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From med school to SAHM, MD

9 years 6 months ago #74970 by SAHMdoc
Yikes, has it really been almost 2 years since my last update? Have I really been that busy, busy, busy?
Let's see...where to start? First off, I am still primarily a SAHM, MD, now homeschooling both children (They are now 5 and 8). I am also still teaching A&P at the local community college, but now teach most of my courses online, so am able to assume a heavier workload. Online teaching works out well, as I get most of my work done late at night after everyone's in bed.
As for my student loans, I've found a work-around solution: the new Income-Based Repayment loan. I re-consolidated all of my loans with the federal government, which made me eligible for a new 3 years of economic hardship deferment, after which I will pay a monthly payment based on family income (I think it works out to around $300 per month, which is less than the interest payment on my loans!) After 25 years of repayment (including deferment), any remaining balance on my loans will be forgiven. However, if I work full-time in public service (that includes teaching at a state community college!) then the remaining balance will be forgiven after just 10 years of consecutive payments. Of course, I am not working full-time right now, so my current job doesn't count toward the 10 years, but I can see that becoming a possibility at some point in the future. So, no huge worries about the student loans. If I ever end up going back to practice medicine, I will someday be able to afford the payments to pay the loans off in full. If I never go back to earn a physician's salary, then eventually my loans will be forgiven, at least by the time I reach retirement age. So, that's a huge relief!
I also finally attempted Step 3 just last week (just a week shy of the 7-year deadline!) Gee, and I thought Step 1 was bad...Step 3 was an utterly EXHAUSTING 2 days! I feel as though I failed miserably, but I won't know for sure for 3-4 weeks. Obviously, there is a reason most people take this test after at least a year or two of residency. My lack of clinical experience hurt me the most on the CCS cases- I know I seriously messed up several of them. I guess I'll just have to wait and see what the results show. At this point, I would be thrilled to settle for passing Step 3 by one point, just so I don't have to worry about it ever again.
Of course, the chances of my doing residency at this point are quite slim. Most programs in the U.S. explicitly reject applicants who have been out of medical school for more than 5 years (or even 2 years, in many cases!). On the other hand, many FP and IM programs aren't all that competitive and maybe some program somewhere might give me a chance, someday.
My husband and I have discussed the subject of residency repeatedly- he thinks I should try to go back at some point. He also says he would love to be a SAHD again, now that the kids are older. However, we both agree that 80 hours per week is still just too much time for me to be away from the kids. Not to mention- I don't think he has the discipline to homeschool the kids, at least not right now. And we will definitely plan to continue to homeschool, for the benefit of my older son, who is really flourishing (more on that later.)
So- I will likely plan to remain SAHM, MD for the near future. However, IF I end up passing Step 3 (and that's a VERY big IF!) maybe I can start asking around if anyone would even consider my application at some point in the future, maybe in a couple of years when the kids are older. If so, we can start to seriously consider if/when this might be a possibility and if it would be workable for our family. If not, I will just have to forget about clinical medicine- and continue pursuing an alternate career in teaching (which I love, but unfortunately it pays a small fraction of a physician's salary.)
OK, I promised to update on my older son and how he's doing, but my eyes are glazing over from fatigue, so that will just have to wait until next time. I promise, I won't wait 2 years this time!

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9 years 6 months ago #74982 by SAHMdoc
As promised, here's the update on my 8-year old: overall, he is doing terrific!

I have been homeschooling him for almost 2 years and it has worked out remarkably well, far surpassing my greatest expectations. Academically, he is working at or above grade level in just about every subject. He does have some attention deficit issues, but fortunately he learns things fairly quickly and I do my best to break up his day to optimize his learning potential. I just have to brag on his handwriting: I am blown away by how easily he has learned cursive...he writes beautifully, far better than my own best efforts! And just think, this is the same kid who could barely print his name just 2 years ago! And the OT's told me he would likely never be capable of writing much, so he would probably require an assistive typing device for the rest of his life! NOT!

We typically spend less than an hour daily on formal "sit down" schoolwork so we are able to devote most of the day to extra-curricular activities (i.e., lots of opportunities to practice following group directions, socialization and independence...) He's involved in a huge variety of extra-curricular activities: he's been taking violin lessons for over 2 years and piano for almost a year. He also takes gymnastics lessons and after several months of begging, started taking ballet lessons (after he saw the "Nutcracker" in 2008). In the past year, he started playing violin with a youth orchestra and got to play onstage in a formal concert (black tuxedo and all!) He also fulfilled a dream by dancing in his ballet school's production of the "Nutcracker" last December (he was a cherub). Amazingly enough, he also played baseball on a Little League team last spring. Most people who know him have absolutely no idea that he is (or was?) on the autism spectrum. He does still have significant speech articulation delays, so it's sometimes difficult for strangers to understand him, but that is improving too, over time. (His pronunciation is probably more like that of a typical 4 year old...which is itself a significant improvement from when HE was 4 years old- at that time, his speech was virtually unintelligible to anyone other than his dad and I.)

