Monday, May 27, 2013

MiM Mail: Where now?

Dear MiM,

I am so grateful that I have come across this community. I have now spent many, many hours putting my 20m old to sleep and then lying in darkness and reading your posts on my iPhone.

So, I thought I would ask for some advice....

I am 35 yr old Intern and mother of 3 boys, aged 6y, 4y and 20m. I live in Australia and have been very lucky, thus far, with balancing work and family. I was able to do most of my internship part-time with two 10-week terms of full time work.

I LOVED my part time work. I had time for my boys, I could help at my son's school, I had time to read up on topics in medicine that interested me (or I needed to brush up on), I found some time to sew (my creative outlet). Ironically, I also felt that I was a better doctor - when I was at work my heart was really in it.

I am now in week 8 of one of my full time terms and I am tired, cranky, my house is falling apart, my 4yo is waking up in the middle of the night and coming to check if I am around, my 20m old is glued to me from the moment I walk in the door, I barely know what my 6yo is up to at school.... At work, as the afternoon slips away I catch myself checking the clock and trying to speed through the jobs. I am way too tired to read anyting medical. My sewing machine is collecting dust.

And, I have to make up my mind as to where from here. In Australia, we have 2 general hospital years (Internship and Residency) before we decide what to do with our careers. In a few months time I will need to make some decisions.

I went to medical school thinking that I would do O&G. However, I realised that I was a lot more 'natural birth' camp (my 3rd child was born at home) than medical intervention - which was not really compatible with O&G culture here. Also, I was not prepared to work the hours this specialty requires.

So, what is left:

Option 1 - Anaesthetics. I like the 'doer' aspect of it, I would love to have all that knowledge of physiology, I like the science of it, I love being organised, I like putting lines in, I like OR, I like that at the end of my training I would be able to control my hours and that part time is a real option here. BUT I would need to put in at least 3-4 years of full time work (and how will I cope if I am a mess after 8 weeks of full time?). Getting on the training program is difficult; it is very competitive. I have some advantages - I have a PhD (in Molecular Biology) and research background.

Option 2 - Family medicine (or, as we call it, General Practice). What appeals is the possibility of doing a lot of women's and children's health (I love this aspect of Medicine). I would love to do a Diploma of Children's health and Diploma of O&G which could focus my FM practice a bit. I could also easily train part time. But, will I get bored (I do not like office that much), will I end up in some 'sausage factory' medical centre, will I ever be able to focus my practice to the areas that I like. There is a fair bit of discontent amongst FM doctors here - about mountains of paperwork they are expected to do, about poor pay, about pressure to 'churn' patients through... Will I become bitter?

I should also mention that my husband works full time and has a very busy job with fair amount of traveling. He is supportive of whatever career choice I make but ultimately I am the primary carer of our boys.

I am now obsessed with making a choice, chosing a path, getting settled onto something. I cycle through these options many times a day, and it all seems like a big Rubic's cube to me - I line up one side just to find out that the others are not in order.

Dear MiMs could you please give me some advice?

Dr Mum & 3 boys


  1. Hi Dr Mum!
    I don't have any answers for you, but I'm going to be you in a couple of years, but hopefully just with 2 kiddies! (I will be 35 when I do my internship, too.) Just wanted to say hi, and well done :)

    1. Hi there and thanks for replying.

      I hope you find a great program that will allow you to happily combine motherhood with rewarding work in medicine. Even in internship year this is entirely possible.

  2. Hi Dr Mum,
    As an Australian part-time GP trainee with four children I can thoroughly recommend the pathway. The training is fantastically family-friendly and the clinical work is endlessly varied. Good luck with whatever you choose.

    1. Hi Pene,

      Thank you for taking time to reply.

      It is fabulous that there some very happy mothers in the GP training program - it has to be a good sign.


  3. Hi Dr Mum

    I an an Aussie GP, recently fellowed. I took over 10yrs to do the training program, and the two training consortia I was with were both very flexible and helpful.

    I have 3 kids, the first one at the end of my RMO year, and the next one between GP terms. My last child was born after completing advanced skills in anaesthetics. If things hadn't gone completely pear shaped for me during that pregnancy (back surgery at 20wks), I would now be a GP anaesthetist working in both clinic and in theatre.

    I worked FT for the first part of my GP anaesthetics training, this was astoundingly hard for us as a family due to the very early starts. I really felt I was failing my kids, who were 4 and 2 at the start of that. I then negotiated a 0.8 equivalent and longer training time - this worked better.

    However the freedom of general practice works much better for me. I now work three mornings a week and have time for the paperwork your colleagues bemoan before school pick up (usually spend an hour or two extra one day each week). My practice is varied and enjoyable. If I feel I start doing too many "tears and smears" there are many options for mixing it up a bit. I teach, I have the option to explore skin clinic, there are always psych opportunities and adolescent or indiginous med options.

    My friend has had her 3 boys as an anaesthetic trainee and needed her husband to be a stay at home dad a lot of the time which didn't really suit his CEO style career - they ended up enlisting lots of family support and feeling very stressed. She has succeeded and is now a consultant and can go more PT, but specialty training is really tough on families (though as specialities go, I think anaesthetics are the friendliest).

