The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, April 30, 2008

Enough Already!

I have stayed mostly quiet on the topic of the Macleans article that hit newsstands in January. It examined the doctor shortage across Canada, gave tips on how to find a family doctor, and looked in particular at the shortages in rural areas. Sprinkled liberally with anecdotes and horror stories, it was intended to sell magazines. It caught my attention, and the Bean and I took a trip to our local Chapters to peruse the article in question over a Starbucks Soy Chai (the Bean is sensitive to dairy). 

It was just another verse of the same song. I've complained about it before. And now other people are complaining about it too. The backlash from the article was heard across the country. Blaming female physicians for the doctor shortage is misguided. Now I know that the plural of anecdote isn't data, but I don't know of ANY female physician throwing it all away to spend more time with her children. But that might be because I don't know many female physicians who are married to male physicians. In the real world, income usually wins out over traditional gender roles. If Mom's income potential is $200K and Dad's income potential is $80K, if one of them is staying home with the kids it sure as hell isn't going to be the one who gave birth to them. Particularly not with med school debt to pay off.

I've said it before and I'll say it again... louder this time, for those of you in the back.


Physicians just aren't like that anymore. Gone are the days of the kindly old doc who has a family practice, delivers babies, does shifts in the emerg, cares for his inpatients in the hospital, does house calls, visits the nursing home, and does coroner call on the weekends. You know the type... known to everyone in the community but a stranger to his own family? Men have wised up. That's not a life. No one ever lay on their deathbed and wished they'd spent more time at work. The popularity of 'lifestyle specialties' is a testament to this. For the past few years, there have been spots left over after the match in specialties like general surgery, orthopedic surgery... hell, even neurosurgery hasn't filled in the first round. At the same time, the popularity of anesthesia, radiology and emergency medicine have gone through the roof. It seems that the only surgical specialties that are still uber-competitive to get into are the ones that offer a reasonable lifestyle on top of the hefty paycheque-- like ENT and plastics. 

Family doctors as a whole are setting up sustainable practices. That means picking a practice structure (FHT or FHN) that lets you leave work behind at the end of the day. That means less call. That means building a practice that won't leave young physicians burned out in 10 years. That means having a life outside of medicine. Imagine the nerve of these young physicians, trying to have it all! Since more women are entering medicine, it MUST be their fault!

Ask any of the old-school docs nearing retirement. They'll back me up. It's not just women. It's ALL new doctors. We're soft. We didn't train as hard as they did-- we didn't have to live in the hospital, we were allowed to be married. We got days off. We're paid. Our residency is shorter. We are protected by a union that enforces the rules and keeps us from being used as slave labour. We aren't willing to be on call. We protect our leisure time with the ferocity of a rabid dog. We don't want to work more than 60 hours a week. How dare we.

Why complain about it? The evolution of medicine has been positive in many respects. We aren't paternalistic, and medical decisions are now made with the patient calling the shots. We listen. We consider more than just the illness (in family medicine, anyway) but the social context. We have lives outside of medicine, and protect the longevity of our careers by not working to the point of suicide or burnout. We make a decent living, but are more likely to choose a smaller paycheque in order to work fewer hours. And what's the harm to the system? Well, maybe we'll need a few more doctors. We've seen that coming for years. And those doctors will be better people for the choices they've made... none of which can be attributed solely to gender.

Saturday, April 19, 2008

Medical Spouses, Revisited

I was reading with interest the blog postings over at Edwin Leap's place regarding the wives of doctors. It's a topic that is of interest to me, seeing as how I don't really understand how anyone would knowingly choose to marry a doctor. I have sung the praises of my own medical spouse here before. What was more interesting to me was the fact that Dr. Leap didn't know any husbands of physicians to include in his interviews. Interesting. I can only infer from that fact that Dr. Leap is considerably older than I am, since the year that I graduated from medical school over 50% of my graduating class was female. And of that class, everyone who matched to emergency medicine was female. 

But I digress. I just figured I'd give Dr. Leap a hand from the other side of the fence. On behalf of my husband, here is what sucks about being married to a doctor (some specific to emergency medicine, some not):
  • Clerkship and residency. Nothing about this part DOESN'T suck. You watch your spouse work themselves into the ground, miserable and sleep deprived and can only hope to God that things will get better. Sometimes they don't. (see: surgeons)
  • You marry their debt, too.
  • The not-so-subtle insinuations that you're a kept man if you're married to a doctor
  • The assumption that you're rich because your wife is a doctor
  • Having to socialize with other doctors
  • It's a job that's hard to leave at the door when they get home
  • Often unpredictable work hours... just because their shift ends at 8pm, doesn't mean you'll necessarily see them home before 11pm. And you're expected to take that in stride.
  • Your career often takes a backseat to their career, whether you like it or not.
  • The possibility of bringing home more than they bargained for-- Norovirus, influenza, hepatitis... all real risks. 
  • The assumption that because she is a doctor, your wife is a pompous know-it-all.
  • Childbearing delayed for longer than biologically ideal
  • Holidays rarely being celebrated on the actual day, causing issues with extended family.
  • You don't have to worry about nurses preying on your spouse (as mentioned by Dr. Leap) since the majority of nurses are still female. Then again... 
What doesn't suck about being married to a doctor?
  • Good income, once the debt is paid off.
  • Wearing scrubs to work means less laundry
  • For most specialties, your spouse is employable pretty much anywhere-- nice flexibility.
  • In the case of emergency medicine, you will have a spouse whom you actually see and can spend time with.
  • I'm cute. :-)
In all seriousness, I wouldn't have married me. My husband is a glutton for punishment. 

Thursday, April 17, 2008

Random Thought for the Day

I was talking on the phone with my cousin today. She just had her second child by repeat c-section. She had her first by c-section as well. So that got me thinking.

