This post is inspired by Twitter and the silly threads you’ll see there featuring “wrong answers only.” This kind of thread is often inspired by a funny picture… or one that could have many possible explanations. If you’re not on Twitter yet, head over there to see what I mean, and get a dose of humor. It’s true, some use Twitter like a living curriculum vitae (CV). That’s certainly the case in my field of interventional radiology. The platform lends itself to sharing interesting cases and learning points, especially image-based ones. Even if you’re in a less image-oriented field, there is plenty of #MedEd to be had. Physicians and other healthcare workers post about thought-provoking patient encounters, dealing with difficult situations, and all kinds of advocacy. To be honest, it can be a lot to take in. It’s a cacophony of voices. But those are a couple of reasons Twitter keeps me engaged from time to time, and why you might want to jump on that bird app yourself. And as promised, here are some reasons why I’m successful at work (wrong answers only).

Why I’m successful (not!)

I never have a complication (they happen).

I never miss a diagnosis (we all do).

My perfect hair (it has a different personality each day, and I don’t spend a lot of time fighting it).

My people skills (I try, but I’m still learning).

I smile at staff for no reason (I can’t smile my way through life. It’s not naturally me.)

I floss my teeth at work (…it has to be done, but I try not to get caught)!

You’ll never see me lose my cool. (Um, have you heard practicing medicine can come with some inherent frustrations?)

Everyone likes me (really, some just tolerate me).

I get along with everyone. (I try to find some way to make some small connection with those on my team.)

I’m kind and patient in the IR suite. (In reality, everything is time-sensitive. And you just kinked my wire again, newbie…)

Gender bias is a thing of the past (…sadly, it’s alive and well, but I don’t let it stifle me anymore).

Here’s some radical honesty about being successful.

So the next time you think you need to be perfect to succeed in medicine, think of me! I’m proof there’s no need for perfection. We are succeeding when we’re doing the best we can each day (truly). If you need a reminder, make sure you listen to my recording, 7 things to keep you going strong on the path to becoming a doctor. I share some secrets and foibles there. 

Hungry for more encouragement and connection? That’s the aim of my new podcast, Save Lives, Enjoy Your Own, which you can consume anywhere you get your podcasts! I’m a fan of the Overcast app, but I’ve used the Apple podcasts app as well. It’s even on Spotify, so now, you can instruct Alexa to fire up an episode of “Save Lives, Enjoy Your Own!”

Please take a moment to drop a comment below, about why you’re successful at work. Wrong answers optional!

You can leave a comment by clicking “hide/show comments” below this post. I love hearing your reactions, thoughts and experiences.

‘Till next time, keep thriving!

What is someone like me, a full-time interventional radiologist, mom, and blogger– what am I doing starting a podcast?? I never thought I would do start one, even when my friends told me I should. A podcast is so much more accessible than a blog because you can listen on the go, they told me. I knew they were right, but to be honest, I was intimidated by the learning curve. And the extra work. But here’s the thing. Hearing the sound of someone else’s trusted voice has helped ME at times when I’ve felt so lonely. And listening to podcasters and leaders has made me feel so connected to others. It’s a powerful medium. And we need connection now more than ever. So I started a podcast. According to my personal mantra, it’s called Save Lives, Enjoy Your Own.

Another driver behind the podcast is that I see LONELINESS in training as a problem. I think this is particularly true for those aspiring to competitive fields, and/ or fields in which there is a prevalent “bro” culture. If you’re a woman, you might feel left out in that kind of environment. That’s why I think projects designed to stamp out loneliness and isolation are the key to thriving in medicine. As an example, check out the Stanford Story Rounds. It’s a regular meeting on campus for students, trainees, and attendings to tell their stories, as a way to build community and support each other. That is what I’m trying to accomplish here, in a way. I think this platform can support women in the traditionally male-dominated fields of medicine. 

The why behind my new podcast. 

One day, pre-COVID, I was asked to present a talk at the Medical Students’ Scholars Dinner at the annual meeting of the Society of Interventional Radiology. I was so excited to address some of my future colleagues in this forum. But it was in Seattle, in March of 2020. Let’s just say I was relieved when the meeting was canceled. I didn’t want to risk getting sick, or worse, bringing back the virus to my elderly and infirm patients in Southern California.

So I recorded that talk (here). It featured some of my most awkward failures, and what they taught me. And the feedback from that recording touched me. One medical student, an aspiring plastic surgeon, told me how she listened to my talk again and again, even as she fell asleep. I do that too… sometimes with guided meditation, other times with an audiobook. Often, I drift off to the voice of someone I admire. And it’s an honor to be able to play that role in your life: to be one of your guides as you traverse your own heroine’s tale. 

What to expect from the Save Lives, Enjoy Your Own Podcast

This podcast will provide a backstage pass to my book. Every other week, I will work my way through the book, introducing each chapter and a personal story around it. I’ll share excerpts of the book, and my own answers to the Spill Your Guts exercises at the end of each chapter. My aim is to remind you, through the sound of my voice, that women not only exist but can thrive in their chosen specialties, even those traditionally known to be boys’ clubs.

The podcast is unedited. It’s real talk. And for now, it’s just me. 

Check it out here!

If you like what you hear, please share with a friend, subscribe, and leave a 5-star review! 

I hope you enjoy your own.

Let me know how you aim to do that this week in the comments below!

