Thursday, March 5, 2015

MiM Mail: Whose dreams come first?

My name is Jenny and I am 24. I am a single mother to a beautiful 6 year old and a handsome 5 year old. Their father is not really a part of the picture. I receive no financial support from him and he sees the kids once a week for about 8 hours.

I am a research assistant at an amazing lab and absolutely love research. I have planned on going back to grad school soon. The grad school where I'm located also has a med school and there is a MD/PhD Program. I have always dreamed of going to med school. It was my dream since I was 12. And even when I became a teen parent, I still knew I wanted to go to med school. But I never thought I'd had to go as a single parent, so I've gone a different path which has led me to research. As I start to prepare to apply my heart screams with such a passion that it becomes difficult for me to hold back the tears. Med school is where my dreams are. Research driven physician is where my heart is. It's what I've always wanted. But I'm a mother now and a single mother. The program is ideal because of the stipend. I cannot take 4 years off work to go to med school when I have children. But with a stipend I could get by. And I know I have to apply. Even if I don't get accepted, I have to apply. But if by some miracle I do get accepted would it be right for me to go? I have been in school for the majority of my children's lives. If I was to do the program, my kids would be adults when I finished. My daughter would be 19, my son going on 18. I would have spent my children's entire childhood in school. How is that fair to them? I would be so busy with school there would be no dating, no man to step up and be a step father. It would just be us with me always in school and studying. My kids will be adults. I'll be 37. And eventually that will happen anyways, but how much will we sacrifice if I kept going for my dreams? Isn't the mother supposed to put the child's dreams first? I don't know what to do. I feel either choice I make will break my heart. I would appreciate any feedback.

Thank you,


  1. "But if by some miracle I do get accepted would it be right for me to go?"

    I wouldn't say there's a right or wrong answer here. Rather, I think it's about wisdom or prudence. I'd ask, given your circumstances, would it be more (or less) prudent for you to attend med school?

    Also, given your circumstances, why not just opt for the MD only? You can still do research as an MD only. In fact, you can even end up running your own lab as an MD only.

    "If I was to do the program, my kids would be adults when I finished. My daughter would be 19, my son going on 18."

    If your daughter is currently 6 and your son 5, then that's 13 years from now. Assuming you already have a bachelor's degree and have done all your prerequisites as well as MCAT, then med school should only be 4-5 years away from now. Residency is a minimum of 3 years, although it depends on your chosen specialty of course. So the fastest you could become a physician is about 7-8 years from now. you'd be in your early 30s and your kids in their early teens. Not too bad.

    Of course, the MD/PhD is longer. But you'd essentially be trading time for money. If you do the MD/PhD, yes, you would most likely come out financially ahead than doing the MD only. But if you do the MD only, you'd save a lot of time. If it were me, I'd prefer to save the time over the money, mainly because of the opportunity costs. In other words, if doing the MD/PhD takes you a total of 6 years, whereas doing an MD only takes you a total of 4 years, then that's 2 years of potential income you could be earning as a physician. At a bare minimum, although again it totally depends on your specialty, you should be earning $100k-$200k per year as an attending physician even in primary care (e.g. pediatrics, internal medicine, family medicine).

    "I would have spent my children's entire childhood in school. How is that fair to them?"

    Sorry I can't be of much help here. I suppose this is a question mothers can best answer.

    That said, there's often a difference between quantity of time spent with your kids vs. quality of time spent with your kids.

    "I would be so busy with school there would be no dating, no man to step up and be a step father."

    I don't know if this is necessarily true. You might be surprised. Maybe it'd harder, but I know of people who dated and got married during med school. This includes a single mother with a kid who was almost exactly your age too.

    "My kids will be adults. I'll be 37. And eventually that will happen anyways, but how much will we sacrifice if I kept going for my dreams? Isn't the mother supposed to put the child's dreams first?"

    On the one hand, it's right and good of you to desire to put your children first even to the point of sacrificing your own dreams. But on the other hand, you don't necessarily need to sacrifice your own dreams to be a good mother and raise good kids. There's a third or middle way: you could do both. In fact, by becoming a physician, it's possible you could give your kids a better future to someday fulfill their own dreams.

