Tuesday, March 06, 2012

life or something like it

OK, so let's talk about this:

Some of you may remember an Op-Ed in The New York Times this past summer, written by Dr. Karen Sibert, entitled "Don't Quit This Day Job." If you haven't read this piece already I strongly recommend that you do, because I think it can spark a lot of good dialogue on the topic of work-life balance in medicine and what it means, personally and on a systems level, to find that balance. I wrote a response to that Op-Ed here, and we all discussed and discussed and discussed that some more. In particular (I've been doing a bit of traveling and speaking this past year and as a result have had the pleasure of spending a lot of time with doctors in various stages of training--pre-meds, med students, residents, fellows, what have you), I find that young doctors are especially hungry for dialogue on this topic, which seems to be foremost on everybody's minds and yet often discussed furtively, behind closed doors.

Dr. Sibert has recently started blogging as well, and posted a piece today entitled, "Give yourself a break--don't have a baby during residency." An excerpt here:

Overheard in the OR—a surgery chief resident ruefully explaining to a senior surgeon why no intern or junior resident was available to scrub in on his case. “Everyone in our department is either pregnant or on maternity or paternity leave,” he said.

The senior surgeon just shook his head. 
From my vantage point as the anesthesiologist on the other side of the drapes, I thought to myself, “Really? What’s wrong with these people? What would give anyone the idea that residency is a good time to have a baby?” When I look back to what it was like to deal with pregnancy, give birth, and look after an infant, all I can say is that internship was easier. After all, as an intern—even in the bad old days—I had some nights off. 
Yet having a baby during residency is increasingly common among male and female residents alike. For women especially, it sounds perfectly awful. We’ve all heard the stories—pregnant residents struggling with nausea and fatigue during long nights on call, or vomiting into a trash bag in the operating room; new mothers trying to breast-pump in the hospital locker room during a half-hour lunch break. 
One possible response is to argue that senior physicians should be more sympathetic to pregnant and nursing residents, and give them longer lunch breaks. This would be in keeping with the kinder, gentler world of limited resident duty hours and mandated nap times. 
But it’s equally fair to consider that residency might be a bad time to have a baby.

Even with today’s work hour limits, residency training in any field involves stressful days at work, limited control over your schedule, and frequent nights on call. It’s hard to get nutritious meals on a regular schedule, even if a pregnant resident could stomach the food in her hospital cafeteria. Nor can she get enough rest. Anyone who’s been pregnant can recall moments of such profound fatigue that she would kill for an afternoon nap, and a resident can’t simply lie down when she feels like it. Can this be a healthy way to go through pregnancy?

(Read the full blog entry here.)

So, a little background to catch everyone up first, just to show that I have some perspective of which I speak on both sides of the "when to have kids" quandary.  I got pregnant with Cal the fall of my second year of Pediatrics residency.  I can't speak for every Pediatrics residency experience, but to be a resident at the Children's Hospital of New York was a very intense experience--lots of call, tons of ICU time, patients on the general wards that would have been on the unit in any other hospital, it was (and I think I can safely say this now) much more difficult than my anesthesia residency, even on the "best" months. Cal was born soon after I switched into Anesthesia residency, after which point I began in earnest the balancing act that is having a child during training.  (Because, you know, that's the real difficult part--not so much the pregnancy, but the part where you and your baby are actually in two separate places.)  I spent the entirety of my first trimester with Mack finishing up my Anesthesia residency, and he was born about five months into my first job out of training, when I was a junior junior junior (junior) attending.  Now I'm about three and a half years into my post-graduate career, working full-time and more or less settled in my current job situation, and as you know, our third child is due in July.

OK, so to sum: one pregnancy early in residency, one half-in-half-out-of residency pregnancy, and one pregnancy as an attending.

First things first: Dr. Sibert is right on a couple of points.  It is more difficult to have a baby during residency, for many of the reasons that she mentioned and more.  I can't argue that.  I lived it.  It's a daily challenge.

But here, now is a partial list of just a few other things that are also more difficult during residency: Being in a relationship.  Being a good partner to your spouse.  Spending time with your friends.  Calling your parents.  Keeping up with current events.  Making time for your hobbies and creative pursuits.  Studying for your boards.  Reading a book for fun.

I wouldn't tell you to not do those things either.

Right, so in part I jest, because obviously the choice to have a child during residency (and that is what we by and large have as privileged, educated ladies and gentlemen: a choice--that is, unless certain members of the Republican Party intelligentsia have their say) is obviously a huge one that should not be taken lightly.  Nor do I think it is one that people do take lightly, or look at as just another point on their "achievement checklist" (as per Dr. Sibert's blog entry):

In a way, the determination and single-mindedness of physicians may help to explain why they have children during residency. Having a baby becomes part of the achievement checklist. Finish college—check. Finish medical school—check. Score residency position of choice—check. Find life partner—check. A baby becomes the next item on the list, and residents often feel additional pressure from parents and in-laws who are anxious for grandchildren. For the young female resident who’s been a bridesmaid in her best friends’ weddings, it can be hard to watch them all start having babies without feeling the urge to have one of her own.

No, I don't think that it is a decision that people make on a whim, or a life milestone that people fall into secondary to intertia or because of societal expectations or because their parents are screaming for grandbabies.  Remember, these are people who to this point have been through between four to eight years (give or take--if we're talking about medical residents) of post-college education and training, who knew what they were getting into (med school isn't exactly something you end up doing by accident), knew that it was going to involve a lot of hard work, and make choices to live their lives outside the hospital a certain way. The life of a medical resident is not a "Cathy" cartoon, after all. (I'd say my life is closer to a Calvin and Hobbes strip, actually.)

Would I tell all med students to try to have baby during residency? No, of course not, that would be ridiculous. But equally ridiculous, in my mind, is the blanket statement that no one should have a baby during residency. These are individual choices that people have to make for themselves given their specific circumstances, where they are in their lives, where they're looking to be in the future--all with more nuance and interpersonal variability than can be covered with any overarching recommendation. What I would say on this issue is the same thing I tell people when they ask me if they should go into medicine in the first place.

"You can do it. But you have to want it."

You have to want it. It comes down to that. Very few things in medicine are easy--and if I may venture, very few parts of parenthood are easy.  (In most ways, like I said before, the pregnancy is the easiest part.  Never again will you be able to have this much control of your offspring, nor will they ever again be so portable!  But I digress.)  You have to know exactly what you're getting into, you have to know your own limitations and what you're going to have to do in order to make a more difficult than average situation work...and you have to want it.  But you can do it.  It can be great.  And you and your family can thrive.

Joe and I (and I say this just as a personal anecdote--everyone's situation is different) went through a kind of specific calculus when we decided to have kids during residency.  And our calculus, basically, was this: "What exactly do we do with our time when we're not at work?"  Well, we were medical residents living in Manhattan.  Obviously we worked long hours, and we not infrequently worked for 24 to 36 hours at a stretch.  We weren't big partyers, and since most of our friends were also medical residents (and therefore pretty busy as well), most of our free time we spent with each other.  We'd eat out, get coffee at the bookstore to read free books preview books that we intended to pay money for, go to the movies, occasionally splurge and go to a nice restaurant or go see a play. And this was fun, having that kind of relative free time, and a little teeny bit of disposable income.

