Showing posts with label career. Show all posts
Showing posts with label career. Show all posts

Wednesday, October 26, 2016

Help with attending job interviews!

T minus 8 months until I join the real world.

I am now 4 months into my breast imaging fellowship. It's about that time I start looking for my first attending job!! As someone who went straight through in my medical training, I have no idea what a job interview truly entails. Yes, I've done plenty of interviews. I know what it's like to sell myself as a medical trainee but as for joining the real world, I have absolutely no idea.

My experience looking for a job might be a little different than some because I am geographically limited. My husband started his (first) attending job in a city 2 hours away from where I am doing fellowship. On a side note, this situation is so much better than our west coast east coast marriage while he was doing fellowship last year! As much as I am looking forward to joining the real world, I am really looking forward to our family of 3 to finally be living under the same roof!

I went on 2 interviews so far. The first one was not the same location but same group as my husband's place of work. Given that it's part of the largest managed care organization in the United States, questions outside of who I am, what I can offer were really not asked. Details of what the contract would entail, how much I would make, what my benefits were and etc. were not discussed. Mostly because I already knew the answers to these questions and the fact that I was told that there was no need to go over a contract from this place as it was standard across the United States. I came back from this interview thinking it went well and that it wasn't much different from a fellowship and residency interview. A downside to this job is that it will be a 45 minute commute to where we will most likely settle down.

The second interview I went on was a large private practice group in the city where my husband practices. It's a group of approximately 80-90 radiologists. We talked about my dual boarding in radiology and nuclear medicine. We discussed the possibility of working within my preferred subspecialties (breast imaging and nuclear medicine. We discussed the possibility of working part time, which got me really excited. I also met some of the radiologists in the group, who all seemed very nice. However, I came back after my interview most of my conversations with my attendings at work went like this.

"How was your interview?" "Good. I really liked the practice"

"What is your base salary?" "I don't know..."

"What is your retirement?" "I don't know..."

"What benefits are offered to you?" "I don't know..."

"What about maternity leave? " "I don't know..."

"Do you get paid overtime for call?" "I don't know..."

"How many years until partnership?" "I don't know..."

Basically, I felt like an idiot. And now, I am waiting to hear back from both jobs but I feel like I cannot really compare and contrast since I don't know the answers to these questions!

How do you go about asking these questions during a job interview? Do you ask right away? Do you wait until there's a proposal? Is these anything else I should be asking? Do you need a lawyer to review your contract?

Thank you in advance for your help!

Wednesday, August 17, 2016

The things we do to succeed

I didn’t want to do it again, but here I go retaking my Pediatric Boards. I can list all of the reasons why I was unsuccessful at my first attempt: I was working too much (50-60 hours per week, getting paid to work 32), I was too stressed (issues with my former boss that I can’t discuss), I wasn’t sleeping enough, I have testing issues but my boss told me she couldn’t adjust my schedule so that I could study more. So here I am hundreds of miles away from home spending close to $2000 to take a 6-day intensive board preparation course. I am doing all that I can to succeed this time. And I refuse to allow the posttraumatic stress of retaking this test overshadow all that I am doing to succeed.


I have met so many outstanding doctors, most of them mothers, who have their own stories of failing their general boards or their specialty boards. These women are some of the best doctors I have ever met and provide exemplary care but they each failed the exam the first time. The stories read just like mine: working too much, stressed, not sleeping enough, family obligations, poor work-life balance. Some have a history of failing other board exams (USMLE or their specialty boards) but others don’t. Why does the cycle repeat? Why don’t we shake our little doctor sisters and say “wake up girl! There is no way you can balance all of this! Cut something back. Cut something out. Or else!”. “You can’t go on like this!”. “You either sacrifice now and focus primarily on passing or you’ll be forced to retake the test after failing!”. “Girl! Don’t do what I did. Let me tell you how I didn’t rock this test!!!!”. Or “Friend! Let me help you pass this test!”.

That’s how I want to recreate my narrative. I’m going to pass this test even if it’s by the skin of my teeth and then I’m going to mentor little sister docs so that they don’t make the same mistakes I did in post-residency auto-pilot mode thinking “well 60 hours is so much less than my resident’s 80 hour work week”. Let me tell you something - it’s not better after all of the years of sacrifice and don’t even pretend like you are not exhausted and burned out. And trying to work that much on top of passing this exam if you have even a hint of testing challenges is a major no-no.

So yeah, please Mothers in Medicine, send me some good vibes because I’m away from my family in this cold hotel room wrapped in blankets giving my all in order to succeed.

