Wednesday, August 13, 2008

How I Became an Internist, or Here Comes the Patriarchy Again
~ by Jay

Anna responded to my questions post with several interesting inquiries. Since that's the only response I've had so far (not too late! hop on over and add yours!) I'll take one at a time.

Anna asks how did you pick your medical field? did you consider others?

Well, shortly after my wedding, when I was in my third year of medical school and starting to consider residencies, my grandfather (the retired internist) asked what I was planning to do. Hadn't decided yet, I replied, but strongly considering internal medicine. "Nonsense", said he. "You can be a radiologist, a psychiatrist, an anesthesiologist or a dermatologist. If you have to be an internist, you can be an allergist". What do all these fields have in common? "They will allow you to fulfill your primary responsibility as a wife and mother". My mother, to her credit, burst out laughing. She may have thrown a napkin at him, too.

Then there was the anesthesiologist I met during my surgery rotation, who asked me why my husband was allowing me to become an internist. And the classmate who told me that the residency I'd chosen was perfect for women because "they understand if you don't take medicine seriously".

Sorry, I seem to have been distracted. Where was I? Oh, yes. I was getting to the irony.

The irony is that I chose my specialty because I was married to Sam. I really wanted to be a family doc. But I also wanted to actually live with my husband, after years of being apart, and he was in graduate school in an area without any good family practice residencies. And he was hoping for an academic career in a field with maybe two or three tenure-track jobs a year, so we would have to go where he could get a job. Family docs are portable but practicing family medicine is very different in a major urban center than in a rural area. I didn't want to find myself somewhere where family docs were second-class citizens, and I was destined to be the trailing spouse.

It wasn't all about Sam. I'm a third-generation internist. It wasn't just Dad; both of my grandfathers were board-certified before 1942, which is pretty remarkable considering that the exam was first offered in 1936. When I mentioned my interest in family medicine, my father wrinkled his nose and said "You don't want to do that. You'd have to do well-baby exams." And I also considered psychiatry, but my family didn't think psychiatrists were real doctors (sorry, Tigermom) and I had no exposure to psychiatrists doing actual therapy; treating profoundly disabled schizophrenic patients didn't appeal to me. Internal medicine was the obvious and easy path, and I took it. Sam and I never discussed it. I never considered asking him to modify his plans in any way for mine. We both assumed I would go wherever he went. After all, I was more portable. Or so we assumed.

I laughed when I read this in that article about shared parenting in the Times:
{The researcher cited} two actual couples, one in which he is a college professor and she is a physician and one in which she is a college professor and he is a physician. In either case, Deutsch says “both the husband and wife claimed the man’s job was less flexible."
I suspect if Sam had been the doc and I the academic, I would still have ended up as the trailing spouse. That was my expectation, as well as everyone else's. So I compromised and did what I had to do.

I'm an excellent internist, but I've never felt like I belong. Internal medicine prides itself on being cognitive, rational, dispassionate. I'm a smart doctor and a damned good diagnostician, but my heart lies in the affective, in the world of stories and emotions and relationships. I don't get excited about finding the zebra, the rare disease that eludes diagnosis. It's much more satisfying when a patient looks in my eyes and says "I always feel better after I see you, because I know you really listen to me".

Now, nearly 20 years after I finished residency, I am planning to take another Board exam. In October, I will take the certification exam for a subspeciality in Hospice and Palliative Care. I'm still practicing primary care - I haven't given it up yet - but I'm now spending 50% of my time doing hospice work. I've finally found a specialty where my values are shared and my skills - all my skills - are appreciated. It wasn't the most direct path, but I know I'm in the right place.


Orange said...

My internist joined her dad's internal medicine practice. (It's her husband who's the radiologist in the family.) I wonder if her experience was anything like yours.

Ariane said...

My GP (general practitioner - I'm guessing this is our local equivalent) is awesome. She is brilliant, she listens, she considers my input, shares her knowledge (and lack of it!) and makes me feel entirely respected. I really believe a medical system succeeds or fails on its GPs. Mostly in Australia it fails, but I scored a good one. Your locals are very lucky to have good one. And truly, those called to hospice medicine are few and far between, more power to you.

Jeez, this is turning into a fan mail. :) But I really respect people in medicine who measure their success by the happiness of their patients. I worked for one once and I will probably always hold people up to his standard.

dr said...

That's a really interesting story, Jay. These decisions are difficult, as are the balancing acts. When a pediatrician friend of mine was in med school, she kept being told that she *shouldn't* simply go into pediatrics because she was smarter than that -- but she's now in a field that she loves, where she gets to help families figure out how to take care of their children. Like you, for her it's about more than the diagnosis.

Anna said...

Ok, I had to laugh at "They will allow you to fulfill your primary responsibility as a wife and mother" because that's the basis on which my husband became a dermatologist! (For the primary father responsibility, that is.) I think if there were no family ties, he would be some kind of super crazy vascular surgeon, or niche cardiologist, or one of the other kinds of divorce-prone specialists. But he decided that since he married me because he - ahem - actually likes me and wants to spend time with me (and later his kid as well) that it would be best to go into a more family-friendly field. He did consider radiology but that had too little patient interaction for him. It's too bad that all of these things are trade-offs and can't co-exist. I know he is sad (and I am sad for him) that he doesn't get to fulfill his intellectual potential (he would most likely have been doing clinical research as well). Sometimes it feels to me like a huge loss for all of medicine that there is this persistent brain drain of both men and women away from the fields of intesive hours into fields that don't require quite as much time but are also less directly "important". Anecdotally, I know that Penn has had to go lower and lower on its match list each successive year to fill the ranks of medicine residents, as those in highest demand go off to do derm or ophtho, or whatever. That probably sounds a little more elitist and snobby than I want it to, but I don't really have time to rephrase.

Anonymous said...

Jay, this post has had me wandering in a daze since I read it. I have been assuming that the next step in my career is more fluid and open to options than my significant other's and that he should have, say, a 51% say in what happens. I convinced myself that my goals can be accomplished anywhere though his are more rigid. Giving it a two-second thought however, the idea that someone fresh out of grad school has limited options in where they get their first job is flat out not true.

We are in the midst of starting to discuss planning a wedding, as well, but this realization has helped me see that we need to have a renewed talk about our expectations and our careers.

Thank you.

Mary P Jones (MPJ) said...

I'm thinking about how careers are ever evolving, as we are -- and how you and I are both still finding and defining our niches.

blue milk said...

I am really loving these posts. It is like meeting you in person or something. Fascinating stories.

sara said...

Hmm I must have missed this sometime. Interesting post. And I'm in the same urban/less urban family practice dilemma.