Sunday, March 15, 2009

Eye Opening...

'What was practicing general surgery like?'

"Horrible!! Absolutely horrible. The ER would call with "this old lady has non-specific belly pain...I'd like you to come lay hands on her?" As if my hands are magical. As if I can really tell what the hell's going on. The ER doc is just trying to cover his ass (which is necessary in a society where patients see a 'normal, expected complication' as an opportunity to get rich), so it makes my workload that much heavier. So, I got lots of these CYA calls. Also, I was oncall every 4th night. And sometimes that would increase if a member of our group was ill, or otherwise absent. The money was pathetic, especially for the amount of time you're available...I couldn't even have a glass of wine with dinner, for fear I may be called in. I wouldn't make promises to attend events, or meet other obligations (that may be more meaningful to my life and well-being), just in case I got called in...or happened to run late on a case. This is a big imposition on your life..

Basically, your life is unbalanced. You miss tons of things that are important to you. You go thru life sleepy and tired...chronically. Your health isn't optimal...and it's all for what? To be called 'a surgeon.' That will get old as your children begin acting out in school....or choose grandpa over you for comfort and snuggles. When they seem to not like you very much...and you feel excluded from their lives. When you have a mild, dull headache from lack of sleep (or some other vital ingredient to a healthy body), on that 1 day off you may have in 10. And, low and behold, if you get 2 consecutive days try to make-up for lost time. Guess what? You *cannot* make up for lost time. So, do you really want to spend your life doing this? And if not, why torture yourself for a decade, give up your 20s/30s, when you could be building something more sustainable....mentally, and physically?

'Any advise for those who may be trying to decide on a specialty?'

Shouldn't students pursue something they'll enjoy rather than a choose based on lifestyle? I agree that you should do a medical specialty that you (think you'll) enjoy. But, how long will you enjoy a miserable lifestyle? Is the practice of 'that specialty which brings you joy' going to be *enough joy* to off-set the absence of life outside of work? Like seeing your kids play little league. Being there at your daughter's dance recital. Taking your kids to a puppet show in the middle of the week at the local library. Sleeping in late on Sunday morning, then going out to brunch, spur-of-the-moment with your wonderful family. Drinking until you're tipsy, and then having great sex with your spouse. Just having time for creative flow of energy, and silence to obtain inner peace!! These things may not be possible if you only get one day off a week...and you have a ton of basic life stuff to attend to. For the rest of your life...imagine 'not having enough time.'

Who runs your household? Grandma or mother-in-law? That may be better than a nanny, but it's still not ideal. A mom who's in her 30s - 40s is a lot more attentive, active, and better able to deal with toddlers/tweens than a grandma. Besides, Grandma has raised her kids...and now it's time for her to be a *Grandma.* It's one thing for Grandparents to be intricately involved, and to hire a nanny for supplemental support as needed. But, if they're raising your kids instead of'll have to consider the consequences of that (for both you, your family, and your children).

Would you rather pay someone to be the Mommy while you're the doctor...or would you rather be home doing the mommy (or daddy) thing yourself? Would you rather have other kid's fathers who have time to coach flag-football on Saturday mornings teach your son how to throw a football, or otherwise be present as the male figure in your son's life....while you're at work being the 'greatest surgeon ever?' It's no wonder that so many old men end up saying "Rosebud" as they lay dying, alone, on their deathbed.

You'll need to nurture your marriage, or it won't last. People (including spouses) will only tolerate so much. Even if you think your wife is "happy staying at home" one gets married to be alone.

