My place in medicine...

 Last month, there was an op-ed piece in the New York Times written by a physician and mother, Dr. Karen S. Sibert, arguing that women working part-time in medicine accounts for a significant portion of the current doctor shortage. She highlights some of the other problems leading to the shortage, such as not enough residencies, lower salaries due to Medicare and Medicaid cuts and malpractice lawsuits. However, she settles on putting a disproportionate amount of the blame on women, particularly mothers. I haven’t been able to get this article out of my head, and in particular the expert that follows: 

“Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especially — to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.”

The full article can be found at http://www.nytimes.com/2011/06/12/opinion/12sibert.html?_r=2&src=me&ref=general. 

Ten years ago I hated almost every vegetable, today I’m a vegetarian. When I applied for medical school two years ago, when I entered medical school last year and even today I don’t believe I want children. But, as my mother and my vegetarian status can attest, I’m a fairly fickle person and ten years from now I may want children. I realize at the absolute earliest, I will complete my formal medical training right before my 29^th birthday. In reality, due to my current interests, the date of my completion, when I become a “real doctor” will be after my 30^th birthday. I realize now and I realized when I applied to medical school that this career was more of a vocation requiring more time, care, attention and morality than most occupations. These indeed were the qualities that lead me to medicine.  I try to think of what my response would’ve been to the question Dr. Sibert poses above if it was slipped into my medical school interview.

Interviewer (almost always inevitably a PhD. who wants to talk about my research for too long): Tell me about your research project, your role in the project and your contribution to your published papers?

Me: Emery-Dreifuss Muscular Dystrophy blah blah blah… (I hope I’m explaining this correctly, I think this guy studies nuclear membrane proteins too. Ekkkk)

Interviewer: Are you going to have children and as a result cut back on your hours of work (because god forbid your husband/baby daddy cut back on his hours)?

Me: (stares blankly for a few minutes) I just turned 21???? The sight of a pregnancy test in Target terrifies me.

Interviewer: What are you suggestions for dealing with the organ shortage? (Or other ethically challenging question)    

In the future, I see myself as a full time doctor no matter if I have children or not. But, to place blame on the people who do decided to devote more time to their children is inappropriate and actually quite useless. I’m sure I am not the only person in my class who has yet to cast their vote on the mommy/daddy job and I’m positive no one in my class is using medical school as a fun way to wait out the single life. There is no way you would torture yourself with this much studying or student debt. However, I’m confident there will be those in my class, who after a pain-staking process decide to cut back hours or leave medicine to assume a bigger role as a parent. They, however, couldn’t predict this future in their med school interview. The solution to the doctor shortage doesn’t and shouldn’t lie here.

 The keynote speaker at my classes’ White Coat ceremony was Dr. Jennifer Niebyl. She graduated from Yale, in a class of 100, with only 5 female students.. She went on to train/practice at New York Hospital-Cornell University Medical Center and Johns Hopkins Hospital before coming to Iowa in 1988. She joined the staff at Iowa as the Department Head of Obstetrics and Gynecology. She was the third OB-GYN department head in the country. She is a role-model for all young physicians to be, especially women. I’d heard her speak before the White Coat Ceremony and I’ve heard her since, and her message always remains the same:

“As an obstetrician-gynecologist I want to talk to you about reproduction.  Have your children while you are young!  It is biologically easier, you are more likely to succeed in having a pregnancy, and you have a lower risk of a Cesarean section.”

This is my one and only life. I’m devoting most of it to medicine and I’m utterly grateful that I’m allowed to do this. I know how hard applying to medical school is. However, being as it is my only life I have some other plans. Maybe one of those plans will be having a baby and maybe I will have to make some adjustments to my work (more ideally my future husband would but sadly we live in reality) and that’s okay. This year my friends and I each created a “30 under 30” list. We have seven years to do the thirty things on our lists and only one on my list is medically related. Medicine is my devotion…but I have plenty of other interests. 

I found a rebuttal I was very pleased with and helped my stop fuming from the NYT’s article, http://www.psychologytoday.com/blog/wont-hurt-bit/201106/the-mommy-wars-medical-edition. Since reading Dr. Michelle Au’s rebuttal I got her first book “This Won’t Hurt a Bit (and Other White Lies): My Education in Medicine and Motherhood", and devoured it quickly. Thank goodness for my Kindle in Romania. It restored my faith in the opportunities and choices that lie ahead in medicine and made my hair stand on end with fret for the USMLE and Match Day. I would recommend this book to everyone – especially my classmates – it’s smart, funny and honest. She has also writes a blog that she began as an M2, http://theunderweardrawer.blogspot.com/. The book has a short portion on pre-med and the pre-clinical years of medical school. I got to read my exact thoughts written in a concise funny way. I decided to glance back at her old med school blogs and found her complaining about an Immuno test and her professor expecting them to write 3-4 sentence essays on the broadest topics in the world without leaving out a single detail or chemokine. I guess Immuno sucks everywhere.

I have some lofty expectations of my future career in medicine. I hope to be able to practice clinical medicine, teach, work abroad and work on health policy. I don’t know if all these things are possible but my idealistic med school self refuses to give up before trying. And if I want to add mother to my resume, by god I will try to fit that in to. I just hope my maternal instinct, if I have one, heeds Dr. Niebyl’s warning and kicks in before I’m 40 and I require in vitro fertilization. For now, my baby Dylan is okay with me being gone long hours and spending a summer in Romania.  

Dylan