**Female Attendings** career help

[EBKame]

I'm a PGY-4 and have started to look at career options once I graduate next year. I was always convinced I would do academics because of my interest in teaching and medical education. However, now that I've recently become a mom, I'm realizing there is some appeal to going into the community and having all the time you spend out of work be truly your family's time, rather than worrying about curriculum/lecture planning, grant writing, meetings, and all of the other obligations in academics.

Ideally, I could see myself doing part time work while my kids are young and then taking on more shifts once they're older. My concern with this is that there don't seem to be part-time options in academics for recent graduates. Part of me wonders if I'm just feeling this way because I'm currently still in residency and have the tendency to take on much more than I should. Maybe full time work as an attending will feel a lot better than residency and I'll have plenty of time to spend with my family. I'm also worried that if I go into the community, I'll miss the colleaguality of academic practice and it seems hard to go back into academics once you've been out for some time. I would like to hear your comments on:

A) How your family has effected your career decision making
B) If you have experience with working part-time in EM...do you get benefits/do you end up working closer to full time with additional obligations/how did you negotiate your part-time contract
C) If you switched from academics to community or vice versa and why.

Thanks for your input! I'm also happy to hear from the men...

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[EBKame]

Anyone?

 

[Birdstrike]

.

 

[Zanegray]

I recently finished residency and work now in the community. It is hard enough being a mom and working in EM with weekend holiday night shifts. I wholeheartedly recommend part time work if you can swing it, be ause as Birdstrike says, you can ALWAYS work more shifts, but it's hard to work less.

They may take you in academics in a place that needs bodies, but I think a part time academic job out of residency would be hard to find. Maybe someone else could weigh in that found that job, though. Where i am minimum hours per year for full time (benefits) was the same in both community and academics- 1600/ yr. Of course it's actually more because of documentation, being understaffed etc. The academics didn't even want to talk if you wanted to do less.

So I hope you are able to find the job you want... If you are flexible about location you may have more options.

GL

 

[la gringa]

my career advice is to work with the least catty nurses possible. always great to find out after you start somewhere the # of female docs who have left...

 

[Glitterbox]

my career advice is to work with the least catty nurses possible. always great to find out after you start somewhere the # of female docs who have left...

Interesting. How would you get a sense of this prior to starting? Have you noticed a different between physician-nurse interaction when the physician is a man vs. woman?

 

[la gringa]

at my current gig, yes. prior gigs, no.

the best i can say is look at how many female attendings there are... i thought it was just an anomaly.

i am fortunate in that i don't need a whole new job b/c of this, b/c my group has multiple hospitals. this is only an issue at one of them.

 

[EBKame]

Birdstrike, thanks for the advice and reaffirmation of wanting to do what is best for my family. I feel like a huge sellout right now considering a community gig, but truthfully my attendings don't make academics look like much of a family choice. They seem to work all the time and be at meetings, lectures, conferences when they are not working. While I'm sure no longer being a resident will feel like a break, if what I really want is to spend more time with my family than at work or recovering from work, I should really seek out part-time work up front.

The region I'm looking at is highly competitive, which I'm sure is limiting my choices. I may need to branch out to find the ideal practice environment.

I like the suggestion to write an actual shift number into the contract. I just finished talking with one of our recent graduates who is routinely suckered into working an extra 2-3 shifts/month. He says he feels like a resident again. I certainly do not want this. So, I guess I'd be willing to accept a longer commute if that meant being able to work part-time.

Any suggestions on how to broach the issue of working part-time with employers? Should I write that into my cover letter? Wait for the interview? Offer to work full time x a particular number of months, if that guaranteed that I could work part time after?

I'd also be interested in hearing from part timers if they get benefits or are expected to pay their own. I can't imagine how much it would cost to provide your own malpractice, life, health insurance.

 

[txterp98]

Also not female...hopefully I can still be of some use, though.

Where I currently work, we're a community site but we have residents rotate with us monthly. We are more than invited to go to the primary site for weekly conference, give lectures, teach at skills labs, participate at journal club, etc.

Maybe you can try to find a job like that? It's really the best of both worlds if that's what you're looking for. Good luck on the job hunt. And congrats on the latest addition to your family!

 

[ptarmigan]

I feel like a huge sellout right now considering a community gig.

Just curious why you feel you are selling out by practicing in a community hospital. Some of the brightest and most procedurally adept emergency physicians I know now work or used to work in community hospitals. EM thrives in the community. In general I don't see other specialists in my ED unless a patient needs to go to the OR, and even then they will often trust my diagnosis and just meet them upstairs. It's all me now, and I feel that my role is that much more important to the patient than it ever was in academics.

