7.23.2007

Choosing a Specialty - Being Gay, a General Surgeon, and a Woman...tell us more.

Surgeons are so cool...aren't they?

What's your specialty, and how did you get there? And did being gay cause any difficulty during the process?
I've completed my surgical residency, which took 6 years. Following graduation, I worked at a hospital as a staff general surgeon for 2 years while I contemplated my next move. I took and passed my surgical boards during this time. Additionally, I had my first son. I then completed a vascular surgery fellowship, and now work as a vascular surgeon.

Being a lesbian in medicine makes you the brunt of lots of jokes and off-color remarks. Moreso in surgery, I think, because it is so macho male dominated. The culture has been so testosterone driven that, it's almost *acceptable* to say inappropriate things. And you feel stuck. What can you do....who can you tell? In the end, most gay medical students and residents feel it's just easier to deal with the abuse...than to fight the fight when you're completely at the mercy of the establishment.


How did you obtain a spot at a top medical school and subsequent residency program?
I basically put my life on hold from high school graduation until the completion of residency. I believed that (as young ladies are told) "you can have fun later...study hard and don't get distracted (i.e. pregnant)." So in high school, although I had a fully developed social life, I felt tremendous pressure to perform well so I'd 'get into a good college'. While in my 'good college' I had to work my ass off...more so than if I'd have went to simply an 'okay college.' But, you need to have a degree from a 'good college' to earn serious consideration for entry into a 'good medical school.' So, in college, I studied....volunteered...and basically had no social life. I kinda regret that now, in retrospect. I don't have a strong network of college contacts as my law school friends do. If I had that to do over, I'd probably choose a college a bit closer to home, less expensive, and would allow me to excel academically while having a social life.

Once in medical school, I worked harder than I'd ever worked before. Even the most dedicated and diligent study regimen only yielded mediocre scores. But, since I wanted 'the very best residency' spot, in the 'most prestigious surgical program' in the area....I worked even harder, sacrificing everything else, basically. I didn't eat Thanksgiving dinner with my family because that "vacation" was prime study time before the winter mid-terms. During winter and summer breaks (and vacation) I did research. That's a necessity to publish a paper...and publishing is mandatory for a top echelon residency spot. I kissed a lot of ass, and ate lots of crow. I did the song and dance every arrogant surgery attending enjoys in a surgery department. I tolerated the character defamation, humiliation, sexism, and picked up the surgical instruments from the OR after the surgical attending threw his weekly temper tantrum (because the bed wasn't 'tilted enough to the right'...or some other equally stupid powertrip gone wrong). In the end, I ended up co-authoring 2 papers as a medical student...and earned AOA recognition in my clinical years.

In exchange, I had no meaningful relationships outside of my family. And I wasn't available, mentally nor physically, when my grandmother (whom I adored) fell ill. I was so consumed doing this insane thing as a doctor in training, I actually missed spending time with her...and she died too soon. I missed weddings, and birthday parties. To the point where I was no longer even invited. My friends found new friends who had time to return a phone call...and I was very isolated.

How did you stay sane during training?
I didn't, actually. I just worked all the time. I gained 25 pounds, and developed varicose veins and plantar faciitis so painful, I took analgesics constantly. My blood pressure went up, and despite my best efforts, I could not eat healthy as a resident. I developed prediabetes, and basically ignored my physical needs altogether. It is a show of weakness to express the need for the requirement of basic human needs as a surgical resident. Going to the bathroom was a big deal, actually. My only saving grace was the fact that I was only in my mid/late 20s, and my body tolerated the abuse...abuse that would be difficult (perhaps impossible) to physically recover from for someone a bit older.

I had no hobbies, nor could I engage in any meaningful discussion with other people (outside of medicine), since I had no time to engage in the world activities and issues. I became very one dimensional, and my entire identity became "me, the surgeon."

