Interested in humanitarian medicine? How to choose a specialty.

A Daunting Choice

The decision to select a specialty in medical school is one of the most exciting and intimidating moments in our careers. Many factors and external influences weigh in, even among students planning for more conventional career paths than us with global health ambitions. In the context of global medicine, won’t your specialty have different presentations of disease and treatments, as well as potential projects for research? Certainly, your case list as a plastic surgeon in the U.S. will look quite different than in a developing country. Some specialties have been involved in the public health realm for decades, like pediatrics and infectious disease, while others are recently emerging as population needs have been brought to light, like surgical oncology. So how do we commit to just one specialty?

How We Did It: The Path to Specialty Isn’t Always a Straight Line

As Josh and I entered medical school, we had many discussions about our big-picture goals and what specialty we should choose. We talked about the fields with big impact factors, thinking seriously about fields like obstetrics and infectious disease, as these areas seemed to have an obvious impact on large populations and seemed to be popular choices for others interested in humanitarian projects. Like many students in our class, we attended all of the interest groups for medical specialties, largely for the usual free lunch offered, and I genuinely could see myself doing a variety of things as 3rd year approached. Once into my clinical rotations, I mostly felt happy and immersed in whatever rotation I was on, with a few notable exceptions. I preferred the hospital to clinic settings, and preferred high acuity to chronic illnesses. I enjoyed working fast with high intensity.

Because I had amazing mentors in the field, I decided to pursue cardiac surgery. At the same time, my husband was strongly favoring neurosurgery; he talked often about how he worried that his specialty would not be useful in underserved areas. My perspective was that we should just choose the fields we were most passionate about, and make a way to provide the care where it didn’t already exist.

We had many conversations that seemed to go round and round about these topics. Nearly every car ride lasting longer than 15 minutes, this was the discussion. What should we become? Was that choice consistent with our hope to become humanitarian physicians?

Our 4th year, Josh did a sub-I month at a Cure Hospital in Uganda, working with the neurosurgery staff. This rotation helped solidify his confidence that there was plenty of potential for global neurosurgery projects.

We both matched into our dream program at Mayo in Rochester, MN. He in neurosurgery and me in general surgery with intentions to pursue cardiac. I went on a trip to Ukraine with an amazing organization called Novick Cardiac Alliance, and I saw first hand a successful project to elevate care in an underserved country. They had similar projects all around the world, and I loved hearing the accounts from the nurses, intensivists, and surgeons, about their different locations. This experience was formative. It showed me first hand that sophisticated, cutting edge, and resource-intense surgical care was possible anywhere. However, the irony of this trip was that the actual cardiac surgery that was happening was less interesting to me than the bombing of the Ukrainian city of Donetsk 50 miles away, with possible traumatic injuries that needed tending, and the illusion of cardiac surgery as the perfect fit for me began to crack.

In the cath lab in Kharkiv, Ukraine.

Within the year, I decided, definitively, to switch to Trauma and Surgical Critical Care as my specialty. It’s a perfect fit for me for many reasons, and is certainly one of those fields that has relevance in any setting around the world. Trauma is emerging as a hot topic of discussion for global surgery funding and improvement projects, as it is the leading cause of death and disability among young people. I do admit that this is one of many aspects that attracted me.

One detail I would like to mention, but not dwell on (I’ll save the long story for another post), is that I personally experienced a traumatic injury in a motor vehicle accident in high school, which was extremely formative for me. It undoubtedly changes my perspective when caring for my patients. However, I resisted going into the field of trauma surgery for a long time even though it weighed heavily on my mind. Having pondered this for a while, I think that I was rebelling a little bit against the idea of letting this negative experience steer my life in such a way. Ultimately, I think that the influence of this incident will enrich my passion for the field and help me to connect with my patients on a personal level.

Another attractive aspect about my field is that because it encompasses trauma care, surgical critical care, acute care general surgery, and elective general surgery, I can be quite flexible in how I work. Not to mention where I work. I can vary my schedule, and every week can be a little bit different depending on if I’m in the ICU, covering Trauma, or doing elective cases. Personally, I think that any job that was the same schedule, 9-5, week in and week out, would lead to burn-out for me. I like variety.

Josh has never waivered from his decision of neurosurgery, and he has had the benefit of observing one of his former chief residents, Will Copeland, MD, move his family to Kenya to work at Tenwek Hospital. Dr. Copeland is doing outstanding work there and is a great role model for Josh.

