Wednesday, July 31, 2013


I know there's a touch of irony in adding this disclaimer given that I haven't updated this blog in, like, half a year, but: LONG ENTRY AHEAD.

There's a snippet of a cartoon I remember from my childhood--I can't remember if it was "Tom and Jerry" but if it wasn't it was in a similar vein--where a mouse is reclining in a hot tub. He's sitting back with his arms along the rim of the tub, maxing and relaxing as cartoon mice do, wearing that look of smug satisfaction he was prone to. (As an aside: I never liked Jerry. I always thought he was a real jerk to Tom, a cat who was just fulfilling his evolutionary imperative after all. Ditto Road Runner. Ditto those capering harpy kids that keep taking the Trix away from the rabbit. JUST GIVE HIM A BOWL, YOU ASSHOLES.)

So anyway, the mouse. He's enjoying the hot tub. He's relishing the water, the heat. But the water starts to get a little bit hotter. And a little bit hotter still. Suddenly it's not so comfortable anymore. Not hot enough that he wants to get out of the tub or anything, but just...hotter. He starts sweating. His fur starts getting a little frizzy (from the humidity, you understand). Then, finally, he turns around and notices the cat behind him, slicing onions and carrots to add into the now boiling water. (My memory of this part is not quite as clear, but the cat may have been wearing a chef's toque.)

I've thought of that cartoon clip a lot in the last year.

But let me back up for a second.

If you've ever followed this blog with regularity in the past (though I'm sure with my sporadic updates I've winnowed that number down to only the die-hardest of die-hards) you've probably noticed that I haven't had the time to write much of substance since I went back to work after my maternity leave last September, and that I haven't updated basically at all since December. The reasons are all those that you could probably expect: busy job, three kids, and the responsibilities and duties associated therein. The explanations are always boring because everyone's reasons for being busy are pretty much the same, but to put it in medical terms: it's just a matter of triage.

It's hard to know where the tipping point was--though I have to presume that it was at least in part associated with the addition of our much-beloved third child into the mix--but at some point in the last year, things started getting hard. Not impossible, not un-doable, but subtly, Joe and I started to notice just how tight things were getting. Time was tight, at home, with the kids, with each other. Emotional resources were tight. Patience was less of a resource we could reliably depend on. The days and weeks started becoming these things that we were enduring, rather than living, let alone enjoying. Again, the imagery from an old movie comes to mind--inmates in a prison, grimly notching off yet another day on the wall of their cell.

I don't mean to imply that our life is a joyless dirge--far from it. We love our family, we love our jobs. Even working the hours that we do, we try carve out quality time when we can--long weekends, holidays, family vacations where they fit in. We bolus our family time because our basal infusion rate is so parsimonious, but we do make an effort to compensate. And we liked to tell ourselves that this bolus dosing was sufficient, and it worked...not well, but well enough.

But it didn't change the fact that over the past few years, and over the last year in particular, the feeling of our everyday lives becoming something that we were tolerating started to feel more an more pervasive. When you only see your kids for an hour or two at the very tail-end of each day, only to perform the most basic of maintenance for them (bath! brush teeth! yell at them for not taking their baths and brushing their teeth quickly enough because I'm tired and they're tired and everyone's tired so LET'S ALL GO TO BED AS SOON AS POSSIBLE) you start to feel like you're consisting on a diet of discarded crusts in an otherwise empty pizza box. Maybe you can piece together a life in these scraps of the day, but split between three kids, it's simply not enough time.

Joe and I have been discussing for years our long-term outlook for modifying (read: decreasing) the work hours for at least one of us to have more time with the kids, and for the longest time, our party line has been: soon. We're going to do it soon. "Maybe in a few years or so," was the stock phrase. But there was always the next thing. We'll think about it when I finish my fellowship. We'll figure it out it when I get more settled in my job. We'll do it if I make partner in my group. Later. We'll do it. But later. Meanwhile, time marches on.

Then: I was talking with one of my partners at work a few months ago. He has four kids, the oldest of whom had just turned eight. "I just realized," he said as we were chatting in the front hall of the OR, sidestepping a stretcher careening down the hallway from the PACU, "that he's eight. In another eight years, he's going to be in high school, driving, getting ready to go to college. Half my time with him is already done. I mean, they come home after they go to college and all, but you know what that's like. It's not the same. Half my time of having my son in my house is over already."

There feeling that I had after having that conversation was not unlike being wrapped in a piece of wet burlap and gently asphyxiated. Because Cal was turning eight too. Half our time raising our oldest son in our home was done, and not only had this particular calculus not ever occurred to me, but looking back, I can't say I really know where those eight years went.

Because see, we've always lived like this. Cal was born when we were residents. His entire life--and thus of course, Mack and Nina's entire life too--we've worked. Both Joe and I have worked our tails off. We're not residents anymore of course, and some of the specifics of our jobs have changed from year to year, but the fact of it is that we each work on average 50-60 hours a week, more if we're taking weekend call, and although we've been saying for years that we were going to try to get more control of our work schedules to put some more time into our family life, it hadn't happened yet. The decision point was always pushed off down the road. Later. Soon. Not yet. Someday. And now Cal was turning eight and I have no idea how time passed so fast.

If I'm going to be completely honest with myself I'm sure some of this particular grim inertia was also linked to a perverse macho pride. I've always spoken a lot about work-life balance in medicine and how these antiquated notions, about doctors functioning as around-the-clock automatons sacrificing their personal lives for the greater good, would have to evolve along with the rest of the world. But I think that in some ways I felt safe championing the choice for others to go part-time because I myself chose to work full-time. You do what works for your family, everyone's definition of work-life balance is different. But saying it from the vantage point of someone with three kids and still worked full-time herself felt like a secure platform from which to proselytize, like I was somehow above reproach from people who might accuse all part-time doctors of being lazy or uncommitted. DO WHAT YOU NEED TO DO; BUT AS FOR MYSELF, I AM DOING ALL THE THINGS.