What about the residency work hours?
We didn't have them when I was training. I do advocate for them, however. As the environment of medicine changes in this country, we need the physicians to participate on every level. To participate meaningfully, they need to have more dimensions to their persona.


Also, to tolerate years and years of abuse, at the expense of your relationships with family, being present for ill loved-ones, and at the expense of your very own health...isn't worth maintaining the status quo.

What was practicing general surgery like?
Horrible!! Absolutely horrible. The ER would call with "this old lady has non-specific belly pain...I'd like you to come lay hands on her?" As if my hands are magical. As if I can really tell what the hell's going on. The ER doc is just trying to cover his ass (which is necessary in a society where patients see a 'normal, expected complication' as an opportunity to get rich), so it makes my workload that much heavier. So, I got lots of these CYA calls.

Also, I was oncall every 4th night. And sometimes that would increase if a member of our group was ill, or otherwise absent. The money was pathetic, especially for the amount of time you're available. It even got so bad that the hospital wanted to stop paying us, unless we actually operated!! As if my time, just making myself available...taking time away from my life....isn't worth payment. I couldn't even have a glass of wine with dinner, for fear I may be called in. I wouldn't make promises to attend events, or meet other obligations (that may be more meaningful to my life and well-being), just in case I got called in...or happened to run late on a case. This is a big imposition on your life, and to not be compensated for your time is crazy.


Then, it got to the point where we were actually covering 2 different hospitals, miles apart. Not on the same night, thankfully. But the drawback of that is, where do you live? Getting to and from work is a hassle if you're covering 2 or 3 hospitals that are far apart.
You spend your entire life (all of your waking hours) sleepy and fatigued. You try to have a normal wake-sleep cycle so you can at least see your children. But you're freshest, sharpest hours are spent in the hospital. The rest of your life gets the "scrub time". The days are a blur. Sleeping becomes your favorite thing to do (instead of other hobbies, or spending time with loved ones). Life moves very fast...and you miss it. Your vacations are very planned well in advance...and only come once a year. Think about it, would you exchange a 2 week vacation to Europe for one 3 day weekend a month, every month, do hang out locally and bond with those closest to you...and then spend a week in Europe and later that same year a week domestically, like Florida? What I'm saying is, you'll get to do once a year big things. But it's the frequent, smaller things that I prefer.

Basically, your life is unbalanced. You miss tons of things that are important to you. You go thru life sleepy and tired...chronically. Your health isn't optimal...and it's all for what? To be called 'a surgeon.' That will get old as your children begin acting out in school....or choose grandpa over you for comfort and snuggles. When they seem to not like you very much...and you feel excluded from their lives. When you have a mild, dull headache from lack of sleep (or some other vital ingredient to a healthy body), on that 1 day off you may have in 10. And, low and behold, if you get 2 consecutive days off....you try to make-up for lost time. Guess what? You *cannot* make up for lost time. So, do you really want to spend your life doing this? And if not, why torture yourself for a decade, give up your 20s/30s, when you could be building something more sustainable....mentally, and physically?

The variety of work was non-existent. Appys and choles. The occasional exploratory lap. And sometimes you'd get to do a minor surgical procedure when the ER calls for help. But, overall, it's the same cases. The best (most interesting) cases go to the 'appropriate' subspecialist covering that part of the body. So, a cool upper bowel case will go to the foregut guys. Or a complicated heart or lung case would go to the cardiothoracic guys. The exciting trauma cases...the trauma guys. We, general surgeons, pretty much got the parts of the body that aren't 'interesting enough' to have their own subspecialty.

What about malpractice?
That's an issue, but is covered by the group/hospital.

How much did you make?
Not enough. About $200,000 year. Sounds like a lot...but let's break it down.