As my loyal readers know, I had a c-section back in December with my first (and possibly only... the happy amnesia hormones haven't kicked in yet!) kidlet. My indications for section were listed on the OR report as 'left occiput transverse causing arrested second stage". In English, that means that the Bean's head was turned to the side and wedged behind my left hip. I pushed for 3 hours in a variety of interesting positions, but he just wouldn't turn into a birth-able position. My midwife was wonderful, but after 18 hours of labour to have to have a c-section felt frustrating and disappointing.

And then I thought about everyone else I know who has had a baby in the past year. Doing the math in my head, my rough estimate is that about 90% of my friends who had a first baby this year had a section. And only two of those (out of about 15 or so) were scheduled (one was breech, one had pre-existing medical conditions)... the rest were 'failed' attempts at vaginal delivery. All the reasons seemed legitimate-- fetal distress, not dilating past 6 cms, that kind of thing. But the c-section rates in my circles seem abnormally high. So my first thought would be to wonder what is biasing my sample.

My friends are all relatively young (between 25 and 35) although perhaps a little older than biologically ideal for a first-time mom. They are all professional and well-educated, healthy and fit, and all work full-time. But that's where the similarities end. They have a variety of body types (short to tall, tiny to less tiny), have a variety of careers (pilot, teacher, sales, medicine)... none used reproductive technologies to get pregnant. The time it took them to conceive range from "oops, we're pregnant" to nearly a year. None of them were "too posh to push", and all but one had intended to birth vaginally. Every reason they were given certainly sounded more legitimate than "let's move this along so that I can get home".

Is there something fundamentally wrong with us that so few women are able to birth vaginally these days?

I find this odd.

Monday, April 14, 2008

The Reality

This week I had to head back to the Centre of the Universe (home of TBFTHITW) to do my ATLS course. That's Advanced Trauma and Life Support for those of you not in medical circles, an intensive two day course designed to prepare doctors for dealing with various trauma situations. It's a great course, and I've been meaning to take it since first year of residency. But it was never in convenient places, never at convenient times, and it cost over $700. So the time was never 'right'. But I need it to work in the emergency room, and I'll be ready to work independently very soon. 

No biggie. So load up Mr. Couz and the Bean and head down for a weekend of fun and trauma, right? Except the Bean still screams bloody murder from the moment he's put in the car until the moment we take him out.* The COTU is about a 5-6 hour drive away. A variety of other logistical reasons made it increasingly obvious that bringing the family with me was probably not the smartest thing to do.

So on to plan B. I was to go alone. There was enough expressed breast milk in the freezer to easily last a few days, and I'd bring my pump with me to keep up my supply. A breast pump is not a glamourous thing at the best of times, but we do what we have to. The course coordinator promised that she was sympathetic to my situation and there would be a place for me to pump during the course. And there was. An empty auditorium with windows in the doors that was open for any random people to wander through. Um, thanks.

So there I was, sneaking out of my trauma lectures every 3-4 hours to get intimate with my breast pump while sitting on the floor of the handicapped stall in the women's washroom. 

It doesn't get more glamourous than that. We'll see how well this pumping thing works out when I'm back to work in May. He'll only be 5 months, and I'd rather not wean him quite yet. 

This Dr. Mom thing is tricky.

*And to those of you who have ever said 'he'll just cry himself to sleep', I wish you were in the car for our entire 8 hour ride to grandma's house. Four 15 minute naps were the only respite from the screaming and crying. We're transitioning him from the infant bucket seat to a rear-facing convertible carseat in the hopes of helping the problem. Cross your fingers for us. 

Sunday, April 13, 2008

Running the Recruitment Fair Gauntlet

Recruitment fairs are commonplace in my neck of the woods. Communities are looking for doctors, and are eager to lure new grads to check out what they have to offer. This can range anywhere from free housing to locum physicians to incentive grants and pens with the community's name embossed on them. Woo-hoo.

Last week, we had a local one. It was restricted to communities from the north, so not as broad a scope as the annual "Physician Recruitment Fair" that tours the academic centres in southern Ontario every fall. As I am still unsure of what my future holds, I decided to attend. And since he gets as much say in it as I do, Mr. Couz came along. And we brought The Bean, which was our excuse to make a speedy getaway if needed. 

I was quickly reminded why I hate these things. Picture a long hallway, flanked on both sides by booths plastered with posters staffed by eager recruiters reaching out at unwitting candidates as they pass by. Sometimes they are joined by physicians from the town in question, or various local politicians or hospital CEO's. Often they have tables covered with pens, corkscrews, canvas bags and other various pieces of junk emblazoned with the community's name. 

According to Mr. Couz, I am far too polite at these things. I was really only interested in two particular communities... towns that were large enough to have an emergency department that had dedicated emergentologists (as an aside, I'm not sure if that's a word... in Quebec, however, I'd be an 'urgentologue') rather than family doctors who staffed the emerg. Plus Mr. Couz and I have a longstanding agreement about how far away from our families we're willing to be. Our view is that if we're going to be far enough that air travel is required to see them, we might as well move to Victoria where the cherry blossoms bloom and the weather is perfect all year round. 

In spite of the fact that we went to the event with the intention of just speaking with those two communities about their return-of-service agreements and whether or not they're hiring this year, I managed to get waylaid by nearly every small community in attendance. And I always feel compelled to politely hear them out, even if I have no intention of moving my family to whatever godforsaken place they're selling. 

I don't know why these things make me so damned uncomfortable. I feel bad for the communities trying so desperately to recruit doctors. It's one of those things that makes me feel guilty for not practicing family medicine. But I know I'm not what they're wanting.