Thursday, December 15, 2011

Ob/Gyn: Helping to expand families at the cost of your own?

At its very worst, that is how it feels. Like two nights ago, while lying in bed with CindyLou, who was bubbling away about her class Christmas party which was happening the next day when she stopped and said earnestly to me, "Mommy, you know, you can come to the party tomorrow if you want!" And, ugh! That familiar little stab of mommy guilt shot through me once again. It is never that I don't *want* to attend her daytime school Christmas parties, sign language presentations, or field trips (scarcely ever announced any earlier than 2 or 3 weeks prior to the actual day they are happening, assuring that my clinic schedule will be full, and if that isn't the case, I am likely on call). Every morning as I am leaving for work, my kids ask if I am on call. If I say "no," it is met with cheers. If I say "yes," it is met with boos, extra hugs, and sometimes tears. So, yeah, my kids are definitely affected by my chosen profession. (And we are in a situation that is *light years* better than the one we were in prior!)

Unfortunately, as many have stated, medicine is not as "family-friendly" as many other careers can be, and to many physicians, we don't stop working when we leave the office/hospital. Our chosen profession is all consuming in general, and Ob/Gyn can be demanding in particular. I feel you have heard the following from me before, I am having a distinct case of writer's deja vu The hours? Horrible. Babies have no concept of time and generally it seems that labor gets good and active sometime between midnight and 4 am. The pace? Grueling. In a medium sized practice, in order just to cover the cost of your staff and overhead, you have to do a set amount of deliveries just to break even. We get very scant education about the whole "running a business" part of medicine in our training, and while it would be great to see one patient an hour, the practice would go under in a year at that pace. As others have astutely pointed out, part-time in medicine is hardly part-time in any other sense of the word, and for Ob/Gyn, with malpractice costs, you just cannot feasibly make it work. If you want to do Ob, you have to be all in. That means call, and most of us work 24 hour calls followed by a full office or surgery day the next day...way more than what residents are doing in their training these days (makes for a rough transition to the "real world," to be certain.) No one is looking over my shoulder and counting how many hours I worked this week (hint, more than 80!!) Malpractice environment? Scary. No really. It is.

I can't say how many times I've bemoaned my career path, pulling myself from my cozy bed at 12, 1, or 4 am to make the mad dash to the hospital. I've thrown too many one person pity parties to count for myself as I work on nights and weekends and holidays while it seems the rest of the world is spending time with their friends and family (before anyone jumps me, I know this is *not* the case, but, pity party, you know, work with me here), but, by the same token, if I really try to sit and think of anything that I would love to do better, I couldn't tell you a thing. Because in the moment, I really do love my job. Once I am in the door of the hospital and with my patient, bringing her baby safely into the world is the focus of my attention. I never cease to be amazed at the miracle.

My family knows that the work that I have the privilege to do is important, and this is the reason that sometimes I can't be with them....even when I really want to be. I hope they grow up understanding that having a job they are passionate about is important, as well. My house isn't spotless, I'm not homeroom mother, I barely know any of the kids in my children's classes, I don't pick them up or drop them off at school, I don't go to Zumba, and am seldom well put-together (read: schlepping about in scrubs). So no, I don't "have it all." I have a good career. I have wonderful friends and a great relationship with my children and my husband. I think that is the best for which I can ask.

8 comments:

  1. I have recently stumbled upon this blog and love reading all the different points of view. This post particularly intrigued me as I am considering going into this field when my education is complete. I am actually a student in a physician assistant program (in my first year) and not currently a mother but hope to be soon after graduating. I was curious if you have any insight as to whether the schedule demands in this field are as tough on PA's as they are the doctors? A large part probably depends on the PA's role in the practice, so my next question is what type of role do you typically see a PA filling in the field of Ob/Gyn? I know what I will be capable of doing once graduating but was wondering how it plays out in reality. Thank you for such an honest blog post.

