Thursday, April 23, 2009

There's a reason they call them "fellows"....

This is going to be a bit of a rant, so apologies in advance...

I've made no secret of the fact that I'm not terribly enamored with the field of medicine or being a doctor, but I've managed to actually find a specialty that I love. And within that specialty, there's a subspecialty that I'm very interested in. I've been nerdishly dreaming about a one-year fellowship for a while now, but it's beginning to look like that dream isn't going to be able to come true for me.

I'm not going to get into the details of my own situation, because "it's complicated" (like my younger brother's Facebook relationship status). But I am going to make a really broad generalization and say that it's really rough for a woman with a child to do a fellowship. Granted, some women do it. I know because I see female fellows with pictures of babies on the back of their IDs so I'm guessing they're mothers (unless the photo came with the ID badge). But it's rough.

Here's why:

Fellowships tend to be competitive. So unless you're doing a fellowship nobody wants, like, in rectal exams, you have to be geographically flexible. (There's no such fellowship, by the way. Didn't mean to get anyone's hopes up.)

Being geographically flexible means possibly uprooting yourself to do the fellowship. It's not quite as big a deal to camp out in Whereverland for a year if you're a single person, but it feels a lot more selfish to force your spouse and child to move with you. To give up your home, your daycare/nanny, your spouse's job, etc.

For a man with a family, it can be just as hard, but I'm going to go out on a sexist limb and say that it's harder for a woman for a couple of reasons:

1) There are a lot of men who are totally cool with being stay at home dads and I salute them. But most men aren't. In this economy, it's not easy to find a job and there's a chance your spouse could be unemployed indefinitely if he gives up his job. For a lot of men, this would be a huge blow for their self esteem, possibly one that's unacceptable and would result in marital discord. For women, less so, in general.*

2) I think a lot of women tend to feel that their career takes a back seat to their husband's career and their family's needs. For me, the thought of uprooting my family for my own selfish career aspirations just feels really wrong. I can't do it.

So that's that. My nerdy dream, up in flames. Sigh.

*I am making a bunch of broad generalizations. Please don't throw something at me if you are an exception.


  1. As a fellow with an 8 month old, I will agree that it's difficult. I was lucky, my hometown (where I did my residency) happened to have a fellowship program in my chosen field (Pediatric Anesthesiology). I was also lucky that they allowed me to start in October rather than July (when I was 8 mos pregnant).

    There was a fellow a few years ahead of me, who was a single mother with two young chidren. She did this fellowship after getting divorced with no family in town to help. The program I'm in was very good about her situation - no call on the night she had a babysitting gap, getting out for MD appointments for the children, etc. It made me feel much more comfortable about doing the program.

    But the hours still suck. Even though I take home call, I almost never see my baby on call days (she gets up after I leave and is usually asleep before I come home), and generally only see her for a few hours in the evening.

    I will say that I see remarkably few female fellows, and those that I do see are either single or married and childless.

    I would offer you some hope, that there may be a program out there for you.

  2. Thats great man.. after your article, I totally agreed about this fellowship thing. keep sharing.

  3. I'm a PM&R doc and mom of 2. I did a fellowship before I had kids, but I'm so glad I did it. Yes, the barriers to doing a fellowship are many for moms with kids, but why not be selfish for one year so you can feel content and satisfied for the rest of your career? Yes, it's a lifestyle specialty, but I still spend a lot of time at work. I am so pleased to be doing the kind of physiatry I really love.

  4. Much as I want to do a fellowship, even if I didn't have kids, it would be really hard for me to ask my husband to give up a job he loves in an economic climate where he might not be able to get another decent job for years to come. I mean, I'd have to feel like there was no way I could be happy without the fellowship and I don't think that's the case.

  5. this may not be doable, but it is only a year- why don't you let your husband keep his job- and just rent an apt for a year and get it done? take the kids and get a full-time nanny, or leave the kids and get a nanny and let your husband bare the brunt of the childrearing for that year. I understand your children play a huge role, which is why I'd be likely to take them with me rather than leave them, even if I did have to hire a lot of help. But that takes the pressure off of your husband.

    in today's economy, I have to agree with you. if I were him, I wouldn't want to quit a good job to move for just one year. but maybe the above idea isn't something you've considered? me and my husband (no kids, I know that changes things) are going to be apart for a year of residency, and though we're not excited about it, it's not forever.

  6. Anon: My husband is just as attached to our daughter as I am and I don't think he'd be OK with living apart from her for a year, especially when she's so young. I don't think she'd be OK with it either... a year is an eternity for a small child. And I certainly would be miserable if I were away from her for that long. My career isn't important enough to me to make that kind of sacrifice.

    If it were just me and my husband, it wouldn't be an issue. He and I have done the long distance thing before.

  7. Does your husband make as much money as you do (or will)? If not, it seems to me that your career aspirations should take precedence over his. That's not selfishness, it's just practical. If the genders were reversed, what would the decision be? If you would quit and maybe take a lower-paying job for the sake of your joint future prosperity, why shouldn't he? How is that not just sexism at play? And you shooting yourself (and your family's potential earnings) in the foot?

  8. Well, yes Anon, it is sort of sexism. My max earning potential is a lot higher than his, maybe twice as much. The recruiters and my parents point this out a lot. But there are things that are a lot more important than money. I know my husband and if he doesn't have a job that provides him with some satisfaction, he would be really unhappy and our marriage would suffer. Whereas I am not as tied up in my career and will probably be happy as long as I get to spend adequate time with my family. In an ideal world, we wouldn't have to choose between his career and mine, but since we do have to choose, I think the decision has to go to him.

  9. Fizzy, I, like you, had to make some sacrifices after residency for the sake of marriage and family. We currently live in a city w/ no family near us, and (now) 4 kids. My husband is a private practice physician and in order to make sure one of us spends some time w/ our children, I have put my career on hold. I have taken jobs which require minimal to no call and allow me a part-time schedule. In return, I have either worked in poorly run clinics or in clinics which have very questionable patients or in clinics which have a patient population I am not excited about (i.e. in the VA w/ old men). However, to be able to spend the time w/ my children is completely worth it. No regrets at all.

  10. I can 100% sympathize about the uprooting issue. I just matched for residency and while it's different when it's for more than one year, the trauma of husband finding a new job, finding a home, dual-commutes, nanny/childcare, etc. is the same. I feel your pain! And, if it helps, you wouldn't be the only villainess out there! I just decided that I would have too much regret if I didn't seize the opportunity. Therein may be the real problem, women are more likely to allow themselves to not try to have it all...I'll keep you posted regarding whether it's possible!

  11. I don't suppose your husband's company or whatever would give him a year's sabbatical/unpaid holiday/let him work from distance & fly back periodically for a year??

  12. 1) I have several friends who have worked as attendings -- sometimes for several years -- before going back to do fellowship. You could consider that, and perhaps the economy will be better and your husband will be able to find a job.

    2) I completely understand not wanting to be away from your family for a year or two. I honestly can't imagine my life without my husband at this point, and I don't even have a child. That being said, maybe your family could consider relocating to a city with more opportunities for your husband for your job as an attending. Then you could try applying and maybe wouldn't have to move.

    Just some thoughts. Try not to let it eat you up inside.


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