Thursday, August 20, 2015

MiM Mail: Why the disparity in advice to prospective doctors?

Dear Mothers in Medicine,

There seems to be a disparity in the advice given to prospective doctors. Sometimes the tone is tense, heavy, and almost bitter. Warning people of the commitment, the intensity, the sacrifice of medical school and residency. And other times the thread takes a completely different tone and instead offers encouragement and suggestions for making it work, and the reassurance that more and more people are finding ways to get through those grueling years with a family.

As I try to work out the cost benefit analysis for myself, I'm curious how much of these perceived sacrifices and other costs are specialty based or otherwise dependent on the choices of the student. For example, yes, the financial cost of medical school is significant, but there are scholarships, there are repayment for service programs, and there are ways to mitigate the costs. What impact does the choice of specialty have on the stressors of residency?

How often are medical students able to get a residency near their medical school so they do not have to move their family?

Currently, my kids are 1, 4, and 5. To put the next 10 years into medical school means my kids may pay a steep cost during their childhood, and I'm not sure how much benefit they will receive. From their standpoint, I'm concerned this next step for me could be particularly hurtful. But I want to focus on primary care, which I suspect could be a milder journey, and therefore ask less of my family.

My husband is 100% on board. Wholly and completely. His work allows significant flexibility but insignificant pay. So he's happy to move with me and make this work. I just need to figure out what we'll be asking of the kids before we move forward.

Any insight for me?


  1. I think a lot is dependent on the choices of the student/luck. I tend to be the encouraging sort. I would do it all again in a heartbeat. I also went to a medical school that became free while I was enrolled, so I only paid 1.5 years of tuition and have very little debt (I was on a merit scholarship for undergrad) and then enrolled in a residency in a discipline that I love and is completely suited to my personality, but also was A) not surgical and B) had many in-house call-free months (fast-track program/phone call replaced in-house call early on.) To me the big questions are:
    1. How will you pay/how much of a hardship will earning 50k/year be for you.
    2. Where will you live and are you the sort of people who will find supports anywhere. It's not about being near your family, it's about finding "family" near you. We live 100's of miles from family (and moved about 500 miles from medical school to residency), but have made very close friends and reconnected with our friends in the city we found ourselves in, so we never want for a helping hand.
    3. Will you enjoy what you're doing? I know tons of surgeon-moms. They tend not to post stuff online because they're crazy busy, but they're happy because they LOVE surgery. If you don't love it, even primary care isn't worth it.
    4. Will you be able to keep it in perspective? The free time you have in medicine is proportional to the free time you want to have -- I had almost no free time the first two years of medical school. In retrospect, that was a choice; with more perspective, I could have studied much less. You need that perspective and that discipline to make it through while parenting.
    5. I'll add that I don't just see my medical training as something I did *to* my daughter, it was also very much something I did *for* her. I am a much better mother getting to do something I passionately love every day; it sets a good example for her that she can grow up to do something that SHE loves and I wanted very much to show her that women can have jobs and be parents, too.

  2. The tone of the advice depends entirely on the advice-giver. I am also one of the encouragers, because I love what I do and I think in general people are more likely to regret *not* chasing a dream, in the long run. The people I know who stress the grind and debt are, in general, pretty burnt out. They often seem to have gone into medicine either with dollar signs in their eyes or with an unrealistic idea of what it would be like - and many have been abused by their learning experiences, especially residency.

    I didn't have kids until well after I finished training. My daughter still finds herself sometimes playing second fiddle to my work schedule (a few days ago she announced that she intends to be the kind of mother who always has home-baked cookies around, and that she knows I couldn't do that because "you have no time"). OTOH, she participated in an interview project on daughters of women docs a few years ago, and she said she wanted to be like me because I showed her what it was like to have work that matters and that benefits people. She's proud of me, and she knows I love her and that I'm available to her when she needs me (and often when she doesn't even want me around - she's 15).

    There are no guarantees. This is a gut decision, not one you can do with a calculator.

  3. I'm an M2 with 2 kids (1 & 3), I'm a non-trad, and I am doing it because it is my dream.

    A commitment to medicine is not unlike deciding to be a parent. It's expensive, it is difficult, there is joy in learning and caring for others. So imagine a parent at various stages being asked about parenthood. It can be hard to be encouraging when you're in the trenches of a difficult transition; sleep deprivation and the pressure of high stakes are just like that. Oh, also medicine doesn't love you back. But. It is truly what some people want, and you can make it work if it is your reality. There are simply some hurdles at initiation.

    I think another hard part of going through training as a mother in medicine is feeling the difficulty through your kids, and not finding a lot of fellowship in a traditional student body. But there are online resources (mim!), and some study said you really only need one friend to feel happy in any job situation. I started M1 as the only mother in my class. Now I know 2 mothers in the class ahead and behind, with another due soon. We find our tribes. And as for the kids, the time will pass anyway, they will make transitions anyway, kids move schools and learn resilience and grow up no matter what, so don't shoulder guilt for making them pay a cost. You aren't moving to mars, you're training in a highly practical field, and that's a great thing.

