I have a friend, another MiM, who is nothing short of inspiring.
Born in the former Yugoslavia, she was raised in Germany and ultimately went through medical training there. Like all of us, she has stories to tell about her specialty, OB/GYN, that range from hilarious to horrifying. Like us, she has a family - two children, both born in Europe during her medical career. Although training in Germany, as in the US, was demanding, she found the time and courage to return to her home country for a short time during the Balkan War. She worked on casualties in a hospital there while bombs dropped in the distance.
When her husband wanted to accept a job offer in the US about 6 years ago, she didn't hesitate. She dropped everything, including her career, and helped organize the move to a different continent. She supported her children, who didn't speak a word of English at the time they arrived. Since then, their family has thrived. Her son and mine play ice hockey together. We are both now rearing teenagers and commiserating about their lack of frontal lobes!
She did all this thinking that eventually she would resume her career here in the States. To prepare for this, she passed all the USMLE steps and met all the criteria for the match. I remember when, more than 2 years ago, she asked for my help in preparing her personal statement. Having fortunately sailed through my own match as a newly minted American grad, I thought, "Boy, this should be easy - who wouldn't want such a brilliant physician in their program, one with such a broad range of experience?" I'm sure she thought, "I've been through OB/GYN residency, a war, and a move to a different continent - how hard can this be?"
Boy, were we naive.
Since then, my friend has been through two matches without even a single interview. She has done research in an academic GYN lab and is published as a result. She spent a summer in the Himalayas doing medical mission work. Despite everything she tried, she had no success.
I am astonished at what I have learned through her frustrating experience. At the two hospitals where I work, I frequently encounter physicians who are foreign medical graduates (FMG's). Because of this, I assumed there were plenty of opportunities for all comers. Not so.
Speaking to two different residency program directors, I heard the same story. These days, it's all about year of graduation from medical school. If you are more than 2 years out, your application is not even considered. It goes straight to the trash - American or foreign grad.
The other factor is the competitiveness of the market. With the economy in its current miserable state, applications to med school are through the roof. Med schools, seeking extra tuition, are expanding the number of spots available. New med schools are opening in response to the perceived worsening shortage of physicians. However, residencies are not adding positions - they are federally funded, and there is no extra government money for expansions.
This translates into lots of applicants for available residency spots - brand new, shiny American graduates. One program director told me that by 2015, there will be more American med students graduating than there are residency positions to be filled. She said, "At that point, we won't even be looking at Carribean graduates, much less FMG's. If she doesn't find a job by then, she's doomed."
Wow. I had no idea.
We hear a lot in the media these days about the projected national shortage of physicians. We are all concerned about this. How will it affect our jobs? How long will our wait times for new patients become? Who will take care of us when we (or our family members) become ill? How will we divide work with physician extenders?
If this shortage is such a huge problem, why on earth are we shutting out an excellent source of new and yet experienced physicians? There must be hundreds of physicians like my friend, eager to work and already skilled in their fields of expertise. These are intelligent, productive people who will support their communities and pay taxes. If there are not enough residency positions available to accommodate them, why can there not be a parallel program tailored to bringing FMG's into the workplace? Perhaps an apprenticeship model would work...
(I do understand the concerns about FMG's. The American system is different even from Europe's, so it is hard for them to adjust. Language barriers can be significant, even crippling. The quality of FMG's is not consistent, so it is hard to know how much remediation may be necessary on the front end. If a physician has been away from training or practice for too long, the knowledge gap may be large. However, medical training is never easy with any group of students - these concerns are not insurmountable.)
Beyond this, I have concerns about future MiMs in particular. If date of med school graduation is a key factor in residency applications already, this means possibly catastrophic difficulties for women who want to take time off for pregnancies or to care for small children. Admittedly, 2 years is a long time, but it seems to me that even one year off could be considered a serious liability in this competitive climate. Add to that the pressure of student debt. What happens to the med students who cannot match, cannot get a residency position, but owe large amounts? With what means will they pay off that debt?
My talented, courageous friend is the canary in the mine. The difficulties she has experienced with the match process are a harbinger of things to come for many of those who seek to follow in our footsteps.
Encouraging note: My friend is now actively in a preliminary general surgery residency position. We are hoping that this will be the foot in the door that will lead to either a categorical surgery position or a primary care match for her.
Thursday, January 5, 2012
Wednesday, January 4, 2012
Ode to Birth Control
Sometimes people write in to Mothers in Medicine with guest posts, asking, "Should I become a doctor?" Whatever the answer to that question is for you, the truth is that none of us would be doctors and this blog wouldn't even exist if not for one thing:
Birth control.
My great-great-grandmother had ten children. She wasn't so much thinking about whether OB/GYN or family medicine was the right decision for her. I don't know if she worked but she sure wasn't considering a career that involved nearly a decade of intense training. It wouldn't have been possible.
The earliest female physicians such as Elizabeth Blackwell were unmarried and didn't have to worry about children. Most women with any sort of career were unmarried. Being pregnant nonstop and caring for a brood of children makes it very hard to have a career outside the home.
I think it's easy to forget that up until recently, birth control wasn't a given. As recently as the 1960s, many states actually prohibited use of contraception. In 1965, the Supreme Court ruled that a Connecticut law prohibiting the use of contraceptives violated the "right to marital privacy." It wasn't until 1972 that the case of Eisenstadt v. Baird expanded the right to possess and use contraceptives to unmarried couples. That's only 40 years ago!
Think about what your life would be like if birth control wasn't available to you. What would your career be like if you had ten children like Great Great Grammy McFizz? And what if birth control was suddenly taken away from you? How would that affect your career and your family?
So I have to say a great big thank you to birth control. And express my anger that there are people out there, potentially in positions of power, who would like to take it away.
Birth control.
My great-great-grandmother had ten children. She wasn't so much thinking about whether OB/GYN or family medicine was the right decision for her. I don't know if she worked but she sure wasn't considering a career that involved nearly a decade of intense training. It wouldn't have been possible.
The earliest female physicians such as Elizabeth Blackwell were unmarried and didn't have to worry about children. Most women with any sort of career were unmarried. Being pregnant nonstop and caring for a brood of children makes it very hard to have a career outside the home.
I think it's easy to forget that up until recently, birth control wasn't a given. As recently as the 1960s, many states actually prohibited use of contraception. In 1965, the Supreme Court ruled that a Connecticut law prohibiting the use of contraceptives violated the "right to marital privacy." It wasn't until 1972 that the case of Eisenstadt v. Baird expanded the right to possess and use contraceptives to unmarried couples. That's only 40 years ago!
Think about what your life would be like if birth control wasn't available to you. What would your career be like if you had ten children like Great Great Grammy McFizz? And what if birth control was suddenly taken away from you? How would that affect your career and your family?
So I have to say a great big thank you to birth control. And express my anger that there are people out there, potentially in positions of power, who would like to take it away.
MiM Mailbag: Giving up the baby
Dear MiM,
Has anyone else had to temporarily give up their children in order to facilitate their career in medicine?
I am a junior general surgery resident a few weeks away from delivering my first child. The pregnancy was a surprise, but I am eagerly awaiting the baby. I wrote "I" rather than "we" on purpose- although I am married, my husband lives in another city, some 1500 miles away, where he is at the top of another incredibly demanding, long-hours, "mistress" profession. We did originally live together in intern year, but with my blessing he accepted his current position and moved away. It was shortly thereafter that we found out about the pregnancy.
I have had a dream pregnancy with absolutely no problems- no morning sickness, no cravings, no complications, a total weight gain of 15 lbs, and no stretch marks! My clinical performance has not been affected and I remain passionately committed to surgery- it is absolutely the right specialty for me.
Here's the problem: I have 4 wks of maternity leave. The baby will come in February, which means I return to work in March. My husband will get a month of paternity leave and spend it in my city, which he will take for the second month of the baby's life. This puts us through to April, but I will have 2.5 months of the academic medical year remaining. The hours of a surgical resident, it goes without saying, are not conducive to single parenting- how on earth could I arrange for nannies/ au pairs / daycares to cover 90hr weeks, weekends, night call, unpredictable hours, etc-- especially on a resident's salary? We have no family within 2000 miles, and no family members can take off 2.5 months to be the primary caregiver. So, we have concluded, the only thing to do is to send the baby away to be cared for by relatives, who will love and adore him and give him the 24hr, unconditional attention I cannot.
This arrangement will only be for those three months. I'm starting my gen surg research years in July, and the lab I'm entering will be in my husband's city. So we will all be reunited and normal again after a few months.