But then came the next question, "Are we willing to give some of that up--have less free time to do adult things and spend more time doing baby things, as a family?"  Yes, we decided, we were.  Also we considered, "Are we making enough money to have a baby?" Yes, we decided. It would be tight, predominantly because of childcare costs, but we could make it on what amounted to a single salary after paying for a nanny.  "Do we have enough time between us to take care of a baby?"  Again, like with the financial resources, we would be tight, but we thought we could do it.  (It helped, I think, that we had a dog for a few years by this point--the juggling act of allocating time and responsibility for the care of another living thing was good training for us in terms of the childcare calculus.)   In other words, we went through the exact same decision method that most other couples go through when deciding to start a family.

And finally, the last question, "Do we really want to do this now, or do we want to wait until later?"  Later was, I think, kind of an indistinct entity.  When, exactly, is the best time to have a baby in your medical career?  Everyone has different opinions, but I will tell you this as someone who has basically tried it a lot of different ways: it's never a good time.  It's always going to be inconvenient.  There's always going to be something making it difficult, and there's always going to be conflicting demands on your time, attention, and resources.  With Mack, for example, I had just started my first job as an attending anesthesiologist, and Joe was a newly minted fellow who was taking call every single night, including weekends and holidays, for a year and a half straight.  Thing 3 is set to be born this July, and I don't think I can even anticipate what that's going to be like--three young kids at home, two parents working full-time, lots of expenses, both of us taking night call. Also, to be honest, I'm going to be seven years older this time around than when I had Cal, and I worried (and continue to worry) about the byproducts of my sad old aging eggs.  The "perfect time" to have a baby is a myth.  So you have to do your calculus.  You decide if and with whom and how you you're going to get there, and you decide how much you want it, and when.

Joe and I wanted it.  We wanted Cal, we wanted Mack, exactly when and where and how they came about.  They made things harder.  But they also made things better.

Now let's also talk about the fact (because in many ways having a child as a medical trainee is very different from having a child in any other professional context) that you have to want to be a good doctor too.  That's an important part of it, just as important as the other half.  As a trainee, especially, you have an awesome responsibility to your patients and the future of your medical practice, and you have to figure that into your plans as well.  You have to make time for your education, and having a lot of responsibility outside of your work does not excuse you from your responsibilities while you're there.  There's no half-assing this one--people in the hospital need you too.  You have to put in the time and you have to give that sweat and blood the same as everyone else--in some ways, you have to put in more than everyone else.  But that's part of knowing what you're getting into as well.  Like I said: you can do it.  But you have to want it.

I have seen the argument again and again that having a child during residency makes you a sub-par doctor and a sub-par parent.  I would beg to differ, of course, but how I'm doing on those two fronts is not really for me to judge.  My patients and my colleagues decide how good of a doctor I am.  My kids will decide how good of a set of parents Joe and I are--maybe not right now, because they are both young and therefore still think we are awesomesauce--but down the road, ten or twenty years from now, they'll be able to tell us.  Still, we try.  We knew what we were getting into and we work hard and we try to do our best.  And if I may say, I think we're actually doing pretty OK on both fronts.

On such weighty, personal topics, I would never tell people what to do purely based on my own experience.  (In fact, the only real advice that I can give unreservedly to all medical trainees is: learn at least a little Spanish, and buy some comfortable shoes.)  But I will gently remind you that no matter what stage of training you're in, medicine is just one part of your life, not your life in its entirety.  You'd be surprised how easy it is to forget that.

No doubt residency is hard.  Being a doctor is hard.  But know what you're getting into, get as much information as you can, and thus armed, decide: do I want to do this?  Am I equipped to do this?  Do I have the support to do this?  And then make your choices.  Reading opposing viewpoints is good.  Reading different people's experiences is good--it's largely why I wrote my book, and why I continue to keep this blog, year after year.  Talk it over with your partner, your friends, your colleagues, your mentors.  All these things will inform your choices.  Live your life in whatever configuration, in whatever order you choose to live it in.

And then let the rest of us know how you're doing it too.

(Edited to add: I would love to hear discussion on this issue from all sides, and I'll thank my excellent readers in advance for keeping things collegial--in particular towards Dr. Sibert, who I don't know in person but is obviously a professional colleague in the world of anesthesia. We don't all always agree, but how boring life would be if we did.)


  1. I totally didn't realize that this lady started med school after having a baby (so did I). This is the part that shocks me:

    I certainly understand the desire to have children. I had my first at the age of 22, and started medical school when she was four years old. Not once did it cross my mind to have another until I was done with my fellowship—life was busy enough. My other children were born after I went into practice.

    So that means that her first and second child are like 13 years apart. Holy cow! I can't believe that she wasn't even tempted to have another baby earlier.

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  2. I had a baby 6 weeks ago, and we are *just now* beginning to sleep 4 hours consecutively *sometimes*. I can't imagine being back at work, as a resident, 6 weeks post-partum. I have told my husband repeatedly that if we have a second one, it will have to be during my 4th year of med school because I think having a baby during residency might actually kill me. Waiting until after residency isn't an option for me since by then I will be in my 40s.

    Still Dr. Siebert's tone kinda rubs me the wrong way. I don't really think she's wrong about the difficulty involved with being a resident and the mother of a newborn, but I also think it's none of her business when residents decide to reproduce. Chalking the desire to have a baby to something else to be crossed off in the life "to-do list" is flippant and a little condescending, if you ask me.

  3. I cringed when you wrote Dr. Siebert has a blog...Definitely won't be my go-to spot for encouragement. Honestly, I don't know what I would do if I didn't have husband and 3 year old son to keep me grounded during medical school. And we intend on having another little one before graduation. When you sacrifice family goals for career (if that isn't what you really want to do) I see nothing but regret coming from it - and probably premature burnout.

  4. Great comic too, by the way. :)

  5. thank you thank you for a wonderful post. Not sure what is up (excuse my language) Dr Seibert's butt about this issue, but she really seems to refuse to even CONSIDER that her way isn't necessarily the best way for everyone. Also her reference to "mommy brain" is unbelievably condescending and in fact irresponsible---anyone who reads her blog may be swayed to avoid pregnant doctors for fear of poor treatment---or women doctors altogether because who knows when they may be secretly pregnant? I wrote papers, took my subspecialty boards, submitted grants and all kinds of intellectual tasks while pregnant. Yes I was tired but I don't think I was rendered stupid. And the career demands weren't nearly as arduous as the demands of my toddler during my second pregnancy!

    That being said, i don't think i could've survived having a baby during residency (pre work hour restrictions blah blah); it took every ounce of physical and emotional strength to survive those years as it was. But it wasn't even on the table for me, as I didn't marry until the last year of residency; maybe I'd have thought differently if I'd been married for a while and we were at that stage. I know plenty of people who did it, and don't regret it, and are fantastic doctors and mothers now. And your point is well taken---everything is harder during residency; that doesn't mean its not worth doing.

    1. Ah yes, the "Pregnancy Brain" issue. I didn't want to address it in the body of my entry (figured I was not the most impartial voice on the matter at this moment) but I don't believe I've experienced that particular...uh, pathology.

