Tuesday, August 8, 2017

MiM Mail: Choosing between nursing school and medical school

Hi,

I came across your blog many times while looking for answers about being in medicine. A little bit about myself: have a BA in Biology and in History, an EMT license, and I work as a nanny to small children. Long story short, my mom died when I was 16 and she wanted me to be a doctor rather than a nurse in order to support myself better. Since this was the only path in medicine we had ever talked about, I now feel like I am betraying her by thinking about nursing. I also want to be a full time stay at home mom (in the far future) which only adds to my dilemma.

In terms of being a mom: I know that it is a loooong ways off, but I am a planner. I have run a household when I was 16 and 17, and I am a nanny to several families. One of these families both the mom and dad are doctors and their kids see the nanny more than their parents. I know I don't want that for my future family. I also do not have a good support system with people who could help take care of kids.

I know for a fact that I want to be somewhere in Emergency Medicine whether it be an NP on an ambulance, a RN in the ER, an ER doctor, or a trauma surgeon. I started thinking about nursing school while becoming an EMT because of the amount of patient contact nurses have in ER. I also know that I'm great with taking care of patients as tech.

BUT, I have been struggling with the idea of nursing for over a year now. I want the higher education of being a doctor and understanding the full picture of diseases. I want to be able to practice good medicine since my family has had so many doctors malpractice. I want to be able to be there for my patients like I imagine you all are. I was accepted to a medical school and I declined because I was engaged at the time.

Things I am struggling with:
1. Patient contact in the ER (I love how nurses are more hands on)
2. Education level (I have come across all types in both fields and most nurses and doctors encourage medical school, but I want to spend more hands on time with patients which I know will not happen in the ER)
3. I want to be able to help restructure programs and protocols to help improve patient care
4. Time to complete both (It is very likely that I will not be able to have children starting around 29/ 30 and I am almost 22. This makes me concerned about residency programs and being held back a year)
5. I've always dreamed about being a doctor and a stay at home mom (reality is hitting that these do not always go hand in hand)
6. I'm struggling to complete nursing school apps (I could get through with little debt in comparison to medical school)
7. Wondering about working part time as an ER doctor vs ER nurse

So, I am looking for your opinions about medical school vs nursing school. It's been hard to find someone who can give me answers when one of their solutions to one part will not work for me. I'm hoping that maybe as doctors and as moms you might see something different, or maybe offer some clarity on the medical school/ residency process. Thank you for taking the time to read an to think, I really truly appreciate it.

Thank you,
Kelly

42 comments:

  1. I am a physician but not a mother, but there is one piece of advice that I think I can give in your situation: Don't go into medicine for the money. While the large salary is appealing and is really nice once you get there, it takes a lot of time, money, and sacrifice to get there. In addition to missing out on time to invest and having a huge debt to repay at the end of training, it is also harder to live frugally as a physician, because most people expect a doctor to live a decadent lifestyle. Pick what you are most interested in doing as a career, and adjust your spending to live within the salary it pays.

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    1. Hi Solitary Diner, thank you for your opinion! I definitely is all about patient care for me. Practicality is the only reason I mention finances. I don't want to accrue large amounts of debt while trying to figure out where I belong in the medical world.

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  2. Be a PA! There are PA emergency medicine residencies and PA's share some of the conceptual training of medicine with much of the hands on practicality of nursing. ... whatever you choose, your mother would certainly want you to be happy and fulfilled much more than she'd want one specific profession for you. Nursing and PA routes offer a lower economic, psychic ad family burden and both allow people to support a family comfortably. You have clearly matured into a thoughtful, responsible person. Your mother would be proud and would expect you to choose the right path for yourself. I am sure she'd hate to be held to a preference she uttered long ago rather than have you live your own life now.

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    1. Hi DingChun, Thanks for the response and the suggestion. I have considered it in the past and I narrowed it down to help make my choice, which still hasn't been made haha. It looks like I have lots more research ahead of me!

