Advice Wanted - Retreat Weekend

DW and I are going away for a weekend together, leaving the kids with her parents; we'll be gone for two nights. We're framing it as a "retreat" for the two of us and we're going to spend most of our energy on the normal couple time stuff but we're also going to talk about and try to plan a bit of the next 5-10 years.

Which is where the request for advice comes in. What should we be thinking about? One thing that we're going to try to do is envision different kinds of practices -- so try to figure out what we want our lives post-training to look like -- and work backwards from that to what residencies can achieve that, what clerkship electives to choose, etc.

And then there's residency -- on the one hand, residency is temporary, but on the other hand, it's FIVE YEARS OF (temporary) HELL which could easily add another 2-4 years if her interests change, so it's kinda important.

[Inicidentally on residency - right now the most likely residencies she would want are Endocrinology, IM, Family, Family+mini-Endocrinology semi-fellowship, or maybe Emergency. She likes endocrinology and managing diabetes (she's on an endo consult/clinic service right now) and the first four are all different ways to do that. Emergency is something she's not sure whether she's attracted to, but hasn't had a chance to rule out yet. But this is very much subject to change.]

But as to the main thing - thinking about what we want our lives to look like after training -- what should we be thinking about? I'm thinking stuff like where we're living; where she's working; where I'm working; what sort of school arrangements we have for the kids; financials from her and my work, loans, mortgage etc; number, frequency and timing of vacations; things like that.

Are there things about post-training career that didn't seem to matter much beforehand but suddenly mattered a lot afterward? (I'm thinking about personality match of other people in the practice, maybe?) Is there anything you wish you had known before residency/post-residency decisions were made? If you could go back in time and tell your ten-years-younger self anything, what would it be?

I have the Surviving Residency book and I'll be reviewing it for ideas beforehand, and bringing it along too. Any other book recommendations? I got the AMA "The Medical Marriage" book from the library last year and read it, but didn't find it very helpful... is it worth re-reading?

Thanks!

[MDPhDWife]

Although it isn't specifically relationship based, I bought DH a book called "The Ultimate Guide to Choosing a Medical Specialty" a couple of years ago and we've both referred back to it several times since then. http://www.amazon.com/Ultimate-Guide...ref=pd_sim_b_1 It was written a few years ago so keep in mind the salary estimates in there may be a little outdated, but otherwise I consider it a great source.

Have fun and I hope you and DW enjoy your weekend!

Although it isn't specifically relationship based, I bought DH a book called "The Ultimate Guide to Choosing a Medical Specialty" a couple of years ago and we've both referred back to it several times since then. http://www.amazon.com/Ultimate-Guide...ref=pd_sim_b_1 It was written a few years ago so keep in mind the salary estimates in there may be a little outdated, but otherwise I consider it a great source.

That is a great book!

I'd focus on the "couple stuff", with a discussion about possible specialty choices, but try not to obsess to much about the rest of it ... for now. Sooooo much depends on specialty choice -- from what kind of residency experience you'll have all the way to what kind of employment opportunities she'll have (and I know NOTHING about how that works in Canada).

If I were you, I'd push EM ... hard. 3 year residency, shift work -- man -- if I could have sold that one to dh (or even knew to try), I'd have done it in a heartbeat.

[poky]

If I were you, I'd push EM ... hard. 3 year residency, shift work -- man -- if I could have sold that one to dh (or even knew to try), I'd have done it in a heartbeat.

I think EM's actually 5 years in Canada (or 4?) Still not horrible. I'm glad DH is still leaning that way!

[Ladybug]

We know a lot of female endocrinologist that have a great lifestyle. I'd say it's a solid choice for balance. I think EM can be hard when you have to work night shifts, etc., especially as a mom. Personally, I'd enjoy the more long term patient relationships that come with endocrinology too.

The biggest thing I would go back and tell myself is to minimize the debt while in training and start off slow afterwards. It sounds like a lot of money but it goes quickly with loan repayments, starting with nothing, etc.

Above all enjoy this weekend together!!!