200K was about a $10,000/mo bring home. But, that's for a tremendous work load. And my loans are in excess of a quarter million dollars. I couldn't even afford to purchase a decent house, and simultaneously pay back the loan at $1500/mo. House note of about $6000 /mo (for a 3 bd 2 ba 15oo sq/ft house in the city-center). Insurances at $1000/mo. That leaves $1500 left. Currently I have children, so I know that childcare in this city exceeds $1000/mo for the hours I need them. At the end of the day, you can clearly see that $500 left is hardly enough to live on. There's utilities, car note, and miscellaneous. There's no money for incidentals, so they're charged. There's no savings, no investment money, and no emergency fund. I pay the minimum on my credit cards (which I have 2). The only saving grace was, during this period in my life, I had a working spouse and only one child.


Also, keep in mind that the ancillary staff I work with were making, hour for hour, just as much (and some of the RNs even more) than I made. This fact takes a toll on your morale as well. You feel that society expects you to be very altruistic, to the point of self-detriment. In a place, like France, where you are debt-free as a doctor, and you have a pension waiting for you when you retire, and where you're not sued for things gone wrong when you're not at fault...you can get away with making less money. Afterall, society has decided that doctors are worth this effort. In America, if I can't pay for food....I starve. There is no "village" looking out for me, vested in my well-being....making it difficult for me to justify self-sacrifice for society.

Why not just buy a cheaper house?
Where? Even a shit house in Compton is over $300K. Our home is a modest $800K. It's no multi-million dollar mansion. Nor do I drive a benz. My lifestyle was below where I'd like it to be. Well below where it needed to be for the services I provide. It was below the "break-even" point in the equation of time vested vs. income. I had to do a different thing. My parents are getting older, and my dad may soon need to come live with me. The people who've been supporting me throughout this process deserve a bit of my time and resources. I couldn't take care of them. I needed to make a change.

So, what did you do?
Well, I took 6 months off to regroup, and worked in an outpatient ambulatory surgery center. This was a much better environment, but kinda boring. During this time I was pregnant with my second son, so it was ideal. Later, I decided I'd go back and do a vascular surgery fellowship to decrease my burden of in-house call, make more money, and spend more time with my thriving family.

How did this work out for you?
It was a great decision for me. I always thought I'd want to be a general surgeon. To have the ability to do various procedures, and not be stuck doing one type of procedure on one part of the body. I was never interested in ophthalmology or cardiothoracic surgery for this reason (very popular choices among those who are able to hack it gradewise). Vascular surgery offers me a variety of projects, since vessels are everywhere. Granted, I don't operate on vessels in the brain, nor on a few other body parts that have others who'll likely do a better job (like hands/feet). But, I don't get called at home often. My scheduled cases are routine enough for me to feel comfortable doing it. Routine enough for me to find it easy. Routine enough for me to master it. But exciting and different enough where I'm not bored. Exciting enough to keep it interesting. And exciting enough to make my training, and the sacrifice worthwhile for me. Especially since I make over $300K now...which is plenty to cover my bills/debt, and care for my children and parents. I have a savings now, and feel more secure.


Any advise for gay medical students and residents -specifically?
Medicine needs you. Medicine needs more diversity, period. More women, more color, more spice....
I think it's safe (depending on the part of the Country in which you live) to allow the fact that you're gay to be exposed. If you live in Podunk Mississippi, perhaps you shouldn't. Eventually you'll have to allow yourself to thrive and live the life that best represents your essence. This probably means that you'd be better off choosing a training location where people are better educated. Eventhough you may be willing to fight the fight....you have to consider what type of environment you'd like to raise your family in. Where will your partner be comfortable? Medicine is labor intensive, and time consuming...and you'll likely not have the time, or energy, at the end of the day to deal with closed-minded, dumbass Podunkians.

Any advise for those who may be trying to decide on a specialty? Shouldn't students pursue something they'll enjoy rather than a choose based on lifestyle? I agree that you should do a medical specialty that you (think you'll) enjoy. But, how long will you enjoy a miserable lifestyle? Is the practice of 'that specialty which brings you joy' going to be *enough joy* to off-set the absence of life outside of work? Like seeing your kids play little league. Being there at your daughter's dance recital. Taking your kids to a puppet show in the middle of the week at the local library. Sleeping in late on Sunday morning, then going out to brunch, spur-of-the-moment with your wonderful family. Drinking until you're tipsy, and then having great sex with your spouse. Just having time for creative flow of energy, and silence to obtain inner peace!! These things may not be possible if you only get one day off a week...and you have a ton of basic life stuff to attend to. For the rest of your life...imagine 'not having enough time.'

