It can be a roller coaster, folks. This life of putting your hands, needles, and scalpels on people. A week in the life of a superheroine can be trying.
One week I am lauded for saving a life, and the next week, I can deeply disappoint patients and colleagues. That’s the way it is.
I just need a mantra at these moments: “I can’t destroy my reputation with one procedure.”
That’s my hope, at least.
No pressure, right?
Of course, there is pressure. It’s peoples’ lives and limbs at stake here.
So I messed up at work. Like I really made a really stupid, thoughtless mistake. I haven’t made this exact error ever before, and I haven’t made a comparable error in years. But when you do a thousand procedures, you might make a dumb mistake in there somewhere. It sucks, but it’s true.
This error is something I did, and I did it alone. I confirmed the plan with the nurse in the room, and then 5 minutes later proceeded to do the procedure on the wrong side, and my assistant let me. It’s not his fault, he lacks experience, and probably couldn’t even see where I entered the skin, with the fluoroscope blocking his view.
I didn’t recognize my error until hours later, as I went to dictate the case. Right. I worked on the right side. The pain was on the left. My face flushed, and my head slumped into my hands. Fuck fuck fuck fuck fuck. No no no no no. Not on this patient. She had already been through enough. Why would I do this, when I should have been paying attention? Everyone matters and is theoretically equal, but if anything, I should have been hypervigilant in this case. This patient trusted me implicitly, and I let her down.
I felt nearly incapacitated with shame for the rest of the day. I notified the department manager, who entered an incident report. Will they take my license over this? I don’t think so…
As often comforts me in these cases where the outcome is short of what I’d hoped, I tell myself, if no one died it’s going to be okay. The thing is, I told the patient there were serious risks, and then I proceeded to work on the wrong side as if I didn’t take it seriously enough. I stated the gravity of the rare (but real) risk and then disregarded it with my actions.
I spent the afternoon trying not to hate myself for making a mistake. Trying not to blame anyone else, because that’s my go-to move when I feel vulnerable or hurt, is to blame. It is certainly not a tendency I’m proud of, and it’s one I’m actively working on. Blaming fills some kind of need in the moment, in a maladaptive way.
I felt horrible making a mistake. Later that night, I was called in emergently to care for someone who was bleeding to death. I selected the bleeding vessel instantly as if driven by some sort of dumb luck. Incredible fortune, I thought. I was lauded by the vascular surgeon who came in for an update, just as I’d finished. I did my show-and-tell, pointing to my angio and embolization on the screen, as he admired my work.
“Great job,” he boomed. “You saved a life!”
I muttered, “After the day I’ve had, I guess I had an easy select coming to me…”
My new colleague and I exchanged phone numbers and parted ways. The patient was coming off blood pressure support. A victory, but in the shadow of my mistake.
The next day, the victim of my error returned for her procedure: for another chance to get it right. She was gracious and listened to my apology. The case went well. I think it will help her.
I returned to the ICU and the person I ‘saved’ the previous night is now on four vasopressors. She stopped bleeding but her heart couldn’t take the insult. Does this feel like whack-a-mole to anyone else?
And riding the emotions of a week in the life of a superheroine can feel like being on a roller coaster. I’m not going to lie. In one way you’re up, in another way you’re down. It balances… sort of. If you’re a good doctor, you care… and people are sick. Outcomes can be good, bad, and everything in between.
And this is to say nothing of those who greet you at home, from your fur babies to your partners and children. They add other (mostly) wonderful variables to your life: they can make the roller coaster ride sharply turn left or right, as it coasts wildly up and down.
Back at work, you can be a savior, a dunce, and everything in between. But this is the life we chose- a life of one challenge after the next.
“Why not?” we probably thought at some point. We are talented and bright, and we can do so much good. It’s just that in these moments– and in these tough weeks– the challenges overwhelm. The shame stings. We try to help people as doctors, and we’re not perfect, no matter how hard we try, or how much we wish we were.
I’m just being transparent. This is not a boring, stable life. Not for me, not this week. This is a week in the life of a superheroine.
If you are feeling some similar way, I’m sending my solidarity and hugs to you, superheroine.
Motherhood as a female physician has been an incredible journey so far, overall. It’s gratifying, joyful, and exhausting. It’s a rolicking sort of balance. I love it. But I’ve noticed that working moms get a lot of subversive messages that can make us wonder if we’re doing a good job or not. There’s a lot of talk about overwhelm and mom guilt in the media. It’s true, I work more than 40 hours per week as a surgical subspecialist. And I’ve felt “cheered on” at times as a working mom. But many times, I have felt pressured to be as close to a stay-at-home mom in my free time as I can, and that’s a recipe for burnout. I’m here to tell you that if you choose this life– the life of a doctor mom (or dad), you will need to decide how you feel about it, ideally without the interference of others. You can’t let those societal messages hijack your brainwaves. It’s way too easy to let others’ opinions steal your joy, and you don’t have to let that happen. I’ve decided to reject parts of the societal narrative on mothering in order to create my own definition. And I’m a great freaking mom. Here’s my perspective on how my being a doctor really affects my kid.
