Match Day

Congratulations! This years residency match is over:-)

What a relief that I never have to relive that event again. Ever. My nerves can only handle so much excitement and drama.

I remember the absolute feelings of fear. Will he match? Will he match some where we want to live? Will it be close to our family? Will we know anyone? Will the people be nice? Will they have a Chipotle?

I had at least four different plans that had been previously worked out that were ready to be put into action the minute the news was received. I was probably a little over confident and had my heart set on one location in particular because it felt like home. Something about it seemed to call to me. Mind you I had never been in the state other than an airport layover years earlier. I had seen pictures that my husband had taken during his rotation and interview there. The location was far from home, and the climate was like nothing I had experienced before.

I knew before the match results were in that it was where we were going. We were supposed to be there. I could feel it in my bones.

Thankfully I wasn't disappointed, but I easily could have been. There are so many working parts to the match. Any one of them could have derailed our dreams. My husband assured me that he would match. But there is no guarantee than anyone will. We have good friends who didn't match the first time and had to scramble! Scrambling is about as much fun as the name implies.

We feel lucky that it worked out the way it did. The city we moved to was good for us in so many ways. We had been married for two years and had a small son. We grew up during residency, if that is possible for a pair of grown-ups to do. Rather we matured.

I am so excited for all the families who are starting this next adventure in the pursuit of medicine. Residency is about so much more than medical training. It is relationship and marriage refining. It is human development and social experimentation. It is strength AND endurance training.

I hope that you will look back on these years as some of the best of your life. I used to roll my eyes at the people who would say that about difficult years, but now that they are mostly behind me I can see what they mean. I wouldn't trade those 6 long years for anything:-)

P.S. They won't be the best because they are easy. Trust me, they won't be easy. They will be the best because you will discover who you are, what you are made of, and what you can do. Your husband will find that out for himself, too.

Congratulations!

Big Game Hunting - It's Interview Season!

Job searches begin during different seasons for everyone. There isn't one right time.  Hopefully, you have a job before you finish residency or fellowship. We have friends who have secured jobs 2 years before they are eligible to practice and others as short as 4 months. I told my husband long ago that I would prefer to be closer to the 2 year mark than 4 months. So much for my preferences.

But it is here. Interview season has called for us. We/he is up. This is the make or break point. This is it - THE ONE!

I am getting anxious just thinking about it. That either means that I will be on the computer more than I have been, or less. It means lots of blog posts, or a sparkling clean house. It means home-cooked three course meals with dessert, or take out. It means organized closets or piles of laundry collecting all over the house and no clean clothes to wear. It means lots of exercise or lots of chocolate. It is going to be a nail bitter.

We will have to see how this one shakes out. I am more nervous than my husband! This weekend can't come fast enough.

Student Loan Fun

I had the happy occasion yesterday to go looking for our student loan statements. Sadly, I found them.

Here is the sobering news. Our total student loan debt (just medical school) now has a balance of $300,800.05 - next month it will likely be more. No, we haven't borrowed a dime since medical school but this balance is multiplying like rabbits! Maybe faster than rabbits:-)

In March of 2011 I documented our total student loan balance as $290,707 and growing. In 18 months the balance increased by almost $10,000! We have even made monthly payments of $230 on this loan ($2,760 last year and $2,070 so far this year). All those payments haven't slowed the snowball. If you are familiar with Dave Ramsey, our debt snowball seems to be working in reverse.

What is sobering is the total amount borrowed to attend medical school was only $240,725.31. The other 60,074.74 is all capitalized interest (and we have already paid interest that isn't included in that total). It's probably more like $65,000 over the last 6 1/2 years.

And then I read that you cannot deduct student loan interest payments from your income taxes if your modified adjusted gross income exceeds $150,000 married filing jointly (see IRS Publication). Guess what? For the tax year 2013 our income will exceed that! Or at least it better be so we have a fighting chance to pay back our student loans.

I know you can't deduct interest paid on most sources of debt: vehicles, credit cards, personal loans, etc. It would be a nice gesture if there were some kind of "break" for that portion of our future income that will be diverted to paying down this huge debt.

In the end the amount of "interest" we will pay will probably be around $80-100K depending on how fast we can get it paid.

Luckily, our interest rates are low: 3.375% on the majority of the balance, and 2.75% on about 1/4 of the balance. I know that for many of my friends, and readers, who started later you have much higher interests rates. I am so sorry, because I know your final numbers will look even more dreary.

If you have the ability to make payments on your student loans while in residency, consider doing it. At least you will be able to deduct the interest you pay on your taxes at a much lower rate and possibly increase your tax refund by reducing your taxable income. I know it's already pretty low, but lower is better.