And to be honest, we were getting by. It wasn't wonderful, but it was OK. We were surviving. Maybe we weren't "living our best life" to invoke an Oprah-ism (and I don't even know how I know that since I never even watched Oprah) to day, we were getting by.

And then, the week before Memorial Day, our nanny of five years quit. With no warning, and giving zero notice. She just left one day and mentioned on her way out the door that she wasn't coming back.

Boom. Game-changer.

I'm not going to talk too much about the nanny thing because frankly, after probably the most stressful two months of our lives, I'm just over it. It wasn't even so much the issue of finding a new nanny--though that, obviously, was a huge part of solving our problems, at least in the short term.  But the larger and more important part was having to honestly evaluate our life, our choices, and just how much time we did indeed spend at work, away from our children. It was like turning the stark, faintly buzzing fluorescent exam light onto the fish-white underbelly of what kept things functioning at a level that passed as "OK" for the past five years. And what we realized was that: it really isn't OK. Having to outsource this much of our children's care--of our children's lives--to someone else, particularly someone who after five years could walk out on them without so much as a backwards not OK.

(This is putting aside the obvious logistical difficulty of finding a non-live-in person to work 50-60 hours a week. It's a tough sell to say the least. One suggestion, perhaps less helpful than most, was that we should just hire two nannies. To which my reaction was, if you have to hire two people to take care of your kids while you're at work, it's possible you're not spending enough time with your kids.)

So. Joe and I discussed and agonized and number crunched and evaluated. We talked to a lot of people. We agonized some more. And what's going to happen now is this: as of September 1st, I will be going part-time at my job. Joe and I would have been fine with either one of us working less, but because of the ways our jobs are structured, it makes more sense right now for the part-time working parent to be me. My new schedule will have me working three days a week, mixed in with my share of nights, weekend and holiday call. And my main goal for the other two days of the week? To do some of the things that I've never been able to do with my kids because I've haven't had the time. Simply to be around more.

I know this all seems unnecessarily melodramatic of an announcement to some, because plenty of people in a multitude of fields choose to work part-time. But for me, it is a big deal, because to be honest, when you're accustomed to following a prescribed path, swimming against the current for a change can be scary. And there are a lot of issues--job guilt, fear of resentment from co-workers or being perceived as less than fully committed to medicine, concerns about crippling my career potential--that I'm working through having finally made this decision. There's a fear of not wanting to let people down.

But that's it on the other side too, isn't it? I don't want to let people down. I want to do my job well. All my jobs. And I think that right now, I need to spend more time with my kids. Nothing's broken, I still love being an anesthesiologist, and the fact that I've worked full-time for the first eight years of parenthood wasn't the wrong call nor has it damaged our family. It's just that our choices then are not the same as our choices now, and when we have better options we owe it to ourselves to take them. We could be making more of this life. We could be doing better.

I'm not going to be there hovering in the periphery for every single second of my kids' lives, nor frankly should I be. But I'm looking forward to just being around more.

So that's what's going on with us. In most ways, it's really no big thing. But in other ways, it's the biggest thing.


  1. Well, I can say this, it might take you FOREVER to post but when you do its a doozy!! I have been following you since med school and I have always admired your tenacity and constant moving forward with your life and goals. I know this was a hard decision for you to come to and I hope it helps. As a single mom of two kids, I always felt as well that life was moving too fast and that at the end of the there was only time to save the teeth! This will be awesome for you guys! You will have time to do fun stuff that you will never forget! (and maybe post a little more often??) Good luck!!!

  2. I think you've made a brave choice, and I applaud you for doing what you think is best. I think that's what it comes down to anyway. Some of my female classmates have had babies on a Friday and been back in class on a Monday, and that works as well for them as the female docs who choose to work part-time. On a self-involved note, I'm looking forward to reading more blog posts or seeing more pictures. Woot!

  3. We too have 3 kids (4yo, 1.5yo twins), and I dream of being able to cut back on work someday. I worry once my older son starts school and we enter the world of short days and random days off that I'm going to need more flexibility with my time. I'm a scientist working in biotech, and unfortunately there do not appear to be many part-time options for me. After our twins arrived, I inquired about switching to a 4-day work week and was shut down. My job requires my presence here during the work week, and there are hundreds of other PhD scientists out there willing to work 5 days/week if I choose not to. I really enjoy what I do, but fear I'm going to have to make a major career change if I want to make more time for my family.

    Good for you & Joe for working together to find a solution that works for you family. I hope it's a smooth transition for everyone. Good luck!

  4. My dad always says "Can a decision be reversed?" and if the answer is "yes" (stripping away all arguments of complication, time, expense, etc), then he would suggest that trying the new thing is the right choice. (Things that fall into the "no" category, such as "amputating a limb", obviously require much more consideration.) I guess what I'm saying is, should you hate this decision after giving it a go, you can (hopefully - I'm not a doctor, so am unfamiliar with the intricacies of your position, the hierarchy, etc) always change your mind. Best of luck!

  5. Good for you for making the tough decision that works for your family! And I'm selfishly hoping that this means you'll have more time to write awesome blog posts!

  6. Congratulations! I totally relate to how hard it is to go against the crowd. Or to join a crowd and wonder if it's the right one. But doing either is brave!

  7. Anonymous3:39 PM

    First off, I consider it kismet that I checked your blog today as I haven't been here in months too. Second, Congrats on getting off the treadmill. That's what I like to call it. The "push, push, go, go, get through it" of medicine is so much a part of our culture. It can be so hard to even think differently and realize that you don't have to be that way. I am actively NOT working toward promotion and enjoying my life. I hope you do too!