As my kid transitioned from diapers to the potty, and words to sentences, I wondered when he’d come to know what I did for work. He’s four, and I thought this revelation might come later, at 5 or 6, as he gained some awareness of different occupations in the world. But it happened earlier, when I introduced the book, “Is Mommy a Doctor or Superhero?” by Dr. Amy Faith Ho, an emergency physician. It has really helped him get him acquainted with the idea of having a doctor mom. This book explains why mommy sometimes has to leave late at night to go to the hospital, something he’d started to notice happening. Sometimes his dad has needed to take over for bedtime, as I’d head out to embolize a bleeding organ. Wes was fascinated by the scenes in the book, and excitedly asked to read it again and again.
It warmed my heart to see relatable scenes in the book, like mom getting patient related calls at the playground. The book illustrates nurses and patients on the other end of the phone. This helps explain the doctor-mom life so well, in simple terms that kids can understand.
One of Wes’ favorite parts of the book is when the little girl can tell if her mom had a good day or a bad day. There have been times I came home and cried after a hard day. Through seeing my emotion, and with the help of our reading, Wes is able to cultivate an understanding of his own emotions, and hopefully, empathy.
Being a physician exposes my kid to a network of amazing people he might not otherwise know. One of them is his pediatrician, who is a friend we get to see on a regular basis. She is part of a special group of kind, brilliant, and understanding moms, all of whom are physicians or married to one. Were it not for my line of work, I might not have assembled such a group of friends. We were brought together by the common lifestyle of the physician/ professional mom.
It’s true that my current position occupies more hours of the week than I’d like right now. I plan to tweak that in the future, especially as Wes needs me more. But for now, I don’t dwell on the hours we are apart. I can see countless benefits of his spending time with the various people in his life. They are his whole village, and he’s learning more from all of them than he could from me alone. We have our own special bond as mother and son, and that bond doesn’t require a certain number of hours to maintain it. Nightly bath time, bedtime, and so many other times are ours. Consistent quality time and an amazing community really affect my kid.
As the breadwinner in the house, my work not only helps others, it helps us too. My kid has a roof over his head, and chicken nuggets in his belly. Because of my toils, my son will grow up with a level of privilege experienced by about 1% of kids in the world. Is that a good thing? I think so. We have a lot to teach him about the responsibility that comes with that privilege, and we will have the resources to put toward the effort as well. This will have a massive effect on my child as he grows and enters the world as an adult.
I was inspired by this tweet from a fellow interventional radiologist, proclaiming his love for tumor ablation, and his pride in sharing his win with his teenage son. I can imagine such an exchange with my little boy in the future.
My little sprite doesn’t yet know what cancer is. But I look forward to the day when I can tell him I killed someone’s cancer. Doctoring is worthwhile work, and seeing us live this way benefits our kids and their development. So if you have kid(s), or would like to someday, don’t let a medical career stop you.
You may not be room mom, or make cupcakes from scratch– or maybe you will, if you choose to prioritize those things. Through your actions, you will model one of the many ways in which to live with purpose and meaning.
Loving your kid(s) doesn’t have to conform to a schedule. You can love them in a thousand of ways, and it’s okay if some of the traditional moves don’t fit into your doctor-mom schedule. There are so many ways to love my son, I know I’ll be doing them for the rest of my life.
So I ask you to consider this: what if it’s not just mom guilt, heaviness, and sacrifice, the way it can be painted sometimes? What if what we do during the day inspires our kids? No matter the path they take, our example will stick with them for years, maybe through their entire lives. My being a doctor really affects my kid, but not in the way some would assume.
When I stop to think about it, what more could I want for him?
As an interventional radiologist at a trauma center, I also happen to be a human and a mom. You might wonder, how do I balance the sometimes demanding, unpredictable schedule of emergency call with the rest of my life? Well, I take a week off nearly every month, for a total of 10 weeks per year. That might sound like a lot, when you’re used to 3 or 4 weeks off per year as a trainee! So what does a momma doc actually do with all this time off? Here the top 10 things you’ll find me doing in my spare time.
1. I’ll extend my morning routine. This might involve sleeping an extra few minutes, but I don’t sleep in like I used to pre-child. I get my little man ready and off to pre-school by 8:30. We have some time for coffee, breakfast, and potty. This gives my husband a break, since he does toddler mornings when I’m working.
2. On a week off, I’ll head to some appointments. Whether I need a skin check at the derm, new tires, or a sit-down with my accountant, it’s all part of self-care as a mom who also works outside the home! And every week off is an opportunity to see my therapist, who helps me with relationships and stress management.
3. Eat healthy food. I fast until 11, then fill up on some eggs and avocado toast. If I crave something sweet or feel like a bottomless pit, I might make a protein shake from Body Love.
4. Whether I’m working or not, I blog. When I’m off, I have more time to brainstorm upcoming topics to share here. I’ll also write drafts, edit, format, and publish posts. I used to plunk down at a coffee shop for a few hours at a time to do this, but I’ve gotten more efficient with practice.
5. Manage the finances. I look at all our accounts, and make sure the money is going where it’s supposed to. How is my 401k balance doing? Do I need to reinvest some dividends? How’s our progress toward savings goals? Or do I have excess cash lying around, looking for a job?
6. Most days, I aim to get outside with my little dude, who is three. Whether we head to the park after school, or visit our equine friends at the local stables, we make it a point to get out for some desert sunshine.
7. Hang out as a family. This can involve a trip to the local air museum, bubbles in the backyard, or recording the latest musical sensation in our little studio.
8. In the evening, I’ll sign and send some copies of Save Lives, Enjoy Your Own. I love my label printer, which reminds me of my play cash register as a kid. Any chance I can feel like I’m playing is a win!
