How much does independence matter?

[FulfilledDeer]

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Hey everyone,

So as I'm going through medical school, I'm trying to figure out the things that are important to me in a job, regardless of the subject matter (that determination will come later). I have a lot of reasons that I'm attracted to EM, but one that keeps drawing me back is the freedom of shift work. Freedom to change locations (maybe different hospitals, maybe different cities or states....even countries for NZ apparently), freedom from building a practice.....freedom from you know, other stuff. Ease of locum tenens. Whenever I think about other specialties where this kind of freedom doesn't exist, I feel trapped. Even though I doubt I'd take advantage of a lot of what I'm talking about, not having it feels so confining.

Anyway, I thought I'd ask you all your thoughts? Is this something that was important to you? Is it still? Have things changed? I'm not really trying to ask about EM specifically, it just happens to be the poster child for this kind of freedom. Thanks for any help.

 

[RustedFox]

Yep. No way could I be bothered with the logistics/responsibilities of "having a practice". Patients frequently ask where my "office is" so they can see me there, and then they look stunned when I say "you're in it."

If I don't like my present arrangement, I can just up and move to a new one.... see how that feels, and.. go from there.

The key is: don't buy a house, and don't have kids. Period.

 

[la gringa]

Yep. No way could I be bothered with the logistics/responsibilities of "having a practice". Patients frequently ask where my "office is" so they can see me there, and then they look stunned when I say "you're in it."

If I don't like my present arrangement, I can just up and move to a new one.... see how that feels, and.. go from there.

The key is: don't buy a house, and don't have kids. Period.

my theory as well, though some just have to procreate! (i'm not against it inherently, but as a female physician i don't think i'd be good at both jobs at once. something must suffer!)

 

[Anonymous M4]

my theory as well, though some just have to procreate! (i'm not against it inherently, but as a female physician i don't think i'd be good at both jobs at once. something must suffer!)

Of course something must suffer, and for maximum freedom don't have kids, but if female physicians take the attitude that we can't do both at least pretty well, are we taking the view that females can only be good mothers or good doctors, so choose one and forget about the other? That makes my ovaries hurt. I understand you were speaking personally, but "as a female physician" got me wondering if you think that, in general, female physicians should choose not to have children, or if you were speaking directly to maximizing freedom.

I see you are not "inherently against" it, but do you think you personally are different than other women in that you "wouldn't be good at both jobs" or is it that you think it is impossible (Or nearly so) to be good at both?

 

[RustedFox]

People underestimate just what "having kids" takes from you.

I will never have kids, but I have so many buddies with at least one that is aged 1-6. They're busier than me. Period.

 

[Croooz]

You cannot be great at both. One cannot be both a great parent and a great physician. You can either be a great parent and a good physician or a good parent and great physician but not both. You are setting yourself up for enormous disappointment to think you can be great at both. Throw into the mix a third occupation such as spouse and things get even trickier. Keep your sanity and chose one which you be great at, one that you will be good at, and one that you will be okay at...otherwise you will be bad in all of them.

 

[The White Coat Investor]

You cannot be great at both. One cannot be both a great parent and a great physician. You can either be a great parent and a good physician or a good parent and great physician but not both. You are setting yourself up for enormous disappointment to think you can be great at both. Throw into the mix a third occupation such as spouse and things get even trickier. Keep your sanity and chose one which you be great at, one that you will be good at, and one that you will be okay at...otherwise you will be bad in all of them.

Oh B.S. Give me a break. It doesn't require 140 hours a week to be a good doc, nor to be a good dad. Life is a balancing act. That's like saying you can't be a good doc if you have any outside interests. It just isn't true. In a lot of ways, the outside interests make you a better doc. Having kids has made me A LOT better seeing kids in the ED. I had a long chat with a kindergartner last night about whether she likes Sam or Pat better. Rusted Fox doesn't even know what animal Sam is.

 

[wjs010]

I watch children's Dallas and those docs seem like pretty great parents. Seeing some of the discussion here is pretty depressing. I mean really? You can't be a great physician working 50 hours a week and also have kids. ? Please tell me this is not true. I'd like to have a few one day

 

[NOsaintsfan]

I have twins and its difficult but doable, given I'm only a student. My job isn't to be a doctor yet, its to study and whatnot, but the time commitment is still there.

They key is to have a spouse/partner that you can share the responsibility of raising kids with. If I was single it would be impossible for me but some may be able to do it.

Don't let fear of having kids scare you away from what you want to do. If you want children it is possible to make it work without being a bad parent.