  8. I'm going play the good for you card too. If this is what works best for you and your family, it is the right thing to do.

  9. I say congrats on your choice! I am a fellow doctor who did the same thing, and I have not looked back once on my choice (makes it sound easy, but trust me it was HARD for many of the reasons you wrote about it). You'll be defending your decision daily to everyone who decides to comment, but it gets easier as you realize how awesome it is to just be. around. more. Bravo to you for the courageous shift. (Side note - I blog and under the About Me tab is my same process of making my decision. Seems we female docs often feel so alone, but you're not.)... Jen @

  10. That must have been a really tough decision. You're a good doctor but also a great mom. It's the old "you'll never wish you spent more time at work" argument. Enjoy your kids and work hard. You can do both, just...with the scales tipping the way you need them to.

  11. Anonymous5:11 PM

    I'm sure your kids will really appreciate you being around so much!

  12. Martha5:13 PM

    I'm in medicine too, and I've seen this decision be made by many other individuals & couples that I've worked with. It's not something I've had to face yet, as I currently do not have children and haven't yet had to consider the math behind working & making more time for loved ones. And I don't intend for this to sound critical of the choice that you have made, which as you describe is best for you and your family, but I do think it's worth discussing--that for all the couples I've seen where one person makes a choice to work less, it always seems to "make the most sense" for the woman in a heterosexual partnership to go part-time.

  13. I envision your future family life as something to be really jealous of (me: European full time surgery resident, separated from full time anaesthesiologist daddy of 3 yo beloved daughter) and completely feel the craziness behind the neurotic mechanisms that also make me say: Going part time? Unimaginable. For others? Hell yeah!

    BUT can I just say: just for ONCE I would have loved to read about the GUY cutting back on his hours.

    Seems like we always find an excuse why it can't be them - nor both equally (each of you 4 days instead you 3?).

    1. Martha and Kris:

      Hi! Re: gender disparity in going part-time, believe me, I've thought about that too. There are two answers: the nuts and bolts answer, and the REAL TALK answer.

      Nuts and bolts: I'm and anesthesiologist and Joe is a surgeon. Many people say that it makes "more sense" for the wife to go part-time in these situations because she makes less money in her job, but that's not the case for us, at least not at this point in our careers. What makes our jobs different is the nature of the beast--or of our respective beasts. Anesthesiology is a job that offers relatively more flexability in many circumstances because of the ability to be "plugged in" (or, in this case, unplugged) from the OR based on case demand. Joe, and many other young private practice surgeons, however, need to first build a sustainable practice on their own. That means they need to be more available to see patients, do procedures, and do surgery in the OR. In other words, him dropping his patient availability to 60% would translate to a much, much more than 60% decrease in salary.

      But now, REAL TALK: If I were the surgeon and Joe were the anesthesiologist, would it be precisely mirrored? When it comes to taking more time for our kids, do I just "want it" more? Would it be less well received for Joe, even in a different field of medicine than the one he's currently in, to drop his work hours for family reasons at a relatively early point in his career than for me? All these things are real considerations too.

      I will say, though, that Joe and I have talked about him eventually scaling back as well, or at least more efficiently scheduling the time he has at work. But it's a process. One step at a time.

  14. kerry5:24 PM

    Woohoo! Whenever I hear women agonizing about how to add another week or two onto their maternity leave, I want to ask them, "Do you realize how much more awesome your kid will be at one (or five, or eight)? Save it for then!" So glad that your hard work over the years means that you now have the flexibility to spend more time your already awesome children.

  15. Michelle, I'm so glad I happened to read your post today. I also am contemplating a part-time schedule after all these years of trying to juggle full time private peds endo practice, taking call 24/7 365 days a year, and missing out on so many things for my now oldest 5 year old son! His brothers are 3 and 2 and don't verbalize as much, but my 5 year old is ALWAYS asking when I will be home, if I'll be able to spend more time with him, and asks for more Mommy and Son alone days, because typically he only sees me the last 1-2 hours of his day. I truly feel your emotions of all this. So many past mentors always taught as a female physician NEVER go part-time because you get taken advantage of; but as I've gotten older, I'v learned life can be flexible and for my kids now, they need me to be around more! Babysitters and Au Pairs just don't fill in the same as their mother. So, congratulations for a brave, and well-planned life decision. I'm eager to hear how things progress once fall is here :)

  16. I've been wondering what happened! I'm glad you are going to get to spend more time as a family. I love reading your blog (whether you update it or not). Best of luck on your new adventures and way to go on making such a hard decision!

  17. I hope now you can enjoy everything more!

  18. Anonymous8:12 PM

    Taking a breath is good. For all of you because you will all feel the change and it will be nice. This time with your children is VERY fleeting. I am glad you are in a position to make this choice. Joy to you all.

  19. I have to admit that I thought the same thing as Kris did re: you vs. Joe scaling back. While that's part of it, I'm also really happy for you that you've come to a decision you're happy with. I don't think it's an irreversible one either, should you ever desire to resume full time work. It IS hard seeing my daughter only 1-2 hours a day, even though I love what I do. Sometimes I worry that it's not going to be enough for me over the enxt couple of years during residency.

  20. Well this couldn't be more timely. I've just fellowed so I'm finished training (I'm a GP - I thinki you call them family doctors with obstetric qualifications so I also deliver bubs) and I'm 28 weeks pregnant. There's been a lot of angst over the last few months as we try to figure out what to do.

    My husband is not a doctor and is military so has no work flexibility in terms of part time. I do. So it makes sense for me to take the time off and then recommence part time. But I've been struggling with that same feeling. It's been go go go in my career for so long (15 years all up counting med school) and I feel like I'm LETTING THE TEAM DOWN. Which is irrational - but I suppose that's how we're trained.