If you can't, then you will deal with it later - like I am. It would have been impossible to start paying back our loans any earlier than we did. (Maybe not impossible, nothing is impossible). The only reason we started paying is because we had to. There was no way around it, and maybe we should have started residency planning on doing it instead of planning on deferring for as long as they would allow.

It will be happy day when I log on to post: WE DID IT- SALLIE MAE HAS BEEN PAID!

What is left to be decided is will we live like this until we do, or are we going to live a little? I know what my husband wants to do, so we will have some compromises to make. What are your plans for tackling student loan debt?

My Budget Exposed

Here is a look at our first year.  I was SOOOOO prepared. I spent hours, days, weeks working on this (6 years ago). You see as soon as we found out where we were matching I hit the numbers hard. I came up with a budget that I thought would work, based of course on how we had been living that year, payroll calculators, tax estimators and then tweaked a little to make it work (e.g., forced it to work). I was congratulating myself for my responsible approach and wise calculations.

What you will see next is really three budgets. The first is the one we were living with during medical school. The second I projected while planning for internship/residency. And the third was reality in internship/residency (an average of the months July-Dec). 

As medical students we were poor, or I thought we were poor. We were living in my DrH parent's second home so we had no rent, we did pay utilities, but even then our income was gone. Granted it was a large metropolitan city in the west and just insuring our cars was expensive, not to mention cooling a house in the summer. But we didn't do anything! We did have a baby and one on the way ($$). But I am not kidding when I say we didn't do anything.

I was foolish to believe that we could continue living like we were then long-term, and even more foolish to believe that the only thing that would change in our budget equation was a mortgage payment. That I could somehow keep everything else constant. Life was going to teach me a lesson the hard way. No matter how much you plan and prepare, if you don't plan for the "what if" you aren't prepared.

I am going to admit right now that I am embarrassed when I look at this budget. Another benefit of anonymity. Even with all my knowledge about budgeting, even though I had been successful at it, I still fell into traps. The same traps that are waiting for you. Even with all my best laid plans my budget didn't have any room to breathe. In my calculations, nothing could go wrong 6 years. That just isn't likely. By Christmas we had used up all our savings and were financially suffocating.

I am feeling the need to defend my spending to you. When I look at it I am appalled that I was so "off" when I made my estimated budget and what actually happened. The only pleasant surprise in the whole thing was that is cost less to insure our cars in our new state so we saved a little money there. But just a little. Everything else was more than I expected. We just bought a house! I was pregnant! We were having a new baby! We had the baby! Our toddler grew!

This wouldn't just be a one time deal either. How were we supposed to survive the next 5 1/2 years? How did this happen to me, I thought I was prepared? This wasn't supposed to happen.

I also want to point out that I had a line item on our budget for credit card payments. I previously said that from the day we married we committed to never put anything on a credit card that we couldn't pay off that next month and we have lived that way ever since. Unfortunately, before we were married we weren't so disciplined and had one credit card with a balance of $4,000 that we made monthly payments on until the day it was paid off nearly two years ago. That was $115 dollars a month out of our budget for those years that we were spending on something(s) we purchased and consumed in the past when we probably didn't need it. Using credit is robbing your future at precisely the same time your future needs it! I am unaware of a credit card that will allow you to charge without making payments. They have to be paid, and your budget cannot afford it.

So, go ahead and say that this won't happen to you. You will be better prepared, you will make better decisions, you will be different. But what if you aren't? What will you do?

Next: The Mistake My Budget Couldn't Recover From

An Intern Must Make More Than A Student, Right?

In my last post I wrote about the differences between those who graduate form medical school and those who graduate with other advanced degrees. Think law and business school grads. That is where we get these rules, because everyone who graduates and lands a job feels as though they have arrived. But alas, the medical profession is the exception to the rule.

In the real world you graduate, get a job, and your career starts. In our world, we keep training and our income shifts from student loans to paid training, but the numbers don't change that much.

I went to our medical school website to see what the current tuition/personal allowances were for the academic year 2011-2012. These numbers are probably fairly close to your personal allowances too, regardless of where you trained.

This budget information is provided to assist you in estimating your monthly budget and managing your available financial resources (e.g., employment earnings, financial aid, and assistance from your family members) for the 2011-2012 academic year. You should refer to the base expense budget given below when estimating your expenses. The average monthly living allowances listed below were derived from the 2011-2012 Cost of Attendance figures developed by the Office of Student Financial Services. Your expenses may vary from the "average" cost of attendance for your class. Consequently, you should calculate your monthly expenses based upon your anticipated expenses for the 10-month academic year. These monthly estimates should be derived to ensure you have enough funds to complete the year.