9. Strategize how to reach more people with my book and its message. This involves researching people of influence like medical school Deans and podcast producers, so I can introduce myself.
10. Though most weeks during the pandemic involve staying home, my list had to include checking off a bucket list item. A recent example: I’d been dreaming of seeing Grand Teton National Park for a decade. So I convinced my husband to get on board, and we piled in for our first socially-distanced RV adventure, traveling from Palm Springs, California to Jackson, Wyoming.
Was it worth the drive? Heck yeah, it was! I relished the change of scenery in a whole new way I don’t think I could have pre-COVID.
Medical training teaches you to put your nose down and work for long-term gains and delayed rewards. But after training comes the rest of your life, and it’s finite. So don’t forget to assemble your own Grand To-Do List, and start checking things off!
What’s on your bucket list?
What are you most likely to do on a week off, once the laundry is done, and you’ve called your mom?
Tell me in the comments below!
I’ve been so busy promoting my book, my head is spinning! In the midst of planning the launch of Save Lives, Enjoy Your Own, I was asked to join the 5th Annual Northeast Vascular & Interventional Radiology (VIR) Symposium at my home institution of Brown. So despite the book launch, I was excited to take part in the symposium. It was an honor to join other outstanding women in my field at the event, which happened on September 27th. The questions from the Northeast VIR Symposium were so good, I thought I’d share them here on the blog.
Those were some highlights from the Northeast VIR Symposium, which normally takes place in person. The virtual version was the next best thing!
What questions do YOU have about being a woman in VIR or in a male-dominated field of medicine? Leave a comment below!
And if you have a chance to attend the Annual Northeast VIR symposium in the future, I highly recommend it.
I also wanted to let you know about a new podcast called Marriage, Money & Medicine, started by my friend and fellow radiologist Dr. Kate Louise Mangona. I’m one of her inaugural guests! In our episode, we chat about how we came to form our families, and the finances of physician families, specifically as it relates to being a female bread-winner! You can check out that podcast anywhere you listen to podcasts. I’ve been enjoying Overcast, if you’re not totally happy with the medium you’re using. Link to the podcast page and show notes by clicking here.
This is a guest post from a blogger who is doing some good in the world. Catherine Burke helps those who’ve been suckered into payday loan schemes to find their way out. When she asked the kind of content she might write for you, I liked the idea of covering the emergency fund. It’s a bit of a loaded topic for residents, who are often saddled with educational debt. Does a resident actually need an emergency fund? Here’s a breakdown from Catherine.
-Barbara Hamilton, MD
You could call an emergency fund the backbone of your personal finance strategy. If an emergency arises suddenly, you will have the emergency fund to support you. That is why personal financial specialists have always endorsed having one.
In this article, the focus is on demonstrating how such a fund will work for medical residents who are getting an annual salary of $45,000 to $60,000.
“Keep the emergency fund intact in case you lose your job or income.”Michelle Singletary
For a medical trainee, directing an amount of money towards an emergency fund may not seem a practical option, but it is really important.
You don’t know what is going to happen with you tomorrow. Maybe you need money suddenly, like in the case of a sudden accident. Then the money you’ve saved in an emergency fund will come in handy.
That is why you need to save at least 3 months to 6 months’ salary in your emergency fund. Suppose, as a medical resident, your income is $60,000 per year. Then you should aim to save $15,000 to $30,000 for an emergency.
Believe me! Creating an emergency fund and saving at least 3 to 6 months’ savings is necessary for a medical trainee.
The Student Loan Hero website states that on a standard medical student loan repayment plan where the payment duration is 10 years, you have to pay a regular monthly payment of $2,300 per month on a $196,250 loan amount and 7% interest rate.
In addition, you have to pay for your food, utilities, rent, etc. You may feel like you don’t have enough money left over to save.
So, try to save some dollars in the emergency fund slowly but steadily. The amount of money is not important here. The important matter is to maintain the Emergency Fund and continue to save dollars in the Emergency Fund regularly every month.
You can say that online banks are currently a good way to store your savings. Online banks currently offer higher interest rates compared to brick and mortar banks.
So, the ideal account for keeping the money for Emergency Fund purposes is an online account.
According to the Bankrate.com report and our estimation, if you want to open an online bank account for emergency savings purposes, you can rely on 2 online banks.
These are Citibank and Vio Bank. Citibank is offering 0.90% APY (Annual Percentage Yield). You don’t need any minimum balance to open a savings account in Citibank. You’ll get access to the ATM with Citibank.
Vio Bank is offering 0.83% APY and you need a minimum of $100 to open a savings account in the Vio Bank. (Editor’s note: Ally, CapitalOne360, *Etrade, and many others offer high interest rate savings accounts. Mine is at *Etrade.)
Financial experts always suggest that you should create a separate account for emergency purposes if you already have a savings account.
The thought may arise in your mind that if you already have a savings account then where is the need to open a second bank account?
Well, the 2 accounts have different purposes. In the savings account, the money you’re going to save is for your future. The savings account will provide you financial security.
The bank account you’ll open for emergency purposes will serve your emergency purpose needs. In case, you need some money suddenly, you can instantly withdraw the cash from your emergency account.
That is why you need to strictly follow the rule that you’ll only withdraw money from the emergency fund just for emergencies that arise.
With the emergency fund, you should take care of your debts too. As a medical resident, maybe you have unsecured debts like credit card debts or a payday loan, in addition to your medical student loans. In an emergency, it is easy to depend on credit cards and payday loans to control the situation instantly. But in the long term, you’ll face problems while paying off the credit card and payday loan balance with a high-interest rate.
