Thursday, September 10, 2009


I am not really interested in politics, and I'm not really interested in debate. I've been presented with a lot of information about health care and how it's delivered and how the medical system works in these past few weeks. I have some burgeoning thoughts. I have very little time.

So, here's what I'm thinking. I'm going to write them out, to figure out what I think. I'm happy for you to know what's going on in my head, but please don't hold me accountable for having a perfectly coherent picture of things. This is my processing.

It really bothered me that at a "What is OB?" luncheon this week the sole woman on the panel answered the question, "what about your personal life? Are you married, do you have children?" with this answer,

"Yes, I've been married for 10 years. My husband did his PhD and postdoc at UC Berkeley, so we've been apart for 8 of those years, but it has been wonderful to be in the same state for the past year and a half."

Whoa. Seriously?! 8 of the 10 years of her marriage, this lady and her husband lived on opposite coasts during RESIDENCY, not exactly a time when you can fly back and forth every weekend. And that is the "hopeful" answer to work/life balance?

There are like 25 things about this that bother me.

First, I am surrounded by fellow med students who are living hundreds or thousands of miles from their boyfriends/fiances, etc. (I don't talk to many boys apparently =). This is a struggle, but they work at it.

Then there are the number of fellow female med students who are younger and upon hearing really basic things about my marriage act really awed and impressed about it. I say something like, "If we wouldn't have been accepted in the same city, we wouldn't have done it. One or the other of us would have gone to school, or we'd rework the whole plan. We wouldn't have split up for it." To me, that's really fundamental.

Getting married is and was a big deal for me. My idea of what a marriage is involves real, ongoing relationship. I don't see that view as "above and beyond;" I see it as really bare minimum. I get that I am perhaps a little more high maintenance in relationship than the average girl =), and have some serious communication needs. I am not trying to impose my views on other people, but I feel bothered that so many of my incredibly bright and talented peers don't expect a certain level of sacrifice (on both sides) out of relationship. That seems like a disaster waiting to happen. (By the way, when Ron and I were facing the real possibility of no schools lining up, we had a conversation where he made it crystal clear that if someone was giving something up, it was going to be him. He said he couldn't live with himself if he'd been the one to keep me from being all that I could be. If it didn't line up, I was going to med school, he'd go to law school later. So, he's wonderful.)

For many months we had a scenario that involved both of us going to our second choice schools and having a long (but reasonable) commute. He had already been accepted to Harvard at the time, which was his longtime first choice, but we began spending our time choosing to find the good things in our second choices and thinking about how we'd make it work. It would involve sacrifices on both sides, but it wasn't really a question when posed with, "what is more important, your career or your marriage?"

So, it bothers me that my relatively young, impressionable colleagues are being presented with a picture of relationship that normalizes a level of selfishness and promises a robust and healthy relationship under conditions that obviously don't allow for that.

Then, it bugged me that this OB's 80+ hour work week is lauded and impressive to this culture. How is it good for patients to have a physician whose personal life is a mess (or hollow)?

I think the real reason it bugs me is because it scares me. I really love medicine. I love the learning, the future teaching, the ability to positively impact people's health. But, I really love my husband, my family, my friends and my kickboxing too. I am terrified that being an excellent physician is going to push me to give up or squeeze down to nothing these other parts of myself. The work IS just that interesting. I see how it is compelling and you want to do that. But, I don't want to BECOME that.

It isn't like I didn't see this in the business world in my working life part I. But, it is a little easier to see that the girl who spends 90 hours a week at her consulting job making a for-profit corporation more money each quarter is trading off her life for her money. When your job is "saving lives" and "helping" is it healthy or selfish to spend your extra hours away from work? I really don't want the answer to be selfish.

I don't take lightly the responsibility that comes with the privilege of learning to practice medicine. But, I really hate the culture of medicine that honors the overworking.

In Norway, I saw a completely different picture. One of my cousins there has a partner who is an Anesthesiologist. He works 40 hours a week and if he goes over, he takes comp time or gets paid overtime. This was true during his residency and during his practice. I don't quite remember, but I think he's basically employed by the government (government pays for health care). He makes a great living and he has a great life. He said they consider the American physician working schedule "barbaric" and "dangerous to patients." I think he's right!!

Then, there's the part about the patients. It's becoming more and more accepted that working more than 80 hours a week unnecessarily endangers your patients.

But, that aside for the moment, what about the less dramatic scenario? The part where you're admonishing your patient to take care of herself, get enough sleep, eat well, exercise and manage her stress. Why should she believe me when I as a doctor can't keep any of that under control? It sets a bad example.

So, I feel like even though I love Embryology and I'm really interested in Women's Health, I'm afraid to consider OB/GYN too seriously because I don't want to live my life in a culture that constantly is trying to uproot my priorities. I am not afraid of working hard. I'm not even afraid of working long occasionally, or as necessary.

But, I am not willing to trade my work for my life.


Matt said...

Amen to that! I have the same struggle with engineering, although not to that level. I refuse to sacrifice time with my girls to work 50-60 hours a week in order to get ahead in my career. Maybe that means I won't EVER get ahead in my career, but I'm willing to take that risk.

Mystery Robin said...

Wow, I'm so glad you posted your processing on the internet. I see very few people take that kind of stand for marriage and family and you're right, it's a bare minimum.
I saw it in consulting, too. People traveling 6 days out of 7 and only having Sundays with their family. I have lots of tragic anecdotes about that.

I know you're trying to work out right now how you'll lead a balanced life, but I have complete confidence that you'll do it. Once you set your priorities, the decisions make themselves, just like they did with school, and I love that you both still got to go to your top choice schools!

Also, having had 3 babies, I've seen many doctors start out in OB/GYN only to stop delivering babies because of how that took over their life - good call there!!

EMILY said...

My ob only works part time which relates to 40 hours per week. You could always do it that way.