Tuesday, February 5, 2013

MiM Mail: Rank List Dilemma

Dear MiM,

I am a fourth year medical student anxiously awaiting March 15 (match day). I enjoyed almost all my rotations and nothing jumped out to me as "the one." I ended up applying in Emergency Medicine and Internal Medicine (2 different specialties, I did not apply to any combined programs).  I also have a toddler who IS my joy and passion. My ultimate career/mom goal is working as a part-time ER doc or as a hospitalist with a week-on-week-off schedule, which, as far as I could see, would allow me the most time to spend with my child while still practicing medicine.

Here’s the catch: my husband, also a fourth year medical student, is applying in General Surgery. I have no illusions about how much I would see him as a surgical intern/resident anyway, but to add to that, he's applying to programs that (while less than an hour away from where I hope to be) will necessitate him living away from my daughter and I for several months out of the year (the program he's looking hardest at rotates where I'll be a good bit). I want to stay where we live now because we have an  awesome/ideal amount of family support and a nanny that we love.

Most of my anxiety stems not from actual worry about intern year, but rather about never seeing my daughter. To that end, I'm basing my rank list on whichever program will allow me to spend more time with her (because, again, I love EM & IM both, and can't find another way to choose...also, she's my priority).

I've been able to negotiate with my favorite IM program a 3 months on, 1 month off format, which will extend my residency from 3 to 4 years (however, they're reluctant to do this with intern year, which I understand, but still isn't ideal). I am not sure if it would be better for my child if I was gone all the time for a shorter period of time or home one month out of four (but extending residency by a year). Stability vs. Seeing Mommy (at least sometimes). Of course this also has decreased salary and benefits. On the other hand, EM would mean not seeing her much at all on days when I work (usually 10-12 hour shifts) but then having whole days with her when I'm off (and still getting out in 3 years). There's also the night work, which means some more day time, but having to arrange night time care (fortunately, I am in a situation where I can do this).

I know no one can make this decision for me. Nevertheless, I appreciate the chance to get some feedback on my situation from people who might understand it better than most. Any thoughts on which one is more do-able (in the short and long run?). Rank lists are due Feb. 20 and I'm going back and forth on this.


At a Crossroads


  1. I would suggest picking the specialty that you think will make you most happy in the long term, and worry less about what life will be like next year. That's what most people have told me when I have expressed these concerns myself.

    As a side note, I find it really reassuring that you found an IM program director who was willing to be that flexible with you.

    Good luck!

  2. OMDG - I totally agree. I think there is a lot of room for flexibility in either IM or EM. The short term is important, but ultimately do you want to be an internist or an EM Doc? That's the more important question. IM and EM are quite different so you need to think about which you enjoy better.

  3. Why aren't you couples matching? Could he take a gap year to get you through internship in whatever you choose so that the next two years of residency are less stressful (no concurrent internships)?

    Choose your specialty based on long term, and the residency afterward, based on short term needs.

  4. What a wonderful thing that any residency program would offer to let you be part-time! That seems monumentally important to me. How times have changed! I am a primary care (primarily outpatient) doc, and I have to say, ER and Hospitalist work seem very inviting to me: long, intense shifts, but no take-home work, no pager. When you're off, you're off. Amazing. Think long-term- you'll be fine. Good luck.

  5. Wow! That IM program sounds amazing. I would soo sign up for that (says the overworked Peds Resident). I agree with all of the comments, regardless residency is going to be very grueling. Do what you think you will LOVE in the end. As us Interns always say "you can do anything for a month" (ie, you can make it to the end of the rotation), your house may be junky but every extra second you get you will spend with your Little One.

    OH yes and when things get rough, remind yourself that your toddler won't start making long-term memories until much later!!!

    May the force be with you :-)

  6. I agree with above, do what you love, but my oh my I wished I loved EM. I was terrified of the spontaneousness of it all, realizing as I say this how much I love frozen sections and immediate calls in radiology, but the ability to craft my life around shift work reminds me of why I was so jealous of med techs during my residency training in pathology. A two physician family is very tough - I know from experience. Think not only of your little one but time for you and your spouse. Long term, that is. You can make it work no matter what you choose, but you've got a long hard road ahead. It will be worth it in the end. Good luck!