If you end up in this situation, you might consider consulting an expert on the repayment of credit card and the payday loan debt. You can use options like debt consolidation, card balance transfer, or payday loan consolidation to solve your problem.
Personal finance experts like Suze Orman and Dave Ramsey are quite vocal about the emergency fund.
Dave Ramsey has advised that all Americans should start by saving $1000 in an emergency fund. Once you have saved $1000, then you can aim for the larger goal of saving 3 to 6 months of your annual salary.
Suze Orman states you will be in a better position if you save 8 to 12 months of your annual salary.
So, the personal finance experts have supported the emergency fund quite vocally.
Your emergency fund is the test regarding how much you’re prepared to face an unexpected scenario. If you are generally living a paycheck-to-paycheck life, start by saving $100 each month. The best option is to use a high-yielding savings account, as previously described. You’ll be glad you have it in case of an emergency.
As Greg McBride, Chief Financial Analyst for Bankrate.com has said, “Nothing helps you more than knowing you have money tucked away for an emergency.”
What is your experience with the e-fund: do you have one? Where do you keep it? Does it help you feel financially secure?
Catherine Burke is a financial writer for Online Payday Loan Consolidation. She provides resources to help people get out of predatory debt. She lives in Kansas and has hard-won knowledge when it comes to payday loans.
I don’t actually talk about personal finance in my book, Save Lives, Enjoy Your Own. I allude to the fact that as a physician, you will be able to make a living that allows you to make choices that suit you and your family (if you choose to have one). You’ll have the resources to get help as your career makes demands on your time. I left personal finance out of the book because it’s a huge topic, and will likely be the subject of its own book. So as we prepare for book launch, and the important task of finding your place in medicine, here are some financial considerations for you, the budding physician. And read through to the end to find out how you can learn more about setting up your finances with my friend, Dr. Bonnie Koo, a.k.a. WealthyMomMD.
Most of us incur educational debt on the path to medicine. But it should be kept low/ manageable enough so as to NOT affect your career choice. I know, six figure debt a huge amount, but you can do it. Even if you choose a lower paying specialty with a high debt burden, you can always go for a student loan forgiveness program. If you want to read about the different kinds of student loan forgiveness programs available, The Physician Philosopher’s Guide is a great resource. TPP delves into these programs in detail, in an understandable way.
So what should career choice be based upon? Well, I did a deep dive into that topic in my new book. My approach is tailored to those who think they might want to work with their hands, in a procedural or surgically-oriented field of medicine. Check it out!
As you accumulate student debt, it can be really anxiety provoking. I know this first hand. As you work and study so hard, and push yourself to exhaustion at times, you just can’t afford to lose sleep thinking about your loan balances. It’s not good for your well-being. As a defense mechanism, professionals in education debt become numb to it. As you do the best with what you have, know that you’ll have more resources to deal with your debt when the time comes.
Basically, you have a mortgage on your mind. It is a valuable investment, even if there isn’t a lot of tangible evidence of its value just yet. Hang in there. One day you will have a paycheck large enough to make real decisions about where the money should go. Whether you decide to tackle your debt head-on, or refinance and let it simmer for decades, that’ll be up to you!
As you make your first moonlighting paycheck, or that first sign-on bonus, you might be wondering when you’re ready for a lifestyle upgrade. This can be an incremental process. It’s enjoyable to increase your lifestyle, after all. It’s part of why we work so hard!
One mistake I see is people making a lifestyle leap. They get their first job and lease a luxury car. They make decisions based on a lack of financial goals.
Speaking of financial goals: Do you know how to setup your finances? You might even feel the pressure of being the breadwinner of the family. That’s what prompted me to start learning all about personal finance.
Let me know what personal finance questions are on your mind.
To your health, wealth, and happiness!
Writing a book is like giving birth again. How did this even happen? Where did I find the time? I thought I’d write a little e-book on finding your place in medicine. Then, I stumbled upon a book coach in a physician Facebook group. My coach is a neonatologist, preventive medicine specialist, and social entrepreneur who is making the world a better place through the cultivation of first-time authors. And as a coach, she delivered. She told me where I needed to add a story here, or clarify something there. That’s when Save Lives, Enjoy Your Own started to look like a real book in the making.
This book is for those in medical school, who are staring down one of the biggest decisions of their life– choosing a medical specialty. That’s why I focused on medical students as I wrote and edited (and edited… and edited) this book. Yet I also wrote the book as a person who found herself at a fork in the road mid-way through residency. I had to decide whether I’d be a diagnostic radiologist, or dive into the ultra-male-dominated, adrenaline-soaked field of interventional radiology. That’s why I understand that some residents may need the book when they’re in the midst of their training. And still others may find the book as a pre-medical student or non-traditional post-baccalaureate student. There is value in the book at each of these stages.
Many women entering medicine will identify with the messages in the text. As they begin to encounter some of the more traditional and even outdated ideas about gender in medicine, I hope this book helps to light the way. Others who want to learn more about what their female colleagues face as they become physicians may read the book as he-for-she advocates. Finally, students and trainees who identify as underrepresented minorities may find guidance and comfort in the pages of Save Lives, Enjoy Your Own. For aspiring and training doctors finding where you belong in the medical field, I’ll show you how it’s not easy, but it’s worth it.