    I'm sure I'll love the time off with the new little person but I'm still feeling uneasy. I mean, not working??? Say, what?

  21. Anonymous9:25 PM

    Yaaaaaay! It sounds like there's a good chance you will be happier with this life change, which means I think all your die-hard-y followers are happy too. Thanks for continuing your excellent blog.

    Any initial plans for the new time at home? (Cue Homer: "I'm going to drink a lot of beer and stay out alllllll night!")


  22. Kudos to you on your decision! I went through a period of guilt when I made the decision to stop working several years ago. Took me quite a while to get over that despite the fact that I was SOOO much happier being able to spend more time with my boys & being more involved in their day to day activities.

  23. Anonymous10:24 PM

    Congrats! Great news!
    Good work unapologetically pursuing your dreams. It's ok (and appropriate!) for your dreams to be 'getting home on time and spending more time with the fam' at this stage in your life.

    I'm a woman doctor who works full time and my husband works part-time. He stayed home when our daughters were tiny and now takes them back and forth to school. He stays with them when they're sick. He does the grocery shopping, the laundry, and cooks dinner every night.
    His job was just more conducive to flexibility than mine so that was the path we took.

    It's wonderful to have such a progressive and forward thinking partner but I'm not going to lie that sometimes I get jealous of how much time he spends with the kids. That's a real thing! It's not just society and sexism and 'pre-defined roles'!

    A lot of my fellow working-mom/stay-home-dad friends have had the same experience. It's something to think about! My husband enables me to chase my dreams, but after my kids were born my goals quickly became "get home on time" and "eat dinner at home EVERY SINGLE NIGHT".

    If Joe went part time while you worked full time you'd get lots of fist bumps from fellow feminists but it's harder than it looks.

  24. Anonymous12:25 AM

    Thanks for the updates! I am a fellow female MD mum, who have been following your blog since yours & my med school days. I am currently working FT and my husband, an engineer, part time, because his job allows the flexibility and I earn quite a lot more $$-wise. I am fortunate that I have a husband who is capable of keeping track of the kids' schedules and deal with the day-to-day laundry/meals/cleaning. We may 'switch' some day, but for now, this is what works best for our family. Good luck! We look forward to more news/photos of Cal, Mack & Nina! (& the dog).

    1. Yes, I often think that if Joe's career was at a different point or he had chosen a different field of medicine, he would perhaps be better suited to taking more of a childcare role than I. He's certainly more patient than I am, and he is better at really playing and working with the kids, particularly the boys.

      Ultimately the goal though is that my move will streamline Joe's schedule by association. Right now he plans his clinic and OR schedules around my call schedule--like he literally imports my call schedule from iCal into his clinical schedule. And it makes his time very choppy, because he tells his schedulers "you can't put any cases or appointments on after X o'clock any days my wife is on call" (works out to about twice a week, not counting weekends) and obviously it's not always the same days. Hopefully with some of these constraints lifted, HE can schedule HIS work time better, which means more efficiency which means more predictable hours at work and at home.

      Sigh. The stuff they don't teach you in medical school could fill a textbook on its own.

  25. Anonymous3:28 AM

    Somewhat long-time lurker, first-time poster. I discovered your blog (and book!) within the past year and have whiled away the time between posts sifting through your archives and laughing my butt off late at night when I should have been working on my personal statement to medical school. I myself am pretty far away from the point in your life that you're at now, but it's extremely insightful to me nonetheless to know what I'm getting myself into.

    Anyway, just want to let you know that your readership is not dying as you worried about in the beginning of your post! You're still providing lots of wonderful stories and perspective (and Tumblr pictures!) to the next generation of not-yet doctors.

  26. Anonymous7:22 AM

    Kudos to you, Michelle, for being the captain of your ship. It's wonderful that you sat back and prioritized your life according to your own convictions as opposed to the all the social pressure bullshit we women are under. I am in my second year of residency and juggling two small children, my husband lives in another state and is completing his residency. When all is said and done I will most likely go part time and will flip the middle finger to anyone who thinks I am letting the team down. The only team that matters is the one I come home to each night.

    You and Joe deserve to live your lives with vitality and not "just making it." You have put your time in, now reap the rewards. I have been following your blog since you were finishing up med school and have even used a lot of your examples to progress forward in my own career and family managing. Thank you.

  27. Anonymous8:27 AM

    I made a similar decision when my second child was born. I originally thought it would be just for a couple of months while I eased back in from maternity leave and now it's been almost a year. I have no desire to change it. As an added bonus, we've made a lot of new friends in the area. Before, all my free time was just with my family. Now, I meet other part-time moms and arrange play dates, etc.

    I think it was the year after you graduated, but Madeleine Albright came to campus and said, "You can have it all...but not at once." That's really stuck with me. There are still many years of career left after your kids are in high school/college.

    1. Totally agree. I also think that keeping a foot in things allows me to dial back up in my career if I want to when the kids are a little older. Despite the fact that on its face, this is cutting back on work, we're actually considering this an "in it for the long haul" career move.

  28. Anonymous11:25 AM

    I am a pre-med student and I have loved your blog ever since I found it several years ago. I've always admired your ability to balance family and work so when I started reading this post, I felt more and more apprehensive the longer I read. I don't have kids at this point and may never have them but I like to think that it's an option on the table. However, I also know that after all the work I have/will put into my career, it's not something I'll be giving up easily. I thought you were a prime example of how the two could coincide but as I read the beginning of the post, I was afraid perhaps it "couldn't be done" after all. So when I got to the paragraph saying you were cutting back to 3 days/week I thought, "Oh, that's not bad. I can handle that." I know I am being ridiculous since it is not my life, my family, or my job but all the same, I'm happy you found a way to continue to blend a career that you love with a family that you love. I will stop rambling and return to studying for the MCAT. Best of success to you and yours!