SIDE NOTE: In other random news, I just learned that the Peds Boards may become an open book test in 2017. Mwomp mwomp mwomp for me! If I could sit this round out, I would, but my new position depends on me passing this year. I hope the open book re-certification exam doesn’t cost more. Alright, I’m going to block all of that out and keep my nose to the grindstone.

EDIT: I removed the part about the salaries of the American Board of Peds folks because I cannot figure out how to fact-check it so it could be very untrue.

Monday, July 18, 2016

Surprise! Female physicians are paid less.


I am sure many of you have seen this recently published article about physician wage gender disparity in the New York Times. The original research article was published in JAMA Internal Medicine, and received a lot of popular press with mentions in the New York Times, Time magazine, Boston globe, Marie Claire and many others. I am always a little wary of science/research reporting. I sometimes try to read the primary research paper behind the news item, especially if the topic interests me. Pay equity for physicians is certainly a topic of interest for me.

This article put a specific number on the gender pay disparity: female physicians make roughly $20,000 per year less than male physicians. This is after adjusting for age, experience, faculty rank, specialty, scientific authorship, NIH funding, clinical trial participation, and Medicare reimbursements. This news came up in a non-work context with a male resident physician. He told me that the problem with these types of studies was that they don't account for the amount of work put in. According to him, "female physicians work less than male physicians". Well how do you mean sir? Do you mean more female physicians work part time? He said, "In my experience, women complain more and work less, period. They always have to go pick up their kids or some other excuse and they dump their work on me". Ugh! Alright then Dr. Curmudgeon.

The paper is well written and the research is pretty well done, I highly recommend reading. Sad statement, but female physicians being paid less won't come as a big surprise to anyone. Safe to say, I was being ironic in the blog post title. Gender based pay disparity occurs in the rest of the US workforce. The dicey question, which Dr. Curmudgeon raised, is the pay disparity unfair? It maybe unfair from a social standpoint. Women ending up with more childcare or household responsibility and not being able to match male productivity. But is it unfair from an economic standpoint? Are they truly being paid unequal amount for equal work? Is there is an inherent bias towards them? This paper suggests that there maybe a component of both social and economic unfairness.

Comparing unadjusted salaries, i.e. without taking into account specialty, faculty rank etc., the difference is even larger, $51,000 per year. It may be true that more women than men make choices that lead to being paid less, such as working in certain specialties or working part time. But women don't choose to be overtly discriminated against. The authors adjusted for a lot of factors that could explain the pay disparity and still found a gap of roughly $20,000. The authors lacked some information, most importantly, full time vs part time status. They did two things to counteract that. One, they used Medicare reimbursement in their multivariate analysis to adjust for clinical volume. Two, they eliminated bottom 25th percentile of income data, with the assumption that it would eliminate part-time workers from analysis. They are imperfect measures, but the best that could be done with the lack of available information.

I am pretty early in my training, and from my own limited experience, I do believe that there is at least some inherent bias. Dr. Curmudgeon is not an exception, there are more people like him inhabiting the medicine world. They may be outspoken about their biases, or maybe not, or maybe only in certain contexts. They may be aware of their biases, or maybe not. I suspect, a lot of Dr. Curmudgeons are even in positions where they can influence factors, like promotions and pays. If you have encountered one of these Dr. Curmudgeons, I'd be interested in hearing your stories in comments.

Wednesday, July 13, 2016

All of the ways I forget

I had my 90-day evaluation in my new position today. I left the clinic I was working in, one overrun by burnout and toxic management, in order to remember why I went into medicine at all. I love my patients and this work, but I love my family more. I now work 3 days a week in health care administration and quality improvement. I sleep well at night now that the main cause of my insomnia has ended. My family is happier. My evaluation went very well.

Immediately after my meeting, my husband reached out and said he needed to talk. I needed to talk too. He is finishing his dissertation this week, we just bought a new house, and my parents came in town for the weekend. We have been passing like ships in the night. Both busy and not really checking in enough. With moments of hugs and kisses and simple appreciation. But overall, we haven’t been checking in frequently enough and we definitely haven’t been having the weekly meetings that are my bookends at work.

I feel lonely. He feels unappreciated. Why didn’t I offer to help with his appendices? Why didn’t I read the chapter he asked me to read so many months ago (honestly, he gave it to me and I forget and he never mentioned it again until today and now I feel like dirt). He feels that my work has taken priority in our family for years (medical school, residency, the toxic job took so much of our family’s energy just to stay afloat). And now I’m studying for my Boards again after I failed them last year (more about that later, I have a lot to say about it but it's so raw and traumatizing). And he’s finishing his dissertation and starting his first job as a professor at the state university.

