For docs w/family: Money, free time, and on-call?

[NonTradMed]

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I thought about putting this in the residency forum or allo, decided to put it here for now.

I had a chance to chat with a gasdoc and he said that the most important thing that a medical student should look for in a residency is (in rank of importance) is:

1. Money.
2. Free time.
3. On-call.

I wasn't sure what to make of this. I'm not the type to believe that love of patient care is all I need to keep me fed and my mortgage paid. But I always thought making money as the single most important reason to go into medicine would make for a miserable doctor.

Now, this gasdoc (anesthesiologist) loves his job, and he said so after even after a busy day's work, so he's not a bitter ol' cynic. His schedule is good (4 days/week) and he is satisfied with his paycheck, yet he felt the need to spend quite a long time lecturing to me about the importance of money and free time for 'when I have a family'.

He had the nurses all agree with me about this (I was observing a procedure when we had this chat). He said once I had a family, it doesn't matter what type of job I had because the most important thing will be my family, being able to provide for them, and spending time with them.

While I think family is very important, I found it disconcerting that he believes that everything I do in my life should center around supporting and serving my family. I don't want to be like my dad and be stuck in a job he hates, counting down the ten years to retirement. Is that what I may have to do in order to be a good mother and wife?

I always figured this isn't some third world country where the difference between having a well paying job and a less well paying job is starvation, that the US offers a comfortable enough lifestyle for most professions without forcing people go into miserable jobs in order to put food on the table. I figured medicine offered me enough choices that I could do something I love without forcing my family to suffer for it. Was I being an optimist? Is there only a few professions that truly will make me happy once I have a family?

My other thought was that medicine changes enough that specialties which pays well may not in the future. It always seemed foolhardy to choose a specialty you don't particularly like for the money---what happens when the money disappears?

I don't think this gasdoc was making a sexist jab at me when he mentioned all this. He said lifestyle was his primary reason in choosing gas and he never wanted to be like his super-busy doctor father who loved his job. Hence, this gasdoc's own reason for picking the lifestyle path as an adult so as to not emulate his father.

My question is for those with family: what are your thoughts on choosing a residency vs. balancing a family's needs? Do you do medicine for your family? How much does your family needs vs. your needs enter your thoughts when choosing a specialty? If you had to choose between a specialty that was good for your family but bad for you vs. a specialty that was good for you but bad for your family, how would you choose?

 

[Re3iRtH]

Are you talking about gastroenterology or anesthesia?

 

[NonTradMed]

Are you talking about gastroenterology or anesthesia?

Anesthesia. 😀

Sorry, I'll make it more clear.

 

[Blade28]

You should always be mindful of who gives you advice - there's a certain degree of self-selection going on when people choose their various fields.

So the viewpoint of the average anesthesiologist vs. surgeon vs. pediatrician vs. radiologist vs. emergency physician will be quite different - and rightly so, since each of these people chose their field for different reasons.

 

[DoctorPardi]

You should always be mindful of who gives you advice - there's a certain degree of self-selection going on when people choose their various fields.

So the viewpoint of the average anesthesiologist vs. surgeon vs. pediatrician vs. radiologist vs. emergency physician will be quite different - and rightly so, since each of these people chose their field for different reasons.

That is a very good point, what the doctor was telling you basically is what was important to him, not necessarily you.

I have nothing more to add here 🙂 .

 

[Steiner]

If someone has a family and they're not the most important thing in their life, it would suck to be the other people in that family. I have a family and no matter what I go into, at the end of the day I will look forward to leaving my job and heading home to what is really important.

I agree with everything that he told you. I know people who resent their parents' obsession and devotion to their job because they felt neglected. I think he should have worded it that you should look for something that you enjoy but does not take priority over other parts of your life i.e. friends, family, etc...

If, right now there is nothing more important to someone than being a certain type of physician, then, by default, it is not the time to have a family.

 

[elderjack21]

I.....While I think family is very important, I found it disconcerting that he believes that everything I do in my life should center around supporting and serving my family. I don't want to be like my dad and be stuck in a job he hates, counting down the ten years to retirement. Is that what I may have to do in order to be a good mother and wife?.....My question is for those with family: what are your thoughts on choosing a residency vs. balancing a family's needs? Do you do medicine for your family? How much does your family needs vs. your needs enter your thoughts when choosing a specialty? If you had to choose between a specialty that was good for your family but bad for you vs. a specialty that was good for you but bad for your family, how would you choose?