How many awkward comments will you receive, and how many awkward questions will you endure as a woman in a male-dominated field? So many. And sometimes they’ll be prefaced with the cringe-worthy, “I’m not trying to be sexist but…” How do you field them gracefully, so as not to alienate those around you?

The latter question adds insult to injury, doesn’t it? The biased and even blatantly sexist remarks women face in the workplace can be compounded by the backlash they can receive when they (you) respond. Being in an attending role, I’m asked how to handle these kinds of incidents. Here’s a recent example, from a mentee, a medical student traversing her clinical rotations.

A chat with a vascular surgeon gone sideways

She reported: “I’ve enjoyed vascular surgery so far, and they’ve involved me in a lot of procedures! I got to cut a metatarsal this week! I’ve also seen several IR procedures this week, like thrombolysis and an EVAR. It’s been interesting to see how we think through the decision to approach a case at surgery versus in interventional radiology (IR). I mentioned to one of the vascular surgeons that I was interested in IR. He replied “I’m not trying to be sexist but…” then proceeded to tell me that as a woman I shouldn’t choose a surgical specialty and asked how I’d be able to have kids if I pursued IR…”

My response initially was…

That’s why I wrote this book…

And basically… I don’t know if you can change him, or if it’s worth your time.

But (I’m sad to say,) I’d expect to hear more comments like that in the future.

You could reply or try to stand up for womankind, but depending on how it’s received, you could face backlash, like a lackluster grade on that rotation. 

Here are some possible responses. I’ll leave it up to you whether you say them in your head or out loud. 

When you’re fielding blatant sexism, try:

1. “Anything preceded by ‘I’m not trying to be sexist but…’ is nearly guaranteed to be sexist, and doesn’t excuse you from saying it.”  
2. “Who determines who ‘should’ pursue a certain career path?” (The individual in question, or the crusty, outdated notions in your little head?)
3. “What year do you think this is?”
4. Define mansplaining to the perpetrator. Suggest that if he (or she) hasn’t actually been a mother in said field, he probably shouldn’t advise on it. Or, cite numerous examples of inspiring and successful women in the said field. 

Approach with curiosity

5. “Do you think that comment is helpful?”
6. “Why did you choose a surgical specialty? Did you ever consider that women may have the same motivations, aspirations, and skills? Did you ever consider that to deny someone’s potential because of their gender is an idea not fit for this century?” 
7. Ask, “Do you have kids? Who is fathering them when you’re operating and seeing patients?” 
8. Ask, “Does your wife work outside the home?”
9. “Do you realize that women comprise more than half of the talent pool entering medicine these days?” 
10. “Do you realize that because of systemic biases, women have to work harder and be objectively better than their male peers to be noticed, respected, and trusted?”

Judging them… and prompting them to judge themselves

11. “Sorry, can you repeat that?” (With an incredulous tone, and a quizzical look)
12. Make a face… “Why would you say/ think that?” 
13. “Would your mother approve of that attitude toward women?”
14. “Do you find gross overgeneralizations helpful… in general?”
15. Did you know women comprise more than half of med students these days? You’d better hope they do become surgeons so there will be one to take care of you when YOU need one. 
16. Would you want your own daughter to make career decisions based on her reproductive equipment, or based on the fact that she’s a person with the brains, heart and soul of a doctor? 

Dripping with sarcasm, if regionally appropriate

17. “Did you know they actually allow women to be surgeons now?! It’s wild…”
18. Women physicians have been shown to have superior outcomes. So… perhaps men shouldn’t be allowed to be surgeons.  
19. “Do you have kids?” (Yes, I have two, they’re great, blah blah…) “How did you expect to do that and be a surgeon?” 

Responding to, “Women shouldn’t choose a surgical specialty. How will you have kids if you do?”

20. “Whether or not I choose to procreate is independent of my career choice, actually.”
21. “I have a partner who believes men and women should both be involved parents.” 
22. “Have you ever given birth or been a mother in medicine? Then how do you know what it’s like or whether it ‘should’ be done?”
23. “Have you heard of benevolent sexism? It’s the idea that men know better than women, simply because they are men. I suggest you read about that tonight.”  

If all else fails… and he wasn’t trying to be sexist… he was just trying to help

24. Did you know that sexist comments like that are damaging to the environment and to future physicians’ careers?
25. Did you know it’s not 1970 anymore? 
26. Hand him a copy of my book and suggest he donate a copy for every member of the nearest medical school, so he can help the student body to learn not to perpetuate these disempowering notions.
27. Hand him my website so he knows sexism is a problem in medicine, and not to be a part of it. 

Don’t get fired reacting to sexist comments

But don’t let them derail your dreams either. That’s the tightrope you’ll walk as a woman in training. You can do it. You can probably do it backward in high heels, like Ginger Rogers, or in awkward clogs on 3 hours of sleep. Despite these sexist comments that fly at you, you are strong, and you are worthy. It’s these comments that are all wrong. They’re trash; a product of lazy thinking.

How you choose to respond to sexist behavior is up to you. You don’t have to die on this hill, and you don’t have to verbally slap anyone across the face. But in the right moment, if you find a receptive ear, you might just find an opportunity to examine the bias you find and stomp it out. 

attending: so what are you interested in?
me: surgery
attending: you’re a tiny little thing, you think you can do that? maybe ophthalmology

???????