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  3. I would echo the comment about looking into PA programs. You have the clinical hours, I am guessing your biology major would fill the prerequisites (although many PA programs require a year of A&P plus microbiology, MD programs are more flexible), and I know an ER PA who loves her job. If you go back to get your BSN in nursing school you are essentially getting your third bachelor's degree, which isn't a bad thing, it just means you are spending more money on the same level of education rather than building on what you have already worked to accomplish.

    Regarding being a stay at home mom, I would say you have many years of work and at-home flexibility ahead of you. I am forty and have four kids, the oldest of which which graduate from high school before I finish medical school. I have been a stay-at-home mom, I have worked a range of hours from part-time to full-time, and I am going to medical school now that my youngest is school age. I love the different stages of life I have had, and am incredibly thankful for each unique season. Enjoy the ride! You have a great adventure ahead of you.

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    1. Hi SRB, thank you for sharing your story with me. I truly appreciate it since I have thought about delaying medical school. Thank you for the insight about how different programs work as well. If you don't mind a followup question: how are MD programs more flexible than PA?

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  4. I'm a physician (Anesthesiology) and a mom, and I wok very part time. There are fields - Anesth, ER are two good examples - where you CAN see your kids and work as a doctor. But the road is long and you may have to delay childbearing for a while if you want to be present. I did, but then I had to do IVF to get pregnant (see my posts under PracticeBalance on this blog).

    MD is a long road but offers lots of autonomy and more power to impact protocol change/etc. RN is pure shift work, less autonomy and creative problem solving but as you mentioned more direct patient contact. I would also recommend looking into PA careers as mentioned above.

    There is no right answer to this and you can always switch paths along the way. Good luck!

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    1. Hi PracticeBalance, thank you for being so open about your story. Knowing that it can be done later in life is refreshing and puts my mind a little more at ease. I will definitely be reading more of your blog posts!

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  5. Go be a nurse and in the future keep the comments about those awful parents whose kids are raised by nannies to yourself.

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    1. Yes!! It also makes literally zero sense to go to medical school if you want to be a sahm unless you are made of $$$

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    2. I have seen double doctor parents that literally spend no time with their kids and double doctor parents who are very plugged in (I like to think of myself that way in past when I was married to a doc and had a nanny) so I wouldn't take that too personally.

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    3. I didn't read the posters comment as saying those parents are awful, just that she did not want that for her family.

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    4. Hi OMDG, thank you for your response. And oh my gosh, I am so sorry that I offended you. I'm not saying those parents are awful by any means; they are actually the most in-tune set of parents that I nanny for! I know that for sure whether it is BSN, PA, or MD that at some point I will need outside help. I simply want to give my (very future) children the same opportunity I had with a stay at home mom. My mom passed away when I was barely 16, and my younger siblings were 12 and 14. I wish I had more time to spend with her. Hope you have a nice evening!

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    5. Gosh, I really do hope that if I die when my daughter is a teenager that it doesn't influence her life plans in this way. If she wants to be a sahm she should do so because of that, not Bc of missed time with me.

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    6. It became important to me to be a sahm after my mom passed for the reasons stated above. We were also left with a loving but incompetent parent which strengthened my practical planning trait. Unfortunately my family and I have bad medical history so I am expecting kids to have more sick days than most.

      I know I will regret being a nurse if I can't see the entire picture of disease, I know I will regret being a doctor if I am not allowed to have a decent amount of patient contact, and above all I know I will regret not being a sahm for a certain amount of time. I'm searching for that balance in life!

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  6. Are you looking at nursing schools that have a fast track for those who already have a college degree in science? These programs would probably get you through in under two years. Medical school is expensive and training is long and arduous. Also rewarding. But - It has to be want you really want. The fact that you turned down med school once because of being engaged is a predictor for poor outcome for you unless you have analyzed what went wrong there and possibly reviewed your issues with a therapist. A few months of working with a therapist might help you make your decision in a logical way.