When we get busy I forget that my marriage needs check-ins, scheduled ones, on purpose because they are priorities. And when we are busy, we both have to go the extra mile to make sure that my needs, his needs, and our family’s needs are met.

And I’m sitting here at work, dragging my feet because at home I am reminded of all the ways I forget. I need to go home and start remembering again. And I need to be gentle with myself because we are juggling plates and though many of them are scuffed up I pray that none of them are smashed and destroyed. I’m going to head home now in order to remember that I love him immensely. And loves me. And we can't forget.

Tuesday, May 24, 2016

Are You Suffering from Overcare?

Dear MiM,

This is my first post, so I will introduce myself. Thank you so much to KC and all of you veteran MiMs for this opportunity. I've been a reader for years, since residency, and found MiM so helpful when thinking about my future career. I'm a family physician in a mid-sized Canadian city. I've been in practice for seven years, which still feels very "early career" to me. I work full time - 35-40 hours/week counting clinical plus admin time. I call it full time but always somewhat sheepishly around other physicians! I have a three year old son and one year old daughter, and a work-from-home husband. I'm involved in refugee health work and am community faculty for our medical school. For me, some amount of "big picture" work has always helped me maintain enthusiasm and appreciation for the clinical work. I look forward to reading your stories, and sharing mine!

N.

---

A few months ago, I was getting bogged down by excessive self doubt and perfectionism at work. The main way it manifested was in ruminating and worrying over decisions once I'd made them, but there was also over-thinking clinical choices, triple- (quadruple?) checking, and asking for advice when I really didn't need to. I try to take a pretty balanced approach to life, accepting the "good enough" principle and refraining from placing unrealistic expectations on myself. But "good enough" never seems to fit with medicine. I can accept vulnerability and imperfection in other areas in my life, but medicine? There's no room for it. I think our patients and society echo this as well; after all, it's comforting to think that physicians are the ultimate authorities in health and it's disconcerting that we are inherently flawed humans. We are socialized and trained in this mindset as well. Of course, we must be conscientious physicians. I'm not talking about being sloppy or less than thorough. But, recognizing that we are human, even when we are conscientious, careful and keep our knowledge and skills up-to-date, we'll falter.

During this time, I came across an excellent article on the topic of Overcare, written by the late Dr. Lee Lipsenthal and adapted from his book "Finding Balance in a Medical Life". Overcare was a new concept for me, and a useful one. Dr. Lipsenthal talks about overcare as a chronic emotional state that physicians can get into, and it involves agonizing over decisions we have made, and at the core of it, wondering "Am I a good enough doctor?" There are several factors at play. Our personalities tend to be perfectionistic, and we do carry a lot of responsibility. He talks about our addiction to being needed and how the intermittent positive reinforcement we get from patients can lead to us doing more and more, hoping and waiting for the "reward" of a satisfied patient. The perfectionism expectation in medicine is often instilled into us during training, and also informs how we judge others; we in turn also fear being judged harshly by our colleagues. This is especially true for me as a family physician. Any time one of my patients is seen in the Emergency Room or by a specialist I've referred them to, my care will be under scrutiny. I find that Impostor Syndrome often tags along with this overcare and perfectionism. If your expectation is that a "perfect physician" is the default, yet you witness your inherently imperfect self, impostor syndrome can creep in.

How can we counter overcare? Personally, it helps to remind myself that I am competent and doing the best that I can. And that I am human. I try to consciously make a decision, and make peace with the inherent uncertainty. I ask myself a useful question from cognitive-behavioural therapy for anxiety: am I problem-solving, or worrying? If the latter, move on. Do I think about patients after hours or change my mind about decisions? Of course, but I have a better sense now of what qualifies as being conscientious, and what is actually overcare.

Do you struggle with overcare? Are there any strategies you've found helpful?

Monday, May 16, 2016

MiM Mail: RN considering medical school

Hi MiMs,

I would first like to say thank you for sharing your stories and your day-to-day experiences and challenges of being mothers and physicians. Your stories have been helpful to me as I consider making a change in career paths. I am 25 years old, unmarried, no children at this time. I work as an RN in an ICU in the south. Prior to becoming a nurse, I studied biology and psychology and then obtained my MSN to become a nurse. I'm considering returning to medical school and becoming a physician. One of the reasons for this is that I question whether I will live up to my potential academically by remaining a nurse, and I have a thirst for greater knowledge than what I currently have. On the flip side, I enjoy my work as a nurse, taking care of patients, leaving work at work when I come home, and having a flexible schedule that allows me free time to travel and have a life outside of work. My sister is married and is in her intern year of IM and most of the time seems miserable and can attest to the strain placed on a marriage by residency. Although I'm not to the point of motherhood currently, being a mother with multiple children is something to which I have always aspired. My concern is that if I become a physician I wouldn't have the time to spend raising children and taking care of them like I hope to. I would love to hear your thoughts on this. Thank you!