Observations

As I was discussing this post with Josh, he quickly surmised, “I think I know someone in every surgical subspecialty doing humanitarian work.” We are lucky to be in a place where our colleagues and friends have these shared ambitions and have launched into humanitarian careers around the world.

I’ve also benefited from many connections in social media, particularly Twitter, where countless organizations representing the full variety of medical specialties are represented. Online journal clubs are becoming more common, as are twitter-hosted journal club discussions (@MayoGlobalSurgJC for one example). To see the many excellent accounts I follow on twitter, see my list under my profile at @IndieDocs1.

Summary

In the end, I chose the specialty that suited my personality and interests, as did Josh. The simplest way I can describe my decision is that I chose what sounded like the most fun to me, and I’m very happy and confident with the choice. I took into consideration personal as well as professional goals. There is no doubt that we will both have abundant opportunities to serve patients and elevate local surgical care if we remain dedicated to that cause. Therefore, the answer to the topic, “How to choose a specialty,” is both simple and complex. Pay attention to the little thoughts and reflexes in your mind as you encounter diseases and treatments in each field, and be honest with yourself about what truly interests you. Allow your past experiences to form the type of doctor you are going to be. Be open minded about the possibilities of providing advanced-level medical and surgical care in low and middle income countries. Seek mentors and role models, but don’t choose a specialty solely because you like or are encouraged by your mentor. Pick what you can do all day every day, and also what will allow you to have a sustainable lifestyle and work schedule.  Don’t be afraid to change directions as you obtain new experiences and perspective. If you choose a specialty in which you can work passionately and sustainably, you will undoubtedly have a significant impact as you serve your community.

What weighs into your decision for pursuing a specialty?

Do you have any additional insight or suggestions for young trainees?

Please comment below!

Two-resident-and-a-baby household: Logistics and finding balance

Excuse the chipped nail polish.
Yep.

June 30, I walked out of the OR around 8:30 p.m., finished my floor work, and turned off my pager, placing it into a pre-addressed manila envelope. I changed clothes and walked out of the hospital for the last time as a  General Surgery Resident at the Mayo Clinic in Rochester, Minnesota. It is surreal to have this challenge behind me; 6 all-consuming years of my life including my Surgical Critical Care Fellowship, not to mention medical school and the preceding marathon of hard work and stress. I started this website near the end of my residency and had planned to do a post on our crazy dual-residency routine (my husband Josh is a neurosurgery resident), but with board prep and trying to wrap up a million tasks on the to-do list, I never got around to it. Still, I think sharing what life was like these past few years might help someone else navigate their own rocky trail, so I thought I would share some of the more pragmatic aspects of how Josh and I managed our day-to-day routine. In the spirit of Indie Docs, I would like to emphasize that no two lives or routines look the same, and this is all about cultivating our best life and thriving where we have intentionally and stubbornly planted ourselves.

First, we needed quite a bit of help and intentionality to make having a family work. I researched possible childcare options before deciding to start a family; I could not even mentally commit to becoming a mother without having a workable plan. I honestly didn’t think it could work until I researched the au pair programs. I was surprised to realize that the program was affordable, particularly in comparison with the larger full-time daycares (with extended hours) in my city. Having someone live with us was essential since we were often both on-call. I planned to return to work after 6 weeks, and the au pair couldn’t start until the baby was 3 months, so I reached out to family members to help me and was so blessed that my aunts were able to move in with us for 6 weeks to fill in the gap. Looking back, I wish I had considered just slowing down and staying home; I didn’t even seriously look at the finances and just assumed I needed to get back to residency. This was a very hard time physically and emotionally and not something I ever advocate for families and babies, but I digress.

Finally home from work.

The au pair program limits work hours to 45 per week, so we needed daycare in addition to the au pair. My husband had a stroke of genius in finding our daycare. He searched for all the childcare licenses closest to us, and just started cold-calling them based on proximity. Less than a mile away, in our neighborhood, was a wonderful lady with decades of experience and an opening! Once we hit that 3 month mark, we had our au pair and day care established. For the next couple of years, the routine was essentially the same; I left home around 5:30 or 6, our au pair would keep the baby until 8:30, drop off at daycare until 3:30, then keep baby until we got home around 6:30 or 7. My husband and I did our best to stagger our call nights, but there were plenty of nights when the au pair knew she was also “on call” and we would wake her if we both got summoned to the hospital.