Student Service Fee                                      512
Health Insurance                                           2,700
Disability Insurance                                     50
Books & Supplies                                         3,398
Room & Board (rent, utilities, food)
     On Campus                                              13,090
     Off Campus                                              16,490
     With Parents                                             2,100
Transportation
     On Campus                                              1,104
     Off Campus/With Parents                        3,092
Auto Insurance/Registration                        1,650
Personal Expenses                                      3,650
Loan Fees                                                     1,177
Total
     On Campus                                             27,331
     Off Campus                                             32,719
     With Parents                                           18,329


These numbers need to be broken down into manageable numbers for purposes of comparison. The information from the school says that these figures are intended to cover a 10-month academic year, not the entire 12 months of the calendar. Easy math: divide the total by 10 to get the monthly amount you have to work with.

It may seem silly to compare a medical student budget to a real doctors budget (ha, ha, ha), but I am telling you now you may have had it good in medical school! And that is no joke.

Depending on whether you lived on campus, off campus, or with your parents makes a difference - until you move out and are living on your own. And really, how many people did you know who lived with their parents? That is assuming your got into medical school in the same town that your parents lived, and they would LET you live there. Not very likely. So from this point forward I am going to make comparisons based on the living off campus total, since that is what you will be doing. Welcome to the real world.

$3,272 dollars a month sounds great... even now that sounds like a nice sum to work with. I know you didn't actually get all this money to divide out because the school took everything that was theirs first. This is GROSS dollars. (For the record we didn't receive anything close to this. Six years ago, our figures were closer to the living with parents numbers). 

So what are the interns at our program making this year gross? $45,990 annually or  $3,832.50 monthly. But here is the catch. Not only is that gross (pre-tax & withholding), it is also misleading due to one BIG factor. Our program doesn't pay semi-monthly, they pay every two weeks.

Why should that matter? Well because if you are paid, say on the 1st and 15th of every month, you will have exactly the same amount of money to budget each month. If you are paid every two weeks, there are two months of the year (which we celebrate around here) approximately 6 months apart in which you will get paid 3 times. Yippee!

Before you get too excited, it isn't really good news. What it means is that the other 10 months of the year (and I would argue they matter most) you get paid less. It works like this. You take your gross divided by the number of pay periods. If you get paid every two weeks, there are 26 pay periods. If you get paid twice a month there are 24. The same amount divided by 24 will always be larger than if it is divided by 26. It is math, there is nothing I can do about it.

The reality is the gross paycheck of an intern at our program is $1,768 per pay period. Because 10 months only have two pay periods the real amount of gross dollars you will be working from would be $3,537/month.

It still seems like a nice sum to work with, but because you have gone from borrower status to earner status you are also expected to pay taxes. I am sorry to be the bearer of such bad news. When it is all said and done you may even have less money to budget as an intern than you did as a student.


Next: Taxes and Net Income, the Real Numbers Story

We are Done!

Yes, you have a degree. Yes, you have a family or maybe one on the way. Yes, you worked hard. Yes, you have sacrificed much. And for all those things I say Congratulations! You did it!

Finishing medical school is a big deal, but don't let your exuberance blind you to the reality of what is coming up next.

The primary thing that you need to establish in your mind is that medical school isn't like other degree programs, or advanced degrees for that matter. Law school graduates, MBA's, etc start working at competitive wages right after graduation. Seemingly overnight, they go from being mired in student debt and Ramen noodles, to having an income that is significantly larger than the one they previously had. That is not us. Yes, we went to school longer. Yes, they will hand out a diploma that says "Doctor". But what no one told you is that you aren't really done. You are almost done. Undergraduate degree was just the beginning. Medical school is the middle. Residency is the end (or at least when you finish it will be, unless your DrH wants to do a fellowship - then fellowship is the end).

For all intents and purposes internship/residency is more schooling without tuition payments and no access to student loans. When you actually graduate from that program in 3-7 years, depending on your desired specialty, THEN you will be done. That is the graduation certificate that officially says it is now over, welcome to your career.

I remember the first few conversations I had with people we meet in our new city now that DrH was officially a "doctor". They were awkward. I am sure they couldn't figure out why I was driving an old beat up car and my kids were wearing clothes from the thrift store, and my purse wasn't a brand they recognized. I had fears of people looking up my address and taking a Sunday drive hoping to get a glimpse of the "doctors" house only to be disappointed when they found a 35 year old bi-level ranch with a sinking driveway and peeling paint.

