Can you be a surgeon if put your family life first?

[ArrogantSurgeon]

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Is it possible to be a surgeon at an academic center if you want to put your family ahead of your career?

I know that my wife and kids will always come ahead of my career aspirations and was wondering if this is conducive to a career in academic surgery (with emphasis on research). I've seen many attending surgeons with poor family lives or who are divorced, and I do not want my wife and kids to take a back seat because daddy was too busy being Mr Big-Shot Surgeon. I must say that one reason I'm going into research (aside from the fact that I enjoy research) is so that I can possibly have more time with my family.

I realize it can get tough during residency, but I was wondering more about ways to tailor an academic career so that you have maximal time with your family once you become an attending. My hope is to not work more than 50-60 hours per week once I become an attending.

 

[womansurg]

Two of my senior level colleagues are looking as though they are going to be going through divorces, and I am in a quite benign program, by nearly every standard. My resident friends who have graduated all tell me that it only gets more difficult at the staff level.

I know my husband is a self sacrificing saint and that is largely why he has stuck around through my training. I sure wouldn't want to be married to a surgeon.

 

[Apollyon]

Originally posted by womansurg
My resident friends who have graduated all tell me that it only gets more difficult at the staff level.

Is that in academic programs, private practice, or both?

Family time (if I ever meet a woman that will go out with me) is one of the big reasons why I'm in EM.

 

[womansurg]

Originally posted by Apollyon
Is that in academic programs, private practice, or both?

Both actually. My impression is that academic surgeons are putting in the longer hours. Don't have anything to back that up other than my own experiences.

 

[Foxxy Cleopatra]

pba-

That is a good and interesting point. Though the divorce rate seems high in surgery (and medicine in general) it also is in the regular population.

I figure that when in private practice, you will still have rigorous days and be taking call. However, I'm all about hiring help with cleaning/chores/other unpleasantries so that your free time can be spent doing enjoyable things.

But then again, this is coming from someone who will just be starting internship that doesn't want to have kids. I'm going on the hope that if I find a man that I really want to be with, maybe it can work if I make the most of the time I do have off. Lord, I hope there are some interesting single men in my new city!
😉


To the OP-

Would you consider private practice (either general or something after a fellowship)? Though I'm not experienced enough to say what it is like on a day-to-day basis, I felt that what I saw as a 4th year when I met some private practice surgeons was much different from my 3rd year experiences with attendings in an academic center. I actually really enjoyed what I perceived private practice had to offer- it was not at all what I expected. I think (if your schedule allows) that is worth the time to check out during 4th year.

 

[surg]

doesn't directly answer the question, but here is a citation:
Medical Specialty and the Incidence of Divorce
Rollman B. L., Mead L. A., Wang N.-Y., Klag M. J.
Extract | Full Text
N Engl J Med 1997; 336:800-803, Mar 13, 1997

Key items:
Study Population:
The Johns Hopkins Precursors Study is a longitudinal cohort study of 1337 persons who entered the Johns Hopkins University School of Medicine from 1944 through 1960.5 Our analysis was confined to the 1248 persons who graduated. Marital information was available for 1222 (98 percent) of these graduates, of whom 1164 (95 percent) ever married; of those, 46 were excluded because of missing dates of marriage or divorce, leaving 1118 physicians for analysis.

Key finding:
The choice of specialty was significantly associated (P<0.001) with the risk of divorce (Figure 1 and Table 2). The cumulative incidence of divorce was highest for psychiatrists (50 percent), followed by surgeons (33 percent) and "other" physicians (31 percent). Among internists, pediatricians, and pathologists, the incidence of divorce was similar (22 to 24 percent).

Multivariate analysis showed an odds ratio for surgeons of 1.7 (1.2-2.4 95% confidence) as compared to internists (Psych was 2.7!)

 

[ArrogantSurgeon]

Thanks for the replies everybody...and thanks for the NEJM article surg.

From the looks of it, it seems as if it is difficult to have a very fulfilling family life as an academic surgeon. I'll have to investigate further the option of working strictly on a part-time or at most 3/4-time basis after I finish residency.

 

[md03]

I wonder how that statistic breaks down for those married prior to becoming a surgeon vs those married after starting surgery training?

My thinking is that if you are married before you start residency, the lifestyle for residency and beyond represents a significant change from baseline. Howeve, if you get married after you are a resident your future spouse would be more likely to be willing to adapt to the lifestyle as he/she would know what he/she was getting into at the start.

Interesting statistic for psychiatry...guess it's hard to turn off the psychoanalysis at home!

 

[ArrogantSurgeon]

Originally posted by md03
I wonder how that statistic breaks down for those married prior to becoming a surgeon vs those married after starting surgery training?

