Thursday, June 27, 2013

MiM Mail: Finding a career in medicine in your 40s

Hello Mothers in Medicine!

I'm a 41 year old mom of two kids, ages 13 and 10.  About 3 years ago I thought, ok... it's time to start thinking beyond stay-at-home mom jobs that are part-time and intermittent.  It's time to think of what career I want to choose, now that my kids are in school during the day.  I have a bachelor's degree in Social Work, with a minor (actually almost a major) in music.  I love working with people.  But, after working in the social work field for 6 years prior to having kids, I decided I wanted something different. I also taught music for several years while my kids were at home, but found I wasn't being challenged enough. Social work was too open-ended for me.  I wanted to diagnose a problem, then make a plan to work on fixing it. Around this time is when my mother became very ill at the age of 68.  A normally healthy active person, she exhibited many odd symptoms that stumped many doctors.  Finally an infectious disease doctor diagnosed her with Cryptococcus Gattii, fungal meningitis.  I helped my parent's through her horrible disease, and realized after a year of her being in and out of the hospital and rehab facililties for physical and occupational therapy, that I loved medicine. It was the hardest year of my life, watching my mom suffer.  And, it also changed me.

In a casual conversation with my mother's doctor, he said, "Oh, I think you'd be a great doctor!" Something clicked in my brain at that point, and I began to obsess over the possibility of becoming a doctor. I couldn't get it out of my mind. I spent the following weeks researching programs, and figuring out what I'd need to do to get into med school.  Of couse, I quickly became overwhelmed with all the classes I'd have to take. But, I've started taking one prereq class at a time.

Here's where I'm at...my passions really are mixed.  I love medicine, and helping people heal.  I also strongly believe that we need to treat the whole person, not just the disease.  I believe that helping a patient in the healing process involves not just the medicine, but their nutrition, their mental and emotional health and well-being, and finding the source of the disease and treating that. Asking the question: "Why did the patient become ill/injured in the first place?" is a really important question.  Because of this approach, I'm very interested in Naturopathic Medicine, integrated with Allopathic Medicine.  I'd love to see the two working together.  Both have important things to offer, and both are critical in the healing of the whole patient.  My mom would have died without the administration of Amphotericin B. But, I can definitely say that naturopathic medicine could help clean up the aftermath of the disease, if it were included in her insurance. I would love to become a Naturopathic Physician.  But, again, I am 41 and have kids.  Doing this would mean 4 years of medical school, plus a residency (which in natural medicine is usually about 2 years). Another option would be to become an MD, instead of an ND, and focus on integrative medicine. This is looking at 4 years of medical school, plus about 4 years of residency. My OTHER option is to become a Physician's Assistant. It basically requires the same prereq's as the other degree's, ND and MD, but it's only 2 years of intense schooling rather than 4-8.  I would need 2000 hours of health care experience in order to apply to a program, which I don't have yet. It would take me 8-10 years to become a doctor (prereq's + med school + residency), and about 4 years to become a PA ( prereq's + healthcare experience + school).

Another problem area for me is that I am not able to uproot my family for schooling.  I live an hour away from an excellent medical school (OHSU), and also an hour away from a really good naturopathy school (NCNM). These two schools would be my only option to become an ND, MD, or PA. Kind of putting all my eggs in one of 2 baskets!  I'm leaning toward becoming a PA, just because it's less time, and I'm older.  Plus, I could work in an integrative clinic and do the natural health stuff that I'm interested in.

Here's some questions I have for you:

What's it like to be in med school when you have kids? Can you have any sort of life?

What are your thoughts on ND vs. MD vs. PA, considering my age and phase of life?

We are a single income family, and make about $70,000/ year. We've learned to live simply, but I'm worried about the amount of bills I will rack up in medical school.  Is this a valid fear? How long did it take you to pay off yours? I fear that I'll be spending my entire career paying off my med school bills.

If you had it to do over again, what would you have changed?

So many people say to follow my dreams, and go straight for becoming a doctor.  But, they don't realize how much sacrifice that would be for my family. If I didn't have a family I would definitely become a doctor.  But, I don't want to lose what I have with them. This is why I am seriously considering becoming a PA. Am I cheating myself? Or just being realistic?