— livv (@inbedmd) December 31, 2020

Is it hopeless? No. If I thought it was, I wouldn’t spend all my free time here writing about how you all should join me in male-dominated fields. I think once we as women, (minorities, and non-binary identity folks) reach a critical mass, our presence will become the new normal, and things will continue to slowly change.

It’s not your job to fix anyone. You already have the burden of doing your best every day and learning as much as you possibly can. In the end, it doesn’t matter what some guy (who is wrong) thinks. It’s your plan! They’re your dreams!

I’m not trying to be sexist but… I think women are often better than the guys, because they’re required to work harder for the same level of respect. And when I need a surgeon or specialist one day, I’ll be praying it’s a lady. 

Sometimes, I hear from one of you, and it reaffirms what I’ve suspected all along. That you’re still hearing the same old ridiculous garbage comments and advice, as you chase down your dreams in medicine. I got permission to share a recent exchange with a rising star, a fourth-year medical student at the University of North Carolina. Ms. Ainsley Bloomer plans to become an orthopaedic surgeon. Here’s our exchange. Incidents like these leave me thinking, “Seriously, can you believe this guy?!” This is not to say there aren’t a lot of great male advocates out there… but we still have a long way to go to reach gender equity, especially in the male-dominated fields of medicine.

She writes:

Dr. Hamilton, 

Thank you so much for sharing your passion for your job and your family with the internet. I think it would be super helpful to hear about how one should handle difficult professional situations as a woman in a male-dominated field. If you feel comfortable sharing anecdotes along with tip/tricks for handling tricky to navigate situations, that is a topic I cannot hear enough about. It is great to be able to learn from someone else’s experience.

Best,

Ainsley Bloomer

I responded, intrigued

Hi Ainsley!

Thank you for that idea.

Can you tell me more? 

What’s a difficult situation you’ve witnessed or experienced yourself?

I recently heard from a mentee that a vascular surgeon told her women shouldn’t do IR, so I planned to respond to that encounter in the form of a post. 

If there’s a difficult situation I don’t feel qualified to speak to, maybe I can find a guest to write one.

What stage are you at by the way? Student, resident?

Have a great weekend!

BH

Future orthopaedist receives discouraging messages from various unnamed offenders… can you believe these guys?

Absolutely! This is something I have thought A LOT about as I hope to one day be a mentor for others as we work to improve our current medical atmosphere. I apologize if this is a lengthy response. But I feel this is something I don’t quite yet have the right words to express. I can provide examples, and I would guess you have a list of your own experiences to share, too. 

I am a 4th year medical student at UNC SOM applying into orthopaedics. 

Some examples of comments I have received include:

“You’re not strong/big/tall enough to be an orthopaedic surgeon.”

“Do you know all orthopaedics surgeons are men?”

“Why would you want to do that? It’s so labor-intensive and you have to physically work so hard.”

“Do you know it’s really competitive to become an orthopaedic surgeon?” 

“Do you think you’re qualified?”

“You’re going to do hand or peds, right? That’s what all the women do.”

Truthfully, these types of comments motivate me more than deter me, especially when I consider the source. I think it’s important to respond in a calm tone and in a leisurely and relaxed way. I think it’s also important to be subtly assertive in your commitment to your field of interest. It’s my hope that over time, we can eliminate discouraging medical stereotypes and open these pathways so that others don’t have to go through the same obstacles in the future. 

Supporting each other through gender bias

I think this conversation is so important. There is a theory of learning termed “fire walking” where trainees can learn from the mistakes or experiences of their teachers so they themselves do not have to go through the experience to gain the knowledge. Although there are certain aspects of education we have to work through on our own, some knowledge can be passed down verbally. It really helps to hear an attending level perspective on handling situations whether from a “what I would do” or a “what I wish I would have done” point of view.

The other thing I anticipate hearing in my future career are questions about kids and having a family. I also have seen and experienced some of the tension that can occur between female nurses and female medical students/residents/attendings. This is also something I think would be such a helpful topic to hear about from attendings as to the best way to calm any hostility from the get-go. I aim to be a team player and respectful in every interaction, but sometimes things go sideways, and it is helpful to have the skills to recover from these interactions so we can go back to being productive. 

I look forward to hearing more bits of wisdom!

Best,

AB

This is why I love hearing your truth…

This is great, thank you so much! I have to chew on this a bit, and I’d love to hear your take. 

How have you responded to these comments, if at all? 

I have a blog post which is specific to interventional radiology in some ways, but covers some overlapping stereotypes. It’s called myths in interventional radiology. I meant it as a myth-buster so people wouldn’t see these discouraging comments or stereotypes as real. I wanted to dismantle them and show their ignorance!

But the post doesn’t deal with how to respond. 

I think so often, especially with the power differential as you come up the ranks in medicine, it’s not always possible to give a response. And if the comment hits a nerve, it’s not always possible to give a composed response on the spot. In my experience, that is very hard! 

That’s why I think so much of this is internal. What I mean is, women are doing internal workarounds to deal with the biases and put-downs that come their way. And community can be a salve. We need each other just to validate the struggles we face, and support each other, whether in person or virtually. I wonder what you think…

Do you think it’s your responsibility to make the road smoother for everyone who comes after you, by correcting those who make these comments? It’s a noble thing to do, but it’s not required. 

And in my opinion, just you being where you are, and doing what you are doing is giving other women permission to do the same. It’s teaching old school and narrow-minded people that it’s not only possible for women to do these things and have these roles, but that it’s going to become the new normal. 