We have received a variety of comments on this arrangement, some of which are meant to be helpful ("don't do anything you will regret forever"; "you should sue your hospital;" "why can't you just take a normal 6 month maternity leave."). Many others are to the effect that I am an unfeeling monster who is a defective female and should never have children in the first place. Most people- especially at work- assumed that I would terminate the pregnancy, and were shocked to learn that was unequivocally not on the table. I won't deny that there has been a lot of guilt (my husband, who is unbelievably excited about being a father, feels a great deal of blame) and concerns about emotionally managing the separation, but we truly believe this is what's right for our family and our unborn son.
I was wondering if any other mothers in medicine have had to make a similar choice, and what their coping strategies were? I know, for example, many foreign-trained residents have to leave their children behind when coming to the States for residency. I would really like to hear some stories from people who have "been there," and not to feel so alone.
Thanks very much for the blog- I really enjoy it and its variety of perspectives, particulalrly the advice from the women in long-hours specialties.
Best,
L
Has anyone else had to temporarily give up their children in order to facilitate their career in medicine?
I am a junior general surgery resident a few weeks away from delivering my first child. The pregnancy was a surprise, but I am eagerly awaiting the baby. I wrote "I" rather than "we" on purpose- although I am married, my husband lives in another city, some 1500 miles away, where he is at the top of another incredibly demanding, long-hours, "mistress" profession. We did originally live together in intern year, but with my blessing he accepted his current position and moved away. It was shortly thereafter that we found out about the pregnancy.
I have had a dream pregnancy with absolutely no problems- no morning sickness, no cravings, no complications, a total weight gain of 15 lbs, and no stretch marks! My clinical performance has not been affected and I remain passionately committed to surgery- it is absolutely the right specialty for me.
Here's the problem: I have 4 wks of maternity leave. The baby will come in February, which means I return to work in March. My husband will get a month of paternity leave and spend it in my city, which he will take for the second month of the baby's life. This puts us through to April, but I will have 2.5 months of the academic medical year remaining. The hours of a surgical resident, it goes without saying, are not conducive to single parenting- how on earth could I arrange for nannies/ au pairs / daycares to cover 90hr weeks, weekends, night call, unpredictable hours, etc-- especially on a resident's salary? We have no family within 2000 miles, and no family members can take off 2.5 months to be the primary caregiver. So, we have concluded, the only thing to do is to send the baby away to be cared for by relatives, who will love and adore him and give him the 24hr, unconditional attention I cannot.
This arrangement will only be for those three months. I'm starting my gen surg research years in July, and the lab I'm entering will be in my husband's city. So we will all be reunited and normal again after a few months.
We have received a variety of comments on this arrangement, some of which are meant to be helpful ("don't do anything you will regret forever"; "you should sue your hospital;" "why can't you just take a normal 6 month maternity leave."). Many others are to the effect that I am an unfeeling monster who is a defective female and should never have children in the first place. Most people- especially at work- assumed that I would terminate the pregnancy, and were shocked to learn that was unequivocally not on the table. I won't deny that there has been a lot of guilt (my husband, who is unbelievably excited about being a father, feels a great deal of blame) and concerns about emotionally managing the separation, but we truly believe this is what's right for our family and our unborn son.
I was wondering if any other mothers in medicine have had to make a similar choice, and what their coping strategies were? I know, for example, many foreign-trained residents have to leave their children behind when coming to the States for residency. I would really like to hear some stories from people who have "been there," and not to feel so alone.
Thanks very much for the blog- I really enjoy it and its variety of perspectives, particulalrly the advice from the women in long-hours specialties.
Best,
L
Sunday, January 1, 2012
In the Air
On December 26th a helicopter went down in Florida, taking the life of a heart transplant surgeon, an organ procurement technician and the pilot. Although the donor heart could not be used, the intended recipient was fine and awaited another donor match.
I heard the news through a text message from my on-call partner, interrupting me two stories into the bedtime routine with my 3 year old son. “A helicopter went down going to get a heart.” The heart transplant community is a small one, this news hit close to home. Often these procurement missions include multiple transplant teams (i.e. heart, lung and abdominal) with young surgeons in training riding along. I often send my fellows or students and have gone myself.
On a rainy night in September I drove along a narrow road on the far side of the airport. I was looking for the private hangar, and once I arrived I pulled into an empty parking lot. There was a dim light on inside so I grabbed my bag and headed for the sliding glass doors. I stood in front of the door and waved my hand but the sensor was not on. I knocked and a handsome man in a flight jacket walked over and let me in. I told him I was part of the transplant team and he looked at me skeptically. I wondered if I should have identified myself as “doctor”. I was the first one there so I sat in the waiting area and helped myself to some coffee and spiked it with hot chocolate.
The last one to arrive was our heart transplant surgeon. With the team complete we carried gear to the awaiting plane. The supplies were placed in the cargo area, but the cooler would ride with the passengers. I lifted it into the cabin, I noticed it was light and empty. As the heart transplant surgeon grabbed it from me his gaze held conspicuously on my belly. Even wearing scrubs I could not conceal the fact that I was five months pregnant. He then climbed out of the plane and practically lifted me up into my seat, he was sure that I did not miss a step.
Once we were strapped and secured into our seats I studied his face and could tell there was something on his mind. I met his glance confidently and smiled slightly. He shook his head, “Do you know how dangerous this is? An entire team from Michigan was lost a few years ago. You know, I am a pilot for fun, and know a lot about aircraft. These guys are good, really good I make sure of that. You must always insist on safe transport. Never go in a prop plane and never let them take you in a helicopter.”
I took in his advice, committing it to memory. As we taxied in the darkness my mind considered the precious cargo including 2 pilots, 2 attending surgeons, 2 fellow surgeons, organ procurement specialist and myself. Then I thought of my patient that we were leaving behind, in the CCU on a balloon pump desperate for a new life. Finally, as we sped down the runway and I felt the first few bumps of flight I placed my hands on my belly and said a little prayer. To the hands of God I give the battle for life, miracle of healing and trust in His protection. The only tragedy that evening was the untimely death of our donor whose family gave the beautiful gift of life.
As the details of the accident in Florida unraveled I learned that I did not know the individuals involved. Not personally. But the event awakened the reality of how close we dance every day on the brink of life and death. Upset, I asked my husband to finish the bedtime routine and retreated to have a short conversation with my colleague. He summed it up perfectly when he said, “This job is humbling…. in so many ways.”
I heard the news through a text message from my on-call partner, interrupting me two stories into the bedtime routine with my 3 year old son. “A helicopter went down going to get a heart.” The heart transplant community is a small one, this news hit close to home. Often these procurement missions include multiple transplant teams (i.e. heart, lung and abdominal) with young surgeons in training riding along. I often send my fellows or students and have gone myself.
On a rainy night in September I drove along a narrow road on the far side of the airport. I was looking for the private hangar, and once I arrived I pulled into an empty parking lot. There was a dim light on inside so I grabbed my bag and headed for the sliding glass doors. I stood in front of the door and waved my hand but the sensor was not on. I knocked and a handsome man in a flight jacket walked over and let me in. I told him I was part of the transplant team and he looked at me skeptically. I wondered if I should have identified myself as “doctor”. I was the first one there so I sat in the waiting area and helped myself to some coffee and spiked it with hot chocolate.
The last one to arrive was our heart transplant surgeon. With the team complete we carried gear to the awaiting plane. The supplies were placed in the cargo area, but the cooler would ride with the passengers. I lifted it into the cabin, I noticed it was light and empty. As the heart transplant surgeon grabbed it from me his gaze held conspicuously on my belly. Even wearing scrubs I could not conceal the fact that I was five months pregnant. He then climbed out of the plane and practically lifted me up into my seat, he was sure that I did not miss a step.
Once we were strapped and secured into our seats I studied his face and could tell there was something on his mind. I met his glance confidently and smiled slightly. He shook his head, “Do you know how dangerous this is? An entire team from Michigan was lost a few years ago. You know, I am a pilot for fun, and know a lot about aircraft. These guys are good, really good I make sure of that. You must always insist on safe transport. Never go in a prop plane and never let them take you in a helicopter.”
I took in his advice, committing it to memory. As we taxied in the darkness my mind considered the precious cargo including 2 pilots, 2 attending surgeons, 2 fellow surgeons, organ procurement specialist and myself. Then I thought of my patient that we were leaving behind, in the CCU on a balloon pump desperate for a new life. Finally, as we sped down the runway and I felt the first few bumps of flight I placed my hands on my belly and said a little prayer. To the hands of God I give the battle for life, miracle of healing and trust in His protection. The only tragedy that evening was the untimely death of our donor whose family gave the beautiful gift of life.
As the details of the accident in Florida unraveled I learned that I did not know the individuals involved. Not personally. But the event awakened the reality of how close we dance every day on the brink of life and death. Upset, I asked my husband to finish the bedtime routine and retreated to have a short conversation with my colleague. He summed it up perfectly when he said, “This job is humbling…. in so many ways.”
