Monday, January 28, 2013

MiM Mail: Career impasse in academic medicine

I was so pleased to come across this blog while trying to research career options. I am currently at an impasse in my career and looking for some insight.

I am currently two years into my first position as a full-time medical oncologist at a major academic center. As a bit of background... I have been at the same institution for medical school, residency, fellowship and now as an attending. I am specialized within oncology, but did complete my board certification in IM, hematology and oncology so as to keep my options open in the future. I chose my specialty with no consideration of future family planning, but because I love these patients and find the work very rewarding.

I met my (now) husband in medical school and we have since married and have a 6 month old baby at home. He (my husband, not the baby) is also currently embarking on an academic career.

I am only now realizing the extent of sacrifice that will be required of both of us to have successful careers in academic medicine. I find that my priorities may be shifting now that we have a child and plans for future children and I am struggling to decide how to juggle my career and family. I am no longer sure I am willing to sacrifice so much time with my child for work obligations.

I am trying to see what opportunities may be out there for both clinical and industry work if I were to take some time off or switch to a part-time position for a few years or permanently. I am just not sure if I can take time off at this point in my career and expect to be able to find a position down the road.

What I do know is that my child will only be little for a short time and I want to be with him as much as possible.There are also certain financial issues to consider given that we are both in academics and have a pretty sizable amount of debt from med school.I would love any feedback from those of you who have been in a similar position. Particularly to those of you who have found part-time work.... is this a common situation? I know that at my current institution, it is unlikely that I would be able to stay on faculty part-time, so I would need to find something elsewhere.

Thank you so much for providing this blog as it reassures me that I am not the only one struggling with these decisions.

9 comments:

  1. I recently wrote about the benefits of working part-time and why I've made that decision. I know oncology is pretty intense and there aren't a lot of part-time positions, but if your current institution really loves you, maybe they can figure out a way to make it work for you.

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  2. Wow, this is a tough struggle - one that I have seen women go many different routes with.

    I know a pathologist who trained at the greatest institutions with the biggest names - pretty impressive to a little Arkansan like myself who has never strayed from home. She was crazy smart - she and her academic path husband were here for a couple of years before going back to a big name out West. I watched her try to go part time in academics after she started a family at our institution and then the one out West and suffer a lot of grief and struggles. They recently made a move to another big name in MidWest where living is cheaper and she could be a full time mom to their three very young kids. I'm flying up to visit them with my kids next month. I can't wait - it's been a while.

    I know lots of women in medicine that stay full time as moms (me!) and those that go part time. It's a struggle all around. One of my best blogging friends when I first started a few years ago was a young retired ED doc to be a full time mom. Crazy smart and fun, fun, fun. Never did learn her name or location. She got healthy, got happy, and quit blogging so much, but I always wondered if she was struggling with regrets of quitting medicine while she was blogging. I think of her a lot, and hope she is still happy. I remember being really jealous of her time with her kids.

    There is no right path here, there is only your path. Good luck to you, I know from experience no matter what you choose it isn't easy, and it is often trial and error. You will always have regrets (me! From being a full time doc! But luckily a pathologist) but you will also hopefully learn to find happiness wherever you end up and peace with your decisions for you and your family.

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  3. I am a nephrologist, part time academic faculty, with a clinician-educator faculty appt. I basically do about 60% FTE. I do that fraction of night call, weekends, Clinics, and inpatient hospital teaching months. Its working and I feel love the educational environment. Stick to your gut feelings and negotiate! Good luck!

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  4. I am at the end of my heme/onc fellowship and very much struggling with the same issue. I always thought I would stay academic, but the idea of making better money, possibly working part time, better retirements, etc etc have shed some serious doubt on that plan. I also have substantial med school debt and a strong interest in sending my kids to the best schools I can afford.

    Your story is interesting me to becasue I have a lot of attendings who are trying the sell the academic path as the far more flexible option when compared to PP or Kaiser. One day of clinic/week with rest of your time to structure how you see fit - so long as that grant $$ comes in.

    I have a friend who works in industry (MD/Phd who got the gig straight out of heme/onc fellowhsip) and describes his life as "living the dream". Enjoys a high level of autonomy and intellectual challenge "running" industry sponsored clincial trials (I think he and his employeer would object to the use of "running" in that context , but whatever). I think those types of jobs are highly dependent on where you live geographically - he's in LA. Not a lot of travel with the exception of larger meetings (ASCO) . No patient care. Lots of pressure to get the study published.

    I was pretty surprised by how difficult part time work is to find in heme/onc. Some Kaisers will allow it, but you have to share 100% call no matter what fraction of patient care you carry (and get paid for...) I've heard of a few PP groups where everyone works 4 days. In my (very) limited experience, the least happy people are the primary clnical heme/onc staff at major academics centers - they get paid less than PP or Kaiser and see lots of patients. But they get to be specialists.

    Anyway, I wish I could figure it out. I am a few months from the completion of my fellowship and all options are still on the table.

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  5. I am an anesthesiologist working officially 0.8 FTE at a private practice. I also take off an additional day off per week as manpower allows. I have not had to struggle with giving up an academic career, but I am much happier to have time for my children. For me, only regret is that I put my career ahead of my husband's and cannot be a SAH. "There is no right path here, there is only your path." How true and profound. Good luck to you in whatever you decide.

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  6. Many institutions (including mine) offer part time faculty positions on the clinical track and on the tenure track. You should talk to your Chief / Chair and see what you can work out. Academics is flexible, because we measure output, not time on the clock (given that you have to show up for clinic and other in-person obligations and you have to get something done).

    What kind of options is your husband considering? Is this also his issue, or is it only yours? What corners have you figured out you can cut? How do you divide responsibility-- for finances, for home, for family, etc? You need to sit down as a couple and talk honestly about what it is you want to accomplish in life, what is feasible (e.g., given your debt), and how your two sets of goals and desires interact. Figure out what it is you are looking for and then go to your Chair and figure out if you can get it.

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  7. Many institutions (including mine) offer part time faculty positions on the clinical track and on the tenure track. You should talk to your Chief / Chair and see what you can work out. Academics is flexible, because we measure output, not time on the clock (given that you have to show up for clinic and other in-person obligations and you have to get something done).

    What kind of options is your husband considering? Is this also his issue, or is it only yours? What corners have you figured out you can cut? How do you divide responsibility-- for finances, for home, for family, etc? You need to sit down as a couple and talk honestly about what it is you want to accomplish in life, what is feasible (e.g., given your debt), and how your two sets of goals and desires interact. Figure out what it is you are looking for and then go to your Chair and figure out if you can get it.

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  8. I'm a peds ER doc at an academic institution & a relatively recent fellowship grad. What I found when looking for a job is that there are many different versions of an academic career in medicine, depending on the institution. Some places are have really stringent publication & grant money requirements; some don't. Of course, there are trade-offs (a less well-known name, less well-developed research infrastructure, less protected time, for example) at places that aren't so much the research machine. Agree with Gizabeth above that there's no one right path. It comes down to figuring out what you want/need, owning that & then figuring out how to do it. And I don't think that's ever a final decision. For me, balancing work and home requires continuous negotiation & trade-offs. It's not something I could do without a lot of communication with & support from my husband. I've yet to find the perfect balance point, but I've decided that's OK. We've found what works for now. We'll see how far this gets us & then go from there.

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