Medical Students and Residents – Transitioning to Practice

Posted on July 2, 2008
Filed Under Medical Students, Medical (MD, DO)

American Medical Association Alliance

Reprinted with Permission

Any transition, be it from college to the work world, or the common transitioning between jobs, can be difficult. But most transitions happen fairly quickly, in a matter of a couple months, compared to that of the medical transition. Transitioning in the medical profession is a way of life, whether it be from student to internship, internship to residency, or residency into a fellowship, specialty or private practice. The family of medicine is always there to support their physicians in training and make the transitions as smooth as possible.

Planning—The Key to Success

The first step in any transition is planning. How much time depends on each person and his or her priorities. For example, for Gary and Ashlie Schooler, physician and spouse started planning at different times. Gary Schooler, a fourth-year medical student at the University of Oklahoma, began planning on the first day of medical school. “I knew doing my best throughout my pre-clinical and clinical years would afford me the best opportunity to be successful in gaining access to the specialty that was best fit for me,” he said. But for his wife Ashlie, planning began in his second year of medical school. “This was the time to start budgeting…so we could afford for me to travel to most of the cities [we were considering for his new job and our relocation] with him,” said Ashlie. “I also saved my vacation through the year at my job to allow me to be gone. With this plan we were able to visit neat places together.”

For others, the planning process was approached in steps. For Dr. William and Gretchen Dupps, the first step was related to the program or job that was the best match for the physician. The second step was researching the areas that were being considered, including the school systems and culture of the region. “After we painstakingly went through lots of research and visits, we would make a list of pros and cons,” said Gretchen, whose husband Dr. William Dupps is two years out of fellowship. “Ultimately the most heavily weighted part of that list would be the job opportunity.”

With this transition process being one of the most challenging decisions of a physician’s life, research is very important. No one knows better about this transition than those who have gone through it. “I asked many questions of the residents who just recently were in my shoes,” said Adam Ostendorf, a fourth-year medical student at the University of Iowa starting his transition to a residency in pediatric neurology in St. Louis. “In addition, certain staff physicians have been extremely generous with advice regarding both transition to residency and the transition to a new city.”

And while some physicians are very open to the idea of moving to a different city, others want to stay close to their roots. “Getting back ‘home’ is most important to us,” said Darla McVay, spouse of Dr. Bryan McVay, a surgical resident in Pennsylvania.

Matchmaking

The “match” process can be stressful for the student and his or her family.

For some, the result can create an easier transition than for others. For the Hogrefe family, their transition takes them no farther than into a new home. Christopher Hogrefe, a fourth-year medical student at the University of Iowa, will be working in a residency in the same city he went to school in, and he will start working with his spouse, Amy Hogrefe, who is a nurse at the University of Iowa Hospitals and Clinics. “However, we laugh frequently because of all of our life changes that are occuring this spring and summer,” said Christopher. “To briefly recap, we [experienced] Match Day, bought a house, will graduate from our respective graduate programs at the University of Iowa, I am starting a new job and Amy is having a baby in July!”

The matching process can take longer for some than others. Gary Schooler was always under the impression after talking with other specialists that when the best specialty for him presented itself, he would just know it was meant to be right away, like a light bulb coming on. But his process was a drawn-out system of weighing likes and dislikes before coming to his conclusion.

Sometimes the conclusion isn’t thought of in great depth because the outcome is already assumed, as in the case of Brent Owen, a fourth-year medical student at the University of Iowa starting his residency at the Via Christi Family Medicine Residency in Kansas. “Originally we planned on [a] residency closer to home but really enjoyed the Via Christi program when we interviewed.” And while a lot of planning can be put into the transition, it can still be overwhelming. According to Adam Ostendorf, “Our lives are about to change in almost every aspect.”

Transitions happen to many people across the country on a daily basis, but most people only make major transitions couple times in their lives. The profession of medicine can make the lives of physicians and their families seem like a constant state of flux. “There are so many transitions throughout training that I felt we were in transition for our entire course of training,” said Gretchen Dupps. “I think we are just now feeling like we are getting settled. This is the first time in our 15 years of marriage that we have been in a location for an [extended] amount of time.”

Along with the continuous state of transition that is unique to the medical field, there are many other factors that only seem to affect those in medicine. “There is certainly nothing like ‘the match’ in the regular working world,” said Adam Ostendorf. “What a stressful process! Then it is complicated by such a short amount of time to tie up loose ends in medical school and then move to your new home.”

Christopher Hogrefe points to another challenge, “Try getting your first job at 26!” Dr. Edward Hill, faculty at the North Mississippi Medical Center and former AMA President, concurs. “Perhaps there is some delay in the development of social skills outside of medicine as well as a lack of opportunity for a balanced lifestyle since being immersed in focused medical studies for seven to 12 years post-college. The physician completing training has non-medical college classmates that have been in the real world already for those seven to 12 years.”

