Showing posts with label becoming a doctor. Show all posts
Showing posts with label becoming a doctor. Show all posts

Tuesday, July 7, 2015

Attending Status: let's go!

I woke up to the sounds of the birds chirping and then “Mommy!” as my almost 4-year old tried to start his day at 6:45am. Quick detour for a potty-break and then promptly back in his bed because, “It’s still too early. Time for sleep.”

As I sit at our desks, I double and triple check that my Epocrates app is up to date so that I can quickly calculate drug doses. Today is my first official day as an Attending. I am returning to my dream health care system to work in the pediatric clinic I did my third year community pediatrics rotations in. The Attendings and many of the front desk staff remember me back when I was a medical student and they, like me, are super happy that I have returned.

We had an all-day orientation yesterday that was truly inspirational - yes, I’ve drunk the Koolaid as they say and am already one of those super happy people to work where I work. Providing care to children in our nation’s capital is truly an honor and one that I do not take lightly.

During times like this I refer back to my favorite book The Alchemist (Paulo Coelho). I was tested immensely in these last few years, but every second of the journey brought me closer to the realization of my dream. Every struggle. Every triumph. And I’m here. In this moment. Feeling the immensity of years of pre-medical studies, MCAT struggles, public health school, medical school, biochemistry challenges, clinical year excellence, pregnancy during USMLE Step 2, birth, and being a mother in medicine.

I am totally ready for this aspect of my journey. I vow to do great things. So let’s go. Let’s get it. Pediatric Attending status 2015! (happy dance, happy dance, happy-praise dance!)

Monday, March 2, 2015

In between promise and fatigue: here's to the end of residency

“Tell your heart that the fear of suffering is worse than the suffering itself. And that no heart has ever suffered when it goes in search of its dreams.”

“Before a dream is realized, the Soul of the World tests everything that was learned along the way.”

“Every search begins with beginner’s luck. And every search ends with the victor’s being severely tested.”

I can see the end of residency. My schedule is set. I know that June 23 is my last official day of my pediatric residency. I am standing on the edge: the edge of my time as a “trainee” and the beginning of my time as an Attending Pediatric Physician. As one of my closest mentors says, “Medicine is about delayed gratification,” and she is so right because I can feel the end of training, it’s palpable. It stands looming in the distance. I see the promise - the chance to continue to create the career that I have envisioned for so long. One committed to the underserved, adolescents, and new families. One committed to medical student education and helping to forge a path in medicine where the marginalized student feels less alone. One committed to enhancing trainees understanding of health literacy, compassionate care, holistic care. One committed to clinical excellence and rigor.

I can feel the promise of creating a career where I can share more of the child-rearing responsibility with my husband. We have had the chance this year to experience up to 2 consecutive months of me having a “regular” or non-Ward schedule and it has been amazing (family dinners, weekend outings, dates, sleeping in). My Attending friends tell me that this is how life can be post-residency and that I have to work hard to get a schedule that allows us to feel more like a regular family. Interviews have been going very well, but none has felt quite like “the one.” I can feel “the one” coming though and am giving myself until April to keep searching and networking.

But I can also feel my fatigue. It also stands looming and sometimes sneaks in for a jab or two. The tight pull of my neck as I continue to type into our electronic medical record. The beginnings of a tension headache as I work on licensing applications during Zo’s nap time. I can feel my strain and my friends’ strain as we begin conversations about our final residency rotations with “I am soo over this!” Invariably all of our texts, phone calls, and in person conversations include our “being over” being on call, covering in the wards, and Interns doing crazy things. Then we laugh and talk about how a friend who is a new Attending has told us something wonderful about his or her life.

As my Residency Director said, “You’re not supposed to love residency” because it’s not a permanent job, it’s just a big hulking stepping stone.