In the academic center, it seemed like the place was crawling with specialist; there was too much help. I trained at a well respected county center that was supposed to be hard core, but we called ortho to do simple reductions, optho to look at anything but a corneal abrasion/FB, and the trauma residents were pushing us out of the way to evaluate the stable rollover MVC. Almost every chest pain was seen by the hospitalist after an obs period, and we never had to set up follow up for anybody because there wasn't any available.

Going into residency I thought I would do academics because I love education. I miss teaching and I miss the educational environment within my own department, but in every other way I find community EM more satisfying - even despite the pressures.

You mentioned you are looking in a competitive region. I trained in one of the top ten hardest places to find a job, and all the private groups preferred to hire people part time. Extremely difficult to get anything full time, especially out of residency. Grads who want to stay will pick up a couple part time jobs and then end up "making it" full time within a year or so.

 

[Birdstrike]

,

 

[coup detat]

Longtime lurker, new member here. EM pgy2.

I know what you mean about feeling like you are selling out. I initially also had my sights set on academics.But its really not selling out: someone has to staff all these EDs. I came to the same conclusion as birdstrike after I became a mom. I coud live with regrets if my career didn't pan out 100% as I'd like. Dont think I could live with regrets about lost time with my kids.

 

[beanbean]

I am a mom with 3 kids (ages 16, 14, 9) and have been in practice 1.5 years.

I echo what Birdstrike and the others have mentioned. Your health and well-being is the first priority. Without that, what can you do for others? Your family is second. Work is a distant third.

Keep in mind that "full-time" can vary greatly. For my group, which is a large national EM corporation, full-time is 108 hours per month to receive full benefits such as malpractice, health insurance, 401K, business expense account, etc. Some places may expect significantly higher hours to obtain said benefits.

It can be difficult to compare offers. Dollars per hour are only part of the full-package. Comparing benefits is a bit more complicated to determine how much each package is truly worth.

Enjoy your search and know you are highly in demand as a BC/BE EM doc. May quality of life is amazing now compared to residency and my family is all the better for it.

 

[Hercules]

Not a female but am in the community. Full time to get health insurance, 401k, malpractice in my group is working 11 shifts that are ~9hrs so right around 100 hrs a month. Every now and then my non-EM friends remind me that working 22 hrs/week is considered part time for most of the world.

I also have never understood the sellout concept. I was a chief resident and one of the lower levels said they were surprised that I would take a community job. I have to admit that I felt like practicing academics would be selling out to me for a number of reasons. Not saying it is for everyone, but different strokes for different folks.

 

[EMedGrrl]

A) How your family has effected your career decision making
B) If you have experience with working part-time in EM...do you get benefits/do you end up working closer to full time with additional obligations/how did you negotiate your part-time contract
C) If you switched from academics to community or vice versa and why.

Thanks for your input! I'm also happy to hear from the men...

Academic faculty x several years, mom of two. I think academics has a lot to offer re: flexibility. Sure there are meetings, conferences, etc. but a lot of the non-clinical stuff (lectures, research) can be done at home with a glass of your favorite beverage while the kiddos are in bed. Pick up an administrative responsibility, and suddenly you're working less clinical hours while still getting a full-time salary.

Part-time works differently in different places. Most groups (community or academic) have a minimum threshold for benefits (50%, 70%, etc.) - I would ask about this at interviews and see if any others in the group have worked or are currently working part-time, and how that has worked for them. I went to 70% after my second was born, and then back up to full time when she started school, and it worked out great.

In the end, I think if you're passionate about academics, there's a way to make it work for you and your family. If you'd rather pick up some part-time or per diem work at a community hospital and have more control/flexibility, that can work also - partly depends on whether you are the primary income for your family and need benefits, etc.

PM me if you want to chat more. Happy to help/advise.

 

[VienneseWaltz]

I have been out of residency for two years. I was pregnant with my first when I finished and worked part time primarily at an academic center ( a short stint at community as well) until he was about 18 months, then switched to full-time. A few thoughts:

1. Part-time vs. full-time: Part-time is awesome, but the downside is that benefits are hard to come by (how important this is depends on your spouse/partner's work situation). I eventually transitioned to full-time for intellectual interests that I didn't want to pursue for free as well as the benefits. I personally like having "work" mean other things in addition to seeing patients. It is much easier to go part to full-time than the other way around, so if you think you want to go part-time, start there and transition later if you feel it's right for you.