We have a core group of homeschooling families that we hang out with on a regular basis, have playdates at each other's houses, go on field trips together, etc. My son doesn't really have a "close" friend among these kids, but he does enjoy being in their company and having them over, maybe playing a game of pick-up baseball with them on occasion. His best friend is actually his younger brother, who is now 5. The two of them spend most of the day playing together, so they occupy each other nicely. Of course, they also fight, like any siblings, but on the whole, they are very good playmates. In fact, I suspect that's why my son doesn't really feel the need to seek out other kids too much, because he enjoys playing with his brother so much.

On a personal level, he has become extremely affectionate to me over the past year or so. I never would have thought it possible. Just about every day, he hugs me and tells me how sweet I am and how much he loves me. It's so unreal, it's like a dream. I can't believe this is the same kid who, at age 2, appeared completely indifferent to my presence, who never, ever returned a hug or kiss. Wow, it is truly amazing how far he has come.

Tantrums? Never. Crying fits? I think I can count on one hand the number of crying fits he's had in the past year. Sensory issues? Well, he still has a restricted range of foods he'll eat, but that is improving. Other than that, I can't really think of anything.

So is he "cured"? No. He has come a long, long way, but there is still a lot to be learned before he will be able to function independently in this world. For example, he is still far too passive and far too compliant. He lets other kids break in front of him in line, push him out of the way, and even hit him without defending himself. On his baseball team, for example, I once observed another child hitting him- and he was unsuccessful in getting the child to stop or in getting the Coach's attention. He is still very slow to react- so he's always the last kid to get back in the dugout or back on the field. He sometimes "spaces out" and forgets what he is supposed to be doing (which, again, is developmentally more in line with a 4 or 5-year-old than an 8-year-old- but it's still progress!) He often has a tendency to ramble on and on, without checking in to see if anyone is listening. He also tends to talk to himself out loud for sustained periods of time- and I've heard other kids make fun of him for this, as well as for his speech difficulties. So, he still has a lot of challenges to face- but fortunately, he isn't really aware of it and so he doesn't suffer under that burden. He's a really happy kid, with a very strong self-image. I know that, if he were in school, this wouldn't be the case, because there is no way he could possibly fend for himself for 7 hours a day- that would be like throwing him to the wolves. Instead, I am trying to teach him the skills he needs to function independently, but I do it at his pace- so he goes to his classes and other activities for just an hour or two at a time. I try to always be nearby to observe from a distance and, later, interpret for him what happened and offer him suggestions for how to improve his functioning in the future. So, regarding the talking out loud, I might say "You know, while you were in the dugout, the boy next to you seemed to be annoyed by your talking out loud for so long- that's why he and the other boy were laughing." Then I might suggest that he should keep his thoughts to himself, just think them quietly, unless there's something in particular that he wants to share with others. And so on...the work continues!

So, that's why I'm still SAHMDOC, MD. It's all been worth it so far. If someone could have told me five years ago, when I started this blog, that my child would be playing violin in a youth orchestra or playing baseball on a Little League team, I would never have believed it possible. I am so thankful that I have had this opportunity to be here for him the past five years. We have come such an extraordinarily long way...there are still challenges to be overcome, but I continue to be hopeful for the future. So, even if it turns out that I will never be able to go back and do residency, never be able to live my dream of practicing medicine, it's all been worth it so far. I have no regrets.

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9 years 6 months ago #75173 by SAHMdoc
So here is the post I've been dreaming of making for the past five years...
Step 3 scores were released at midnight. The verdict is in...I passed! I actually passed quite comfortably. HOORAY! What a relief! So I passed despite complete lack of recent clinical experience and not sleeping a wink the night before the exam. I also felt like I had completely messed up several of the clinical case studies, but that turned out to be one of my strong areas.
So, for anyone out there contemplating Step 3 without residency: I'm proof that it CAN be done. I've basically been studying for this one on a very intermittent basis for the past 5 years (basically, since medical school graduation). If anyone's interested- I primarily used Master the Boards, and the Kaplan Qbook, which I carried around with me wherever I went (Kids' gym, orchestra rehearsals, etc.) I completed the entire question bank on USMLEWorld twice, scoring roughly 50% the first time around and 60% the second time. I also did all of the CCS cases in USMLE World twice. I took the NBME self-assessment a week prior to the real thing and scored 560, which translates I think to 220 or so. I also took the USMLE World self-assessment prior to the real thing and scored in the low 200's.
Actual score: 225/96.