You need to be present while your kids are kids. In 12-15 years, they won't need so much of your time...and a large part of your influence over them (your parental guidance) is over.
Are surgeons so cool? Yes and no. The work is like no other. It's exhilarating when you can cut someone open, and fix the problem. It's easy to get an ego...which is almost a requirement if you want to survive the process of training. If you're to compete, and not become an emotional shield yourself from criticism with an enormous ego. This translates to the rest of your life....and your personal relationships will become antagonistic. At times, the only thing in your life going as planned So you hold on to that. Surgeons are as diverse as the population. I'm sure there are some who get off on being a surgeon because everyone says "ooohhhh." But, most people are just as impressed when you say "I'm a doctor." Nothing special (or even distinctive) about being a surgeon to much of the population. So, who are you really trying to impress? Other doctors? Your partner? Yourself? And that ego, that desire for respect and accolades, keeps 'em coming to surgery....even if it's not the right career choice for them. That thought of 'surgeons are so cool.'

Criteria used to decide:I say, decide *overall* what's important to you...and find a way to make those things fit together. This may mean choosing "your second favorite medical/surgical specialty" instead of your dream specialty...if you want a *dream life* overall!!

Thursday, March 12, 2009

The Other Side of the Curtain

So I'm now three quarters through my surgery third-year clerkship [and what, 15 months until my MD? Yikes!] and I'm thinking maybe it isn't the field for me. Not that I don't think the surgeries aren't cool, they really are for the most part, but there's a lot of baggage that comes with a surgery practice that I'm less keen on. There's the time spent in clinic, the time rounding on patients, the notes, the forms, the dictation on the phone, the frequent (and frequently busy) nights on call, the fact that my days run easily 14, 15, 16.....27 hours long, blah blah blah. And this isn't just residency, it's pretty typical of what an attending needs to do in general surgery too. I'm not letting all that cloud the coolness of doing surgery itself, but is it worth it? The money would be decent, but the lifestyle sucks and the practice is only a shining prize under a pile of detritus. I really don't know if that prize is worth the substantial cost.

I sense in myself the perspective that I wouldn't want to live this way my whole life and I would easily end up in a sub-specialty like colon/rectal (which sounds bad, but is actually cool because I have a fondness for the digestive system - don't know why), but once there I'd have to still do plenty of clinic/office time just so I could perform my half-dozen specialty procedures which I fear would eventually bore me. How awful.

So now I'm peeking over the curtain and considering another field: Anesthesiology. It's chock full of procedures (which are my favorite), they get to play with some of the most powerful drugs known to man, virtually no clinic, call is generally more limited and when called it isn't to consult but to do a procedure (intubate/epidural/general anesthesia/what have you). Anesthesiologists can also have a much more varied practice where they can be in the OR, on the labor floor, and in the ER or ICU securing a difficult airway all in one day. People tend to not realize this, but anesthesiologists are critical care specialists (as would make sense since they put people into a state of respiratory arrest multiple times daily) and often run the codes at the bedside. Plus, an anesthesiologist's day is defined by shift parameters so that when a case in the OR is running late, the anesthesiologist is relieved by the night shift at six or seven pm and goes home to eat dinner with his/her family while the surgeons go on working late into the night. And to top it all off, the compensation for anesthesiology is great - typically even better than a general surgeon.

In addition, there's virtually no overhead for an anesthesiologist's practice (which equates into significant freedom of where to live and where to work), they also get to wear pajamas (scrubs) to work all day, and they get to potentially participate in the full range of surgical procedures - pediatrics, plastics, brains, hearts, trauma, etc. - without being pigeonholed in a given specialty. The residency is also shorter, the people tend to be more personable, and the training is far less malignant.

Sounds pretty good, eh?

Some concerns: Would I get bored sitting in the 'cockpit' watching vital signs during those long cases? Will I be jealous of the surgeons and down the line regret my decision? (I have the same worry mirrored that if I'm a surgeon would I regret not choosing anesthesia? Though general surgery residencies have a 20% attrition rate, with most residents leaving for anesthesia. Comparatively, leaving anesthesia for another field is rare.)

Do CRNAs pose a real threat to the practice of anesthesia as we know it? (I doubt it.) Will socialized medicine reign in America to the point that I'd have to fill out more red tape and work longer hours for less compensation? (Same concern I have for most of medicine.)