Wednesday, December 31, 2014

MiM Mail: Defer or start medical school with a newborn?

Hello MiM!

I am a mom of two kids - one in school, one starting next year - currently in university in and applying to medical schools in Canada. MiM has been an inspiration since I started working towards a career in medicine, and I am thankful for all the stories that have been shared here.

To get right to the heart of the matter, I am pregnant with our third child and due in late August. I'll likely be delivered 1-2weeks early due to my history, so by the start date of the med schools Kid 3 will only be a few weeks old.

Acceptances come out in the spring, and I need to decide (if I get in!) whether to defer for a year or whether to start med school with an infant just a few weeks old at home, which will also have meant a big move while 7-8 months pregnant. I would imagine, in the circumstances, I could likely get permission to do the first few weeks' work from home, something I have heard of med schools allowing before.

My husband will be taking eight months parental leave for Kid 3 in addition to any leave I take, so we won't have to deal with putting a tiny infant in daycare and I will have help at home during that transition time.

I am hoping to hear from MiMs who have experience with having babies during first year. I have a few months to mull over my options, and if I don't get any acceptances it won't be necessary to worry, but ultimately I would prefer not to take an entire year off from my education if I could be okay with just taking a few weeks at the start of the year.

Your input is much appreciated!

Thank you,
MiM in Canada

Monday, December 29, 2014

MiM Mail: Advice for non-traditional mom

Hello and thank you for your blog! I am wondering what advice you might give for a slightly older mom considering medicine after the baby-phase. My husband and I are both teachers at an international school and we are looking to transition to living back in the States near our families. I am considering applying for medical school for the fall of 2016 and have completed all the prereqs, taken the MCAT, and have all my letters of rec on file.

We have four children, ages 12, 10, 5, and 17 months. I would start medical school with my oldest beginning high school and my youngest being three years old. I am in my late thirties, and investing in a career in medicine would combine my pure love of science with a passion for extending the tremendous care-giving roles I have had over the years.

I have hesitated to go down this road because of the tremendous financial investment as well as the time required, but I have loved my various experiences in health care throughout my career up to this point. I would love any personal advice on whether this path is worth it!


Tuesday, December 23, 2014

Guest post: Having Babies during Residency: A View from the Bridge

This post is in response to our MiM Mail: Residency limit for leave and having children posted in November.

The problem of maternity leave for residents goes well beyond the good will, or lack of it, of training directors and local programs. Different specialty boards establish minimum standards for residents to be board eligible, and these usually involve specified upper and lower limits of time spent in particular areas. Stipends come from multiple sources and are tied to the work that the resident does, which makes it difficult to set aside money from one year to pay for time doing make up work in another. When a resident goes on leave, other residents have to pick up her responsibilities, and they will not receive compensation for doing so. At the same time, they may not violate duty hour limits.

Program directors, of which I was once one, have to figure out how to create maternity policies that do not violate minimum requirements, do not unduly burden other residents in the program, do not violate other regulations and still acknowledge the legitimate needs of the resident who requests leave. When I became a program director, my youngest child was 4, and the issues of maternity leave were still very fresh in my mind. My first thought was to ask the department to hire a PA or master’s level nurse who could float to cover the clinical responsibilities of residents who took leave. That went nowhere, though I still think it would have been feasible and fair. I then tried to get the program directors organization to survey its membership to see what different programs were doing. The push back was immediate and negative. Programs with generous leave policies were reluctant to publish them, for fear that residents would select them to take advantage of them, multiplying the headaches of trying to make accommodations. Many programs had no policies at all.

I am sad to see that so little has changed in the last eighteen years—soon, my daughters will be the ones who have to deal with maternity leave. Change is unlikely unless more women become program directors and choose to work on modifying the policies of various specialty boards. The family practice board position (see MiM Nov 10, 2014) is one that others could adopt. It suggests that programs might create some creditable elective time that could be spent reading or doing some other scholarship from home. Women should be allowed/encouraged to schedule the more taxing rotations early in pregnancy (and I would suggest also front loading as much call as one can). It is still up to the program how much leave to allow and whether it will be paid or unpaid. The AAFP also leaves unanswered how to deal with what may be competing demands of the law in a particular state and the requirements of a specialty board.