      I will say however, that I think that these days bias against women in medicine--in particular pregnant medical trainees--need not be made worse by actually stating explicitly that they are dumber or unable to make tough decisions.

    2. Cornflake7:00 AM

      Hasn't the 'pregnancy brain' issue been exposed as myth, anyway? The original study which claimed there was evidence for its existence was flawed (and tiny), and there was a big National University of Australia study a few years back, with 1241 women over four years, that concluded there was no cognitive difference in terms of memory etc between the women who didn't get pregnant over the course of the study and those who did.

      I'm currently almost 39 weeks with my first baby and can honestly say I've experienced nothing of the kind - if anything I've felt mentally more focused. Having a biological deadline will do that for you when you're a writer.

  6. Anonymous4:24 PM

    I totally agree, there is NO perfect time to have a baby. And waiting until you finish your residency, fellowship, etc, often means waiting until women are old enough to put them in a (potentially much) higher risk category too. Higher risk of miscarriage, higher risk of infertility/subfertility, higher risk of chromosomal abnormalities, higher risk of all sorts of things. Waiting isn't a panacea either.

    1. I completely agree. I know too many people who waited until after residency and regretted it for the very reasons you mentioned .

  7. Anonymous4:24 PM

    Dr. Au, you are my hero!!!

  8. Dr. Siebert is judgmental, discouraging, a danger to medical trainees everywhere, and just plain ignorant on this subject. If you didn't have a kid during residency, why comment on it? I had a kid during medical school, another during surgical residency and we are pregnant with our 3rd--still in surgical residency. I've never been just a resident or just a mom, I've always had to try to strike a balance. Michelle, you are right. I have wanted every minute of it. I'd be lying if I said it wasn't hard sometimes but what isn't. This is just more woman on woman violence to me. I just think that women in higher positions in medicine should be more encouraging to the younger generation.

  9. Anonymous4:40 PM

    I noticed that on her blog Dr. Sibert says that she has 3 kids and on the NYT article and most other sources it says 4. Not that it really matters, but I found it odd and wondered if there was a story behind that.

    1. cobalt4:54 AM

      Her blog has an entry where she mentions that she had a daughter who passed away at 5 months of age. Thus, she's had 4 children, 3 of whom are living.

      That information made me feel more sympathetic towards her as it seems to humanize her a bit more. However, for someone who has undergone a tragic loss (presumably during medical training), I find it surprising that she adopts such a seemingly rigid & uncaring approach to medical trainees.

  10. I agree with you 100%, Michelle.

    I was so ticked by her post that I blogged a piece during lunch today. You were much kinder to Dr. Sibert than I was.

    1. Link! Link! Link!

    2. www.patientspatienceandpaces.blogspot.com

      Thanks for letting me link (I would never do it otherwise)!

  11. 1) Pregnancy brain: I don't have any published data on this, but someone I met on the MFM fellowship interview trail who was doing a project on just this subject. Mythbuster! She told me at the time that her prelim results showed that pregnant women did as well on cognitive tests as non-pregnant women; they just had a slower pace, consistent with sleep-deprivation. Which makes sense to me.

    2) I understand Dr. Sibert; I spent a lot of time during my recent pregnancy sidelined to my couch, terrified that everyone was mad at me. I wrote about something similar here:

    Which is to say, perhaps we are mad at the wrong people? Women can - and probably should - have babies whenever they and their partners decide they want to, and perhaps, since this is a reality, medical staffing should reflect that, as it reflects our need to sleep and occasionally pee.

    3) Infertility gives one a different perspective on this. It is not, in fact, "now or later" but perhaps (and increasingly) "now or never". I struggled to get pregnant at a relatively young age, but I'm so grateful I started then. Because as terrible as it was (and it was pretty terrible at times), I was lucky and ended up with what I wanted. Never was not an option for me; but if we make it the only option, we will lose a lot of smart womenfolk.
    - C

  12. Anonymous5:07 PM

    I am applying in Anesthesia this fall, and I noted her program, and I will make sure not to apply there. I am an older, yet extremely competitive applicant, and I simply cannot wait to have kids. I have one child that I had during second year with no time taken off other than Christmas. I've never asked for accommodations. I pumped in bathrooms, classrooms, my car, and in ten-minute segments I had free. I'm hardcore, smart, and capable, and I don't need anyone's pity simply because I want to get pregnant and have more than one child. That seems reasonable. I'm just curious how she expects for more children to be born if women do not have them. Maybe we will genetically engineer males to have a uterus?

    1. I think she is saying that men in residency shouldn't have babies either!

  13. Anonymous5:20 PM

    I want to thank you for writing this perspective. I'm about to start medical school in late summer, and I'm almost 30 yrs old. I have no immediate plans to start a family, but I also know (since I'm into medicine and stuff) if I wait until I'm finished with residency - the window might be closing on up, or odds of becoming pregnant easily will at a minimum be significantly decreased. I would hate to think that someone would suggest I either not pursue medicine - which is something I have been working towards for several years after quitting my previous career, moving cities and doing the various other things you do to prepare for medical school - or give up on the idea of having children. It's also nice to hear, that at least for some people, having kids while training to be a doctor was feasible, and it was also possible to keep a good sense of humor while doing it.

  14. Cecily5:27 PM

    Totally agree that there is never a right time. I got pregnant near the end of residency, was lucky enough to be "studying" for boards while I was puking my brains out at the end of 1st trimester (luckily I did not puke during the boards, which I passed - woo!) then started a new job and because my pregnancy was "pre-existing" I did not get paid maternity leave. My husband gets paid as much a grade school teacher, so that was a bit stressful. I will say that our internal medicine residency, despite being extremely demanding, was also relatively family friendly, so if I could do it over again, I would probably have planned having baby the latter half of fourth year. And now, I am starting to want #2. I am an employed physician with several other docs in the practice, and I'm, I dunno, scared is too strong a word, but very hesitant. I don't want to place extra work on my colleagues but...as Tina Fey said, "Work is not going to take you to get mammograms" or something like that. :)

    I also agree that we cannot fight biology, whether talking about infertility or simply having the energy to take care of the baby - everything is easier when one is younger!

    Thanks for bringing this up again...it is such an important topic. I have to say I was pleased to hear that male residents are taking paternity leave. I'm learning that sometimes my son doesn't need my guidance all the time or a lesson or to be played with. Sometimes he just needs me to be physically there with him. I hope this discussion leads to more parent-docs being able to be "present" for their children as well as their patients, without the side of guilt and finger-wagging.

  15. I'm a lawyer, and while the physical demands of my job are certainly a lot less demanding than residency, you used to hear the same arguments being made in the legal profession. Now they're only made behind closed doors. But as Dr. Sibert acknowledged, there are two possibilities: the job can accommodate you, or you can accommodate the job. In recent years, my profession has mostly come around to thinking that the job should accommodate you -- having children is something most people choose to do, it's a normal part of life, and it affects many employees for a relatively short period of time. And the physical effects, obviously, are limited to women, so the effect of not accommodating for pregnancy is to discriminate against women. The solution cannot be to say, "Don't have kids." You can choose to mold your life around your career, but for most people this is just not realistic. You can't ask thousands of women to put their lives on hold for their careers, especially when their husbands don't have to, and when fertility problems are so prevalent.

