Docs Who Cut Back #20: Dr. Academic To Community

Dr. Academic To Community (ATC) is an emergency physician who was on an express track to an academic career when she and her husband started a family. Her goals evolved and she recalibrated her life accordingly.

My fascinating interview with Dr. ATC proceeded in a non-linear fashion. A central theme was the struggle to balance career aspirations and intellectual passion with family commitments - reconciling heart and mind.

Any pearls of wisdom contained below are courtesy of Dr. ATC. Any shortcomings in conveying the richness and depth of the conversation we shared are mine alone.

1. What is your specialty, and how many years of residency/fellowship did you complete?

I am an emergency medicine physician who completed a 3 year residency followed by a 3 year administrative and research fellowship at the academic institution where I had trained.

I had my first daughter during the last year of my fellowship. I began to cut back during my first academic year as faculty after fellowship.

I then left my academic position to work 2 day shifts a week at a community hospital nearby, and I have worked there ever since.

2. What did your parents do for their livelihood?

My mother worked as a teacher. In a striking parallel to my own life, she stepped down from teaching when she started a family. Once my siblings and I grew older, she resumed her education and studied psychology, ultimately becoming a therapist.

My father owns a small electronics business.

I would characterize my upbringing as financially insecure. We were raised in an affluent area of Southern California where we had less income relative to our neighbors. In spite of that fact, my parents were always wise in their spending.

My siblings and I didn't own lots of stuff but didn't feel we needed it. We had healthy food on the table and felt loved and supported. Compared to classmates with all the latest material possessions but absentee parents, we felt wealthy in ways they were not.

This affected my blueprint in two ways. On the negative side, I've never been great at making money because it was never a priority growing up, so I suppose I could have earned a better income if I'd made it a greater priority. On the positive side, since I never felt like money was that important, I didn't miss it as much.

3. What motivated you to cut back?

At the time I cut back I was a full-time attending with a faculty appointment and a newborn at home.

I spent my days teaching residents, conducting research, working clinical shifts overseeing residents and medical students in the ED. I was also moonlighting one shift a week at a local community hospital.

At the time I had my daughter, I had no idea just how much I would want to be present in her life in a way that made sense at an intuitive level.

Every couple of months after becoming a mother, I would reassess how to reduce my commitment to medicine so I could increase my time at home with my daughter until it felt right.

First to go was my moonlighting gig.

I still had full-time responsibilities to my academic institution. I was in the midst of a large research project, with multiple medical students working under me.

I reached out to my faculty mentor and the head of my department to see how I might pare back anything I didn't absolutely need to do so I could spend more time with my infant at home.

We kept adjusting my schedule over the course of a year. I recall expending great effort letting go of any responsibilities that were not crucial. I cut my clinical time to 0.6 FTE. I continued my research. I reduced my teaching responsibilities.

I loved caring for patients, I loved academics, I loved conducting my research, and I loved teaching.

Yet I had no idea how I could be with my daughter in the way I wanted to be with her, and at the same time fulfill the academic responsibilities I'd cultivated over the years.

I had a grant for my research, multiple physician collaborators and medical students as research assistants. I had a number of people depending on me, I had papers to write up, I had a mentor who had invested deeply in ensuring my academic career was on track to succeed.

Somehow I had thought I would give birth, let other people take care of her, and keep doing all the things I was used to doing, and it was going to be okay with me.

I thought I was going to do it all, but I instead felt this unanticipated huge calling to be home and present with her. I spent the better part of a year trying to adjust my schedule so my time at home felt adequate.

I cried.

I questioned myself.

I was all over the place.

I couldn't intellectually understand it, but my heart was calling me to be home more with my daughter. It seemed crazy to leave this position that I had wanted so badly, after the institution had created a position for me.

It made no sense - my career was just starting to gain momentum, I'd been appointed Assistant Professor, all these people had supported me.

Yet if I stayed I felt I was selling out where my heart wanted me to be.

I completed my two research projects and published the results. It was important to honor my research subjects and my colleagues. I knew I couldn’t step down until I finished what I had started.

I had some really hard conversations with my department chair and my mentor. Both were supportive, with my mentor continually meeting with me to figure out ways to make my job work.

