As I sit here half-naked, with what was no doubt concocted as some medieval torture device strapped to my chest, otherwise referred to as a ‘breast pump’, I contemplate my passage into motherhood, as well as a number of other things — 1) how ridiculous I feel, 2) why I even bother putting a shirt on these days, and 3) the fact that there is absolutely no way to prepare anyone for how drastic of a change it is to become a parent. I feel like I am constantly overwhelmed with all sorts of emotions (maybe it’s the hormones?), but most of all, I was already sensing the dread creeping in as my thoughts drifted to returning to work and leaving my precious little one, with whom I had become so well acquainted, but yet was just starting to get to know.
Through all the emotion and contemplation, I was left pondering, am I doing the right thing? Are we, as a medical community, embracing the role of motherhood to the best of our ability? The career demands placed on women and men of today’s society are fairly equal, yet there remains a seemingly striking inequity in the world of child rearing, often forcing women to choose between sacrificing their career or sacrificing their family. This is especially not an easy choice in the world of medicine, where most females have amassed the same amount of debt and committed just as much time and energy to their training as their male counterparts.
When I was pregnant, people frequently inquired about how much time I would have off for maternity leave. I found that I was usually faced with one of two responses…either “What!? That’s it?” or “That’s pretty good.” I took 6 weeks off which was a combination of all of my vacation, sick, and personal leave days. I could have utilized FMLA to have an extra six weeks; however, this would have prolonged my training and would have been unpaid time off without benefits, which quite honestly we couldn’t afford to do financially as a family on a resident’s salary.
After returning to work, I had a fairly constant and overwhelming sense that I was doing it all wrong — there had to be a better way. I found myself continually comparing my abilities (at least internally), with all those “working moms” who had come before me, and I was convinced that they had managed this transition (or maybe transformation is a more suiting term) much better than I. Perhaps it was the sleep deprivation, but I really just didn’t understand why there seemed to be no “pause button” so I could just catch up! Was I putting all this pressure on myself? I have a wonderful, task-accomplishing husband (who is self-employed, and in an effort to keep his business from suffering, took all of 3 days off when the baby was born). Unfortunately, even with his assistance there were many tasks that required my attention alone. I was left attempting to give 110% to breast-feeding, residency training, extracurricular activities, managing household duties, and really just trying to remain sane. I often wondered if I was being realistic with my expectations of myself?
One of the most stressful and anxiety filled components surrounding this new chapter of my life was breastfeeding, which is practically a full-time job in itself. Although breastfeeding is temporary, it is not meant to be a brief endeavor when you take into account those recommendations set forth by the American Academy of Pediatrics (AAP) (1). As I embraced my new job as a mother - on top of my already existing roles of wife and resident physician - I have to also try to juggle and accommodate the hours required for breastfeeding and pumping. I would also like to note here that I birthed only one child (not two, three, or more) and I was fortunate enough to have an uncomplicated birth, where everything went “according to plan”.
I’m now back at work, lugging this ever so important sidekick (my breast pump) everywhere and treating every last drop of breast milk like it is pure liquid gold while hoping I just don’t mess it all up and if I even have enough time to “get it right”. Did I do my son justice by going back to work when I did? I knew having a baby during residency would be a challenge, but after completing undergraduate education, followed by four years of medical school (especially when you decide on medical school a little later on in life) residency is ultimately when many women are at their prime reproductive age (2).
Then there is the sense of guilt that I am not getting more out of my“time off”. Because I utilized essentially all my days off for the year, I had some very idealistic goals of studying and being incredibly productive (e.g. completing research, reading, etc.) during this time away from work. However, then reality sets in and I realize that the only self-education I am actually doing is learning how to be a Mom, which really doesn’t leave much time for anything else.
I know my story is not unique, and I am quite aware that many other women have faced situations even more challenging, which I think makes this topic ever present. Through all of this turmoil, trials and tribulations, I continue to wonder as members of the healthcare industry whom are supposed to be proponents of health and well-being, are we doing all we can to ensure that those female physicians, who also choose to become moms, feel supported and encouraged? Instead I wonder if there are other mom’s who feel like we are being asked to compromise one dream in the pursuit of another? This is especially important during a period when nearly half of all medical students and residents are women (3). What better time to reflect and ask ourselves, “is this the best way”?