In the end, women physicians cannot expect to be treated more fairly and generously than other women. Having a child during training will never be easy, but we should be mindful that we are generally privileged. We may have to delay some phase of education, or prolong it by working part time, or even chose a specialty or a position we would otherwise not have done, because of having a child. Compared to the pregnant UPS driver who gets fired, or the Walmart worker who has to stand on her feet all day, or the mother who can’t work at all because she can’t afford childcare, we are lucky indeed.


Monday, December 22, 2014

MiM Mail: Med school with young children

My name is Megan. I have 2 children. My son is 2 1/2 and my daughter is 7 weeks old. I am only 20 years old.

When I was younger my dream was to become a physician, specifically an OBGYN. When I had my son at the mere age of 17, I figured that dream was over. I decided to settle on nursing with the hopes of becoming an L&D nurse. I started going to school; while taking pre-requisites for the nursing program, became a CNA. I started working as a CNA at a hospital and had my daughter when I was 19. Having a second child while still being a teenager didn't stop me from going to school. However, working in the hospital made me realize: I DO NOT want to become a nurse. Most of the nurses complained about their jobs, seemed bored, and I did not want that to happen to me. I want a fulfilling career that makes me reach my full potential in life. I didn't want to just settle.

So I decided to go back to what I really want to do in life: become a physician. I am really determined, and very excited, but it seems like everyone around me can't stop telling me how hard it's going to be.

I guess I'm writing this to ask for support and advice from mothers who went to med school with young children. My kids will be 5 and 3 by the time I start med school. Any support and advice is appreciated. And another question, did anyone with young children have anymore kids later on in life? I'm not sure if I'm okay with being done at 2.

Thanks in advance.

Friday, December 19, 2014

I'm too old for vacation care!

It's arrived.  The 12.5 year old boy child who already thinks he's 22 and in charge of his own life. Occasional glimpses of my sweet, tender, gentle boy peek out between the lashes of the billy goat gruff.  Sigh, always knew it was coming, still a shock when it's here!

 My problem, however, is not BGG, for I know it too will pass.  It's actually vacation care.  Entering high school next year, vacation care no longer exists!  The problem is, not only does he have a 9 year old sister, who will still require vacation care, but I actually think he's too young to be spending vacation days at home alone.  All that unsupervised internet at the very least.  He wouldn't be allowed out of the house, so I'm not so worried about his wandering the neighbourhood, although it's a slippery slope, and I'm sure it wouldn't be long before "Mum my can't I meet my friends at the wherever?"  The other issue of course is little girl then feels hard done by, if BGG is allowed to stay home, and she has to go to vacation care.  Another Mum at my work faces the same dilemma - her eldest is a girl, and she has two younger siblings.  Her daughter is already telling her she's too old to go to vacation care - at least my son hasn't cottoned on to that just yet, but I know it's coming (I wonder if I can still sneak him into vacation care with my daughter?)

I know many have trodden the boards before me - what does one do when vacation care disappears?
Or are the apron strings too tight?

Vacation care is an Australian version, I think, of Summer Camp - run by the YMCA (and other places), for days when school is not on, and held Monday to Friday of all school holidays (breaks?).  It's for ages up to 12 years and held at your child's school.  It's day care only, dropping off each morning, picking up each evening.  

Thursday, December 18, 2014

Group think: What is the solution to the overwhelm?

It's 5:51am and I have 9 minutes to write this post. Well, I just spent a minute thinking about what I want to say and so now I have 8 minutes.

Lately, it's been feeling like I just can't do all the things I want to do, let alone all the things I've already committed to do, let alone all the things I have to do. This last year of residency has been a great one and I've become involved in many different projects that I feel passionate about: research, education, resident wellness. I feel an increasing sense of clinical mastery, which basically means I know what I know and also how much I don't know but it doesn't scare me as much. I've been active in my synagogue and at my daughter's school. I feel like all the pieces of the puzzle are, if not falling into place, at least face up on the table and waiting to find their place. But it seems like there is at least 100% if not 200% more to be done in every day and week and month than I can do.