    At the same time, and knowing what I know now, if I could talk to my past self about choosing medicine as a career, I don't know if I'd recommend doing it again. Medicine has a lot of positives, but also a lot of negatives. Although I'm still relatively young (30s), and I enjoy medicine and helping patients most days, I have to admit I'm also disenchanted with medicine. There are other good careers. Maybe most aren't as financially lucrative as medicine, but they're also not as demanding on one's life. It's a trade-off.

    However, if medicine has always been your dream, then it may all have been worth it in the end for you.

    1. Just some additional advice if you do end up choosing med school:

      Make sure to pick your specialty wisely. All other things equal, try to pick based on what's important to you, not what's important to other people.

      When picking a specialty, consider not only the medical science in your specialty, but also other factors like the bread and butter diseases you'll most likely be encountering, your patient population, practice environment options, etc.

      For example, neurology as a field might seem really cool to some people, because the subject may be inherently interesting to them. The reality though is you'll be dealing mainly with diseases like strokes, dementia, and other neurodegenerative diseases. Also, generally speaking you'll be working with an elderly population. You'll likely have long-term relationships with most your patients, following-up with them, and so on. Clinics can be quite long. For some people these may be positives, while for others these may be negatives. Point being, neurology is a good specialty but for the right person.

      The same applies to all other specialties.

  2. I'm in my last year of my MD/PhD (year 8) and I have a 3 year old. What you didn't mention is family help. Do you have family or a support system to help with child care? This is really the only way I think what you're describing is feasible since you'll need a lot of help and won't be able to hire the help you need on the stipend you're given.

    My partner works full time and we've had to rely heavily on family for help (in addition to FT day care) with child care the past 2 years. Obviously anything is possible and you're not me but I can't imagine doing it solo. I don't want to discourage you but my program has a decent number of parents (1/3-1/2 of graduates have kids) and they are all married with supportive extended families. I haven't seen anyone do it as a single parent.

    I can't comment on what is an isn't "fair" to kids but I'd think long and hard about whether this process will be worth the sacrifices for you and your family if you don't have good support. An MD might make more sense for you as you'll be making $$ sooner which will give you more flexibility and you can do more research when the kids are older.

  3. Arranging childcare will be clutch, and if you don't have family help, you will have to pay for it. It is not cheap. You will need someone to be home with your kids before school when you need to be at the hospital at 6AM, and be home with them overnight when you have night rotations. These are not rare occurrences during medical school, and happen basically every day during residency. I still don't make enough money as a resident to cover our childcare expenses. I can't imagine it would be possible to do this as a single parent without a trust fund or extensive family help. One thought: you could wait until your oldest is 13, at which point they would be legally allowed to be home by themselves.

    If you're not wed to research, another alternative could be PA school. It's only 4 years and you can get a job immediately afterwards with similar responsibilities as some doctors but with better hours.

  4. I agree with the above comments. Medical school is unlike any other educational experience I have had (rigorous college, rigorous graduate school while working 2 jobs); it was the hardest thing I have ever done before having a child. When you say "dream of med school" that gives me some nightmares.

    FEW QUESTIONS: you spoke repeatedly about your dream of going to medical school, but you didn't say what part of medicine you are most interested in pursuing. Given that you are a researcher, have you done any recent shadowing? I would HIGHLY suggest you spend some time shadowing in various fields as there are soo many different ways to be a health care provider these days (physicians, physician assistants, PT/OT/ respiratory therapists, midwives, doulas, lactation consultants, recreational therapists, nurse practitioners, clinical social workers, parent educators).

    I HIGHLY recommend that you think about what you want your final work days and weeks to look like and talk to folks about it - shoot, you can write another post and tell all of us and we can help. You may find out after talking to some of us in training and in practice that the job you really want doesn't require a medical degree and if it doesn't run as fast as possible away from the medical school track. Like "rockingwithhawking" said the day to day interactions with your specific patient population will be most important to your life after training (but as a Peds person, let me say Peds Neurologists work with additional issues).

