Friday, September 30, 2011

Practicing Medicine Part-Time

Advice for Mothers in Medicine:  Consider Part Time Practice

I have worked part time since I started working as a family physician in 2001.  I was fortunate to have a husband who was on board with this idea, as we planned our family and tried to decide how we wanted to raise our children.  

But after grueling work hours in residency, this can be a daunting idea for many female physician starting practice, especially if you have not yet started your family.  We are used to 100+ hour work weeks, putting our personal lives second to those of our patients.  This all changes once your own darling baby looks up into your eyes, silently saying, "I'm here!  Mommy, you don't need THEM, you have ME!".  And for the most part this is true, but we are doctors, this is what we do.  It's engrained, we will somehow find a way to be there for everyone, to do it all.  And this is how it starts.  

It's an impossible task, really, but slightly more manageable if you work part time.  That is I think the best way to put it.  Especially for those of us who have multiple children, our lives grow, our children grow.  Eventually something has to give if you want to be the best you can be.  I used to think the early days were hardest, juggling maternity leave, pumping breast milk in empty patient rooms on lunch breaks, going to work with an infusion of caffeine with the same adrenaline rush that used to keep me going on a post-call shift.  Now that I have school-aged children, I am surprised to discover how much more my daughters need me, and how much more I need time for myself.  There would be no hope of any of this if I worked full time.

Part time medicine has many obstacles, however, many of which are perpetuated by the myth that we are not "real doctors" if we don't work 6 days a week.  Malpractice coverage is more difficult to navigate, and it's important to be clear from the start how many hours a week you will work and how available you will be for issues when you are off.  Some fields of medicine are more "family friendly", but I have still encountered many types of discrimination due to the fact that when I am off, I want to be OFF.  This does not mean I am not a doctor when I am not at work, I am just not YOUR doctor.  No, I don't want to stop by after the kids are at school to listen to my neighbor's lungs.  I want to do my errands and go for a run.  This is the type of problem that as women, mothers, and physicians we face.  One thing I have learned is that in the work life balance, even with ourselves, mothers in medicine need to set boundaries.  

Setting my boundaries to work part time has helped me to be more available for my children, my husband, and as a result I believe that I am a better, more focused doctor when I am at work.

A Jew in Idaho

L'Shana Tovah.  We just celebrated our first Rosh Hashana in Idaho.  One of my favorite times of the year, often a time of reflection, peace and family.  I enjoy the food, friends and sense of community that the High Holy Days bring.  I was naturally looking quite forward to experiencing this in our new environment, away from the hustle and bustle of the east coast.  The weather is warmer, we are happier.

We dressed up as usual to attend services at the local synagogue.  And it was... a bit disappointing.  I expected the crowds of Jews that this occasion usually draws- Jews who are observant, not observant, or simply "cultural"- usually everyone usually manages to bring themselves together for a time where bonding with people whose origins and history unite them, making the High Holidays the glue that bonds even the most detached Jewish families together.   It's the kind of thing we complain about having to sit through, but once the rabbi starts singing and the congregation comes alive, I think it brings about the sense of community that so many of us are lacking.

At least that's what I was expecting.  What we found was that most of the children had gone to school that day, and most of the parents of young children were likely at work, business as usual, until perhaps sharing a meal that evening with friends.  This is in fact the first year we have HAD to take our kids out of school to celebrate the Jewish Holidays, as in New York, there was a school holiday to facilitate observance.  The social hall of the synagogue was only partially filled, the empty seats to me a reminder of the fact that so many Jews have perhaps lost that sense of community and belonging that goes along with living on the east coast.

My kids will have that, if it kills me.  I am not particularly religious, and believe me, my husband would rather be tackling the 300 emails piled up at work than sitting in services.  But we were there, we took the time out of our busy lives to slow down and think about what really matters in life:  our children and each other.  For this, I am grateful.  

Happy New Year!

Wednesday, September 21, 2011

The Unfriend

I want to Unfriend you.  As in the popular song my daughters love, sung by that little boy (he looks quite young, don't you think?).

Not everyone, just some of you.  Let me clarify.  Being a physician and a mother is a very tricky job.  I think most people are aware of this.  I think my problem stems from the fact that I work part-time.  The reason I work part time is so that can raise my children and I don't have to pay a nanny to do ALL of the little stuff in between.  Just some of the stuff.