Every email I write starts with the phrase "Sorry for the long delay in my response." Balloons that were up for my daughter's birthday party two weeks ago are still up and the stack of Thank You cards for her gifts still sits blank on the cluttered ledge between our living room and dining room, along with unopened mail and other flotsam from our stitched together life. I've been getting up one hour earlier than I have to for the last month to try and get on top of some of the research and scholarly work that I want so much to get done, and this has been helpful, but I'm so exhausted by the nighttime that I feel like I am not the kind of parent I want to be to my daughter in the few hours we have together during the work week -- I'm easily frustrated, less playful, and distracted, just waiting for the moment when I can lower myself into bed. I fall asleep in literally 5 seconds. The cost of starting a couple of new projects -- all of which I am excited by -- is that I'm spread thin on all of them, taking weeks longer than I promise to get things done, always twenty or thirty items deep on the to-do list. If I feel like I'm a leg up on the work side of life, I'm one step behind on the parenting side of the equation, with friendships and marriage and housecleaning and family always tap-tap-taping at my chamber door. And did I mention the emails? Oh, the emails. How and when will I master the emails?!

Sometimes I wonder to myself: Are we busier than people used to be? Am I uniquely incapable of multitasking? But wait, all I do is multitask. And is the overwhelm an external reality or is it a reflection of something about me? Would I be overcommitted and frazzled even if I were shipwrecked on an island with nothing but palm trees? Should I be doing fewer things? Or maybe this model of living is a successful one -- after all, in the end I do manage to do a lot and much of it at the "good enough" or even "good" level. But I long for a little peace.

I'm already over time by 9 minutes and 9 minutes and late for the shower that leads to throwing some kind of lunch in my bag that leads to hitting the road, so I'll pose my question and see what your thoughts are. Does anyone out there have creative strategies for getting on top of the overwhelm?

Thanks in advance for your thoughts!

Monday, December 15, 2014

MiM Mail: Year off

Hi MiM Community!

I am in the middle of a year off, and at a bit of a crossroads. I got pregnant with my second child in the middle of MS2, took the Step 1 7.5 months pregnant (not recommended), and gave birth at the end of August. My school told me that I would only be able to take 6-8 weeks off max (8 was stretching it) if I wanted to continue with MS3. If I wanted/needed more, I had to take a year LOA and come back next July to start rotations with the next class. When I had to be off my feet during my 9th month, I decided to just take a LOA and enjoy my year off with my new baby and toddler.

I'm now 4 months into the time off and unsure what to do. I have been dabbling in continued research, but my heart is not as into it as I thought it would be. I do miss school and really look forward to going back and finishing, but all the plans I had for this year pre-baby (research, volunteering) just doesn't seem as exciting. Is it so terrible to just be a mom for a bit? Am I selling myself short for future residency applications?

I did OK on step 1. Not great, not terrible. I am not necessarily interested in a very competitive specialty, but I am very geographically limited (to basically the one big city I am in now) due to the abundance of family and support, and my husband's job. I know that this is my last chance to take my older daughter to ballet, join mommy groups, take my baby to music class, etc. Can I just enjoy my time without feeling guilty about not progressing my medical career? Or is that just not realistic and I should "get my act together?"

Thanks again for being an amazing community!


I am a MS3- to- be with a 2.5 y/o and a 4 month old. I love having an active lifestyle and looking for interesting things to do with my family around our wonderful city.

Wednesday, December 10, 2014

I Don't Know How To Dress Myself

And I know I'm not the only one...

I was thrilled to see a physician-mom address this in the Atlantic: The Clothes Make The Doctor, by Anna Reisman. In this thoughtful and humorous piece, she describes how she met with a potential new primary care doc, and was put off by the sharp-dressed woman's stiletto heels and expensive suit. She then explores how physicians should ideally dress, and thus, present themselves.

She hit on a perennial topic of discussion and debate amongst my colleagues, both male and female. Male colleagues bemoan that they are expected to wear a collared dress shirt and tie, day in and day out. But female colleagues complain that they have no real "dress code", and thus, no guidance, on how to dress for patient care.

In my office, which is an all-female practice, the "work uniform" runs the gamut from: clean and pressed white coat over smart dress suits and heels, to dress suits and sensible shoes without the white coat, to business-casual with or without the white coat, and then, to me.