Thanks for reading my really long message.  I'd love any input any of you might have.  I know you're very busy with career and family.  So, I will be patient and wait for your response. Thanks for your help in this huge decision I'm making.

Sincerely,
C

49 comments:

  1. Whichever you decide, please for the health and safety of your patients, practice evidence based medicine.

    ReplyDelete
    Replies
    1. (I am the person that wrote the post)
      I appreciate your concern about this. I feel that evidence based medicine is important too. I think there are some people in natural medicine that don't practice evidence based medicine,which is unfortunate. But more and more people in the profession are working alongside Allopathic medical professionals to compliment what is already being done. My hope is that more doctors of all kinds are able to work together in this type of integrated setting, that is based on evidence and not touchy feely stuff.

      Delete
    2. It is my understanding that you can be fairly limited in practice as a naturopath. (Am I wrong in this?). If you want to practice the full scope of medicine, become an MD, and than acquire subsequent training to allow you to integrate your appreciation for holistic medicine.

      Delete
    3. Actually, Pve, that's a good question. Naturopathic Physicians (which are different than homeopath's) can practice the full scope of medicine in the state of Oregon, where I live (it varies state by state). Here they are licenced, and have the same prescribing abilities as MD's. So, ND's have to take boards just like other doctors, and their training is very similar to that of an MD. In fact, it's my understanding that the first two years are exactly the same. An ND (at least the good ones) does a lot of the work of a family practice physician combined with the work of a nutrition therapist. The drawback is that you often have to open your own practice, and not all insurance will cover ND's.

      Delete
  2. Become a pa if you think it'll make you happy. Med school debt is significant and you'll have to worry about college costs and the guilt of missing a huge chunk of thwir childhood. Fwiw I'm a 3rd year md/phd student with a toddler and so far happy with my decision but I only took 1 year off after college and will graduate without debt. If you go the md route you either need a lot of family support or $$ for hired help.

    ReplyDelete
    Replies
    1. I second that. Do PA or NP school. The NPs got to do deliveries, procedures, and high level patient management on a recent NICU rotation I did (i.e. all the cool stuff). I've seen NPs/PAs be first assists in surgeries, midwives, primary care providers, specialty inpatient care providers on services like transplant. Seriously, it's like 1/2 the school, 1/2 the headaches, and they are getting more and more autonomy every day. I didn't do it because I wanted to be a physician scientist, but I'd advise anyone who wanted to do primarily full time patient care to go the NP/PA route.

      Delete
    2. My aunt is an NP-- she taught NPs for a while and is now the president of a hospital system. My family is very pro-NP.

      Delete
    3. Great advice! Interesting that PA's can also be first assists in surgery, another area that really interests me!

      Delete
    4. As a very recent medical student (and mom of two during medical school), I would actually support the PA route. Medical school is tiring, expensive, and time-consuming. And depending on what kind of doctor you want to be (sounds like you would be primary care), PA or NP school would really be more like 1/3 the amount of time of medical school. (You would also want to consider how difficult it could be to be accepted at the one medical school you listed. Many people apply all over and don't get in).

      Delete
    5. I second PA or NP school. As a Peds Senior Resident with a 2yo, it's the way to go. I have a few friends who are PAs and they are well into practicing real medicine outside of training. I also think the PAs knew their clinical practice better than we MDs did during training. And from what you are saying about wanting to do patient education and diagnosis, you'll probably be given more latitude to do that than us MDs.

      Delete
  3. I'm 10 years younger and you, and can't even imagine starting now, and in fact, am strongly looking at career alternatives to practicing clinical medicine. Taking on that kind of debt when if you didn't, you'd be less than 20 years from retirement sounds crazy to me. I don't mean to be discouraging, and my baby is sick and not sleeping this week, but I would really think hard about other options that didn't have as much money and time involved in the start up cost.

    ReplyDelete
    Replies
    1. There are articles out there about the benefit to cost ratio (both financially and personally) of entering medical school at a certain age. I think I found them on mommd.com. The article stated that at 40, it would not be worth it financially. I once discussed this with a mother and peer of mine who entered medical school at 30 (she is now in radiology residency). She agreed and said that she would not do it again. Granted, she has three small kids.