[Vanquisher]

I don't know much about endocrinology, but I would push ER hard too. Also, make sure to take a close look at the ROAD specialties. Sometimes, people spell it ROADE (radiology, ophthalmology, anesthesiology, dermatology, and emergency). They are considered to be a great combination of lifestyle and money.

I wish I had pushed harder for the ROADE, but if any of those are contenders, consider them highly. If money isn't as important, there are other specialties that provide a lot of time and really easy residencies. Physical Medicine and Rehab, for example, I think those docs work a "long" day if they are still at the office after 2 p.m.

[DCJenn]

Our peds endocrine pals (all military) seem to have a pretty nice set up (other than that pesky deployment thing that your wife wouldn't have to worry about) and enjoy it still. How does she like working nights? If she hates it, then EM might not be such a great match. I don't know about in CA but here a lot of the ROAD specialities are getting hard to match in to precisely because they're pretty sweet hours and pay comparatively.

There's a massive shortage of child neurologists, in case she's interested!

Jenn

I don't know much about endocrinology, but I would push ER hard too. Also, make sure to take a close look at the ROAD specialties. Sometimes, people spell it ROADE (radiology, ophthalmology, anesthesiology, dermatology, and emergency). They are considered to be a great combination of lifestyle and money.
.

Hmmmmm....we're one of the ROADE specialties (gas), and I would not consider it a lifestyle specialty from what I've seen from DH's job for the past 5 years. DH works 75-80 hours per week (sometimes more) and I feel that I barely see him with all the in-house call he has, including two weekends per month. He comes home exhausted every single day and needs to take a nap just to make it through the evening.

[SuzySunshine]

I think everyone can make general statements about specialties - but regardless of the specialty it is JOB specific. We have a friend who is an ER doc in Boston and it seems like he's home ALL THE TIME! We have friends here who are both anesthesia and radiology and they have great hours too. We have a friend that is derm that had great hours then he opened his own practice so now he works a little more. Here the clinic employs a lot of CRNA's so the anesthesia hours are good. Some clinics don't have CRNA's so the hours are more.

[Deebs]

I can hardly respond to this thread. I almost didn't because I love this board and know you are all well intended (and I'm really toning down my response because I love you all and know you're well intended). First of all, it is a little premature to be choosing a specialty. your SO really needs to start doing rotations to see what she likes and where she fits. If you want to encourage her to choose rotations that may be easier on your family with the hope that she will fit into one of those specialties, go for it.

As far as EM being a lifestyle specialty, it really depends on how you see that. We have MANY friends who are in EM in MANY states at MANY different types of hospitals. DH is really active in ACEP, so we've met all of these people also in various stages of their careers. I really think this is a specialty that you do if you can see yourself doing nothing else (much like surgery). If I were working outside the home, there is literally one day this month I would have had off with DH. Most of his days off are during the week. He is almost, without fail, off on Wednesdays. Most months, he gets one weekend off. Some months, he gets no weekends off - this is not unusual! He also works at least one of the major holidays. Every year. Most EM groups don't get their schedules out far in advance (which I realize makes no sense). There are groups that schedule 12 months at a time, but they are few and far between. It makes scheduling a family life very difficult.

We have had weeks, as an attending, where DH has not seen the kids for over a week straight. His "shifts" don't always end at their scheduled time, and there are times that he leaves before the kids are up and doesn't return until after they're asleep. Nights are hard. There is no sleeping in the ED, unless the doc is in a really slow ED (most board certified docs wouldn't even look at those hospitals). A night shift means the doc is up all night working. Good luck doing anything the next day and good luck returning to days.

We had a birthday party last year where DH had lost not one, but two babies the night before. He really wasn't in the mood to be with a house full of children. The only specialty that loses more patients is oncology. This is very difficult to deal with.