    Women are going to get pregnant. We as a society need to deal with that as a normal part of life.

    1. Great reply. Thanks for the law perspective :)

    2. Cool perspective! Thanks!

  16. Molly6:35 PM

    And it's worth pointing out that many pregnancies are unplanned. Contraception failure can happen to anyone, and even very smart doctors make mistakes with their birth control. In my mind, if women are expected to not get pregnant during residency, that functionally says to women who become unintentionally pregnant, "We can't accommodate that, you need to have an abortion." Which, no. I am a raging liberal pro-choicer, so I'm very opposed to any system that puts pressure on women to have or not have an abortion. The workplace doesn't get to make itself a stakeholder in a woman's choice. If she thinks that residency is a bad time to have a child, she can end the pregnancy -- if she decides her best option is to become a mother, she is still exercising her right to choose.

    Any women who becomes pregnant for any reason has the right to keep her child, full stop. If that "inconveniences" her workplace, the burden is on her workplace to reevaluate its approach to work-life balance, not on her to end her pregnancy.

    Just wanted to throw that out there! Thanks for a fair and balanced review of Dr. Silbert's perspective, Michelle.

    1. Anonymous6:07 PM

      I think that is an excellent point. The choice to have a child, or not, is not always black and white. Just as a couple may be faced with unexpected infertility and be unable to have a child when they want, a couple may be faced with an unplanned pregnancy to deal with. For that matter, I have not seen any pregnant residents who were single, but I wonder how they'd be treated?

  17. Thanks for calling it like it is. Anytime someone makes blanket statements and starts to tell others how to live their lives, I get a sour taste in my mouth. Especially since Dr. Sibert never had a child in residency. This seems particularly strange that she believes herself to be an authority on the subject.

    I'm returning to my first year of med school this year (on medical leave), and quite honestly, thinking about the next 8-12 years of your life in medicine and trying to keep alive the hopes of a family are more than overwhelming without the old school mentality that god forbid a woman reproduce during her education. This is the 21st century. Everyone is free to do exactly as they damn please. (Within reason, of course.) The best thing to do is educate oneself about every aspect, and I thank you for keeping this blog so that people can see it *is* possible. Self-combustion not required.

    I'd also like to note, for the record, that I want to have children not because it is on this so-called women's checklist, but because I want to have a family with the love of my life. The claim that women in medicine reproduce because it's simply the next step and all their friends are doing it is beyond absurd. We're not automatons. We're people who are intelligent and completely capable of making informed and educated decisions.

  18. Wow it strikes me how hard some women can make life for others. In Aust there are a great many 'mature aged' residents - and our training schedules aren't as straightforward as in other places. In most fields, including surgical ones and anaesthesia, it takes 3 years to get onto a training program, so at least 2 years of being a general intern and resident across a range of areas such as ED, medicine, paeds, gen surg, etc. So even if you start (as most people do) internship after finishing undergrad (3-4 yrs) then med school (4yrs usually) at 27, you'll be 30 before you start training in your field (if you're successful in gaining a place! In some fields this takes a few years eg ophthalmology).

    So while we all know having kids in residency is hard, can create workforce issues, and makes our personal lives incredibly complicated, we simply have no choice. And if you're a little older like me (34), pregnant with your first (wonderful) and applying for paediatric surgery (7 years of training, moving to a new city every year), life is hard!

    That others such as Dr Sibert will disparage us for choosing to have kids and also to train in our chosen field is unfortunate and regressive. When will we learn that it helps all of us, not just doctors but all members of society- to allow our talented women to have fulfilling careers without sacrificing their choice to have children?

    I agree with you Michelle - our field needs to catch up with the rest of the world!

  19. Anonymous8:24 PM

    I thought there were rules about how much call trainees could take. Every day seems like it would be too much? How would you have a baby if you were on call every day for a year and a half?

    1. Anonymous4:52 PM

      Two of my preceptors (a couple who married right after med school and trained in the late 60s/early 70s) once made some hilarious/disturbing comments about call rooms. Caused another student to choke on a potato chip.

    2. It was home call for the Oculoplastics fellowship--sometimes he would get called in to examine a patient or for surgery, sometimes he would get called but could deal with the issue on the phone, and sometimes (rarely) he wouldn't get called at all. We still got to see him most nights, though.

  20. Anonymous9:00 PM

    It's home call for which there are no hours restrictions.

  21. I had a baby at the end of my third year of medical school and I certainly dealt with my share of discrimination for doing so. However, despite what people think, we planned to have a child. We wanted a child. Sure medical school is hard, and residency is even harder. But in the end you just have a job. Your family is your life. It's what grounds you and supports you and makes what you do worth it. I make no apologies for having a child in med school nor will I if I decide to do so during residency. Thanks for being a great source of support and giving some great advice for women. Love reading your blog!

  22. Well as a registrar in O and G I'm just going to put the other perspective in it which is to say that there is NEVER. A right time but delaying until you are older and a consultant is certainly not helpful with fertility!

    Michelle I think, as always, you've got it just right.

  23. Anonymous11:49 PM

    I can see this from both sides. To be told you "should" wait until you are completely done with med school & residency (and are then ~28yrs old or more)is presumptuous, even if it is based on statistics that imply that it is better for the medical establishment itself. Individuals are not the medical establishment, and must do what is best for their own situations. I went into nursing instead of medicine because of my desire to have a family and to be the primary caregiver during the early years. This was a personal choice, and it was a good one for me, especially since I had miserable morning sickness for my first trimesters and then bedrest for the end of each pregnancy. Med school and/or residency would have been derailed by these things; a nursing career could accommodate it. But, now that my kids are older, I am finishing up my last prerequisite and taking the MCAT in May. And yes, I "want" to be a doctor, nearly as much as I want to be a good mother & wife & friend.

  24. Anonymous1:36 AM

    All things being equal I will graduate med at 27, and hopefully be a fully fledged, grown up Dr in my mid 30s. Waiting until after residency/training is not always a good option, medical women are better placed than most to understand that the biological clock ticks and it ticks for us all. I am willing to risk rueful head shaking at 'what things are coming to' from other people to have a reasonable chance at having the family I want as well as the career.

    I will however be buying those mythical cupcakes of 'proper motherhood' that everyone keeps talking about, not baking them.

    - Taiki

  25. Anonymous7:56 AM

    There is NEVER a good time. Had my first in residency (born a preemie after an arduous night on call, then had to go back when he was 4 weeks old, never mind that he just came home a week or so before); my second as an attending and currently am expecting my third. I am in pediatrics, traditionally family friendly, but let me tell you my partners in my current practice were MUCH LESS supportive than my friends in residency or at the hospital, they are LESS than thrilled with a modified scheduled for pumping (Even though I am starting earlier/working later to make up the "missed time).....and because this current baby is now post-dates, I am once again ending up with only 4 weeks of maternity leave. NEVER a good time.

  26. I can think of a few reasons why someone would choose to have a baby during residency (background: I don't have children and I'm a family doctor):

    1) fertility. A lot of people have commented on this already.

    2) I can't speak for the U.S., but in Canada, most physicians are considered self-employed and are not eligible for maternity or paternity benefits from the government. However during residency, you are eligible for maternity/paternity benefits for up to one year.