Sincerely,
Laura

Thursday, February 4, 2016

MiM Mail: Turning Back

Dear MiM,

I was first introduced to MiM 7 years ago when I was on the path to do a clinical psychology PhD and considering changing my career to medicine. A great mentor was trying to encourage me in both my dream to someday have a family (I was single at the time) and to practice medicine. Fast forward and I am sitting in a "How to make a Match rank list" meeting, fighting back tears.

The problem is, I'm not sure I want to Match. Don't get me wrong, I love medicine and I don't feel that anyone led me astray. I can see myself practicing (probably part-time) in the future and being able to love my work. I am not discouraged by the notion of having a family in medicine. I simply do not think I have three more years in me. For months, I've been interviewing and trying to envision how my life would fit into each residency program and I've become increasingly discouraged. I am envious of my friends with their 8-5 jobs that support their lifestyle and am disheartened by the concept of spending a lifetime trying to make my lifestyle fit my career. My partner - who still loves me dearly and who has patiently supported me through a post-baccalaureate program and four difficult years of medical school (and poverty) - has talked about us splitting because he does not believe he can survive three more years of bending to my schedule and being alone so much of the time. (As an aside, I do not blame him for considering this, and I ask that you do not blame him either.) Add to that, there are no programs where we currently live. We have just begun to fall in love with where we live, we have many non-medical friends, my partner has a fantastic job (that is not transferable), and our families are within a reasonable drive. When I started down this path, a partner and a family were merely figments of my imagination. Now, I am the worst half of a relationship, the partner who is never available to be spontaneous and when I am, is exhausted and out of shape. I am the person who is hindering my partner's career and tying him where I need to be. And, perhaps even worse, I owe him everything because I could not have made it thus far without him. Plus, I have some health issues that may impede my fertility, and the clock is quickly winding down to when the risks of pregnancy far outweigh the benefits. Add all that to $400k of debt and I feel terrible while all my classmates around me excitedly making their Match lists.

So do I pack it all in now, graduate with my MD and move on with my life, ashamed but being free of the struggle for balance in medicine? Or do I go through the Match, probably lose my life partner and simply cross my fingers and hope that a) I make it through with my mental health relatively intact and b) I can overcome my resentment and still enjoy medicine? This is such a sensitive topic that I am afraid to reveal my reservations to my mentors and I have valued the fantastic insight of the MiM community thus far. Thank you, in advance, for your support!

Sincerely,
Struggling with the Match

Thursday, January 14, 2016

The Three Mentors You Need

A lot has been written about mentorship. In medicine, we are often assigned mentors based on our clinical or research interests.  Sometimes we get guidance on how to cultivate these relationships, sometimes we don’t. 

In 2013, the author and expert on gender and workplace issues wrote a book called “Forget a Mentor, Find a Sponsor” where she argued that in the workplace we don’t need mentors who just give us advice but we need sponsors who will pull us up, get our names out, and have our backs. 
I whole-heartedly agree that everyone in medicine, especially working moms in medicine, need sponsors but I have also found that we need more than that.   Over the course of my career I have found that three mentorship groups make a huge difference in my career and my life. 

Here’s what I have:

1. A  Sponsorship Team

I spent some time last year formally identifying sponsors and now have a team of them.  This team includes people who traditionally fill the role of a mentor such as more senior faculty at my institution but also come from outside this traditional role.  For example, I identified someone who has a career path that I admire and contacted him.  In some settings, there is a formal process to meet with your sponsorship team as a group but often the meetings are one-on-one and casual.  The key component is knowing who your sponsors are so that you can cultivate long-term relationships.

2. Peer Mentors

I can’t overestimate the value of peer mentors.  A few years ago, a colleague and I started organizing monthly peer mentorship lunches where we discussed topics that were relevant to us.  It was a safe environment and a huge success. The format was informal: one person picked a topic and everyone chimed in. Topics ranged from delegating tasks to staff to negotiating better pay to saying "no" when you have too much on your plate. The connections I made from this group are amazing and very valuable to me professionally and personally.