It won't be easy, but I flat out disagree with people who say you can't do both.

 

[RustedFox]

Oh B.S. Give me a break. It doesn't require 140 hours a week to be a good doc, nor to be a good dad. Life is a balancing act. That's like saying you can't be a good doc if you have any outside interests. It just isn't true. In a lot of ways, the outside interests make you a better doc. Having kids has made me A LOT better seeing kids in the ED. I had a long chat with a kindergartner last night about whether she likes Sam or Pat better. Rusted Fox doesn't even know what animal Sam is.

Sam had better be a dog. Max is a rabbit.

I'm not saying its not possible; but its difficult I imagine. Hell, I don't have kids.

What I am saying is; my friends who have kids... maaan. They're busier than I am.

 

[dotcb]

You can do whatever you set your mind to. The more ambitious it is, the more challenging it will be. Can you be an excellent physician and a great parent? Yes. Absolutely. I work in academics, and almost all my colleagues have kids. I have to guess they are great parents. I know they're great physicians, scholars, and teachers. My father was a professor and he was also a great parent. It taught me about balance - that you can have a job you love and a great family. You can't do it all, but you can probably do what you want.

 

[Croooz]

You can't do it all. No one is saying you cannot be good at all but you cannot be great at all. Perhaps defining the terms, great, good, and okay... I've met plenty of great physicians who were good parents, and okay spouses...yet they would be considered phenomenal by others. It's just the nature of time and you will not have enough time to be outstanding in every area. You can do your best in each area and that's all you can do. In the end who's criteria matters? Each family is different and their expectations for each vary so what makes me a good husband to my wife will probably rate you as a great one with yours. I'll just have to brush up on Kama Sutra #317 and my flexibility to get a higher rating.

 

[deleted6669]

What I am saying is; my friends who have kids... maaan. They're busier than I am.

this is the truth. I have a lot less free time than before my kids were born. I'm glad I'm a dad but what has ended up coming in third isn't work or the kids, it's my free time to do outside stuff. I used to go on a scuba vacation every year. I used to run multiple marathons/yr. now I work, do stuff with the kids, and try to get some sleep in before my next shift...

 

[wobit]

this is the truth. I have a lot less free time than before my kids were born. I'm glad I'm a dad but what has ended up coming in third isn't work or the kids, it's my free time to do outside stuff. I used to go on a scuba vacation every year. I used to run multiple marathons/yr. now I work, do stuff with the kids, and try to get some sleep in before my next shift...

+1

If I weren't a physician, maybe I'd be spending more hours each week being a mommy than I do now, but I think they would be snarkier, more shrewish or depressive hours. Having a career that excites me makes me a better person to be around and even my 5 year old benefits from that.

Based on how my Attendings interact with their kids, I think that EM is a great career for a parent, so long as you have either a domestically minded partner or put some time and effort into planning it.

It's also true that no matter whether you are a bookseller or a businessman, kids are a huge amount of work, and many people just don't want them, and that's totally fine. I have lots of friends who are "child-free by choice" and I applaud their self-knowledge.

 

[RustedFox]

(Okay guys, someone fill me in on just who the hell Sam and Pat are.)

 

[Croooz]

(Okay guys, someone fill me in on just who the hell Sam and Pat are.)

Lo!
I don't know either because I'm just an uncle of teenagers.

 

[Birdstrike]

Hey everyone,

So as I'm going through medical school, I'm trying to figure out the things that are important to me in a job, regardless of the subject matter (that determination will come later). I have a lot of reasons that I'm attracted to EM, but one that keeps drawing me back is the freedom of shift work. Freedom to change locations (maybe different hospitals, maybe different cities or states....even countries for NZ apparently), freedom from building a practice.....freedom from you know, other stuff. Ease of locum tenens. Whenever I think about other specialties where this kind of freedom doesn't exist, I feel trapped. Even though I doubt I'd take advantage of a lot of what I'm talking about, not having it feels so confining.

Anyway, I thought I'd ask you all your thoughts? Is this something that was important to you? Is it still? Have things changed? I'm not really trying to ask about EM specifically, it just happens to be the poster child for this kind of freedom. Thanks for any help.

It depends on how you define "freedom." When I was 26, "freedom" from the 9-5 Mon-Fri was hugely important. When I was 36, married with little kids who were all locked in to the 9-5, suddenly I felt like a slave to the insanity of rotating shift work, and wanted the 9-5, badly. Sleeping during the day when my family was awake, being awake while my family was asleep, being "off" on my kids birthday or Christmas when actually I had to work the night before until 4 a.m. that day and get up after 2 1/2 hours of sleep trying to be bright-eyed, energetic daddy...began to suck. Never being on-call, but always feeling "post call" and no longer able to selfishly sleep whenever I wanted like a single guy....These things made me want a boring, 9-5 Mon-Fri job.