I recall having the thought that if only my mentor would leave our department, then I would feel free to go - it was a reflection of how deeply he'd invested his time and credibility in helping me to succeed, and how indebted I felt to him for that support and our relationship.

I voiced this thought to him during one of our meetings, and he finally understood how conflicted I felt. To his credit he responded by saying that I needed to step down and he was going to help me do that.

I also felt indebted to my mentor's wife, herself an academic physician. He had invested significant time developing my career that he might instead have spent with her and their children. I was failing to live up to the potential they both saw in me. To my surprise, she responded by telling me I'd never regret my decision.

Intellectually it was hard to accept that I was stepping away from everything I'd worked toward.

Intuitively it made perfect sense.

I loved my institution. I loved teaching. I loved discussing cases. But when I commit to something I can offer no less than 100%. They kept trying to help me carve out a position that offered me less and less responsibility, but I did not feel good participating in this way. I did not feel okay sitting on our faculty and contributing less than everyone else was contributing.

I left my academic position for a community hospital, where I met with the director and explained my situation. We agreed I would work two shifts a week with no additional responsibilities.

I wanted to give 100% when I was working in the ED. When I left work I wanted to be 100% with my daughter.

When I was on the academic track there were always papers to be written, talks to give, always something hanging over my head that I could never set aside. Now when I am with my children I can be present without being distracted by 40 competing priorities.

As if to validate my decision, shortly after I decided to step down I discovered that I was pregnant with twins.

[CD: Sometimes the universe sends messages that are not subtle.]

4. What were the financial implications of cutting back?

When I decided to step down from full-time emergency medicine, we were living in home with a mortgage looming and twins on the way.

We made an explicit choice that love, time and presence were going to be our most valuable inputs in raising a family. Once we acknowledged this, it felt like less of an opportunity cost to lose income because income was not our metric for defining success.

My husband is both a musician and a graphic designer. In order for me to spend more time at home, we agreed that he'd reduce time spent on travel and music and spend more time on his graphic design business. We arrived at this decision as a unit, and there was a shared trade-off.

We did not downsize our home. Our original home was going to be our starter home when we were on plan A. Plan B simply meant we would stay put and make a smaller home work. We downsized the plan rather than the home.

When our twins were born, I took a leave until they were 10 month old. We maintained an emergency fund, but did need to tap into our savings over that time period. In the end we took a 4 year pause in making retirement and 529 plan contributions.

We're careful, but we have enough.

5. How did colleagues react to your decision?

On the whole they very supportive, and they did not openly criticize or judge me.

When my mentor realized the strength of my desire to be home, he changed course from trying to help me remain in a job that could no longer accommodate my needs to helping me depart the job gracefully for one that was a better fit.

At my new community position, I have never felt disrespected. More likely, I am regarded as an oddball. I have a fancy educational pedigree, and when colleagues find out about my unusual career choices, it opens a fascinating dialogue. Other docs who are struggling with how to carve out nontraditional paths that honor their values tend to seek me out.

Perhaps I'm less susceptible to external judgment because I struggled internally with my decision, thinking long and hard about how I would judge myself.

My internal criteria don't make rational sense to most people, and barely make sense to me, but I recognized what felt intuitively right.

Once I accepted that I needed to leave my academic position, I felt great freedom and quickly altered my trajectory.

As a result, when people ask me, "What were you thinking?" I don't grow defensive. To the contrary, I reply with affirmation: "I know, right!"

Since I'd already judged myself, and I am my harshest critic, I can understand and empathize with why others might be baffled by my choices.

I made the decision to leave my position at the end of the academic year. Shortly after announcing my decision I found out I was pregnant with twins. I think it made it easier for colleagues to understand me decision knowing I had a 1 year old at home and twins on the way.

By the time I started my position in the community I was only able to work for a couple of months before I was put on a medical leave due to issues with the twin pregnancy.

One of the partners in our group encouraged me to return once a week for a day shift after my leave. I gratefully accepted this offer and when I returned the group was willing to give me the same day shift each week so that I could set up reliable childcare.

After a few years I returned to working 2 shifts a week. Again the group generously allowed me to work the same two shifts a week which made it possible for me to create a consistent routine for our family. We have chosen an alternative path for educating our children which includes homeschooling and having a predictable schedule has been a huge factor in making this possible.