They would ask innocently what kind of doctor my husband was. Maybe he was the kind of doctor that doesn't make any money like my science teacher in high school who had a PhD. I would tell them that DrH was a intern and that we would be here for six years while he finishes his training in neurosurgery. Out of curiosity they would ask what that was, and I would explain it was a surgical speciality of the spine, nervous system, and brain. That would always get them. I married a brain surgeon. Yes, I did and here I am.

They would find clever ways to ask about how much money he made: "So does he get paid during his internship"? Without actually giving them the exact amount of money our family now earned instead of borrowed, I would tell them that he makes about the same as a school teacher in our particular state but works much longer. Everyone knows that teachers are underpaid, but compared to an intern/resident - we have them beat, hands down.

The funny thing is the women I had these initial conversations with are now real friends. They get it! Or maybe I just did a really good job explaining it.

Residency is still school/training and if you can approach it with that mindset you won't be disappointed.


Up Next: An Intern Must Make More Than A Medical Student, Right?

When Are You Leaving?

From the moment we moved to this community six years ago and announced that we would be here for six years we've been asked "when are you leaving". Now that the time is rapidly approaching when we will actually be leaving, the frequency of these questions has picked up.

At first it was fun to share our news, again. But then it became a little tiresome. How many times do I have to tell the same people when we are leaving and where we are going? Aren't they listening? Are they secretly hoping that it would be sooner? Are they getting tired of us? Have they been waiting 6 years for us to get out of town? Maybe they didn't like us as much as we thought.

I tell myself they can't help it and they are excited for the next phase of our training to begin (and end). I tell myself to smile and respond as politely as I can. In truth, I felt myself checking out of our community months ago.

We had a new family move into the neighborhood with two small children and one on the way in December. We had them over for a play date in October. It is now February, she has had the baby and I haven't been over to say congratulations. In my defense it is the middle of a not-very typically winter, but winter still the same. I just can't muster up the energy to pursue a friendly relationship with a new person I will never see again. For one it would require getting dressed and leaving the house. Chances are good we are not going to become fast friends. And I feel like all my time and energy needs to be focused here at home. (I am dreading the day the For Sale sign goes up. How am I going to keep this place clean all the time just in case some one wants to come see it, and hopefully they will want to see it).

Even with some of my old friends, who I am going to miss terribly, I have found myself pulling away a little. As if I am trying to lessen the impact by gradually retreating so when the time comes we can just disappear without a trace. I don't want to think about leaving my friends, I don't want to think about trying to make new friends when we will only be there for a year. But, friends are important - they just take energy and I feel like mine is all spent.

I am so grateful to have found an online community of friends who are all in various stages of the same process. I have a feeling I will need those connections to get me through this next year when it hardly seems worth the effort to unpack boxes.

Getting My Hopes Up

Did you see that cute little counter I added a few weeks ago? It's the first thing in the column on the right. Today it says we have 254 more days left of residency. Yeah! We still have another 12 months of fellowship after that, but it is getting closer every day.

DrH decided to take a sneak peak at the jobs that were available at the moment for fun. Right now most of them are looking for people to start summer 2012 not 2013 so it really was window shopping. He read an recruiter ad that sounded too good to be true, so he had to call me to see what I would say about it.

Work 4 days/week 7 am - 5 pm.
2-3 cases/week
5 other Neurosurgeons to share call with
Protected research time
Starting salary $500K + Call $180K annually
Located in the Southwest in a community of 1M.

Besides my first thought being how can they really afford to pay you so much for working so little (not possible), but it was the last part that really got my attention. See, we are both from the Southwest and it is our ultimate dream to be there. Plus, there aren't that many cities of 1M or more in that area, so we were already guessing about where it would be. DrH called the referral number and yeah, it was too good to be true. You see, their idea of Southwest is Tulsa, Oklahoma. Really? Since when is Oklahoma considered the Southwest?

Being from the "real" Southwest I call any state that shares a border with Mexico the Southwest. Last I checked, Oklahoma wasn't near Mexico. I looked at the map and calling Oklahoma Southwest is really stretching the truth. Just because their northern border is the same latitude as the northern borders of both Arizona and New Mexico doesn't really make them a Southwest state. I consider Oklahoma more of a Central state, they could have called it South Central and been correct, but not Southwest. Really the state is almost smack in the middle of the country east to west, technically lower than the mid line north to south.... but I refuse to acknowledge Oklahoma as a Southwestern state. Furthermore, they are in the central time zone. Take that!

Warning: Read those recruiter ads with a skeptical eye:-)

Million Dollar Baby

Our baby girl may not actually cost us a million dollars, but what is the difference between a million and some other amount when you don't have it!