We are a month out from book launch in October. In order to tease some of the contents of the book, here are the foreword and mini-bios of the amazing physicians who contributed.
Sometimes the phone rings just after the first precious hour of sleep. The trauma surgeons need my help. When I rush into the hospital for an actively bleeding patient, I might not return home until dawn, but as I work, I’m in the zone. This work is a part of me. Being able to save a life is worth it every time. And I want you to find the kind of work that engages and fulfills you, too.
But how do you find the right field of medicine, in which you can harness your unique talents and skills? How do you find your calling while drinking from a fire hose? I’ll address these important questions, with the help of some colleagues in various medical specialties.
Unfortunately, the male-dominated atmosphere, outdated ideas about what constitutes women’s work, and concerns about work-life balance can discourage some women from surgically-oriented fields like my own. If your desired field is a boy’s club, how do you figure out if you truly belong there? How do you navigate a sometimes foreign environment and succeed, despite the lack of female representation there?
If you dream of transforming from an uncertain student or trainee into one who confidently pursues her career path, you’re in the right place. From the decision to work with your hands, to finding the right balance and learning to lead, this book will light the way. I’m so excited for you to join me as a physician who saves lives and enjoys her own!
I would like to thank the women who contributed to this book. It’s a privilege to call them my friends and colleagues. They know it’s possible to save lives and still enjoy your own. The following are abridged biographies, which highlight some of their many accomplishments.
is an interventional radiologist who was named a Washingtonian Top Doctor in 2018 during her time at the MedStar Georgetown University Hospital in Washington, D.C. At the time of this writing, she is transitioning to her new roles as an Associate Professor of IR, IR Division Director, and Vice-Chair of Interventional Affairs at the University of Alabama at Birmingham.
is a third-year medical student pursuing an MD/MBA degree at the University of Miami Miller School of Medicine. She aspires to be efficient, autonomous, and joyful throughout her career. Her specialty choice is yet to be determined, and she plans to take a year off to consider her options, which include IR, surgery, family medicine, and OB/GYN.
is a Past President of the Society of Interventional Radiology. She is a Professor of Radiology & Surgery at the Emory University School of Medicine and the Chief of Service for Radiology at Grady Memorial Hospital in Atlanta, Georgia. She’s passionate about leading patient-centered change in healthcare and is an avid cyclist, skier, and snowboarder.
is a board-certified vascular surgeon in private practice in Southern California. She specializes in endovascular & vascular surgery including the treatment of venous disease. In her free time, she enjoys quality time with her son, Bikram yoga classes, and long-distance running.
is an Assistant Professor of Pediatric Interventional Radiology at the Emory University School of Medicine. She is a leader within the Women in IR Section of the Society of Interventional Radiology, in which she works to increase the gender diversity of selected speakers at national meetings.
is a board-certified obstetrician-gynecologist in private practice in Southern California. She’s a world-traveler, outdoor adventurer, burgeoning cook, and trivia geek.
is an interventional radiologist who has spent the majority of her career in private practice. She continues to find her balance with the help of entrepreneurial endeavors since completing her MBA at the Kellogg School of Management. A leader within the Society of Interventional Radiology (SIR), she led the development of the first Women in IR Champion Award.
is an early career IR in private practice. She is a passionate advocate for mentorship, with countless projects completed with the Residents, Fellows, & Students (RFS) Section of the SIR. As a leader within the Women in IR Section and as a SIR delegate for the Young Physicians Section of the American Medical Association (AMA), she continues to lead into early attendinghood.
is a rising PGY-3 IR/DR resident at Stanford Hospitals and Clinics. She aspires to be compassionate, creative, and relentless in the pursuit of leaving her community a better place than how she met it. She likes improv and baking cookies.
is an academic bariatric surgeon. A former Scholar in Residence at the Stanford University School of Medicine, her research focuses on gender equity, well-being, and the challenges women face in the workplace. She is an internationally recognized speaker and an activist against sexual harassment.
is an orthopaedic surgeon in private practice. She is also a mother, half of a dual-physician couple, a writer, a speaker, and a podcaster (The 6% with NancyMD). Through these roles and her online content, she helps open doors for those that wish to be more and do more in their own lives.
is a practicing Vascular & Interventional Radiologist who is board-certified in Internal Medicine (ABIM), Nuclear Medicine (ABNM), and Radiology (ABR). She is a Clinical Assistant Professor at the University of North Dakota. A passionate advocate of women in radiology and informatics, she founded the Facebook community Radiology Chicks.
These women prove it’s possible to save lives and still enjoy your own. I’m inspired by them, and I know you will be too. They’ve found their respective place in medicine. From academics to private practice and beyond, they represent several different subspecialties. They share their experiences and career lessons to help you see that there are many ways to be a woman in medicine.
You can still purchase a signed special edition of the book by clicking right here.
This week’s blog is a guest post from an allied health provider who has transitioned to an alternate career herself. With the ubiquitous concerns around physician burnout and the ramifications for our health systems, I felt this was an interesting share. Are you afraid of burning out early in your career? Let me know what you think in the comments below. -Barbara Hamilton, MD
Working in a healthcare environment is intense and demanding. The epidemic numbers of physicians experiencing burnout has grabbed the attention of third–party payers, legislators and professional organizations.
As the level of technological advancement in medicine rose, healthcare leaders hoped it would improve the levels of physician productivity and satisfaction. Yet digitizing processes had the unintended consequence of producing alienation and disillusionment in even medical students, residents, and early career doctors.
