Thursday, September 20, 2012

Anguish. Choosing a medical specialty is difficult, Part II

The following was recently posted by an anonymous woman as a comment on a blog post I wrote about the difficulty one has in choosing a medical specialty. I was so taken with it that I wanted to give it more exposure. [Note: The comment contained a few typos which I have corrected. Otherwise it is unchanged.] My response has been amplified slightly.

Since you are so senior to me, let me ask you for your thoughts. I got into medical school, studied, worked hard, got into residency and learnt, spent hours and hours in hospital, loved critical care and got into fellowship. Along the way met a guy (both were residents at that time), fell in love and we both dreamt and read and learnt and discussed cases. He decided on cardiology and I decided on critical care. Both got into fellowships ....worked hard, spent long hours into fellowship...we were committed. We ARE committed but divided.... We had kids and now every day I feel divided. I have a feeling that all "old timers " like you who worked for longer hours and did frequent night calls, had " spouse" who take care of your kids and you did not have to worry as much. Times were different. Times were not so dangerous and kids’ safety outside of the house was not so concerning.

In my situation, my spouse and I are both physicians in fields that require us to spend lots and lots of hours in hospital. If I were to find a traditional practice and work every 3rd night, who will raise my kids? Who will teach them right from wrong? Everything is on rise–drug abuse, physical abuse, drop-out rates. I WANT to raise my kids and be there to guide them. So yes I want a practice where call frequency is lesser, where I can spend evening with my kids (not because I want to have fun but I want to be there).

We do not think about all this when we get into medical school and I did not think about this when I married my husband and we did not think about this when we chose our subspecialities. Perhaps that was a mistake.

It was easier for us. There were far fewer women in medical school. My class of 180 had only 20 women in it. Our chances of marrying another doctor were much lower, especially since same sex marriage was not in vogue back then. I was fortunate to have married a woman who is both a nurse and a saint. She took 13 years off from work to raise the children.

Have you thought about joining a group and working part-time, maybe with shorter hours and fewer nights on call?

I was touched by your palpable internal turmoil. My heart goes out to you. I hope you can find the balance you seek. Your last paragraph sums it up. Everyone in medical school should read it.


Korhomme said...

I graduated 40 years ago, in UK. There were 10 girls in a class of 90 or so. In those days the only girls we met were either doctors or nurses. I met my wife when I worked abroad, in Europe; she was a doctor, took 10 years out of her career to raise kids, and then returned to work. Alas, she returned to her home country to work; I had the kids (and the occasional au pair). You can guess what happened...

There is no easy answer to your situation. Today, in the UK, at least half the graduates are girls, and I think I see a trend for them to go into service specialities, or ones where the on-call is limited or non-existant. They can easily work as GPs or, say, in dermatology. Working in more demanding specialities is very difficult.

I can only suggest that you work fewer hours, perhaps job-sharing; enough hours so that you don't get de-skilled, but not so many that your kids suffer from your absence. And try to correlate your on-call with your husband's -- not easy, I'm sure. In your next life, perhaps you could choose a different speciality. I know of one girl who trained as an ENT surgeon, but now seems to be a staff grade, doing minor ops. She also is a writer -- search for Gabriel Weston.

What is your main priority, the work or the kids? Choose, then perhaps what you should do will be easier. Good luck.

ADS2015 said...

What are the options? I am trying not to make that same mistake. What if I don't blow the boards out of the water can't choose a "lifestyle" specialty? Is joining a group the only choice I have??

Anonymous said...

Oh, I do work. I started out working full time and then changed. I currently work M- F. But do clinic only till 2- 30 pm. Day starts anywhere b/w 8 30 to 9 30 depending on the number of patients I have in the hospital to be seen before clinic. However, I told my group that i can not do weekday calls ( the call day and post call day , we were having to get random babysitters to take care of kids at odd times- and that's want I expressed in my last post- we just diddnt feel safe about that and didn't think our kids can be raised like this without us being present and gone for sommuch time). In return, I do more weekend calls (1.5 out of 4).

Despite this, my senior partners , " old timers" often express that they are " more committed" " work longer hours and do more frequent night calls" and " my generation" is not that committed. It makes me feel divided and I do know that the quantity of my commitment as has decreased - but it's not because I am lazy, not because I want a better lifestyle, not because I want more free time. But because , I want to be there for my kids.

Sorry for the typos. That previous post was written while I was walking over to clinic from hospital.

Skeptical Scalpel said...

Thanks for the great comments.

Korhomme, thanks for telling your story. Interesting that you had the same ratio of males to females that I did.

ADS2015, I wish I had the answer for you. I hope other commenters join the discussion.

Anonymous, I was hoping you would see this post. I appreciate your sharing your frustrations and misgivings. I think it will help others to know that they are not the only ones going through this.

Kiwi Doctor said...

A very good blog post, I am currently doing training in anaesthesia.
I have just passed my anaesthetic primary exam while my wife (whom is on maternity leave and is also a Doctor) raised our child, now 16 months old, who can say shoes, cat, dog, mama but not poppa or dada. I can empathize with how she must feel.

My advice as I live in New Zealand is if you can afford it is to move countries. The current hospital where I work 4 of the obstetricians and 2 of the orthopods, plus one or two physicians are american, they mainly moved for the lifestyle.

In general on a weekend most consultants are in the hospital for a couple of hours, if you are medical the time to do a ward round. Rarely do medical consultants come in an night unless it is something that medical resident/registrar can't handle, if that is the case they usually end up under the care of ICU and anaesthesia becoming my problem.

In larger public hospitals than the one I currently work in night call and weekend call can be anywhere from 1:5 to 1:8 with some hospitals also having rotating months of non-ward time (with no call).

The downside is that the pay is probably significantly less than you currently make. Although working in private is a possibility in bigger cities.
Australia is similar, but the pay is better.

Skeptical Scalpel said...

Kiwi, thanks for commenting. Interesting to hear what it's like in NZ. What if you work in a hospital with no registrars or residents?

Anonymous said...

As a critical care nurse, I know that there are some hospitals where there are full time intensivisits who work 12-hour shifts without parallel office (clinic) hours. They do not have to maintain a pulmonology or surgical specialty practice as well as managing the ICUs. They have overlapping coverage with an NP/PA so that for part of the day, there are two intensivists. I believe that with this kind of predictability, it is easier to manage home life.

Of course, this involves finding a hospital/ practice that will allow this kind of scheduling. You would be employed by the hospital or by an intensivist group, and contract with the hospital, much like anesthesia practices do.

I chose to work overnights when my kids were in school so I would at least be there during the day when they got home and I was available (if not completely awake) to attend some school functions, go to MD appts, etc. We also used au pairs and babysitters and we were lucky to find young women who were responsible and who truly loved our girls (with one memorable exception).

It is never easy and I 'feel your pain.' I always felt equally committed to being a wife, a mother, and a critical care RN, but in practice, you always feel like something is suffering. One thing you can count on is that the children will not be little forever. I wish you luck and success. Tricia

Skeptical Scalpel said...

Great comment. I agree with you. In retrospect, they grow up in the blink of an eye.

Kiwi Doctor said...

The only hospitals that do not employ residents/registrars are private hospitals which are mainly restricted to elective surgical work such as scopes, joint replacements, hernia repairs etc..usually in healthy patients, with the public system taking complex cases.

In the larger cities they would do CABGs etc.. However most serious complications (i.e. requiring ICU) from such private hospitals are transferred to the public system.

Skeptical Scalpel said...

Thanks for the clarification. That is not so here in the US. Most hospitals do not have house staff.

Post a Comment

Note: Only a member of this blog may post a comment.