If you missed the post about the baby we had, she was born three weeks ago tomorrow. She is perfect in every way. Thank heavens! Yesterday was not perfect, however. My parents (live in childcare providers/entertainers for the last 3 weeks) left the Midwest for their home in the Southwest and I received the first of many bills that are coming my way. Double whammy!

As some background, the hospital we are "employees" of merged with another larger hospital last year and introduced a new health plan - only one option: take it or leave it. I would have thought with a bigger pool of covered employees, all forced into the same plan, there would be some improvements over the last plan. Wrong. They disguised an awful plan with beautiful brochures and advertisements. They should have saved that money and put more into their plan!

This isn't the first baby we've had mind you. We now have four, all by c-section. The first was born during a year off of medical school between 3rd and 4th year and we had insurance from the University my husband was doing research at. That birth was FREE, covered 100%, no deductible, no co-pay, nada! Our next two were born during residency under the hospitals previous insurance plan and each cost us about $2,500 out of pocket. I thought that was bad... turns out that was nothing compared to the bad news we just got.

Tuesday we received an information sheet from Blue Cross Blue Shield. You know the one that says This is Not A Bill - but is a foreshadowing of what is going to come. It showed what was billed and what they covered with an "amount you may owe provider". I showed it to my husband and about passed out. He responded optimistically with "that may not be the actual amount we owe". I said "we'll see". And we did... yesterday. Our first bill from the OB/GYN for obstetric care only showed the amount we owed, after insurance did their part, was $2,682.59. Do we really have insurance? That is more than we paid total for our other births. And that doesn't include the other bills that are coming: the anesthesiologist, the pediatrician, the hospital stay, etc.

When we found out we were expecting we immediately started saving for this particular expense. I wanted to have the money for the baby saved before she was born so we wouldn't have that particular stress to deal with. I thought we were being responsible, and we were. So the day we walked into the hospital I had $2,500 saved to cover what I thought (hoped) would be our expenses. After seeing this first bill it is obvious we won't have near enough.

I immediately sent the doctor/husband a text with a picture of the bill. He called when he could and I was still crying. I asked him, when he had a moment, to make a visit to the HR department and find out exactly how bad this is going to be. It's going to be bad. Let me explain how this plan works.

After our annual deductible for our family of $3,200 is met, we pay 10% (and that is the discounted rate for using this hospital instead of another) until we hit the magic number of $4,000 out of pocket expenses for the year. After which, all further expenses are covered at 100% for the year. That means our contribution to this is a maximum of $7,200 each year that we require services. And then they do something rather clever, or sneaky, depending on how you look at it. They give each family a Deductible Reimbursement Account and contribute $1,200 to it automatically. Why not just reduce our deductible? Then you can subject yourself to health screenings and get another $600 upon completion. Currently, my husband has been screened and is having phone counseling sessions to get this money. We just found out I can be screened as well and hopefully get another $600 for our DRA. So the math now changes to $7,200 minus the $1,200 they automatically give, minus the $600 for each of us, assuming we pass the screenings and undergo necessary counseling/coaching sessions, bringing our out of pocket totals to $4,800! I am pretty certain we'll meet that number, or at least close to it. With just one bill we are already more than half way there. Oh, and our annual premiums are another $4,000.

I am MAD! After complaining to HR about the situation they retorted that he should talk to housekeeping. Sarcasm, that's helpful. Meaning that they make less than he does and have the same coverage. I'd like to slap them. Housekeeping staff may have the same insurance but they can't compare the two! They suggested he could ask the doctors for professional discounts. That's a great idea, but why should I ask the doctors to reduce their fee? It isn't their fault the insurance the hospital provides is awful. And someday my husband will actually be the beneficiary of his own billing. The doctor isn't to blame.

I will have no problem whatsoever asking the hospital to reduce their portion of the bill for us, and this is why: They have taken our father/husband from us for the past 5 years. He works upwards of 80 hours a week without adequate compensation for his time. The don't allow him to moonlight as a way to increase his earnings so we can pay for our out of pocket health care expenses. Is that the same for housekeeping? I don't think so! They get overtime, shift differentials, and can have another job if they want. Last I checked we didn't have that same luxury. It is insulting!

I was already pregnant when they switched insurance plans, there wasn't much I could do. And maybe that is my real issue. I believe maternity care should be treated differently than other medical procedures. Maybe that is influenced by my pro-life stance. A pregnancy isn't a disease. Or maybe by my belief that a baby who provides joy to a family shouldn't come with a price-tag that requires financing. And I don't believe that the number of babies that would be born by members of this plan would be so great that covering those expenses in their entirety would bankrupt the insurance company or the hospital. I'm tired of giving all my money and my husband to the hospital. What is left for us?