Knowing the factors that contribute to burnout can help keep you from burning out yourself. Just knowing the viability of alternative career options can reduce the risk you’ll feel stuck, should you experience burnout in your career.
The Medscape National Physician Burnout Report for 2020 surveyed over 15,000 doctors. Results showed:
The report also found that reported coping mechanisms ranged from constructive to destructive. The strategy most used was isolation, which can perpetuate burnout. However, the second most used strategy was exercise, which is a constructive method of reducing stress.
Slightly more than 50% of women were willing to take a pay cut to have a better work life balance. But, isn’t there a better option?
According to Dr. Dike Drummond, author, speaker and consultant on physician burnout, “There is an epidemic of physician burnout in the United States, and it has a pervasive negative effect on all aspects of medical care, including career satisfaction.”
Burnout is directly linked to striking number of consequences:
A survey of doctors in 2014 found that 54.3% had symptoms of fatigue. 32.8% reported excessive fatigue, and 10.5% reported a significant medical error in the last three months. It’s no wonder we are afraid of burning out. The price paid by physicians and society is steep.
After completing hours of one-on-one coaching with physicians who experienced burnout, Drummond determined that the five biggest causes are:
Like factors named by Gagné and Deci, who study intrinsic motivation in the workplace, these factors increase a doctor’s risk of burning out. The pillars of intrinsic motivation are autonomy, competence and relatedness. Each has suffered as a result of healthcare restructuring.
Physicians experience a lack of control over their time, contributing to burnout. They are forced to check off boxes to meet billing standards, leaving them less time to develop therapeutic relationships with their patients. These factors are related to the three top contributors to burnout found in the Medscape 2020 report: bureaucratic tasks, hours at work and sensing a lack of respect from administration.
While work-life balance may not have been stressed during medical education, it’s critical to foster a personal balance as a physician. The characteristics that supported great grades during medical school should also be channeled toward personal wellness. Finding balance starts with identifying physical and emotional areas that may have been overlooked in the pursuit of a rewarding yet often demanding career.
Self-care basics: exercise, nutrition and sleep. Under the stress of work, maintaining relationships, and growing a family, basic self-care can fall to the wayside. However, prioritizing physical and emotional health is key to avoiding burnout in the long term. This means adequate exercise, healthy eating and getting 7 to 8 hours of quality sleep each night. These basic strategies improve a physician’s ability to withstand external stressors.
Set boundaries. Doctors who don’t uphold personal boundaries may be at increased risk of burning out. A lack of boundaries between work expectations and down time can create tension and stress, in turn raising the risk of burnout. It is vital to deliberately set boundaries and then protect them as a physician.
Knowing and practicing these simple strategies may help you reduce the potential for burning out in the future.
The skills gained during medical education and practice are remarkably transferable to different career options. Yet a physician’s education is highly specialized. Here are several alternative options that may allow a physician to return to clinical practice later if they are burning out.
Physicians may not consider clinical practice outside their specialty but it is a viable option. Physicians from a variety of specialties find wound care challenging and rewarding. The subspecialty has less stress, a predictable environment, a competitive salary and keeps physicians clinically and procedurally active. Family practice, plastic surgery, internal medicine and vascular and general surgery are just some of the specialties that involve skills that transfer into wound care.
This is a long-standing option that physicians have taken over decades. Physician administrators may be more apt to initiate change based on the challenges and frustrations experienced by clinical staff. Physician administrators often have the respect and goodwill of other doctors in the hospital, which improves their ability to be successful. Hospitals are seeking a balance of clinical and administrative skill to more fully integrate the needs of physicians with the demands of third-party payers. One hurdle some physicians face is a lack of business knowledge needed to run a hospital profitably. Some have completed an MBA to overcome this challenge.
Teaching offers physicians the option of continuing clinical work while engaging with medical students. Most academic positions are seeking physicians who have published in peer reviewed journals and prefer doctors who have specialized. This is an opportunity for physicians who prefer a daily routine and have the background and clinical practice to support an academic career.
Doctors who enjoy writing and translating complex medical concepts into language the general public can digest may consider this alternative career. Pharmaceutical companies, research studies, and editorials all offer venues for physicians to help propagate medical knowledge.
This is an option that allows physicians to continue to interact with patients through clinical practice, while benefiting from predictable hours. Telemedicine is flexible, allowing for a part-time or full-time schedule. In an environment where more people are apt to stay at home, the global market for telemedicine is growing.
Telemedicine and in-home visits are a hot topic and area of study, even in interventional radiology! So if you are afraid of burning out, take comfort in all the options at your fingertips, from preventative strategies to career alternatives in the future.
Author: Gayle Morris is a freelance writer who has written on health and wellness for over ten years. She spent over 20 years as a certified nurse and nurse practitioner before hanging up her stethoscope and picking up the pen.
To hear my personal take on early career burnout and some strategies I used to deal, check out my recorded talk on balance. You can access it by clicking here.
And let me know what you think about this post in the comments below! Share your experience, or your unanswered questions. Are you afraid of burning out?
One of my favorite residents asked me this as we talked on the phone recently. She wondered how she’d be able to balance all the expectations she herself and everyone else might place on her in the future. It’s a good question, and I’m sure I’ll only scratch the surface of this complex topic. But to be honest, my first reaction was, “Nice? That’s what she’s worried about?” As a physician, she’ll soon be in charge of getting things done, as efficiently and safely as possible. So how is she supposed to manage that degree of responsibility, manage people, and… be nice? Well, it might sound harsh, but being nice isn’t always my highest priority. These are my thoughts on being nice as a boss lady.
