Read part one here: https://www.thepivotingphysician.com/post/the-pivot-within-a-personal-account-of-life-coaching-s-influence-on-my-journey-part-one
Read part two here: https://www.thepivotingphysician.com/post/the-pivot-within-a-personal-account-of-life-coaching-s-influence-on-my-journey-part-2
The path to becoming an attending physician is notoriously long and arduous, even torturous, depending on who you ask with their personal lived experience. It starts out choosing a pre-med degree, then the 4-year medical school. At my med school back in the Manila, Philippines, we had 3 years of classroom and laboratory instruction. Then 1 year of hospital clerkship.
I am particularly nostalgic for this period, as we recently celebrated our 25th silver homecoming at UST, University of Santo Tomas Faculty of Medicine and Surgery.
We retold our stories, looked back in amazement of how we ever survived those years. One particular detail that made for a core memory for all of us was called "edema rounds". Where the senior residents would gather us for rounds during the overnight calls, in the middle of the night - 11PM, 12AM and it would last for 2 or 3 hours. We wouldn't particularly wake the patients but we'd be outside the room, discussing the cases as the 4th year students are grilled with questions. Then, you'd still have to prepare for morning rounds with the attending physician/consultant at 7 or 8 am.
After clerkship, you graduate and get to attach the MD after your name.
In the Philippines, everyone does an internship year. Then on to their chosen residency. I completed my internship and did not do a residency in the Philippines. At the time, I have met my husband to be, Mike, and we had planned to do training in the US. So I moonlighted as a general practitioner for a while.
In the US, after medical school, you participate in The Match. One would apply to residency programs and hopes to get matched to their top choices.
Countless of applicants, both US grads and foreign grads (mostly foreign grads) do not match. Then they would have to wait another year to go through the process again.
Before you qualify to apply for the match though, you have to pass USMLE Steps 1, 2 and Clinical Skills. For a foreign medical graduate, this is a grueling and costly endeavor in itself. Twenty years ago it was about $600 or so to take each step and $1000+ for Clinical Skills.
Once you pass, you then apply to residency programs. The more residencies you applied to, the better chances you had to get an interview. Then once you get invited you'll then have to travel for the interviews. These days I've heard that you interview through Zoom.
So, my road map was and most everyone's:
Finish Pre-med.
Pass the NMAT or MCAT.
Finish 4 years of med-school.
Finish internship year.
Pass USMLE Steps 1, 2 and Clinical skills.
Apply for the Match.
If you're lucky, get in residency program of your choice.
Finish residency.
Pass the Medical Boards
Become an attending physician
And so I did.
It was not straight forward, it took me a while, but I did it. All in all, it took 20 years after I graduated high school to finish the 10 steps. In between there, I had a few years of being a general practitioner before I got married, moved to the US, became a stay at home wife while my husband finished his residency. I couldn't say housewife cos my husband still did most of the cooking and chores.
And then I became a mom.
I guess what drove me in the pursuit of my career was getting to the next level. That pattern of thinking of "I'll be happy when..." Or "it will get better when..." With every step, I looked forward to the end, so I can get to the next level. Not really enjoying the process. And this desire to get there fueled me to keep going. Chasing the relief of finishing a level, and anticipating and dreading the next step. And I kept telling myself it will get better, once I become an attending. Just get to that finish line.
The so-called Arrival Fallacy.
Arrival fallacy was coined by psychologist, Dr. Tal Ben Shahar, the false assumption that you'll find enduring happiness once you get there, but find that it's not what it promised to be. The feeling of achievement is fleeting. Eventually the hormones adjust and you're back to baseline.
Once you become an attending, things finally settle, there is no finish line to chase.
I was in primary care for 15 years. As anyone in primary care would tell you, it is a hard job. We had a private practice for a while there. As if patient care was not hard enough, it also came with unique challenges of dwindling reimbursements, expensive and hard to navigate EMR, keeping it afloat so you can pay employees. Some months you don't get paid as the physician just so you can pay the bills. That was not fun.
Gave that up after 6-7 years. Became an employed physician. Pretty soon the satisfaction of helping and treating patients gets overshadowed by all the other crap that goes along with it. I faced the hard reality of the current state of medicine and of the health system as a whole in the US. Burnout is real. It was not as simple as looking for another job, or moving to a different location. I knew it would have been more of the same. Yet, I could no longer imagine myself doing this for 10 or 15 more years.
Do you believe that if you pray to God for guidance he will provide you with an answer? Or if you're not religious -- send the universe questions that they will provide you with the answer?
In my most burned out moment, I kid you not - the universe provided me with so many answers.
Part 4 coming soon!