Next for my working-nursing-mom spinning-plate trick: I was hoping to breastfeed as much as possible, but I honestly expected to need to do a combination of formula and breastmilk. I even had a package of formula on hand when we got home from the hospital, just in case. I was lucky enough to have a great supply, and I managed to keep a schedule that allowed me to pump enough milk to create a surplus before going back from maternity leave and then more than enough to keep up with day to day demands for the next year. I’ll be candid here, I was freakin’ proud of myself for making all that milk and for having the discipline and determination to keep going through the year. I’m happy to share my specific schedule with anyone interested, but in general terms it took a lot of time, energy, and so so many calories. I ate more at this time of life than I could even have imagined before. I pumped while getting numbers, while dictating, answering pages, patient phone calls, reading…I may have also nodded off a time or two at 3 a.m. in the ED pump room. I also dealt with a few unsupportive colleagues and staff. One OR assistant told me not to tell him when I was going to pump because it was gross, to which I replied, “Well, considering you are alive, I’m assuming YOU were also breastfed around 50 years ago, so that’s a tad hypocritical.” He laughed and was very protective of my pump-time afterward. On the other hand, one of my attendings never ever wanted to hear about it and wouldn’t even give me 5 minutes between cases (she wanted me there for turnover) to hand-pump in the restroom (I attempted this out of pure desperation because I was in engorgement agony), and I got two bouts of mastitis on her service. Despite the challenges, it was worth it to have the bonding time with my baby and feel like I was providing for her even while we were separated so much by my work schedule.

As a money-saver, (and probably also as me wanting to go the extra-mommy-mile as over-compensation for working so much, ahem) we use cloth diapers. I had help with the laundry from my au pair, but honestly the effort expended on this routine was minimal. I would much rather do a load of laundry than rush out to the store to grab a pack of diapers. We used disposables for travel and at night. After getting used to the routine and realizing how much money you can save even using cloth diapers some of the time, it’s hard to believe that cloth diapers aren’t a more common part of life for most families.

Whenever we had a weekend off together, we were intentional about trying to spend time outdoors. We got into camping during the beautiful Minnesota summers, and we hiked as much as possible.

Camping on the bank of the Root River

I used either a woven wrap or a Beco baby-carrier for hikes. We also have a big Osprey baby carrier gifted to us by a neighbor for serious backpacking, which we’ve only used a couple of times, including for a music festival (Eaux Claires).It was pretty awesome for keeping the baby strapped in and comfy while we carted her around from stage to stage.

Eaux Claires music festival 2017

Admittedly, we didn’t get much time to ourselves for the first 18 months or so, as we were constantly trying to maximize our family time during golden weekends. Having an itty-bitty is stressful for many healthy relationships, and we are no exception. For 10 years together before our first child, Josh and I thrived on spending lots of time with just the two of us, and suddenly we had almost none. One revolutionary change we’ve made in the last 6 months is having date-nights, which has been wonderful for our relationship.

The days and nights over the last couple of years have gone by in a blur. I could not possibly be prouder of my little girl or of my husband. She is thriving with her routine, and she is incredibly loving and affectionate with us, our animals, and her many baby-dolls. Josh is in the thick of his Chief service time now, but I have opted for a research fellowship with a flexible schedule this year in anticipation of baby #2 arriving in September. I know that I will always cherish having this short, precious time to spend with my girls while they are tiny, and it will help me feel eager and ready to take on my first position as a trauma surgeon after Josh graduates next year.

Moving forward as physicians with humanitarian-focused careers, we will need to remember how to focus our time and energy on what truly matters to us. I’ve discovered some amazing resources to help focus our priorities by Jillian at Montana Money Adventures. Mrs. Montana has created some wonderful mentoring worksheets for focusing time and resources that I will be utilizing and sharing here at Indie Docs. Many thanks to Jillian for sharing her wisdom and for being open to allowing us to document how we are utilizing her worksheets.