  7. I think a big question you must ask yourself is how well when you handle the changes in your sleep schedule? For EM, I think this is the million dollar question. I must say, SOOOO much of what you said here resonates with me. I did a year of obgyn (which I loved) but my baby was my priority so I switched out- interviewed for both IM and EM positiions. I just knew that I wanted shift work, no pager, and the option to work part time after residency. I ended up going with IM bc the nights were brutal for me. I don't handle sleep deprivation well and after my nights on I would crash for 8 hours. It would take me 3 days to get out of the "daze" that flip-flopping my schedule did to me. What I found was that even if I had more literal time off on EM, I was not completely engaged with my child because I was in a sleep deprived haze. If I were you, I would hang on to that IM program and run with it! one month off every three months is AMAZING. you will have a ton of time to recharge your batteries and connect with your little one. I say it is definitely worth it to extend it one year! I wish I had this option. Also you have to look at the culture of a program. If this PD is willing to work with you consider yourself very, very, very lucky. At a lot of places, they could care less if you are a mom. That is harsh, but not all programs will work with you. That is a very good sign that their IM program is good. The big question is, would you be happy with hospitalist work? If so, that is what I would do. I am thinking I will do part-time hospitalist work and pick up some shifts in rural ERs for kicks. I know people say IM can't cover ERs blah, blah but it happens all the time where I am (southest) bc the ERs are very understaffed. Good luck and let us know!!!


  8. I let my thoughts marinate for a day or so on this letter, mmostly because it made me so angry. Who's advising you at school? Did you hint, or god forbid mention, "lifestyle" was the reason for going into EM on your interview trail? Because going into EM for lifestyle is almost a burnout guarantee and residency directors flag those candidates with that answer. And EM is a lifestyle all its own, it's weekends and overnights and holidays...between 12/23 and 1/3, I worked 9 days including Christmas Day and New Years Day because I had off Thanksgiving so others in my group had similar time off (but worked Thanskgiving). You need to love EM to be awake as you are at 5am as you are at 5pm because overnights are manadatory until you "put your time in" (years and years). And my hospitalist colleagues will probably tell you the same thing as the hospital, like the ED, never closes and admissions and the already admitted need your attention.

    I think it's okay to not know EM vs IM, even though they are very different. But to make this decision on lifestyle and not what speciality makes you happy (even if it's not EM or IM) is going to make you an unhappy doctor, which will make you an unhappy person, which will make you an unhappy parent.

  9. Wondering if you can still couples match, or whether you had considered that. In choosing between IM and EMed would think about long term career joys and satisfactions rather than the immediate residency situation, if at all possible. Amazing that you could negotiate something with a program before the match has occurred. I hope things work in your favor, for the 3 of you!

  10. Everyone, thank you for all the support! Sometimes I feel isolated in my experiences and I'm very grateful this blog exists for me to connect with other women going through similar things.

    KS & T--We are couples matching. However, we only applied to a limited geographic area so I'm not sure what added benefit it will give us. I don't think a gap year is an option for either of us..we have some serious loans to repay.

    I am thrilled the IM program is willing to work with me. Of course, nothing can be formalized until/unless I match there (it will have to be submitted and approved by ACGME, ABIM), but they have graciously done much of the legwork. I went out on a limb bringing up the possibility during my interview, and I bet you can imagine I was walking on air when they told me they'd look into it.

    Gizabeth--good advice. It's easy to lose the "we" in the everyday shuffle...I know it's only going to get moreso.

    C--The sleep thing is definitely relevant. I struggle with this too, as I found myself (even in my limited experience) skimping on sleep the day after a night shift so I could spend more time with my girl.

    Mommabee--I have reminded myself too many times to count over the last few years that I don't remember anything before my 5th birthday.

    Thanks again everyone! I made a pro/con list this morning and I'm adding to it as I go...I will definitely let you know what happens!


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