Saturday, December 31, 2011
hello!
I spotted a small URL labeled "Mothers In Medicine" about a year ago, linked from the blogroll of a total stranger (as, let's admit it, most of them are...). I was excited for what can be described as only the most obvious reason - I am a physician and a mother and was looking for an online community comprised of other moms battling midnight pages and midday parent-teacher meetings.
It is difficult, for instance, to describe the emotional contortions required to function professionally in the darkest days of someone's life, then go home and play freeze tag and tea party with your children. As there are physicians who choose not to have children and mothers who choose not to work specifically to avoid having to compromise their ability to perform in the respective role of physician or mother, it could stand to reason that those of us who have decided to undertake medicine and motherhood might be doing so to the detriment of both.
And now having actually put into words my greatest insecurity - that as a doctor trying to be a good mom and a mom trying to be a good doctor I am not doing either very well - I have to say that aside from those occasional days when it seems as though I am actually being lit on fire, for the most part I am proud of my ability to do function in the two, sometimes adversarial, roles.
Or more honestly put- I am doing the best I can. I try not to think about it more than that as, by virtue of still being a trainee, there is little I can do to reshuffle my priorities. I tell myself that I am, and I hope you feel the same, one of the lucky ones - I have a career that expands my intellect and a family that expand my heart.
So it has been a pleasure to follow this blog along and occasionally submit a guest post. We don't have the same specific experiences or opinions (although I have yet to read of anyone complaining about working too little...) , but are able to build a camaraderie around the monumental experiences of medicine and motherhood.
It would be ill-advised of me to try to summarize the state of modern motherhood in medicine, so I will just say, it's really good to be here.
(And please forgive all spelling and/or grammatical errors because, as anyone who as seen anything I write knows, I truly cannot edit.)
Friday, December 30, 2011
Guest post: Being a nursing mom on the residency interview road
Editor's note: For companion reading, see my op-ed column "America, get over breastfeeding hangups" from Tuesday's USA TODAY.
I have been blessed to be on maternity-leave since 3 weeks before my due date. My days as a new mommy consist of nursing, diaper changes, cuddling, singing, reading, video chat dates with my distant new mommy friends, sending daily pictures and and videos to my husband and Lil Zo's grandparents, and phone calls with my family. Similar to most other mothers, I chose breastfeeding as the method of feeding our baby in the prenatal period. I knew it was the best thing for Lil Zo, but after consulting several breastfeeding friends, I also knew that it would have its challenges. Thankfully, I delivered at a breastfeeding-friendly hospital and Lil Zo nursed successfully within minutes of our natural delivery. The feeling was bittersweet, I was excited that he’d latched but it was uncomfortable. His latch was perfect but it still hurt for at least a week as my nipples became accustomed to his vigorous sucking. In the neonatal period, he lost a few ounces, but quickly regained them with on-demand (often hourly) nursing for his first few weeks (I am soo glad that phase is over, growth spurts are an entirely other issue).
Now, at 11 weeks old, he and I have had a great time getting into our rhythm and he has even begun taking an occasional bottle from my husband when I am out running errands. Interview season threw a wrench in our well-oiled machine. The weeks before my interviews began, I looked at my freezer milk stock and began to freak out. How much milk would he need? What would happen if I had to supplement? Would his sitter understand how to prepare the milk? After consulting a very nice woman with the La Leche League, I knew how much milk he would probably need. Thankfully, my family has been able to watch him and I haven’t had to rely on strangers.
Based upon the wonderful advice of the Pediatric Clerkship Coordinator at my home institution, I called each of my interview locations 3 weeks prior to my interviews to inquire about pumping facilities. Pediatrics is awesome!!! Everyone was very helpful and my worries about being a bother were quickly dismissed. Thankfully my furthest interview was only 4 hours away and my husband was able to accompany me. Armed with my handy Medela Pump in Style and my briefcase, I began each day discussing pumping times with the interview coordinators. Although I wasn’t able to pump every 3 hours as is recommended, I was able to pump in the car on the way to and from the interviews, once in the morning, and once in the afternoon. My time pumping was also a nice chance to reflect on my interview day and have a brief break from smiling incessantly and coming up with impromptu questions. Thankfully, Lil Zo didn’t require any formula and remains an exclusively breastfed baby.
In my humble opinion, UNC Chapel Hill had the best pumping facilities. The Resident Call Suite provided a private room with comfortable chairs, a desk, and a sink. It was nice to be somewhat removed from the main interview location and to not have the Residency Director on the opposite side of a thin wall. I am indebted to the many Attendings that I affectionately referred to as my “Pumping Godmothers” (note: I did this in my head and would never, ever tell them) who let me know that they too had had to pump during interviews, training, and now daily as they provided the optimal nutrition to their newborns.
Now that I’ve completed my first full days of pumping, I realize how difficult it must be for full-time working mothers especially during residency. What has your experience been? Are there any breastfeeding medical students, residents, or attendings who were able to exclusively breastfeed through the 1 year mark?
Mommabee is an upperclass Medical Student at a mid-Atlantic medical school who is interested in community-based Pediatrics and has a background in public health. Lil Zo is her first child.
I have been blessed to be on maternity-leave since 3 weeks before my due date. My days as a new mommy consist of nursing, diaper changes, cuddling, singing, reading, video chat dates with my distant new mommy friends, sending daily pictures and and videos to my husband and Lil Zo's grandparents, and phone calls with my family. Similar to most other mothers, I chose breastfeeding as the method of feeding our baby in the prenatal period. I knew it was the best thing for Lil Zo, but after consulting several breastfeeding friends, I also knew that it would have its challenges. Thankfully, I delivered at a breastfeeding-friendly hospital and Lil Zo nursed successfully within minutes of our natural delivery. The feeling was bittersweet, I was excited that he’d latched but it was uncomfortable. His latch was perfect but it still hurt for at least a week as my nipples became accustomed to his vigorous sucking. In the neonatal period, he lost a few ounces, but quickly regained them with on-demand (often hourly) nursing for his first few weeks (I am soo glad that phase is over, growth spurts are an entirely other issue).
Now, at 11 weeks old, he and I have had a great time getting into our rhythm and he has even begun taking an occasional bottle from my husband when I am out running errands. Interview season threw a wrench in our well-oiled machine. The weeks before my interviews began, I looked at my freezer milk stock and began to freak out. How much milk would he need? What would happen if I had to supplement? Would his sitter understand how to prepare the milk? After consulting a very nice woman with the La Leche League, I knew how much milk he would probably need. Thankfully, my family has been able to watch him and I haven’t had to rely on strangers.
Based upon the wonderful advice of the Pediatric Clerkship Coordinator at my home institution, I called each of my interview locations 3 weeks prior to my interviews to inquire about pumping facilities. Pediatrics is awesome!!! Everyone was very helpful and my worries about being a bother were quickly dismissed. Thankfully my furthest interview was only 4 hours away and my husband was able to accompany me. Armed with my handy Medela Pump in Style and my briefcase, I began each day discussing pumping times with the interview coordinators. Although I wasn’t able to pump every 3 hours as is recommended, I was able to pump in the car on the way to and from the interviews, once in the morning, and once in the afternoon. My time pumping was also a nice chance to reflect on my interview day and have a brief break from smiling incessantly and coming up with impromptu questions. Thankfully, Lil Zo didn’t require any formula and remains an exclusively breastfed baby.
In my humble opinion, UNC Chapel Hill had the best pumping facilities. The Resident Call Suite provided a private room with comfortable chairs, a desk, and a sink. It was nice to be somewhat removed from the main interview location and to not have the Residency Director on the opposite side of a thin wall. I am indebted to the many Attendings that I affectionately referred to as my “Pumping Godmothers” (note: I did this in my head and would never, ever tell them) who let me know that they too had had to pump during interviews, training, and now daily as they provided the optimal nutrition to their newborns.
Now that I’ve completed my first full days of pumping, I realize how difficult it must be for full-time working mothers especially during residency. What has your experience been? Are there any breastfeeding medical students, residents, or attendings who were able to exclusively breastfeed through the 1 year mark?
Mommabee is an upperclass Medical Student at a mid-Atlantic medical school who is interested in community-based Pediatrics and has a background in public health. Lil Zo is her first child.
Wednesday, December 28, 2011
Love of Reading
I've loved to read ever since I was a kid. When I was eight years old, I discovered The Baby-sitters Club, which I'm embarrassed to admit sucked me in and got me reading regularly. In grade school, I read like crazy.... kids books, adult books, whatever someone recommended to me and I could get my hands on. One time I read three library books in one day. It was my passion.