Until then, I hope that catching a glimpse into our world can help someone realize that having a happy family is possible even with our career demands. In fact, you can be an extended-breastfeeding, cloth-diapering, baby-wearing, semi-crunchy-granola mom AND a surgeon! The key for me has been accepting our reality and feeling satisfied in my efforts (no guilt) and cherishing the precious time I was able to spend with my baby. Also, asking for plenty of help, especially in the realm of childcare, was key. In turn, my hope looking ahead is for a happy future of global surgery work, travel, and a happy family. For me, that’s what Indie Docs is all about.

 

Enjoy this hilarious, heartbreaking, and candid tribute to nursing moms…

The Reality Of A Working/Breastfeeding Mom Sucks

Work, travel, exercise wardrobe in one? The holy grail of trousers.

#GirlMed indulgence here. Thanks to Natalie Wall over on Twitter @nataliemwall, who gave out the tip that these “On the Fly” Lululemon pants could be worn to clinic, I have found the workhorse everything pant.

I was reluctant to drop the $100 on them but totally justified it by thinking they could also work throughout my maternity wardrobe needs.

It is actually and practically true that a 26 week pregnant resident can:

Top is Old Navy $6 active apparel that I’ve worn approximately seventy-billion times over the past 3 years, pregnant or not.

1. Bike to work in these pants (mostly downhill).

2. Put on a blouse and flats (I also paired with a nice black sweater, and a lab coat for procedures) and look professional while rounding on patients

I will never have Natalie’s style, but I try.

3. Do a HIIT workout in these pants after work (after this 26 hour day, I actually I just rode my bike home, ate cake, and went to bed).

4. Wash and then re-wear on any trip in any airport.

5. Wear multiple times per week if really not dirty/sweaty and changing into scrubs immediately upon arriving to work.

6. Wear home and immediately get down and play with toddler…no harried suit-stripping on home re-entry :).

So one pair of pants can work in virtually any setting of my life short of a cocktail party. I never have cocktail parties, so…Awesome. Money, time, and closet real-estate well spent. I’ll be living in these pants for the next 14 weeks for sure. I might even get them in olive-green!

Announcement: Humanitarian Travel Scholarships through Doximity

Many physicians reading this are familiar with Doximity, a professional social media site that publishes articles ranging from scientific papers to editorials. Most of us are also keenly aware that finding funding for humanitarian medical travel can be very difficult and time consuming.

I’m very happy to share that Doximity is now sponsoring travel scholarships for humanitarian projects. The process is a simple application, and currently 80% of projects are approved! To check out their website and apply, follow the link.

 

Happy Mother’s Day…Getting out of the “Mom Box”

I have to admit that I really feel like I have it all. I complain about my crazy and exhausting life sometimes, but I wouldn’t change it. I have the residency of my dreams and I’ve reached the end of my Chief year (Holla!!!), the man of my dreams (you’ll appreciate this more in a minute), and a beautiful and fascinating baby girl. I even have a borderline-magical beast of a dog that will get his own post one day, but suffice it to stay he’s my hero and definitely one of my besties.

There is a detail in here that is actually quite vexing to me, and it’s the mom part. We were married for 10 years before having a baby, and during that time, I was pretty hard core anti-motherhood. I read and related to articles examining the decision to never have kids. I was “not maternal.” I couldn’t talk to kids. I was impatient. I didn’t like clutter or messes. I was 100% career driven and proud of it. So what happened? Well, I slowly started to get to the point where I didn’t want to choose between a career and a family. Certain aspects of motherhood started to appeal to me, and for half a dozen little reasons that aren’t important, I decided I wanted a baby. I figured out that an au pair would be essential and also doable with our money and space. So I became a mother, fully expecting a tsunami of life-altering invasions of time and privacy that would leave me grouchy and struggling to maintain sanity. That’s what all the advice focused on, right? How to “survive” the first year. How your life as you know it gets destroyed by a baby and you deal with it for 18 years.

Well that’s not how it happened. From day 1 to now day 600-and-something, it’s been fairly awesome. Truly, I’ve loved it. I’ve given up lots of sleep, yep, and breastfed forever, pumped countless time between cases, felt the push and pull of work responsibilities and fatigue, but I’ve never felt like it wasn’t manageable or that it destroyed my life. It’s been fine.