So, my two cents. How important your family is to you is totally on you, you will have to cross that hurdle when you get there. You can specialize in whatever you want and just cut back your hours if that is what you want to do. I work with a pediatric neuroradiologist who works 4 days a week (8-5) and limited call so she can spend more time with her son.

I have a family. I am doing medicine for me, they want me to be happy in my career, so they support me fully. No matter what type of doc you become, you will easily be able to provide for your family (now...depending on your background, your wants may be different than your needs...but when it comes down to living comfortably, I have a family of four, made about 50k a year and had no problems "providing" for them...I would assume that you would have a spouse who would work as well so money probably wont be your biggest concern)

In the end kids only want one thing...your time. Once they hit somwhere between 10-12, they don't even want that. So you really have to worry about that when the time comes for you to have a family.

 

[JacobSilge]

If family is the most important thing, I think the priorities in that list are at the bare minimum in the wrong order. I know I'd care more if my parent/spouse had predictable hours such that we could plan to spend time together than if said spouse made a lot of money.

 

[Doctor J]

Sounds like that anesthesiologist nailed it. Money is quite important, free time is even more so, and on-call schedule is what can make a day great or horrible. The days that are horrible turn your weeks horrible, which turn your months horrible, which makes you dissatisfied with your career.

I predict a few doom and gloom posts about money being a bad reason to pursue medicine because of declining reimbursements and blah blah blah. But really, no one works for free. And we are all fairly intelligent. We follow the path of least resistance, which is why the most competitive specialties are the most competitive.

You say that you can't see your family being more important to you than anything else, but you don't have a family yet. If and when you do, you'll see it to be a fairly accurate statement. Time off to pursue your own interests (family time, travel, boating, whatever), set schedules with clearly defined 'personal' time, and good pay for a job we enjoy at times... This is what everyone wants, not just MDs.

 

[Long Dong]

Sounds like that anesthesiologist nailed it. Money is quite important, free time is even more so, and on-call schedule is what can make a day great or horrible. The days that are horrible turn your weeks horrible, which turn your months horrible, which makes you dissatisfied with your career.

I predict a few doom and gloom posts about money being a bad reason to pursue medicine because of declining reimbursements and blah blah blah. But really, no one works for free. And we are all fairly intelligent. We follow the path of least resistance, which is why the most competitive specialties are the most competitive.

You say that you can't see your family being more important to you than anything else, but you don't have a family yet. If and when you do, you'll see it to be a fairly accurate statement. Time off to pursue your own interests (family time, travel, boating, whatever), set schedules with clearly defined 'personal' time, and good pay for a job we enjoy at times... This is what everyone wants, not just MDs.

Yeah everything he/she said.👍

1. Money.
2. Free time.
3. On-call.

1-3 all adds up to me to more time with family and friends. I'll add this the other day I know for sure I saved a girls life, that felt really good, but not as good as that 6 hours of sleep I got after call that same day.

 

[OncoCaP]

I talked to a gastroenterolgist (attending) about this very subject. This is someone I have a lot of respect for and his comments echoed the comments of a surgeon I respect as well (who works 7a-5pm, by the way, with occasional call). The gastro doc is pretty high up in his department, so that adds to his work. He probably works 60+ hrs per week, but not as much as people in private practice work.

Anyway, I asked this gastroenterologist about balancing work and family, residency, etc. He said when it comes to training (e.g., residency) you just need to do what you need to do. Residency isn't the time for "balance"; it's a time to learn.

Now, after residency, it does become a question of how much money and fame you are after. The usual tradeoffs for a particular person are how much to work to gain money / fame. The more you work, usually the more money and fame you get. Each specialty seems to have its own curve in this respect. Below a certain threshold (amount of work) you start to lose the respect of your peers and it becomes problematic. That threshold might be high in something like invasive cardiology (where working 40 hrs per week would be a "slacker") and lower in derm (where working 40 hrs might be the norm for all I know).

My impression of medicine is that it is hell with respect to balancing work and family in most cases. Even some women I know who work 1/2 time seem to hate it. I'm not sure why exactly. I don't think amount of free time or money is really a panacea here. My current theory is that you happiness is not really related to your work per se ... it's something you bring to your work and the rest of your life. While some people derive a lot of satisfaction from their work, it seems like a risky thing to tie your mood to.

 

[Doctor J]

Happiness comes from within but unhappiness can be forced upon you.