3. Outsider Mentors

I have a group of family and friends who don’t practice medicine and aren’t in academics but know me as a person. I’ve often discussed career challenges with them.  For example, I have a group of college friends in different industries that gets together periodically to do life assessments.  I am so close to these women and value their opinions tremendously. They are the people to whom I turn to when I need a reality check from someone outside my industry or when I am thinking about change.  I find that the outside perspective helps me keep things in perspective.


That’s it! These are three (groups of) mentors who have helped me.  Keeping up with these groups may sound daunting but often the maintenance of these relationships can be weaved into your lives and often they bring tremendous value to your career.

Monday, August 17, 2015

MiM Mail: PCP to PM&R?

I am an older mom to a one and only, fabulous, wonderful little boy. I had a career in human services before medical school. I completed my internal med residency. I have worked as a PCP for about a year and, frankly, it's awful! I like my patients. I chose to work in an underserved area with a lot of folks who are newcomers to the United States and I really like this part of the work. I feel like all I do is tap on the computer instead of really dealing with the human being in the room with me.

I had never heard of PM&R in med school. The more I hear about it and read about it, the more I feel like it might be a good match for someone like me. (You know, someone who likes to talk to patients, take a history, do an actual physical exam, maybe have time to do a procedure....)

Does anyone have any suggestions about residency training? It doesn't sound like the PM+R residency would be that much worse than the schedule of an attending PCP. I am able to sacrifice salary due to a very type A doctor dad in the picture. (In that way, I am very, very lucky.)

Thanks!

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!)

Tuesday, June 23, 2015

Girls Don’t Cry

I have been following the response to Sir Tim Hunt’s incredibly sexist comments on women in science and thinking about how it relates to a working mother in medicine. If you haven’t heard of Tim Hunt, he is a Nobel prize winner who made headlines earlier this month for saying “…three things happen when [girls] are in the lab…You fall in love with then, they fall in love with you and when you criticize them, they cry” at a lunch for women journalists and scientists in Seoul.

Not surprisingly, the response has been overwhelming.  Some of my favorite tweets:


and…

and my all-time favorite…















But all joking aside, sexism still exists in science and medicine.  And as a working mom I’m very sensitive to issues of sexism, ambition, and differences between men and women.

This may be because I am constantly pulled in two directions (career versus family) and wonder if my ambition is ever questioned. On the one hand, I don’t want to draw attention to the fact that I am very much pulled in these two directions and must balance work and life.  But on the other hand, I do want to draw attention to this struggle to help support other women and help others understand decisions working moms need to make.

The fact is that I make very conscious decisions that incorporate both my work ambitions and my motherly ambitions. No, these decisions do not involve being distractingly sexy or crying in the lab but they do involve taking a slower and, sometimes, more convoluted paths.

I have rejected significantly higher leadership positions because they would squash my flexible schedule, I consciously avoid travel, and I am not willing to move my entire family for my career. To some of my male colleagues, these decisions may seem crazy, but, for me, these decisions are very calculated. 

I’m very conscious of burnout and hope to keep a level of balance that helps me work full time, find satisfaction in what I do, and keep me on an ongoing trajectory so that when I am no longer in the weeds of motherhood, I will still have interesting and meaningful career opportunities.

That being said, there are times when keeping the reins on my career is hard. I wonder whether I am being left in the dust when I see male colleagues make different choices and move up the ranks faster than me. And as a working mom, I never want to compromise other women by having my ambition questioned. 

But even with these doubts, I am incredibly proud of the difficult career decisions that I and every working mother have to make.  I know I will only have a short time with my kids at home and I want to cherish that time.  I’m sure there will be time in the future to turbo charge my career if I want.


In terms of Tim Hunt, I’m not sure if #distractinglysexy and #crybaby necessarily come up as issues for my career but ambition, choices, and timing certainly do. I think if we keep open dialogues and try to respect for each person’s decisions then I think we can push the conversation.  What do you think?

Monday, May 18, 2015

The Do-it-Again Equation

Cutter’s excellent post and the comments to follow really got me thinking. What factors go into our thoughts about whether we would do it again (become a doctor)? Can this change?

This is just my way of thinking about the question (one way of potentially many), but I think the simplified, general equation may look like this:

Outcome - Sacrifice    =    DiA
                    time

If DiA = positive, you would do it again. If negative, you would not.