How is this possible? Well, firstly I would say that I have no shame about asking for help raising this little angel. Yes it would have been more enjoyable to stay home more, I fully admit, but that’s not the path I chose or was meant for, so I enlisted the help of my two aunts when Eddy was an itty bitty (6 weeks to 3 months) and then an au pair plus day care as she got a little bigger.  She loves day care and our au pair, so even though her day from 6 a.m. to 7 p.m. routinely is with them, I don’t get stressed about that. Secondly, Josh and I have equal parenting responsibilities. I’ve observed that in many families, even where the woman works full-time, the mom is the “dominant parent,” responsible for much of the mental burden of planning and decision making among the family. Josh simply doesn’t have the reflex to push that stuff onto me, and for the most part I let him do things his way. Admittedly, Dad-style can be less polished (like when the baby’s clothes don’t match or fit and are out of season), but is reliably more efficient. I’ve actually adopted some of his techniques and been happier for it!

From the beginning, I have had a routine of bathing Eddy and safely co-sleeping (according to pediatric safe sleep guidelines), and so we spend all night together. This has helped me feel like I wasn’t missing her so much and I think it also strengthened our bond and made nursing much easier at night. I think another key has been that I learned a parenting style from my Mother-In-Law, who had a very late in life baby, that allowed for a full range and display of emotions from the little one without taking it personally or even reacting. I joined a gentle parenting group on facebook that reinforced these principles, and I think it saved my sanity and helped me maintain patience. I got into a discussion one time with a friend who was absolutely miserable trying to stay firm with their 1 year old over sleep training, and in that discussion I created a new mantra, which is “If snuggles solves the problem, there really is no problem.” I will fully admit, this philosophy is as much about my happiness as my child’s.

I’ve been thinking about parenting in the context of pursuing humanitarian work and the Indie Docs lifestyle quite a bit. Josh and I have talked about the best way to raise our kids and make sure their education doesn’t suffer. In the process the topic of being flexible has come up, as has different parenting cultures. Josh sent me this article the other day: Secrets Of A Maya Supermom: What Parenting Books Don’t Tell You, and it was a great article talking about how skewed our idea of parenting is in Western Society. I love the author’s imagery of how we have put parenting, motherhood, in particular, but this is relevant to the many stay-at-home Dads I know, in a box and expect one person to do it all. It’s not normal or necessary, and I think it generates a lot of anxiety and misery among parents. Of course, reading the article I felt validated in my parenting style (after being called “crunchy” a few times in various contexts) and in my skepticism of some parenting advice I was hearing over and over (like hard-core sleep training, we can have that discussion another day).

Perhaps more relevant to Indie Docs per se is the fact that we will demand a lot from our kids as we pursue this mission in life. They will need to understand that a huge portion of our time and money goes to help others. They will have to be flexible and adaptable to other cultures, and will likely sacrifice some aspects of the prototypical American kid existence from a social or sports context.

Now to inject some reality that life is not a fairy-tale. I got mastitis 3 times on a rotation where my attending would not let me pump. I was so tired one time that I came home and while holding Eddy to nurse her, I hallucinated that it was raining inside my kitchen. I’ve gone on a job interview just to have a night away in a hotel, and I felt FABULOUS after getting that night of undisturbed sleep. I’ve let the au pair feed Eddy her dinner while I hid in my room either power napping or vegging out for 20 minutes. Our marriage has undergone a tectonic-plate-shifting adjustment, and I had to delve into relationship podcasts and articles to try to undo some of the damage done by the paucity of quality time we had together. Going back to work when Eddy was 6 weeks old was one of the hardest things I’ve ever done in life, and her sleep habits only got worse over the next 6 months when she was waking up every 2 hours to nurse. But we coped and managed and continued to enjoy the moments and milestones along the way.

Fortunately, I did not experience postpartum depression, or have a colicky baby, or have any major medical concerns that would be much more challenging and beyond my control.

This is a huge topic that is both paramount to life as a physician parent and in related to upcoming big decisions about where and how to raise our kids. I hope to become more open minded in how I guide my little one through life, and most of all I hope I can maintain the inner peace that motherhood has brought to me. And to any reluctant trainees contemplating whether it’s worth it, I can offer my anecdote that having this child in my life is the most interesting, entertaining, and warm-fuzzy-feeling-inducing thing I’ve ever done. As The Ruth Bader Ginsburg has said, having a career and being a mother gives balance, and one helps you find respite from the other. I hope everybody finds their tricks and techniques that can make this huge responsibility wonderfully enjoyable.

Happy Mother’s Day to all moms out there making it work! 

