The short of it is that I switched over to a research track after my internship year when my daughter was a wee one. Now my youngest is seven and I'm getting ready to get back into the clinical world. I am very scared but am trying to keep moving forward despite that.

Volunteered in my seven year old's class this morning for a couple of hours. Now I'm home working on some online CME. (I've been at home full time for the last two years when I quit my research positon.)

I have two overlapping goals at the moment. One is that I'm thinking about applying to do a second residency in the next match season. (I finished a public health and preventive medicine residency after my internship in internal medicine.) I am looking into dermatology. So far, things are looking positive. I attended a derm conference for primary care docs on Friday; it was all interesting to me. I also have leads on several derm faculty at our local medical school and am getting ready to approach them about helping out with research and doing some clinical shadowing of some sort. I know derm is competitive, but I did well in medical school and have good research experience under my belt. Also, I am in a position such that I could move the family for a few years if needed (Hubby works remotely anyway). I don't think it will hurt me much to give it a try. If it doesn't work out, I'm okay with taking a different path. (This is what I think intellectually at least, even though my gut is tense with fear.)

Other issue is that I haven't done any clinical medicine since 2002. I have a full medical license but haven't actually used it. Last year the state medical board added a "non-practicing" category (or something like that), which I checked off. I need to call them and find out what the process will be for re-entering, even if just right into another residency program. For now, I'm doing lots of reviewing and also getting my CME for the year done.

I'm stressing myself out a bit too much. Trying to add some relaxation/meditation to the end of my day. That helps!

Kids are at school. There are many things I'm scared of doing today such as contacting my old med school student affairs to start the conversation about applying to another residency, contacting the state board of medical examiners to talk about the "re-entry" process, contacting local derm faculty, contacting the derm dept to see if they mind if I start attending their grand rounds.

I did get several hours of online CME done yesterday.

Instead of doing anything too scary today, I think I'll do some more textbook review.

We are having an unexpected "pest" situation in our crawl space that is creating a bit of havoc in our lives during the last couple of days. We are in the process of trying to nip it in the bud, but it's causing unwanted stress for me and my husband (particularly me) and unfortunately also causing noise at night that is interfering with our sleep. Fortunately it doesn't seem to be causing any problem for the kids, who don't even know about it.

I was able to drink enough coffee to sit and read while the kids were at school. I am reading Sapira's Art and Science of Bedside Diagnosis. I read somewhere that this text is much richer than the book I learned from in medical school. It's nice to sit and read it now that I'm out of school. I wanted to refresh on some parts of physical diagnosis that I may have forgotten and also review with an eye towards dermatological conditions.

I got this textbook and several others at our local medical school library. They allow licensed MDs to check out books. I am still very attached to my own red Harrison's internal med textbook, circa 1995, but I figure that if I'm going to review, I should use the most current edition. I had always wanted to just sit and read the full Harrison's. Not that I'm going to do that now, but if I didn't feel rushed to try to apply in the next match season, I just might try to do it.

A note to the doc who replied to my initial blog posts, I think the moderator moved your post. I'd love to read your message if you want to send it to me directly or post it elsewhere. I know there are also other mom MDs on this site who have taken breaks from practice and have a lot of experiences/thoughts/advice about re-entering. I'm happy to hear from anyone who wants to share thoughts with me. Just send me a personal message.

Just writing this down and sharing it, though, is helping me get through my anxiety of going through this process.

I put my reply back - it was still on my computer clipboard. When I saw someone had moved it, I thought maybe I had posted it in the wrong place or something and removed it - I'm new to this - sorry!

I am coming down with a cold this morning, just as my husband is packing up to play in an ultimate frisbee tournament for the weekend. Between the two kids we've got three soccer games this weekend, the first one starting at 8:30 Saturday morning. Looks like this weekend will be tiring.