As I got to high school and both my school workload and my social life picked up, I didn't read as much. In college, I mostly read the books I was assigned in class. (Some of which were great... that's how I discovered Jane Eyre.)
When I got to medical school, I made a conscious decision: I wasn't going to read for fun anymore. I felt that if I was reading something, it ought to be related to my medical education. So I quit reading for eight years. It didn't feel like that big a sacrifice because I hadn't read something I really enjoyed in a while.
Then in my last year of residency, KC asked if any of us could review a book for this blog. I volunteered, and when I read the book, I remembered how much I used to enjoy reading. So I started up again.
Recently, I was reading an article about a woman who read a book a day for a year. This is not something I could ever do, for many, many reasons. Just reading the article brought on a bit of an eyestrain headache (I take frequent breaks to avoid this). But I was inspired by this woman's quest, and how her love of reading inspired a love of reading in her children. My daughter recently observed me reading and said, "How come you're not saying the words out loud?" Then she seized my book and pretended to read it herself. (This is why I don't own a Kindle.)
There's truly nothing like getting lost in a good book. Unfortunately, I've had to wade through some junk, but it's worth it for the good ones. I also joined a book club that's inspired me to read some stuff I wouldn't have read otherwise (e.g. The Help, best book of the year).
I haven't exactly read 365 books a year, but I've been keeping a reading list linked off my blog and it looks like I've read 43 books this year. I always keep a book next to me for when the baby falls asleep while nursing. If reading is something you love, you can always make time for it.
As I got to high school and both my school workload and my social life picked up, I didn't read as much. In college, I mostly read the books I was assigned in class. (Some of which were great... that's how I discovered Jane Eyre.)
When I got to medical school, I made a conscious decision: I wasn't going to read for fun anymore. I felt that if I was reading something, it ought to be related to my medical education. So I quit reading for eight years. It didn't feel like that big a sacrifice because I hadn't read something I really enjoyed in a while.
Then in my last year of residency, KC asked if any of us could review a book for this blog. I volunteered, and when I read the book, I remembered how much I used to enjoy reading. So I started up again.
Recently, I was reading an article about a woman who read a book a day for a year. This is not something I could ever do, for many, many reasons. Just reading the article brought on a bit of an eyestrain headache (I take frequent breaks to avoid this). But I was inspired by this woman's quest, and how her love of reading inspired a love of reading in her children. My daughter recently observed me reading and said, "How come you're not saying the words out loud?" Then she seized my book and pretended to read it herself. (This is why I don't own a Kindle.)
There's truly nothing like getting lost in a good book. Unfortunately, I've had to wade through some junk, but it's worth it for the good ones. I also joined a book club that's inspired me to read some stuff I wouldn't have read otherwise (e.g. The Help, best book of the year).
I haven't exactly read 365 books a year, but I've been keeping a reading list linked off my blog and it looks like I've read 43 books this year. I always keep a book next to me for when the baby falls asleep while nursing. If reading is something you love, you can always make time for it.
Thursday, December 22, 2011
The 20 Stages of Pregnancy
1: Disbelief
"How did what we did that other night create a human life? Is that possible?"
2: Panic
"OMG, how am I going to manage a whole other person?"
3: Denial
"I'll bet my period will come any day now. 30% of pregnancies end in miscarriage."
4: Panic 2
"Oh no! I'm spotting! What if I lose the baby??!!"
5: Fatigue
"I'm so tired all the time. How am I going to manage a whole other person?"
6: Discovery
"Maternity clothes are so cute! Even I look good in them. And I love my Bella Band."
7: Emerging love:
"Aw, she's hiccupping. That's so cute. I love her."
8: Acceptance
"Pregnancy isn't bad at all! I kind of like it! And I get to eat everything I want!"
9: Anxiety:
"Oh god, I'm gaining too much weight. I need to stop eating everything I want."
10: Panic 3:
"I don't feel the baby moving. When I last feel her move? Oh god, oh god. I'm going to press on my stomach and bother her till she moves."
11: Weariness
"For the millionth time, it's a girl, and yes, I AM tired. Should I wear a sign on my chest?"
12: Disgust:
"Look at my giant belly. Nobody will ever find me attractive again."
13: Living it up:
"Let's go out to dinner since we won't be able to do it once the baby comes. Let's see a movie too. An R-rated movie."
14: Dread:
"I won't be able to do anything once the baby comes. This is so depressing. Why did I destroy my life this way? Things were so good before."
15: Cuteness overload
"Lookit these teeny baby clothes! So cute! I can't believe I'm going to have something teeny enough to fit into these teeny clothes!"
16: Fear:
"What if I need a C-section? What if the epidural doesn't wear off? Labor is going to hurt a lot, isn't it?"
17: Weariness 2:
"This baby needs to come out of me RIGHT NOW. I literally can't stand it another minute. I'm going to have sex, eat a jalapeno, and jump up and down till I give birth."
18: Nesting:
"OK, I'm finished cleaning the entire house, assembling the crib, and painting the baby's room. Now I'm going to finish writing my novel."
19: Acceptance 2
"You know what? Whatever happens, I'm good. The baby can come any time she likes."
20: Panic 4:
"Oh no, I'm going into labor! I'm not ready! This is going to HURT!!!!"
"How did what we did that other night create a human life? Is that possible?"
2: Panic
"OMG, how am I going to manage a whole other person?"
3: Denial
"I'll bet my period will come any day now. 30% of pregnancies end in miscarriage."
4: Panic 2
"Oh no! I'm spotting! What if I lose the baby??!!"
5: Fatigue
"I'm so tired all the time. How am I going to manage a whole other person?"
6: Discovery
"Maternity clothes are so cute! Even I look good in them. And I love my Bella Band."
7: Emerging love:
"Aw, she's hiccupping. That's so cute. I love her."
8: Acceptance
"Pregnancy isn't bad at all! I kind of like it! And I get to eat everything I want!"
9: Anxiety:
"Oh god, I'm gaining too much weight. I need to stop eating everything I want."
10: Panic 3:
"I don't feel the baby moving. When I last feel her move? Oh god, oh god. I'm going to press on my stomach and bother her till she moves."
11: Weariness
"For the millionth time, it's a girl, and yes, I AM tired. Should I wear a sign on my chest?"
12: Disgust:
"Look at my giant belly. Nobody will ever find me attractive again."
13: Living it up:
"Let's go out to dinner since we won't be able to do it once the baby comes. Let's see a movie too. An R-rated movie."
14: Dread:
"I won't be able to do anything once the baby comes. This is so depressing. Why did I destroy my life this way? Things were so good before."
15: Cuteness overload
"Lookit these teeny baby clothes! So cute! I can't believe I'm going to have something teeny enough to fit into these teeny clothes!"
16: Fear:
"What if I need a C-section? What if the epidural doesn't wear off? Labor is going to hurt a lot, isn't it?"
17: Weariness 2:
"This baby needs to come out of me RIGHT NOW. I literally can't stand it another minute. I'm going to have sex, eat a jalapeno, and jump up and down till I give birth."
18: Nesting:
"OK, I'm finished cleaning the entire house, assembling the crib, and painting the baby's room. Now I'm going to finish writing my novel."
19: Acceptance 2
"You know what? Whatever happens, I'm good. The baby can come any time she likes."
20: Panic 4:
"Oh no, I'm going into labor! I'm not ready! This is going to HURT!!!!"
Wednesday, December 21, 2011
Oh, No! Mr. Elf!
I am sure you have heard of the Elf on the Shelf, haven't you? I have, and have been avoiding him for years. I first heard of him from my sister in Atlanta - the book/concept was published in Georgia, I believe, a few years ago - it took that state by storm. I vaguely understood the concept - that there was a tiny elf that moved around in the middle of the night, occasionally causing mischief and mayhem ("The boys were so surprised to find cereal all over the floor! Underwear on the Christmas tree!"). He reported back to Santa about how the kids were behaving. Kids were not allowed to touch him, only adults, or the magic would be gone. I am sure I am partially murdering the concept, having not read the book myself. To me it sounded like one other thing to have to worry about doing during the Christmas season, as if there wasn't already enough.
Then, this fall, at the kids new school, the author of Elf on the Shelf paid a visit one day. I got advance notice in the kid's folders with an order form. They were so excited, I would have been Scrooge not to have gotten them each one ("There has to be one at Dad's house, too!"). So I buckled, bowing to the marketing genius of the mother-daughter traveling team.