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    1. Hi DrNana, thank you for your insight. Yes, I turned down medical school at the time because my ex-fiance was Navy Special Warfare which meant a ton of moving internationally (we would have seen each other maybe 2-3 times a year for a couple days). I was planning to go to medical school once he was done and we were financially stable. However, he is no longer a consideration so my decision is up in the air again. I really do want to be a doctor in order to help patients, but I guess I'm unsure about the patient contact part.

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    2. And yes to the fast tracked nursing programs. It's very hard to go from pre-med to applying to nursing schools with the different requirements, so it has been quite the searching process!

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  7. My partner had a daughter, one of three kids, who was cerebral like him. His biggest wish for her was to be an MD and after a full scholarship to Vanderbilt she examined all the options, could have gone to Med School easily, but chose nursing to be more flexible with motherhood and getting through quicker. I think she's smart - I would make my daughter look at that long and hard bc PA route is growing so much these days and MD climate is kind of rough. I am impressed with your experience and patient contact - I think it will help you make the right decision for you. I know your mom is rooting for you and she will be happy no matter what. And as others above have pointed out NP make a great salary - probably as much as some generalists depending on where you live. Good luck to you!

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    1. Hi Gizabeth, thank you for your kind words. It comes down to wanting patient contact and being able to provide great patient care. Since the medical world is changing so quickly and the job descriptions are always changing, it makes me rethink everything!

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  8. Well first, I think a lot of us have been in a place where we have wanted VERY conflicting lives. It is stressful. You feel like you have to make a decision that will impact the rest of your life, and you don't know which way to go. It's a hard choice, especially at 22. I don't think you will find any answers if you are trying to do it all, all the time, for your whole life (be a full time doctor and a full time mom and have patient contact) But you CAN do it all, not at the same time, at different points in your life. You also have a ton of options, which is good, but also increase the indecision.

    My background: 2.5 years as an ER nurse, 2.5 years as a SAHM while doing premed part time, now starting med school. First advice I give to ANYONE pursuing medicine is if you can see yourself doing ANYTHING other than medicine, do it, for obvious reasons. NP and PA and REALLY, really, good options. If you decide to do nursing, you can do a 1 year accelerated track since you have a degree, work in the ER and get that patient contact you want, then go on to NP, then be SAHM or work part time or whatever. But if you think you will live your life wishing you were a doctor, then do that. Not because of the money, or job stability, or pride, but because you would not be happy in any other field. If all you want to do is pop out babies and stay home, do that!

    A quick comment on patient care in the ER, it is likely not what you think it is. You may know this as an EMT, but it's a lot of grunt work, getting yelled at, cleaning poo, drunk people etc. And, once you are an RN, you have to do a lot of documenting, which decreases patient contact time relative to a tech. Also, the ER is a fast revolving door, and you may not get the time you want with each patient (everywhere in medicine). As a nurse my job is to prioritize which patients to work on first, monitor them, and carry out orders. But I wanted to make the decisions and problem solve, so I choose to change careers. Not to dis ER nursing, I loved it, personally, because the environment creates a camaraderie, you never know what is going to walk through the door, you see it all, and every now and then a patient truly thanks you. But it just may not be that youtube video with the soft, flowy music that makes you cry.

    As a provider (PA, NP, MD) yes the contact is less but the impact can be the same if not more. Patients will really listen to you, and remember you if you are a personable and caring provider. Depending on your state, emergency medicine can be VERY lifestyle friendly. (it's what I'm going for!)