    3) If you're an attending with an office-based practice, chances are you will still have to pay overhead during your maternity/paternity leave while not generating any income. Not to mention, who is going to look after your patients for you?

    4) if you're going to use pregnancy brain as a reason (seriously?), I'd argue that the learning curve is actually the steepest in your first 2-3 years as an attending. At least you receive some supervision as a resident. I suppose Dr. Sibert would say to just wait until you've been out in practice for at least 2-3 years.

  27. I didn't have a chance to read through all of the comments but wanted to say two things:
    First - awesome blog entry, Michelle. Excellently stated and enjoy your perspective of having being there from ALL sides.

    Second - not all residents really have the option of NOT having a baby during residency unless they fully support abortion. Even the best contraceptives fail. (Sorry if this was already mentioned.)

    In my final year of residency, I was the only resident NOT to have a baby (and I was the only single resident). One male resident and his wife planned their child for right after the exams, but the other two residents ended up having babies smack in the middle of the final year - meaning they were caring for newborns and trying to study at the same time. These were very much unplanned for (but much wanted) babies.
    The female resident had a great deal of family support to help her out.
    I thought it was most ironic that the unplanned pregnancy for the male resident happened to his obstetrician wife - I mean if anyone should have been able to control her fertility it might have been her, just goes to show that SOMETIMES you just get pregnant!

  28. Anonymous11:23 AM

    My parents had me when my mom was in her last year of medical school, and my dad was in his second year of residency. I was a toddler when they were residents, but I don't feel like it damaged me in any way. I mean, they were (and are) very busy (and very tired) all the time, but I loved my nanny, and I loved my parents too. There were times when it was hard, like when I was in elementary school when I would be sick, or my (twin) sisters would be sick, and we'd be upset when our parents wouldn't be able to come get us and take us home (our nanny had school hours off), but that's not a thing that's unique to children of doctor parents. A lot of parents can't get off work.

    I feel like there have been people who expect me to be this attention-deprived rich kid who resents her parents for neglecting her, but that's not the case at all. My parents love us, and they love their careers, and I respect them immensely for that. So maybe you *shouldn't* have kids in residency or medical school, but if you do, I promise, you'll survive, and your kids will too.

  29. This post is amazing and inspirational. Thank you SO much for this post! Seriously, it was perfect timing. Just YESTERDAY, I met an OBGyn who was trying to discourage me from going into her field of medicine (which happens to be the field of medicine I want to go into REALLY bad). She was telling me things like "Oh, you won't have time for a relationship or personal life. Work will take over your life. OB's have a 90% divorce rate. The pay sucks. Blah Blah Blah". What she should have told me was "You can do it, but you have to want it". Trust me, I want it. So thank you, yet again, for showing me that you can make it work.

    *retreats back to Step-1-study-cave hibernation*

  30. Emily2:03 PM

    I completely agree with poster ct that "Dr. Siebert is judgmental, discouraging, a danger to medical trainees everywhere, and just plain ignorant on this subject." I also had one child during my fourth year of med school and my second during residency. I was older when I went to med school so if I had waited I would never have had kids at all. I'm sure Dr. Siebert would say that it was my choice to go to medical school later and I should reap what I sow, etc.

    The reason I have read your blog consistently for eight years, Michelle, is that you approach so much of your life with self-effacing good humor and compassion. You don't pretend to have all the answers (unless it comes to picking awesome pens). Instead, you provide us with a glimpse into your crazy, hectic life where you try to do the best you can. Dr. Siebert, by contrast, is a legend in her own mind (note the section of her blog where a surgeon seeks out *her* help for his upcoming case--as if she's the most sought-after anethesiologist in the hospital). Because of her apparent self-absorption, she is under the impression that her opinion about matters of motherhood and doctoring matter more than other people's. Guess what, Dr. Siebert? You're not that special even though you think you are.

  31. Anonymous2:53 PM

    I got through most of the comments and had to comment. Firstly, I don't feel that Dr. Sibert is saying don't have kids, she's saying that if you want kids, then select a time that is NOT during your residency. I totally agree with her [but not with everything that she says]. Think about it ladies [& gents if any] but if women make up half of the graduating class and most drop to part-time work or quit all together, it's like what's the freakin point? As a doctor, you put almost everything towards the care of others. This is YOUR job. This is what YOU went to school for. I myself have always competed against guys because they are less emotional and more driven to do whatever it takes. And that's exactly why they may not be the brightest but they continue to be the majority. Hands down, I feel that women are smarter then men. It would just be better for the women docs out there to continue to be the strong doctors that they are, that more than anything would be motive for women to pursue medical careers. Never say never, but going part-time after 10 years of medical school and training will never happen to me. But then again, I love helping people so maybe that's what it is. Passion. Either you want it or you don't.

    1. I don't think Dr. Sibert is saying "don't have kids either," I do agree that having children during residency is difficult and deserves a lot of consideration before taking the plunge. I think the problem is the presumption that having children necessarily makes one less engaged in their careers or extinguishes one's passion for medicine. I don't find that to be the case, at least not in my cohort.

      I think another problem that often pops up in this (often emotion-laden) discussion is that it sometimes gets boiled down to a value judgement. Choosing to work in medicine full time (as I do, and as many, many women in medicine with children also do) doesn't make me a better doctor, or mean that I "love helping people" more than my colleagues, men and women, who have modified work schedules.

      (It just means that I love my kids less.)

      (Just kidding.)

    2. Anonymous6:55 PM

      Lol I almost burst out laughing after reading the end!

      Okay so serious talk, I didn't mean for it to be implied that women who work full-time make better doctors, cuz heck, I don't like the majority of doctors out there, male and female [long story]. But I do feel that passion does play a role in the outcome of being an accomplished doctor. At least when it comes to women in this profession. [Disregard men in this case.]

      It's about having your cake and eating it too, right? Can you be a great female doctor without being an absent mother? Men make up the majority of attendings so what gives? Because in this case, sacrifice is inevitable.
      -Meron [Seattle, WA]

    3. Anonymous7:01 PM

      P.S. This reminds me of Mona Lisa Smile when Katherine Watson [Julia Roberts] helps Joan [Julie Stiles] get into the law program at Yale and when she gets accepted, she turns down the offer so that she can be a great wife and mother but says that knowing the fact that she got accepted is a great accomplishment in itself.

    4. Anonymous7:12 PM

      P.S. This whole thing reminds me of Mona Lisa Smile when Katherine Watson [Julia Roberts] helps her student Joan [Julia Stiles] get into the law program at Yale and when she does get accepted, she turns down the offer so that she can focus on being a wife and a future mother but knowing the fact that she was accepted, was a great accomplishment in itself for her.

    5. You do realise that the evidence suggests that the workforce shortages are not just because of the increasing numbers of women but because MEN are also choosing to work less hours and part time?

      I think Dr. Siebert and everyone else who makes this debate about women vs men vs motherhood is missing the bigger picture of work/life balance for everyone. As Michelle says quite eloquently, just because we choose to have some of that life part of the balance weight out more appropriately for us doesn't mean that we don't WANT this doesn't mean that we aren't good doctors doesn't meant that we aren't dedicated to our patients.

      In fact I would argue strongly that a doctor with a strong supportive 'life' outside of work is a more competent physician than someone who is solely about the job.