That's just one guy's experience.

To each, his own.


"Rise up this mornin',
Smiled with the risin' sun,
Three little birds
Pitch by my doorstep
Singin' sweet songs
Of melodies pure and true,
Sayin', 'This is my message to you-ou-ou.....'"
-Bob Marley, Three Little Birds

 

[Arcan57]

Sam had better be a dog. Max is a rabbit.

Speaking of old school video games...

One of my attendings used to say that you can be great at any 2 of the following 3:

1) play
2) family
3) work

but not all three. In general I've found this to be useful advice. One hopes that the people that are great at work and play either don't have a family or are partnered with someone who is great at family and has minimal emotional needs of their own.

 

[FulfilledDeer]

It depends on how you define "freedom." When I was 26, "freedom" from the 9-5 Mon-Fri was hugely important. When I was 36, married with little kids who were all locked in to the 9-5, suddenly I felt like a slave to the insanity of rotating shift work, and wanted the 9-5, badly. Sleeping during the day when my family was awake, being awake while my family was asleep, being "off" on my kids birthday or Christmas when actually I had to work the night before until 4 a.m. that day and get up after 2 1/2 hours of sleep trying to be bright-eyed, energetic daddy...began to suck. Never being on-call, but always feeling "post call" and no longer able to selfishly sleep whenever I wanted like a single guy....These things made me want a boring, 9-5 Mon-Fri job.

That's just one guy's experience.

To each, his own.


"Rise up this mornin',
Smiled with the risin' sun,
Three little birds
Pitch by my doorstep
Singin' sweet songs
Of melodies pure and true,
Sayin', 'This is my message to you-ou-ou.....'"
-Bob Marley, Three Little Birds

So the feeling I'm getting is that it's a lot of freedom.....unless you have kids. I'm glad you posted because the change over time is exactly what I'm contemplating.

What about not having to be so tacked down with a job? Does it even matter in the end whether you can just pack up and move without having to build a practice again? Does that become a non-issue?

 

[dotcb]

There are a variety of opinions. Once you have kids, your freedom goes down dramatically in general and may not have much to do with EM. Some of the docs I work with really like working nights, sleep while kids in school, otherwise home and quite available for them. There aren't that many careers that will allow you to work 8+ shifts/month for such high pay.

 

[The White Coat Investor]

Sam's the lion and Pat's the monkey in the kindergarten reading primers used around here. I have to admit, I was always curious what was going to happen in the next book.

 

[ptarmigan]

You can't do it all. No one is saying you cannot be good at all but you cannot be great at all.

There are some erros in your reasoning:

1) The theory that one person only has so much "greatness" to go around - that if the physician spreads the greatness over multiple pursuits then it gets wattered down to just goodness. As if everyone had the same amount of greatnesss, and they could choose to spread it over 100 things or keep it all consolidated into one thing.

The problem is some people don't have any greatness at all, and others have a whole lot of it. That is the bitter cruelty of life. Some physicians are merely good clinicians, and don't have kids, and aren't great at anything. Some physicians are outstanding physicians but crappy mothers and fathers. Still others are exceptional at all three and can even run a 6 minute mile.

2) The second error is a statistical one. There is a bell curve in most everything, and about 16% of a bell curve population will be 1 standard deviation above the mean. By chance most excellent fathers will not also be excellent physicians, but that is not because of a time issue or because there isn't enough energy/greatness, its becasue the likelihood of being great in 2 different things is lower than being in great in 1 thing. There are many more swimmers that win one Olympic medal than there are swimers who win multiple golds. It's like the chance of having a PE and a stroke at the time - both are rare, the two together are really rare.

You can be great at any number of things. The chances of being great at 2 things are lower than being great at 1 thing by chance alone, and so on. The chances of not being great at anything are relatively high.

3) The variable you are trying to measure is not easily measureable. There is no agreed upon way to measure greatness. It is highly subjective.

Is being great what really matters in life? It depends on what you define as great, and who you are comparing yourself to, and what greatness means to you.

 

[Birdstrike]

So the feeling I'm getting is that it's a lot of freedom.....unless you have kids. I'm glad you posted because the change over time is exactly what I'm contemplating.