I told my husband something needs to be done! What? I don't know. I'd like to give the hospital administration, and the program director a piece of my mind - and maybe I will. If nothing else I feel like this program should be obligated to disclose their horrible insurance plan to residents contemplating this program before the match. Or they should compensate their residents proportionately with the annual out of pocket maximums. It's not enough that we live in a state with one of the highest tax rates (both personal and property) that eat away at our income, now this. I can't wait to get out of here! 11 months and 15 days.

So today my husband is removing two brain tumors. All the while he is worrying about his wife and how we are going to come up with the extra money to pay for this beautiful baby. Doesn't seem fair for the patient, the doctor, or his family. Yes, he is a doctor and we have the worst medical insurance I have ever heard of - what is wrong with this picture?

Hail To The Chief!

Let me begin by saying that today is the day I have been waiting for! The last 5 years have been leading up to this moment, and I couldn't be happier that it is here. From Intern, to Resident, and finally Chief!

What is so great about being the Chief Resident? Let me tell you why "the Chief's" wife thinks it is so awesome: The chief is responsible for making the call schedule. Ergo, the chief's wife gets to have some input. This month it means no call for our daughters birthday, the 4th of July weekend, no call on my birthday, no call on his birthday. Finally, our family schedule is consulted before his work schedule! After five years of being at the whim of another residents scheduling preferences, it is our turn.

Of course being Chief also comes with it's own headaches. Like being responsible for junior residents and medical students, and being the "man" who is on the receiving end of the attendings fury. I'm OK with that. A small price to pay.

So today I am going to bask in the glow that is our final year of residency and I'll try not to think about the upcoming fellowship. 365 days and residency will be a thing of the past. I made it!

Drive Yourself Crazy

I often joke that as part of being married to medicine wives should be given a refillable prescription for the anti-depression/anxiety medication of their choice with no expiration date. Mine would be dispensed out of a gum ball style machine. There are so many things that happen along the way that can really throw ones balance off. Having said that, I jest about taking medication but have never taken them. It has been a temptation on more than one occasion, and it has probably been warranted more often than that! If you do, your mental state is probably a good deal better than mine, and I may be jealous. Once again, blogging is cheaper than medication!

One of the many things that can drive a person crazy is thinking of all the possibilities for the future. Where will we be for medical school, internship, residency, fellowship, jobs? Will they have good schools? Will housing be affordable? Will it be near family? Will I make friends? Will the weather be nice? The questions are endless and can consume ones mental energy for a long time if you allow it.

Trust me when I say I have driven myself crazy over each of these questions! By nature I am a planner. That is how I tend to cope with the unpredictable, I try to plan for it. If I had a crystal ball it would be well used. I dislike surprises and I am not spontaneous, but I like to think I am still fun - I just like that fun to be well-planned:-)

When my husband was applying for internships and residency I researched all of the possible locations. In the end I only needed to research one and I didn't need to start researching until after the match. There was still plenty of time, even for me. This time around, as he has interviewed for fellowships I have had to force myself to NOT go overboard with my planning and predicting. Let's face it, the fellowship won't start for another year and anything I find today could possibly change by then.

I thought I would be relived when we knew where we were going for fellowship, and I am. But apparently not enough. I still fret over where we might end up, because it will most likely be the place we call home for the rest of our life. It's a big deal! So when my husband tells me of where the current positions are available for his speciality I only listen with one ear. I won't allow myself to get all worked up this early in the game. When it comes time to apply and interview once again I may slip into the mode, but only long enough to narrow the list to my preferred locations. No wildly long spreadsheets, no sleepless nights trying to guess where we might go. No more driving myself crazy over something that I have very limited control over. Because if there is one thing I've learned on this journey it's that we don't really control our destiny - we go where we are accepted. Hard pill to swallow when you like to feel in control of your future.

Relax. Breathe. See what life has in store for you. (Advice from myself to myself. I hope I take it.)

Medicine Is A Family Commitment

I realized long ago that in order for this to work we had to be a family devoted to Neurosurgery, we would all be in this together or it would be a disaster.

When we married, my husband was an MS3 and was in the process of deciding what he wanted to be when he grew up. We would talk it over, forward, and backwards. His other interests were Pediatric Cardiology and Orthopaedics, both of which were just as long as arduous as Neurosurgery. So I knew from the very beginning that regardless of which specialty he chose, I would be in for a long ride. What he wanted to be wasn't nearly as important to me as what he would be most happy doing. I couldn't think of anything worse than being married to someone who had regrets about what he chose to do with his life. A specialty is a commitment that is difficult to change midway through.