    6. I fine it interesting that someone would suggest a desire to have a family means you are less passionate about medicine.

  32. I had a baby this year, my 3rd year of obgyn residency. It was the "ideal" time as far as that goes but it was still very hard, hard to come back and still continues to be hard to balance being a mom and being a resident. I tried to be as quiet as I could, making things as unobstrusive as possible. I think you have to know ahead of time it's going to be challenging and a lot of complaints about things won't be as well received. It shouldn't be that way, but it is - so best to try to just go along with the flow. I also am a pumping mom now, I have a claim to a call room and have a hands free setup so I'm answering pages/writing orders etc while doing that. Again, not ideal - would be better to be in some quiet lovely room watching videos of my baby and their cute antics, but you just learn to survive.

    I hope though in the future we can support each other better. It isn't easy balancing our careers and our aspirations in life. A little sympathy and support only helps us all become the caregivers we strive to be at home and at work.

    Thanks Michelle for providing another perspective on this. :)

  33. Michelle, I love how you tackle these difficult subjects and their controversial commenters with such wit and humility. Thank you! I need to read your book.
    I'm a medicine attending in my 2nd year of attending-hood. My daughter just turned 6. She was born during the middle of my MS3 year...she was 100% unplanned, as was my divorce 2 years later from her dad, who met someone else. Life happens, residency, med school or not. As for Dr. seibert, I just don't get her comments at all. Haterz gonna hate, as they say. Btw, I just turned 30 and married husband #2. Life goes on!

  34. cobalt5:33 AM

    From a reader's perspective, your writing style is much more effective than Dr. Sibert's. If one of your goals with this post was to help people make well-informed, well thought-out decisions about having children during residency, I would say that you've succeeded. Dr. Sibert was not nearly as effective at communicating. A user under the name "A" left a very well written comment on her blog post about why she may be perceived as judgmental by readers in light of word choice & writing style. Her response pretty much mentioned that yes, she was making judgements and that she saw no need to be "fair & balanced."
    All in all, thanks for your blog! You write posts that are interesting, useful, and pleasant to read!

  35. Anonymous3:03 PM

    um...i think Im gonna need a Cooper update. Please. Where has cooper gone?!

  36. Anonymous7:15 PM

    Thank you for posting this, Michelle. It is very good to read especially given that I had my daughter during my 4t year of medical school and am now pregnant with #2 and waiting for my Match results on Monday. (crossing fingers!) My husband did 2 years of surgical residency (prelim) and now is doing his 1st year as an IM resident. (catagorical) I am turning 35 this Spring so there is no more putting off family making, for us it's now or never.

    Dr. Sibert has black/white thinking and that simply doesn't work in any career setting. Doctors have to be mentally flexible with themselves, their families and their patients. I would not want her as my physician with that sort of hardline mentality. We know that medicine is often more art than science and sometimes (always, really) you have to leave your ego at the door.

  37. Anonymous8:07 PM

    I find the comments about being a good resident v. having a child surprisingly trite and condescending to say the least. I am a surgery resident due to deliver my first child soon. The check list comment is completely offensive and definitely undermines the intelligence and gravity with which residents, in particular, end up treating the topic of when/if to build a family. My training will be 5-10 years depending on fellowship and research. To take the antiquated approach of it's best to only accept one role in life at a time is a ridiculous over-simplification

  38. Anonymous8:44 PM

    Thank you for your insightful perspective! As a 3rd year med student about to start trying for that 4th year baby, I couldn't disagree more with Dr. Sibert. I am a human being and I want a family. I also want to get outside, see my friends and have time to myself sometimes. None of these things makes me a less dedicated medical student. I can't imagine what kind of horrible doctor I'd be if I didn't have a life outside of medicine.

  39. I'm happy my quarterly check-in to your blog, where I read every post for a few months backwards in time, happened today. I loved your earlier response to Dr. Sibert, and actually use both your piece and her article as a jumping off place for a discussion about work/life balance for the ob/gyn residents I train. I am proud that so many of them manage to have their own babies in the midst of this. I waited until right after my training, but no one who has watched women struggle to have families when they wait to the perfect time puts off childbearing lightly. It's a complicated balance, and I applaud you for being a champion of women doing great things at work and at home. Wellesley was smart to have you speak. I'm sure it was funny and inspiring as your words always are to me. Good luck with your baby girl.

  40. Kandiboo9:33 PM

    Thank you Michelle! I am currently in my 5th year (it's 6 years worth of training here) ObGyn training. In the past nobody ever dreamed of having kids during residency especially in our department - everyone had kids after fellowship and in their >35's - but it has changed recently. First they started having kids earlier, immediately after fellowship, then one had her kid just before our part 2's (I guess equivalent to your boards) and we hired one last year who had a baby in Med school then another one in the beginning of her 2nd year.

    I hate to say it but I have to partially agree with Dr Sibert's idea of not having a kid during Residency - or at least have it better timed. Unfortunately the said Resident who had her baby less than 1 year before our Part 2's didn't pass her exam and we forsee that the mother of two will not be able pass her upcoming exam either. They freely admit that they don't have any time to study after work - already so exhausted from work and having to take care of the kid(s).

    I struggle with this as I know that fertility declines with age, and I know that there is no best time for a baby, but if possible perhaps it can be slightly more well planned, ie between exams, before fellowship etc. I also know of colleagues of the same specialty in other hospitals, or different specialties successfully juggling work, life and babies and handling it beautifully (applaud!). If given a choice I will probably still put work and exams before babies and family - at least until after critical training milestones.

    In the end - it's all about sacrifices and the constant battle with the life clock.


    1. Anonymous6:17 PM

      I agree with your final sentence better than the preceding paragraph. As someone who is currently pregnant with #1, I can tell you that all the planing in the world doesn't mean a thing if egg doesn't meet sperm when you want it to. We started trying at the end of my 3rd year of IM residency and finally got pregnant in my research fellowship, which is probably much better in the long run. Some people do get very lucky and get pregnant exactly when they want to, around tests and difficult rotations and such... and others get pregnant when it happens, even with all the "trying" in the world.

    2. Anonymous6:17 PM

      "planning", not "planing", sorry

    3. (I refer to planning, as in avoiding or delaying pregnancy till a more suitable moment if possible, rather than the opposite).

      Anyway, congrats with your #1!!!!! Isn't being pregnant during your research fellowship probably better and less stressful (c/w IM residency?)

  41. My perspective is that of a 2nd year resident with two young children. When I was an undergraduate, my mentor told me there's no good time to have a baby on the path to a career in medicine, you just have to make it happen when it works best for you. In talking to her and other female doctors, as well as many conversations with my husband (who felt strongly he didn't want to be 60 and still have kids in school - he's several years older than me), we decided to have babies in med school. It worked out great for us. I got 8+ weeks of maternity leave and when I returned after my first baby the beginning of 2nd year of med school my "work hours" where I physically had to be in class was minimal, maybe 4-8 hours per day M-F with plenty of time to pump. My second baby came late winter of my 4th year of med school, and aside from a 3 week outpatient elective when my baby was 3 months old I had 4 months off (you all remember how amazing 4th year of med school was...)