I have worked part time since I started practicing medicine about 10 years ago, right after my first daughter was born.  I am lucky enough to have a husband who is also a physician, and we decided together that this is the way things would be.  He would work full time, I would work part time as a physician, and the REST of the time as a mom.  For the most part, it works.

In residency I had no friends, aside from my wonderful husband and few female colleagues.  They went off to practice medicine in different places, I went off to have a baby and then start working part time in Family Practice.  Along the way I have accumulated several mom friends.  Unfortunately, a few Unfriends as well.

I consider myself a fairly likable person.  I say this because most people like me and I genuinely like people, a common theme among family physcians, or I would think you would lose your mind.  People usually end up wanting to spend more time with me than I have to offer, but I have come to accept this and it usually works out just fine.

So let me just say for the record, that just because I am a warm and friendly person, and you know me in my Mom Life, not my Doctor Life, this does not give you free reign to ask for medical advice.  I have never minded the casual, "Hey, what the hell is that thing on my kid's leg... ok, thanks".  And if there is a true life threatening emergency, OF COURSE I would be happy to help.  The truth is, most things are NOT the emergency that people think they are.  I actually had one Unfriend years ago diagnose herself with hypoglycemia, purchase a glucometer, and proceed to call me with every blood sugar she considered to be a concern.  Multiple times a day.

House calls can be a tricky thing to document, and it's not good for anyone involved to ask a doctor to throw out an opinion without getting some history and or exam.  Plus, I work part time so that I can be with my kids and take time for myself, not so that I can be available to the rest of the world to examine your kid every time she moves the wrong way.

Just in case anyone were to get the wrong idea, I love what I do and I love to help people.  Perhaps I exude this in every interpersonal encounter I have, which is why I can't seem to make people stop putting me in this position.  My goal will be to find a way to gracefully decline, but in the meantime, keep in mind I will simply have to Unfriend you.

Goal Setting

Now that I have embarked on my new blogging career (at least in my own mind), I have decided to make a few goals.  These goals encompass blogging, life, medicine and everything in between.

1.  Write for at least 10 minutes a day.
2.  Do yoga at least once a week.
3.  Read one medicine-related article or piece of information daily.
4.  Laugh with my kids.
5.  Read a novel for at least 30 minutes at night, or until I fall asleep and the book smashes down onto my face.
6.  Really listen to my husband as he talks about his day, making an honest attempt not to think about the 25 million things I still need to do before I can lie down and let a book fall on my face.

I highly recommend all of the above.  I will be reporting back on my success!

Digoxin and Atrial Fibrillation

For some reason, I still see many patients with atrial fibrillation on digoxin.  I don't know if this is because they haven't been in to see their doctors in a while, or if no one is checking their medication lists to update them.  Granted I am still working an urgent care capacity, so not many of my patients are even asking for my opinion on their heart medication when I suture their laceration.  However, I have never been one to refrain from giving my opinion when I feel it is useful.  (Even when not useful I prefer to opine, but that's a story for another day.)

I would like to site an article from American Family Physician from August 15, 2006.
Although outdated, much of its content is still applicable to practice in outpatient setting.

Tuesday, September 20, 2011

Back to Family Practice

Life in the world of medicine is always changing, so is the busy life of a doctor.  Urgent Care was nice while it lasted, but I believe shiftwork is not really conducive to a balance home life.  Or my sanity. 

Today is a perfect example.  At work, seeing patients from 8a-8p.  I'm on my second day in a row, but technically more if you count all the work I do before I GET to work and after I get home.  I'm a bit frazzled as my husband is out of town, kudos to single moms out there.  Anyway, I called home after the sitter picked the kids at the bus. 

Me:  Hi there, sweetie, how was your day?

My oldest sweetie:  All the other parents were there to see our science projects.  Everyone except you.  And my solar oven didn't even work.  Everyone else's worked, mine didn't.

Mommy Guilt:  I'm sorry, honey.  Why don't you have a peanut butter cookie?

And  so on and so forth.  The benefits of an appointment-based practice for working mothers is manyfold, first of all being able to schedule time off to go the science fair.

I do think that this balance and associated guilt makes us better doctors.  We understand the stress that patients go through, and are able to communicate more empathetically.  And in the end, hopefully it will make us more well-rounded parents, able to guide our children with the wisdom gained from negotiating a balance in life, no matter how precarious it seems at times.