In preparation for solo-parenting while ill, I am attempting to squeeze in some rest and self-care today. I had a previously scheduled doctors appointment earlier and then stopped at Nordstroms and bought a sweater (that I did need); it was a nice pick-me-up. I've got an hour left before I need to start rounding up the kids. I guess that I should just rest.

No actual career progress today, either attempted or completed. Maybe some will happen this evening once the kids are in bed.

I'm trying to figure out how to write this blog in the other "blogging" area on Mom MD so that others can post comments. I've written to the administrator.

I am so happy to be up and about again. Had some nasty flu-like illness all weekend. I couldn't really move far from the couch from Friday afternoon through Monday. I made it through the weekend without my husband (who was away) by asking for and accepting a lot of help from friends to drive my kids to their games and watch them. It certainly was not completely "smooth", but I have gotten a lot better at asking for help the more experienced I get as a parent.

Anyway, I made it.

I am very happy that over the weekend I exchanged some personal messages with AliciaM and sahmmd. I absolutely love this website. I have used it at many different times during recent years. It is beyond comparison in its value.

I've dropped my kids off at school and am at my desk now. What to do next? I had been planning to call the board of medical examiners to start talking about what my licensing issues are. The only problem is that I am still a bit mixed -up about what I want to try to do, so I feel like it will be too hard to call and explain all of my "ideas" and discuss what I would do for different scenarios.

I don't think there will be much issue for them to let me just get involved with derm research and clinical shadowing with some dermatologists, so I should just call and ask about that as a first step.

My feeling is that if I am going to try to get into a derm program, I should just get right to it. Life is short and we've had to put off other decisions because I don't know if we're going to have to move in a couple of years (for me to start a dermatology program in a different state) or not. Exploring certainly doesn't = committment, so it shouldn't hurt to take a few months to explore more.

I think calling the medical board is really more of a formality at this point. I'm not even asking about practicing independently anywhere. I'm just asking to function like a student really. I don't see why they should care. I also think it would be better to clarify the situation with the board *before* I get in touch with derm faculty.

Okay, enough procrastinating.

Yay, I did it! I don't know why it's so hard for me to make first phone calls, but it is. Anticipatory anxiety.

I called the medical licensing board office and got put through to talk with a nice administrator lady. They have been very nice every time I have ever called their office to ask questions about taking time off for family as it pertains to my licensure.

I said that I was a licensed physicians and that I had a few questions and that my situation was a little "complex". I explained that I'd moved to the state right after finishing my internship in internal medicine and had gotten my full active license at that point and that I'd done a residency in public health and preventive medicine (PHPM) soon after that. I explained that I'd been doing research and for the most part, no clinical work since then. (I did have a bit of a clinic at the beginning of my PHPM and worked a few times in a free clinic as part of the residency). During those years, I'd always checked off either "public health" or "administrative medicine" as my category on my licensing renewal forms. She confirmed that my current status is "administrative medicine".

I told her that I am now looking into the possibility of applying to a second residency, maybe dermatology. I asked if I needed to do anything in terms of my license if I wanted to just shadow someone and explore dermatology. She said that I can explore whatever I want but that if I have an intention of applying to any residency or working with patients, I need to start an application to "re-activate" my license. She said that it would involve sending in a number of forms, documenting CME hours, paying some fees, and such. I told her that I would do that as my first step. I guess I didn't really push for a clear answer on whether I could shadow another clinician before I get my license reactivated. I did that even as an undergraduate, but presumably now that I am a licensed physician (once "active", now "administrative") the situation is more complicated.

That's fine. If I have to fully re-activate even to apply to a residency, then might as well get that done first.

I downloaded and then printed out quite a stack of forms from the board's website. I haven't looked through all of it yet. When initially searching for the forms on the website, I saw some notes from a meeting discussing someone else's reactivation application. They said that the board wanted the person to complete a certain number of CME hours per year that they had not practiced (25 hours, perhaps, I didn't write it down).