    I did start intern year with a 4 month old. It was tough, but worth it. I am a good doctor and learning how to be better every day. And because test scores have been brought up as an issue - I have gotten great scores on all my USMLE tests and top scores among our large residency program in our inservice exams. However, I personally am glad I did not have a baby in residency (yet) and am not planning to. If I have another, I'll wait until later in fellowship because residency is intense and if you aren't working, someone is working for you and I'm not going to ask anyone to make sacrifices for my decisions. I think that's what is comes down to. If your residency/training program has a few months of electives that you are able to get lined up therefore not making someone else cover your service months, then who cares if you flying to a third world country, doing research, or having a baby?

  42. Anonymous9:36 AM

    This topic is an important one that virtually every female surgery resident I know (married or not) has thought about. Yes, there truly is no good time. But, when you weigh residency vs starting out and trying to build a practice, residency is amongst the most protected time in your career. Perhaps some accomodations have to be made such as switching when your vacation is may affect other residents in your program), or running the patient list through the door while the cheif resident pumps (happened in our program), needing a stool to occasionally sit down during a long case, etc. But its way better than an 8 week absence when you are just starting a practice. I had my first child during my research years, which is possibly the ideal time, but this child will be ~1 when I go back. And I will likely have a second child during a regular residency year, if we think we can manage. Is any of this easy? No--but thats not why we are in it. I have never cut corners in patient care because of personal reasons, but have always tried to be maximally efficient. I don't see that changing. That doesnt mean I love my son any less. I expect that I will spend every minute of free time with him that I can. People make it work. And if some senior surgeon has a bad attitude towards pregnant residents, perhaps my approach can help him or her see it in a more positive light.

  43. Anonymous10:39 AM

    Hi Michelle, did you see Pauline Chen's post on this too? Insightful and a nice balance to Dr Sibert's perspective.

    Good topic thread. Keep it coming. i am back to reading your blog after not liking the Jamaica posts that much. This is a good discussion.

  44. Thanks for reminding me about Dr. Chen's post, I'd meant to put something up about that. Pauline Chen wrote a post entitled "The Plight of the Pregnant Surgeon" that adds some interesting views to this issue, but more importantly (I think) shows how hungry people were to talk about this topic. From the article:

    "Many of the surgeons who responded to the 99-question survey inserted additional pages describing their experiences. 'It was like there wasn’t enough room within the survey for them to tell their stories,' Dr. Turner said."

    It's an important dialogue to have, regardless of the different choices that people make. Because the fact of it is, there are choices.

    Dr. Chen's post here:


  45. Anonymous9:47 PM

    I appreciate this discussion as a whole, but Siebert also implies (and states directly) that doctors are the only professionals whose clients "need" them. I'm an attorney; a public defender. I like to think that my clients need and appreciate my work just as patients need and appreciate the work of their physicians.

    1. Anonymous10:02 AM

      yes, most other professional's clients "need" them also. we are talking about profession where trainees and doctors are stigmatized for taking care of their own personal basic needs. When public feels doctors have to be there for them no matter what. Attorneys and lawyers in general do not get attacked by public the way doctors are attacked. I heard multiple comments from patients who outraged they were doctor had his own medical appointment or family emergency. They stated doctor had to stay working to serve them, because "they knew what they were getting into".

      Why I often see law professionals reading medical blogs and stating lawyers are as important? Of course you are. And you have hard life and hours too. But your clients are less likely to yell at you or write complaint letter on you to your employer if you had dental appointment. I saw both happen in medical practice.

  46. Anonymous3:49 PM

    I was just introduced to your blog and love it. It is so fitting, because I have recently started to think about when the "best" time to have children would be for me (I'm a PGY3). I think one of the hardest things about becoming a doctor is not the knowledge we have to acquire, but how to acquire it all and still maintain balance, something no on teaches you how to do, and something I am continually working on. Thanks for addressing these issues.

  47. Anonymous6:31 PM

    As always, Michelle, I'm happy to hear your perspective on this. I am currently pregnant with my first child and struggling with nausea and fatigue in my first trimester. I'm in a research fellowship, which is both better than residency (no call, better hours) and possibly worse (only me and one other fellow, who will probably have to cover my research when I'm out) for having a baby. It took us nearly a year to get pregnant once we started trying, which irritates me at the people who think that "choice" means that you can get pregnant and time it exactly how you want to (and we didn't have serious infertility struggles like some couples do).

    My residency program had a lot of "good ol' boy" features to it. A female resident could get 6 weeks maternity leave only if she saved all her sick leave, otherwise it was 4 weeks (maybe this is standard? Other programs in different specialties at my school had better policies). The attitudes really bugged me, though. You'd hear comments about how people "deliberately" got pregnant and then "had to miss" their wards or ICU months--when our tight staffing and need to cover multiple hospitals rendered the call schedules ridiculously tight and unforgiving. Our schedules came out almost a year and a half in advance, also, and were difficult to adjust, so that if a woman did become pregnant and had a due date during her ICU month, it was not easy to switch that month to do it another time.

    Yet, men very rarely took paternity leave, so it was only women who seemed to draw the ire of others for taking time off and putting more work on everyone else.

    I don't have any answers currently; the duty-hour restrictions, as they get tighter, only serve to spread the residents even thinner and make call coverage more difficult. Upper level residents are having to take more call, when traditionally in some programs those years were lighter and more conducive to having a child (if you wanted). And yet, many women in their late 20's and early 30's will continue to want to start their families, knowing how difficult it will be. This problem isn't going away, no matter how much Dr. S seems to want it to.

    And why yes, I definitely pulled out my little "checklist" and ticked off "get pregnant" because everyone else was doing it, my mom wanted grandkids, and I just couldn't resist the pressure. Had nothing to do with the fact that I've always wanted a family, have a wonderful husband and financial stability, and decided that the time is right. ;-)

  48. Anonymous8:50 PM

    I am a resident physician and I have a 14 month old and another on the way, due to arrive halfway through fellowship. For a variety of reasons, my husband and I have decided to start a family during my medical training. Some of them are common sense (my eggs are getting old). A lot of it was that we were simply ready to become parents. My career had us on hold for a long time. I now tell junior residents exactly what you wrote up there...there is no good time to do this. So make a plan, figure out your budget, talk about it a thousand times with your significant other and, if you really want it, go for it. I also tell them I have two full time jobs but they are the best two jobs in the world. I am a physician and a mother!

  49. Just wanted to add my belated thanks to you for fostering this discussion. I think it's very helpful for young women in medicine (or thinking about going into medicine) to get exposure to a variety of perspectives and how other women have made it work. And kudos to you for making it work both as a resident and your first year as an attending, married to a fellow! It makes childbearing in grad school seem like the height of luxury in comparison...

    This issue seems to me to be yet another important example of how medicine takes a long time to catch up with change- be it technological, social, or demographic. People bemoan how archaic it is to use paper charts, but how archaic is it to perpetuate a training system based on a time when nearly all the trainees were young, male, and childless/married to SAHMs?

    Anyways, you may have inspired me to trot over to Dr. Sibert's blog just to raise some other issues with her post: 1) the age factor is not trivial- not only are there a lot of women in medicine today, but nearly half will be in their early 30s during residency/fellowship (hence "delaying" until this time, which she suggests...means having a baby in training); 2) the supposed inflexibility of residency programs to accommodate pregnancy and childbirth-- residency programs are not total hostages to Congress. Reform in response to the work hours restrictions, while capping the total number of residents, is pretty good proof that if push comes to shove, medical education can adapt.