    So to summarise:
    1. Patient contact in the ER-may not be what you think it is
    2. Education level- I have met lots of nurses who were premed and went to nursing, some happy, some not, do what's best for you.
    3. I want to be able to help restructure programs and protocols to help improve patient care- You can do this as NP, RN, MD, PA, JD, MPH etc.
    4. Time to complete both - 1 year RN, 2 years PA, 3 years NP, 7 years MD
    5. I've always dreamed about being a doctor and a stay at home mom- you can do it, may have to delay one or the other, and that's ok.
    6. I'm struggling to complete nursing school apps- don't worry about $$$!!!
    7. Wondering about working part time as an ER doctor vs ER nurse- absolutely can work part time as ER doc.

    Once you make your decision, try to let the other options go. Go in the direction that feels lighter, that gives you the most peace, and let everything else go. It's difficult because the grass is always greener on the other side. But trust yourself. Be proud of yourself. Be compassionate with yourself. Not sure if any of this helps but good luck and do update us!

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    1. Hi TXgal, thank you for your response. It's nice to hear from someone who has done it all. You certainly have described everything I am struggling with. I know I simply can't do it all, but I certainly want to!

      The ER is definitely not long term hands on patient care, but out of everyone I've shadowed and everything I've studied on my own, it's what I love. As for the wanting to be a doctor: I love the problem solving and seeing the whole picture. I am always trying to figure out how everything fits together for people with multiple diseases and injuries. But I know that I want to be hands on and have more regular contact with patients, however long they might stay.

      At this point in time, I've considered PharmD, PA, NP on an ambulance, BSN, and MD. I threw out PharmD after shadowing, NP in EMS since it's not in my state yet, and PA because I was trying to make my decision. I think I will kick myself for not going to medical school if I do PA (but I'm now reconsidering). I've tried so hard to let the other option go after I "make up my mind", and I can't let go of either one. The more I shadow, the more confused I become. I've been flip-flopping for about a year which makes completing apps for either one hard!

      It sounds like I may be on a similar path, nursing first and then medical school. Thank you for all of the advice, I really truly appreciate your insight into both worlds. I'm still not sure for the moment, so I will be doing more research!

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    2. TXgal,

      Your response is refreshing thank you. At the end of the day you should do something that makes you happy and it isn't just a job that you must do but a job that you're so passionate to wake up and to do with a smile.

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    3. Thank you TXgal for the detailed response. I am also at the crossroads and reading your post was so encouraging.

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  9. My husband is EM and his schedule is so flexible- he only works 3 shifts/week and that gives him a lot of time for family. He loves the patient care aspect and he (sadly) does have some continuity with the patients he sees... lots of repeat patients. We're expecting our first and if I'd know 8 years ago that I want to work part time when we had kids(which is the plan) I definitely would've chosen PA or NP over the MD.

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    1. Hi Cate, thank you for the response and different perspective. If you don't mind answering, what area of medicine are you in?

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  10. I have said before that smart people go to Nursing school, and those of us with Ego go into Medical school. I love my job, but overall I think that is true.

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    1. Hi Erin, thank you for your opinion. I'm trying to find that delicate balance of everything in life, when I have no idea what life will throw my way!

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  11. Hi Kelly, great set of questions you posed and comments here. Just want to chime in that (experiencing the death of a parent as a 19 year old, myself) even though that was the conversation you and your mother had, take the nature of it as she'd want you to be well-supported and happy in your professional and personal life... in health care (or otherwise) there are a wide range of options. She'd be proud of you.

    Also- sometimes you don't quite know how near or far having kids is!

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    1. Hi T, thank you for telling me about your story. It is certainly a conclusion I am slowly coming to, there was just so much more to talk about, as I'm sure you know.

      And exactly on the kids part! I have no idea when anything will happen, so it is certainly interesting trying to make generalized plans and life decisions when there are so many variables!

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  12. If you know with 100% certainty that you want to be a SAHM for a few years then I would have a hard time recommending medical school right now because the peak childbearing years tend to coincide with the peak difficult training that is rigid and inflexible (residency) when you can do 90%+ of what you want to do as a PA, without the family sacrifice. If you want to put your family first, I'm not sure the MD is as predictably the way to go, there are only a few specialties that have much flexibility and often there is a dues-paying requirement of nights and weekends when you first start, even in the 'lifestyle' specialties. For many docs they feel they would become deskilled with a few years off and it becomes difficult to go back. Even if you feel comfortable with your skills after time off, potential employers might have a hard time with it. I find medicine to be a little backwards in its approach to motherhood, the system might not be built to support you and your many goals :(. I would reconsider PA school.