BH

I have responded to some of the comments. She continues:

Sometimes, others have stood up for me, and that has been a really amazing experience. People who didn’t even know me well have “stood up” on my behalf, and it’s something I will never forget. I hope to be able to do that for others. Sometimes we feel strong and resilient, and sometimes we just don’t. You never know what someone else is going through and what could be their breaking point. 

Your point about the rank/ power differential hits the nail on the head. 

As to your question, I do not think it is my responsibility to fix others. It’s definitely not my place to correct the person, as I don’t want them to become defensive. I hope that by answering in a relaxed and confident manner, a well-intentioned person might refrain from repeating these discouraging or biased comments to the next person. 

In medicine, it seems like we often try to reinvent the wheel, when really, our energy and ability to innovate should move the needle toward progress. There are so many patients to treat, pathophysiologies to explain, and treatments to create, that it feels like such a waste of time to have to defend my career choice and my reason for being here. 

Also, I think there is a tendency for those with “softer” personalities, for lack of a better term, who might have been fantastic in a specific career but were pushed into another field because they did not fit the stereotype. Perhaps those of higher rank told them they would not make a “good surgeon/ interventionist/ orthopod,” etc. Maybe all they needed to succeed was a little support, and some experience to buttress their confidence. 

I think too for those that don’t fit the stereotype, there is a tendency to feel the need to go above and beyond to prove they deserve to be there. 

Sorry… I have a lot of thoughts on this topic, and I can see it from a variety of different angles. My eternal New Year’s resolution is to be more concise.

-AB

Can you believe this guy?

There’s nothing wrong with your response- it’s a complex topic, and your insights are valuable!

I appreciate your willingness to share because I don’t want it to be me “having the answer” as if I’m speaking from on high- because I don’t have all the answers. 

But what you said about people who don’t fit the stereotype being great and missing the chance to be who they were meant to be- that is how I see my former self. I narrowly missed settling for something else, because it’s easy to ‘trust’ people who ‘know more than you’ in medicine. And I think it’s important, as much as you take feedback and examine it, to listen to an inner voice. Clearly, you know what you want to do, and I’m grateful for that! These voices haven’t made your foundation shake. 

BH

What do you think? Can you believe this guy?

What do you do, and how do you feel when you’re on the receiving end of comments like this? Share with us in the comments below.

Hey there, and Happy Holidays! If you are looking for the perfect gift for the doctor in your life, whether that’s YOU or someone else… read on! I’m excited to announce I’ll be speaking at the annual White Coat Investor’s Physician Wellness & Financial Literacy Conference on March 4th-6th. Network and learn from the comfort and safety of your couch. I’ll be speaking about creating money momentum as an early career doc. I have tackled my early career finances in such a way that, despite living in a medium/ high cost of living area in California, I’ve managed to amass some wealth. In my talk, I’ll share some of my money philosophy, mistakes, and moves that have helped get me here. This is a sneak peak into the talk I’m planning for March!

WHY bother gaining financial momentum? 

Won’t I be fine with a doctor’s salary? You might wonder. It was a pretty steep learning curve, and a bit of a smack in the face to learn the stark difference between gross and net pay. That big number you’re working for? It won’t all be yours after the tax bite, so don’t plan to spend it all. 

My wakeup call happened as I exited fellowship, and my husband and I planned for a jump in salary from 70k to more than quadruple that. It was up to me to figure out what to do with it. How could we take care of this money? How would we discipline ourselves so we weren’t tempted to spend it? We sat down with a financial advisor to make a money plan. It takes discipline and an education to take care of your new-found and long-awaited earnings!

Mind your career longevity:

7 years into my career, I’ve identified some keys factors that contribute to career longevity:

• Picking the right career to begin with
• Switching gears from the pace of training to the pace of attending life
• Learning to be mindful and take care of your money-maker (that’s you)

The primary residence: should you buy a home??

According to recruiters, as many as 70% of physicians across all specialties change jobs within their first two years out of training. Even if you plan to stay where you are, you might benefit from renting first while you learn the area.

The bottom line is, maintaining a home generally costs more than renting. Often, it’s a lot more. So if you still have student debt and aren’t on solid financial footing, consider renting until you are. If you’re still itching to buy a house, read this first.  

How can you gain money momentum with all those student loans dragging you down?

Make a plan. Don’t put your head in the sand. 

Lifestyle creep: good or bad?

Incremental creep is okay. But on the other side is hedonic adaptation. When I was a kid, if we were going anywhere with a pool, I wanted to plan my whole day around enjoying that pool. Now, I have one in my backyard. It’s part of everyday life, and it’s hardly exhilarating. Sometimes it’s really nice to soak in the hot tub, while other times, I don’t go in for months, and it’s just another expense to maintain it. The pool is a great example of hedonic adaptation. You can get used to all kinds of lifestyle upgrades, and go broke doing it. So if you’re aware of this dynamic and plan for it, you can decide how you’ll handle it before you go broke on the hedonic treadmill.

Being selectively cheap can power your financial momentum. Last week, I was chatting about cars with my support staff, in the context of my looking at an electric or plugin-hybrid. When they heard what I was driving, they actually laughed in surprise. They all have newer cars than me. Instead of feeling embarrassed, I felt a little proud. Because it’s my choice. I still enjoy the car I have, and I haven’t had a car payment in years. If you have an area in which you can cut costs, it can help supercharge your financial trajectory.