As I always do when I am straddling a new transition, I have begun to re-read selections of "The Alchemist." This book has been with me since the first time I read it in 2004 as a fourth year undergraduate awaiting medical school acceptances. This road has had its share of suffering. Times where I felt failure was imminent. I fought on. In spite of a few very low points, I have experienced joy beyond what I ever could have imagined. Providing excellent patient care, figuring out diagnoses, being hugged and hugging amazing families and assisting them during their lives’ lowest points. I have experienced the joy of getting married to an amazing man that I now call my own and together we welcomed to the world an outgoing, rambunctious little boy that amazes us every day. There isn't a day that we don't pause, smile or laugh out loud and shake our heads at his silliness and love for life.

As I stand on the edge of my most recent life’s transition, I foresee some suffering, some testing, and a whole lot of joy. While I welcome luck, I also know that I have been fortified by life’s challenges and know that you can experience fatigue and promise simultaneously and it still bring so much joy.

Here’s to the end of residency!!!

Quotes above are from Paulo Coehlo's "The Alchemist," 1993.

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.

Thursday, June 5, 2014

MiM mail: His sacrifice or hers?

Hi everyone,

I've been reading this blog looking for pearls of advice and wisdom ever since I was accepted to medical school just over a year ago (in Canada).  When I interviewed for medical school, I was actually 8 weeks pregnant with my first daughter.  I decided to defer for the first year to stay home with my daughter.  Now the time has come to decide whether I indeed do go back to school and become a doctor. This situation is complicated, and I need some advice from some women/mothers who have been there.

A little about me: I am a 32-year old (will be 33 after 2 months of school) family nurse practitioner.  I have a great job and work with an amazing team, but no I have no flexibility in terms of hours.  I have decent pay (but no real opportunity to grow). And the nurse practitioner role is still developing in Canada so there are many other "issues" with the profession as well, including barriers to practice, funding/remuneration issues, and scope of practice limits.  Not to mention that most people in Canada don't even know what a nurse practitioner is.  When I tell people, they think I am training to be a nurse. That aside, I know I would love a career in medicine.  I've been in the healthcare field myself now for over 10 years, and I think I have a pretty good idea and sense of the role.  My daughter will be 9.5 months if/when I start school, and I do want/plan to have 1 or 2 more kids.

The situation is complicated because I was accepted in a different city and province from where we live now.  My husband is working at his dream job and has NO desire to leave it.  He feels (and has been told) that he is on a great trajectory with the company, and has already been promoted a few times in the 2.5 years that he's been with them.  There is no office for this particular company in the city we would have to move to.  There is no family of either of us in the city that we have to move to (but there isn't now either). We just got into an AWESOME brand new daycare on the campus of my current job (for which I am still on mat leave), but we have to pay the monthly fees as of now in order to hold her spot until I go back to work in October.  This is pricey, plus if we end up moving, a huge waste of money. But if we stay, it is super convenient, as I would just have to bring my daughter to work with me and could pop over between patients and see her!

Essentially, it has come to either myself or my husband sacrificing for the other.  He has his dream job with great future prospects.  I can have my dream job in medicine, but not for another 8-ish years (I would probably specialize). Plus, we will go from a two-income family living a comfortable life, back to going into debt and living a student lifestyle. Also, I don't really know how much time I will have for my kids during all of this training. And is that what is best for them? I really don't know what to do.  I feel so guilty about uprooting and making him quit his job if we go.  He doesn't have any prospects in the new city as of yet either, which makes it hard for him to visualize being there.  I can visualize myself there because I know I would be starting school etc.  We have decided that we need to do what is best for our family (daughter and future children). But we can't seem to figure out which path is "best." I wish I had a crystal ball to look into the future and see how each path would turn out.  I really really want to go, but he really really wants to stay.  We both said we would sacrifice for the other, but that still leaves us with a decision to make, and we are having such a hard time.  Any thoughts or advice or wisdom would be MUCH appreciated.


Monday, February 24, 2014

Stop scaring the "fresh meat"

I volunteered recently at a meeting for Latino high school, college, and medical students as a member of my hospital’s Residency Diversity Initiative. I had gotten the announcement a few months prior and realized I would be on a pretty straight-forward month with weekends off. I checked with the hubby that I could take about 3 hours during his prime studying time to volunteer and he agreed.

The students were engaging. The high school students asked silly yet endearing questions. One absentmindedly asked another resident and myself our specialties three different times because he kept forgetting what we said. He was sweet, but goodness, I hope his focus and attention span increase before starting college.