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    1. Hi vellai, thank you for your opinions. Yes, returning to employment after time off is certainly a concern of mine for any medical field. Out of curiosity, do you know if PAs have more patient contact than MDs in the ER?

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  13. Very interesting post and conversation- thank you! I have a few thoughts for you:
    1) You may change your views on motherhood when you get there. I always thought I'd want to be a working mother. Now that I'm here, I wish I could stay home. Alternatively, I have friends who say they'd go crazy if forced to stay home. You might not really know where you fall until you live it.
    2) I'm a year out of residency, have a toddler, work part time. It's exactly what I'd wanted-- but like I said, I wish I could stay at home, and so would have taken a different road if I knew then what I know now. Also it's been pointed out to me that in 10 years I'll probably feel differently about it than I do now, with a young child.
    3) MD vs PA vs NP really depends on where you live. Do you know where you want to be? I highly recommend as much shadowing as much as you can in chosen region.
    4) How much responsibility do you want? If you want to be the one running the codes, setting the bones, doing the procedures, that usually means going to the MD route. I'm not ER, but had lots of ER time in residency and got the impression that the MDs and midlevels had similar time with patients (at least in this region), but the midlevels saw the less acute patients.

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    1. Hi Unknown, thank you for your thought out answer!
      1&2) I definitely agree that life is most likely going to change later. I'm attempting to make an educated/ well thought out decision so every answer here has helped tremendously
      3) I have actually moved quite a bit in the past 4-5 years and have shadowed in the Pacific, Rocky Mountain, and Midwestern regions. All I can say is the more I shadow, the more I like every job.
      4) I'm not quite sure how much responsibility I want. But I love doing ATLS, FCCS, and other "training" sessions.

      Followup question: Which region are you in? It certainly is something to think about when researching schools :)

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  14. Hi Kelly,

    I can definitely relate to your love of what you see on both the nursing and the physician sides of things. I'm very sorry about the loss of your mother and though I've not had the same experience, I definitely agree with T in that your mother would want you to find something which is fulfilling.

    I'm the first in my family to go to college. I put myself through school by working part and full time in the various stages of my careers. The only thing I knew about medical school was that it was long and expensive and at 18, I didn't feel I could make that investment. I wanted to be sure medicine was really my passion.

    I became a nurse first. I worked on a med surg unit, then became charge nurse, code team leader, moved into the surgical ICU, added responsibilities of being a peer preceptor. I ALWAYS wanted to know why we were doing a particular treatment regimen, why this med and not that one, how do we decide to titrate this one up and this one down, how do we put this line in, how do we intubate, how do we garner the trust of our patients and their families when a big surgery or procedure is needed, etc. The docs in my hospital were not so receptive to my questions... "Why do you want to know that, you don't need to know that, you're JUST a nurse." I was helping an anesthesiologist put in a central line in the ICU and I'd memorized all of the steps, one step ahead of him at each go of it and I had an epiphany. I wanted to DO the things. I wanted to MAKE the decisions. I wanted to have the responsibility of making the medical decisions with and for my patients. I was 23 when I made that decision. I'd always wanted to be a mom and to be a doctor. I thought they were mutually exclusive and I chose medicine, hoping perhaps I might be able to also be a mom.

    I made the decision then and there to become a physician. Went back to school for the med school prereqs (for me it was a full BS degree because my nursing degree was an ADN). I worked full time in the SICU every weekend and went to school Monday thru Friday. Applied to medical school and got in. Vacillated between ICU, EM and interventional radiology (common theme between them is procedures)... ultimately I decided on EM because it's shift work, it's a blend of patients challenged with medical literacy and recidivism, critical care, trauma, etc. I've become an academician which has afforded me some flexibility to teach and connect with learners on every level, medical students, residents, fellows, junior faculty. I love working in the ER and I love teaching.