Emily Boyd is a 4th-year resident at Emory University. She is interested in acute inpatient and sub-acute rehab and will be pursuing these interests in her new job upon graduation.
AAP Delegate to the ORR: A Recap of the 2016 AAMC Annual Meeting
By Venessa Lee, MD
The mission of the Organization of Resident Representatives (ORR) is to improve resident physician education and training for the purpose of improving the quality of health care. The ORR is a committee within the Association of American Medical Colleges (AAMC). The ORR provides a platform for residents to provide input into the development of Association’s policy. It also provides leadership opportunities for residents interested in academic medicine and supports its members through professional development activities. Each eligible academic society appoints two residents for a two-year term, representing 46 residents from a large variety of geographical and medical backgrounds. The AAP resident delegates to the ORR this year are myself and Ryan Mattie.
Learn, Serve, Lead
All members of the ORR attended the 2016 AAMC Annual Meeting, held in Seattle, WA. The theme of this year’s meeting was “Learn, Serve, Lead”. I found the annual meeting to be a great networking experience and it brought together all the stakeholders who have significant influence and impact in academic medicine. There were insightful discussions about a myriad of complex issues that affect all aspects of academic medicine, with the dissemination of new concepts and tools for leading innovation and cultural change in academic medicine.
For ORR members, the week started with membership networking and Peer Module Presentations. Members of the committee prepared interactive learning sessions with topics including: residency and career transitions, unconscious bias and tips on how to be an effective facilitator. The opening plenary was an incredible presentation by presidential historian, Doris Kearns, on Leadership Lessons from the White House.
A major focus of the 2016 conference was exploring resilience, wellness, breaking cycles of negativity and preventing burnout. As has been discussed elsewhere, burnout continues to be a major health risk among trainees and practicing physicians.
In relation to burnout, the ORR reviewed and made official recommendations regarding the recent proposed changes to the ACGME Common Program Requirements Section VI. The focus of the discussion and recommendations from the ORR was on wellness for both residents and their families.
The proposed changes can be viewed on the ACGME website and are related to patient safety and supervision, professionalism, wellbeing, fatigue mitigation and clinical experience and education (Duty Hours). Members of the ORR felt that commitment to the well being of healthcare providers and their families will allow them to better care for their patients.
Other proposed changes included changing work hours for PGY-1 residents by eliminating the current 16-hour workday and replacing it with a 24-hour continuous clinical assignment limit, as is currently in place for upper level residents. The ORR voted to support this change with the addition of resources for resident wellness, and a focus on personal and family needs, as well as, provisions for improved maternity and paternity leave.
The next ORR event will be the Professional Development Conference, which occurs in Orlando, FL, from March 9-11 2017. It’s a great privilege to represent the AAP at the ORR and I’m grateful for the leadership experience. The ORR has two PM&R residents serving on the committee, with each delegate serving a two-year appointment. The next call for applications will be in May 2017 so please stay tuned for more information and consider submitting an application to serve in these exciting leadership and academic roles.
Venessa Lee is a third year PM&R resident at the University of Utah.
Physical Medicine and Rehabilitation Fellowship Spotlight: Pain Medicine
Adam Susmarski, DO, Association of Academic Physiatrists Resident Fellow Council Secretary
Academic Chief Resident,
University of Pittsburgh Medical Center (UPMC)
Herbie Yung, MD,
University of California Los Angeles (UCLA / WLA VA)
Pain Medicine is one of the sub-specialty areas in Physical Medicine and Rehabilitation (PM&R) with fellowship training programs offered throughout the United States.
I connected with Dr. Herbie Yung, who is currently completing his Pain fellowship at the University of California Los Angeles (UCLA) to discuss his experiences pursuing a fellowship and career as a PM&R pain physician.