Money momentum can empower you

…but it’s not everything. 

In my view, money can buy freedom. Having an accessible pile of money, like a sizable emergency fund, can give you the flexibility and peace of mind we all crave. In The Simple Path to Wealth, J.L.Collins called this extra money, “F-you money.” That’s because it allows you the financial cushion you’d need to make a big move for the sake of your goals or happiness, like walking away from a toxic job or situation. In this era of decreased autonomy, decreased reimbursement, and increased job uncertainty, there’s never been a better time to have F-you money, just in case. 

Sometimes, even before you’ve reached a net worth of zero, dropping a few thousand on a special trip or experience can keep you feeling like you’re living for the now, not just the future. When I had a five week stretch off after fellowship, my then-boyfriend, now-husband and I had the chance to backpack around Europe. It was well worth the spend.

Will you join us?

The goal of WCICon is to help improve the financial literacy and overall wellness of physicians, dentists, and other high-income professionals. We (WCI and I wholeheartedly) believe that increasing the financial security and overall wellness of doctors enables them to be better partners, parents, and doctors along with reducing burnout, decreasing suicide risk, and improving patient care.

If you join us, you’ll get to hear not just my fabulous talk, but over 50 hours of educational material that you can access on demand. CME credit is available; use your CME funds to learn about wellness and personal finance, including my approach to gaining some money momentum early on!

CME details: let your employer pay!

Continuing medical education credit for physicians, medical professionals, and CE for dentists will be available. This activity will include up to 17 AMA PRA Category 1 Credit(s)™ and dental CE credits. That may allow you to use your employer-reserved CME funds to pay for it, and/or write it off as a business expense. Considering how many conferences were canceled this year, many of you are still sitting on unspent CME funds. This is a terrific use for them.

Check out this lineup, which includes more women than ever before!

The Money Mindset Transformation Class You Wish You Had in Training -Latifat Akintade MD

Successful Budgeting: The First Step on the Pathway to Wealth -Disha Spath MD

How to Nail Your Next Negotiation in 3 Simple Steps -Linda Street MD

Changing Your Life One Line at a Time -Jennifer G. Christner, MD

The Biggest Investment You Will EVER Make -Kate Louise Mangona, MD

Financial Freedom Means Changing (Some) Behaviors -Jess Thompson, MD

When Life Gives You Lemons: Wisdom from a Young Physician -Audrey Jean Roberts Ludwig, MD

How First-Generation College Graduates Can Reach Financial Independence -Dewan K. Farhana, MD

You’re Burned Out…Now What? -Dawn Baker, MD

How to Build Another Source of Income by Investing in Real Estate -Letizia Alto, MD

How to Raise Financially Fit Kids -Sanghamitra Sadhu, MD

And a ton more topics, which you can check out on the conference website here!

And if now that WCICON21 is done, sign up for a course I tailored for the female breadwinner. Get a peek at my new course for FREE, or enroll in the full course right here.

GOT QUESTIONS? Email me at tiredsuperheroine@gmail.com

Happy Holidays! Wishing you health, wealth, and money momentum in 2021!

There are a lot of fields in medicine to choose from. How do you find the right place for you? It’s quite the task to figure out where you belong in the medical field, as complex and varied as it is. Even when you find a specialty that lights your fire– one that makes your hair stand on end and that makes all your neurons fire in the best way– how do you know if you really belong there? It’s a pretty high-stakes decision, choosing the right career. No pressure… pick the right career, or else.

Despite women comprising more than half of medical school students, there are still many fields that seem to repel women. So if you’re interested in urology for instance, how do you keep from being repelled for the wrong reasons? 

Women are clustering in to pediatrics, OBGYN, and other *relatively* lower-paying specialties: think endocrinology. If you are truly driven to be in one of these specialties, then you’re following your true north, and the work itself can be part of the benefits package. But what if you choose in part because… well, it seems easier to work with some other female colleagues around? Or because some attending physicians ‘advise’ you to choose something ‘easier’ than the field you really like?

What are the consequences of picking the wrong career?

1. The gender pay gap no one talks about. 

I’ve noticed that no one talks about the gender pay gap- the huge, yawning gap that arises from women clustering in certain specialties. Take a look at this study. It says as women enter a field in increasing numbers, there is a tipping point at which it loses its alpha allure, men stop entering the field, and pay FALLS. This article made my head hurt. But it also reaffirmed the virtue of pursing the right field based on the work, not the demographics. If you choose a ‘woman-friendly’ field, beware of the pay cut that often comes along with it.

I talked about this article with Bonnie Koo on her podcast, WealthyMomMD. Check it out: 

The right career can help you duck burnout

2. Epidemic rates of burnout

The other reason I’m interested in career choice is because I think it behooves you to pick what fuels you most. Medicine is demanding, so you might as well choose the field that puts you in a time warp. The one where you forget that clocks exist, and you emerge from a case or interaction as if from a spell. That’s what happened to me recently, as I attended to a trauma patient who needed angiography of multiple body parts. He was a one-man code “triage,” and the surgeons and I masterminded minute to minute, in order to figure out what needed to be done next, as his blood pressure floated from the nineties to the seventies systolic. 