  29. Anonymous11:46 AM

    In a completely unrelated train of thought, I think I remember seeing a post about your recommendation for comfortable all-day shoes but I can't seem to find it so maybe I am imagining things? If you did indeed have such a post and could head me in the right direction, I would appreciate it as I am currently trying to decide which shoes I should invest in next.

  30. Anonymous5:17 PM

    Yes!!!! Oh what a fantastic wonderful choice! You have made the RIGHT decision (and dont be afraid to cut down on the night shifts/weekends either.).

    Don't care too much what your co-workers will think; think what your precious children will think! How BRILLIANT that they get to spend more time you, and you with them!! There is nothing a child wants, or needs more.

    well done.

    best wishes,
    from one ex-medic who decided to QUIT full time medical work to be with my children

  31. Anonymous5:34 PM

    Michelle, I have followed your blog for 8 years. You are an inspiration to me for how much you've accomplished and how much you are still juggling. I always assumed you are working part-time since your move to Atlanta. It's even more humbling to learn now that you've always been full-time. I realize that working part-time is an alien idea to those of us who have worked so hard and so long to become doctors. But our field is also full of burnt-out, unhappy people who have long stopped liking their jobs or caring for their patients. I applaud you for making this uncomfortable life decision, and I sincerely believe you will be BOTH a better parent AND doctor because of it.

  32. Long response warning! In all honesty your recent break from blogging, and then this post, have felt both inevitable and surprising. As a very long-time lurker - your mention that Cal is eight made me realise just how long, I charted your progress through training, career changes and family always a few years behind. You have always been such an excellent writer, often seeming to express the tiniest nuances of the realities of this career, and whilst it often felt like reading something by someone who knew exactly what I was going through, you did also seem to have it together so much more than I ever would!

    I am married but have no children, and soon after graduation I moved out of clinical medicine, for a variety of reasons. I love the field I am working in, but I am also honest about the fact that part of my decision was to do with work-life balance, and another big part was to do with the reality of hospital medicine hitting far harder than anticipated, meaning that the home life I did have was lacking in any enjoyment. I feel very lucky to be working in a role that utilises my training yet seems a much better fit for me personally.

    However, I must admit your book, and blog seemed then to be a beacon in many ways of all that I could not be. As ever, your honesty and eloquence in this post has made for fascinating reading but also reassured someone a few steps behind you on the path. Reassured me that medicine, by its nature, requires many types of personality. Reassurance that however together someone else seems to have it, it isn't always the reality. Mostly, though, reassurance, that choosing life as a priority doesn't make you any worse, or any less enthusiastic about your career.

    Good luck with the transition, I know it can't have been an easy decision, but congratulations on an exciting new stage for your family.

  33. Anonymous10:50 PM

    Good luck, Michelle, and don't let anyone pressure you into going back full time until the kids are out of the house. I've been taking advantage of the work from home policy since my daughter was born 5 years ago (some might even say abusing it), and I can say every moment spent with her has been priceless. She will be starting kindergarten in the fall, and I feel a little sad to be losing our time together to the school day.

    Your friend from MIT,

    1. Huang Li De! Glad to hear you and Francine are doing well... :)

  34. Man, I went through a few months of nanny insanity. It was insanely stressful. Sorry you had to deal with that even if it ended up being a turning point to make things happen.

    Enjoy the part-time-ing. And it's okay to give yourself some time to adjust.

  35. Anonymous9:42 PM

    Great post! Thanks for sharing what I am certain was a very difficult decision to make. It gets more fun as they get older and the big stuff that you don't want to miss is just around the corner. My youngest and Cal have the same birthday. My oldest is 13 and is changing on a daily basis. I think you're lucky to be able to have both family and career, many women cannot, in particular those with MDs, MBAs, JDs....For high profile careers, usually you are all in or all out. I am glad you were able to finagle something that works for both you, your marriage, your children, and your career. Looking forward to hearing how it all works out :)

  36. Anonymous3:30 AM

    Well done on dealing with a difficult time, and having the bravery of making a decision that is right for you.
    I recently made a change in speciality from one very time heavy with significant out of hours commitments, to one that (theoretically, in the future) would hopefully, potentially, be more flexible, with a less arduous out of hours commitment. The decision for a need to change was due to personal family circumstances. For a long time I knew something was not right. That something in the equation of all the responsibilities (work, family, etc) that I had, had to give. The question was, what had to give. Once I realised I wasn't happy for the 'give' to come from my particular family responsibility (there were few others to fill that role, whereas there were many, many others parts of a cog wheel to keep the medical machine turning), I realised it was the work bit of my life that had to change. People say that medicine is all -consuming. We know this, yet I know I didn't really fully realise how much of my life, time, focus and long term planning and prioritising it had taken up until that point.
    Once that realisation occurred, it then was a fraught period of at least a year of decision making as to where would be my next career move, that would be a bit more compatible with family responsibilities.
    2 years on from that time of realising, reflecting, change of direction, and a little way down this new road, I couldn't be happier with my decision now.
    That's not to say I didn't have my doubts. I had colleagues express surprise at my decision, try to convince me to stay in the current field, that things could change, get better (I looked around for a long time at colleagues in different places, and realised, actually, they don't really), others told me I was 'too good' to do the other specialty, that I would be 'wasted' there..(They didn't really understand how tough and challenging the work of that other speciality could be!). On top of that, I felt this unseen pressure, and previously unacknowledged pressure as a woman to just get on and do it all.
    But, once I looked upon my situation dispassionately, and looked upon my life, acknowledged the key elements, the core responsibilities, the bits that were personally important to me, and figured how I was personally going to make this work in the longer term, and keep myself not only sane, but more content and less stretched, I knew I was making the right decision for me, for now. And if someone else didn't approve? Well, they aren't the one living my life now, are they?
    Mentioning that Cal had turned 8 made me reflect on how long I had been reading your blog - over 10 years!