I haven't gotten through the forms yet, so I'm not sure if there is a specific recommendation for what I'm supposed to do to prove that I am up-to-date and worthy of having an active license again. I did see though that if there is anything not straightforward about my application (I don't know if mine will be in that category or not), then a committee has to review my application and then present it to the full board. I would have to get my materials in one month before the committee meets and then the board would meet about it the following month.

In any case, I am glad that I am taking this step first because it looks like it is going to take quite a bit of time. It is actually fortunate that I left my research job because I never would have had time to get extra CME done if I were trying to do that too.

A few years ago, I went to a great workshop for women in medicine dealing with stress and balance. A social worker faculty member at the medical school spoke to us. She suggested that we not try to do *everything* at once-- to do different things at different times in life.

So now is my time to get this license reactivated.

I am glad that I made this call now, before contacting derm faculty. I will probably continue to make other calls and figure out plans for upcoming months as I am going through the reactivation process, but it will be good to get this started and to take the time to do whatever CME or other activities they want me to do now.

I'll post more once I have figured out the details of the process.

Take care, all of you Mom MDs.

My husband is away for work this week. Despite that, we are having a pretty good week. I am feeling better from whatever flu-like illness I was having last week. My daughter had strep throat over the weekend but started antibiotics and is feeling good and back in school.

I do have trouble sleeping when my husband goes away, hence the late night nature of this post. I have been searching for information on the SPEX exam on this website. I am not sure if I will have to take this exam or not. In the process, I have read some useful posts from as long ago as 2003 about mom mds who have left and returned to medicine, or who were somewhere along the way.

I am trying to take notes on the various advice people have given.

The one thing I know for sure is that this is the best website possible for me to spend my time. It is everything I need: support, advice, wisdom, colleagiality, and more.

I have decided that from now on, I will post my blog entries both here and on an external website. By doing that, whoever wants to can leave comments on the external website. I am happy to have all of the encouragement I can get! Here is where it is: http://returningtopractice.blogspot.com/

Thanks!

The Pomodoro Method

A friend of mine who is a mom and a freelance writer/novelist recently told me that she uses the "pomodoro method" to stay focused. She said that "pomodoro" means tomato in Italian and it refers to the wind-up kitchen timers that are in the shape of tomatoes.

The method, she said, was that you start the timer and then you have to stay on task for a certain amount of time before you can take a break. If distracting ideas pop into your head (like having to go to the grocery store or needing to email your old college roommate), you jot them down on a piece of paper but then stay on task. Then after x amount of time, you get to take a break. I just googled searched for it and there is a whole website about it (http://www.pomodorotechnique.com/). I don't know all of the "official" rules of the method, but I got the idea.

At the moment, I am giving myself a twenty minute break to write this post. This morning I sat for ninety minutes and worked on my licensing papers. Hurray for me! I have a personal blog that I've been using during the last two years while I've been at home full-time. I have kept some of my goals (personal, domestic, and professional) on lists that appear on the side and make links to websites I need to use frequently.

One thing I did this morning was entered a post with links to all of the websites and documents I need to submit for changing my license from "active - administrative medicine" status (new category in our state for fully licensed docs who are not doing clinical work) to just regular "active" status. Yesterday while I was on my elliptical, I was surfing the web (multi-tasking whenever possible) and found a document on the AMA website that describes everything that counts as AMA PRA credit. I was delighted to find that scientific conference abstracts and first-author publications in peer-reviewed journals both count as a lot of type I CME credit. I never knew this. (One thing I need to submit for my "reactivation" application is a summary of my CME activities.)

I am very excited about this news because it will increase my totals by quite a lot. I also found out that getting medical-related degrees (like my MPH that I did during my preventive medicine residency) count for large amounts of type I credit.

Most of my recent CME has been very clinically-oriented, primary care and internal medicine mostly. From a practical standpoint, that type of reviewing will be what is most important for changing from "administrative medicine" to regular active status. Nevertheless, I am thrilled that my CME hour totals for the period I have to report about are going to be way higher than I thought. That is certainly going to make me look better on paper than I thought I would.