I'm usually in whatever Bargain Basement Clearance Store pants with less-dirty knit top and scuffed sensible shoes I can match when I get dressed in the dark at 5:30 a.m, with a reasonably clean white coat pulled over it all, like a disguise. I can't remember the last time I ironed anything; I think it stretches back a decade or more. I buy all permanent press or knit clothing. If something needs to be dry-cleaned, it's a once-a-year piece. Sweaters, slacks, scarves- they all must go into the washer and dryer, or be relegated forever to the back of the closet. This all is, I feel, most practical. Who has time to fuss over clothes?

I also LOVE a bargain. And while there are women who can browse Nordstrom Rack or Marshall's or TJ Maxx and put together respectable, even snazzy, professional outfits, I am not one of them.

Still, I can't let go of my old habits. In medical school, we had an informal group of women about the same size who met occasionally to "swap": everyone brought a bag of clothes they didn't want, all higher-quality stuff, and we had a party as we tried on each other's stuff. Everyone left with a "new" item, and the leftovers went to charity. If someone I knew suggested this today, I would so totally be there!

I even found my wedding dress, a 100% silk designer ball gown with an impressive train, for $250.00 at the Filene's Basement Run Of The Brides Traveling Sale, back in 2008. I considered it the find of the century, a total coup, and I told anyone who seemed like they cared how much I had spent.

I still have had no qualms with rooting through school fundraising secondhand clothing sales, and leaving with large bags of the clothes of people who are probably my neighbors.

I think some of my reticence on spending money on clothes stems from the fact that I've gone up and down ten sizes within the last five years. Yes, there were two pregnancies in there, but the ballooning waistline was not due to gravidity. It was due to the fact that I gained an unbelievable amount of weight with each pregnancy, on the order of sixty pounds, EACH TIME. Three months after my second baby, my daughter, was born, I realized that I had even GAINED weight while breastfeeding. My BMI was over 30. I was OBESE.

Then, with a two-year-long concerted effort at a low-carb diet and exercise when I could get it in, I lost fifty pounds. Babygirl is now almost three years old, and I've kept the weight off for almost a year.

Despite being back to my pre-pregnancy weight and size for this long, my closet is still filled with a mishmosh of sizes, and alot of "more comfortable" pieces, like Ponte slacks (read: knit pants). A friend and colleague recently pointed out to me, in a humorous way, that Ponte slacks are in the same category as yoga pants. Meaning, not acceptable work attire.

Unfortunately, in order to dress well, one needs two things: Time, and Style sense.

I know I will never have the time or inclination to study fashion magazines or follow style blogs. And for some reason, when I see someone who I think is dressed really well, meaning, how I'd LIKE to dress, I can't seem to replicate their look (probably because of my clothing care learning disability.)

But, I still want to look like a real, respectable, clean, practical yet SOMEWHAT stylish physician. Someone who is aware that it's almost 2015, but who is also willing to kneel down on the exam room floor to look at a patient's diabetic foot ulcer.

I know, I know. Time to grow up, learn how to iron, make the dry cleaners a regular weekly errand.

I also need a personal shopper. I have seen this mentioned on prior MiM posts (that I cannot locate right now), and people have suggested Macy's, as they offer those services free of charge. Of course, to take advantage of that requires several things: Making an appointment, taking some time, and investing in attire.

Sigh. With two children under age five, a working husband who travels alot, and boards study on the agenda every day, these things are not likely to happen anytime soon.

Tomorrow will dawn, and I will likely be pulling on a wool blend turtleneck, my black slacks with a little elastic in the waist, and Danskos.

But I will be comfy...


Monday, December 8, 2014

MiM Mail: Geographically-limited MiM applying to residency

Hi there!

I'm a mom in my third year of medical school with young kids, lucky enough to be going to school in a city with a lot of family help and where my husband has a great job. I've recently decided to geographically limit myself to my current city for residency, for the aforementioned reasons. Although we are in a big city, my chosen specialty only has one residency program with about a dozen spots (at my home institution). I will also be needing to apply for a prelim/transitional year of which my city has three programs. I think I would be a reasonably good applicant in my chosen specialty if applied broadly, however I'm obviously making a risky decision. That said, I'd prefer to remain unmatched and do research for a year or two than move us to a new city at this point while my kids are so young.

The residency program director at my school meets with all students applying to residency, and I would like to get some advice on how to broach with him the topic of only applying to his program. I have only met him once and he knows that I have kids. I want to avoid looking not committed to medicine obviously, and I know that I could be a great physician but being close to my parents/sibs for childcare help and not uprooting my husband and kids would be quite important to my overall success and happiness. Additionally, my dad has metastatic cancer and I know if I was doing residency in another city I would not be around to see him much. Any advice for how to approach this conversation would be much appreciated!

