I’m 31 and I finally have a real job!

Its been a very long time since I have blogged, and for that I apologize.  Thanks to the shaming by some avid readers and mentees, I’m back at it. A lot has transpired since my last post of graduating from residency. I am finally at the point that every medical student dreams about when they first start this arduous journey; I have a signed contract for my first job as an attending. I’m happy to say that I will be joining the pediatric orthopaedic surgery division at the University of Mississippi. If you had told me at the beginning of medical school, residency, or fellowship that I would be living anywhere more south than Virginia I would have said you were crazy; but here I am, and trust me, this period of life feels good.

 

So to somewhat pickup where I left off, I am currently a pediatric orthopaedic surgery fellow at the children’s hospital here in San Diego. This program is hands down one of the best training programs in the country. In hindsight I am still very happy that I matched here, the reasons why being:

 

  • Autonomy- When it comes to doing trauma cases, you are an attending, so you book your own cases that come in when you are on call and you do them. The autonomy also includes clinic where you run your own clinic seeing the many post-ops that get scheduled after you have a couple of busy calls. The opportunity to have this autonomy while still have the back-up of your attendings who can always be called in is so important to building the confidence needed to being a good surgeon.
  • Teaching- Many of the attendings here are truly amazing teachers, and it is the breadth of teaching that really has amazed me. Dr. Mubarak will mention principles he learned from Dr. Blount himself as we talk about various deformity cases, then Dr. Newton will discuss a patient who is getting spinal tethering, a procedure only done at a handful of centers in the country. In addition to having our own clinics, we are also in clinic with our attendings, which is an invaluable experience. So much of pediatric orthopaedics is decided in clinic, so being able to see how these attendings work-up and schedule or choose not to schedule cases has been golden. If I had to give one piece of advice to a resident considering various peds ortho fellowships, I would say that clinic is very very important and that you should go to a program that gives you the opportunity to do it and learn from the masters.
  • Research- This place is a true factory when it comes to research. They have a legion of research assistants and statisticians and graphic designers who make drafting a manuscript truly stress free. Seeing their model has shown me how successful a program can be (even more so than some pure University programs) when you have people doing much of the research grunt work for you. I think it certainly helps that they are in such a desirable city like San Diego, so its not hard to recruit people, but even in Mississippi (I’m just learning how to spell it J ) the opportunity to build a machine is there as long as you have the right people.
  • Volume- If you have ever taken a night of call as an orthopaedic resident, then you know that the peds call volume is always much higher in the summer than in the other seasons. Monkey bars, trampolines, etc keep us in business. Well in San Diego, its always summer so that equates to an unbelievable amount of trauma volume in addition to the large elective volume that they have. This volume equates to me doing and/or assisting in many of the cases I will see throughout my career as an attending.
  • Location- In addition it doesn’t hurt that when I’m not in the hospital or when I want to find a quiet place to write a paper or read a book chapter, I have miles of beach front desk space to choose from 

 

So with all of that goodness do I have any regrets? Yes I do. I think I truly underestimated how hard it would be to spend this amazing year of fellowship 2,300 miles away from my wife and kids back on the east coast. My initial thoughts were that I’ve already been married for 8+ years so my marriage is fortified enough to withstand the distance. I initially thought that I barely spent a huge amount of time with the kids as a resident, many times getting home after they already went to sleep, so this 1 year would just be a continuation of that. I initially thought that the environment of 75 degree weather every day and after work beach expeditions would make any associated stress of the distance melt away. I was wrong on all counts. The truth is that long distance marriages suck no matter how long you have been married. My wife and I have done our best to make it work, spending many thousands of dollars buying plane tickets to make a trip to see each other at least every 2 weeks since the fellowship year started but even that is sometimes not enough. And my kids who I see even less (its much more expensive to fly all 3 of them out then just the wife) initially seemed to be tolerating the distance well, but recently have shown signs of sadness even in school, which is affecting some of their school performance. This improved somewhat after I switched to an iPhone and made sure the kids always had an iPad nearby so they could FaceTime me whenever they needed to, but nothing is as effective as daddy being there in the flesh. Then there is the spiritual component; Satan knows which sins I’m more susceptible to and so do I, and as a man, being away from your wife for days on end, without any ability to relieve the stress that undoubtedly rises in the busy life as a surgeon is not good. Personally, I try to be extremely proactive with this issue by basically not ever even getting close to being in a situation where I would compromise everything God has allowed me to build in my family. What that equates to is that besides my co-fellows I haven’t attempted to make any friends, especially of the opposite sex. At times that can make things quite isolating and lonely especially when my co-fellows are out of town or on call or with their own families.

 

So, in hindsight would I recommend a resident who is considering multiple fellowships to choose a fellowship that would put him or her into a long distance marriage or parenthood? No. I do not think it is healthy. The downsides of being so far away have been buffered by the amazing training and surgical experience I have obtained here, but if you are not man or woman of deep resolve and temperance, the year apart has the potential to destroy you also. I am just truly counting down the days until I can be a full time dad and husband again.