And where Sacrifice = time, money, family relationships, moves, etc , thus far

Outcome = present level of satisfaction with career, may include work-life balance (or work*life product), income, career-related meaning, work-related aggravation

And time, because I do think time is a factor because time attenuates sacrifice/hardship. For instance, if you asked me whether I wanted to have another child while I was sleep-deprived and breastfeeding my newborn Q2 hours during those awesome early weeks of being a new mother, occasionally crying in the shower if I was fortunate to have a shower, my answer may not have been a resounding Absolutely! Not that I didn’t think my child was a magical gift, but wow. My pregnancy/labor/post-partum period were not easy. Fast forward a couple of years and that hardship didn’t seem quite as insurmountable relative to the outcome.  That was kind of a terrible analogy (along with math, not my forte), but I think in general, distance makes the heart grow fonder and the memories fuzzier.  Alternatively, maybe the Sacrifice was way too much and no time in the world would make that value small enough.

For me, my Sacrifice to become a doctor was relatively small and feels smaller with time. I met my husband during medical school. I was really fortunate to finish training with minimal debt, and besides being very tired and on-call during multiple holidays (Thanksgiving dinner with my co-residents in the physicians’ dining room; watching fireworks on July 4 through the 8th floor hospital windows), it wasn’t so bad. My Outcome, on the other hand, has increased over time. I now have more control over my schedule (compared to being junior staff right out of residency), higher income, more clinical knowledge, have engaged in new areas that keep me excited (teaching, research, mentorship, leadership) and after working with all different members of the healthcare team, value the role of physician as leader more than ever. Don't get me wrong- there are parts of my job that are the mental equivalents of how I imagine a root-canal would feel, but on the whole, my career is rewarding beyond what I could have imagined right after my pre-duty hours residency. My DiA started out positive from the start and only has grown more positive with time.

It goes without saying that this equation and its variables are individual, and there could be a fatal flaw that I have not considered in forming this equation. But, it’s not an easy path to take, no matter how you compute it.

Sunday, May 3, 2015

To be or not to be.....a generalist

Hello MiMers!

I'm nearing the end of my Family Medicine residency and am struggling with the age-old question: To be or not to be?....a generalist.

I've always loved the variety and scope of FM. To me, there is such great appeal of being a jack-of-all-trades kind of doctor. I love being the first point of care, collaborating with specialists, seeing new and unfamiliar problems, and flying by the seat of my pants. Growing up in Canada and being surrounded by a culture of Family Medicine has undoubtedly shaped my love for general practice.

That being said, after countless hours of studying, rotations, patient care, and hard work, I am sometimes weighed down by the questions, "What am I GOOD at? What's my area of EXPERTISE?" Sure, there are the things that I see everyday and feel pretty comfortable with: Diabetes, high blood pressure, back/shoulder/knee pain, asthma, preventive care to name a few. But this always comes with the knowledge that I'm not necessarily an EXPERT in those fields. Can I really be giving my patients the best care for their problems if I'm not an endocrinologist (diabetes)? orthopod (shoulder pain)? pulmonologist (asthma)? Could I give a thoughtful, professional-level lecture on any of those subjects?

I've been seduced many times during residency into doing a fellowship. At one point, I've seriously considered a fellowship in geriatrics, OB, EM, sports med, palliative care, dermatology and HIV/AIDS (to name a few). But I can never seem to commit myself to narrowing down to one subject. I find myself getting back to the same fear of getting pigeonholed into one area and losing my ability to be a generalist. It is quite a humorous mind-loop that I get into time and time again.

Ladies, lets discuss. What do you love about being a specialist? Or a generalist? I'd love to hear your thoughts.

Sincerely,
HulaMed

Monday, April 20, 2015

Hurtling toward the next phase


I have searched but I cannot find the flying trapeze story I read a few years ago that explains my life, so I’ll paraphrase and add to it here:

I swing back and forth preparing for my next take off. I have prepared, but I know that this leap is longer and more challenging than ever before. In spite of a long line of successful jumps, there have been some near-misses, some full on misses, some blood, scrapes and even some still healing deeper wounds. This time I jump, my husband is watching and waiting readying himself for his jump into dissertation land and as we prepare Zo waits by ready to take off with us.

Well MiM friends, it’s official, I have accepted a position as a Pediatrician in my dream clinic. I’ll be back in DC working at an academic center-affiliated community clinic. I did my community pediatrics rotation there as a medical student and so many of my respected supervisors and medical school friends are still there.

Interviews were a whirlwind. I met so many nice people, got lost countless times, learned even more about what I need, want, and will compromise on.  

And now onto school finding. Every day I have a mini-freak out when I think about Little Zo starting pre-k. Our cherubic toddler has been replaced by an almost 4 year old hilariously funny and extremely sweet rib-protruding knock-kneed ball of energy. And then I freak out more about making pick up and drop off work and I pray so intensely that we find the right environment for him and that we will find balance so I can rock my boards and O can finish his dissertation expeditiously. I wish I could transplant his daycare to DC.