I struggled the first few days of December, but the kids were enamored. "Let's call him Fisbee!" At first I just moved him around at night and the kids delighted in who could find him first in the morning. But they wondered about the mischief, so I concocted various ways to make him devilish in the middle of the night. He made a mess with the cat food. He sprinkled glitter on the dining room table and hung from the chandelier. Despite their enthusiasm, they became a little scared, I think. Ce-silly took to closing her bedroom door at night, citing her fear of Fisbee walking around in the night while she was sleeping. Jack worried that the elf would abscond with his favorite possession, his itouch. I reassured them both, and wondered aloud if I should send the elf back to the North Pole. "No, mom, he's scary but he's really cool." Jack started to invent mischief based on his morning observations - "Look, he broke an ornament!" I replied, "No, dear, I don't think he is mean, I think that was our cat, Katybell. It was an accident."
I think a lot of parents use the idea of the Elf on the Shelf in an Orwellian Big Brother fashion, but my parents never did this to us with Santa, and I was reluctant to do the same. I believe one should be good for the benefit of fellow mankind, not to appease someone in fear of retribution or punishment. Ce-Silly took to writing messages to our Fisbee at night, and I responded in early morning fog, feeling like I was becoming her best elf friend or on an elf date. "What is your favorite food? What is your favorite color? Do you have a girlfriend? Will you please be 'notty' every night - Don't worry, I won't let my mom get mad at you." I resisted the temptation to reply with broccoli and black soot, cheerily proclaiming peppermints and eggnog and bright red - answers I thought would be popular with the kids. I told her I was too young to have a girlfriend. I told her of course I knew her classroom elf Pinecone and her library elf Snowflake - we all went to elf school together, and she was delighted to tell her friends the next day.
My "notty" (Ce-silly's adorable spelling) ideas were fading fast, so I was delighted one day to get a text from a friend of an elf making a snow angel. That morning, I covered the breakfast table with flour and left Fisbee in the middle, making a beautiful flour angel. The kids were so excited they took pictures with their itouches. I think Jack took 50 while I was cooking breakfast. That's when I decided this was worth it. It was making our lives fun. That day, I googled Elf on the Shelf ideas and was flooded with pictures on the internet of elven antics, for which I was eternally grateful. Elves battling superhero figures with marshmallows over Lego forts. I think I botched that one a little - maybe it was because we are from the South and my kids don't know about snowball fights or maybe it was because I used a tissue box and a snowman decoration instead of Legos and action figures, but they still enjoyed eating morning marshmallows. There were also elves ditching the stockings and putting underwear on the hangers - they got a big kick out of that one. Thank goodness for the internet.
One early morning I was staging a scene I had seen online of an elf fishing out of the toilet with a candy cane, ribbon, and goldfish. I was sure the crackers would dissolve into an unrecognizable shape by the time the kids got up in a couple of hours, so I grabbed a plastic witch finger left over from Halloween and tied it to the ribbon instead, to float in the toilet. While I was staging my "notty" scene, the elf fell into the toilet. Suddenly I was reminded of that old Saturday Night Live skit - Mr. Bill. "Oh No!" Since then, I have been staging "notty" tragicomedies in my head for Mr. Elf - getting singed in the fireplace while roasting marshmallows, electrocuted while watering the Christmas tree, it is getting a little ridiculous, actually. And a little black for elementary school children, but perfect, I decided, for lulling sullen teenagers out of their self-absorbed miserable states. I've got a few years of scenario dreaming on my side for that one. In the meantime, Merry Christmas to all and I would love to hear any elf suggestions, G-rated for the present or otherwise for the future. Whether you partake in this madness or not, all comments are welcome.
Saturday, December 17, 2011
Welcome to Career Topic Week
Welcome to Career Topic Week on Mothers in Medicine! Posts by our regular contributors and readers on specialty choice will be scheduled to post throughout the week. Thanks for reading.
Scroll down below to see the posts...
Scroll down below to see the posts...
Pediatrics is kids and family
How could I have almost passed up the opportunity to post on topic week about a family friendly career? Perhaps because this week I baked for the kids’ school pot luck and bought gifts for their amazing after school counselors and am working on a grand rounds and revising and resubmitting a paper and tweaking the students’ syllabus and conducting meetings with…
All that, and yet pediatrics, the career, is kids and their families. And as such it could not be more supportive of pediatricians raising theirs. Lots of opportunities for part time work, though I have remained full time with enough of “protected” time for non-clinical but otherwise scholarly work, where much of the flexibility is built in.
I aim to be a serious academic and medical educator (albeit still with appropriate levity with my pediatric patients) but at my own pace. After a few “wins” (first grant, first publication, first leadership role) you can pace yourself, pick and choose things (still say yes to almost everything but learn to say an occasional no) in academia. And grow to be a mentor to others.
And all the while my pediatric colleagues have to understand things like pumping, breastfeeding, being called to get your son from daycare, fevers, falls, school performances, and sports events because this is the stuff of outpatient pediatrics. It happens in our lives as mothers (and fathers) in medicine as it happens in the lives of our patients. When I returned from parental leave after 16 weeks the second time around, squeezing in pumping and speeding to daycare pickups, I reassured my boss that that was the last baby for me, and he told me to have as many as I wanted. That was a breath of fresh air (and the legal thing to say), and it was sincere. I continue to have all my patients as “my kids” plus the two of my own, and that is the right number for me in my very full time pediatric parenting career/life.
I think a side benefit of pediatrics as family friendly is it helps in child rearing. You learn the tips, the things we parents struggle with, you read the latest on development, and you can even draw upon your job when you minimize your kids’ screen time, ensure they brush their teeth, buckle up, among other less obvious things. I have nearly said to my children, “If your parents weren’t pediatricians then maybe you could eat that hotdog while playing with matches and then take a ride in the front seat, but….” Furthermore, my children hear me take call by phone some evenings or weekends for our outpatient community-based academic pediatric practice and have nearly become mini-pediatricians themselves. Even though they’ll probably be a rock star (say, Elvis) and an artist (she who draws mostly mermaids).
I didn’t choose pediatrics because I thought it would be family friendly, but much to my joy and satisfaction, in most cases it can be and has been.
All that, and yet pediatrics, the career, is kids and their families. And as such it could not be more supportive of pediatricians raising theirs. Lots of opportunities for part time work, though I have remained full time with enough of “protected” time for non-clinical but otherwise scholarly work, where much of the flexibility is built in.
I aim to be a serious academic and medical educator (albeit still with appropriate levity with my pediatric patients) but at my own pace. After a few “wins” (first grant, first publication, first leadership role) you can pace yourself, pick and choose things (still say yes to almost everything but learn to say an occasional no) in academia. And grow to be a mentor to others.
And all the while my pediatric colleagues have to understand things like pumping, breastfeeding, being called to get your son from daycare, fevers, falls, school performances, and sports events because this is the stuff of outpatient pediatrics. It happens in our lives as mothers (and fathers) in medicine as it happens in the lives of our patients. When I returned from parental leave after 16 weeks the second time around, squeezing in pumping and speeding to daycare pickups, I reassured my boss that that was the last baby for me, and he told me to have as many as I wanted. That was a breath of fresh air (and the legal thing to say), and it was sincere. I continue to have all my patients as “my kids” plus the two of my own, and that is the right number for me in my very full time pediatric parenting career/life.
I think a side benefit of pediatrics as family friendly is it helps in child rearing. You learn the tips, the things we parents struggle with, you read the latest on development, and you can even draw upon your job when you minimize your kids’ screen time, ensure they brush their teeth, buckle up, among other less obvious things. I have nearly said to my children, “If your parents weren’t pediatricians then maybe you could eat that hotdog while playing with matches and then take a ride in the front seat, but….” Furthermore, my children hear me take call by phone some evenings or weekends for our outpatient community-based academic pediatric practice and have nearly become mini-pediatricians themselves. Even though they’ll probably be a rock star (say, Elvis) and an artist (she who draws mostly mermaids).
I didn’t choose pediatrics because I thought it would be family friendly, but much to my joy and satisfaction, in most cases it can be and has been.
Friday, December 16, 2011
OB/GYN: It was the Best of Times. It was the Worst of Times.
How is your specialty family friendly?
While OB/GYN has the reputation for being notoriously NOT family friendly, I have tried to shape my practice to make it at least ‘family manageable’. I know many of our contributors have found balance in academics, for me private practice has made more sense. I own my practice (with 4 other moms); so I can make my schedule somewhat flexible. I work 4 days a week and am on call ¼ of the time. I attempt to plan ahead to take off for my kids plays and special events. Having privileges at just one hospital prevents the added stress of laboring women at two different places. My office which is attached to my hospital is 10 minutes away { make that Seven minutes at 3 am when I am driving the Camero} from my home.
OB/GYN is a field where it is advantageous to be a woman. In general, women prefer to have female OB/GYNs, making it easier to build up your practice. Additionally as a fellow mom, you have an added layer of bonding to your patients. I’ve had morning sickness, stretch marks and sleepless nights with a fussy baby. I think this gives me a level of empathy that most patients appreciate.