When administration makes a decision that makes my eyes roll, what keeps me going is knowing I’m doing some real good in my work. Knowing I’m using my skills and talents at the highest level to help patients is fulfilling, despite the difficulties in our current medical environment. Being the only one in the hospital who can help in a specific way, using my specific skillset, makes me feel like a critical part of the team. And no one can devalue that. 

This is what helps keep burnout at bay. It’s what makes going in at 10 pm for an emergency a duty, not a burden. 

I’m worried burnout, especially in women, though multifactorial, can come from settling. Settling on a career based on extrinsic, rather than intrinsic factors. That’s why the message of my book is to choose the field that fits you best, and ignites you the most. Settling seems a recipe for disengagement and burnout. 

Can you afford to pick the wrong career? 

3. Maybe, but it’ll cost you dearly. 

If you don’t like your job, it’ll cost in career satisfaction. That is a major bummer after all that time spent in school and training, not to mention those student loans!

If you need to change course and apply for a new residency, that’s okay. Lots of successful people have done it. It’s worth a year or three up front, if that pivot lands you where you truly belong. 

If you have an idea of the area of medicine you’d like to practice in, and you grow out of it or realize it’s not quite what you thought, it’s okay. 

If you think, “Why do a fellowship when it’ll cost me a year of attending salary?” I’d say the investment is worth it if fellowship gets you where you want to be. To do a fellowship, you’ll earn maybe $70k, maybe more with moonlighting, if that’s an option. You could be earning $200-300k as an attending though, so you’re “losing” $140k or more, right? NO! 

Not if that fellowship brings your earning potential higher! If fellowship garners you an extra $50k per year (say, on average, even if this is oversimplified), then over a 20 year career, that’s a million dollars in gross earnings. In these decisions, keep the long view in mind, or it’ll cost you!

That’s why I wrote Save Lives, Enjoy Your Own. To help guide you toward the right decision. It will help you sift through your talents to realize how much exploring you need to do. The book will prompt you to spill your guts (my journaling exercises) so you can dig beneath the surface, below other people’s expectations of you, to what you really desire in your career.

Career longevity in the right career

A key component of making a living and building the life you want will be career longevity. If you don’t love what you do, it won’t be long before everything else becomes more important… your partner’s career, your kids… and what will be left of your career? It’ll become low priority. It’ll get what’s left over. 

If you practice something you truly enjoy and can grow into, you’ll be poised for a career that’s as long as you want (and you need) it to be. If you keep working, especially as a primary breadwinner, your family can enjoy the financial security that comes from your ongoing ability to earn. 

Boredom in the wrong career

Getting bored is a thing, even in medicine. And if you stop feeling stimulated and engaged by your work, it can become a slog. So word to the wise, from someone who is entering her seventh year as an attending, go for a specialty that feels like a bit of a reach. Take a leap of faith into something that intimidates and stretches you a bit. Because that big, beautiful brain of yours might get bored of something if it loses its challenge. I’ve seen it in others.

Was I intimidated by all there was to learn in interventional radiology? Heck yeah, I was. There were the procedures, the equipment, radiation physics, not to mention the male-dominated side conversations I couldn’t relate to. Sometimes, it seemed like too much to learn. Still, I knew it was the right career for me, despite the added challenges I saw. It’s not always easy choosing the right career, but it sure is worth it. I did it, and you can too.

Let me know what you think by leaving a comment below.

‘Till next time!

This post is inspired by a post on Twitter from an “M0” pre-med student. She asked #MedTwitter: “What specialty or you in/ interested in, and why? Here’s my answer. It’s easy to love interventional radiology.

Working with your hands

There isn’t an easy way to substitute the feeling of working with your hands, and in interventional radiology (IR), and specialties like it, you can do just that. Did you like crafting, making bracelets, or perhaps video games when you were younger? These are all gateway activities to becoming a proceduralist or surgeon. And to be honest, my day to day manipulation of catheter and wire come pretty close to video games. 

Be stealthy

Using minimally invasive techniques means that in my field, we use the lowest impact access known to do the work, get in and get out! That often means a quicker recovery, less pain, and less cost for the patient (and the system)!

Fix problems no one else can

Is there a lymphatic leak with a refractory chylous effusion? Thoracic trauma or surgery can cause these, and we can often fix them in the interventional suite.

Got gastric varices? Gastroenterology can do a lot, but they can’t reach varies in the fundus. Interventional radiologists can help by placing a TIPS, a trans jugular intrahepatic portosystemic shunt. Or, a coil or plug assisted transvenous obliteration of varices (CARTO or PARTO) might suit the patient better. Better call an IR!

When there are bleeding vessels in the pelvis which are hard to reach or too small to see at surgery, surgeons send them to angio. IR can help.

Save life and limb

If you call me at 2 a.m., I’ll engage. Whether it’s a pelvic crush injury or a splenic bleed, I can save a life. With IR’s endovascular techniques, we can watch the patient’s vitals switch from tenuous to robust in a matter of minutes. 

Work a variety of organ systems, applying your techniques in different areas

The “territory” I work in spans from the neck to the toes. How amazing is that? Because of this fact, you can be the belle of the ball in the doctors’ lounge. My friends and collaborators range from hospitalists to oncologists, surgeons to pathologists… the list goes on! 

Innovate

When you are part of such a young, nimble specialty, you can almost watch it evolve in real time. You can witness as advances are made, and even be in a position to invent a new procedure or device yourself!