Several of the medical students asked very educated questions, ones that showed they knew where they were going. One particularly prepared medical student, dressed smartly in an off white blouse, flattering pencil skirt, and pearl necklace asked a series of questions that we answered. She thanked us and left. Then she came back later to chat some more. She began her new string of questions with “I don’t mean to sound, ummmm, superficial or anything, but even though I’m interested in all types of medicine, I am worried that if I go into Family Medicine instead of Internal Medicine that I won’t be able to pay off my loans.” I shared a quick, knowing smile with the Family Medicine resident sitting next to me and we began to talk to her about following ones passion. We also reminded her several times, indirectly and directly that regardless of what type of medicine you practice, each of us will be in the top 1% of US income-makers. The top 1%.

Yes I know $120,000 instead of $200,000 (in a surgical subspecialty) seems like a huge deal, but honestly, every single Family Medicine Attending the other resident knew and every single Pediatric Attending I know is living very well. Yes, they may have a ton of debt they are working to pay back, but every single one has a family that is well taken care of. Everyone I know has a nice house (mostly owned and not rented), a decent if not really really nice car. And none appears outwardly to be struggling to afford their basic needs. I apologize if these are material things, but that’s what she was asking about and we answered because it’s a very real concern.

And that’s the Attendings, not the Residents. Every Resident I know, including myself, lives in a nice apartment. Many Residents in my program own houses, not rinkey-dink jacked up houses, but really nice grown-up houses with nice yards. We can afford to go on vacations and we buy what we want at the grocery store including at Whole Foods (which my father-in-law refers to as Whole Check). My husband and I budget our limited money well and hope to buy a house in the first several years out of residency. And we are already well on our way to having my student loans paid off within 10 years using the income based repayment straight out of medical school. Don’t get me wrong, if we didn’t have my husband’s graduate school scholarships, our family of 3 with a single working adult (me), we would be very close to being eligible for public benefits (Section 8 housing, food stamps, WIC, you name it); some of our neighbors are on assistance now.

So, seriously, I know many of us including myself are in debt. And I know we need to do things to overhaul “the system” so that serving patients and saving lives is compensated in a common sense and equitable way. One that values innovative, smart approaches such as preventative care and comprehensive services. One that doesn’t cause very capable and compassionate students who are interested in our field to go running the other way as they eye the ever-mounting price tag. But even at the lowest-paying end of the spectrum, we all will make more money than the majority of our country. And if we help each other to become more business-savvy, we should never have to struggle to live well.

The medical student left smiling. I left more inspired. Hopefully we encouraged her to pursue what will ultimately make her the happiest so that she can bring her “best self” to work every day; she owes it to herself and to her patients. Yes, it’s a daunting task and the realities of practicing medicine in our country are scaring the crap out of many of us and our future colleagues, but again, we are still positioned in one of the best fields that exists. I am committed to reminding myself, my colleagues, and the “fresh meat” that this is the reality we find ourselves in. A bit daunting, but not too scary.

Tuesday, February 18, 2014

MiM Mail: From a doctor in physical therapy

Please bear with me through the beginning of this post, but I feel the background is pertinent.  I'm not exactly sure where to start.  I am 33 years old, a wife to a military officer, a mother of a precious 4 month old son, a doctor of physical therapy, and an endurance athlete. 