Thursday, December 4, 2014

MiM Mail: Anesthesiology or psychiatry?

Hi everyone!

As many others have shared, MiM has been such a valuable resource to me since embarking on the path to a career in medicine. Now, I have a more direct question for you all. I have been considering specialties, and while I still have plenty of time to decide, the pressure to make arrangements for research this summer and beyond is weighing on me, especially because I'm interested in two very different fields for obviously different reasons: anesthesiology and psychiatry. 

Anyway, some background first… I am a first year medical student and my partner is a fourth year, currently interviewing for residency. He is pursuing ENT and has mentioned interest in the possibility of pursuing a head and neck fellowship eventually… We have no children yet but starting a family is a huge priority and we both envision a timeline within the next 5 years (i.e., during medical school or residency for me). 

Because family life is extremely important to both of us, and it’s already becoming clear to me that his field will be a lot less flexible in this regard, I’m seeking any advice on deciding between the two specialties above. I know that balancing family life in a two-physician family is going to be extremely difficult regardless and so I am willing to make some career decisions to account for that. It seems that both anesthesiology and psychiatry can make for good lifestyles eventually (though with drastically different levels of compensation) but is there more I should know? Are the residencies drastically different? Is the difference in salaries going to be too stark if pursuing manageable hours (or even “part time”)? I know both can be flexible, but are those lower hour positions more realistic in one field? Anything else I’m missing?

I should also note that because we’re both from, and hope to remain in, a relatively undesirable area near what is considered a highly underserved area, I would seriously consider the NHSC scholarship if I chose to pursue psychiatry. I could also earn an MPH in one year at no cost through my medical school’s MD-MPH program which is something I have also considered (my pre-medical school studies were based in the social sciences).

Thanks so much!


Wednesday, December 3, 2014

Daycare better than me?

Last year, when I was on call a lot and very busy at work, I couldn't get enough time with my babe.  I always wanted more, more, more.  And I still feel that way--about the time I spend with her.  But lately, I've been feeling like I just don't do enough.  When I'm home, I sometimes just want to relax--I don't always want to be doing educational activities, or practicing walking, or force-feeding her.  Sometimes I just want to be at home with her and I don't want the work that comes with it!

But because we now have a nanny who does not provide much educational content during the day, when I get home I feel that I need to do more with her.  And because she is home all day, it's always up to me to provide healthy nutritious meals that are variable enough for her that she actually wants to eat them.  I frequently don't feel that I do a good job in either of the above aspects and I wonder if I would be better off sending her to a daycare where she is exposed to learning and a variety of food and time to play outside and when we get home, we can just spend time together and cuddle and kiss and love.

I know now for a fact that if I was a stay at home mom, I would not be a good one.  I just don't have the energy it takes to provide my Doll with all that she needs!  I'm grateful for my job, and I always want more TIME with my baby, but I just want it to be quality time where I'm not stressed with her.

Does anything I'm saying make any sense?

Monday, December 1, 2014

I am starting to hate the holidays

A few years ago, I made a post that really bothered some people, suggesting that people who have small children get first picks for holidays off, because it may be difficult (or possibly impossible) for them to find childcare. Several people suggested to me that I was a… well, I don't want to use language on this blog, but let's just say a selfish female dog who should probably be fornicating with myself.

I don't want to stir the pot but I will give my experience trying to find coverage for the upcoming holidays when I will be working:

--me: working
--husband: working
--Schools: closed
--afterschool program: closed
--daycare: closed
--babysitter 1: Will be in church and at family functions
--babysitter 2: traveling for the entire holiday
--me: screwed

I'm currently putting together a piecemeal of various elderly grandparents coming by to watch the kids, and working out a plan to come to work at odd hours. It's hard, to say the least, despite the fact that I actually have a very flexible job.

I know I can't be the only one with this problem, yet it's clear that everyone feels really angry about the idea of making any accommodations for people with childcare needs. Maybe a better plan would be for there to be some sort of reliable group childcare out there for people like us (e.g. healthcare workers) who will be working at least some of the holidays. Because right now? The options suck.