A Life-Long Family Commitment

One other aspect of medical life is the need to continue to learn. Medical advancements are made every day, and physicians are expected to stay up-to-date on the latest and greatest ways of helping patients. “I believe the biggest difference [between medical student graduates and college graduates] is that after medical school a doctor’s education is just really starting to become fine-tuned toward their future career,” said Gary Schooler.

The transition not only affects the future career of the physician, but also that of their spouse in most cases. With moves being made to different cities and states, spouses often find themselves having to leave careers, family and friends behind. “After completion of my intern year, we will be moving to a new area of the country to begin my [residency] in radiology,” said Gary Schooler. “My wife will have to quit her current job and find a new one in our new location.”

Some families with children find this transition period the perfect opportunity to spend more time with them. With one parent being obligated so much outside of the home, the spouse decides to make sure that the children continue to get all the attention they are accustomed to, as is the case with Hilah Owen, wife of Brent Owen. “We are planning on Hilah staying home to take care of our son and future children since I plan on being busy, especially for my first year of residency,” said Brent. Still others find a way to continue their careers while always remembering to support their physician spouse. “Fortunately Amy will be able to keep her current job, while making a few adjustments,” said Adam Ostendorf. “It is certainly challenging to have to help me out so much while having her own career and I respect her immensely for it.”

Children can make the life changes even more difficult. Moving away from friends and family that can help with childcare, and taking children away from friends they have made can complicate matters greatly. “My children’s education, and our support system will be determined, in large part, by the nature of the community in which we find employment,” said Dr. Bryan McVay. Meeting fellow medical families with children is what helped Gretchen Dupps get through the difficult residency years. “One of my best friends from residency became a ‘co-parent’ with me,” she said. “She and I would trade off taking care of each other’s children and spent many afternoons and evenings together letting the kids play and enjoying some adult conversation.”

Support System

Friendship can help overcome the difficult times, but it is most important that all family members appreciate each other for their continued support. “My husband and I work as a team, and he has done an excellent job of giving me credit for all I do and for acknowledging the sacrifices we have made as a family throughout his training,” said Darla McVay. And struggling through these complicated times together can make the bond that much closer if it is handled correctly. “Amy and I have become intimately aware of the importance of confiding in one another,” said Christopher Hogrefe. “Such an approach aided us in gaining perspective and understanding how each of us independently views a situation, which is not always identical.”

The process of moving from one life stage to another can draw extended family closer. “We have been fortunate to live within 10 miles of both our parents while attending medical school,” said Brent Owen. “It has been nice to have them so close for support, baby-sitting and advice. The transition of us moving has been equally hard on them as [it has] for us.”

Dr. Hill repeats a quote he shares with the students he advises, “If you fail to plan, you are planning to fail.” He also instructs them to include the family completely in the planning if the transition is to be successful, stressing that a lot of support is vital. Support can come from many places. Young physicians and spouses should not fear asking for help and guidance.

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Comments

8 Responses to “Medical Students and Residents – Transitioning to Practice”

  1. free spririt on July 3rd, 2008 8:29 pm

    I am lucky, because I am not going to have any kids so my time is my own. Change is welcome.

  2. gooddoc on July 4th, 2008 12:26 pm

    i think you missed the point.

  3. Anonymous on July 4th, 2008 8:49 pm

    yeah, by a mile, and sometimes not planning on having kids doesn’t mean that you won’t have any kids

  4. silverspoon on July 5th, 2008 2:34 pm

    I am not having kids, period. And I didn’t miss the point. People are trying to always do all and be all.

  5. anonymous on July 9th, 2008 6:34 am

    a little bit one sided. this was pretty much all men with supportive wives. what of the woman physician with a career husband?

  6. anonymous on July 10th, 2008 8:56 am

    i agree. where were the women with supportive husbands? where were the two-physician families? do these families exist?

  7. Betty on July 11th, 2008 4:15 pm

    I understand the point of the article is about ‘planning ahead’, but it is only comprised of examples of women making accommodations to their husband-physicians. Common today is a 50-50 gender split in medical school classes and there are many student-student & physician-physician couples. Unfortunately, the above examples fail to acknowledge the significant role of women in medicine.

  8. Outside the box on August 15th, 2008 6:45 pm

    What about the families with a dog? Or a cat? What will my goldfish think?

    This is less about the gender/class/career make-up of a marriage or family, than it is a particular view of how the changes in life can be handled.

    Planning, care, concern, forgiveness, and flexibility all make for a two-way, healthy lifestyle. Look for the answer between the lines, somewhere outside the box. Interpolation and extrapolation.

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