Being family friendly goes both ways, though. I have a partner who is due this spring, so I will be working extra to help her while she is out, much as she helped me a couple years ago to take time off when we adopted our son.
The down side to private practice is that it makes it difficult to take an extended leave. We have 20 employees, rent, malpractice, insurance and a variety of other bills that must be paid monthly. So, taking a maternity leave of longer than 6 weeks is financially difficult. Going part time would not be a possibility for me. Also, being a small business owner adds a level of stress to your life: meetings with accountants, minimizing overhead, marketing. This are all concerns that must be added to the ‘to do’ list. We don’t have many business classes in medical school, so it’s mostly learn as you go.
I realize that are there are busy seasons and slower seasons. The fall is crazy. Everyone has babies {curse you snow storms from last winter!}. The surgeries that patients have been putting off all year that are suddenly emergencies now that they have met their deductibles. I know I will have to work more in the fall, but this fourth quarter revenue will help cover my overhead during the lean first quarter months. I plan extra days off with my family during January and February when things are already slower.
At times I miss being in an academic center and teaching medical students. I think that is part of the reason I blog/write is to help fill my desire to teach. At the end of the day I think the autonomy of private practice empowers me to help make my crazy job more family friendly.
What I didn’t realize about OB/GYN until I was in the thick of it:
Being up all night does not get any easier over the years. Yes, it’s part of the job. I accept that and try not to complain, but really it stinks. Leaving your cozy bed at 1 am to drive in the cold to the hospital, then work the entire next day, then come home to tend to the children…. Not easy.
Dealing with loss is emotionally draining. Miscarriage, stillbirth and infertility are truly heartbreaking issues. OB is thought of as a happy healthy specialty, but when things are bad they are often horrific. I recently had a patient that conceived spontaneously, after 10 years of infertility treatments, who then experienced a term stillbirth. There is perhaps, no worse place to be in the entire world, than a baby’s funeral. The emotional toll of this profession can be immense.
Being the bearer of bad news stinks. Probably at least once a week, I tell a nice married lady with a couple of kids that she has a STD. In doing this I am usually telling her that her husband has been unfaithful. This is often completely unexpected and extremely painful. Often I sit with a box of Kleenex, listening to her cry for as long as tears flow. I become more her therapist than gynecologist.
Is it worth it?
I’m in my seventh year of practice and I still absolutely love what I do. It’s never boring. I’ve delivered 8 babies in the last 3 days (that’s why I’m late getting this post done…. Sorry KC); I am bone tired. But even as I write this, I can’t help but smile at the joy that helping bring life into this world gives me. I truly feel like I am making a difference in people’s lives. You can be a workaholic in any field or any specialty and every specialty has its unique challenges. But if you love OB/GYN and are willing to count the costs, then there are ways to make it more manageable for your family.
While OB/GYN has the reputation for being notoriously NOT family friendly, I have tried to shape my practice to make it at least ‘family manageable’. I know many of our contributors have found balance in academics, for me private practice has made more sense. I own my practice (with 4 other moms); so I can make my schedule somewhat flexible. I work 4 days a week and am on call ¼ of the time. I attempt to plan ahead to take off for my kids plays and special events. Having privileges at just one hospital prevents the added stress of laboring women at two different places. My office which is attached to my hospital is 10 minutes away { make that Seven minutes at 3 am when I am driving the Camero} from my home.
OB/GYN is a field where it is advantageous to be a woman. In general, women prefer to have female OB/GYNs, making it easier to build up your practice. Additionally as a fellow mom, you have an added layer of bonding to your patients. I’ve had morning sickness, stretch marks and sleepless nights with a fussy baby. I think this gives me a level of empathy that most patients appreciate.
Being family friendly goes both ways, though. I have a partner who is due this spring, so I will be working extra to help her while she is out, much as she helped me a couple years ago to take time off when we adopted our son.
The down side to private practice is that it makes it difficult to take an extended leave. We have 20 employees, rent, malpractice, insurance and a variety of other bills that must be paid monthly. So, taking a maternity leave of longer than 6 weeks is financially difficult. Going part time would not be a possibility for me. Also, being a small business owner adds a level of stress to your life: meetings with accountants, minimizing overhead, marketing. This are all concerns that must be added to the ‘to do’ list. We don’t have many business classes in medical school, so it’s mostly learn as you go.
I realize that are there are busy seasons and slower seasons. The fall is crazy. Everyone has babies {curse you snow storms from last winter!}. The surgeries that patients have been putting off all year that are suddenly emergencies now that they have met their deductibles. I know I will have to work more in the fall, but this fourth quarter revenue will help cover my overhead during the lean first quarter months. I plan extra days off with my family during January and February when things are already slower.
At times I miss being in an academic center and teaching medical students. I think that is part of the reason I blog/write is to help fill my desire to teach. At the end of the day I think the autonomy of private practice empowers me to help make my crazy job more family friendly.
What I didn’t realize about OB/GYN until I was in the thick of it:
Being up all night does not get any easier over the years. Yes, it’s part of the job. I accept that and try not to complain, but really it stinks. Leaving your cozy bed at 1 am to drive in the cold to the hospital, then work the entire next day, then come home to tend to the children…. Not easy.
Dealing with loss is emotionally draining. Miscarriage, stillbirth and infertility are truly heartbreaking issues. OB is thought of as a happy healthy specialty, but when things are bad they are often horrific. I recently had a patient that conceived spontaneously, after 10 years of infertility treatments, who then experienced a term stillbirth. There is perhaps, no worse place to be in the entire world, than a baby’s funeral. The emotional toll of this profession can be immense.
Being the bearer of bad news stinks. Probably at least once a week, I tell a nice married lady with a couple of kids that she has a STD. In doing this I am usually telling her that her husband has been unfaithful. This is often completely unexpected and extremely painful. Often I sit with a box of Kleenex, listening to her cry for as long as tears flow. I become more her therapist than gynecologist.
Is it worth it?
I’m in my seventh year of practice and I still absolutely love what I do. It’s never boring. I’ve delivered 8 babies in the last 3 days (that’s why I’m late getting this post done…. Sorry KC); I am bone tired. But even as I write this, I can’t help but smile at the joy that helping bring life into this world gives me. I truly feel like I am making a difference in people’s lives. You can be a workaholic in any field or any specialty and every specialty has its unique challenges. But if you love OB/GYN and are willing to count the costs, then there are ways to make it more manageable for your family.
It's Not Rocket Science...
...but it is brain surgery! Neurosurgery has always seemed to have a certain aura and mystique about it as a specialty. It certainly was glamorous to me when I started out as a medical student. After all, neurosurgeons work in and around the brain, the seat of our very existence. In fact, we work more often on the spine than the brain, but nonetheless, we are "brain surgeons."
I was one of those annoying medical school classmates who started from Day 1 wanting to do neurosurgery, and who continued that path relentlessly, without second thoughts. Having walked the long and difficult road, I will say unequivocally that it is in NO WAY family friendly. It's hard to think of a less family friendly specialty. That's one reason why, even today, only 5% of about 3500 practicing neurosurgeons in the US are women.
There are oodles, scads, of reasons why this is the case.
1. Long and difficult training: Residency is an average of 7 years duration (usually not counting fellowship). Even so, it is hard to learn everything you need to know: patient evaluation, types of pathology, technical skills, reading your own radiographic studies, etc. The days are long and exhausting. I don't know how it is now, since the 80 hour work week, but I suspect it's still very demanding. It's difficult to carve out time and energy for your family. It's also hard to be pregnant during residency, the prime child bearing years.
2. Lots of emergencies: Problems like acute brain hemorrhages and cauda equina syndromes can't wait. In fact, sometimes half an hour makes all the difference. This makes planning your day impossible. As soon as you make plans to go out to the theater with your husband or go to your son's football game, the surgery gods conjure up a subdural. Curse you, surgery gods!
3. Unsympathetic colleagues: This specialty is full of men with stay at home wives who do everything for them. Nothing against SAHM's!! But don't expect your fellow residents or partners to understand taking breaks for breastfeeding. Don't expect them to help you in any way, because they have NO IDEA what your life is like outside work.
4. All or none: There is no such thing as a part time neurosurgeon. Trust me, I've seen it tried.
5. Physically demanding: This specialty demands long hours standing without a break. The sleep deprivation and stress are extremely taxing. Even after residency, there are times when you are so tired that you can't decide whether to eat or sleep first. This is after 24+ hours without a proper meal. Sex? Sleep is better when you haven't slept for 2 days! Add a crying baby to the nights you are home...