    This comment ended up being a longer one than I anticipated, but what I am trying to say is well done on the decision and the change. When looked upon dispassionately and in retrospect, the decision will not seem so difficult in time, but at the time of making the decision, it feels so difficult due to all the roles and pressures we feel, often as woman.
    The thing to do remember, it is OK to prioritise family life. Work will always be there in some form, the family situation is a lot more personal and dynamic. Feel no guilt.

    Thanks for the updates Michelle, and I wish you all the best!

  37. Anonymous6:19 PM

    When I finished fellowship (cardiology), I took a part time job and never looked back. I got a lot of snide comments for it, especially from the older male attendings ("what are you doing the rest of the time? playing mommy or something useful like research?") but I kept an academic appointment, and was able to spend more time with my family. Enjoy part-time work, it's still more hours than normal people keep but you will get your sanity back. Why more doctors don't choose part-time work is beyond me. Good luck with this next phase!

  38. Anonymous10:34 PM

    This post totally hit the spot for me! Between looking after 9 month old twins, residency, and studying for my royal college exam in anesthesia (coming up in 2014), I am in survival mode. Fortunately for a very understanding family, we still have our heads above water. At some point, I will have to make the same decision as you have, feel the same 'career guilt', but know the end of the day I'm the only one who can mother my kids, whereas there are plenty of other people can give an anesthetic just as well. Thanks for sharing your experiences, I always enjoy reading them :)

  39. Anonymous6:15 AM

    Due to the content of the very start of this post, I was nervous that it was an announcement you wouldn't be blogging anymore! Obviously you will have many many things to do with your newfound time "off", but I am selfishly hoping that blogging will be one of them again. Happy everything, keep up the great work, and thanks for the update.

  40. Anonymous9:20 AM

    What's the matter with two nannies? we used two for a while. it worked out great. personally, i think it's a much smaller leap to consider two than deciding on whether to use a nanny at all. one was available for emergencies when the other one got sick or took vacation. the kids loved having two different types of nannies. one would take them outside and play a lot, the other was more arts and crafty. the nannies didn't feel like they were causing a headache when they needed some time off.
    of course wife was already working part time by then. however as a primary care physician, her part time was like 60 hours per week. we needed them as we also both took call and had night time and weekend responsibilities. it did take a while for my wife to get comfortable with the idea of having a nanny at home while she was at home. however, that allowed her to pay bills and clean and cook and have one on one time with each kid so she got used to it. she also got to go workout and read, which improved her sense of well being immensely.

    frequently i find that the choice of who works part time is based on many factors, and income (as long as there is a bare minimum) is very low on the priority list. although i'm good with my kids in 3 hour spurts, there is no way i could stay with them all day long regularly and be the same. also, obviously, professional service concerns remain, and each physician has to decide for themselves how much of their personal life they give up for when they chose medicine as a profession. Especially if they are also tasked with administrative professional responsibilities or want to participate in larger roles on societies or teach/research.

    just saying you may find two nannies who work part time each a viable solution in the future as you start to juggle increasingly more after school activities and need drivers and someone to stay with the younger ones after school on days when you are both working. on the procedural side, it can be really stressful waiting for your OR time to start, when you know you have to pick up your kid somewhere at 5 pm, as you know. even you can't be in more than one place at a time. it's not how much time you are spending with them, it's also what kind of experiences do you want them to have. just food for thought.

    best of luck with going part time.
    it's a minor miracle you guys lasted full time this long.

  41. Well, congratulations. Can't wait to hear about your new adventures!

  42. Anonymous4:22 AM

    It is quite sad that in US-style medical practice, going "part-time" actually means cutting back to 40 hours/week, when you take into account the staying late, the on-calls/weekends, and all the little work things we do at home. It really doesn't have to be that way...

  43. Anonymous1:13 PM

    I'm happy to hear this =) I am also a mother in medicine but am taking a one year hiatus from training after a move across the country for husband's job, he matched. I am loving the extra time with my two year old. Returning next year in a more family friendly specialty. It is a tough transition after working so much, but the rewards of being a more involved mom make it completely worth it. Thanks for this post for all of the doctor-moms out there trying to make it work!

  44. Anonymous4:22 PM

    There needs to be a major accounting of what the hell the professional class life is becoming in this country. Working 50-60 hours a week and always being on-call is exhausting whether or not you have children. I hear what people are saying when they note that it's almost always the woman going part-time, but when the choice is between grinding it out and working part time, it's not clear to me women are really losing. I wish more people would question what the goal of working people to burnout by the time they are in their 30s is? I guess money.

  45. Anonymous4:27 PM

    you've got to read "the opt out generation wants back in" in nytimes this week

  46. This comment has been removed by the author.

  47. Anonymous12:58 PM

    I've been following your blog for a couple years now. An older non-traditional student, I'll just be starting my m2 year at 30. To be honest, reading a post like this terrifies me in many ways. Not that I had no idea what I signed up for, but reading a blog about a family of doctors with kids, who, while very busy, seemingly "made it work" was refreshing. Obviously, I'm aware that there are sacrifices everyone makes, but to hear so honestly about the limitations faced, especially when you sort of looked up to someone as an example of someone juggling everything successfully, is sobering. I made a career change to be a doctor, because I'm so excited about it, and feel it's the best career for me, but it is frustrating that being a doctor "full-time" means a lifestyle that most would not consider conducive with the best way to raise a family. That there should be this much...guilt(?) felt when you make this kind of decision. I have to think there's a better way.

