Tuesday, December 13, 2011

On My Reality as a Primary Care Doc and a Mom

As a premedical and then medical student, and even as a resident, I was hell-bent to practice International Health in a third world country. I spent every clinical second I could in far-flung forgotten corners of the world, doing crazy medical stuff. I never imagined myself practicing Internal medicine at a well-to-do practice at a major academic medical center in a big city in the U.S. As a matter of fact, I scoffed at that idea.

And yet, a decade later, I made the very deliberate choices that led me to exactly this reality. Here I am; and as shocking as it would be to my 20-something self, I am pretty darned happy.

It’s a long story how I came to be where I am, a story involving first my own naivete/ a hefty dose of reality, and then my own evolving understanding of myself/ the world. And a lot of therapy. That’s a whole other essay. Now, I can comfortably talk about balancing my growing family with a rewarding career in Internal medicine.

Here is my reality:

I’ve been in practice for 3 years. I was lucky enough to be hired into this small, unique practice that sits within a very large medical complex. Every provider here is part-time. No one sees patients more than 5 sessions a week. Almost everyone is heavily involved with some other aspect of medicine- academics, administration, research. We are on call for our practice for 7 solid days every 2 or 3 months. The reimbursement and perks are pretty good, for academics. We enjoy wonderful administrative and nursing support. The environment is positive, supportive, and progressive. (And, it is subsidized by the major medical center we live in, because they need us.)

I started off heavy in academics and research as well as my clinical responsibilities, but have dialed it back to only clinical responsibilities, 5 sessions a week, FOR NOW. I’m no longer working with medical students, and no longer participating in research. The reason is that I’m focusing on my family- getting pregnant, being pregnant, being with my very young kids as much as I can. And this practice “gets” me. They’re all OK with me stepping off that career treadmill, because most of my colleagues did much the same thing. I know I’ll be back, and I am not worried.

And, Primary care is fun! After 3 years here, I can walk into the exam room where my patient Jackie is and say, ‘Jackie, What the hell! Three ER visits for weirdo bizarre accidents- A staple gun to the hand? A tool box on your toes? I don’t even want to know about that buttocks injury. What on earth is going on?’and she laughs and says ‘I know, I’m a clutz, we’re doing the DIY thing and I think me and power tools shouldn’t play together. Even when I’m not using one, I trip over it’.

Or ‘Mary, we’ve been playing this diet-exercise-and-weight-loss approach to your blood pressure for two years now, and it’s not working. Don’t you think it’s time to throw in the towel and take some blood pressure medicine already?’And she says ‘I know, I know- I was wondering when you would call me on it. I wanted to try, though, and I appreciate your letting me.’

It makes such a huge difference in my day that I am beginning to KNOW most of my patients. And, they know me. I’ve got photos of my family up, as well as this great pregnant belly, and people ask me about them, and share their own stories… I insist on 20 minute urgent visits and 40 minute physicals for my patients, and all that extra time gets used, with talking. Really talking. I think it works- not only for me, but for my patients as well.

So, for now, I work my 5 sessions over 4 days a week, and in my spare time I do some blogging. The rest of my time and energy is spent with my Babyboy (17 months old) and currently, being 9 months pregnant with soon-to-be Babygirl; as well as quality time with my husband and parents. We moved back to this city to be close to my parents, and my mom takes care of Babyboy when I’m at work. Hubby is one of those dream husbands who shares the cooking, cleaning, laundry and just about everything else, while managing his career in the media. FYI, I am the main breadwinner. Our life is not extravagant; our life IS very comfortable. We know we will never be able to send our kids to private schools, nor afford fancy vacations etc. and that’s OK. What we have- THIS WORKS.

I think that what makes this setup work so well is 1. my working part-time, 2. working in such a great environment, as well as 3. the family support we have. And all this was no accident. When I actually set about looking for a job, these key things were exactly what we (me and my husband) were looking for. We did have to move to get here. But we are glad.

I freely admit that in the world of medicine, primary care reimbursement is abysmal. I make a decent living- compared to our neighbors. Compared to my med school and residency friends who are now gastroenterologists, endocrinologists, hospitalists, anesthesiologists, and many other specialists, I make a pittance, even taking my hours into account.

I get frustrated that my med school loans are so huge. The interest grew and grew all those years while I was in training. What I earn is barely enough to pay the loans/ interest as well as the mortgage etc. I never thought about that for two seconds when I was pre-med or in med school- I always blithely assumed that it would all get taken care of somehow. We manage- and again, overall, we are very satisfied with life. But there are times when I get mad about it, too.

I get frustrated that so much of primary care work is not recognized, or reimbursed. For example, it’s my day off at home, and I just spent three hours logged into the electronic medical record to check lab and radiology results for patients, and send them their results as well as a plan; also called one young patient to inform her she has Chlamydia and needs treatment, spent 30 minutes with her on the phone; refilled numerous meds (ones the nurses could not refill without collaboration); responded to several emails from specialists regarding mutual patients; answered several emails from patients (we have a system where patients can email us with questions, which is great but TAKES TIME); and reviewed my schedule for tomorrow as prep. This is normal. The workday often spills over into the evening and the weekend. It ends up being a lot more than what is registered on the paycheck.

Having voiced all those frustrations, I know that no matter what speciality you end up in, there are always frustrations. No matter what walk of life, really, there will be frustrations- when you’re in the nitty-gritty, the negatives present themselves. But, in the grand scheme of things, I’ll take my career over anything else.

I think that as a doctor-mom, I have it pretty good. Overall, I am, and my family is, very happy.

4 comments:

  1. Awesome post! It reminded me of one of my mom's most memorable quotes: "If you want to make God laugh, tell Him about your plans."

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  2. I agree your life seems great! I remember starting business school thinking about what I could do to earn a lot of money. That was honesty where my focus was. But then I got married and had my son and realized I honestly don't need the flashy car, the 3rd house etc - I just want a balance between my work and my family and I want to love doing both. For a long time I HATED my job to the point where I lost all my ambition.

    Its only when I reawakened my dormant dream of being a doctor that my ambitions reignited and my plan came together. I also don't want to go into radiology, derm etc (where the $$ is in Canada) - I just want to be a family doctor because I think I'd love the variety, getting to know the patients and seeing them over the years. I think it would be such a privilege to be so involved in so many people's lives like that.

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  3. Question- do you ever miss the dream of working internationally? Do you think you'll take up the dream again someday? It is a dream of mine as well, and I have chosen a residency that will prepare me to do so, but I can see my family and I choosing not to pursue it for many of the reasons you have explained here.

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  4. Glad to hear you are in a good place with your work-life balance!!

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