6. Culture: In neurosurgery, asking for any help is a sign of weakness. Call me if you need me... but don't call me. This culture is not conducive to supporting things like maternity leave.
7. Help wanted: Out in practice, when most of us are rearing teenagers, it would be great to have lots of partners to share call and PAs to help with the workload. Good luck with that. There is a chronic shortage of neurosurgeons; the ones that exist are difficult to recruit. It took us 4 years to find one to replace a partner who left. PAs are in high demand and would much rather take cushy dermatology jobs than difficult neurosurgical ones. I currently take call every 4th night and consider myself lucky.
8. Social isolation: I didn't expect this to be such a problem. Nonetheless, it has a large effect on our social life as a family. We don't get invited places because friends think I'm too busy. (Or maybe they just secretly don't like me, but this is what they tell me!) At church and school functions, people don't chat with us, they ask me about their aunt's brain tumor treatment. Even neurosurgeons like to talk about the weather and the upcoming football game, y'all!
So having said all that, you may well ask: "Why would anyone ever want to do this awful job?!"
There are oodles of reasons for that, too.
1. It's surgery! How could anyone not love doing surgery? I've said it before... fixing a problem by opening the body and closing it again, and having the patient survive the experience, is nothing short of a miracle to me. It still amazes me after 10 years of practice.
2. Control: As an extreme Type A, I love controlling everything about what I do. I own my practice with my partners, so I am my own boss. What I say in the OR and in the office, goes. My own decisions and actions determine my patients' outcomes, and that's the way I want it.
3. Impact: Every day, I see patients with life-threatening problems. Through my profession, I am able to save lives and keep people out of wheelchairs. Being able to make a real difference in just one person's life makes it all worthwhile. In neurosurgery, that impact on the patient is so often immediate and dramatic. It's high risk, but high reward.
4. Respect: This specialty still commands immense respect, both from patients and colleagues. Not that we deserve more respect than other professions, but there it is.
5. Financial security: It's still a good living, although politics may change that in years to come. Not having to always worry about money is one less strain on a marriage. Further, a neurosurgeon can always provide for herself and her kids should that become necessary.
6. The Challenge: This may be the thing I love most about my job. Every day, every patient, every case brings a new challenge. There are always new things to learn, envelopes to push. I never get bored or complacent, because it's just not possible. Towards the end of residency, I once thought I'd seen it all. Later that day, the nurse at the trauma desk popped her head up to ask, "Hey, are you seeing the guy that got assaulted by the ostrich?!" Never a dull moment!
I love neurosurgery and can't imagine doing anything else. Family friendly? Nooooo. Worth it? Yes! It can be done, although it's not easy. As others here have pointed out, no working mom has an easy time of it. All we can do as MiM's is give it our best and hope that the ones we love understand us and continue to love us back.
I was one of those annoying medical school classmates who started from Day 1 wanting to do neurosurgery, and who continued that path relentlessly, without second thoughts. Having walked the long and difficult road, I will say unequivocally that it is in NO WAY family friendly. It's hard to think of a less family friendly specialty. That's one reason why, even today, only 5% of about 3500 practicing neurosurgeons in the US are women.
There are oodles, scads, of reasons why this is the case.
1. Long and difficult training: Residency is an average of 7 years duration (usually not counting fellowship). Even so, it is hard to learn everything you need to know: patient evaluation, types of pathology, technical skills, reading your own radiographic studies, etc. The days are long and exhausting. I don't know how it is now, since the 80 hour work week, but I suspect it's still very demanding. It's difficult to carve out time and energy for your family. It's also hard to be pregnant during residency, the prime child bearing years.
2. Lots of emergencies: Problems like acute brain hemorrhages and cauda equina syndromes can't wait. In fact, sometimes half an hour makes all the difference. This makes planning your day impossible. As soon as you make plans to go out to the theater with your husband or go to your son's football game, the surgery gods conjure up a subdural. Curse you, surgery gods!
3. Unsympathetic colleagues: This specialty is full of men with stay at home wives who do everything for them. Nothing against SAHM's!! But don't expect your fellow residents or partners to understand taking breaks for breastfeeding. Don't expect them to help you in any way, because they have NO IDEA what your life is like outside work.
4. All or none: There is no such thing as a part time neurosurgeon. Trust me, I've seen it tried.
5. Physically demanding: This specialty demands long hours standing without a break. The sleep deprivation and stress are extremely taxing. Even after residency, there are times when you are so tired that you can't decide whether to eat or sleep first. This is after 24+ hours without a proper meal. Sex? Sleep is better when you haven't slept for 2 days! Add a crying baby to the nights you are home...
6. Culture: In neurosurgery, asking for any help is a sign of weakness. Call me if you need me... but don't call me. This culture is not conducive to supporting things like maternity leave.
7. Help wanted: Out in practice, when most of us are rearing teenagers, it would be great to have lots of partners to share call and PAs to help with the workload. Good luck with that. There is a chronic shortage of neurosurgeons; the ones that exist are difficult to recruit. It took us 4 years to find one to replace a partner who left. PAs are in high demand and would much rather take cushy dermatology jobs than difficult neurosurgical ones. I currently take call every 4th night and consider myself lucky.
8. Social isolation: I didn't expect this to be such a problem. Nonetheless, it has a large effect on our social life as a family. We don't get invited places because friends think I'm too busy. (Or maybe they just secretly don't like me, but this is what they tell me!) At church and school functions, people don't chat with us, they ask me about their aunt's brain tumor treatment. Even neurosurgeons like to talk about the weather and the upcoming football game, y'all!
So having said all that, you may well ask: "Why would anyone ever want to do this awful job?!"
There are oodles of reasons for that, too.
1. It's surgery! How could anyone not love doing surgery? I've said it before... fixing a problem by opening the body and closing it again, and having the patient survive the experience, is nothing short of a miracle to me. It still amazes me after 10 years of practice.
2. Control: As an extreme Type A, I love controlling everything about what I do. I own my practice with my partners, so I am my own boss. What I say in the OR and in the office, goes. My own decisions and actions determine my patients' outcomes, and that's the way I want it.
3. Impact: Every day, I see patients with life-threatening problems. Through my profession, I am able to save lives and keep people out of wheelchairs. Being able to make a real difference in just one person's life makes it all worthwhile. In neurosurgery, that impact on the patient is so often immediate and dramatic. It's high risk, but high reward.
4. Respect: This specialty still commands immense respect, both from patients and colleagues. Not that we deserve more respect than other professions, but there it is.
5. Financial security: It's still a good living, although politics may change that in years to come. Not having to always worry about money is one less strain on a marriage. Further, a neurosurgeon can always provide for herself and her kids should that become necessary.
6. The Challenge: This may be the thing I love most about my job. Every day, every patient, every case brings a new challenge. There are always new things to learn, envelopes to push. I never get bored or complacent, because it's just not possible. Towards the end of residency, I once thought I'd seen it all. Later that day, the nurse at the trauma desk popped her head up to ask, "Hey, are you seeing the guy that got assaulted by the ostrich?!" Never a dull moment!
I love neurosurgery and can't imagine doing anything else. Family friendly? Nooooo. Worth it? Yes! It can be done, although it's not easy. As others here have pointed out, no working mom has an easy time of it. All we can do as MiM's is give it our best and hope that the ones we love understand us and continue to love us back.
Mothers in Medicine
My perspective on being a mother in medicine is a little different than those which have been posted earlier this week. I’ve been at this now for almost two decades, but vividly recall the times when my children were much younger. I have worked 80 hour weeks and been on call 20 weeks out of the year. I have been a pregnant resident. I have been a pregnant attending. This is what I have learned through the years.
All specialties are conducive to raising a family.
No specialty is family friendly.
Wait, what?
Being a mother in medicine is a study in duality. It is the best of times. It is the worst of times.
It is the pride of juggling three, four, five – more – items in a seemingly effortless manner; it is the guilt and defeat when everything crashes around you. It is the memory of your child proudly proclaiming (to anyone who will listen) “This is my mom – she’s a brain doctor!” followed by the innocent (but cutting) comment that “There are lots of moms who stay home with their kids and don't go to work.” It is the sense of relief that you are *finally* home in time for good night stories lined up back to back with the mortification of being shaken awake by your three-year-old shouting “No, Mom! Officer Flossie doesn’t say SNRKK! Read it right!” and recognizing that you’ve fallen asleep mid-sentence. It is ticking off the “to-do” list that you carry in your head at all times and yet – despite the satisfaction of knowing that before 8AM you’ve cleaned two bathrooms, started a load of laundry, fed and dressed three children, got everyone off to school – still feeling the disgrace of arriving at the office 10 minutes late and realizing you’re already behind for the day.