    Good luck with your decision!

  4. Because it so complex.

    Sometimes I don't think it's worth it. We bring our kids into this world, it's a choice we make yet we find something else to do that's even more challenging than kids sometimes - medical training. Who will influence them and raise them to be the kids we want them to be if we don't? Yet when I'm with her (my 6yr old) I guiltily think about how much time I could be spending studying. And vice versa.

    Then again I think it's totally worth it. I want to show my daughter that any woman can do whatever career she wants, she just has to try. And she totally wants to be me right now so that's cool - for now.

    But my biggest dream is to have a successful family, for my kid to have a prosperous life and for my husband and I to survive this roller coaster we call medical school.

    So whether it is worth it or not, I don't know. I'll let you know when I'm an old lady and looking back retrospectively. But I'll sure as hell try to make it all worth my while.

    Good luck in your endeavors

  5. Because medicine can be amazing and amazingly horrible all within a span of 15 minutes.

    I find it to be worth it, but I also worked for a while before I committed to med school, and I think that helped give me some perspective on some of the more difficult parts (the fatigue, the hieracrhy, being a responsible adult, what having a job is like sometimes, long term financial planning). It's also hard when you have little kids because having little kids is hard! The temptation is to blame everything on your career choice, when in fact it's the combination of both (residency + new baby) because it is so socially unacceptable to talk about how difficult it can be to be a new parent, and how draining little babies can be.

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  7. I am in residency and things are really hard for me right now, so I think you need to hear my perspective because it can, and probably will, happen to you no matter what specialty you choose.

    Medical school was easy compared to residency, for reasons that are discussed elsewhere on the blog--support, ability to start and stop, flexibility of hours, no true responsibilities etc. If you get in to medical school you are all but guaranteed to graduate.

    Residency in contrast...suffering is all relative and whether you do an "easy" residency or a hard one doesn't seem to matter. Residents who work less don't look at the surgeons and say "Hey, I've got it pretty good!" I find that they still wish they worked less, saw their families more, had more control over their time and schedule, had patients who appreciated their hard work, had less paperwork and "low level" scutt-y tasks to complete. Everyone questions whether it's worth it.

    I know I could not do this if my daughter were older. At this point, I don't think she "misses" me or wishes I were there, even though I am definitely her favorite caretaker. I know that I really regret missing out on these years of her life. The costs of pursuing this dream are really mounting, and I can't say from here if it will be worth it. I do know that knowing what I know now I don't think I'd choose to do it again. If anyone asks me if I think they should do it...well, the conflict that I feel every day between being a parent and being a doctor is really painful, even if for now, I'm the only one getting hurt.

  8. This is tough. I'm in my 4th and final year of a competitive residency. There are times when I love my job so much I could burst. Being there for people at such a vulnerable time in their lives is amazing and something I don't take for granted. There are also times when keeping up with obligations, literature reviews, publication pressures, presentations, an endless to-do list, conferences, and of course work/shifts are overwhelming. Most of my colleagues have over $300k in debt (I'm half that, despite FULL undergrad, graduate, and medical school tuition scholarships. Full tuition, I'm thankful, but still drowning in debt), I still can't afford to pay my student loan bill if my husband doesn't work too, and the minimum payments are almost a whole 2 week resident paycheck. So sometimes I'd tell eager-eyed med school prospects that it's all worth it. But honestly, more often than not, I tell people to ask me some other time in life. Because each as each year as med school and residency passed, I keep thinking it'll get easier, and if people asked me now, I don't think I'd do it all again. I often think how much easier it might have been to be a paramedic, or a PA, or even a damn good nurse. My son was born this year (after 3 years of out-of-pocket infertility treatments) and I have mad respect for those who had kids earlier in their careers, because I was able to spend a lot more time with him after birth than most mothers in med school or residency. I guess what I'm trying to say is that it feels very much like a rollercoaster, some days I think it's worth it, some days I don't. But I don't think I'd personally do it again. Certainly not at an older (than 20's) age. Just not worth the time and sacrifice and tears and time away from family. Life is too short. At the same time, I wouldn't have listened to me if I was hearing my advice. It's all an individual decision, you CAN do it if you really have your heart set on it. If you can get into med school, you can definitely do med school with a family. If you can get into residency, just make sure it's a family friendly residency and big enough that you can trade shifts, etc with other residents so you're not forced to work on your kids graduation/dance/birthday/holiday/etc. I consider our residency family friendly, yet one of my co-residents/chiefs just stayed back to work while her 3 kids and husband went on vacation for a couple of weeks. If you're prepared to take it all on and prepared for sacrifices like that and educated as to what the challenges will be and ready to face them, then go for it! But understand the warnings, regrets, and guilt some of us express... it's not to scare people like you away, it's to be sure you're going in knowing what you're up against.

  9. Only do it if there's nothing else you could be happy doing. Otherwise it really isn't worth it. --A full-time practicing neonatologist on the verge of leaving clinical medicine after 8 years so that I can be a part of my children's lives.


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