I think I've mentioned before that we've had two discussion during this residency about whether or not we (I) can survive. It is me who just can't seem to go on another day, and me who needs to express it. Both of those times he has said, and I believe him, that he will do something else if it means we will all be happy. And each time I gather enough strength to go on again. Most of the time going forward on your chosen path is easier than giving up and trying something new. Plus I am not a quitter, a whiner sometimes but I don't give up. That doesn't mean I don't have to remind myself that "we" chose this! What I also try to remember is that when we made the decision to specialize in Neurosurgery we both felt good about that decision and agreed to move forward having faith that it would be for our good (and probably good for his patients as well).

It is a long ride, but I don't have the luxury of being a passenger only. When you are married to a medical professional you are a part of what makes that man who he is. Hopefully as a spouse we can make it easier for them to go about doing their "jobs". Our work is often silent and most of the time not nearly as glamorous as I would like, but it's my part in making it work. I certainly wouldn't want my doctor worrying about things at home (cleaning, cooking, shopping, laundry, bills, etc.) when he should be concentrating on my tumor!

My husband often jokes that it is a good thing he doesn't handle our finances, and I agree! I know how much time it takes me, and he doesn't have the time to do it. The role of a medical spouse cannot be underestimated. While I don't always agree that a residents life is conducive to having a spouse or children, it is that same spouse and children that make a residents life complete and well balanced (and well-fed).

Behind every good man/doctor, is an amazing woman. I am meeting more and more of them each day. I just wish they lived closer!

It Could Be Worse

I remember when we were first dating and my then medical student was deciding on what speciality he was going to pursue. I knew what he wanted to do. He would tell me stories about being drawn to journals in that field during his undergraduate years. He warned me that it meant that he probably wouldn't be around much. At the time that possibility didn't seem like a bad thing at all. I had spent the last year living alone and was used to the peace and quiet that comes with that state. I believe I even told him that I enjoyed being by myself and didn't think that would be a problem.

There is a big difference between being alone, as in alone by yourself, and being alone with children, as in all by yourself. Having never had children I didn't realize how significant the difference would be. 

So here we are. Four kids later, and a lot of alone time - but not the kind I had imagined and thought I could cope well with. I am grateful that I am not truly alone. I am grateful that I have my children who provide free entertainment and dazzle me with nearly everything they say and discover. I don't think I could have managed this long without my children. My children have also been the tools responsible for meeting some of my dearest friends. They get this home body out and about in the real world among other moms. Play groups, museums, gym, dance lessons, library, school, we are never short on things to do to keep us busy and occupied.

In the end it could be worse. My husband could be in a job he hates, punching the clock to provide for his family, and miserable. Even if we don't get to be with him as often as we might like we know that he loves what he does, that he does this regardless of what they pay him (one day we hope it really pays), and that even though he may come home tired, he is never miserable. I'll take that over the other any day.

There have been two times during the course of this residency when I have just about had a break down and didn't think I could go on. This dear man would change his plans for me and our family in the blink of an eye. Not because his speciality doesn't mean that much to him, but because we do. I know that our happiness is ultimately his happiness. Knowing that he would do that if I asked him means everything to me. And because I know he would I will never ask. We've made it this far and we can make it farther. 

You Can Be Too Specialized

What I've just realized is that #1 specializing reduces the number of jobs near home. And #2 obtaining a sub-speciality further limits the number of opportunities. Advice: if you want to find a job near your family and friends, don't specialize yourself out of the market in that area.

We've started the job search, and it doesn't look like we are heading back home unless there is divine intervention. If any intervention is to take place it would need to show up in the next 6-12 months. How's that for a deadline?

The options available right now aren't the most exciting. Maybe we can just continue doing fellowships until the "perfect" job shows up.

What Other Profession Does This?

I confuse my family and friends all the time with the process of medical training. For example: we have landed a prime fellowship position, but it won't start until the summer of 2012. That's an eternity. Who else applies for a program 18 months to two years before they ever have any hope of starting it. Only medicine. The next move is searching for a job. Same thing, looking 18 months to 2 years before they are even available to practice. It is a strange thing. So many variables potentially could change over the course of a year.

My husband tried to justify the process to me by citing the sheer number of people involved in the review of applications, CVs, and then coordinating schedules so that all the big players are available on the same day to conduct the all day, all night, interviews. Then they all have to get together and decide who they are going to select. I will admit that logistically it may be a nightmare. Do you know what job you will have 18 months from now? Do you know where it will be located? Would you even consider accepting a job that wouldn't start for that long?