    While everyone is different and you need to find your own balance, from what you say I think GP would suit you well, (and you could become a GP anaesthetist), and would probably work much better for you and your family.

    Good luck with your choices!



    1. Dear Jane,

      Thank you so much for sharing your story. You addressed many of the issues that I am thinking about.

      I think that it is wonderful that you have found your niche in GP. The stories like yours make me think that this can be a wonderful choice of career.

      I wonder if you live in one of the major cities? I would love to be able to work as a GP anaesthetist but am told that I would be very unlikely to find work in Sydney. I would not mind living in rural area but this is not a possibility due to my husband's work (no flexibility there).

      As for anaesthetics training, I think I could cope with the early starts - it is the unpredictable and late finishes that I would find very difficult.

      Thank you again - I will certainly keep your story and your advice in mine when making my decision.


  4. Hi Jasmina,
    Another Aussie GP Mum here. I am still training. I have done part-time internship with a baby, full time internship with a baby, part time residency with a baby, part time residency with two babies, full time DRANZCOG with two babies (HARD) and now have been full time GP training with my two kids 5 and 3.
    I work in a rural area and like Jane combine clinical work with teaching but I think there are many opportunities in GP to find what works for you. If there was a reason for me to be in the city I think I would probably do some work in Family planning clinics, many major hospitals will hire you to help out in antenatal clinics, I would also be drawn to refugee and Indigenous health and keep up my teaching.
    If you were on the GP training program and it really wasn't for you, you can change your mind.
    If you're interested in joining a facebook group of people facing similar challenges come and join Medical Mums and Mums to be.

    Good luck with your decision

  5. Just wanted to add. The idea of working in a super clinic is not my cup of tea at all! It is definitely not all GP has to offer!

  6. Hi Dr. Mum! I'm afraid I can't offer too much perspective on life in Oz, but I can help with life in anesthesia. I'm an anesthesia resident in the US currently and have a 2 year old. The starts are early, but the hours are predictable. When you are off, you are definitely off! My husband and I have it arranged that he, by default, does the "morning routine". I'm out of the house a full 2 hours before my daughter is even awake! But the finishes tend to be early and, even as a trainee, are very rarely late. That means I get to spend afternoons and evenings with my family, which I really appreciate. I hope when I'm finished training to work part time, perhaps 3 days/week, 36 hours total, but I love the flexibility that exists with anesthesia. If you work for a big enough hospital, you can fairly easily reduce/increase your hours as you like. I hope that helps! GP is wonderful for other reasons, as you already mentioned. Good luck with your decision!

  7. Hi Jasmina,
    Like everyone before me I'm reluctant to offer advice but happy to share my situation. I always a wanted to do specialist training, but after the birth of my son 4 years ago I couldn't find part-time work and so (reluctantly) started GP training. In retrospect, I am so glad that I did. It's been a relatively easy and stress free qualification to get - 27-38 hrs is considered full time! And its allowed me to spend time with my 2 children while they are small. I am now planning to start specialist training next year and having an FRACGP under my belt will be a huge comfort should I find out that specialist training is not working out for me.
    I guess what I'm trying to say is that choosing GP doesn't mean NOT choosing anything else. It can be a great first step towards specialist training (if you decide you don't like it) and in fact makes you a more attractive candidate.
    all the best!

    1. Hi Cara - thank you for your insight.

      I can be guilty of tunnel vision. Doing GP for a couple of years while children are still very young might actually be fun to do. Sometimes it pays to stop and consider why is there such urge to get to a goal within a particular time window.

      I did not used to be obsessed with rapid progress through training before but it seems that turning 35 has done something to me ;)

  8. Hi Jasmina,

    I am a mother of 1.5 (20/40, I guess thats a 0.5) and a senior registrar in emergency medicine in Australia. I have found the flexibility of the ED training program fantastic since I had my little boy. There are great oppportunities to work part time and in some of the undersubscribed hospitals you can push them to be pretty helpful with fixed shifts that make child care arangements much easier.

    I would also suggest psychiatry as another good family friendly training program that is full of interesting clinical work.

    I have worked full time for 12 months since I had my little boy. 6 moths of that was retrieval work which was fantastic and exciting and the varied hours meant I still got quality time with my little one. I did another full time hospital job that left me and my family almost broken after 6 months and made me plan never to work full time again while I have a young family.

    Your family is so precious. I would recommend choosing a path that allows you to find that balance that meets with your values as the opposite is just too awful to contemplate, and I would suggest, just not worth it in the end.

    Good luck!

    1. Hi Nic,

      Thank you so much for your comment.

      EM is something that has crossed my mind. Flexibility is great and you can leave work at work.

      I agree with you about the effect full time work can have on family and I feel that, whatever I choose, I will need to have an option of managing my hours. Working 4 days is fine, working 5 + overtime can stretch me too thin.

  9. You could also consider other, non-hospital specialties - occupational medicine, sexual health, travel medicine. Check out the RACP website, there are many other options than we hear about as students and junior doctors. Good luck!


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