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  2. Dr Whoo, thanks for your post. I laughed out loud when I read your children's reaction to you being on call. My children do the same to us. I have to confess that I feel the same way when my husband tells me he is not on call...I have been know to jump up and down and cheer (because I am adult I am not allowed to boo when he has to go). Having done my time in surgery I understand the demands and support him totally but still miss him when he leaves overnight. Your children sound like they love you very much!

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  3. My kids used to fantasize about various fates for the pager: burial, death by drowning, dropping from a height...they never acted on any of them, but I know they wanted to. They are grown up now and pretty well-adjusted, and neither of them have careers in medicine. (Maybe that's a sign of their good adjustment, I don't know).

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  4. Wow, you're right, I had never thought about OB/gyn being pretty much impossible for part time work if you want to do OB. I worked in a small town previously where there were 2 OB/gyns at the hospital who basically were on call every day except 2 weekends a month. Both have young children and stay at home spouses. I don't know how they did it. So thank you for helping us get our babies into the world!

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  5. Anon 6:33~ Thanks for your kind words! I have not personally worked with a PA in the OB/GYN field, but our office employs a nurse practitioner. She comes to rounds in the morning, and helps round on post-partum patients. She does office OB/GYN under our "supervision" (sees annual exams, pre-natal visits, IUD insertions, etc. in the office). Not sure where the ARNP and PA training overlap, but I would imagine the roles to be similar. She is strictly in an office role, though, does not come to the OR or deliveries. Don't know if this helps or not, I hope it does! Good luck with your studies!

    Anon 6:44~ Oh, I think that I boo and stomp my feet quite a bit, adult or not! :) It is nice to hear their sweet voices calling "Mommy!" and catching their running hugs when I come through the door, makes bad days all the better.

    mamadoc~ That is awesome! I, too, fantasize of the pager's demise. Alas, they would just call me at home, and it would do me no good. I sort of have a secret hope that neither of my children will choose medicine as a career, but will support them 100% if they do (because they are going to need it).

    Kelly~ In my prior job, that was my life. On call 24/7, only 2 weekends off per month, a newborn and a toddler, and a husband that also worked full time. It was awful, and I truly do not know how we got through it except for the sheer fact that we had to! More Ob/Gyns do this than people realize, it is really beyond what any normal person should ever be expected to do for a career, yet they take it blithely in stride. Hats off to them, for they are better physicians than I.

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  6. I just wanted to know why one has to work as stated below, because my wife who is ob/gyn is working similar if not more hours

    "In my prior job, that was my life. On call 24/7, only 2 weekends off per month, a newborn and a toddler, and a husband that also worked full time. It was awful, and I truly do not know how we got through it except for the sheer fact that we had to! More Ob/Gyns do this than people realize"

    why not some stand up and fight remember we are living in free demoractic world, I am not qualified to discuss as I am into computer engineer who works from home/coffeeshop/mall/couch

    However my commonsense tells me that no one wants to fight the system and they look for the day when they can come out replaced by a fresh resident who has 250k+ student loan with prefix MD and lost her boy/girl friend or husband/wife during gruling residency and has nothing in the world and I am not even sure why anyone identify needs annonymous because situation described here more or less faced by any physician in surgery

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  7. Just stumbled upon this after a particularly bad call. I am an anesthesiologist and my wife is an OB/Gyn and we have two toddlers, so we know all too well the guilt and frowns on call days and cheers on the rare days mommy and daddy both have off. Thank you for the great post!

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  8. Hi Dr. Whoo,

    I love this blog and your posts especially because I'm considering a career in Ob/Gyn. I am currently doing a postbacc program and was originally planning on applying to medical school but am also considering midwifery (certified nurse midwife). I was wondering if you have ever worked with any certified nurse midwives and if you had any opinion on the career dilemma, I really appreciate your opinion and point of view. I think my personality fits in better in medicine but the kind of lifestyle I want (with plenty of family time and at least a little flexibility) doesn't seem to integrate into Ob/Gyn very well.

    Thank you very much,
    RS

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