I have less than two minutes left on my timer, so I'm going to go ahead and post this now.

I raise my glass to the pomodoro method and to "staying on task".

My husband is coming home tonight too, so "cheers" to that as well.

I am at my son’s piano lesson right now. Later today we are planning to go to the pumpkin patch. One soccer game finished this morning and one more to go tomorrow.

I have been working on summarizing my CME activities for the last five years. I passed my preventive medicine boards five years ago, which adds about sixty CME units for that year. In the subsequent years, the publications through my research job will count as well. I have not been documenting any “type 2” activities, but really most of my time during my days at my research job were reading and critically appraising scientific articles. I am going to meet with my former boss for lunch soon, so I will talk with her about estimating how much time I spent in type 2 activities. I can at least provide the Board with an approximate number.

I also spent a lot of time reading textbooks during these last two years that I have not been recording. Note to self: write down the time I spend reading medical textbooks until further notice. [Note to any mom MDs who may want to take time off: consider keeping a log of everything medically-related that you read.]

That is the work I’ve done documenting my past activities.

Equally importantly, I am looking for all of the upcoming primary care and internal medicine live CME programs in the upcoming months that are within a reasonable driving distance. I have found a couple of relevant options.

Piano lesson is over. Time to go. I hope everyone has a great weekend.

Our eighteen year old kitty died today, so we are sad.

I'm taking the night off from studying.

Ah, my blog. Let's see, it's been a few weeks since I last wrote.

So, our cat died a few weeks ago, which was sad for all of us. I had to keep ploughing on though, with my CME and licensing reactivation paperwork. That was pretty depressing to do in the context of feeling bad about the cat dying. I finally did stop and try to do some more fun things like making Halloween costumes for the kids and some shopping for myself.

I got my direct CME credit from the AMA for passing my specialty board (60 hours) and for two first-author publications (10 hours for each)-- and that brought my average category I CME up to over 30 hours/year over the past five years. That is the period our licensing board wants me to report on for the reactivation form. (I had to pay the AMA $150 just to send me the CME certificates though, which added to me feeling depressed!)

I also had a visit from my sister, which was fun.

I got all of my licensing paperwork submitted last week. Both my regular renewal and my reactivation (i.e., my status change request).

I had to get several forms notarized, which I did at our local UPS store. In the process, I learned that our UPS store owner's father was a physician and that his uncle eventually became a public health officer in a nearby county. He said he didn't get the medical genes but that his son is getting his R.N. degree.

I feel like I'm "outing" myself a bit. It's been a while since I've worn my doctor hat around in public.

Today is rainy and grey. My husband left for a business trip early in the morning and then the kids and I had a series of unlucky events involving getting locked out of the house, missing the school bus, both kids being tardy, and me having to drive around all over town without having eaten breakfast. Also, our dog did not want to go to the bathroom outside this morning because of the rain and so I left her at home. I was worried that by the time I got back she might have ended up having a potty accident.

It turned out fine though. She was sleeping by the front door when I returned, about an hour later than expected, and hadn't even eaten her own breakfast yet.

We have both eaten now. I offered for her to go outside again, but she took one more look at the rain and decided to just curl up and go back to sleep

I am trying to catch up on some self- and home- care this week. Got my desk cleaned up, helped my daughter hang some pictures on her walls, finished a sewing project, am caught up with my meal plan for the week and with groceries. Not bad. The cleaning people came yesterday too, so there are no dustballs in the corners and the bathrooms are clean.

I am also getting in some medical reading. Yesterday I spent about three hours reviewing one topic. It is nice to just read and not be constrained by structured CME activities. I am making a point now to log what I read and how long I spend. I always keep a notebook, but I am being more precise about the dates and times of my notes. If I'd been doing that over the last two years, I would have a better idea of how long I spent reading.

I haven't decided yet what I am going to do next while I wait to hear back from the medical board.

I have a few more errands and things to catch up with around the house, so I'm going to do those first. After that, we'll see.