      It is so hard to determine what the benefits and costs would be for any one individual, though.

      Delete
    2. Really good thoughts. Thanks. Don't worry, you're not discouraging at all. I'd rather have someone be real with me, than sugar-coat the truth. I don't know any women, with kids, who have been through medical school. So, you ladies are my only people with actual experience. It helps a lot.

      Delete
  4. I'm nearing 40, with 5 kiddos and a fairly low-stress, attending-level job I really like. But if I had to start over right now? No. way.

    Your kids are more independent now that they're older, but as I'm sure you've realized, they need you as much now (if not more) as they did when they were little- just in different ways. I'd be wary of leaving them just as they're hitting the adolescent stride when they'll need a LOT of guidance. I'm sure you know med school is not like taking some classes during the day and then having your evenings free to study at home while supervising the kids' homework. It's a full-on, sink-or-swim endeavor that will make your husband feel like a single dad at times.

    Unless you have reason to believe you'll get significant grant or scholarship (not loan!) support, the debt at this age can be crushing, too- are you willing to take on another mortgage payment (that's what it could amount to- easily $100K+ in debt) that you'll have to start making payments on right around the time your kids go to college?

    Sounds like you could be happy being a PA- that's the route I'd go for if I were you. Less time, far less cost, and a less demanding training program that will allow for you to be more physically and emotionally present for your family.

    ReplyDelete
    Replies
    1. These are exactly the kinds of things I've wanted to know. I needed to know how grueling medical school will be, and what sacrifices I'd need to make. There are some things I'm willing to give up, but other things I'm not willing to give up. Your response was really helpful. Thanks!! (and I'm sure my husband will thank you too).

      Delete
  5. I agree with most of the above comments. If you want to practice healthcare, there are better ways than getting an MD & doing residency. PA or even NP (and their may be even more alternatives in the Natural Medicine field---I don't really know anything about that) can see patients, in some states with very minimal physician supervision (for better or worse). No need to take on the financial and time commitment for med school. ($100K at least, most schools cost more than $25K/year). Can you do it? Of course you can. But should you? Given what you've written above as your goals---I don't think so.

    ReplyDelete
    Replies
    1. One of my best friends said, "Do you want to become a doctor because you know that you CAN do it? And, therefore do you think you should do it just because you can?" That really made me think.
      I'm confident now that I could do medical school and become a doctor. But, with the kind of lifestyle I want, I don't know that it's the best choice for me in this stage of life, and I think I would be very happy as a PA.

      Delete
    2. Ugh, my med school was much more than that! And my husband paid our living expenses.

      Delete
  6. You should consider becoming an NP. I have had a wonderful career as a primary care PNP. I really think it's the best of both worlds. I practice with autonomy, I diagnose & treat, and I get to educate families. The best part...I am still a trained & experienced RN and have learned how to treat the patient, not only the disease. I also came out with no debt. I practiced as an RN while getting my MSN, so I paid as I went along. I have a very flexible schedule and no call and am also very well-paid. It has been a great career to have with little kids. When I made this decision 17 years ago, there was always a twinge that I would someday regret not getting my MD (which was my original plan in college). I have been a practicing PNP for 14 years and do not regret a single minute. Good luck to you!

    ReplyDelete
    Replies
    1. Thank you for your response! One of my questions has been whether to go the PA route or NP route, if I end up doing midlevel care. I know I would have to become an RN first. And, the prereq's for nursing school are different than PA school. So, in the long run, I'm wondering if becoming an NP would actually take me longer since I'd have to get my RN first.

      Delete
    2. My only concern with anyone going right into a PA/NP practice is lack of practical experience. I am one of the old-timers who feel it is IMPERATIVE to work as a practicing "something" (RN, EMT, tech, etc) before becoming a provider who diagnose/treats. My background as a PICU and NICU RN was invaluable as a primary care provider. I only caution anyone who is heading in that direction to consider that nursing school clinicals (and I'll guess PA school too) are not anywhere near enough to get good, practical experience. Even my alma mater (Univ of Pennsylvania) allows people to go straight through from BSN to MSN without any practice. I think this is does a huge disservice to both the provider and patient. Please factor that into your decision :)

      Delete
    3. I really agree, Melissa. I simply trust medical professionals with more experience. I was researching the curriculum in both PA and NP schools, and wondered how I would possibly be ready to do primary care with just two years of ed. I'm in the process of looking for work in healthcare, and am hopeful that I'll find work with a doc that is willing to do some hands-on teaching with me.