    And lastly, like Sophia and OMDG both mention child care is a huge, expensive thing. Medical school classes are all day, then you study all night and all weekend. Medical school rotations start at variable hours. And I won't even get into residency - way worse than med school for variable, long hours. Without my husband's flexible schedule I would need an au pair; actually, even with his schedule we would be so much better with an au pair or nanny for sick days and help on longer work/ school days!!!

    I'm not one to say don't go for your dreams, but I think it's time to back up and ensure that the dreams you want require the path that you think and we can all help. Find the most direct and efficient path to get there. May the force be with you!!!!

  5. I agree with many of the comments offered above. I am a fourth year MD/PhD student, about half way through the program. I am married to a resident. The MD/PhD program is an interesting training path, many of us have thought about whether the MD only is the best option, as we all tend to enjoy clinical care. The difference is loans vs. no loans. My med school only friends live the same lives with their loan support. In many ways, MD/PhD students are excluded from almost all scholarship and research funding opportunities.

    There are plenty of ways to gain exposure to research as a medical student. I would recommend looking at places that offer a 5 year program where you take a year off between 3-4th year to do research. Many of these programs offer reduced tuition and a paid year of research. This would give you the exposure and documented training in research that is highly sought after these days, without the extensive commitment and length of an MD/PhD program. Some of these 5 year programs also allow you to complete a masters. It's really an interesting hybrid, and I have seen the model be very successful. Many of my classmates have opted for this option are are excelling!

    It will be hard to train (PhD, MD, or both). PhD hours are much more flexible, granted just as long as medical training at some points. Its important to identify a mentor who will afford you this flexibility. The first two years of medical training are also relatively flexible, but require commitment beyond normal working hours. The difficulty is going to be clinical years, where there is VERY little flexibility... My husband is at the whim of his clinical schedule, and fortunately I am in the position to modify mine, as I'm doing purely research. Unless you're living with family, or they are very close, I would raise concern about how to handle the clinical years of training.

    Also, it is important to remember that you are setting a wonderful example of your children. It is not the easy road, but if it is your dream, it will all be worth it. Additionally, I think it is important to look at other clinical options. There are excellent advanced degrees and mid-level care that allows you to focus on patient care. There are also numerous research opportunities within these specialities. I would look at the research options within these different clinical specialities to see what they can offer - you may be surprised!

    Final note, don't let the stipend influence your decision. MD/PhD is the ultimate delayed gratification, and if you can deal with loans for the time being, there are excellent specialities and loan repayment programs that exist to help individuals in your position succeed! ESPECIALLY if you're planning on doing research.

  6. I'll echo most comments above. As a recent residency graduate with 2 kids and a third on the way, who got through residency with a resident/fellow husband, it was incredibly hard to survive residency. That's with extensive family support plus a nanny (which cost an entire post-tax resident salary). And by extensive family support, I mean we could call my mom at 5am when our nanny called out sick and she'd drive 2 hours to get here for us to get to the hospital just a little bit late. Your kids will be in school so it will be slightly different, but you'll still have random school days off, snow days (depending where you live... we've had A LOT of those this year), school vacations, summer vacation, and kids' sick days.

    I don't think of the decision as fair or not fair to the kids, but really whether it's feasible. Sorry to be possibly be seen as pessimistic but I think the reality of residency with kids is that it is so hard to begin with - as a single parent you have to look at your resources before deciding whether to pursue it.

    The other thought I have because we are at the financial planning stage of life now that I have a real job - if you go the MD only route you could end up for 250k+ in loans which you'd start to have to pay back right about when your kids go to college. We are repaying loans right now and it is a lot of money. It sounded pretend and faraway when we were both medical students taking the loans out but here we are paying thousands in interest and principal every month... While trying to start saving for kids' college tuitions.

  7. I want this to be possible for you. I want women, moms, single moms, anyone, to be to succeed at this.
    Unfortunately, medicine, whether clinical or academic, was designed for people who have a second responsible adult (i.e. a wife) at home who can take daily care of all of their non-school needs for 8 years in a row.

