Thursday, June 5, 2014

MiM mail: His sacrifice or hers?

Hi everyone,

I've been reading this blog looking for pearls of advice and wisdom ever since I was accepted to medical school just over a year ago (in Canada).  When I interviewed for medical school, I was actually 8 weeks pregnant with my first daughter.  I decided to defer for the first year to stay home with my daughter.  Now the time has come to decide whether I indeed do go back to school and become a doctor. This situation is complicated, and I need some advice from some women/mothers who have been there.

A little about me: I am a 32-year old (will be 33 after 2 months of school) family nurse practitioner.  I have a great job and work with an amazing team, but no I have no flexibility in terms of hours.  I have decent pay (but no real opportunity to grow). And the nurse practitioner role is still developing in Canada so there are many other "issues" with the profession as well, including barriers to practice, funding/remuneration issues, and scope of practice limits.  Not to mention that most people in Canada don't even know what a nurse practitioner is.  When I tell people, they think I am training to be a nurse. That aside, I know I would love a career in medicine.  I've been in the healthcare field myself now for over 10 years, and I think I have a pretty good idea and sense of the role.  My daughter will be 9.5 months if/when I start school, and I do want/plan to have 1 or 2 more kids.

The situation is complicated because I was accepted in a different city and province from where we live now.  My husband is working at his dream job and has NO desire to leave it.  He feels (and has been told) that he is on a great trajectory with the company, and has already been promoted a few times in the 2.5 years that he's been with them.  There is no office for this particular company in the city we would have to move to.  There is no family of either of us in the city that we have to move to (but there isn't now either). We just got into an AWESOME brand new daycare on the campus of my current job (for which I am still on mat leave), but we have to pay the monthly fees as of now in order to hold her spot until I go back to work in October.  This is pricey, plus if we end up moving, a huge waste of money. But if we stay, it is super convenient, as I would just have to bring my daughter to work with me and could pop over between patients and see her!

Essentially, it has come to either myself or my husband sacrificing for the other.  He has his dream job with great future prospects.  I can have my dream job in medicine, but not for another 8-ish years (I would probably specialize). Plus, we will go from a two-income family living a comfortable life, back to going into debt and living a student lifestyle. Also, I don't really know how much time I will have for my kids during all of this training. And is that what is best for them? I really don't know what to do.  I feel so guilty about uprooting and making him quit his job if we go.  He doesn't have any prospects in the new city as of yet either, which makes it hard for him to visualize being there.  I can visualize myself there because I know I would be starting school etc.  We have decided that we need to do what is best for our family (daughter and future children). But we can't seem to figure out which path is "best." I wish I had a crystal ball to look into the future and see how each path would turn out.  I really really want to go, but he really really wants to stay.  We both said we would sacrifice for the other, but that still leaves us with a decision to make, and we are having such a hard time.  Any thoughts or advice or wisdom would be MUCH appreciated.



  1. My aunt (in her late 60s now) was an early nurse practitioner in the US. She got a PhD in nurse practitioning and really helped to define its role in the US. Currently she runs a hospital system and is regularly consulted by her state's US senators regarding health care systems. Even if there's not room for growth now as an NP in Canada, you could help to create that growth if you're ambitious. A lot can happen in the next 8 years.

    Given the list of pros and cons you've made, it doesn't sound like there's a lot to recommend this med school at this point in time. Are there other ways to get the things you're specifically missing (growth, freedom, flexibility, etc.) besides something that has all of the downsides you're mentioning? Also, is there a chance of getting into a med school closer to your DH's job if you keep trying? Would you be able to live apart if you do decide on med school?

  2. So from what you've written, I don't see how your family would be financially supported if you moved away from your husband's job to start med school. This is a major issue and one that would definitely sway me away from such a big step. Unless your husband has something lined up that he would be happy with, I can't see how to make it work. Unless you happen to be independently wealthy somehow or have really saved enough to live for a few years---if so, disregard my comment.
    8+ years is a LONG time at this stage in life. I agree with nicoleandmaggie about thinking first about opportunities for growth and challenge as an NP---they are DEFINITELY there in the US, and it would seem those changes would be spreading your way soon enough. The NPs I work with tend to be part-time, specialized in a very specific niche, do research, go to conferences and give talks, teach at the nursing school at our institution, etc... Maybe you just need a new job in a different field of medicine (the beauty of being an NP is you can just switch around, something you CANNOT do as an MD! I know NPs that went from surgery to a pediatric specialty to a nursing home, etc...)
    In terms of your child and future children, they will be fine whatever you decide, kids are awesome that way.

  3. Agree with the above posters. The NPs I've worked with as a student had a lot of autonomy, and were able to operate at the level of senior residents/junior attendings with oversight. Could you retrain and switch fields? Explore doing policy or research? Advocacy? Being an NP is a great career, and options for career advancement are growing every day. Make your own path!

  4. A different perspective- my mother is an RN who deeply regrets not going to medical school. She is in her mid-60s and never thought medical school was an option for her. Marriages can fall apart, people lose their jobs, family members become ill- you never know what can happen. I would follow your dreams and go to medical school, even at the expense of living separately from your husband.

  5. I am also a Canadian mom and I'm applying to med school this cycle. Because our province does not have a med school, we will have to move regardless of where I get in. My husband just got a job he loves, though, so a year from now we may be in the same place ourselves.

    That said, and this may sound hard to consider, have you explored the possibility of travelling back and forth?