      Delete
  7. I'm 40, w/kids who are 10 and 12 and I'm starting at OHSU this August. I was open to relocating but this was actually the best fit school for my goals & personally. I decided to pursue medical school b/c I'm interested in research, teaching & health care policy & service delivery in addition to patient care. If you are primarily interested in patient care then I think a PA or advanced practice nurse track can get you to a very satisfying career without the burden that medical school would put on you.

    ReplyDelete
    Replies
    1. It's nice to know that someone else in the same part of the country, same age, and same ages of kids is in the same boat as me! Congratulations on getting into OHSU! It's not easy to get in!
      I do love the problem-solving aspect of being a doctor. But, it sounds like to me that many PA's are involved in the problem-solving, and just consult with physicians with more complicated cases, am I right? Also, patient care and teaching patients are areas of interest for me, and I think I could do that as a PA. Or, NP.

      Delete
  8. i'd recommend PA, too. I'm mid 30s with 2 little kids almost done surgical residency and i would not like to be any older doing this, i'm not sure the residency programs would be crazy about training someone with less "service years" to give back, and i think it would be pretty hard on your family financially and emotionally. not to be discouraging, as everyone else has said, i'm sure you CAN do it, i just wouldn't recommend it given the other factors in your life. it is a REALLY long road.

    ReplyDelete
  9. I'm a second year medical student, early 30's with young kids. Second year is awesome. Totally do-able with a family. First year... more awful, horrible, no-good than you can imagine. Staring down the barrel of 2 years of clerkships plus 3-4 more of residency... I think I should have gone to PA school. I started out wanting to practice rural family med (or a similar low-access/high need type care), but the more practical I get, the more I realize I'll have to practice in place with good schools for the kids. And I could have achieved the same goals in less time by going to PA school.

    I'm lucky to be on scholarship + living stipend + husband's part-time salary, so thats taken care of, but the time away from the kids -- that is what really gets me. Is it all worth it? TBD.

    ReplyDelete
  10. Not much to add to above but I loved your letter/story - so inspiring. As a pathologist almost 8 years out of 10 years of med school/residency and no end of school loans in sight - not that they are crippling me, just there, I have to echo above that I might not want to start that long road now (I'll be 40 this summer). Look at what you want to accomplish and take in mind immense wisdom given by women from all clinical tracks above (different from mine) and best of luck to you! As they say - there is more than one way to skin a cat . . .

    I cannot speak to med school with kids. Residency with young children was excruciating. Certainly took a toll on my family. I'm glad to have that trying time behind me and revel in the time I am allotted as a private clinician, although never enough as women in many fields, to spend with my kids. Much more satisfying than training hands down.

    ReplyDelete
    Replies
    1. Pathology sounds interesting! You would have had an interesting time with my mom's fungus. I think her spinal fluid was in labs in Maryland, Texas and Oregon. I researched the heck out of cryptococcus gattii.

      Delete
  11. I'm a PA working in dermatology for the past five years and I love it. All my close friends from PA school are also very happy in their careers (ER, ortho, and dermatology). It could be a great choice for you given that it would take less time probably significantly less debt. NPs are also great, but you would need to get your nursing degree first.

    I would look into how difficult it is to get into the PA program in your area. Many PA schools are becoming really competitive because they usually only accept 40 or so students per year and it is becoming a very popular field. Go to an informational meeting early and find out how you can make yourself stand out. Also, start getting the clinical experience you need to apply. Some people become CNAs or EMTs first to get clinical hours. Factor this into your equation.

