Wow, it has been a while! And there have been a lot of changes.

When I first started writing this blog, I was a resident. Time has passed, exams have passed, I have passed those exams, and now I’m in my first (and hopefully last) staff physician position. Woohoo!

…Woohoo…I think?

So many mixed feelings. Many times, over the last couple of months, I thought about writing this post, and discarded the idea. Staff life – how often have my co-residents and I bandied that term about – seemed like this glorious light at the end of tunnel of residency.

I think the reality can be a bit more mixed.

Dr. FIREfly’s Situation

The post-residency/post-fellowship(s) path can vary a lot. Mr. Sparks and I are on very different trajectories with regard to the framework of our post-training life, and I do plan to interview him to share with readers too. He has gone through the process of hiring staff (we were never taught that in our medical training!) and is in the process of setting up his own clinic space. I think the gist so far is – if you are newly out of training, strongly consider joining a practice if possible.

From my end, I was able to parachute into a position. Office space already set up (shared, which was surprising, but nice in some ways), workplace set up (partly hospital-based, clinic also located in hospital), no overhead (whew!). Referrals are set up in a pool, and there is always work waiting (no need to “build up a practice”).

The Pay

Let’s start with the positive – the one positive I can think of that is unique to staffhood compared to residency. (The other positives, like working with learners and learning from each other, working with great allied health team members, having collegial physician colleagues, seeing patients get better, supporting family members – those have happily remained through my many transitions in workplaces, including this most recent transition to a completely new city and province).

The first paycheque was fantastic.

Truly, residents in most provinces make comparable money compared to the national average. It is not a lot to live on in some of our country’s most expensive cities, and certainly Quebec’s salary is noticeably less than the other provinces (but I think is made up for in the benefits provided within the provinces borders?). Nevertheless, for me, it was enough to finish my five years of residency with a positive net worth in the five-figure range, a fair amount of travel to be treasured in my memory banks, and no sense of having sacrificed significantly in my lifestyle to attain this. And by the middle of my sixth year of training, my net worth had broken the six-figure mark (aided in no small part by leveraging and a helpful market).

But that first paycheque? It was five figures.

That blew my mind.

(I think taxes brings it down to four figures, haha. But still!)

The Paperwork

This con is meh. It’s manageable. Though real.

There is a lot more paperwork as a staff physician. From a clinical side, all these forms to fill in order to properly advocate for your patients, fulfill provincial regulations, communicate with other healthcare entities…

From a non-clinical side, for the first time ever I’ve had to think about my own insurance. Healthcare insurance, dental coverage, disability, critical illness – which ones? How much? And goodness, it feels bad to have to pay almost double for disability insurance just for being female! (Men pay more for life insurance).  

And I’m spending fifteen to twenty minutes a day submitting billings so that I will get paid. Never had to worry about getting paid as a resident.

(Mr. Sparks has a lot more ancillary paperwork to deal with, with starting up his own clinic – more on that coming)

The Work-Life Balance

This con is significant, and the main source of my struggles, particularly in the first two months.

I was late for my birthday dinner.

I was late for my wedding anniversary dinner.

I was late coming home every day.

It has gotten a little bit better, but continues to be a struggle.

It turns out that even in a “lifestyle” specialty, you can work an infinite number of hours. And everyone is happy for you to work more – the allied health members you work with, your fellow physician colleagues, your patients, their families, the system…

No one else will protect your time. (And medical school + residency has been all about telling you your time is not as valuable as everyone else’s – this does not translate well when you’re suddenly staff).

And the work is never “done”. At least, that’s how it feels for me. As a *cough* somewhat type A personality, I like to complete tasks and cross them off my list. But with these human beings in my care – and I am the end of the line – it never feels done.

Which leads me into the next bit…

The Responsibility

I used to wake up in the night for whatever reason – maybe Mr. Sparks snoring, maybe an itch – turn over, and go right back to sleep.

Now, as soon as I wake up, I start thinking about my patients, their treatment plans, and thinking about what I can do differently. And this is without any major crises going on.

I stand at the kitchen sink, doing dishes, thinking about whether I’m on the right track with my patients’ care.

On my way to work, I’m thinking about what I need to do at work today.

On my way home from work, I’m thinking about whether I’ve missed something.

I’m now dreaming about work too – this never used to happen in residency!

Conclusion

Well, I’m a staff physician now. There is not really sense in thinking about whether I would prefer to be a resident or a staff – that is not really an option.

My goal these days is to improve my efficiency, draw that line in the sand for myself of when my day is finished, and still provide what I feel is the best patient care that I can provide (without having to stay till 9PM every day to do it).

It’s an ongoing process. Some days are better than others. Some weeks, I feel a bit burnt out by the end of Tuesday, which doesn’t bode well for the remainder of the week.

Two of my co-fellows in my PGY6 training spot asked me staff life was better (they were both slightly off-cycle in terms of time line for finishing training). I blurted out a somewhat disjointed answer to the effect of “well, it’s complicated.”

This post would have been a more organized approach to my answer.

Food for Thought

To all the trainees out there making their way through medical school and residency (and maybe also staff physicians of any stage in their career for whom these struggles still resonate), I would suggest:

1. Your time is valuable. Everyone has finite time. It’s worth protecting.
2. It is okay to take care of yourself. I have found it easier to have a hard end time to my day if I have a time-based commitment to someone else waiting. I am working on being able to hold that commitment just to myself.
3. And on a more prosaic and optimistic note, the pay is solid. Without inflating lifestyle right away, (and if you do not have significant start up costs, like Mr. Sparks is facing) you can start making rather rapid headway towards financial independence once you transition to staff life. Starting saving and investing habits earlier in training will pave your Maglev rail to FI/RE.

Until next time!

-Dr. FIREfly