    One path that would probably be equally rewarding, but much more feasible, would be becoming a nurse-scientist rather than a physician-scientist. There are tons of opportunities in nursing research right now. By becoming an APRN and getting a PhD in nursing research (and I do mean a PhD, not the DNP, which is a clinical degree), you could enter the workforce sooner and rise the ranks faster. Nursing academic faculty/research jobs are all over the place, and there are real shortages of doctorally-prepared nurses. It’s easier to head up your own lab, if that’s what you want to do. Plus, as a profession that was created by and continues to be dominated by women, it is much more flexible/forgiving when you need to take time off – whether it’s a day or a year – for family reasons. (Also, with your research experience – and I assume you already have an undergraduate degree - you’d be a great candidate.) And there’s a lot of overlap of nursing research with medical research; there are few areas where it’s like “no, that is definitely MEDICINE and nurse-PhDs couldn’t POSSIBLY work on that.”
    If this sounds unappealing or like “giving up” or “taking the easy way out” (or my personal favorite “you’re too smart to be a nurse”), that is probably more a reflection of prejudice against nursing than of actual differences between what a physician vs. APRN does day-to-day, or what Dr. MD-PhD does that’s different than Dr. NP-PhD. Sure, you’ve dreamed of being a doctor since you were 12, but did you even know that Dr. NP-PhDs existed? And do you need to limit yourself to a vision that you dreamed up in middle school, half a lifetime ago, or can you expand and adapt?
    Look at this: This could be you!

    Sincerely, a current med student who wishes she had done nursing

    Also, as a postscript: Your kids' dad is responsible for them 8 hours a week and pays 0% of their expenses, while you are responsible for them 160 hours a week and pay 100% of their expenses. If you can be an advocate for your patients, you can be an advocate for your kids and yourself – take him to court.

    1. Thank you for this comment - I really appreciate your perspective as a current person in medicine. I'm an RN (and went to law school with the idea of doing health policy), but now I'm really regretting not going to med school from the beginning, back when I was young and single and could do whatever I wanted. Now I have two kids and I really want a third kid. My husband is incredibly supportive and wants me to whatever I want. (I'm supporting him through his engineering phd right now, which he's almost done with.)

      The idea of med school has come up because I really miss working with patients. I don't want to do bedside nursing though. So if I want to get back to working with patients, it's either med school or NP school (NP rather than PA because I'm already an RN and have an advanced degree, so I'd be a shoo in for NP programs; some programs don't even require an entrance exam if you have a doctorate level degree). Med school would be a LONG road for me, made even longer since I have two babies and want one more. And I would need to take most of the med school prerequisites (I took AP tests for many of the med school prereqs in high school, and from what I can tell most med schools don't accept AP credit. So I'd even have to take English 101 and 102 again! And I'm 33 with a JD from a top law school! And I'd have to take basic biology again, etc. But I would do it if that's what I decide.) On the other hand, NP school would be much easier -- it's a fraction of the cost; it's a fraction of the time; I could start now and be done in a few years; many programs even allow students to do clinicals in distant locations, meaning I could be living wherever we want to establish our family once my husband is done with school and be doing a program in another state; I wouldn't have to potentially move my children when they're older for me to do residency; I wouldn't have to do residency (and honestly, it's residency that scares me while also balancing motherhood, not med school); it seems like I would be able to be more involved in my kids' lives; etc. etc. etc.

      So NP school (and possibly a phd in nursing down the road; I have no interest in doing a DNP -- at that point I would want to do med school) seems like the obvious choice. But I just can't shake the thought of possibly always feeling like a failure for just not going to med school from the very beginning. Of course I could regret going into medicine if I indeed go that route (if I can even get in!), but I will never know unless I do it.

      Here's another point too... back in high school and undergrad, I really wanted to be a health lawyer, so that's what I did. I didn't even consider med school, and my roommate at the time who is now one of my best friends, went to med school. So it's not like I didn't have any influence in that direction. So I try to remind myself that I did do what I really wanted to do. But now I'm just wondering if I did it all wrong!

      Anyways, my friend I just mentioned above genuinely wishes she had been an NP or PA. She recently finished residency/fellowship though, so I wonder if this is what she'll be saying as she gets more confidence down the road.

      So again, thank you for your insight. I really appreciate i!


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