2. Academics vs. community: The relative merits have been discussed extensively elsewhere, but specifically as it relates to motherhood, your mileage will vary. I have passed up opportunities at work that I felt would take me away from family too much and have been able to keep a good work-life balance so far, but it is very easy to take on a lot of obligations that eat up your family time. Not sure where you are in family planning, but pumping is MUCH easier in an academic setting vs the community in my experience.

3. The academic/community hybrids are a good option, too (mostly seeing your own patients but with a rotating resident sometimes).

Please PM me if you'd like to talk more.

 

[EBKame]

Wow! Thanks everyone for your thoughtful replies. I do want to qualify the statement that I made about "selling out." I by no means think less of EM physicians in the community, but for me personally, I do feel like I am taking the path of least resistance by not staying in academics. In my program I'm surrounded by attendings, residents, admin people that think that academics is the only option, so it becomes difficult to entertain other career paths. With that said, much of what you've said about prioritizing my happiness/family over expectations is certainly true. I do not want to be in the position of regretting not spending enough time with family ten years from now, when I can't take it back anymore.

EMedGrll thanks for your opinion on making academics work for your family. I certainly like the balance that academics provides between clinical work and pursing your own intellectual interests. I do think that you need to be well at compartmentalizing if you are going to take your "work" home with you. I have a very hard time not being stressed out by deadlines and particularly presentations and find that I let it invade my home life too much. I have a shift buy down right now as chief, but I spend so much time preparing for my other obligations that I feel like I'm never off work.

ptarmigan - thanks for your insight on finding jobs in a competitive market. I'm more than open to working part time initially or even per diem. I'm interested to hear how people broached this in their initial interviews. I think it is difficult to sound like a hard working new graduate while at the same time saying you'd be willing to work part-time. Also, I could imagine people don't take your application as seriously, if you are looking for full time work, but have only been working part-time x several years.

Beanbean - I appreciate the life is better after residency comment! Many attendings in my department lead me to believe the opposite... I'm very impressed that you are doing this all with three kids. It's also hard to believe that I could find a full time gig for less than 110 hours. Do you end up having to pick up more shifts?

 

[WildMed16]

Just curious why you feel you are selling out by practicing in a community hospital. Some of the brightest and most procedurally adept emergency physicians I know now work or used to work in community hospitals. EM thrives in the community. In general I don't see other specialists in my ED unless a patient needs to go to the OR, and even then they will often trust my diagnosis and just meet them upstairs. It's all me now, and I feel that my role is that much more important to the patient than it ever was in academics.

In the academic center, it seemed like the place was crawling with specialist; there was too much help. I trained at a well respected county center that was supposed to be hard core, but we called ortho to do simple reductions, optho to look at anything but a corneal abrasion/FB, and the trauma residents were pushing us out of the way to evaluate the stable rollover MVC. Almost every chest pain was seen by the hospitalist after an obs period, and we never had to set up follow up for anybody because there wasn't any available.

Going into residency I thought I would do academics because I love education. I miss teaching and I miss the educational environment within my own department, but in every other way I find community EM more satisfying - even despite the pressures.

You mentioned you are looking in a competitive region. I trained in one of the top ten hardest places to find a job, and all the private groups preferred to hire people part time. Extremely difficult to get anything full time, especially out of residency. Grads who want to stay will pick up a couple part time jobs and then end up "making it" full time within a year or so.

Great post!

I'm currently a pgy1 coming off my trauma month at a huge level 1 center. It was definitely an eye opening month.

Like others have mentioned here, I'm somewhat drawn to academics because of the enriching environment and enthusiasm for learning. All of my favorite mentors so far are academic physicians (for obvious reasons). I'd definitely like to get some more exposure to the community setting to see what the level of autonomy is like for comparison.

Over the past month, I've realized that my academic mega center consults out for just about everything. Being the trauma resident, I was getting consulted for almost all the MVCs, regardless of identifiable traumatic injury. It got old really quickly. I feel that as EM physicians we absolutely have to be just as good as the trauma surgeons at identifying traumatic injury. I'm perfectly capable of ordering all the radiation that they do (which was a ton over the past 4 weeks). After a little while, it was clear that we were doing less thinking and more consulting.

I'm still up in the air about community vs academics, but posts like ones above are somewhat indicative to me of what direction I'm heading. I want to be able to do an appropriate workup on my own without consulting out the wazoo (and also giving up all my procedures to a trainee).

Sorry for the off topic post...