  48. Anonymous1:40 PM

    After seeing (but I admit, not reading) a whole lot about "Lean In" by Melissa Mayer I couldn't stomach even reading it, already offended by what was at least publicized choice of chastizing. I don't doubt she's willing to make such career choices, but I cannot fathom the choice right for what she perceives. Ironically, a Bloomberg article, cover title "leaning out" was a counter article to the book - how so many more traditional style families (ie men as primary breadwinners) don't want it all. That having it all isn't what it's cracked up to be and that 'all' can be and should be individually defined. That more men want the chance to be with their kids, involved, and a real part of raising them like women who are more likely the jugglers...You are lucky to be given this opportunity to chase your ALL and enjoy it! You just happen to be prioritizing your family equally with your job and your definition of who you are.

    As a working engineering mom of 3, I am lucky my job not only allows, but also encourages a balance, but it is always manager dependent as well as subject to project demands. I fear any future unknown management structure that could swing the pendulum the other direction. I have also chosen a 'less management' focused career path as well for the balance.

    1. Anonymous2:10 PM

      Ugh I have no idea why so many people demonize lean in without even reading it. Terrible.

  49. I agree with anonymous above. "Lean In" offended me, and Melissa Mayer offended me when she appeared on Cosmo Radio. Do we have to be either on one end or the other of what is a pretty broad spectrum?

  50. Anonymous10:52 AM

    I was working part time, and once I announced my fourth pregnancy, my boss basically told me there will be no work for me after my maternity leave. I was working part time already - as you know , with three kids, it was already a juggling act and I was stretched thin... too thin....
    You are so lucky you can scale back and once the kids are a little older you can go back full time if you wish.
    Right now, I am unemployed, have no idea how I can find a job and worry about that.
    Being home full time is HARD!
    But having both a part time job and being able to be home more is I think the perfect balance and I am sure you will enjoy it!

  51. Anonymous5:04 PM

    Hi, Michelle.

    I have followed your blog for several years. Glad to see everything is OK. I think you have made a great decision. I have been a full-time SAHM for nearly 13 years now. In the beginning I had little choice. My son was a 33-weeker and came home healthy. (but it was RSV season and we were ordered to keep him out of daycare). But soon it became obvious he had hypotonia (benign) gross motor and speech delays. He spent his first 5 years in speech, PT, and OT. Somebody had to be home to take him to all of those appts, and do the homework with him.

    My husband worked many 50+ hour day/night/rotating shifts/overtime weeks for 9 years. Our life would not have worked without one parent at home. Oh, and we had a 2nd baby too, a 36 weeker.

    Now at nearly 13, my son is an honor roll student and violin player. He is utterly non-athletic and a bit gawky, but has come such a long way from where we thought he would be. I do not regret a moment spent at home with my kids.

    My only regret is walking away from my nursing career. Getting back in the door after this long is nearly impossible. You will have the best of both options in your new part-time career. --- Amanda

  52. Congratulations and good for you! Enjoy those kids while their still little! The OR suite will STILL be there.

  53. I'm so glad to come here and read this! It seemed like in your posts leading up to now that you really wanted to make this decision but were worried about how it would look to others (aren't we all), and from an outsider's point of view it was so obviously the right thing for you guys! Because of course I can evaluate and decide your life just from a few blog posts. ;) I am happy for you and for your kiddos.

  54. Anonymous1:13 PM

    Michelle, I am so happy for you and your family. I'm sure this decision will work so much better for all of you.My niece who is married and lives in New Jersey is an attorney. Her husband is also an attorney. They also have 3 small kids.All things considered it worked best for them for her husband to give up his job and be a SAHD. She loves her career and she loves her kids but she has no patience with them and he is an expert at handling them. He also likes to cook and doesn't mind housework. This was just the decision that worked best for them personally. Im so happy you and Joe have made this choice that surely will work to strengthen an already happy and healthy family.

  55. CONGRATULATIONS!! I think you will love it! I look forward to many more pictures of the kiddos, but completely understand if you do not have time (still). I cannot believe Cal is eight...this must mean I have been following your blog for more than eight years. Holy macaroni.

  56. Anonymous10:58 PM

    Awesome... just awesome. Will continue to read as long as you write!
    - Grace

  57. Anonymous3:02 PM

    This sounds, in fact, like a great decision and one that makes perfect sense for you both now and for the "long haul." You are not in the least opting out, you and Joe are sensitive to the need to be equal partners, and to me what is most important is that you will be able to be around for your kids as they get to the age where I really do think they benefit from the steady presence of a loving parent. Weirdly, I found excellent daycare a good complement to us when my kids were young, but once they hit 8-9 or so, an involved parent(s) is really irreplaceable. Just to be there, available, supportive, demonstrating they matter. Most of the time, nothing will really be going on, but I think the willingness to take the time with them is key. Now, I am a tenured professor at an R1 university and run a research center also so my "Mom" time is always complemented with a lot of "leaning in" as well. But it is on my terms. And when they go to college, guess what, I will be cranking out a lot more research and traveling again much more. If you are really great at your job, and you put in the start up hours, you can in fact create a life that allows for meaningful, and powerful, work while at the same time privileging (not triaging) your personal life and family. So brava, Michelle! And if you do have more time for blogging, we will all be thrilled. So congrats!

  58. Hi! I am a part time doctor and full time mommy here and I just happened to stumble onto your blog one day. I was actually looking for congee recipes and came across it. Crazy. Anyway, I wish I had found this sooner, as I love your writing and it would have been great to read during the always awesome time of medical school/residency.