And house hunting on a single income in a very tight housing market is not my favorite thing to do but I guess house hunting without the beloved Property Brothers will always be lackluster. We have several leads on promising houses and are heading up next weekend prepared to make an offer. Can’t wait to have our first home secured and then on to do-it-yourself projects for years to come.

This jump seems epic. Push-pull-push-pull, forward backward forward backward, take off.


Tuesday, March 10, 2015

Career poll: if you weren't a doctor, what would you be?

Since beginning my clinical rotations as a medical student, I have been exposed to so many interesting, dynamic jobs within health care that I never knew existed such as Recreational Therapy, Occupational/Physical Therapy, Respiratory Therapy, Doula, Midwife, Lactation Consultant, Clinical Social Worker, the list goes on and on.


As someone who regularly follows MiM guest posts and who talks to many premedical students, I always find it interesting that exposure to other fields in medicine is so lacking. There are so many different ways to become a health care provider and though Doctors are among the highest in the hierarchy, without a diverse group of providers we not only fail to provide the best service to our patients, but we often fail to address core issues that determine health outcomes. 

With that said, for the physicians around:
  • if you weren’t a doctor what medical professional would you be or would you choose a completely different field?


And for those in training:
  • what other careers in medicine have you researched, considered, or shadowed in? What did you think?


My answers:

  • If I hadn’t become a doctor, I would be a Recreational Therapist with a focus on alternative methods such as massage and reiki or a Doula/Health Coach/Life Coach/Interior Decorator
  • Prior to my training, I didn’t really spend time shadowing Nurse Practitioners or Physician Assistants but should have. I will be entering academic community pediatrics in an urban setting and the overwhelming majority of my mentors and folks whose careers inspire me are Pediatricians. However, if I was interested in more community or rural medicine, pursuing a career as a  Nurse Practitioner or Physician Assistant would have been a possible alternate route to providing primary care with much less debt and better work-life balance.

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.

Tuesday, February 17, 2015

MiM Mail: Missing life before kids

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

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

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

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

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

Monday, December 29, 2014

MiM Mail: Advice for non-traditional mom

Hello and thank you for your blog! I am wondering what advice you might give for a slightly older mom considering medicine after the baby-phase. My husband and I are both teachers at an international school and we are looking to transition to living back in the States near our families. I am considering applying for medical school for the fall of 2016 and have completed all the prereqs, taken the MCAT, and have all my letters of rec on file.

We have four children, ages 12, 10, 5, and 17 months. I would start medical school with my oldest beginning high school and my youngest being three years old. I am in my late thirties, and investing in a career in medicine would combine my pure love of science with a passion for extending the tremendous care-giving roles I have had over the years.

I have hesitated to go down this road because of the tremendous financial investment as well as the time required, but I have loved my various experiences in health care throughout my career up to this point. I would love any personal advice on whether this path is worth it!

Thanks,
Sara

Wednesday, December 10, 2014

I Don't Know How To Dress Myself

And I know I'm not the only one...

I was thrilled to see a physician-mom address this in the Atlantic: The Clothes Make The Doctor, by Anna Reisman. In this thoughtful and humorous piece, she describes how she met with a potential new primary care doc, and was put off by the sharp-dressed woman's stiletto heels and expensive suit. She then explores how physicians should ideally dress, and thus, present themselves.

She hit on a perennial topic of discussion and debate amongst my colleagues, both male and female. Male colleagues bemoan that they are expected to wear a collared dress shirt and tie, day in and day out. But female colleagues complain that they have no real "dress code", and thus, no guidance, on how to dress for patient care.

In my office, which is an all-female practice, the "work uniform" runs the gamut from: clean and pressed white coat over smart dress suits and heels, to dress suits and sensible shoes without the white coat, to business-casual with or without the white coat, and then, to me.

I'm usually in whatever Bargain Basement Clearance Store pants with less-dirty knit top and scuffed sensible shoes I can match when I get dressed in the dark at 5:30 a.m, with a reasonably clean white coat pulled over it all, like a disguise. I can't remember the last time I ironed anything; I think it stretches back a decade or more. I buy all permanent press or knit clothing. If something needs to be dry-cleaned, it's a once-a-year piece. Sweaters, slacks, scarves- they all must go into the washer and dryer, or be relegated forever to the back of the closet. This all is, I feel, most practical. Who has time to fuss over clothes?

I also LOVE a bargain. And while there are women who can browse Nordstrom Rack or Marshall's or TJ Maxx and put together respectable, even snazzy, professional outfits, I am not one of them.