Early in my career, I felt that in order to prove I was a good doctor I had to show my dedication to my job. Putting in long hours I missed more room parties than I attended. I was physically present for my children at the end of most days, but I was exhausted. And I finally recognized that exhausted me wasn’t good for anyone. So I tried to change. It was hard – hard to change the sense that I was somehow shirking if I made it home before 7P on a weekday, hard to change the assumption of my colleagues that I would always be the one who would stay late and pick up the case in the ER. But I found a position that allowed me to grow - as a physician and as a mother. I learned that it was the support of those around me that gave me the opportunity to thrive in my job and at home. I’m not alone in this recognition - it is this support system that is mentioned in almost every essay that has been posted this week. Many have already noted that it’s hard to have everything. Working moms make sacrifices to do what we feel called to do – whether we are in medicine or not. Balancing these sacrifices is the joy and love from (and for) our children, and satisfaction from knowing we have performed a job well done.
Therefore, every residency and specialty has the potential to be the best one for you as you raise a family – or the worst. Look at the support system that comes with the program and then decide. And remember that no matter how good or bad one day is, the next is likely to be the opposite.
It is the best of times. It is the worst of times. Today, I wouldn't trade my experiences for the world. Just don't ask me the same question tomorrow.
A
All specialties are conducive to raising a family.
No specialty is family friendly.
Wait, what?
Being a mother in medicine is a study in duality. It is the best of times. It is the worst of times.
It is the pride of juggling three, four, five – more – items in a seemingly effortless manner; it is the guilt and defeat when everything crashes around you. It is the memory of your child proudly proclaiming (to anyone who will listen) “This is my mom – she’s a brain doctor!” followed by the innocent (but cutting) comment that “There are lots of moms who stay home with their kids and don't go to work.” It is the sense of relief that you are *finally* home in time for good night stories lined up back to back with the mortification of being shaken awake by your three-year-old shouting “No, Mom! Officer Flossie doesn’t say SNRKK! Read it right!” and recognizing that you’ve fallen asleep mid-sentence. It is ticking off the “to-do” list that you carry in your head at all times and yet – despite the satisfaction of knowing that before 8AM you’ve cleaned two bathrooms, started a load of laundry, fed and dressed three children, got everyone off to school – still feeling the disgrace of arriving at the office 10 minutes late and realizing you’re already behind for the day.
Early in my career, I felt that in order to prove I was a good doctor I had to show my dedication to my job. Putting in long hours I missed more room parties than I attended. I was physically present for my children at the end of most days, but I was exhausted. And I finally recognized that exhausted me wasn’t good for anyone. So I tried to change. It was hard – hard to change the sense that I was somehow shirking if I made it home before 7P on a weekday, hard to change the assumption of my colleagues that I would always be the one who would stay late and pick up the case in the ER. But I found a position that allowed me to grow - as a physician and as a mother. I learned that it was the support of those around me that gave me the opportunity to thrive in my job and at home. I’m not alone in this recognition - it is this support system that is mentioned in almost every essay that has been posted this week. Many have already noted that it’s hard to have everything. Working moms make sacrifices to do what we feel called to do – whether we are in medicine or not. Balancing these sacrifices is the joy and love from (and for) our children, and satisfaction from knowing we have performed a job well done.
Therefore, every residency and specialty has the potential to be the best one for you as you raise a family – or the worst. Look at the support system that comes with the program and then decide. And remember that no matter how good or bad one day is, the next is likely to be the opposite.
It is the best of times. It is the worst of times. Today, I wouldn't trade my experiences for the world. Just don't ask me the same question tomorrow.
A
Guest post: Thoughts from an Anesthesiologist
I am currently in the midst of a fellowship in pediatric anesthesiology, after completing a rigorous anesthesiology residency at a major academic medical center this past summer. I had my first child mid-way through my CA-1 (PGY-2) year and my 2nd during fellowship. I won't lie, completing the residency as a mother in medicine was ROUGH, despite being in a department that honestly was very supportive to me. There were (many) days/weeks when I thought there was no way I'd make it through, and even if I did make it, it wouldn't be worth it given all I would sacrifice to get there. Fast forward to present: even though I'm still in training, fellowship has been significantly better than residency, I can totally see how my life as an attending will be different than these past 4.5 have been, and I REALLY like my job. I like the people I work with, I love the work I do, and the academic medical center where I work is overall fairly family-friendly (compared to stories I've heard from elsewhere).
When I started residency, I was positive I would not be doing a fellowship and that I'd be headed to a bread-and-butter style private practice job as soon as I could. As I found out during residency, though, part-time private practice jobs in anesthesiology are incredibly difficult to come by and essentially were not an option at all in the area where we'd like to live (near extended family). Surprisingly, though, landing a part-time job in academic anesthesiology is much easier, the down-sides being that a fellowship is pretty much required and obviously the pay is lower. The upsides, though, are better work-life balance, opportunity to teach residents & students, and a daily dose of challenging cases.
Although I love my children dearly, I wish I had known how tough residency would be with a child before embarking down that path as early in residency as I did. I don't know that I would have been able to tough it out were it not for my awesome husband. He is not a physician (engineering background/works in business currently) and that has made all the difference in our ability to manage my schedule and our family's needs together. He totally gets the demands of the schedule of a physician and consequently does all the day care drop-offs (not a single one in our area, including the hospital's daycare, opens early enough for me to do the drop-off and make it to work on time), serves as back-up for daycare pick-ups when I get held up later at work, happily plays "Mr. Mom" when I'm on weekend call, and stays home on the days our kids are too sick to go to daycare. That's not to say that we've been immune to the challenges of managing it all-he does travel periodically requiring extended stays from my mother to make it work, and has a fair amount of work-related evening commitments, sometimes making it seem like we barely see each other.
Although being a working Mom will never be easy and certainly neither will being a Mother in Medicine, I do feel that anesthesiology has been a great choice of specialty for me. There are opportunities to work part time, there is minimal work that follows me home, most days I leave the hospital by 4p (sometimes even earlier), giving me a decent amount of time with the kids before bed, and the call schedule is very manageable, at least at my current institution. While no one is thrilled when one calls in sick, honestly my dept tends to roll with it; as advocates of patient safety working in a life-and-death specialty where a lot of vigilance is required, no one wants you there when you are not healthy enough to adequately perform. Everyday there is at least one person scheduled as "back-up", to help get all the first-case starts underway, to cover in case of illness, or to provide extra anesthesiologists in the event of a particularly heavy case load that day. While there will still be days that are rough and make me question my career, today I can honestly say that I'm happy with my choices and as a mother in medicine.
When I started residency, I was positive I would not be doing a fellowship and that I'd be headed to a bread-and-butter style private practice job as soon as I could. As I found out during residency, though, part-time private practice jobs in anesthesiology are incredibly difficult to come by and essentially were not an option at all in the area where we'd like to live (near extended family). Surprisingly, though, landing a part-time job in academic anesthesiology is much easier, the down-sides being that a fellowship is pretty much required and obviously the pay is lower. The upsides, though, are better work-life balance, opportunity to teach residents & students, and a daily dose of challenging cases.
Although I love my children dearly, I wish I had known how tough residency would be with a child before embarking down that path as early in residency as I did. I don't know that I would have been able to tough it out were it not for my awesome husband. He is not a physician (engineering background/works in business currently) and that has made all the difference in our ability to manage my schedule and our family's needs together. He totally gets the demands of the schedule of a physician and consequently does all the day care drop-offs (not a single one in our area, including the hospital's daycare, opens early enough for me to do the drop-off and make it to work on time), serves as back-up for daycare pick-ups when I get held up later at work, happily plays "Mr. Mom" when I'm on weekend call, and stays home on the days our kids are too sick to go to daycare. That's not to say that we've been immune to the challenges of managing it all-he does travel periodically requiring extended stays from my mother to make it work, and has a fair amount of work-related evening commitments, sometimes making it seem like we barely see each other.
Although being a working Mom will never be easy and certainly neither will being a Mother in Medicine, I do feel that anesthesiology has been a great choice of specialty for me. There are opportunities to work part time, there is minimal work that follows me home, most days I leave the hospital by 4p (sometimes even earlier), giving me a decent amount of time with the kids before bed, and the call schedule is very manageable, at least at my current institution. While no one is thrilled when one calls in sick, honestly my dept tends to roll with it; as advocates of patient safety working in a life-and-death specialty where a lot of vigilance is required, no one wants you there when you are not healthy enough to adequately perform. Everyday there is at least one person scheduled as "back-up", to help get all the first-case starts underway, to cover in case of illness, or to provide extra anesthesiologists in the event of a particularly heavy case load that day. While there will still be days that are rough and make me question my career, today I can honestly say that I'm happy with my choices and as a mother in medicine.
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