Tuesday, February 17, 2015

MiM Mail: Missing life before kids

I am a family doctor in southern Ontario but previously worked in remote northern Canada for 3 years. Up north, I worked in full-scope practice, including OB, ER, home visits, hospitalist, fly-in communities, medivacs and nursing station phone support. When I became pregnant, I could not have my job modified to have a healthy pregnancy. I was concerned about extremely bumpy boat rides to get to and from clinics, helicopter transfers, working in very cold environments, nearly being flooded, stray dog attacks, dust, bugs, and not having safe shower or tap water in certain fly-in communities. I had asked to not work nights but was told this was not an option due to lack of staffing.

Sadly, I left the community I had intended to stay in all my life. I moved near my extended family in southern Ontario. We bought a farm, and my husband stays at home with the baby and farms. We have the wonderful support of 4 grandparents. We now have a very happy toddler and another baby on the way in the summer.

Down here, I run my own clinic four days/week. I am doing walk-in clinics on the weekend. Although I enjoy it and have a very reasonable schedule, I am growing antsy to do more. I find that down here, even the simplest issues are referred to specialists. Compared to the north, people are not very sick when they see me. I enjoy being home with the baby, but only for a few days a week. I am happier working as a physician the rest of the time. I miss the action and adventure of northern medicine. I keep looking at job openings in the north and trying to figure out how this could work. What I always seem to conclude is what is best for me isn't best for my family.

The things that are keeping me from going back up north? Well, for one, I am 16 weeks pregnant. I plan to have two kids, so after this one, pregnancy won't be a limiting factor, but breastfeeding will. My husband doesn' t want to move north, as there are no farming options for him there. He has farm animals that require daily care, so even doing locums and bringing him with the kids isn't possible. I could go alone, but that would be very stressful on a baby and toddler.

Maybe I should just stay put and accept the current situation. I just feel like my skills are being lost for every year I don't use them. I would love to hear some advice or suggestions from others.


  1. Is it possible to do your previous job a few months of the year? I guess I'm confused as to why it's impossible for you to do that now. Are mothers obligated to maximize time with their children and their personal safety at the expense of everything else in their lives? Are you calling ME a bad mother because I don't do that?

  2. A) Breastfeeding is an option. It's certainly not a necessity. Nursing made me miserable for the year that I did it and I regret it. I became a much better mother the minute I stopped -- if breastfeeding is getting in the way of you having your dream job, seriously consider that a fulfilled formula-feeding mother is a better mother.
    B) I don't understand farming at all, but it sounds like you're having a conflict between your dream job and your husband's dream job. You've let him do his for awhile, so I think it's time to discuss him making a sacrifice so you could do yours for a while. Or consider places in the northern US. For instance, northern Michigan/Wisconsin are very rural and will allow you the scope of care you want, while supporting farmland.

  3. As one who experienced multiple unexpected pregnancy complications, I wholeheartedly support the idea of protecting yourself and your baby during the next 5 or so months. The last thing you want is to have complications and think you did something to cause them, or at the very least wonder if they could have been avoided or less severe had you made different choices.

    I will forever cherish my short time breastfeeding. And as a mom who mainly pumped, I miss that too. The time commitment and physical drain are challenging, but many find value and worth breastfeeding. To each her own.

    Are there any jobs in your area for underserved populations? It seems they're often sicker; perhaps that could provide some additional challenge for you?

  4. Could you take part time ER shifts in more rural areas? You might have to travel for the weekend - but I know someone in rural U.S. who has done that for years. I also know family docs in rural US who do part-time hospitalist shifts. If urban Ontario has no need for a versatile family doc maybe you can travel somewhere (less extreme) and do that on more of a part-time basis?

    1. I second that. More ER work sounds like what's you're looking for. You want sick patients, we got that. You want a literally unlimited diversity of patients and problems, we got that. You want equipment challenges, communication problems, and difficulty accessing specialist back-up? Oh yes, we've got that.

      You might need more training to cover ED in or near Ontario, or you might need to travel, but if you need to be where you are, but are one of us crazy people who, as the poet says, are "only happy when it rains," EM might be a good path for you.

  5. Now is not forever. Maybe you will be able to figure out a way to get more of what you want while meeting your family members' needs. But if you aren't, take comfort in knowing that they won't be a baby and a toddler forever and that your desires can take primacy in a few years. If that is the case, the important professional consideration is keeping your skills up in the meantime.

  6. I agree with now is not forever. Also I got very restless during my second pregnancy. For me, staying put at the time was a better choice because the challenges of functioning with two kids and a job were enough, I didn't have the mental energy to take on anything more. I did breastfeed but husband gave first bottle at night to get me maximum sleep. Now with an older child, a toddler, and my husband switching to a less demanding schedule I am starting to do more at work.


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