EM has a really high burnout rate. DH and I really think the docs that burn out tend to be the ones who went into it thinking there is a ROADE with an E, and then realizing that the pay doesn't come close to the other ROAD specialties, and the lifestyle isn't anything similar. In general, higher paying jobs in EM are the jobs that are tough to fill. Chicago, for example, is a lower paying market because there is a plethora of docs. Texas tends to be higher paying. If your spouse sees themselves in nothing but EM, he/she will go to work and come home from it in love. Otherwise, he/she will burn out. After me saying all of this, DH really does think he has the best job in the world, and him being happy makes my life much easier.

OH - and EM is WAY preferred to any surgical specialties, which I do think constitute hell on earth. I'm with the suggestion of encouraging her to do a PM&R elective to see if she likes it. Her last call will be at the end of intern year, liability is low, low, low, and hours are great. Many med students aren't even exposed to that specialty.

RANT OVER.

All that being said, I get where you are. It's a really unsettling time. Med school is so difficult because you really have no idea of your future. I can't even think of the number of times I said "if we only had a crystal ball." If you have the need to plan, I'd focus more on whether or not you're going to limit yourselves geographically, what types of rotations she's going to goal for during med school, etc.

Thanks, everyone. All of the feedback is very useful.

I think what we're trying to figure out is more like: in ten years, do we want to be just settling in to our 3rd place, or have stayed in the same place? And how much does that matter to us, overall? And: does she want to do private practice, or also academic things like resident education, research (and if so what kind?).

Right now she's on her first almost-rotation and is really liking the mix of research, clinic, and consult; but it's all fresh and new and fun and the scutwork doesn't feel like scutwork yet, (not that she's allowed to do anything, anyway). Her real rotations start next March, and her electives will be front-loaded (what electives there are, since that's mainly what got deleted in turning a 4-year program into a 3-year one), so we are starting to think about that.

I ran into an acquaintance from the neighborhood yesterday at the park. She's a hospitalist on the hematology wards, and she did her residency here (FM, ten years ago), so she was able to give me some concrete information about what it was like for her. Her strongest piece of "advice" was to choose a specialty that there will be jobs in, in ten years. Pass the crystal ball.

[Michele]

Re: Advice Wanted - Retreat Weekend

I'd have to second the advice that you can't really "choose" a specialty at the start of med school. Russ ended up making what I would consider a 180 flip at the last minute and now I can't see him doing anything else.

In HS anatomy lab he threw up during the eye dissection. In college his research and coursework was heavily biased toward neuro. He started med school thinking OB an Rep Endo. During rotations, he loved his neuro rotations. Then at the last minute he had an Ophtho class and loved it and scrambled to get a rotation in before the match. I'm glad he chose something on the ROAD but he wouldn't even consider them in the first year and a half of med school. He actually had to work harder to get his application ready because he was so far behind when he decided on Ophtho (early match).

And not all of his Ophtho aways were equal. If he'd have only done one he may not have continued with it. But it's a tech-y, gadget filled specialty that really fits him.

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[oceanchild]

I think everyone can make general statements about specialties - but regardless of the specialty it is JOB specific.

Yeah, I agree with this. Nobody puts peds on the ROAD, because the pay isn't very good (comparatively), but there are lots of ways to structure a peds career, and it's one of the more flexible fields in terms of working part time or job sharing. So I think those are the questions you want to be asking. Even if you don't know WHAT you want to do, HOW do you want to do it? What do you want both of your careers to look like?

We have been having these conversations from time to time for years, and we're slowly getting a handle on what we'd like. Don't expect to have all the answers today.

Re: Advice Wanted - Retreat Weekend

my .02 cents:

Focus on the next two years. This is not to say, put everything else on the back burner. It's just that the setup and prep you guys do now can help you down the road in going through the application, interview, and match process, which impacts residency, which leads to all of these other things we'd love to have the crystal ball for. Encourage her to network, join an interest group, a journal club, a volunteer group with a patient population she's interested in. (In other words, keep building the C/V.) Suggest she start forging relationships with the people who will write her recommendation letters. Remain open to change. Even if she changes 180 degrees by the end of med school, those relationships with her mentors will be invaluable, both in helping you guys navigate the application process, as well as serving as references, either on her behalf directly, or perhaps by introducing her to the person/people who will write her recommendation letters in the area she ends up applying to.