While you want to be nice enough in any situation, I strive for polite. As a physician leader, I consider it a good day if my staff and I didn’t offend anyone. That’s because patients are so different, and they’re usually struggling with health issues when I see them. They’re not at their best. Add to that the family dynamics that enter our department, or the expectation that we answer for something that was said or a cancer that was not diagnosed by someone else, even if it was months or years ago. As physicians, we are expected to handle all these situations with as much patience and empathy as possible, at all times. Sometimes it’s relatively easy. Things go smoothly, and the patients are sweet, respectful, and grateful.
Other times, the interpersonal aspect of doctoring can be more demanding. You could find yourself repeating yourself, or rephrasing, hoping for another shot at understanding one another. The work of translating medicine for patients can involve drawing pictures. Or it might be followed by several phone calls to distant relatives around the country, as you realize your patient isn’t sure what you mean, and maybe never will be. This is all part of being nice as a doctor. It is what we do every day, and it’s really just part of the job. All of these personal touches are on top of the core work of actually diagnosing and treating your patients. And most doctors do this for between 50 and 100 hours per week. Compassion fatigue, anyone?
Because of the demands on doctors I mentioned above, it’s incumbent on you to get help from the people around you. It might not seem “nice” asking someone else to do things for you, but as a doctor, delegation isn’t optional- it’s a necessity. If you don’t delegate, you’ll scurry about, spending bandwidth on tasks that could’ve been handled by someone else. And you will still have the doctoring to do. No one can do that but you. There’s a reason they call it a healthcare “team,” and if you’re handling stuff the support staff could handle, there’s an opportunity cost to that.
In a healthcare environment, it’s up to everyone to operate “at the top of their license.” And as the doctor on the team, it’s up to you to ensure everyone else is working in their scope, with an appropriate degree of autonomy. Most people thrive when they have a degree of ownership and independence in their work, and the ability to make their own decisions. When I give more responsibility to technologists, nurses, and schedulers, they’re often eager to learn and help me within their role. When you empower people to do what they’re trained to do, they end up more fulfilled. And, you’ll strengthen your skills as a leader at the same time!
As a byproduct, the more you delegate, the safer and better a doctor you can be. You have more time to double-check those pre-op labs, look up the next patient consult, or work on a hospital safety initiative. And when you delegate well, you’re more likely to have time to enjoy pleasantries with patients and staff, or even FaceTime with your family for a minute! In the end, a doctor who delegates is nicer.
People who take the time to engage in small talk are often seen as nice. But as a busy doctor, you have an agenda. Even if you grew up the person who cared about everyone and everything all the time, it’s hard to maintain that as you take on doctoring and all its accompanying responsibilities. And sometimes, people misunderstand and think you’re less nice when you need to move quickly or get to the point. But it’s not you, it’s the role its attendant responsibilities.
You are there to diagnose and treat, then move on to the next person who needs help. So when there’s less time for small talk, you might run the risk of coming across as less than “nice.” But don’t worry. If you can’t find extra time for hand-holding, sometimes a smile or solid eye contact is enough.
When there’s time, it can be fun to chat with the people around you. This can make work more enjoyable. Side conversations are a great way to deepen rapport with your co-workers, as long as they don’t get in the way of patient care. For some people, it’s a fine line, and as the leader of the team, it can be your job to re-direct people, and remind them of their responsibilities. I might need to call for a dose of IV analgesia in the middle of someone else’s conversation. Is that nice? For the patient, it is.
In another way, in the procedure suite, small talk can be a useful tool. We call it “social anesthesia.” Since we do most of our work with local anesthesia and moderate sedation, a bit of social anesthesia can go a long way to ease a patient’s nerves. A bit of therapeutic distraction by the sedation nurse can help bridge the gap as the sedation takes effect. It can help redirect a patient’s attention from their fear to their happy place, usually some tropical paradise without fluorescent lights. In this way, small talk is a kind act of generosity. It often has a reciprocal effect, putting everyone else in the room at ease. The best nurses do this automatically, but as the boss lady, you can chime in or remind them, as in, “A bit of social anesthesia please!”
The problem with “nice” sometimes, is the expectation that it should always be a priority for women. But when you’re in a healthcare environment, or leading a team, being nice isn’t always the first priority, to be frank. At worst, trying to maintain this standard can be distracting, or even dangerous, when you’re a doctor. People’s health is in your hands, and that comes first.
Long-term, the expectation of “nice” can trap you in an exhausting cycle of people-pleasing. And while pleasing people sounds good, you really can’t please everyone, so you definitely shouldn’t base your success on it. If you do, you’ll always fail somehow! My goals are more realistic. In my most challenging moments, I try to curse as quietly as possible, and I generally avoid anything that could get me fired.
Because of societal expectations, women in power, including female physicians, are still expected to do things men aren’t. They have to bend over backward, manage relationships first, and pad their statements with niceties, or risk social backlash. But it’s too much to ask. And it holds us back, in my opinion. Over time, as people come to know you as a leader, it gets easier. Once you’ve built a track record of doing the right thing for patients every time, people will understand and trust your intentions. They’ll empathize with your frustrations, rather than demonizing you. And hopefully, they’ll understand when you bark an order, it’s to resuscitate a crashing patient, not because you’re a “B- word” (not boss… the other one).