    As a PA one of the most important decisions you will make is who you work for. If you have a great supervising physician that continues to teach but also allows you the appropriate level of autonomy it can be very satisfying. As long as you don't have a big ego and you are happy to work as part of a team it should be a good fit. Also, PAs are often not expected to carry quite as heavy a patient load as physicians, so you may actually get to spend a bit more time with your patients.

    Good luck whatever you decide!

    ReplyDelete
    Replies
    1. Thank you so much! So nice to hear that you and your colleagues are all loving your jobs. It's nice to know that all my research is confirmed by what you've said. I've been thinking of how I want to get my clinical hours,and have also been thinking of what kind of doctor/specialty I'd be interested in. I know some great doctors in town, and have several good connections.

      Delete
  12. Wow, I'm amazed at how helpful you all have been. I truly am thankful. This decision has been weighing heavily on me, and I feel like I'm about 90-95% convinced that becoming a PA would be a good move for me. So, thanks for all your input and advice. I wish you all well with your careers and families.

    One last question about prerequisites:
    Organic Chemistry (science major level) is not a required course, but a suggested course for becoming a PA. I'm debating whether I should take it. Do you feel it's a really helpful class? If I take it, I'd need to take it this fall, while the Gen Chem is still fresh in my mind.

    ReplyDelete
    Replies
    1. Hated it and struggled immensely through it! Not sure if I remember a single thing from it, not sure if it helped at all with Biochemistry in medical school. You make your decision, but it might be better to take a science major level physiology class or spend some time shadowing in a hospital. At least you'll remember something and learn something about patient care.

      Delete
    2. Mmm, good to know. Definitely don't want to take it if I don't have to.

      Delete
    3. If it will help your application, take it, but if not don't. It definitely has not helped me in med school -- AT ALL. And I say this as a person who liked OChem.

      Delete
    4. From what I understand, what will help me most is to have the required courses done, and really good grades in all my sciences. So, I think it best to stick with the classes I know I will do better in, like bio and Anatomy & Phys.

      Delete
  13. I strongly recommend shadowing PAs and maybe doctors and NPs too. Shadow both inpatient and outpatient settings. This will help you decide if being a PA is right for you and it is also good for your application and interview.

    ReplyDelete
  14. hi there.. just letting you know, it is possible to do your MD studies AND have the kiddies also.. but only if you've got some thorough family or other support. My situation is that I am 35, have a 6&4 year old and am in my second year of graduate medicine in Australia. It is constantly a battle between being a good mum and a good student, but I've come to learn that I am never going to be a "good" anything.. just mediocre at both for another 2 yrs till I graduate. I hate not knowing things and being only semi-ok at the medicine side but I've made my peace with it and figure I will learn more when I get into hospitals than from a textbook. And it's ok. I have my parents and my husband and they're working hard to help me get thru.

    so thats my 2c worth. hope you choose what makes you happy and know that anything is possible if it is meant to be!

    ReplyDelete
    Replies
    1. I appreciate you giving your 2c worth.
      My husband is in full support of me, but doesn't have the extra time to be able to help out much with the kids, because his job is also demanding, and often unpredictable. Also, we just don't have the finances to hire someone to help out at home, and take over things I won't be able to do if in med school. I could figure out how to make 2 years of school work, just not sure about 8 years...Hmmm, still thinking though.

      Delete
  15. I'm a PA who works in outpatient internal medicine. Have two kids, ages 7 and 4 - had one of them during clinical year of PA school. It was pretty tough but clearly not impossible. I've worked in EM, Urgent Care and now Primary Care. So far, I like it and am quite happy.

    There are several VERY important things to consider before you pull the trigger for PA school, though:

    1) Your attending will want you to practice however he / she practices. You may not agree with this. Is that going to be okay?
    2) You will NOT be the "final word". Is that going to be okay?
    3) After doing the job for 10+ years (essentially finishing your "residency"...you may feel like (and you may actually) know more than some MDs just starting out...yet you will make much less. Your income, while pretty good, will have a lower "ceiling" than that of a doctor's. It may not be a big deal at first, but a few decades into it...you might think, "I'd be getting paid 4x what I'm making now as an MD and I'm doing the same job."

    Also, PA schools are pretty competitive nowadays. Good experience and academics aren't quite enough...you need something sets you apart. I attended a top 5 program; we had ~1000 applicants for 60 spaces.