5b. Was your family supportive or critical?

My parents and siblings were totally supportive. They saw that I felt torn. My mother in particular understood that the way I wanted to be with the kids was not compatible with full-time work.

Thus far, my kids still enjoy being with me and prefer that I don’t leave to work. Since kids thrive on routine, they appreciate the predictable schedule I've been fortunate to work out with my workplace - not an easy feat to pull off in emergency medicine. It helps the kids to know when I'll be gone and when I'll be around. They are very grateful to be able to homeschool and realize that my working part time is what makes that possible.

6. What have been the main benefits of your decision to cut back?

I am able to be with my kids in a way that I deeply value. I feel present without distractions.

I didn't know I'd want this until it happened, but we have the flexibility to choose to do this thanks to my having cut back.

As much as I wanted to be at home with my kids, I also found myself incredibly challenged being at home alone with three small children. I knew I needed support and tools for improving the way I was communicating with them as toddlers.

There were many days that I wondered why I wasn’t leaving them with a “nice” nanny so I could be in the hospital giving orders to people that would actually listen to what I had to say! Despite these self-doubts and challenges I still felt at an intuitive level that being at home was exactly where I was supposed to be.

Luckily I found a co-op where I was able to get the support and education that I needed as a parent. From this experience I decided I wanted to be able to help other parents that were also in need of support. I completed a training program and began facilitating workshops as a parent educator.

Helping others and teaching have always been my calling. I'm grateful that once I left academic medicine I was able to do this outside of the hospital in workshops and group courses.

In a way, I channeled my academic energies into working with other parents. I realized that the same information and support that helps us to communicate more effectively with our children is translatable to all relationships and my work as a facilitator has grown to supporting educators, athletes, business executives, physicians and other groups of individuals interested in well-being and effective communication.

There's some truth to the notion that once I decided not to pursue the standard career track in medicine, I was better able to see possibilities outside of convention in other areas as well.

Being home has also enabled me to pursue an alternative educational path with our children. Prior to having children we bought a home in a neighborhood that was known for its excellent public schools. Little did we know that we would end up homeschooling!

There is solace in knowing that if things aren't working you can seek broader solutions like those I pursued in finding the best educational approach for my kids.

When we decided we wanted to educate our children in a nontraditional way, my career choice made me unafraid to experiment and try a different approach.

If you have different values and needs, it helps to experiment without judgment until you find something that works.

We all want to help others and be of service. Not feeling handcuffed to preconceptions of education or work opened me up to new ways of being more true to my values.

7. Main drawbacks?

Financially, I don't earn full-time salary.

Intellectually, I miss the academic workplace. I miss being on the leading edge of state of the art research. I miss being part of a medical community of thinkers collaborating on creative solutions.

8. If you are honest, how much of your identity resides in being a physician?

Being a physician is a facet of my identity I cherish. I am grateful for the trust my patients place in me, and for the opportunity to serve in a meaningful way. But it's one facet of many.

Depending on the day, I also identify as a math teacher for a group of kids who home school; volunteer at local aquarium; an educator and facilitator for individuals interested in effective communication; and a home schooling parent. Every day, I'm a mother.

Each identity makes me feel gratitude for the opportunity to serve in a new capacity.

Had my identity been 100% wrapped up in being a physician, I could not have made the unconventional choices that have helped me live my most authentic life.

9. If you had not gone into medicine, what alternate career might you have pursued?

I might have pursued psychology, likely teaching within an academic environment. I am passionate about optimizing mental health and well-being.

10. What activities have begun to fill your time since you cut back?

THE KIDS! Home schooling 3 kids takes work. I spend significant time educating myself on theory and practice, and using what I learn to work with others to foster well-being and effective communication.

11. If approaching retirement, what activities have you begun to prioritize outside of medicine so that you retire to something?

I am approaching retirement solely in the sense that time only travels in one direction.

I don't ever want to stop working. I want to produce and learn and be of service until I die.

I expect my productivity will just shift to things I'd do without respect to the paycheck.

I'll likely do more work in well-being and effective communication. I've organically been pursuing work I love, and I'll do that until the day I die because I'm passionate about it. So this part of my life will likely fill more of my time.

12. Did you front-load your working and savings, or did you adopt a reduced clinical load early in your career?

I worked a lot before we had kids, and had no intention to stop.