When I was younger, I spent 4 years in the Air Force as an aerospace physiology instructor.  I completed my A.A.S. in Aerospace Physiology Instruction through the Community College of the Air Force, and my hard work and high performance was recognized numerous times and at various levels through awards, such as the junior enlisted member of the quarter and year.  My flight commander felt that as an enlisted member, I would never reach my full potential, so he encouraged me to separate from the military to complete my degree.  I followed his recommendation, separated from the military in 2005, and took the remaining classes required to complete a B.S. in Biology.  I remember studying for a biochemistry final, looking up at a poster that read "Physical Therapy- We're Hands On," and thinking that might be an interesting profession to look into.  I shadowed with a home health PT who LOVED her job after 20+ years, then worked as a physical therapy technician in an outpatient orthopedic clinic for several months.  I educated myself on the profession, read the APTA's Vision 2020 about how the physical therapy profession was moving towards direct access, autonomy, lifelong learning, and educational programs were now doctorates.  My undergraduate GPA was good, but not stellar, so to demonstrate my ability to succeed academically, I completed a rigorous M.S. in Biology while concentrating my studies in neuroscience, cell and molecular biology, graduating with a 4.0 GPA.  I scored the highest in all of my classes- in fact my pharmacology professor wrote a note on one of my exams thanking me for scoring so well because after grading my classmates, she was beginning to think she was failing at teaching.  My hard work paid off- I was accepted to the University of North Carolina at Chapel Hill Doctorate in Physical Therapy program.

Fall 2008 I started my doctorate.  About a month into the program, I noticed I wasn't as interested in the physical therapy coursework as I was in the pathology or pharmacology classes.  I missed the "science" I had loved so much during my masters...  This trend continued.  I began thinking about medical school, but had committed to physical therapy and thus felt I needed to give it a chance. 2010 I bought an MCAT book, but again talked myself out of it.  Student loans were piling up- did I really want to increase those?  2011 I graduated and began working as a physical therapist.  I spent over $4500 in continuing education that year in an attempt to find something I liked in PT: lymphedema, manual therapy, vestibular therapy, biomechanics of running, treating the multisport athlete (these last two were very interesting, especially since I am a triathlete), etc.  I am a very positive attitude person, yet have found very little in PT that I love besides being a clinician and working with patients.  My masters research involved neuroelectrophysiology on CA3b neurons in the hippocampal formation and very little human contact- although I loved the research, I missed working with people (and my PI never spoke to me).

I thought becoming a doctor of physical therapy would enable me to teach (which I love), but most universities require a "terminal degree" such as a PhD or EdD.  I thought direct access would allow patients to walk into my office with acute injuries and I could treat them before these injuries became chronic- well, not all states are direct access, a lot of insurance companies don't pay without an MD Rx, and in some states I can't even perform Grade V manipulations- something I am well skilled in doing!  Differential diagnosis was heavily emphasized throughout my schooling and clinic work- I am able to recognize flags that warrant a medical examination and referral to a medical doctor.  What is the point of the profession moving to a doctorate when, even as doctors, we are so limited?

Fast forward to today.  I think about applying to medical school everyday.  I read books on perinatal stem cells, biochemistry of obesity, metabolic pathways, pathologies affecting the nervous system and I get EXCITED!.  I want to treat patients- not by teaching them how to walk or improve muscle function- but I want to attack their diseases at the cellular level!  I want to physically excise tumors, shrink them pharmacologically, and get involved in research.  Yet, I hesitate and question if this is practical.  I have read several mothers in medicine posts about burnout, disillusionment- would this happen to me?  If I apply and am accepted, my family will be supportive, but I will be increasing my student debt (I already have $160K), taking time away from spending time with them, and I'm certainly not getting any younger- am I selfish in even wanting to become a medical doctor?  If I become an MD- or even an MD/PhD (I do love research), complete a residency, and fellowship will I have time to spend with my family, continue training and competing as a triathlete, or even just sit back and relax?  Also, my husband plans on spending 8-14 more years in the military before retiring.  I have spoken with PTs that became MDs and are now much happier- but they have all been male.  I have sought guidance from my mentors from PT school- they encouraged me to stay in PT...

I was excited to find this blog!  What thoughts do you all have?  I feel I need to make a decision- this contemplation has been going on since 2008...

Sincerely, Kelly

Tuesday, August 26, 2008

The Speech I Never Gave

Being on a medical school faculty, I have just listened to a slew of speeches welcoming the new students. Everyone from older students to the dean exhorted the students to be diligent, caring, dedicated and so on, and tried to capture the transformation that occurs between layman and doctor. The students all seemed overwhelmed, being told medicine would be a rewarding but all consuming life. While the speakers honored the families from whom the students came, none said anything to reassure them that their future lives might include families of their own. I listened with the ears of the lonely single woman I was on my first day of medical school, and I felt the mixture of aspiration and despair the dean’s vision evoked.

