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Finding – and Redefining – Balance: It’s Not about Better Multitasking

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This time of year, when residency and medical school interview processes are revving up, many of us feel overwhelmed. Here’s a brief but thoughtful piece I’ve saved over the years; it’s about balance. As you consider your future career choices, it’s worth thinking about issues the author covers like clarifying what brings you joy, considering your goals while understanding they will change, and defining balance for yourself.

In this day and age, one can choose a traditionally tough specialty but work in a practice setting that allows for some autonomy and flexibility. But you need to know what you want, and you need to give yourself the room to explore those goals in order to guide yourself in the right direction.

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Study Shows Women Earn $2 Million Less Than Men in Their Careers as Doctors

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A survey of 80,000+ physicians estimated that women make 25 percent less than their male counterparts over a 40-year career, according to a New York Times article. The troubling findings were published in a paper in Health Affairs. Of note, factors like specialty, type of practice, and patient volume were controlled for. Had they not been, one of the authors said, the discrepancy would have doubled. The salary gap starts at the beginning of women’s careers and then only worsens.

According to the Times article, the pay gap is wider among healthcare practitioners than among those in computer and engineering jobs. Considering that, women pre-meds who are on the fence about a career as a doctor have every right to seriously consider another profession…

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I’m Worried about Emergency Medicine

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While my career has been a good one until now, I’m increasingly worried about the field of emergency medicine. See my October 21 blog on the current dearth of emergency medicine jobs. The American College of Emergency Physicians (ACEP) recently published a report on the future of the field’s workforce, concluding that there will be nearly 10,000 too many emergency physicians by 2030.

Dr. Thomas Cook published a piece recently called A Few Feasible Solutions to EM’s Workforce Crisis. He demonstrates a healthy skepticism for the possible solutions that ACEP proposed. See his piece here.

In the meantime, corporate emergency medicine is depleting some physicians. A group has even considered unionizing.

In addition, burnout has been a big problem for the field – even before the pandemic. 

Medical students, as great as the specialty of emergency medicine is in many ways, I would be remiss if I didn’t tell you to consider these issues seriously when making a decision about your future field.

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Happiness

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As you interview now for medical school, dental school, residency, or fellowship, it’s important to think about what will make you happy in the next phase of your career.

When I was a medical student applying for emergency medicine residency programs, a well-meaning dean gave me some bad advice. I was determining the order of my rank list and was particularly concerned about one program that had an excellent reputation but was in a city I didn’t like. The dean told me, “You’ll be so busy during residency it won’t matter where you live.” Luckily, the advice rubbed me the wrong way, and I wholeheartedly disregarded it. Where you live for your training is as important as the quality of your training program. The reasons are several-fold:

1. Training is time-consuming, and you want to be in a city you can enjoy fully when you’re able to blow off steam. 

2. Training is stressful, and you want to be in a city where you have social support.

3. Training is not completed in a vacuum. Your personal life continues. If you’re single, you may meet someone and end up staying in the city where you’ve trained for the rest of your life. If you’re in a long-term relationship, you may decide to have children (or already have them); down the road you might not want to relocate your family.

Not everyone gets the opportunity to train at an institution in a city s/he likes. But prioritizing your contentment will increase your opportunity for well-being and career longevity.

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The Week I Spent 138 Hours in the Hospital and What it Means for your Residency Application

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During my internship, on my surgical rotation, I once spent 138 hours in the hospital in one week. If you think this isn’t mathematically possible, I will tell you that I was on call from Monday morning to Tuesday evening, from Wednesday morning to Thursday evening, in-house on Friday, and then on call from Saturday morning until the next Monday morning. (I had to stay in-house that Monday until evening rounds were over too.) As you can imagine, I was barely human by the end. How this schedule was good for patient care is beyond me.

I thought of that ghastly time recently when reading this oldie-but-goodie article in the New York Times called “How Job Stress Can Age Us” written by Dr. Dhruv Khullar. The author reports on a study, “Physician-Training Stress and Accelerated Cellular Aging” that assessed the DNA of 250 first-year medical residents around the country. Researchers examined the saliva samples of these residents, focusing on their telomeres – the bumpers at chromosome ends that prevent DNA damage – before and after the first year of residency. Researchers found that the DNA of first-year residents aged six times faster than normal.

Six times faster.

I found this both shocking, upsetting, and validating. Residency training is as hard as we think it is. 

What I would strongly recommend is that you compare residency programs’ hours as you decide where to apply and before you create your Match list this coming winter. Strangely, many applicants don’t even consider this important issue when making decisions about their next three to five years. Also, many residencies support physician wellness programs and night coverage. Especially in the setting of severe burnout among doctors, your happiness should be a primary factor in your career choices. If you’re not sure, consider your shrinking telomeres. 

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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