    I'd be happy to chat with you more about this if you'd like, not sure if my comment will leave my contact info. Let me know if I can be of any help.

    ReplyDelete
    Replies
    1. Oh wow, you asked some GREAT questions. Thought provoking.
      So, here are some possible answers...just thinking out loud:
      1) Boy, I guess I would say it was ok if I agreed with their methods of practice. I have a hard time doing anything at all if I don't agree with the person in charge though. I am a great team-player, if I feel that all those on the team are making wise choices with the best interest of the patient in mind. However, if I disagree with someone and feel they are not making choices or diagnoses that are correct or in the best interest of the patient, I feel that I'd have a hard time keeping my mouth shut. Although, if you're just talking about how maybe I'd go about something a little different if it were me, and I don't fully like how the attending is going about it...I think I could do well at working out a compromise, or at least making a strong effort at understanding where they are coming from. I don't feel like I need to always be right. I'm willing to learn. But, I cannot stand injustice, arrogance or selfishness in the work place, just so one can get ahead.
      2)I think I am ok with not having the final word - but again, as long as I feel that the attending is capable of their job. I assume they would be because they made it through med school and residency, but there's always that "what if". Bottom line though, if I trust someone, I'm totally fine with them having the final word.
      3)This is also a great question, but I'm not really motivated by money. I've never really had much, and don't know what I'd do with a lot of it. I was thinking the other day what we'd do if I made $80,000 as a PA, and was about floored, since that's more than my husband and I have ever made combined. However, I do see your point. I have worked in jobs as an assistant where I did as much (or more)work as my superior, and got paid much less. That can be a bit irritating.
      About PA school, I've noticed how hard it is to get in! The school I'd like to go to accepts 2% of the original applicants. I'm hoping I will stand out. I have almost 20 years of experience in the fields of social work, community networking and neighborhood strengthening volunteer work, music education, and caregiving that will hopefully make me stand out. I also am great with people of all ages and socio-economic status', and am able to find ways to help people connect. My husband and I live in a neighborhood that historically has had a higher crime rate. We've done several things in our neighborhood that have brought our community together, and helped neighbors get to know each other. I'm hoping that some of these things are recognized as good things that would set me apart.
      What kinds of things do you think set people apart?

      I'd also love to chat with you more, but don't know how to go about that without leaving my contact info on a public page. Can MiM help us connect privately on email?

      Delete
    2. Sure- If Marcus can send an email to mothersinmedicine@gmail.com, will connect you two.

      Delete
  16. Hi C,

    Thank you for your beautiful and thoughtful post! I have not had a chance to read all the responses in depth, so I hope this is not a duplication. It feels taboo to say what I'm about to say, but here goes: if I had it to do over again, I would probably choose to become an NP or a nurse midwife instead of a physician. I am a second year pediatrics resident who came into medicine via a post-bac after working in another field. Your inspiration to go into medicine sounds a lot like mine -- I was a doula and loved the intimate, healing connection with people so much that I decided to go into medicine, only to discover that the rich connection with people that I had as a doula is much harder to cultivate in the high volume, high turnover environment of modern medicine. The financial and personal burdens of medical training have been really staggering. I am in an enormous amount of debt (180K+) and will be paying that off for thirty years (into my 60s), forestalling such important financial milestones as buying a house and saving for retirement (what retirement?!) I feel distanced from some of the core things that were important to me before I started medical training (art, literature, spirituality). I have an 18 month old and while I work very hard to ensure that our bond is strong, I am away from her most of her waking hours on most days. I have an amazing partner and parents who help a lot -- without those things it would truly be impossible during residency. I can't speak to attending life, but I can say that more and more physician fields require fellowship on top of residency, so tack on another three years of low pay and long hours. There are wonderful things about being a physician -- it's intellectually interesting, you can do a lot of good for people, and you find within yourself qualities of strength and leadership that you didn't necessarily know were there -- but the cost is very high. I love pediatrics and feel that it is the right home for me given that I have committed irrevocably to medicine, but I do wonder sometimes whether I should have chosen a path that would lead to some kind of conclusion more quickly. Unless you really need to be the boss on the medical team or have specific research or clinical goals that could not be accomplished another way, I would strongly consider PA or NP school. I don't mean to squash your dreams, which are wonderful, inspiring dreams that you should embrace, just consider that there may be more than one way to fulfill on those dreams. Good luck with whatever you choose!

