The Match is complete, and now the fourth-year medical students are preparing to make their move to residency and chief residents are preparing to start their new career as an attending. The next phase of their lives is about to begin. The Match got me thinking about a comment I read recently from a doctor who decided to not become a general surgeon, which she had always wanted to be, and switched instead to a specialty that had a “better home life.“ It is a misconception that general surgery doesn’t have a good home life. There is no specialty that has or does not have a good home life. The home life you have is determined by you and how you organize your life, not by the specialty you choose. Yes, some specialties have more call, but that alone will not ruin your home life. I was a general surgeon in private practice for 20 years. Then I became a locums surgeon for three years. Both afforded me a good home life because I wanted to have a good home life and made it so. When I first came to town, my partners made rounds and took care of their own patients on the weekends if they were in town, and they expected me to do the same. That was not what I wanted. I wanted to have the weekends off if I was not on call. I knew this was a battle I could not win. So I took a different tact. I bought a motor home. With the motor home, I was able to check out to whoever was on call and take my family away for the weekend. When I bought the rig, my kids were nearly three and one. We often went camping at a campground just outside of town. We purchased an inexpensive, used motor home, with 47,000 miles. But it gave me my weekends off with my family, which was my goal. Four years later, after hiring another surgeon, we changed the weekend coverage. Whoever was on call for the weekend would cover for all surgical patients. When my kids needed a soccer coach on the U-8 soccer league, I volunteered. Games were on weekends, and I could set the weekday practice days. Tuesday was my day out of the office and on Thursday, my operating day, I was done by three. So practices were Tuesday and Thursday at 4 p.m. I asked to not be on call on Thursdays during soccer season. I had a parent who could be my backup if there was ever an emergency that kept me away. I enjoyed being a youth soccer coach. We chose to buy a house that was close to my office and close to the kids’ school. It was a choice we made for a better home life. When my kids had a school event, I could duck out of the office, see their part of the program, and get back to the office before anyone missed me. Many doctors choose to buy their house out in the country, which meant their kids went to the county schools which are a long way from their offices in town. Having my house close to work also gave me a short commute, enabling me to spend more time with my family. I was even able to make it home for lunch several times a week. Weekend call was Friday at 7 a.m. to Monday at 7 a.m. After my 72 hour call weekends I was usually exhausted and had lots of clean up to do on Monday. Other doctors with the same schedule had their Monday fully booked and had to work their weekend add on cases into an already full day. I took that Monday off, which cost me some income, but it gave me some breathing room. If the weekend was light, I spent the day off with my family. If it was a tough weekend, I could finish the work from the weekend and go home to sleep. We chose to pay off all our debt and become debt free. Which meant I could take a lot more time off, as I didn’t need money to make payments on the house, cars, credit cards, etc. Others chose to run up debt by purchasing toys they just had to have. Without the debt, I was able to take 12 weeks of vacation a year. I chose a lower income for a better home life. I had always wanted to be in a play. I auditioned and was cast in On Golden Pond at our local theater. I made a deal with one of my partners to trade call. He took all of my call for 12 weeks so I could be at all rehearsals and every performance. After the show closed, I took all his call for 12 weeks. I came up with a way to do both my job and something I really wanted to do for fun. As you can see, I could have missed out on many things and claimed that general surgery was bad for my home life. But I found ways that made my profession work well with my home life. You can too. When you become an attending, it is you who chooses where you will live. You can live close to the hospital, or the office, and have more time with your family, or you can live out in the country and not see them as much. If you have a long commute, is that the specialty’s fault or yours? You can’t believe how many times someone has told me they “had to” buy a house out in the suburbs and have a one hour commute because of some special circumstance. Then they complain about their work hours keeping them from their family. You choose the size and expense of your house, how much you spend and how often you buy a car, and which toys you acquire. Your debt burden is completely within your control. Now is the time to decide what kind of life you want. A big house, expensive cars, and lots of toys equal many hours working to finance these luxuries. A modest home, reliable cars and toy purchases, only after becoming debt free, will grant you more time with your family and a less stressful life. I have seen many doctors who have made poor choices blame their lack of family time on their job. They spend their free time working extra shifts to earn more money to spend on new toys, a bigger house, or a special vacation. While their family is at home wishing they could spend more time with them. It’s time we took control of our lives and do the right thing. Create a working environment in which we and our families can thrive. In the recent Medscape burnout report, general surgery had a burnout rate of 46 percent. Pathology had a burnout rate of 33 percent. If it was the specialty driving the issue, pathology should have a very low burnout rate. Pathologists have little to no call, they never deal with dying patients, and they have extremely low stress. Yet 1 in 3 pathologists is burning out. It is not the specialty that is the biggest detriment to becoming burned out or to a poor home life. Make your family a priority. Make your home life a priority. If you make them important, and not just say they are important, then you will have a great life as a physician no matter what specialty you choose. So choose the specialty that you like the best, with no regard to its perceived home life or income. Make your home life what you want and take control. Even employed physicians can have a very nice home life with a little negotiating. Take control of your job; don’t let your job control you. Source