Dr. Adam Susmarski (AS): What attracted you to pursue a Pain Medicine fellowship?
Dr. Herbie Yung (HY): I like the large amount of versatility in the field of Pain Medicine. I get a chance to work with a lot of different types of medical professionals and patients. Additionally, I enjoy working with all of the exciting technology out there, with not only fluoroscopy and ultrasound guided injections, but also neuromodulation, intrathecal pumps, radiofrequency ablation, and regenerative medicine, just to name a few.
AS: What are the aspects of fellowship that applicants should carefully consider when making their rank order list?
HY: I think it’s really important to look at how you fit in a fellowship program, for example, is there good mentorship to help guide you for the rest of your career whether it’s academic or private practice? Does the program offer the procedural training and exposure to the patient population (e.g. cancer pain, palliative care, pediatric pain, and/or pain rehabilitation) that you are interested in integrating into your future practice? Are there research requirements or an opportunity to teach medical students and residents? Is location a factor? Completing your fellowship in the region you want to end up long term can help with your job search.
AS: How did you choose which fellowship was the “best fit” for you?
HY: In addition to the above factors, I think it’s important you find that you click with the attendings at the program. Even in that one short year, you will spend more one-on-one time with them than you did with your attendings during residency. If possible, talk to someone who completed that fellowship to get some insight into what that program offers you that no one else can.
AS: What has been your favorite experience as a fellow?
HY: The whole year is just a whirlwind of new information, terminology and procedural techniques to absorb. I think my favorite experience thus far is taking the next step in my medical career and starting to make the transition from resident to fellow to attending which means taking in further patient care responsibilities and autonomy.
AS: Now that you are approaching completion of fellowship what is some advice you have for residents applying for fellowship?
HY: Try not to stress and enjoy the journey! Go to as many interviews as you can afford (time and money wise) so you can really see what all the programs have to offer, and make the best decision you can. You’ll meet many great people along way including other applicants like yourself. Pain medicine is a small field and you’re guaranteed to run into everyone again, who knows, you may even one day apply for a faculty position at an institution where you interview.
Rehabilitation Research— My MSSCE Experience
By Shelly Guhar
MSSCE Members (from left) Jerald Gomes, Shelly Gulhar, Christen Samaan, and Dr. Robert S. Mayer
PM&R. Truth be told, I did not understand the significance of these three letters until I stepped foot at Johns Hopkins Hospital for my two month Medical Student Summer Clinical Externship (MSSCE). I initially applied for the externship because my friend after finishing her first year of Physical Medicine and Rehabilitation (PM&R) residency described PM&R as “the coolest field ever”. She had piqued my curiosity with her enthusiasm for her profession and I was determined to experience PM&R for myself.
Each week during my externship I experienced something entirely new as I learned PM&R encompasses numerous subspecialty clinics including Brain Injury, Spinal Cord Injury, Pain, and Pediatrics just to name a few. I found out the hospital even had a clinic just for patients who were a fall risk! While during residency each resident physician spends a month or more on each unit, I unfortunately only had a week to experience as much as I could in each area of PM&R.
My first day during general outpatient clinic exposed me to the world of intrathecal Baclofen pumps and ultrasound guided injections for the treatment of spasticity. It was a short time later when unique medications common to the field such as Gabapentin became second nature to me. I also learned how to do a complete American Spinal Injury Association (ASIA) exam while on the inpatient spinal cord injury unit. In the pediatric clinic, I saw how paraplegics used electrical stimulation, aquatic therapy, and/or a robotic exoskeleton to help them regain their mobility.
One of the most surprising facts I learned about this field was the use of a multi-disciplinary approach to patient care. A patient’s care routinely includes the coordination of care between a physiatrist (PM&R physician), a physical therapist, occupational therapist, speech therapist, a prosthetist/orthotist and more! In a meeting, the entire team would discuss not only the patient and their current status but also their individual lifestyle and goals to come up with a unique rehabilitation plan that worked just for them. This is very unique to PM&R and something I really appreciated given that a common complaint from patients is the diminished time spent with medical providers in the current health care climate.