How do you make it work?

[axm028400]

I'm currently a fourth year student, and after much debate have decided to apply for an IM residency. I was considering another subspecialty with a much more cush lifestyle, but after much thought feel that I'll like medicine much more and see myself doing this field, as its what I'm most interested in. My question is, how do you make it work? I currently have a 1 year old child and am happily married to a very supportive spouse, and I want to be able to be a great mom and wife. We are fortunate to have a great daycare and family support I might add. Is it possible? Any input would be greatly appreciated.
Thanks!

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[NightVision]

I would consider being a hospitalist in a academic university. Your hours will be good, maybe 8am-4pm, you will have residents who do most of the work. You can attend lectures and be involved in teaching which will keep the job fun. Salary will probably be around $150K/yr.

 

[MidwestMD]

Axm028400.

I think that IM is a field that is family friendly, as long as you know what you want and are willing to make sacrifices (as with all things in Medicine and in life). Residency is always tough, no matter what field you go into. What you'll need to decide is how rigorous you want your training to be and where you see yourself in 10 yrs.

From a residency standpoint, a quick glance at various threads on SDN will show you which programs will fit you best. Trust me, you can put up with almost anything for 3 yrs. With a small child at home and your current support network, I would suggest choosing a program that's close to home though. I'm assuming your question is directed more at your overall career and lifestyle thereafter.

I agree w/ NightVision that a Hospitalist job provides quite a bit of flexibility at a higher pay-rate than the traditional outpt practice for primary care (some private groups offer as much as $300K, but the locations are less desirable). Unfortunately, Hospitalists have a high burn-out/turn-over rate. IMO, it's do-able as long as you're careful to join a well established group.

I'm in my 3rd yr as an academic hospitalist at a large university program, and my wife (Peds PGY 3) and I are expecting our 1st child next month. I've had to cut back my hours as a result...so I understand your desire to keep family a high priority. With my reduced work load (60%), the job is definitely more manageable and it's easy to switch shifts w/ colleagues. Also, if you end up bored at home w/ that much time off, you can moonlight on the side (usually make more $/hr this way as well). I usually try to work an additional 24hrs/mo (12hr shifts x 2) or make myself readily available for emergency shifts. I know of other colleagues who work part time w/ 2-3 kids at home and seem to pull off being great parents and clinicians.

If you're fellowship bound, I would suggest looking into Allergy/Immunology or Endocrinology as they tend to have better lifestyles than the other subspecialties. Not too different than Derm or Opthy in some respects.

Guess this was more like my $5 instead of my 2 cents, but I hope this helps.

 

[axm028400]

Thanks so much for the feedback, I could definitely see doing the hospitalist or pursuing a fellowship. I was also wondering if there is anyone out there who has advice for getting through residency, especially intern year, which I've heard can be incredibly time intensive, especially since I'm hoping to match at a good program. I really appreciate the feedback thus far!

 

[futureres]

Thanks so much for the feedback, I could definitely see doing the hospitalist or pursuing a fellowship. I was also wondering if there is anyone out there who has advice for getting through residency, especially intern year, which I've heard can be incredibly time intensive, especially since I'm hoping to match at a good program. I really appreciate the feedback thus far!

Internship is hard everywhere but there are some programs (namely Hopkins, MGH, maybe the Brigham too) that are so intensely front-loaded that it's difficult and I would avoid. I'd recommend a program that has more graded responsibility...but that also means that your PGY-2 and PGY-3 years will be harder than those in the programs I mentioned.

UCSF has an amazing "flexible" track for people who are starting families or are dealing with severe illness that spreads residency out beyond 3 years for a more manageable schedule. I'm not familiar with other programs that do this...maybe there are but UCSF embraces it and puts it front/center. Depending on where you live, if you are near some great programs where you see a lot of residents with families, you'll have a support system both at home and within your program because they'll be more understanding about your family life. It sounds like your options will be determined by geography. Hopefully there are some solid programs near you that have what you are looking for.

 

[elwademd]

what's your idea of a cush lifestyle?
what's your idea of being a great mom?

i feel like sometimes people think that everyone has the same idea... and then find out opinions vary.

 

[ukdoc74]

Thank you for the answer.

From your experience and talking to colleagues what about rheumatology and heme onc are they as favorable as allergy. Would appreciate brute honesty because i love rheum and heme onc over allergy and endocrine. Anyone else can also chime in with their views. Thank you to everyone.

Axm028400.

I think that IM is a field that is family friendly, as long as you know what you want and are willing to make sacrifices (as with all things in Medicine and in life). Residency is always tough, no matter what field you go into. What you'll need to decide is how rigorous you want your training to be and where you see yourself in 10 yrs.

From a residency standpoint, a quick glance at various threads on SDN will show you which programs will fit you best. Trust me, you can put up with almost anything for 3 yrs. With a small child at home and your current support network, I would suggest choosing a program that's close to home though. I'm assuming your question is directed more at your overall career and lifestyle thereafter.