 

Is Financial Independence the Key to a Global Medicine Career?

If I had to point to one single resource that has motivated and inspired me like no other these past few months, it must be the “FI” community, particularly the Choose FI podcast.

I am a complete newbie to this world. In fact, I got connected to “Physicians on FIRE” on facebook (through my Physician Moms Group), and I did not know that FIRE was an acronym for Financial-Independence-Retire-Early. So for anyone out there as clueless as me, FI stands for Financial Independence, and it’s propounded “Fye.”

At first encounter, this seems like a fairly narrow focus. I was peripherally aware of some nuts who wanted to retire by age 30 and did all sorts of weird financial acrobatics to accomplish this, but I did not consider any of that relevant to me. I finally listened to one of the Choose FI podcast as I was exploring options for accomplishing the Indie Docs lifestyle (although I did not have that term for it at the time). Josh and I kept discussing the best plan for funding our dream of being humanitarian physicians, and without charity funding it seemed that achieving financial independence was essentially mandatory. Otherwise, debt obligations alone would be prohibitive to traveling and working for little-to-no pay. While religiously affiliated programs and some fellowships exist that can fund 1-2 year projects or even longer missionary careers (topic for another post), we ultimately decided to leverage our income potential to control our own destiny. Hence, my portal into the Financial Independence world.

I quickly discovered that FI is so much more than extreme budgeting, saving, and investing. Mr. Money Mustache was for me, as for many people, the gateway to a whole new mindfulness toward how I should spend my attention and time in addition to money. He calls out many ridiculous notions of consumerism in a compelling and entertaining way, and at this point I’m practically inhaling 2-3 of his archived posts every day. On a very practical level, he convinced me to ride my bike regularly to work and for errands around town, and this has been a very enjoyable, economical, and healthy transition. His post “What do you mean ‘You Don’t Have a Bike’?!” is what first intrigued me–Click the hyperlink to judge for yourself!

Saturday grocery trip. Hauled a full load of groceries in the bike trailer with Eddy. Workout-check.

While riding my bike, I’ve listened to several more episodes of the ChooseFI podcasts, and discovered resources like Get Rich Slowly, Raptitude, Frugalwoods, Making Sense of Cents, and many other blogs. I explored the travel rewards section of the Choose FI website and listened to the Travel Rewards podcast episode. This topic also deserves an entire post in it’s own right. The obvious practical implications of finding a way to travel at a huge discount would be a total game-changer for humanitarian physicians. I realized that I had done a very mini-version of their travel hacking by opening the Chase Sapphire credit card years ago and using the miles for airline tickets and recently a sweet deal on a rental car, and subsequently opening two Delta cards between myself and my husband to qualify for bonus miles and free companion tickets. So in the past 6 years we have played this game 3 times, but not in a super-savvy way and totally unaware that there was a whole busy and geeked-out world of travel hacking teeming below the surface.

Yesterday, I listened to the Choose FI podcast episode 48, which featured Jeff from The Happy Philosopher, a radiologist who experienced severe burnout and found a path to professional fulfillment and happiness again as he pursued financial independence. The episode gets fairly deep into a discussion about burnout and it’s effect on all aspects of life, and practical approaches to emerge from this crisis. I myself have experience full-fledged burnout and will definitely devote a post to this topic, and I was again amazed at how relevant the FI discussion is to so many of life’s complex emotional problems.

On the most basic level, achieving FI will open up possibilities to spend our time and money on the projects we are most passionate about. One of the earliest steps in the path to FI is becoming debt-free, and this is a particularly large hurdle for many physicians. It seems that the college and med school tuition and student loan structure are practically designed to keep us working as many hours for as long as possible just to pay back this obligation. When we get past residency and find a “real job,” our work schedules are optimized for billing, and many physicians would find it impossible to spend a significant amount of time pursuing humanitarian projects; in fact, I personally know several wonderful physicians who devote over half their vacation time to short term projects. In addition to paying back the loans, we need to make up for a decade of lost time funding retirement accounts and other funds, such as kids’ college.

However, if you can imagine that suddenly you are financially independent, the game changes drastically. You can insist on a part time schedule, find a work-share situation with another physician, or simply walk away forever. Even if you have a full time physician job that you love, it frees up your financial obligations to make a huge impact on your passion projects rather than paying back the bank.