Unfortunately, lady bosses can be called expletives for behavior that would be praise-worthy in a man. When we take charge or heaven forbid, correct someone, people misinterpret this as “she is upset.” I think “upset” is a booby trap for all female leaders. It minimizes and de-legitimizes concerns as emotional rather than rational. So sometimes it helps to clarify, “I wasn’t upset, but I needed to make sure you understood the dose wasn’t documented correctly,” or “I wanted you to call me prior to discharging that patient.”
So from my perspective, as a mid-career physician and department leader, I’d be careful with striving for “nice.” It can distract or deplete you with its demands. Personally, I don’t make it the top priority. Don’t get me wrong, being nice is pleasant… like a luxury. But it’s less likely to save your life than the lady who takes charge and knows her priorities.
As an aspiring or training doctor, you’re my hero(ine). Right now, as a student, you might be facing tuition bills of fifty thousand dollars per year or more. You’ve got stress, and you’ve got exams. Or, if you’re a resident, you’re facing some tumultuous times in medicine, and you might be freaking out a little. Either way, you’ve got some obstacles between you and your future life as a doctor. It’s hard to imagine what your life will look like after all the hard work you’re putting in right now. So I got to thinking about lifestyle design for the aspiring doctor. As a practicing physician for six years now, I’ve made the huge transition that you’ll be making yourself soon. Here’s a framework to start thinking about your future and what you’d like it to look like. When you think about lifestyle design as an aspiring doctor, you’ll have a better idea of where you want to go, so you can start steering in the right direction now.
Some physicians are outspoken, while others are go with the flow. I skew introvert personally, so it’s somewhat surprising I’ve wandered into multiple leadership roles. As you contemplate your medical career:
Some of the things you’ll need to think about as you transition from the student/ trainee mentality to an attending mentality will be your work-life balance. Generally, what do you expect, and what do you have control over? Having some idea will help you pick the right job when the time comes.
Say you really like interventional radiology but don’t love waking up in the middle of the night- well you could choose to work at an outpatient vascular lab with no call, or you could work somewhere with a larger number of rads who share the call, and therefore take less of it. You could open your own outpatient based lab and focus on fibroids, varicose veins, or cosmetic IR. While none of these paths are easy or built overnight, they are all options.
When I thought about my own lifestyle design, I considered my own drive to feel needed; it led me to practice in a smaller community that needed more interventional radiology coverage and expertise. I like being the one who knows how to stop the bleeding when no one else can. It’s been my choice to be on call at our trauma center two weeks out of each month, and it’ll be your choice too.
When you look at your attendings, you’ll notice that some seem to spend a lot of money. They are sharply dressed, with a dry-cleaned wardrobe and a perfectly pressed white coat. They drive a BMW, and spend a quarter million dollars educating each child (before college!) at a private fancy school. So you might wonder, is that what doctors do? Is that what I should do?
From the high overhead costs to practice medicine, to the educational debt we take on, many doctors get used to spending money they don’t have. But the cool thing is, you get to decide how you’ll manage your finances. So start learning about personal finance as soon as you can. Read about how people “survive” on $30k per year for some perspective- this has helped me. Learn about the concept of a savings-rate, so you can be prepared with a goal when you get that first attending paycheck. If you don’t have a plan, the money will sit in your bank account, looking like it’s there to be spent. It’s your choice how you manage your money, but the earlier you think about and get used to saving, the better. Your future self will thank you!
When you’ve had your nose to the grindstone studying medicine, it’s hard to remember you have a right to make all these decisions about your life, just like everybody else. At least that’s how I felt at the end of training!
You’re the heroine in your own adventure. And while you won’t always have control (over your fertility or the challenges life throws your way), a lot of this stuff is up to you. You can be a surgeon with four kids, and train other future surgeons! You can have four kids and Chair a Radiology department. Or you can opt to have fur babies, or a pet project instead. Lifestyle choices don’t dictate your career choices; you can do what you wish. Don’t let anyone tell you you can’t.
Would you believe I took 12 weeks off work last year? What did I do with all that time?
When I take a week off, I can actually go to therapy (during banker’s hours!), where I work out the mental and emotional kinks. Without the extra time off, my schedule simply wouldn’t allow for it. With the remaining time left, I can read with my kid, hang out in the pool, and manage my blog.
Aside from self-care and family care, I’ve made a hobby of learning about investing venues like real estate. I’m learning to be a landlady, with the end goal of long-term passive income in mind.
Continuously tweaking my own lifestyle helps me get closer and closer to the ideal life for me.
You have a lot to think about as a student or trainee, and you are already super-human for what you’ve accomplished. But in a quiet moment, you might look up from your study guide and wonder, what does my future look like?
Well, it’s up to you to design it. Use someone you identify with as a template, but don’t forget to add your own flourishes. It’s your life, after all. It’ll be built on your individual desires, preferences, and priorities.
These are some of the things you can consider as an aspiring or training doctor. You’ve worked hard to build this life- don’t forget to enjoy it!
...and perfect is the enemy of good.
These concepts in medicine & parenting are parallel.
As an aspiring or training doctor, you’re my hero(ine). Right now, as a student, you might be facing tuition bills of fifty thousand dollars per year or more. You’ve got stress, and you’ve got exams. Or, if you’re a resident, you’re facing some tumultuous times in medicine, and you might be freaking out a little. […]
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