As my family has observed, I always want to be the bride at every wedding and the corpse at every wake. Sitting there, I tried to think what I would want to tell the students, especially the incoming women, about what lies ahead. I suspect a more feminine image of devotion and change might have been of comfort to them. After all, they are joining a profession, not a convent or a monastery.

Becoming a doctor, I would have said, is a lot like becoming a mother. When you imagine it, based on the images of motherhood that surround you, the vicarious experience of friends or family, and your own experience as a child, you imagine the change occurs suddenly and thoroughly. The baby is placed in your arms, you expect to be flooded with tenderness, to know what to do in every circumstance, and to have the respect of those around you. In fact, the process is gradual. The day you find out you are carrying a child is like the day you get your medical school acceptance letter. The child grows in your mind and occupies many different roles before it ever becomes a flesh and blood reality. How many different specialties did we practice in our heads, before we put on our first white jacket and tried to find a comfortable place to stash the stethoscope? Delivering the baby, like the first day in anatomy lab, doesn’t suddenly make you a mom, or a doctor, not the way you imagined it would. It takes time, sleepless nights, anxious days, moments of profound resentment and moments of even greater tenderness before you fall in love with this child, a love that evolves and changes as the child becomes more and more complex and separate from you. As with medicine, the more fully you embrace this new focal point in your life, the more your inner sense of self changes. Various milestones—the child’s smile, the end of your first period of exams—mark progress toward your new self, but the real transformation occurs privately. It can be sudden—the day someone calls you mommy, or doctor, and you don’t jump. More often, it is retrospective. You look back and realize that somewhere in the past few weeks, months or years, you have become what you and others have expected for so long—still yourself, yet profoundly and irrevocably other than what you were the day you first began to dream.

Do not be afraid, I would have said to them. The sacrifices you will be making will not be more than you can bear, and the rewards will be more than you can imagine.

Monday, August 18, 2008

Mothers, don't let your daughters be doctors

Stranger: "Little girl, what do you want to be when you grow up?"

Me: "A doctor." [Looks to mother for approval]

Mother: "That's right."

Before I even really knew what a doctor was, I knew that was what I was supposed to be. My parents, both doctors, expected it of me, and I accepted it, much like an arranged marriage. After all, there was nothing else I really wanted to be, other than maybe a ballerina (in retrospect, that likely wouldn't have worked out too well).

In high school and college, I entertained thoughts of other careers, but my father made some very compelling arguments for med school that I was unable to refute:

1) How many careers are there out there where you can really help people?

2) As a woman, this is one of the few fields where you will earn a decent salary and not have to rely on your husband to support you.

3) Just take the MCATs already and see how you do.

At the end of my sophomore year of college, I "just took the MCATs to see how I'd do" and when I got my score back, it was good enough to apply to medical school. And after having taken an eight hour exam, I already felt time committed. Why would I put myself through that and pre-med biology if I wasn't going to apply to med school?

So here I am years later, a new physician. I can't say that this was the perfect career choice for me, but now that I'm at the tail end of my residency, I'm not about to quit and start folding jeans at the Gap** either.

People ask me if I plan to encourage my daughter to become a doctor. At this point, I'd settle for her not coloring all over the walls, but my specific answer to that question is, "Absolutely not."

In fact, not only will I not encourage her to become a doctor, but I will actively discourage her from entering a life in medicine. I will tell her every awful story I can think of about the abuse med students, residents, and (I can only presume) attendings are put through. I'll complain incessantly about how being a doctor means giving up your life to your patients. I mean, yes, I'll buy her the toy doctor's kit, but that will be mostly for me to play with.

And after all that, if she still wants to be a doctor, I can't say I'll be disappointed. What mom doesn't want her daughter to follow in her footsteps? But it's important to me that she gets to that decision on her own. Because medicine is not a career anyone should be pushed into.

And best of all, this way if she ends up hating it, I'll get to say, "I told you so." I've heard mothers love saying that.

**Favorite alternate joke career of doctor trainees who want to quit, for some reason