The joy (and confusion) of post-training adult choices

I recently had the pleasure of meeting The Medical Post’s very own Editor-in-Chief, Colin Leslie, for a lovely sunny afternoon coffee in beautiful Victoria. During our fun and casual conversation, he asked me: “So, is your new position going to change your schedule and lifestyle drastically?” I thought about this question for a short while before I answered: “Actually, there was already a drastic change in my schedule and lifestyle between residency and fellowship. But what will change dramatically, and what I am having a hard time wrapping my head around, is the change in personal autonomy that comes with no longer being a medical learner.” I think anyone who pursues subspecialty training after residency would be lying if they said that they didn’t consider their eventual lifestyle when making the decision to prolong their medical education. There is no doubt about that consideration when leaving a busy obstetrics and gynecology residency program for a much more laid-back reproductive endocrinology and infertility (REI) fellowship. In most of Canada, REI subspecialists do not continue providing general obstetrics and gynecology services—unless they choose to. So, what used to be 100+ hour work weeks filled with no-sleep nights on call and early morning starts in the operating room were replaced, overnight, with non-hospital based clinic days that never lasted more than eight hours, and weekend calls that involved living your everyday life with your cell phone always handy. The past two years of my fellowship gave me back so much more time. . . time for myself, time to rediscover my passions and hobbies, and most importantly, time to be with my husband and children, who were mostly neglected during my busy residency. I did work general obstetrics and gynecology locums on my long weekends, holidays, and during my vacation time, but this was completely my choice. And, this was a choice I made because I wanted to start attacking my mountain of medical training debt and to keep up my skills, lest I was unable to secure a coveted REI position after my fellowship. The one thing that didn’t change, though, between residency and fellowship (and was even more prominent in medical school) was the lack of autonomy and control over my own time and schedule. When you are a medical trainee, there is no fooling anyone that your time is “your own time.” Inherent to residency programs, and in the case of my fellowship program, is the service component of “learning.” The reality that a hospital service or clinic cannot run effectively without the medical services provided by residents means that filling the schedule the other things you may have going on in life. And related to this is the misconception that time spent providing services equates to the quality and quantity of skill and medical knowledge acquired. But I digress on that point for now. The medical establishment is also solidly built on the bedrock of “this is how it’s always done.” Such a foundation leaves little room for modifications in virtually any aspect of medical training. As a junior learner, you just learn to deal— if you miss your children’s dance recital because you’re scheduled for something, well that’s life as a medical learner. As you become more senior, maybe you advocate for yourself a bit harder, or you bargain with your colleagues to switch shifts, or you ask someone to cover for you, if you dare. But by and large, that still doesn’t ease up the pressure too much because everyone is overworked, tired, and has their own life they’re trying to live. When schedules come out in four-week blocks and you’re only allowed to request one weekend and two weeknights off per block . . . well you end up having to rate the priority of everything in your personal life. After much arguing and advocating for myself in the setting of a less-than-flexible fellowship program, I will be completing the last two months of my fellowship as an elective in Vancouver —a choice I pushed for since my family has already relocated to Victoria for the start of my new position in January. The last two months of my fellowship will be at the parent clinic affiliated with the new clinic of which I am a part. As such, it has been structured very much as a training, familiarization, and “getting settled” with the clinic, but within the confines of the objectives of training set out by my home program. I was shocked and left speechless when I began getting emails from the clinic manager and scheduler asking me such questions as: • “What kind of computer would you like?” (I have a choice of computer? You mean Mac vs. PC? Oh, you mean any computer I want? I just pick it and it’s ordered? OK.) • “What time would you like your clinic days to start and end? (I get to choose this? What does everyone else do? They make their own schedule? Huh. Well, this is a hard decision . . .) • “How long do you want for lunch?” (Lunch? You mean a break? I get to pick a time to eat? This is also a hard decision, mainly because it’s been at least seven years since “lunch break” was a part of my life.) • How much time do you want scheduled for your new patients and for followups?” (I can’t say I’ve ever thought about this . . . since I just do what my staff does. And now I’m the staff . . . and I get to decide? I need more time . . .) Last week, when I finished writing my second royal college exam, I was overjoyed at the mere prospect of having more autonomy over my own time when my fellowship is complete. But since this flurry of planning emails has come my way, I am beginning to realize that the autonomy that comes with being a medical staff rather than a learner is farther reaching than I could have ever imagined. The truth is that I have spent so long being told what to do, when to do it, and how it’s done, that when given the ability to make all these decisions myself, I feel paralyzed! This sudden barrage of independence in planning my lifestyle and the day-to-day aspects of my career has got me thinking more about how necessary it is to strip adult medical learners of so much of this autonomy throughout their medical training. In my life as a staff physician, I look forward, to encouraging a higher level of personal and professional autonomy in my own medical learners. Because in my opinion, objectives of medical training and service requirements are not the only important aspects in the lives of medical learners. How they manage their lives outside of medicine, their personal time and their preferences within their practice are arguably just as important in the Big Picture of medical education.

The joy (and confusion) of post-training adult choices

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Blog Author

Ginevra Mills

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