my options open. And although I am a big fan of the OR, a non-surgical specialty will help with my hours and my call schedule.

Basically, I like a lot, and love nothing and I am hugely disappointed by this. I have wanted to be a "doctor" since I was a young girl, and have worked so hard to obtain my MD; but, right now I feel lost.

As a woman, I feel it is so much harder to choose a specialty. At the end of the day my family is number one and I want to do what is best for them. At the same time, I have spent so much time and money and worked so hard to get where I am that I don't want to sell myself short. I feel like I have to choose between what is best for me personally and professionally.

Sorry for the insanely long rant. I just really need some solid advice - really ANY advice at all. Please help me, MiM!

Sincerely,
One confused MS4