I agree w/ NightVision that a Hospitalist job provides quite a bit of flexibility at a higher pay-rate than the traditional outpt practice for primary care (some private groups offer as much as $300K, but the locations are less desirable). Unfortunately, Hospitalists have a high burn-out/turn-over rate. IMO, it's do-able as long as you're careful to join a well established group.

I'm in my 3rd yr as an academic hospitalist at a large university program, and my wife (Peds PGY 3) and I are expecting our 1st child next month. I've had to cut back my hours as a result...so I understand your desire to keep family a high priority. With my reduced work load (60%), the job is definitely more manageable and it's easy to switch shifts w/ colleagues. Also, if you end up bored at home w/ that much time off, you can moonlight on the side (usually make more $/hr this way as well). I usually try to work an additional 24hrs/mo (12hr shifts x 2) or make myself readily available for emergency shifts. I know of other colleagues who work part time w/ 2-3 kids at home and seem to pull off being great parents and clinicians.

If you're fellowship bound, I would suggest looking into Allergy/Immunology or Endocrinology as they tend to have better lifestyles than the other subspecialties. Not too different than Derm or Opthy in some respects.

Guess this was more like my $5 instead of my 2 cents, but I hope this helps.

 

[MidwestMD]

Thank you for the answer.

From your experience and talking to colleagues what about rheumatology and heme onc are they as favorable as allergy. Would appreciate brute honesty because i love rheum and heme onc over allergy and endocrine. Anyone else can also chime in with their views. Thank you to everyone.

Rheum is also generally considered a "less demanding" subspecialty that I forgot to mention. Heme/Onc is still pretty busy (not to mention competitive) and is more likely to get an emergency c/s in the middle of the night than the other 3. I'm currently applying to Heme/Onc myself.

I'm not sure what you mean by "as favorable as allergy." Do you mean lifestyle, pay, or respect from your colleagues?

 

[Scottish Chap]

I'm currently a fourth year student, and after much debate have decided to apply for an IM residency. I was considering another subspecialty with a much more cush lifestyle, but after much thought feel that I'll like medicine much more and see myself doing this field, as its what I'm most interested in. My question is, how do you make it work? I currently have a 1 year old child and am happily married to a very supportive spouse, and I want to be able to be a great mom and wife. We are fortunate to have a great daycare and family support I might add. Is it possible? Any input would be greatly appreciated.
Thanks!

I'm presently sitting in the pediatric ED with my wife and my two-week old who is about to be admitted. I am a medicine resident at a very intense hospital - but one that cares enough about their residents that they insisted I leave work today to care for my family. Go to one of those residency programs. Bottom line: while you're a resident, you're going to feel you're not the best parent or resident you can be if you have a family.

 

[ukdoc74]

Yes pay, respect, and lifestyle. Also, do you have any advice for interns to maximize our chances for the Heme Onc match. Any advice to help from your experience and talking to successful applicants that you talked to would be appreciated. Thank you very much.

Rheum is also generally considered a "less demanding" subspecialty that I forgot to mention. Heme/Onc is still pretty busy (not to mention competitive) and is more likely to get an emergency c/s in the middle of the night than the other 3. I'm currently applying to Heme/Onc myself.

I'm not sure what you mean by "as favorable as allergy." Do you mean lifestyle, pay, or respect from your colleagues?

 

[MidwestMD]

Yes pay, respect, and lifestyle.

Unfortunately, I don't know enough to comment on specific salaries for the other fields...but I believe Heme/Onc generally makes more than Allergy, Endo, and Rheum (chemo reimbursment, etc).

Respect/prestige is a non-factor for me and totally subjective as well as silly. Now if we're talking "sexy," then none of these fields compare to Cards or GI It's kinda like asking if the 2nd to last kid picked for dodegball is more cool than the very last kid picked (maybe not the best analogy).
If you insist on some sort of ranking though, Heme/Onc is considered more competitive than the other 3... I can see jdh71 rolling his eyes now.

Also, do you have any advice for interns to maximize our chances for the Heme Onc match. Any advice to help from your experience and talking to successful applicants that you talked to would be appreciated. Thank you very much.

Research, research, research. You don't even have to be published by the time you interview. Just make sure you get into a lab (basic science seems to be the best for Heme/Onc) or jump/start on a project w/ a well-known faculty member in the field you're interested in. When I was at MSKCC and other top notch programs, everyone seemed to be an MD/PhD or had amazing research backgrounds. What seemed to blow it for me last time was a lack of significant research. You can say "academics" till you're blue in the face, but if you don't have any significant research to back it up it doesn't matter.

If I had to do it all over again, I also would have gone to ASCO/ASH each year to get a feel for who the big names are in the field. It also doesn't hurt to network by presenting posters, etc. I HATE HATE HATE playing the game, but that's what you have to do for the more competetive fields.

Lastly, have your game face on ALL THE TIME during residency. There are a lot of people who will tell you they only care about doing well while on their elective/rotation of interest...that's BS. You should bust your butt regardless of who's watching...and be consistent. Your colleagues and attendings notice = excellent LORs. Might also make the difference between someone being willing to go the extra step and make a call on your behalf. I can't stand people who think learning about the other aspects of Medicine is beneath them.

Time to get off my soapbox. I'm interested to see what others think. Good luck!