Who runs your household? Grandma or mother-in-law? That may be better than a nanny, but it's still not ideal. A mom who's in her 30s - 40s is a lot more attentive, active, and better able to deal with toddlers/tweens than a grandma. Besides, Grandma has raised her kids...and now it's time for her to be a *Grandma.* It's one thing for Grandparents to be intricately involved, and to hire a nanny for supplemental support as needed. But, if they're raising your kids instead of you...you'll have to consider the consequences of that (for both you, your family, and your children).

Would you rather pay someone to be the Mommy while you're the doctor...or would you rather be home doing the mommy (or daddy) thing yourself? Would you rather have other kid's fathers who have time to coach flag-football on Saturday mornings teach your son how to throw a football, or otherwise be present as the male figure in your son's life....while you're at work being the 'greatest surgeon ever?' It's no wonder that so many old men end up saying "Rosebud" as they lay dying, alone, on their deathbed.

You'll need to nurture your marriage, or it won't last. People (including spouses) will only tolerate so much. Even if you think your wife is "happy staying at home"...no one gets married to be alone.

You need to be present while your kids are kids. In 12-15 years, they won't need so much of your time...and a large part of your influence over them (your parental guidance) is over.
Are surgeons so cool? Yes and no. The work is like no other. It's exhilarating when you can cut someone open, and fix the problem. It's easy to get an ego...which is almost a requirement if you want to survive the process of training. If you're to compete, and not become an emotional wreck....you shield yourself from criticism with an enormous ego. This translates to the rest of your life....and your personal relationships will become antagonistic. At times, the only thing in your life going as planned is...surgery. So you hold on to that. Surgeons are as diverse as the population. I'm sure there are some who get off on being a surgeon because everyone says "ooohhhh." But, most people are just as impressed when you say "I'm a doctor." Nothing special (or even distinctive) about being a surgeon to much of the population. So, who are you really trying to impress? Other doctors? Your partner? Yourself? And that ego, that desire for respect and accolades, keeps 'em coming to surgery....even if it's not the right career choice for them. That thought of 'surgeons are so cool.'


Criteria used to decide:
I say, decide *overall* what's important to you...and find a way to make those things fit together. This may mean choosing "your second favorite medical/surgical specialty" instead of your dream specialty...if you want a *dream life* overall!!

Work doesn't define you...and neither should being a doctor. You'll be disappointed if you don't understand, and clarify, this distinction. Balance doesn't just happen...you have to make informed decisions in order to achieve it.


*written with the input from a vascular surgeon.

29 comments:

Pseudo_Doctor said...

Being a second year medical student who's had surgery cross his mind, I'm glad you wrote this because I always wondered how the lifestyle would affect my chances to living a "normal" life later on. Thanks for opening the door into your world. I'm glad that you are much happier now and can actually have a normal life again...

Toni Brayer MD said...

What a great post and many thanks for your honesty. Profession is important but family and friends are the essence of a good life. I really identified with being so macho you wouldn't take time out to pee! I have gone entire days and into the night and realized I never stopped. Crazy!

SeaSpray said...

Excellent post!

Anonymous said...

Fascinating post, especially life as a general surgeon and the economics thereof.

Anonymous said...

Reading this makes me respect my orthopedist (trauma repair)even more. He was the best doctor I'd ever had, in every way, and I work hard to maintain excellent health just to stay out of doctors' offices. The best to you always.

Anonymous said...