My thinking is that if you are married before you start residency, the lifestyle for residency and beyond represents a significant change from baseline. Howeve, if you get married after you are a resident your future spouse would be more likely to be willing to adapt to the lifestyle as he/she would know what he/she was getting into at the start.

Interesting statistic for psychiatry...guess it's hard to turn off the psychoanalysis at home!

Good point.

I always thought psych was one of those specialties that gave you a lot more free time to be home with the family. I guess there is more to family dynamics than just having more time to spend with them. I wonder what could explain the 50% divorce rate for psychiatrists? Maybe too few psychiatrists were sampled😕

 

[womansurg]

I think (trying to be tactful here, and keep in mind, I am the daughter of a psychologist...) the high divorce rate among psychiatrists reflects the kind of person who is interested and goes into the mental health professions, not the demands of the job.

High functioning, emotionally healthy people typically find interacting with emotionally damaged people to be frustrating, limited and not very interesting. Usually folks who are inspired to work in mental health find it interesting work, in part, because of the process of having to deal with their own personal demons.

My opinion, nothing else.

 

[surg]

By popular demand: the multivariate analysis

relative risk
Practice Specialty p<0.001
IM n=311 1.0
Path n=52 1.1
Peds n=84 0.9
Psych n=65 2.7
Surg n=328 1.7
Other n=67 2.2

Marriage before grad n=463 1.6 p=0.003
Less close to parents n=227 1.4 p=0.04
Death of parent before grad n=94 0.6 p=0.04
Anger score top quartile n=102 1.8 p=0.004
Year of 1st marriage p=0.002
before 1953 n=232 1.0
1953-1957 n=272 1.5
1958-1962 n=250 1.9
after 1962 n=153 2.3

Female sex and AOA member were not significant in the multivariate analysis but were significant in a univariate analysis for higher divorce rates.

 

[Winged Scapula]

Short answer...sure. Will it be easy? No.

Life is what you make it, and lots of other platitudes. I suspect that marriages BEFORE residency find more trouble during and after than those that occur with some sort of knowledge of the road ahead by the non-surgeon/physician spouse. Just my thoughts on the matter.

I'm not so sure that giving up your dream is in the best interests of you or your family. Perhaps you could be happy doing something else - but would you grow to resent the family that "made" you do this? No one knows, nor could anyone...at least not until you have the benefit of hindsight.

There are options which would require fewer hours, especially as you get more senior. Have you considered the VA route? Smaller VAs often have less "traffic" and the attendings, while often academic (ie, they have med students and residents rotating through), tend to work less hours than those in more traditional, university type programs. Community hospitals also can be academic without the pressures a big time uni program would place on you and your family.

Keep mindful of your concerns and ask those around you to let you know if you are neglecting those things which are so important to you right now...better to know early, than when its too late.

 

[gabbydoggie]

My opinion is that you can make it work. I plan to. 🙂 I am doing my residency at a combined program--both community and academic aspects. The staff have chosen this atmosphere so they can have family time. They sacrifice a larger salary to be here, but it is awesome! You have to decide what you want and make it happen. You want to go to med school--you made it happen. 🙂

I'm female and married and will have kids in the future. For my first few years outta residency, i'll try to work in a group practice and hopefully part-time so I can have babies. It will work. Have faith.

good luck to you!! There is no better field~~~~

 

[athena21]

This is interesting because the overall population divorce rate is 50%, last I heard (could be wrong though). In that case, surgeons have a lower divorce rate than the general american population, while psychiatrists are right on par with society.

 

[Skylizard]

Originally posted by athena21
...the overall population divorce rate is 50%, last I heard (could be wrong though). In that case, surgeons have a lower divorce rate than the general american population, while psychiatrists are right on par with society.

I kind of heard the same thing, i.e. about 2/3 of American marriages end in divorce.

I was talking with some practicing surgeons the other day and a senior FP resident. They were telling me how their life works and some of the scenarios you can find in the community.

Surgeon A: Work like a dog year 1 and possibly year 2. 110-120 hours per week. Takes call for your practice about Q3. Partnership will require "buy in" for some pretty good cash. For the hospital, the community surgeons take turns on trauma call and it comes out to around Q8-9. As you are not partner, you pay the practice for the clinic overhead. Earn <150k before taxes.

Surgeon B: Works like a dog too. Not partner either. However, NO "buy in". Just works for a year or two and then get to become partner and profit share with the group. The "practice call" is around Q4-5. Also in the trauma call rotation Q8+/-. Earn 150k before taxes and do NOT pay for/cover overhead...straight salary.

FP senior resident: She has a contract to go and work for the VA. She starts at 120k, no mal-practice insurance issues, no overhead or partner issues, NO CALL! All outpatient clinic, off on all fed hollidays, federal employee benefits, etc...

It all depends on what you enjoy and what will keep you happy and intellectually sharp.