  50. Anonymous11:03 AM

    I can somehow understand Dr Siebert. I did ICU with a very hard working senior resident. She was double degreed formerly trained as ausronaut, now doctor. She was micromanaging every step of our patient care and made my calls with her more difficult than they should have been. When she shifted off that rotation and I was still on it, she came to check on all my patients the next morning to "make sure" even though another senior resident was now in charge. In restrosepct I understand she was beaten too hard into her career path and responsibilities -it became unhealthy. And I can imagine she had a miserable personal life never being able to relax, rest, recuperate for next shift. It appears that Dr Siebert is of that breed, unfortunate people who see world as black and white, who, though doing a noble job, are not fair to themselves or others. When Dr Siebert procrastinates about the state of healthcare in the country and how women doctors are traitors, it makes me smile a sad smile.

  51. Dr. Sibert is just old school. It's like our attendings who wear as a badge of honor their hazing (oops, I mean training) days of q2 call, working 36 hours at a time. Times have changed. The culture of medicine has changed. We are becoming much more family friendly. The older doctors are typically the ones who still hold fast to the merits of the old system, although there are also some young ones who are equally old school. I'm glad that our culture is changing though. It's what has allowed me to work 100% outpatient and be with my kids on weekends and evenings. And for the record, I had a child in my last year of residency, took 8 weeks off, and made up 2 weeks. I had to do clinic and a reading/writing rotation for most of it. My second child was while in private practice, so I've done it both ways.

  52. Anonymous2:51 PM

    I am a 30.5 yr old stay at home mom of a toddler and a surgery residency wife. My husband is general surgery PGY2 and works a TON. I won't get into his hours but trust me it's alot! I am 3 months pregnant with our second child. We really wanted our second child. Then I got pregnant and I'm wondering what I was thinking. I'm one of the unlucky people who gets REALLY sick. Like hyperemesis gravidarum, despite my zofran intake. Life was pretty miserable MS3 with my first pregnancy but how quickly we forget and have hopes for the next pregnancy to be "different and better". We wanted our first and we want our second. Being pregnant has been a miserable experience thus far and much harder this time around. I'm always hungry, always tired, always with my head in the toilet and guess who is NOT there to pick up the slack?! My husband. He wasn't there the first time or now and he won't be around for other pregnancy's should I ever decide to have another. I don't say this to make him sound bad. He's a great husband but he just can't be of much help scrubbed into a case or when he gets home at 8pm 4 days a week. I know tons of his classmates who got pregnant in medical school and residency. None are surgery specialties. I don't know if any woman at his program has EVER gotten pregnant. I cannot imagine what a woman would physically be doing to herself working the 28-ish hour call shift and going 15-28 days straight without a day off clocking 100 hours some weeks, getting up at 2am to read for various conferences throughout the week all while keeping a fetus alive in her belly, keeping a toddler alive at home (and a dog) and being a somewhat decent spouse. I agree certain specialties should NOT have children in residency. With that said my friends who are anesthesia, ob/gyn, pediatrics carry their babies to full term and find a balance. Though I do have a friend who had a still birth and then had a healthy full term baby as a resident. We live far from family and our parents despite their graduate and medical degrees STILL DON'T GET IT as far as how to help us. We need $. What resident doesn't need $. We need responsible adults to show up a few times a week to help with the simple things like walk the dog, take out the trash, do a load of laundry. All I can hope for is I'm not placed on bed rest and that my nausea and vomiting will subside...it took 5 months before I could eat with baby #1. I hate to agree with an old school surgeon but not all specialties are created equal. I could NEVER go through any pregnancies and be a full time surgery resident. To each his own.

    1. Anonymous6:29 PM

      Please, get rid of the dog! I hope you were joking when you said (and a dig)

      And yes, modern grandparents feel grandkids is not their responsibility. Hope your life gets better. Hire help.

    2. Anonymous10:07 PM

      Ha! I wish I were kidding. I really do have a 65 pound dog that ran away 6 months ago. I was so sad and then two days later (after we found her) I was just cursing her for existing. She was our first kid which was good because we screwed up quite a bit and our human daughter benefitted. I have hired help. As a resident wife I've got a whole crew of housekeepers, babysitters and lawn guy. You'd think I'm the queen of sheeba or something. But honestly, I'm not. I've got too many grey hairs, I look more pregnant at 12 weeks than the author of this blog at 21 weeks and I'm glad to hear modern grandparents are a bit worthless. Musta' been that hippie movement or something. The only thing worst than my job is my husband's job...i'm glad he is learning something because otherwise this life would just not be worth it. PS I love this blog and all the insights people provide.

  53. My pharmacy class is having about 8 babies this year as P2s (the worst year of our 4, but probably less awful than babies during rotations when we have less flexibility). My family included a 2 year old when I started pharmacy school and we are struggling with infertility, so there's no planning anymore. We just hope that someday we get another baby. I'm glad we didn't wait any longer than we did because I'm in my late 20s now and had we waited until I finished my PharmD to try for kid 2, we'd have even lower odds of success since I'd be older. I think it's important for a few things to happen: first, men need to take paternity leave so it's more obvious that parenting is what takes time rather than being a female parent. Second, we need to keep reforming healthcare culture to allow for a life outside of work. It reminds patients that their providers are people too, and it prevents burn out in providers. When my doc called in sick the other week, I was thrilled to reschedule because I appreciate that my doc took the time to stay home sick and I told my doc so when I did finally get in for my appointment. AND IT DOESN'T MATTER THE GENDER OF THE DOC, or that I have the impression it was a sick child work absence. There is life outside the clinic/hospital/pharmacy, so let's get there sometime and enjoy it.

  54. Anonymous7:49 PM

    thank you very much for this entry.

  55. Just came across this blog post today. I'm a little behind on keeping up with my "for fun" reading in M3 now. At age 35, I had my first in the middle of M3. It was an ordeal, with a complicated pregnancy and a premature birth (but the boy at almost 6 months is a TANK now). I put off having children because I decided to switch careers at age 30. I ended up struggling with infertility, with IVF being the magic bullet for me. I can't imagine if I had put it off until, oh, age 40, when I'd be done with residency!

    I'm also a member of www.mommd.com (sorry for the plug) and we had kicked around our opinions of this article as well. Some see Dr. Sibert's point, but most of us have come to the same conclusion as you. It's not awful, awful, awful advice per se by Dr. Sibert, however, as we know in medicine, one size does not fit all. So thanks for your post, it pretty much agrees with my opinion on the topic as well. Except for the choice excerpt. I'm not a Republican (helloooo Libertarianism) but I am pro-life. Staunchly. ;)

  56. Anonymous10:10 PM

    Are the male med students, residents etc. having this conversation?

    Are male general surgery residents thinking of changing specialties (like the female surgery resident I spoke to today) because they want a family?

    It's 2012 and women STILL do NOT have the same options as men. What has really changed since 1950?

    A 55 year old nurse who had no chance of attending medical school since I got pregnant at 20. My advise: do what YOU want without having to settle or compromise or give up your career or dreams.

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