I’ll end with quote from Ziv Haskal, the outgoing and ultra-successful Editor of the Journal of Vascular & Interventional Radiology:

 “IR began as—and still is—the coolest specialty in medicine. It focuses on extraordinary things never done before that astonish, and ideally, gradually become routine and mundane, offered to all.”

Dr. Ziv Haskal

Dr. Haskal and my colleagues in medicine know, it’s a point of pride and a pleasure to bring these minimally invasive treatments to the masses.

You can see why it’s easy to love interventional radiology. What other specialties are you considering alongside IR?

Women in male-dominated fields can feel isolated. As an interventional radiologist, there have been countless times I was the only female physician in the room. And the demographics in orthopaedic surgery are even more skewed! This spurred Dr. Nancy Yen Shipley, the subject of this post, to start her podcast. She named it for the tiny proportion of women in orthopaedics: she called it The 6%. On her podcast, she interviews successful women across the spectrum of male-dominated industries, from sports trainers to film directors, CEOs to mechanics. And of course, her fellow physicians. It’s a multidisciplinary approach to the subject, and I think it’s brilliant! Because in my opinion, women in fields like ours have a lot to share across disciplines.

Collaborating to support each other across male-dominated fields

Dr. Yen Shipley and I connected on Twitter when I randomly saw her Tweet announcing her new project– this idea for the podcast she’d been harboring for some time. As her ortho practice slowed down during COVID-19, she decided that it was as good a time as any to get the podcast out into the world!

When I saw her announcement, I had to meet her, and DM’ed her immediately. That’s how I came to be a guest on The 6% (Season 2, Episode 5). In our conversation, we talk about “Leading Differently as Women.” In our episode, you’ll hear more about my back story, and factors that propelled me into the field that I love so much! We chat about how nerdy (yet gratifying) it is to read about leadership in your spare time, and how women can navigate the different expectations placed on them as leaders, especially in male-dominated fields.

Here’s my podcast with NancyMD: 

And here’s the episode page where you can see an outline and take a listen.

Another superheroine in a male-dominated world 

Dr. Yen Shipley, a.k.a. “NancyMD,” is an example of a real-life superheroine in the world of orthopaedics. Once I’d met her, I had to interview her for my book, Save Lives, Enjoy Your Own: Finding Your Place in Medicine. In case you gotten your copy yet, the book contains soundbites from women across the surgically-oriented fields, from OB to ortho, and of course, IR. 

As I mention on the podcast, and as I blog about here— empowering ourselves as female physicians isn’t just about being treated fairly in our careers. It’s about empowering ourselves financially as well. NancyMD, like me, is a female breadwinner and mother.

Here’s a little more about her: 

• She’s a board-certified, sports fellowship-trained orthopaedic surgeon in private practice in Portland, Oregon. 
• She’s an avid podcaster, writer, & speaker who is passionate about sharing her path to medicine with the next generation of physicians. 
• NancyMD took a unique path, starting in the snowboard industry and event planning before landing on medicine.

Want to hear more about Dr. Yen Shipley?

Well you can! On Thursday, 11/19 at 8 p.m. Eastern/ 5 p.m. Pacific Time, she’ll be presenting a live virtual event in partnership with the digital lending platform, Laurel Road. She’ll speak on her journey to becoming an orthopaedic surgeon, and how she’s learned to manage her finances along the way. The event will aim to inspire those entering and establishing themselves in medicine to take control of their own finances.

NancyMD describes herself as a financial “late bloomer,” and I can’t wait to hear more about why she says that, and what she’s learned!

Here are the details about this upcoming live virtual event: 

• The Event:
  • Dr. Yen Shipley will discuss wins & challenges in the context of her career and financial journey during this live virtual “fireside chat.”
  • She’ll share her experiences that led to becoming a top orthopaedic surgeon, and how she had to let go of external financial pressures.
  • She’ll provide financial tips and tricks she’s learned in her journey.

This virtual event is FREE, and the first 60 attendees will receive a thank you gift! Register now by clicking here.

A recap: this event will inspire you to get your financial life in order, no matter your stage.

The event is: “Jumping Into Your Financial Journey: Q+A with NancyMD”

On: Thursday, Nov. 19 at 8 pm Eastern/ 5 pm Pacific Time

The conversation will be geared toward medical students, but the event is open to all!

Register now.

I’ll be there!

What money questions have you been pondering lately? Let me know if there are any topics you’d like me to dive into on the blog!

Leave a comment below, or email me at tiredsuperheroine@gmail.com

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. 

Extended a.m. routine

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. 

Self-care for a momma doc

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. 

Strategy for the momma doc

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?

Family matters

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. 

Sharing the message of the empowered doc

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.  

Mind the timeline

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’m beyond pleased to tell you, I’ve completed my book giveaway as part of the launch of my new book, Save Lives, Enjoy Your Own. I’ve sent over 700 books around the globe, from the US to Switzerland, Nigeria to Saudi Arabia, and Hong Kong to Australia. This process involved a steep learning curve. Sometimes I fought with my email service provider, other times I was running to Staples for a critical roll of label tape. Sometimes I had a surge of energy, personalizing an inscription by first name, wishing them success in their career and beyond! Other times my signature looked like a middle school boy’s boxy scrawl, signaling the fatigue I didn’t realize was creeping in. All of this was actually a part of an ideal week for me. Why? 