Edit: This may be a bit unclear so I'll clarify. Most people have the capacity to be happy in normal circumstances, where they have enough time to themselves, their needs and wants are met, they have close and rewarding relationships with others, their intimacy issues are being dealt with, they feel they are appreciated by others and thus have decent self-worth, etc. Notice that only a small portion of these needs are tied to your career, namely, money, free time, and some sense of satisfaction of doing a good and necessary job.

If you are unhappy and these needs are being met it is because of a sense of spiritual ennui, a personal problem. Happiness when these needs are being met (true for almost everyone... or at least, most everyone -can- be happy as they are a few choices away from having these needs met) comes strictly from within.

Contrast that to unhappiness being forced on you... I can imagine many situations where almost no one could be happy because their needs aren't being met. Happiness when you are isolated (except by personal choice), overworked and under appreciated, sleep deprived, continually berated by those you hope to emulate... Hard to come by even with the best internal psychic economy. In other words, it comes from without. And that is most certainly possible if you choose the wrong career.

 

[Luxian]

1. Money.
2. Free time.
3. On-call.

Um, those may all be important things, but I think the order is wrong. For me, free time will always be first. I mean, there's a tradeoff of course. I wouldn't want to be poorly paid, but no amount of extra Kate Spade bags or Jaguars will make up for not having time to spend on yourself, your spouse, and your family.

I don't mean to be cliched, but he's an anesthesiologist. Of _course_ money was important in his decision or he wouldn't be there. It's not necessarily a selfish thing. My friend went into anesthesiology and now sends money back home to take care of his elderly parents. But money is most definitely a factor in choosing that field.

Let's hear what other docs have to say!

 

[montessori2md]

The problem w/ residency is you don't really control over your schedule. This makes it hard to schedule a personal life. As an attending, hopefully you can schedule your hours around the kids' soccer games, etc.

The problem w/ working lots of hours, as anyone, including dishwashers, is that you're so tired that when you do have time, you aren't likely to enjoy it unless you are asleep -it's hardly the way to be when you have a kid throwing a tantrum b/c you want him to eat his peas.

There was a thread awhile back describing how, once you go over say, 65-75 hours/wk (depending on your own sleep needs), there is a line you cross in your ability to take on ANYTHING -including just going to a movie, or making a pot of coffee. For myself, I don't want to spend any more of my life in that state than I need to. But even that "lifestyle" is pleasant for some people.

45 hrs/wk is my normal work routine and it's quite enjoyable, even w/ the premed bs thrown in with it -I'm actually a little bored. My DH routinely works 60 hours and is still a perfectly functional family member.

Kids sleep. Like 12 hours. It will be ok. Just get a housekeeper and don't expect to put a 5 course meal on the table and make placemats like Martha Stewart.

 

[kdburton]

This anesthesiologist said that when choosing a residency you should be concerned about all those things or when choosing a specialty? As far as $ and time commitments go in residency... Most hospitals pay their residents fairly close to the same salary regardless of which specialty they are training in. At the same time those residents could be working wildly different hours (almost a guaranteed 80hrs for surgery and maybe only 50hrs for EM for instance). So assuming that you're talking about what field you want to go into as their career... The way that I've always thought about it was that Medicine is a job - just like any other job. The vast majority of people don't love their job and the only reason why they get a job is because they need to support themselves [and their family] and they also want to be able to do things that they actually DO love to do such as spending time with friends/family, going on vacation, having nice things, etc, etc. So in that sense this guy is right because you need $, time off of work and a fairly controllable lifestyle in order to do those things. Some people would rather just do what they love as a career. The people that say you should only go into medicine because you love it are kidding themselves. If you looooovvvee neurosurgery or some other specialty that requires you to give up a controllable lifestyle and free time then by all means go ahead and do it, but you have to realize that you're giving up time that could be spent doing other non-work things that you might also love such as your family and your vacations to the Bahamas. On the opposite end of the spectrum, if you love a specialty that isn't as demanding you can do what you love and as a consequence of the nature of your field you'll still have time to do other things you love. And you'll still be making a comfortable living in the eyes of 90% of the population no matter which field you go into. Money is the single biggest motivator in the US and it is why there are so many people who are very good at what they do (lawyers, business owners, bankers, doctors, athletes, etc). Its not to say that many of them don't like certain aspects of their jobs, but you have to realize that its big $$ that draws in the best people in each field. So to say that motivation for money will make a bad doctor is not correct. Some of them may be unhappy, but going back to my EM example from earlier, if you're only working 36 hours per week and making six figures I bet you're still going to be a lot happier than the guys who are landscaping your yard in 100 degree heat 60 hours/week... Right?