Josh and I have just started investigated new strategies to start our FI journey. I love the easy equation that comes up often on the Choose FI podcast that (Money Made) – (Expenses) = Your Gap, and the Gap is what you invest to achieve FI. Our income is relatively fixed as two residents, but I do supplement with teaching courses and plan to do Locums this year for some bigger boosts. The big category I’m fired up about now is minimizing expenses to maximize our Gap. I’ve started taking my lunch to work, riding my bike to work, really cut dining out. (I truly enjoy my PB&J, which is super charged with rich omega-3 supplemented peanut butter, rhubarb and strawberry jam, and gourmet whole grain bread).

Packed lunch for the playground, pretty identical to work lunch except more “snacks” for Eddy.

I bring my coffee to work every morning; I don’t have a coffee thermos that I can toss into my backpack, so I rigged one using a mason jar and a breast-milk insulated carrier from my diaper bag (see photo), and I have no plans to upgrade as it works great. We have always used cloth diapers at home (day care requires disposable), and it is a huge money saver that is so easy I have no idea how all families don’t at least have a hybrid cloth/disposable diaper system.

After July, we will no longer employ an au pair, and I will be able to cut out a smart phone line and cable and sell a car (saving money on the insurance also). At that point, I’ll look into budget smart phone carriers to try to find something cheaper than Verizon (have a feeling that will be pretty easy). We have a few low-interest debts that I will look into paying off, but we are in a debate as to whether it’s wise to use part of our emergency fund to do this when we are only a year away from both having full-time attending jobs and can reasonably float these small loans a little bit longer. I think we are paying too much for house and auto insurance, so I’ll look into switching that in the next few months. I have to take my general surgery boards in July, so some of these items will have to wait until that task is complete.

We will revisit FI again and again on Indie Docs, as well as explore other ways of funding a humanitarian medicine career. For now, enjoy visiting the amazing resources available through the hyperlinks above. Please leave comments with your favorite financial blogs, websites, or podcasts, as well as any practical tips and tricks you have for maximizing The Gap.

 

 

How to start a global health interest group at your institution

Despite having a huge campus, state of the art healthcare, and an amazingly diverse group of employees, my hospital did not have a Global Surgery “group.” There were surgeons, nurses, scrub technicians, and even pharmacist going on medical and surgery missions projects and lots of individual efforts going on. We have a fund available to us as residents for competitive scholarships to various locations for humanitarian health endeavors. But no one was getting together to have discussions and provide wisdom and support to the group. No one was addressing the enthusiasm of our medical students for this field. And no one was promoting education of the larger group of employees regarding all the potential benefits of participating in humanitarian projects. I could imagine an amazing Global Surgery department at our hospital, much like what I explored via the internet sites from Harvard and Stanford.

I tried to think of the most basic first step. What was the move that would be completely without controversy, free, and easy for this one person to pull off? The answer: Organize a journal club. Journal clubs are ubiquitous, 100% educational and therefore in line with the mission of my program, and flexible. I could design it to meet when and where was convenient for me (I hosted the first few), and also drum up enthusiasm and support from others that might want to participate.

So that’s what I did, and we just decided to see what might happen next…

We had a small group of highly enthusiastic participants, including medical students. We met at the homes of group members and enjoyed very wonderful home made food. I was thrilled that some of our attending physicians agreed to host!

I was committed to meeting monthly with the exception of December and selected articles that tried to set the groundwork for understand the current state of the Global Surgery arena. We started with the Lancet publications (see http://www.lancetglobalsurgery.org/) and ended up talking through various publications from this series for the first 3 meetings. We branched out to publications featured on the Lifebox website (see http://www.lifebox.org/professional/publications/).

Group members started to undertake fantastic research projects and promotion of humanitarian missions. As a group, we brainstormed about how to establish a Global Surgery center, which is our current active goal.

Perhaps most importantly, we became a close-knit and defined group of Global Surgery enthusiasts, and there is tremendous motivation in having this support from peers and mentors.

Starting a Global Surgery, or medicine, or pharmacy, or simply global health, journal club, is a quick and easy first step for starting the fire at your institution. With consistency, you can build an alliance of folks looking for camaraderie and practical advice. There are no downsides!

Let me know if you’ve had a successful strategy for starting a humanitarian medicine group of any subspecialty at your institution in the comments below. It would be great to share strategies for success!