Because as I signed and packed each book, I knew it had the potential to change the course of someone’s future career. I knew each little package could contain just the encouragement the recipient needed to become the next superstar in medicine. 

What’s an ideal week for me as an interventional radiologist?

Once, a mentee asked me what an ideal week looked like for me, as an IR. It’s an interesting question, and it varies from week to week. Since I spend most of my work life at a level 2 trauma center in the community, I’ll describe my ideal week there. As to my ideal week off, that looks pretty different, so I’ll write about that next. It definitely deserves its own blog post. 

Rolling out of bed: before 8 am is an emergency

My ideal week as an IR involves coming in each day at 8 am. I’m on call through the night, and the ideal week involves racing in once per week to rescue a bleeding trauma, whether from a pelvic crush injury or a liver laceration. The best weeks for me include a moment where I sweat: I race to fix the bleed as fast as I can. 

Since I thrive on the variety of cases in private practice at my insitution, the ideal week also includes a uterine artery embolization with peri-procedural management and follow up. It involves a few image guided biopsies, where I can stretch my ultrasound skills a bit, and perhaps a thermal ablation of locoregional disease, like a liver metastasis. I love doing peripheral arterial work, and I recently had the pleasure of taking over a case from a colleague, where he thrombolysed, or dissolved clot in the popliteal artery harboring an underlying aneurysm. I was able to exclude the aneurysm with a well-positioned stent-graft.

The ideal work week includes routine cases, too

My ideal week involves bread and butter cases like permcath & port placements, declots, bone biopsies, and abscess drainages. Every case is an opportunity to hone my techniques, with the goal of operating as painlessly and stealthily as possible. Routine cases also allow for time to teach my growing team about peri-procedural management for common procedures. 

A typical week involves going home anywhere between 3 pm and 8 pm when I’m on call. At my hospital, one IR is responsible for all the work that comes in, so we leave when the work is done. There is a typical rhythm to each week: I stay a bit later on Mondays and Fridays, while the mid-week days are (a bit) more predictable. Even on call, I might meet a friend for dinner, as I did the other day. 

The evening routine

When I’m not catching up with a friend, most nights I’m headed home. Thursday nights my husband teaches a music lesson, so sometimes I’m rushing home just in time to be with my little boy as my husband starts his lesson. We eat and play, this week, rolling a rubber ball around the living room. Wes takes a bath while I shower, then he demands a late night snack as I try to brush his teeth.

After our little sprite is down, my husband watches some of a movie, while I listen to a mindset recording. We prepare to get some rest! 

Getting going each morning: my routine

Mornings involve a pot of coffee and a simple routine before I’m out the door. I have a blessedly short commute of less than 10 minutes to our local hospital, and I appreciate that every day. Side note: I highly recommend you take this into account as you choose a job and place to live, when the time comes. A shorter commute= a better quality of life!

At work, I supervise residents who are interested in learning simple procedures like paracentesis, catheter removal, and the like. They pop in and out of my procedures when they can, and they come to me with questions. Though I don’t have radiology or IR residents, I enjoy the teaching and interaction that occurs at my community teaching hospital with trainees of different stripes.

My ideal week has room to breathe

During room turnaround time, or during quiet moments, I might type up a blog post like this one, or edit, or format one. I might call a plumber or make an appointment to see my accountant on my next week off. There’s usually some space in the day to have a phone call with a colleague, answer some emails, or complete a task for my committee work with the Society of Interventional Radiology. 

In summary, my ideal week at work involves some straightforward cases mixed with a breadth of challenging cases and consults. I truly enjoy my work, and generally don’t feel it encroaches too much on family or personal time. Even during busy weeks, there is plenty of time for sleep and basic self-care.   

Taking care of myself as I care for patients

I always sit down for lunch, but the specific time varies, since I squeeze it in between cases. During my break, I chat with colleagues in the doctors’ lounge about our patients in common, hospital politics, and life. Each day, as long as I eat lunch and have time for tea, I feel like I’m taking care of myself, no matter how hard I’m working. 

An ideal week is one in which I feel I did the best work I could, and no one got hurt. It’s one in which I feel in sync with my colleagues, and we have a chance to talk about the practice and any issues at hand. If I got to save a life or help a patient understand their condition better, that’s icing on the cake. 

What’s your ideal week like right now? Or, what do you think your ideal week SHOULD look like? Build the ideal week for you, and you might just find it out there in the job market!

Share your thoughts by leaving a comment below. 

And a final note for this week: THANK YOU to all the sponsors who bought books for students and trainees around the globe! I couldn’t have accomplished this without them.

Click on their names or business names to learn more about the good they are doing in the world!

The Save Lives book giveaway was accomplished with the help of the following sponsors: 

Physician on FIRE

Guerbet Medical

PearsonRavitz

Argon Medical

The Physician Philosopher

Dr. Agnes Solberg

Dr. Tara Hanjan

Dr. Shervin Rafie

Dr. Monica Uceda

Dr. Arun Thunga

Dr. Damien Dupuy

Dr. Hirschel McGinnis

Dr. Allan Lipkowitz

Dr. Linda Armstrong

Dr. Grace Huang

Dr. Eric Presser

Dr. Carlos Ledezma

Dr. Learned Gonzales

Dr. Mike Obedian

Student Loan Planner

Dr. Linda Street

PassiveIncomeMD

Kelly Schoenfeld 

Dr. Sandra Weitz