Hardworking fellows deserve personal satisfaction

There are three simple goals in a clinical fellowship: clinical excellence, advancement of the field through research, and being happy as a human being while doing the aforementioned.

Easier said than done.

The truth is that many have said the triple threat — researcher, teacher, clinician — is dead in modern day medicine. We live in a world in which specialization is becoming the rule rather than the exception.

There is also a trend for the new generation to walk a path of less adversity with more privileges than the previous generation. It is what our parents have always wished for us, but we are constantly reminded that back in the day, they walked uphill both ways to school.

Managing time

I was one of the last physicians-in-training to work in excess of 80 hours a week in 2003, and I find myself still old school in my view of lightening work hours in favor of fragmented shift-work care of complex patients. It appears that we as physicians-in-training and members of the MTV generation have put more emphasis on lifestyle. Can fellows fulfill the new personal triple threat and perform clinically, do research, and complete their personal lives at the same time?

Roderick Tung

Research as a fellow is either interspersed throughout three years in clinically oriented training programs or an entire year is blocked off for research in more academically oriented programs. Research productivity is governed by two forces, inspiration and inertia. Objects in motion or rest remain in that state. I find that there are disadvantages to both research time-blocking schedules in which one may need more time to focus on a project when momentum builds in an interspersed schedule.

On the other hand, in a year of dedicated research without time constraint, there is less a sense of urgency and resting inertia may be significant. You can always pick out the research fellow in any rotation because they arrive to work a couple hours later than everyone else, in casual clothing with a smile on their face. In a career where training is so rigorous and most of our lives have been spent sleeping in hospital bunk beds every third or fourth night, a break from the routine of clinical rotation can be refreshing.

That being said, we are all creatures of habit and often feel guilty when not working like a dog. The nature of research is phasic and some days may be heavy and some extremely light. During residency and fellowship, I would often hear someone say on their light days, “I kind of feel guilty that I am not doing more or working that hard.” It is unfortunate that physicians-in-training, who albeit have a high pretest probability of type A personalities, are so used to working hard that they can’t even relax when the external demands placed on them aren’t high.

Living life

Universally, fellowship is less demanding with regards to work hours when compared to residency. This gives us all more time to do other things like research, extracurricular interests, and focus on families and relationships, the things that we neglected for three years as a resident. Personally, I have had more time to spend with my friends and family, play in a weekly soccer league, golf, exercise, and travel.

Many of my friends have taken their moonlighting supplements and made down payments on first homes. It seems that every couple months, I receive an emailed picture of a newborn baby from one of my close friends from residency.

The issues with starting a new family revolve around childcare, affording new inherent expenses and wanting to spend any free time at home. In periodically talking with friends back in Boston, I noticed that, not surprisingly, those with families don’t keep up with the late-breaking trials as they once did during residency. It just demonstrates how we are all limited in our time and passions and are forced to choose to devote our attention accordingly.

At a certain point in fellowship, we all make choices with regards to our research ambitions, which are often the cause and effect of our personal lives and academia vs. practice decisions. Most who are purely interested in private practice abandon serious research projects by the middle of their fellowship. I, too, believe that the triple threat as it existed back in the proverbial days of giants is dead in the current generation of fellows-in-training.

In my humble opinion, two out of three of the new personal triple threats during fellowship are pretty good these days, as long as the latter, personal satisfaction, is one of the two fulfilled.

Roderick H. Tung, MD, is a fellow at Cedars-Sinai and is a member of Cardiology Today’s Fellows Advisory Board.