    My husband worked in Alberta for two years. During that time, he was gone for months at a time and came home for short periods. He started this when our youngest was 10 months old and it did no damage to their relationship. It might be less than ideal, but kids are pretty tolerant of this stuff. You'd be home for several months in the summer, over breaks, and could do electives near your home. As an army brat and a maritimer, parents leaving for months at a time out of necessity is pretty normal to me anyway, so my comfort level with this may be significantly different than yours.

    We have this on the table for us as an option, particularly as our oldest has special needs and waiting lists for services can be long enough that we won't be able to move on short notice.

    I hope you can figure something out that will work for you guys. My situation is different in that I don't have a pre-existing career as an alternative choice so declining med school isn't an option.

  6. Agree with nicoleandmaggie, Ana, and OMDG--I would explore options for growth as an NP if I already had that training and experience under my belt. What are the things that are drawing you to medicine? If it is flexible hours, room to grow, and remuneration--you are not going to find any of those things for 8 long years, and even then it is not a guarantee that you'll have an amazing, flexible schedule as a young attending. If you have a hunger for knowledge or want new challenges, there are ways to seek out training opportunities and professional development within NP field. Maybe there are other opportunities that would give you the satisfaction you seek by building upon your NP foundation with 1-2 more years of additional (possibly part-time while working) training. It sounds like with your family situation it may not be worth all of the sacrifices.

    Honestly, as a current intern who is just over halfway through that 8-year long tunnel I oftentimes wish that I had pursued the NP pathway, especially after seeing many fabulous NPs in action, and watching my age-mates who finished their NP training years ahead of me who are already doing great work.

    I wouldn't put too much weight on the "you might regret it forever if you don't do it" argument because you never know if the opposite may also be true. What if you decide to do the MD and spend your life regretting that you didn't stay on the NP pathway? There are always potential regrets for every scenario. Personally, I would try to analyze the situation (using heart and brain) and do whatever makes most sense for me, and as you've recognized, my family. Good luck with the decision!

  7. I, too, would explore NP options. I cringe a bit hearing what the move might do to your husband and family. someone else said to not consider that because things can change but I disagree. they are what you have right now and are worth sacrificing for. I'm jealous of your chance to make a different choice now before you've invested too much because realizing you wish you'd done something else after you're too far in makes change seem impossible. good luck.

  8. When you finish medical school, your job security will be greater than your husband's and your current occupation.

    New specialist grads (in Canada) are experiencing difficulty finding work, particularly in academic centers. Even for those in non interventional/non surgical areas.

    I think it depends on what the ultimate goal is. If it is to work in an academic center as a specialist, the amount of time and training this is going to require to be considered for such a position may not be worth the sacrifices at this point in your life. If the goal is to be a family physician, I think this would be doable, and with the shortest amount of time investment for the greatest job security and from a financial viewpoint if you factor in the number of years earlier you would be able to work (vs. specialist training).

  9. Go for one year. Just one year. Then make a case to transfer to your home medical school.

    You will regret this if you don't try. You put a lot of work to get into school. Canadian medical schools are no joke to gain admission to.

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  11. Maybe decide what exactly it is you are missing with your current career and talk to people to see if they found those things as a physician. Also I would calculate out the debt you will have including interest and lost wages. Get a number and see if that amount of debt plus working 80 hours a week for many years is worth it to get to your goal.

  12. I'm an NP in the states so I have no idea how the system is in Canada. Are there no other opportunities in your area for part-time work or work in a different field but still as an NP? It was my experience as a new grad that the flexible and part-time positions were rarely advertised and had to be sought out almost office to office.

    If you have a burning desire to be a physician, then I agree with those here that you must try. I never had that was burned out of me from watching my brother go through the hellish years of medical school and then residency. I'm a person who craves balance and I just knew it would be an eternal struggle (and I admire those of you here so much who have found it!).

    I currently work two part-time but very flexible positions as long as I plan ahead of time..I don't there is any such thing as an NP position that is flexible at the last minute. I haven't missed a field trip. awards ceremony or days at the water park. I do all of the morning drop off at school and those car rides to school with my high school daughter are treasured for sure. Please know that as your kids get older, they feel your absence so much more acutely.

    If it makes you feel better, as an NP in the US I still have patients who are confused by my role and we still have political and role issues. I'm not sure that will improve overnight.

  13. A few years ago, I was in a similar boat. I had been accepted into a Post-Bacc program. My husband didn't want to leave his current role, so I turned down the acceptance and continued on in my current career. Fast forward a few years and the women who had taken the post-bacc program are almost done medical school. I am still in my current career, which is unfulfilling, but supports the family. I am also getting a divorce. I still think about Medical School, but it seems far away these days. You need to make sure you are fulfilled in the NP before giving up medical school. One of the reasons my marriage failed was that I resented my sacrifice.

  14. Thank you sincerely to everyone for their comments. I was in need of hearing some real honesty from some women who have been there. I just wanted to update everyone on the decision we have made. I am so relieved and happy to have actually come to a decision, as we have been going back and forth about this for over a year. I finally KNOW what I am going to be doing with my life (ie. going back to work vs. going back to school). It is such a huge weight lifted off of my and my husband's shoulders.

    So... the decision was made just a few days ago. We have decided that, yes, I will go to medical school. The tipping point was when we found out that my husband's employer was willing to be supportive (albeit not overly thrilled) of the move to the new city and will allow him to work remotely with some commuting back and forth. So, in the end, he will be able to keep his dream job, and I can have my dream too. I really can't believe that it has finally come to this. I know it is not going to be easy, and I start classes in a few short weeks, but I am officially part of the MiM cohort now!


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