    ReplyDelete
    Replies
    1. Interesting. Thanks for your response and your honesty. I've come to realize that there are some sacrifices I'm not willing to make, and some that are worth it to me. Everyone has their limits, and it's important to know those when you are going into any sort of helping profession. This blog has really helped me to detect my limits, and to understand what my priorities are.
      I would love to have endless knowledge of how the body works, and why sometimes disease takes over. I would also love to have endless time with my kids and husband and a self-cleaning house. But, that's not reality, and I have to choose what's going to be the best-case scenario for my family AND future career in medicine. It may not be realistic to have everything, but I can certainly have some, and be happy with that.

      Delete
    2. Hi CBH,

      I totally agree -- some of all the important things is a good goal. All the best of luck to you!

      Delete
    3. Dear m - I was sad to read your comment, mainly about feeling distanced from what was previously important to you. Just wanted to share that, as an attending, I feel very satisfied with my work and with the amount of time I can spend with patients (and home).

      At my institution, we have an every other week narrative medicine session among staff - interdisciplinary - where we read short stories or poetry and write about our caregiving. It is nourishing and sustaining.

      I think medical training should be better designed to build in resiliency, meaning, reminding us of why we went into medicine in the first place. Maybe I'll work on that..I also did not do a fellowship and went right into academic hospitalist work. Hope things settle down some and you can bring back in what matters to you and keep it there. It really is much better on the other side of training.

      Delete
    4. KC - I think I would like where you work. Sounds like a good atmosphere. I'm going to tuck that idea (narrative medicine session) in the back of my head to use in the future.

      Delete
    5. and to m - I imagine that your career/life will settle down in a few years. Having an 18 month old ALONE is challenging. For me, it was the most challenging time with my kids. They were at their very cutest, but they were SO busy and into everything. And the tantrums!

      Stick with it. From what I've heard, residency is challenging. You may look back and be glad you did!

      Delete
  17. I'm a little late to the game, but I thought I'd chime in. I'm in NP school, getting my MSN with a family health concentration. I have a BS in psychology, 28 credits toward my MSW, and then realized I was NOT cut out to be a social worker. My husband and I married young (I was 19, he was 20), and though we waited a few years to have kids, they came right as I was working on my MSW. My kids were my ticket "out" of grad school. I returned to nursing school and finished my second degree in nursing 4 years ago. I'm now done with my first year of NP school and know it's the best fit for my family. NPs tend to have more autonomy and privileges than PAs (depending on the state). There IS, however, a great push toward having a NP have a doctorate instead of a master's degree. There is truly no way to have it all, so you pick what's most important and go from there. Every single NP I've worked with has said she/he has NO regrets about the career path and they would do it again!

    ReplyDelete
  18. I know nothing about being an ND, but in the MD universe it's not medical school you'd have to worry about but residency. Even if you get into OHSU and get through medical school, you'd have to go through the Match for residency, and that may leave you with very few options if you are geographically limited.

    Not to mention that you'll be paying student loans until retirement unless you get some sort of spectacular deal -- you'll be at least into your 50s before you can start paying these back, and it takes a long time. I graduated from medical school in 2003 and have barely made a dent, since I've been in training for most of those years making peanuts. I would definitely second the cost-benefit analysis suggested by a poster above.

    I would strongly consider the NP or PA route, but would also explore other medical careers (nursing, therapy, etc) that might be less burdensome in terms of time and cost of training. I have worked with both NPs and PAs and both can be great. My experience has been that the NP approach might fit with your philosophy and interests better, since they are more invested in the whole patient -- PAs I've worked with (not necessarily representative, mind you) have been skilled and dedicated but have been more likely to approach patients' problems as tasks to be accomplished.

    ReplyDelete

Comments on posts older than 14 days are moderated as a spam precaution. There may be a delay between submitting your comment and its publishing. Thanks for commenting!