Tuesday, April 7, 2009

My aptitude for family medicine: poor, apparently

I did the University of Virginia medical specialty aptitude test purely for sport recently and was startled to learn that of 36 medical specialties, the one I am least suited for is family medicine.

I'm not surprised that family medicine did not rank first. I chose it only partially because of any natural inclination toward it, and mostly because the training and practice of it meshed best with other priorities in my life, particularly raising a family. What did take me aback was that it occupied the very last spot on the list.

Pathology and radiology ranked at the top.

From time to time I flirt with the idea of returning to residency, but what it comes down to is that I would rank my current job satisfaction as a family physician at a 9/10. Is a chance at boosting that to a perfect score worth three more years of residency, a massive reorganization of family roles, a significant reduction in my time spent with the kids and a hefty kick in the pocketbook? I don't know.

William Maxwell, fiction editor of the New Yorker from 1936 to 1975, said upon retirement: "For nearly forty years I have shaved with pleasure in the thought that I was about to come to this job." How I love that quote. What a gift, such perfect happiness with one's work.

Of course, while he was shaving his wife Emmy was likely frying up the breakfast bacon, readying their daughters for school, preparing for a day of housework and granting him the enviable ability to be single-minded.

That is what I find most difficult about mixing medicine and motherhood: the diffusion of focus.

My work in refugee medicine is profoundly rewarding; raising three little ones even more so. The two have proven to be compatible. And yet at some point the efforts put into one require sacrifices made of the other. There simply are not enough hours in the day for me to invest what I wish I could into both spheres. I have erred on the side of mothering, and while I do good work at the clinic, my career trajectory has been modest.

I say this cheerfully. So far, I don't regret any decisions I've made. And every day presents an opportunity for new and different choices. Maybe one day, when the kids are a little older, I'll alter my career track or return to residency.

But for now, and maybe forever, a 9/10 is good enough.

(Cross-posted at my personal blog.)


  1. 9/10 is amazing actually.. I'd settle for an 8 or even a 7. Why would you even consider going back to training if you love your job so much?

  2. I'd have to agree...you're very lucky to be able to say you have a 9 out of 10...I'm hovering around a 4 or 5 right now (and hence debating a career change). But in my circles anyway, and those circles are mostly non medical, I'd say that most people I know are low on the job satisfaction scale. If you can report being more than half satisfied that's impressive!! Now that probably has to do with the fact that you actually get to HELP people on a daily basis and do something meaningful, as opposed to the paper pushing that most of us get to do! There's my 2 cents...

  3. Interesting. My #1 was med onc, something I seriously considered doing and still sometimes think about going back to specialize in.

  4. you know, freshMD, I recently commented that I have two favorite med blogs that are nothing alike: 1. yours and 2. a young surgeon with no children. I am at the end of my third year of med school and have been so dismayed in trying to choose my specialty. According to the virginia quiz, I am not suited for primary care, but rather a surgery oriented field. But I want a large family and would be thrilled to achieve the balance you have in life, and a 9/10 ain't too shabby! Just wanted you to know your words are heeded.

  5. haha!!! my dream specialty ranked last on the list as well.

  6. Darn. Family medicine (which I've been doing for the last 27 years) was next to last. Dermatology was #1. I think from the way the questions are written and scored the quiz writers are a bit predjudiced against family medicine, though. Why not, everyone else is....

  7. @Fizzy - I'm grateful for the 9, but I guess I feel shortchanged that all the work of medical school and residency didn't deliver a 10. And if a 10 is attainable, why not go for it? My husband's theory is that because I'm home with the kids so much (I work 2 d/wk) I have the time to dream up new avenues to pursue.

    @Kathy - I agree that most of my job satisfaction comes from direct patient interaction. There's never any doubt in my mind my work is important and significantly impacts patients' lives. But some days I wish it were just me, a microscope and a batch of slides.

    @ Anonymous 10:00 PM - Agree. I wonder how the questions are scored. I think I lost a lot of points for family medicine because I repeatedly answered that I did not enjoy caring for patients. But 'caring' can be defined different ways; I enjoy my patients immensely and I love to organize their care, but I take little satisfaction from hand holding or being responsible for their care.

  8. Curious, I just did the test too. Family medicine was also last on my list, though that wasn't much of a surprise. Apparently I should have been a dermatologist, endocrinologist, or radiologist. I must have answered "lifestyle, lifestyle, lifestyle" somehow, which is spot on at this point in my life. Turns out my aptitude for medical oncology, which is my career, is fair to middlin'...#17 on the list. But I really like what I do. Guess there are lots of intangibles that no questionnaire can ever get at.

  9. There is not much validity testing or psychometric research that went into that "assessment". It's no better than a cosmo quiz and to take the results seriously would be misguided.

  10. @Jeanette - I agree. That's why I did it "purely for sport." I don't expect anyone would choose/change their career based on the results of one quiz. It did raise some interesting ideas though e.g. Are you a thinker or a doer? Enjoy making decisions? Tend toward individual or group work? etc.


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