Still, I can't let go of my old habits. In medical school, we had an informal group of women about the same size who met occasionally to "swap": everyone brought a bag of clothes they didn't want, all higher-quality stuff, and we had a party as we tried on each other's stuff. Everyone left with a "new" item, and the leftovers went to charity. If someone I knew suggested this today, I would so totally be there!

I even found my wedding dress, a 100% silk designer ball gown with an impressive train, for $250.00 at the Filene's Basement Run Of The Brides Traveling Sale, back in 2008. I considered it the find of the century, a total coup, and I told anyone who seemed like they cared how much I had spent.

I still have had no qualms with rooting through school fundraising secondhand clothing sales, and leaving with large bags of the clothes of people who are probably my neighbors.

I think some of my reticence on spending money on clothes stems from the fact that I've gone up and down ten sizes within the last five years. Yes, there were two pregnancies in there, but the ballooning waistline was not due to gravidity. It was due to the fact that I gained an unbelievable amount of weight with each pregnancy, on the order of sixty pounds, EACH TIME. Three months after my second baby, my daughter, was born, I realized that I had even GAINED weight while breastfeeding. My BMI was over 30. I was OBESE.

Then, with a two-year-long concerted effort at a low-carb diet and exercise when I could get it in, I lost fifty pounds. Babygirl is now almost three years old, and I've kept the weight off for almost a year.

Despite being back to my pre-pregnancy weight and size for this long, my closet is still filled with a mishmosh of sizes, and alot of "more comfortable" pieces, like Ponte slacks (read: knit pants). A friend and colleague recently pointed out to me, in a humorous way, that Ponte slacks are in the same category as yoga pants. Meaning, not acceptable work attire.

Unfortunately, in order to dress well, one needs two things: Time, and Style sense.

I know I will never have the time or inclination to study fashion magazines or follow style blogs. And for some reason, when I see someone who I think is dressed really well, meaning, how I'd LIKE to dress, I can't seem to replicate their look (probably because of my clothing care learning disability.)

But, I still want to look like a real, respectable, clean, practical yet SOMEWHAT stylish physician. Someone who is aware that it's almost 2015, but who is also willing to kneel down on the exam room floor to look at a patient's diabetic foot ulcer.

I know, I know. Time to grow up, learn how to iron, make the dry cleaners a regular weekly errand.

I also need a personal shopper. I have seen this mentioned on prior MiM posts (that I cannot locate right now), and people have suggested Macy's, as they offer those services free of charge. Of course, to take advantage of that requires several things: Making an appointment, taking some time, and investing in attire.

Sigh. With two children under age five, a working husband who travels alot, and boards study on the agenda every day, these things are not likely to happen anytime soon.

Tomorrow will dawn, and I will likely be pulling on a wool blend turtleneck, my black slacks with a little elastic in the waist, and Danskos.

But I will be comfy...

-Genmedmom

Thursday, December 4, 2014

MiM Mail: Anesthesiology or psychiatry?

Hi everyone!

As many others have shared, MiM has been such a valuable resource to me since embarking on the path to a career in medicine. Now, I have a more direct question for you all. I have been considering specialties, and while I still have plenty of time to decide, the pressure to make arrangements for research this summer and beyond is weighing on me, especially because I'm interested in two very different fields for obviously different reasons: anesthesiology and psychiatry. 

Anyway, some background first… I am a first year medical student and my partner is a fourth year, currently interviewing for residency. He is pursuing ENT and has mentioned interest in the possibility of pursuing a head and neck fellowship eventually… We have no children yet but starting a family is a huge priority and we both envision a timeline within the next 5 years (i.e., during medical school or residency for me). 

Because family life is extremely important to both of us, and it’s already becoming clear to me that his field will be a lot less flexible in this regard, I’m seeking any advice on deciding between the two specialties above. I know that balancing family life in a two-physician family is going to be extremely difficult regardless and so I am willing to make some career decisions to account for that. It seems that both anesthesiology and psychiatry can make for good lifestyles eventually (though with drastically different levels of compensation) but is there more I should know? Are the residencies drastically different? Is the difference in salaries going to be too stark if pursuing manageable hours (or even “part time”)? I know both can be flexible, but are those lower hour positions more realistic in one field? Anything else I’m missing?

I should also note that because we’re both from, and hope to remain in, a relatively undesirable area near what is considered a highly underserved area, I would seriously consider the NHSC scholarship if I chose to pursue psychiatry. I could also earn an MPH in one year at no cost through my medical school’s MD-MPH program which is something I have also considered (my pre-medical school studies were based in the social sciences).

Thanks so much!

T