What about not having to be so tacked down with a job? Does it even matter in the end whether you can just pack up and move without having to build a practice again? Does that become a non-issue?

Ironically, despite doctors belly aching about the greater prevalence of hospital-employed positions (non-EM), one of the advantages of this trend is that it actually does make it easier to pack up and go find a new job, as a non-EM physician. General Surgeons, Ortho, Neurosurgery, Neurology, and many other specialties have this option now. You have less "independence" in the sense that you're not solo, but you do have the option to pack up and move to the next hospital employed position. This is a huge trend now. It's not exclusive to hospital based specialties anymore. Medicine is changing.

 

[Hercules]

There are some erros in your reasoning:

1) The theory that one person only has so much "greatness" to go around - that if the physician spreads the greatness over multiple pursuits then it gets wattered down to just goodness. As if everyone had the same amount of greatnesss, and they could choose to spread it over 100 things or keep it all consolidated into one thing.

The problem is some people don't have any greatness at all, and others have a whole lot of it. That is the bitter cruelty of life. Some physicians are merely good clinicians, and don't have kids, and aren't great at anything. Some physicians are outstanding physicians but crappy mothers and fathers. Still others are exceptional at all three and can even run a 6 minute mile.

2) The second error is a statistical one. There is a bell curve in most everything, and about 16% of a bell curve population will be 1 standard deviation above the mean. By chance most excellent fathers will not also be excellent physicians, but that is not because of a time issue or because there isn't enough energy/greatness, its becasue the likelihood of being great in 2 different things is lower than being in great in 1 thing. There are many more swimmers that win one Olympic medal than there are swimers who win multiple golds. It's like the chance of having a PE and a stroke at the time - both are rare, the two together are really rare.

You can be great at any number of things. The chances of being great at 2 things are lower than being great at 1 thing by chance alone, and so on. The chances of not being great at anything are relatively high.

3) The variable you are trying to measure is not easily measureable. There is no agreed upon way to measure greatness. It is highly subjective.

Is being great what really matters in life? It depends on what you define as great, and who you are comparing yourself to, and what greatness means to you.

Awesome post with some great points in it. Our preceding discussion completely ignored innate abilities. I think the original point was more that you have limited time to devote to various pursuits. Maybe a better way to put it would be that you can't completely maximize your potential in all aspects of your life. You have to choose which you will spend more time to develop.

 

[FulfilledDeer]

Ironically, despite doctors belly aching about the greater prevalence of hospital-employed positions (non-EM), one of the advantages of this trend is that it actually does make it easier to pack up and go find a new job, as a non-EM physician. General Surgeons, Ortho, Neurosurgery, Neurology, and many other specialties have this option now. You have less "independence" in the sense that you're not solo, but you do have the option to pack up and move to the next hospital employed position. This is a huge trend now. It's not exclusive to hospital based specialties anymore. Medicine is changing.

This is exactly what I was asking about, but apparently didn't know it. Thanks for reading my mind. Is there a general reason for the complaining other than shutting down private practices? That is, when just looking at the work itself, not its effect on the system?

Relatedly (that's a word?), I've been thinking about Kaiser (and related groups). I hear working there can be pretty nice, especially for some specialties where private practice can be demanding (Ob-Gyn comes to mind). But I always hear how terrible Kaiser is as a patient....any thoughts on the distinction? I mean, I've been to Kaiser as a patient, and I thought it was fine. But then I didn't really have much in the way of problems so I'm not really comfortable using my experience as a guide. For some reason, probably because of the complaints, it feels like selling out.

And it's not like I have to be making this decision immediately, but I don't even understand if what I think is important is actually important.

 

[Birdstrike]

This is exactly what I was asking about, but apparently didn't know it. Thanks for reading my mind. Is there a general reason for the complaining other than shutting down private practices? That is, when just looking at the work itself, not its effect on the system?

Relatedly (that's a word?), I've been thinking about Kaiser (and related groups). I hear working there can be pretty nice, especially for some specialties where private practice can be demanding (Ob-Gyn comes to mind). But I always hear how terrible Kaiser is as a patient....any thoughts on the distinction? I mean, I've been to Kaiser as a patient, and I thought it was fine. But then I didn't really have much in the way of problems so I'm not really comfortable using my experience as a guide. For some reason, probably because of the complaints, it feels like selling out.

And it's not like I have to be making this decision immediately, but I don't even understand if what I think is important is actually important.

Some docs like the indepence of a solo (or small) private practice and having full control, and not having to be told what to do by a hospital or administrator, or whoever. Others don't want the headache of running a practice, but instead have the headache of a hospital or administrator running them.