    I'm also blessed to have a wonderful 5 year old. I'm now a single mom, an assistant professor, an ER doc and though this is not the picture frame I envisioned years ago, I'm very happy with what I'm doing. One of the wonderful things about emergency medicine is its flexibility and if you decide down the line that you want to change your clinical practice, you can move to a lower acuity practice when your kiddos are in school... or you can explore an EMS directorship... or you can work part-time and spend quality time with your kiddo(s). Though I have a nanny and she works a fair number of hours, my son knows his momma. Our time is quality time. I put work away until he's asleep or he's with his dad. The hours are long, varied, but the payoff is huge.

    Though I cannot speak to personal experience as a PA, I have plenty of friends who are ER PAs as well and moms, and I'm happy to facilitate an introduction if you'd like to pick their brains as well.

    Are there drawbacks and challenges? Absolutely. Is it worth it? Only YOU can decide that. Happy to chat further if you'd like. Perhaps KC can put us in contact, if you like.

    Cheers!

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    1. Hi Emeducatormom, thank you for going through details with me. A common thread between everyone's replies is that EM is flexible which is so nice to hear.

      Both nursing school and PA school will require more undergraduate classes in order to be eligible for applying. It's terrifying talking to them and finding out that some/ most of my classes won't transfer (I'm blaming the college system and their desire for money). However, I've been out of school for about a year and I'm ready to start learning again.

      Thirst for knowledge is definitely one of the factors pointing me towards medical school. I absolutely love the hands on "training" I've been given during ATLS, FCCS, and other courses; some of the "training" was intubation, cricothyrotomy, and chest tubes.

      I actually haven't considered EMS directorship, but it sounds like something I would love. I'm always trying to figure out how I can make communication better between different medical fields.

      I would love to talk to you more in depth about a few things! How can I help KC put us contact?

      Thank you so much!

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    2. I would e-mail KC at the mim share address you used to submit this and ask for her help. KC put me in touch with Emeducatormom a couple of years ago she is a smart lady and fun to chat with.

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  15. So many great replies above! I just want to add that you're only 22. There is so much more you cannot plan for. There are things that you think you may want now that will change and things that you cannot control. Life and priorities change. I started off wanting to do internal medicine in medical school, then while in my surgical internship discovered I was pretty good with my hands and got swept up in the pulse of surgery and changed my mind. Then one night while gently holding neonatal bowel in my hands in the dead of the night realised maybe the surgical life wasn't for me. So I started exploring EM, family practice and internal medicine again. I eventually settled on internal medicine and while there discovered I loved seeing patients in the clinic. My hands were still itching to do procedures so I thought I would do gastroenterology or cardio or intensive care. And then I realised again that perhaps I did not quite enjoy excitement and chaos that comes with emergencies that much afterall. It was great in small doses but wasn't for me for the long haul.

    Fast forward several years and I'm now an attending endocrinologist who has 2 young children and work part time. I never really planned to end up here but I have no regrets. I'm just not cut out to be a SAHM and have so much respect for my mother (and everyone else who is) who did that for me.

    So I guess the short answer is - give yourself a chance to explore what medicine has to offer. It will be hard, it will be gruelling. But if this is what you want then the journey is well worth it. Life changes, opportunities change. What seems set in stone to you now may look so different a few years from now.

    And oh yes, I met husband after my fellowship so you really can never know can you? :)

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  16. Hi gesticulate, thank you for the reply! So sorry to be replying so late (internal hard drive crashed, ugh). It certainly is true that medicine is always changing, along with life. I'm trying my best to explore all the corners of medicine! Thank you for sharing your story with me!

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