    Just wanted to say good for you! Both my husband and I are physicians so we can relate. Working part time, even with full time loans, is probably one of the best decisions I have made (right up there with the "never touch the pancreas" moto during my M3 surgery rotation)

    One advice I wanted to give you (I know free advice is always wanted ;) is that you are probably going to work the same amount of hours as a normal full time person with a regular job.... stay firm on your time boundaries and even if you end up working 40hours a week...IT IS STILL WORTH IT! :)

  59. Michelle! I have been following your blog for several years now, first as a premedical student and then as a medical student. I'm in my second week of medical school right now! Thank you for this incredibly insightful post -- I know this is something i'll have to deal with in the future and hearing REAL LIVE DOCTORS give no-bull answers about the tough choices practicing doctors have to make concerning family is refreshing.

    Back to studying!

  60. I have to say I find it disturbing that your nanny (obviously defacto family to the boys) just suddenly quit. That is mind boggling to me to just up and leave those kids you have invested so much in.

    As far as you going to part time: you need to do what you need to do. AND it is also ok if you want to be a full time stay at home parent for awhile. No shame in putting your family first. The great thing is you picked the perfect specialty for that level èf flexibility!

    Family Med Attending

  61. Anonymous10:41 AM

    I am so glad you are writing again! We had to make this decision a in April. We were about to have a our third child and we, too, had lost a long-time nanny rather suddenly and coldly. I am a more than full-time doctor and my civilian husband decided to stay at home with the children! It is working wonderfully for us. I hope only the best for you and your family. Thank you so much for giving me so much enjoyment and support throughout the many years I have followed your blog. I found you when you were switching into Anesthesiology from Peds and were pregnant at the time. I was also starting my Anesthesiology residency several months pregnant. Ever since then you have been an inspiration - proving to me that whatever I am struggling with IS possible. I loved your book too, by the way. :)
    Thank you so much

  62. Anonymous1:48 PM

    I've followed your blog since Cal was a baby, and you are an inspiration! I'm married to a surgical resident, and it is hard to get much quality family time even with only one doc in the family! Thankfully my full-time job is extremely flexible. I'm so happy for you! I'm glad you're going to get to enjoy more of the "good stuff" in life. Thanks for sharing.

  63. Anonymous11:17 PM

    This is the beauty of career options. As a 2-doctor family, we have made many choices to improve our home life. My husband gave up surgery residency and switched to anesthesia, because there was seemingly no end to the miserable hours. Since he finished fellowship, I have been able to work part time in primary care, and I love it. I will say that his job in a residency program is much more flexible than private practice- he is home at least 2 days per week, generally, and can make trades and request time away fairly easily. Good luck to you on your new adventure!

  64. Anonymous10:36 PM

    I would like for somebody to do a study on these nannies that seem so committed to these doctor kids and then up and quit NO F***ING notice. My nanny did that to me last week. WTH?!?! In other news I'm beaming from ear to ear. So happy to hear you will be spending more time with your kids. There is something super special about having a mom home to make sandwiches, cuddle when one is grumpy/scared, and/or read a book on the couch instead of in bed. I'm a surgery resident wife and my husband's hours are beyond painful. The tail end of residency is beyond bearable. Maybe we were dumb for having a kid in residency but we thought it was the next best step. We love our children we, too, just wish we could spend more quality time with them. I am a stay at home mom BUT I find myself slaving away trying to feed my underweight baby and keep up with my rowdy angry preschooler while their father is away ALL.THE.TIME. I hardly have time to cook for myself, shower or take care of the dog after I'm done feeding, bathing, caring for them. It's all ME. No family for thousands of miles. Regardless of the mommy hat one wears be it "dr mommy" or "stay at home mommy" it's all tough. I'm just so glad you made this choice for your family. Your children and your daughter will love you forever for it. (And that's nothing against other mother's who work full time). My mom worked full time. Let's just say it never gets easy watching your kids cry for you. I'm in my 30's and I cry to my mom's face and in front of my kids every time she has to fly back home after her monthly weekend visits. I wish she would just retire already and be around more. Oh well. We take what we can get. Good luck and I can't wait to hear about your adventures as a part time doc ma'!

  65. Anonymous12:33 AM

    thanks for this - as a mom and MD who went part-time after the 3rd - you expressed so much of what I was going through when I went part-time. I scaled back much more than you but, what's funny, the stay-at-home/part-time mom friends are much more supportive of the decision. I feel more criticism (though indirect) from full-time women doctors. as though my personal decision was an affront to them.

  66. Anonymous12:33 AM

    thanks for this - as a mom and MD who went part-time after the 3rd - you expressed so much of what I was going through when I went part-time. I scaled back much more than you but, what's funny, the stay-at-home/part-time mom friends are much more supportive of the decision. I feel more criticism (though indirect) from full-time women doctors. as though my personal decision was an affront to them.

  67. Anonymous11:26 PM

    Very good article. I certainly appreciate this site. Keep writing!

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  68. Anonymous11:21 PM

    Thank you so much for sharing your journey openly. Being a mom in a two-MD family has been a huge challenge, and your comments regarding tolerating life vs enjoying it really hits home. I've never quite thought about it that way before, but I suddenly realized that I haven't enjoyed my life since before I started medical school more than eight years ago (holy cr*p, that's almost a decade). I'm finishing my radiology residency this year (and fellowship the next), and after that? I have no idea. But I appreciate you sharing your perspective and experiences. It's good food for thought.

  69. I am so happy that I chanced by here again. It's great to read your writing again. Welcome back! And congratulations on what must have been an excrutiating decision. I can relate somewhat, having withdrawn from medical school as an MS1 with a newborn. It was a decision that haunted me and tormented me for years, but over time I realize it was the best thing for all of us. And now that my oldest just started Kindergarten I am acutely aware of how this is the beginning of the end and she just took a major step away from me. I've been a reader of your blog for years and was always in awe of how you were doing it all. You are a strong person, a great physician, and an amazing mom, too. You will love this new phase of your life and spending extra time with all of your children. And when they are older you will hopefully have your pick of what you want to do. Best wishes!

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