Choose your poison.

 

[Arcan57]

This is exactly what I was asking about, but apparently didn't know it. Thanks for reading my mind. Is there a general reason for the complaining other than shutting down private practices? That is, when just looking at the work itself, not its effect on the system?

Relatedly (that's a word?), I've been thinking about Kaiser (and related groups). I hear working there can be pretty nice, especially for some specialties where private practice can be demanding (Ob-Gyn comes to mind). But I always hear how terrible Kaiser is as a patient....any thoughts on the distinction? I mean, I've been to Kaiser as a patient, and I thought it was fine. But then I didn't really have much in the way of problems so I'm not really comfortable using my experience as a guide. For some reason, probably because of the complaints, it feels like selling out.

And it's not like I have to be making this decision immediately, but I don't even understand if what I think is important is actually important.

Patients are actually pretty lousy at gauging the quality of care they received. In general, Kaiser has excellent metrics due to system integration (which was the main ingredient that was missing in the proliferation of HMOs the first time around). The main issue with not having a private practice is you have to practice the way your employer wants you to to maintain employment. We used to have that freedom in almost any practice setting, but decades of abuse and greed demonstrated we (collectively) can't be trusted with it. So now someone else tells us how to practice and we try to mediate between that and what's best for the patient in front of us.

 

[Daiphon]

There are a variety of opinions. Once you have kids, your freedom goes down dramatically in general and may not have much to do with EM. Some of the docs I work with really like working nights, sleep while kids in school, otherwise home and quite available for them. There aren't that many careers that will allow you to work 8+ shifts/month for such high pay.

Yep. +1 this. I tuck them in, go to work, get them off to school in the AM, sleep while they're there, pick up in the afternoon. Rinse & repeat QD.

It's a large part of the reason I'm a nocturnist... but the holidays still blow.

Sent from my DROID BIONIC using Tapatalk

 

[deleted6669]

Yep. +1 this. I tuck them in, go to work, get them off to school in the AM, sleep while they're there, pick up in the afternoon. Rinse & repeat QD.

It's a large part of the reason I'm a nocturnist... but the holidays still blow.

Sent from my DROID BIONIC using Tapatalk

yup, this is my schedule as well. full time nights. student during the day( 1 course/term) in grad program with a bit of sleep where I can get it. 2 more years to finish the doctorate then hopefully will be able to start fitting more exercise and vacations back into the schedule.

 

[FulfilledDeer]

Patients are actually pretty lousy at gauging the quality of care they received. In general, Kaiser has excellent metrics due to system integration (which was the main ingredient that was missing in the proliferation of HMOs the first time around). The main issue with not having a private practice is you have to practice the way your employer wants you to to maintain employment. We used to have that freedom in almost any practice setting, but decades of abuse and greed demonstrated we (collectively) can't be trusted with it. So now someone else tells us how to practice and we try to mediate between that and what's best for the patient in front of us.

Ooooh. I get it. Like Birdstrike said: now there's only have a choice of which poison. Luckily I have slowly gained a tolerance to Iocaine....

 

[MTFer]

Just an opinion, and I get where everyone is coming from about spreading around greatness - we have all come from a background of "succeed and advance" ... such is the nature of medical school/medical training, etc. And my undergrad degree was in economics, so I totally get the concept that we have limited resources in life and every action/pursuit carries an inherent opportunity cost (being "better" and your family or "having fun" will affect your career) However, I think we need to be wary of the value we place on "being at the top" ... I think it's pretty common for star athletes, big time actor/actresses, musicians, CEO's etc to finally reach "the top" and then struggle with philosophical turmoil/depression when reaching that point doesn't give them the fulfillment and happiness that they thought it would. We are all living lives as human beings, not running a company only concerned with the bottom line ... or how great you are at everything you do. Personally, this is a place where faith and spirituality enter the equation for me (ie what I'm called to be/do), but even in the absence of belief in a greater design, the goal of maximizing performance and eliminating inefficiency in one's life pursuits may not be the path to fulfillment. Ultimately then it's about doing what makes you happy ... whether that's being a bad ass ER doc at the expense of other life stuff, spending time with a family, helping others, maximizing income, travel, food, sports, sex, drugs, rock and roll ... or a balance or any combination of those and other things ... We're in such a rat race culture hung up on comparing person A to person B and determining who's better or more successful ... do what you want to do and what will put you in the place you want to be down the road. Don't get hung up or depressed about the economic realities of life like opportunity cost and limited resources ... there's a reason they call it the dismal science