 

Now how in the world did I decide to sign a contract in Mississippi? I have no family there and not even close family friends which is the primary reason many end up choosing their first attending job. Choosing your first job is a complicated process and I would encourage every resident or fellow going through this process to seek the wise counsel of many before signing anything. I interviewed at children’s hospitals all over the country including Orlando, Detroit, Long Island, California, and Maryland. After evaluating all of the options and seeking the advice of numerous mentors, a couple of key points rang true for me:

  1. Where ever you choose, make sure your spouse is happy with the choice. Or in a more man centric phrase, “Happy wife, happy life”. Even if you have the most amazing job in the world with amazing partners and it pays a crap ton of money, if your spouse is unhappy with the location, your happiness in those other arenas will not last.
  2. Academic pedigree is important, but operative experience is more important. Especially in pediatric orthopaedics, this is a push to box new surgeons into subspecialities, such as the deformity guy, or the cerebral palsy person, or the sports person, etc. Especially when it comes to spine, which is a coveted and protected subspecialty at many hospitals, if you even hint that you are interested in spine, many won’t hire you. For me, I actually have very broad interests, which include both spine and hip. To be honest in the future, I do not know which subspecialty within peds ortho I will be most known for, but I wanted that freedom to pursue ALL of my clinical interests without being limited by others in my division.
  3. I did not come from money, and my wife especially did not come from money. We hope to really change the narrative of our future generations and the only way to do that is to build wealth. Being an orthopaedic surgeon does help in that your salary often puts you in the top 5% in the U.S., but salary alone does not equate to a long-term ability to build wealth. It’s not just what you bring home, it’s how much of what you bring home that you save that helps to build wealth. I was amazed, as I interviewed at various programs across the country for my first job just how many places were in desirable locations but had cost of livings that were astronomical, especially for the lower salary that many of them offered. In the end, I realized that the best places to build wealth from cost of living or salary ratio standpoint were programs in the south, like parts of Florida, Texas, Mississippi, Tennessee, etc.
  4. You must like and trust your partners. That is something hard to figure out in that first job interview. Some people have a knack for figuring people out… I think I have that knack, but also I ask a lot of questions… a lot of questions. These questions are not just directed to partners in the group, but also my mentors who tend to know other folks in this small peds ortho world. Use these mentors to verify whether your future partners will be supportive of you, before you sign the contract.
  5. Work-Life Balance? When I interviewed for fellowship at TSRH, Dr. Herring who helped to build that program from the ground up told me an interesting anecdotal story about how he purposefully lived within biking distance of the hospital so that he could make sure that he was close enough to have dinner with his kids and still run to the hospital to do cases if needed. I took this to heart and decided that wherever I chose to work, I would make sure that the choice of location of the hospital and where we decided to live made the commute so short that I could be home for everything important in my kid’s lives. As amazing as many job opportunities were, many were set up in a way that would have made that work-life balance impossible with me traveling to multiple satellite hospitals, stuck in traffic here and there, etc. You can either hope that the work-life balance will somehow materialize once you are well established in practice, or you can be proactive from the beginning and try to build your entire life around it. I aim to try the later.

 

I am excited about the future. I am excited about finally being close to hanging up my own shingle and starting my practice. It is my goal to continue to blog and chronicle my journey to becoming an attending but I am unsure of what form the blog will take after that. What will I speak about? I can’t talk about individual cases I do at the hospital. How about you all leave comments about what you would like to hear from my when I become an attending. I don’t know how this all will work, but I hope you will continue reading along with me as I continue this journey.

 

8 Responses to I’m 31 and I finally have a real job!

  1. jezik says:

    i’ve been reading your blog approximately 5+ yrs
    you always inspired me, thanks. i’m so excited to read all these news.
    God bless you!

  2. Aunty Ricky says:

    I am so proud of you and all you have accomplished. What i would lime to read about, would be your experiences about living in Mississippi. How your interpersonal relationships go in Mississippi. Some of your cases not specifics but General things that you were doing or interesting cases that you have taken on even if you change the names those types of things. But I’m sure that whatever you right I will stay tuned.

  3. Lindsay says:

    I’m interested to hear about the original idea of the blog “missionary doc in the making”, or is that not the goal anymore?

    • DoctaJay says:

      That is a very valid question Lindsay and certainly one worth writing about. Thank you for the suggestion.

  4. Kenel says:

    I live in Florida and would have loved to have you, Sir, as an attending here! As you know, doctajay, I’ve been reading your blog for years. We briefly communicated just when life was getting super busy for both of us (student with wife and children). I’m so proud of you and wife and glad. You made so many valid points that, even though I’m not pursuing medicine, it’s still valid for a software engineer in the making.

    Interestingly, I wrote about a similar sentiment just before the New Year:

    https://poeticlust.com/2016/12/17/the-writing-on-the-wall/

    Thank you for being an inspiration to many! Good luck on your new job!

  5. Tolu says:

    DoctaJay, congratulations on all levels. I have been reading your blog since the MCAT days and it’s such a joy to watch how far God has brought you. I am interested in reading about how you are able to balance work and family, the role your faith plays in the everyday work life, how the family is adjusting to life in the South and any futuristic ideas you have for interactions between medicine and public Health.

    Again, congratulations. I know the future is brighter than ever. Love to the wife and the kids.

  6. Brian says:

    Congratulations DoctaJay! Through the years I’ve glanced at your posts from time to time and am inspired by them. I too have the dream of being able to do missions work as an orthopod. Good luck to you and please continue to update your posts to inspire us all. God Bless!

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