I wasn't particularly saving for the future because I assumed I'd be working full-time into the future. Hence I did not front-load savings.

I reduced my clinical work early on for the reasons elaborated above.

The advantage is I had the experience with my kids I felt deeply driven to have. I sincerely believe I could not have had it any other way and have been at peace with my choices.

As my kids get older, I have the rest of my life to do more medicine or scale up to full-time if I'm feeling so inspired.

If I were graduating residency today I would not have done anything differently. I had offers out of residency at community hospitals that were financially enticing compared to the lower pay of the academic research path.

I struggled to figure out what was going to make me happy in the long run. In realizing academics offered the right combination of teaching, learning and growth I opted to take a lower salary to pursue the more personally satisfying career path.

I stayed true to my values in my job choice and have no regrets.

My career in medicine has reinforced that as long as I remain honest and authentic about what I value, and choose accordingly, life will be good.

If there's a life change, I can always course correct.

I remember thinking after my daughter was born that my life had been rearranged in an instant in a way that I did not anticipate.

I don’t think we can know for sure how we will feel about having children until the day arrives.

Some of us may have planned to take a long maternity/paternity leave and realize we cannot wait to get back to work.

Some of us may have planned a short leave and wish we had longer.

I don’t believe there is one right way to do anything.

I think we learn and grow by trying to be honest with ourselves at each step of the way.

I think we are of the most service to those around us when we are doing what we truly love and feel called to do.

For some of us that means lots of time at work and less at home.

For some of us that means less time at work and more at home.

I think that the less that we judge each other's decisions and the more that we listen to each individual's experience the better able we are to work together to create solutions that work for everyone.

I am grateful to all of my colleagues that have listened over the years and helped me create a balance between work and home that I never would have dreamed possible.

Having children is only one of the many things that may lead to a major rearrangement of our priorities.

It never ceases to amaze me how once I let go of thinking that things have to look one certain way, I am able to realize that there are an infinite number of ways to solve any problem.

The great privilege of the physician blogger world is the opportunity to meet extraordinary people and engage in conversations that cut to the core of our individual values.

It is a risk for a female academic to admit to feeling conflicted about wanting to spend time with family over career - as someone married to a brilliant female physician I shudder every time I hear a "mommy track" comment made in a disparaging manner about a talented doctor who happened to be born with ovaries.

Dr. ATC was willing to make herself vulnerable by exposing her internal conflict for others to learn from. Among the pearls from her story:

• I would characterize Dr. ATC's career transition as an introduction to the power of ordering off the menu. When the available range of existing options won't fit your needs, you need to create your own ideal position. In Dr. ATC's case, when neither academic nor community positions suited her need to spend ample time home schooling her kids, she created a unique arrangement in the form of a two consistent day a week position in emergency medicine. Sometimes you have to build the unicorn job you seek.
• Ordering off the menu as a career strategy pays further dividends by allowing you to envision creative solutions in other facets of life. Dr. ATC applied her intellect and passion to helping other parents to communicate effectively and foster well-being.
  
• ATC views the future with the promise of abundance rather than the regret of missed opportunities. This seems congruent with the ordering off the menu mindset. Instead of asking, "Why would they let me?" you ask "Why can't I do it differently? Who better than me to trailblaze this new path?"
• A key aspect of Dr. ATC's abundance mindset is the ability to recognize that the availability of time varies over the natural history of family life. Just as her mother's second career as a therapist blossomed after she and her siblings grew more independent, Dr. ATC regards that coming stage as an opportunity to return to a deeper practice of medicine.
• Adaptation is an adult skill. Dr ATC found a field she loved and had developed momentum in pursuing her chosen career. Then she started a family, and new priorities emerged that caused her to alter her trajectory. It's healthy to make continual course corrections to ensure you are spending time in accordance with your values.
• Adaptation and the growth it brings can also lead to finding your tribe under new circumstances. Dr. ATC left a faculty position she valued for the intellectual and collaborative community it represented. She found a similarly intellectual and collaborative community in the group of dedicated parents and educators with whom she now teaches her children.
  

You can find prior interviews with other docs who cut back here.

Want to be interviewed? Email me at crispydocblog (at) gmail (dot) com.