Wednesday, October 09, 2013

on being in charge

the readership of this blog is quite diverse, probably because i'm all over the place as a writer [and maybe sometimes as a person :) ].  but i know that at least a handful of you are either in medical training or have jobs in the medical field.  i've been asked a few times to write about what it's like now, having finally 'graduated' to a real job after a mere 11 years of post-college training.

[yes, 11, and all at duke*.  these included:

☑      5 years of medical school rather than the traditional 4, because i had originally planned on becoming an MD/PhD**

☑      3 years of general pediatrics residency

☑      3 years of pediatric endocrinology fellowship]

i want to write about this, not just because i've been asked, but because i feel like sometimes other blogs tend to dwell on the darker side of attending life:  time constraints.  having to do mountains of paperwork [electronic or otherwise].  residency-like hours.  and surprisingly, even continued financial woes: michelle au recently commented on having to track down a pair of lightly used clarks shoes on ebay because the $100 retail cost for a new pair was "you know, over my budget."***

i want to bring just a bit of hope to those of you still in training:  i may be an anomaly, but for me, every step of medical training has been better than the last.

medical school:  fun because of the comeraderie, but miserable at other times because HELLO you are a med student and no one takes you seriously even though you feel you know a lot and are working VERY HARD.  and it's all hard, because, if you're like me, you spend months doing things you aren't excited about because 5 minutes into your surgical rotation you decided that you never wanted to set foot into an OR again unless you badly needed surgery yourself.  hard because of the tests [soooooo many tests] and pressure to succeed in order to get on the career path you want.  and even hard at the end, because particularly in a couples situation the match feels far beyond your control.

residency:  better in some ways, though residency contains the worst lifestyle of the phases, particularly during ward and ICU months. honestly, if it weren't for the sleep deprivation, residency wouldn't be bad!  [except the thing is that the sleep deprivation is MAJOR, and therefore not to be discounted].  the exciting part about residency is that you begin to enjoy the fun part about medicine:  having a special skill set that can actually help people!  you get to think through problems, and at least some of the time carry out your own solutions.  you get to work closely with a group of people with goals similar to yours, and that can be a lot of fun****.  also, you start getting paid for your hard work, even if the hourly rate is a pittance.  it's probably very difficult to stretch residents' salaries in places like NYC, but in NC -- it was fine.  even easy, especially when we were a childless couple without day care or diapers to pay for.

fellowship:  10 steps up, at least for me.  this meant getting to do work i actually really LOVED and felt well-suited for a majority of the time -- well, at least while i wasn't in the lab.  i was finally studying things that felt relevant to my final career.  i became part of a [wonderful, nurturing] department that i truly got to know well, as i knew i'd be with them for 3 years.  there is still PLENTY of busywork, but you do get to start farming out some of it to office staff and [sorry] residents and med students.  and -- megabonus for me -- NO MORE OVERNIGHT CALL.  now, that isn't the case with many subspecialties, but if you are someone who hates staying up all night then it makes sense to choose a career path that addresses that, right?  i did -- though of course i had many other reasons for choosing the specialty i did -- and will never, ever regret it.  taking phone calls from the comfort of my bed >>> in house night shifts [or 30 hours shifts].  the end.

practicing physician: of course, i can't generalize, particularly for this category.  i only know my situation.  i am employed in a community hospital as one of a group, rather than a major academic setting or private solo practice.  thus far, my experience has only exceeded my expectations.  for one, i get to do what i love - work with families and kids with endocrine problems - all day.  even as a med student, i had an inkling that this was what i was destined for, and it's been almost magical to see it come to fruition.  since there are so many different and diverse subspecialties, i think a lot of others must feel the same way -- like, "ahhhhh, i fit in this niche i have found for myself."  it's a great feeling. 

secondly, i get to apply what i have learned over the past 11 years [hopefully, a lot] and carry out my own decisions.  i of course take into account the recommendations of others, but ultimately, with my patients [both outpatients and when i am on call], the buck stops with me on any endocrine issues.  this is slightly terrifying at times, but mostly incredibly gratifying and much more peaceful than having to change my practice based on which attending i was working with [any fellow or resident knows what i'm talking about!].  and as i mentioned previously, when i am unsure of what to do, i am very lucky to have experienced colleagues in the same office to poll about how they would proceed, and there are very few split-second decisions [if any] that have to be made in my field.  

finally, the hours and $$$ are better.  i am on call 25% of the time, which is not nothing, but it's not horrible, either.  3 weekends off out of 4 = amazing, in my [perhaps skewed] view!  on non-call weeks, my work hours are 8 - 5 with a 35+ minute commute each way, so i do have significant time away from home, but most days i can leave close to on time.  i haven't had to bring terribly much work home yet, but that may change as my patient load changes.  but even if i have to do notes at 8pm i can deal with that.  especially now that i am not attempting to cook and clean up every night . . .

i realize that my situation is probably much cushier than some other practicing physicians.  but i don't think it's outlandishly outside-of-the-norm, either.  josh's schedule, for example, continues to be pretty brutal and at times isn't much better than his hours in fellowship.  but there are still more weekends off than he used to have, and i can tell that overall he loves what he is doing. 

in summary:  can i say it was worth it?  would i do it again?  from this standpoint -- today -- i think i would say YES.  the tough years made me who i am today, and taught me a lot about who i am, what i need, and the world.  i do not dread mondays the way i see that others sometimes do on facebook, and i feel like i have reasonable work-life balance.  i do wonder if perhaps i will regret not having more time with annabel and little tbd, and so i aim to reassess my situation regularly to make sure i am doing things the way i want to and not just working full-time on autopilot or because of convention.  but for now, i like my new work life quite a lot and feel good about how things are.

questions?  comments? 

* omg, josh and i nearly died when they took a stab at duke last week on the mindy project.  anyone else obsessed with the humor on that show?  i may have also cried at the end of the episode, but that's another story.

** the absolute wrong choice for me, but i was 21 when i made it, so we'll forgive little SHU

*** michelle is an anesthesiologist and her husband is an oculoplastic surgeon.  i love her writing and much of what she has to say on other topics, but really . . . you do the math.  maybe she was going for some sort of irony but i didn't get it!

**** it helps that i was in pediatrics, a field that tends to attract genuinely nice people.  i loved my class of residents!!

ps: wish i had good pics from all 4 eras to illustrate, but i'm lazy.  so, a rare photoless post!  you get a million asterisks instead.