Wednesday, April 13, 2011

Opportunity Costs

As a trained economist before I started training to be a doctor, I often think in terms of “rational decision making.” In economics, all of the basic models are based on free markets and rational decision making. One key component of making rational decisions is determining the opportunity costs of one decision versus another. After picking up my daughter from daycare yesterday, I (for some odd reason) started thinking about opportunity costs and the difficulty of actually quantifying it in real life - if only I could assign a real value to what I give up with the decisions I make.

Other people may not have such a hard time with this. My husband and I actually started hanging out because I took 30 minutes to make a vending machine selection. I headed down to the basement with a definitive plan to buy twizzlers, but once I realized that this particular vending machine also had sour straws (a blast from the past), I simply could not decide if buying twizzlers was really worth giving up sour straws. As I agonized over this very important decision, my future husband had time to sort two loads of clothes, put them in the machine and wait to add fabric softener. When he saw I was still standing in front of the vending machine, he asked if I was okay, suggested sour straws, and the rest is history! Obviously, my inability to assign a value to sour straws has little consequence in real life, in fact it worked to my advantage since I got a husband out of it. However, when it comes to big decisions I am often paralyzed in trying to decide if my decisions are worth what I lose.

I can’t decide what specialty to pursue, I can’t assign value to the time I will give up with the additional training or the additional demands of one specialty over another. I can’t decide if I honestly think I can finish my surgical residency or is the cost of the time I will lose with my daughter too great. I can’t decide when and if I should have more kids. I can’t decide if my husband should really go for that higher paying job in a city 2 hours away, and I know there is no need to make all of these decisions all at once, but I can’t stop thinking about what I’m giving up.

20 comments:

  1. That's so cool you were an economist!

    I don't think I can help much in answering all your questions, except to say that we all do go through it also. Well, I know I do. And I'm not an economist. Try taking it just one day at a time for a little while and see where that takes you.

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  2. Right with you there! (Minus the husband and child). Frustrating.

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  3. One the key personality traits of a surgeon needs to be decisiveness and confidence. Do you struggle with this at work? The OR team looks to you as there leader in emergency situations. Lots of decisions are not straightforward either in life or medicine.

    This comment is not meant to be caustic, its just that as I read the first paragraph of this, my first thought was well "this person is definitely not a surgeon"

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  5. @RH+: I didn't take your comment to be caustic, thanks for your response. I find that in the OR, in critical patients situations I am clear and concise. I feel comfortable and calm knowing what to do. Every review I have had since starting my residency (and even in medical school) has echoed that point. I was an athlete for much of my life and again as an athlete I make quick decisions easily. Also, I wasn't just an economist, I was a Wall Street economist and calmly worked in stressful situations and made quick decisions. However, as I've gotten older my decisiveness at work is countered my complete paralytic indecision in my personal life. My husband also has recognized the strangeness of this dichotomous relationship and I don't have much to offer as far as why I feel this way. I think most of my colleagues would also be surprised to know this is me writing this blog as I don't come off in life as indecisive. I however, feel this blog is a place I can be open about what actually goes through my head instead of what I should be thinking.

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  6. RH+: my first thought when reading your post was that you must not be an MD because you cannot differentiate 'their' from 'there' or 'it's' from 'it's'

    Great post- I often make these same calculations in my head as a former engineer. My child has thrived despite my career, and my husband has been amazingly supportive. We will figure out the rest as we go. I'm sure you will, too.

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  7. Are all of the physicians posting on this blog MD's or are there DO's as well? I just ask in reference to an above post questioning if the person posting was an MD.

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  8. My grandmother made a similar observation of me when I was just a little girl. She told my mother I had trouble choosing something (a toy in the store, etc.) because I was too busy mourning what I was giving up. My parents occasionally reminded me of this as I struggled with decisions, and that helped me focus on my choices positively, rather than with regrets for what I was not choosing. Over time I've gotten better at this - partially through looking at the positive outcomes of past decisions, including some that seemed hasty or even ill-advised at the time. I took a job in a far off, rural place that was WAY off the beaten track for my Ivy League peers. That happens to be where I met my husband and launched into a life's path that advanced me in one career (journalism), and later led me to another (applying to med school in June.) Were their "opportunity costs" along the way? ... No doubt. But I wouldn't change a thing. It sounds like Cutter might benefit from looking at WHY she struggles with decisions (as my grandmother, even after her death, helped me do.) This is the kind of trait worth nipping in the bud. Perhaps make some (relatively inconsequential) decision quickly and then consider the (hopefully) positive outcomes.

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  9. Sorry Amy (above)... I meant "Were THERE opportunity costs" ... and this not from an MD, but from an Ivy League English major and former reporter. Good editors are hard to find.