The business of medicine works almost completely opposite of the way it does in the business world. When the employer I worked for wanted to hire someone, they wanted them now - not next year! I will give it to these doctors, they must really be a future thinking group. Proactive instead of reactive. Is it possible that they can be so sure of a decision so far in advance? I hope so, we are gambling on it.

Fellowship

The good news just keeps coming! I'm half expecting to open my door and have the sweepstakes van pushing money into my hands:-)

Last night we got the e-mail that an official offer letter would be arriving shortly confirming a spot for a fellowship!!!!! I am so relived to finally know where we will be going, if only for a year or two. This is the one we wanted! No more interviewing all over the country, no more stressing about whether to start looking for jobs, no more uncertainty at least for a while.

The kids were already in bed when we found out, but we celebrated without them: American Idol and ice cream. It was a sweet night.

Not For The Faint of Heart

Medical School, Internship, Residency, and Fellowship are not for the faint of heart.

I think most of us would agree that anyone who is contemplating signing up for 10+ years of graduate school and training, with it's accompanying mountain of debt, is made of steel. The same can be said of those who choose to take the journey with them. When someone finds out that I am married to a Neurosurgery resident they without fail make a statement as to his genius and intellect. He is a smart guy, I wouldn't have married him if he wasn't:-). But he would be the first to tell you that he was an average student. And I usually respond to these statements with "anyone can be a doctor if you are willing to sacrifice enough time and money to make it happen". Well that, and you should probably have some natural desire to do it.

Not too many people are willing to commit to the time, after all it is a decade! Few people can even fathom the amount of debt required to make it all happen. And fewer still have the aptitude to be good at it. But everyone would like to experience the fruit of their sacrifice. The spoils of war. The life of doctors they see portrayed in TV, movies, and books. Even the shows dedicated to resident life don't accurately portray what it really is.

Medical School
We were married during his 3rd year of medical school. From what I understand I missed out on most of the burnout years consumed with didactics, tests, non-stop studying.  I came in at just the right time - as he was doing his clinical rotations. Some rotations were demanding, others were less so, and they only lasted one month. His fourth year was much the same. If this was any indication of what the following few years would be, it didn't seem so bad. It was during this time that we also had our first child.

Internship
One of the injustices of being committed to a partner who is also committed to medicine is that the number of programs located in your home town or home state are very limited if they even exist at all. We moved 2,000 miles from our family, which would mean the number of visits we would make would be severely limited. I don't believe anyone who was involved in structuring medical school and residency ever intended for the doctors to be married or have families. I agree it would be much easier if they were all single and childless in some ways. In other ways having a spouse to share your journey with can be a valuable asset.

Most medical students will go on to do Internships and Residencies in locations that take them far away from their family and support groups. Depending on the size of the program they may have others in the same situation if you are lucky.

The Internship year felt an awful lot like the 4th year of medical school. A different rotation every month, schedules that were sometimes flexible, others that weren't. Even the bad ones weren't terrible because of their short duration. Enter child number two.

Residency
And then there was residency! Welcome to your new life. One that begins to reshape your vision of what you thought a residency would be. It's no mistake that they call these PGY2 doctors "residents". The name implies they live at the hospital, and often they do. Residents don't set their schedules, they come in before the attendings get there and usually leave after they have gone home. They have call schedules that can be as demanding as every other night or every third night. Depending on the hospital they may have to take "in-house" call, meaning they are at the hospital. Or they may be able to take call from home.

Taking call from home is sometimes nice when there aren't many calls. But on nights when the resident gets many calls, no one sleeps much. Have you ever tried sleeping with a pager? You never know when it is going to go off. I thought after a while I would be able to sleep through it, but after having kids my ears are finely tuned instruments listening for any sound that goes bump in the night.

Their hours are not set. You know what time they will leave for work, but you never know when they will be home. Some days you get lucky and it is at a normal time. Other days you might not see them at all. And even on those days when you get the call in the afternoon that they might be home in time for dinner, something always comes up to shatter that. After a while I just asked him to not tell me when he was coming home until he was in the car. I could deal with that.

Fellowship
Ah, the fellowship. It's not a required part of training, but for those who want to further specialize it is often a necessity. And this is where we find ourselves. I thought if I could just make through the 5th year of residency we would have succeeded. At this point in time may residents have job offers accepted and are planning their moves to new locations even though they won't happen for another year. In our case, we have been interviewing for Fellowships.

A fellowship means another move for one or maybe two years. It means an extension of our time in training, it means a real job offer is just that much farther away. We have one child in school and another who will be starting school when we start a fellowship. It means my husband will be 40, and I won't be far behind.

So here we are. The end of our 5th year of residency, interviewing for fellowships, waiting to see where the next chapter of our journey takes us.