Great blog. Your experience as a GS echoes that of several friends from med school. The best advice I ever received was from a surgery chief res in med school -- "dont do this unless nothing else in life makes you happy." I didn't do surgery-- best choice I ever made. Sadly, she was knocked out of practice a few years later as an attending due to a big malpractice case making her insurance too expensive to justify continuing. She's a mom now and happy volunteering in some clinic.

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Ben said...

Good post except for the part where you felt $200,000 was "not enough" and you were complaining about your $800,000 house not being a mansion.

The average house in America costs about $160,000. You didn't need to spend $800,000 on a house, no matter how many excuses you come up with as to why you "needed" to.

You are the victim of our comsumption society... no amount of money you make can ever be enough, because you'll just find new ways to spend it all. Now that you're making $300,000 I'm sure you have upgraded to a $1.2 million house and will soon find some reasons as to why that just isn't large enough for you!

Clearly, a "hard life" during med school and residency means that you should have a house that costs more than 10x as much as the average person's. Clearly.

Sorry for the sarcastic tone, but so many doctors out there, especially the ones blogging, have absolutely no idea how to live within their means or to live "like a normal person". You think you deserve to be super-rich and are perpetually disappointed because you're only "kinda rich".

Let me ask you this, and think about the answer. If you were say, a newspaper reporter, or a zookeeper, and you made $50,000 a year, less than 1/3 the $200k that you couldn't live on (even accounting for your monthly loan repayment), what house would you have bought then? Because that's how the average person lives.

LEARN TO LIVE BENEATH YOUR MEANS. It's really not that hard for a bright girl like you.

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|ost said...

Ben ... get off your high horse, for real.

I m a surgical resident in NYC, near the end of my residency. To get here I had to spend over half a million in school fees, living expenses etc while I earned 0, that's money I *have* to pay back. A zoo keeper doesn't have to spend that much to become a zoo keeper in the first place ... nor does a newspaper reporter. And neither of them had to go through 10 years of training to get there.

As to house prices, come find me a decent (ie not rat/roach infested) apartment in the UES, reasonably close to the hospital I have to spend 80 hours a week in for $160,000. If you do that then you might as well take a minute or two off your day to solve world poverty and cure cancer. You quote averages that have no bearing on the specifics of this blogger's post.
Yes doctors receive decent compensation, but not it's not "rich" if you factor in the time, energy and financial cost involved in actually becoming a doctor. And please don't equate a surgeon that had 4 years of college followed by 10 years of training to the average American. It's far from average.

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menatsu said...

Thank you for sharing this. Reading this made me respect Med People even more. :)

Roxy said...
This comment has been removed by a blog administrator.
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tsultrim Tsangtsar said...

So much ego, sigh hahaha I m glad I just have to take over dad business and live a fun life. I have no idea or m I able to comprehend all those experiences u had. LoL at one moment I thought of doing something serious and be a researcher in medical field or something but recently naaa! Bullcrap! I have only one life, one youth, so I m just gonna enjoy it. Haha and being rich is such a nice thing, although I do feel sad for people who work so hard to attain it that by the time they have it its meaningless! And they find their life is gone. Haha but nice insight! Thanks. And doctors don't earn a lot lol I mean they work for 20 hrs and have to train a lot. I think I m just gonna be the useless burden on society who does nothing and enjoys hahaha so long and thanks I now have new goal enjoyyyyy! Life

Sean said...

Ben... You are as ignorant as they come. Doctors give their life away for years and years of strenuous studying and training in order to help cure and alleviate people in need. Just hope that one day you aren't under the care of this surgeon.

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dave said...

hi

dave said...

well i agree with ben if you cant live on 200,000 a year than you have a problem.i do think doctors should make good money but i also think being a doctor is not about money if thats what you want there are plenty of other ways to get money.i have a friend who owns a buisness and makes 30 grand a month so becomeing a doctor for money is dumb.you should want to be a doctor cause you care about people thats why im glad it takes 15 years to make any money as a doctor cause it stops the people who just want a big pay check from being doctors.

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