Why “Indie Docs?”

The idea for this website emerged from feeling completely overwhelmed by all the decisions and seemingly difficult lifestyle demands of pursuing humanitarian medicine. Josh and I talked about options for full time missions, part time missions, advanced degree programs, traveling fellowships, how we would raise our daughter…the challenges seemed infinite.

I thought about this website and blog as a means to organize the vast information and generate discussion among a like-minded community, and for months I waited for the right domain name to pop into my head. I was frustrated that I couldn’t come up with something that encompassed all the ideas behind humanitarianism, global medicine, travel, professional independence, and philanthropy. Luckily, my husband has a habit of solving these types of problems, and on a long car ride I explained to him all the ideas I was trying to tie together. His face brightened up, eyebrows raised, and he said, “Hey, what about “Indie Docs?” My response: Yeah, good one! After all, physicians pursuing global and/or humanitarian projects need independence, both professional and financial, and a willingness to go against the mainstream. There is also a spirit of fun in the name. It doesn’t emphasize philanthropy or humanitarianism overtly, but I think this broadens our purpose a bit while still providing room for these motivations behind pursuing one’s professional ambitions as a physician, whatever they might be.

Of course I would be dishonest if I didn’t share our love of Indie music as a big influencer in the moniker. Josh and I fell in love at a Christian Indie-rock music festival in Memphis, TN, 15 years ago, and we’ve been bonding over great music ever since. The year before we had our first baby, we decided to go to every music show possible for a year, which despite our demanding residency schedules, was quite a few shows in our area near Minneapolis, MN, one of the best indie music cities in the country (thanks in part to the amazing 89.3 TheCURRENT radio station), and some shows in Nashville, TN. We rocked out to Wilco, Dr. Dog, Feist, Trampled by Turtles, Lucius, Father John Misty, Benjamin Booker, Houndmouth, and maybe a dozen other awesome indie bands. We went to Festival Palamino (VIP tickets!) and Eaux Claires music festival (put on by Justin Vernon of Bon Iver fame).

She’s ready for the show.

Why is indie music special? Without writing a tome on the subject, the artists work hard to simply make and promote good freakin’ music and challenge themselves creatively. Indie musicians have created an amazing community of artists and fans who share their ideals of loving the music rather than chasing commercial appeal and financial success. (For instance, FEIST refused to play her most commercially successful single, “1-2-3-4,” at both of her shows that we saw. Given the chance, I would request at least a performance of the Sesame Street version, “Counting to 4,” which my daughter absolutely loves).

My mom recently paid me one of the highest compliments of my life when she said she listens to Lucius’s “On the Run,” with tears in her eyes thinking of Josh and me. I can’t even count how many times I’ve listened to that song with a little mist in my eyes thinking of the exhausting effort of this path and all the hurting people I can’t reach.

So, if the Indie revolutions in  music, journalism, film making, and other creative fields occurred because the talented artists wanted to take back control of what they produced, give it to the people who needed and appreciated it most, and embrace the idealism that filled their young imaginations in the first place, the medical field might be similarly primed for this same transformation. Rumblings of discontent are growing in the medical community-at-large due to the endless pressures to increase billing and revenue at the expense of spending quality time with our patients. We see small pockets of counter-culture movements, including boutique healthcare, as a response, but there is definitely  a major grassroots movement of many idealistic (no longer a dirty word) physicians towards working in the global health and humanitarian arena.

Cliche as it may be, we went to med school to help people. Doctors have worked too hard and sacrificed too much to get to the end of training and face an unfulfilling career they never imagined or desired. As the oft-quoted study in JACR concludes, participating in global health projects reduces burnout,* and for anyone who has participated in even the smallest humanitarian mission, it’s easy to remember that pure joy of working with clear and present purpose and feeling effective. It is my hope that Indiedocs.org becomes a place for professionals to connect, encourage one another, and share the tips and tricks to maximize our ability to change all the little worlds we can reach with the hardest-working kind of love.

Happy Trails,

Joy

-On the Run-

“And now we pass so many people on the road
They could come along, I wish they’d been told
They may call it a shot in the dark
From what we know, it’s not unheard of

And we’ll one day tell our story
Of how we made something of ourselves now.”Lucius

 

*https://www.jacr.org/article/S1546-1440(17)31353-4/fulltext

http://www.thecurrent.org