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  10. @Amy : Ha! I commited my biggest grammatical pet peeves (there not their). I was in a hurry and did not take the time to proof read.

    @Cutter: Wow, a Wall Street economist and a general surgeon all in the same life. That is simply amazing. Good luck to you as you search your heart to find the path that's best for you and your family

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  11. Just poking fun at the fact that it is easy to draw (inaccurate) conclusions from a posting. I think this is an excellent topic, and can relate.

    I know working mothers in other professions who must make difficult decisions about their personal lives- this is not unique to medicine.

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  12. PS props to all of us for pursuing our passions and making the world a better place than when we got here. That's why I love reading everyone's posts.

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  13. This is a tough thing, indeed, making these decisions. Sometimes we are absolutely able to go back and have do-overs. e.g. wrong specialty choice. A lot of times we are either unable (e.g. having a child) or unwilling (e.g. too expensive) to have these do-overs. At the end of the day though I think you will have learned from any choice that you pick, good or bad. I sometimes kick myself for these decisions too, but the "what ifs" sometimes are just more harmful than beneficial, and at some point you just have to go with it instead of overthinking it.

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  14. I agree that everyone faces these decisions no matter her background or profession.

    I don't think you're indecisive -- although at first blush that's what you're describing. What you're struggling with are decisions that'll affect your home life and that's a big deal.

    One thing to remember is life never remains the same, even your home life. So ... even if your husband does take a job 2 hours away, how long will you guys have to spend that time apart? You'd see him on the weekends at least until you're finished with residency, right? Just a temporary discomfort.

    Back to your daughter ... she won't be young forever. It's important to be there for her and enjoy her youth as much as you can. But, once she's grown and out of the house, what career choice would you be satisfied with? What excites you and gets you out of the bed in the morning? What specialty means the most to you? Is there a specialty you're also interested in that you can still derive career fulfillment and still be able to balance a good family life, too?

    Make the choice that suits you, personally. Everything else will fall into place. It'll be a lot of work, but if you want it bad enough, it'll work.

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  15. Dear Cutter - you have every right to have doubts. Your whole life depends on choice you are making now. Be a surgeon or have scheduled office hours, see your daughter grow up or be torn apart any time there is family emergency, babysitter crisis,etc. I have known women surgeons who quit lucrative careers for government jobs after children. That is less money, more life (back to your economic calculations). Or you can consider still procedural anesthesia specialty which can be "part-time", I heard they accept surgery training as part of theirs.I have known a woman anesthesiologist who was happily able to raise her son since she landed "part-time" anesthesia job, it was 8 to 4 pm for like 7 years, since all group partners wanted calls. She was thrilled with that arrangment.If your husband definitely wants a career, you must choose whatever will always land you a job where he has a job. If he is ok babysitting/work from home/part time, then pursue practically anything. Above comment sounded funny to me. I met several women-surgeons who after 10-20 years in practice were dreaming of administrative or 100% no call 8 to 5 jobs. So, keep in mind that after you raise your daughter you may not want to get out of bed for a 6 am surgery anymore. I have known accomplished women surgeons who unfortunately did not have time to raise their kids and had deep disappointments, uneducated underemployed children. Good luck.

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  16. NO! Do not send your husband 2 hours away for another job. Not unless you have a live-in nanny, or a set of grandparents next door.

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  17. It is possible to survive with husband out of town. You can hire the help you need- and if his compensation is that much better you could afford it. From my experience it is difficult to replace the emotional support and sense of well being that comes from having the entire family home.

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  18. These are tough questions. And I am glad I'm not the only one who can quickly & rationally make important decisions related to patient care, yet stand in front of the cereal aisle for 20 minutes! Throw in the absolute upheaval of motherhood---where all your prioritizes, goals, & dreams are completely re-shuffled....no wonder you are paralyzed. Remember that nothing is set in stone forever. You can always restructure your life to meet the priorities you have at that moment. Sounds like you've done it before.

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  19. I definitely feel you. I am also a mother and surgeon (with life priority in that order) who struggles hugely with making decisions in personal life...and laugh when people who know me professionally comment (often) on how decisive/determined I am!...haven't seen me in the cereal aisle?!
    The good news is that, as both my daughter and I get older, I realize more that I AM making the right (or at least the 'not wrong') decisions for our lives...it does get easier.

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  20. I love your vending machine love story.

    Just a few decision-making tips.
    1. Karen's rule (my cousin--also a doctor): listen to your gut. When you first think about it, is your first reaction "Yes!" or "Oh, s---." Go with the first one.

    2. Martha Beck's advice: listen to your body. She says her mind is a two-bit whore, but her/your body will tighten up if it likes something and relax with happiness.

    3. Matt's rule (my husband): buy both the Twizzlers and the sour straws. Life is too short.

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