Now, who knows if I will ever be in a position to actually do a residency, but at least I have kept that door open by successfully passing all 3 Steps within the requisite 7-year period. Bye, bye USMLE!

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9 years 5 months ago #75350 by SAHMdoc
It seems that every time I get on the computer these days, up pops some horrible headline like this one:

Mom, Autistic Son Dead in Suspected Murder-Suicide; Note Said Bronx Mom was "Overwhelmed"

Last week, it was this one:
Texas Mom Says She Killed Kids Because They Were Austistic

I've read about cases like this several times over the years and obviously, this hits very close to home. How my heart aches for these kids...and for their parents. It's so horrible that these moms saw no other way to cope than to take their children's lives...and often their own lives as well.

In listening to radio chatter and reading people's comments, I'm struck by how many people are so quick to say that the parents "should have sought help". Newsflash: there isn't a whole lot of help out there. Especially not if you're an overwhelmed immigrant family in Texas or a working class single mom in the Bronx. If they only had the slightest idea of how difficult it is to live with a child with autism. Or how long the waiting list is even to get a few hours a month of respite care services.

Of course, I cannot possibly condone what any of these moms did. At the very least, the children deserved a chance. If all else failed, the parents could have at least taken their children to Child Protective Services and given them to a foster family. (Though- I would venture to guess- there aren't very many foster families willing to take on the huge challenges of dealing with a child with autism. Especially an older child with autism. A child who, depending on the severity of his autism, may literally bite the hand that feeds him. Or smear feces all over the living room carpet. Or break his mom's arm. All in the same day.) Still, I hope if there are any other parents out there in the same boat, they will at least try to give their child up rather than ever consider taking such a horrendous, irreversible step.

I'm very fortunate. My child has never done any of the above. Well, I take that back- he did bite me once, but that's when he was a teething toddler. Even during those horrible, prolonged, inexplicable fits of rage that plagued him as a young child- he never displayed a single act of aggression toward anyone else. He's now the sweetest, most mellow (downright passive!) child I've ever met. (Matter of fact, I'm planning to enroll him in karate so he can learn to become a little MORE assertive and learn some self-defense skills, because he still allows other kids to pick on him, push him around, and hit him.)

But I didn't know all this when he was 1 or 2. When, for no apparent reason, he would scream for hours on end, completely inconsolable, no matter how much we tried to comfort him. Obviously, he wasn't able to communicate his needs to us- and so he reacted the only way he knew how- by thrashing on the floor and screaming. Fortunately, that problem has improved progressively over time, as he's gotten older, as we grew to understand him better, and as he's learned to communicate better. Today, he is actually much easier to discipline than his neurotypical younger brother. We are so blessed.

Some parents aren't so lucky. Some parents have 12-year-olds with autism who still cannot communicate adequately to convey their needs. But when a 100-pound 12-year-old (or 150 pound 16-year-old) has a meltdown- it is very different than a little toddler. It can be dangerous, even life-threatening, for both parent and child. I cannot begin to imagine what it must be like to be the parent of this child. I'm so glad I didn't know about these cases when my son was younger. You see, back then, I had no idea of how he was going to turn out. For all I knew, he was always going to be completely in his own world, utterly indifferent to my presence, obsessed only with trains and wheels and things that spin, and screaming for hours on end for no apparent reason.

Even on the worst days, I never thought of harming him, but I will make this confession: there were plenty of times that I wished he had never been born. Especially in the beginning, when we first got the diagnosis, at age 15 months. It seems unfathomable to me now that I could ever have wished this terrific kid had never been born, but the fact is, it wasn't always so terrific. Some days (and nights) were utter nightmares.

But I was lucky. I had a husband who completely abandoned his career path and quit his job to stay home and work with our child. Two years later, he went back to work and then I quit residency to stay home. We both completely devoted our entire lives to helping our son: researching our legal rights (arguing with his service coordinator), investigating therapies, advocating for him at countless IEP meetings (arguing with his service coordinator...), implementing our own home-based therapies when the schools refused to do their share (and arguing with his service coordinator...) It was basically a constant fight with the powers-that-be. It seems they always wanted to cut our son's therapy hours or eliminate his therapies entirely. It was emotionally draining and physically exhausting, not to mention financially devastating, as we ended up depleting our entire retirement savings and taking out extra loans to pay for therapies out-of-pocket when the schools refused to pay. Not to mention it required us to completely sacrifice our own lives, including our marriage, friends, and careers.

And it has all been worth it. My son is a prime example of what can happen with very early, intensive intervention. All of our sacrifices have been worth it thousand-fold. Our marriage has been very rocky at times, but it has survived. Even our finances will recover eventually, now that we no longer have to pay for all of these expensive therapies.

But what about those many, many parents who WEREN'T in our position? Maybe there is no dad. Maybe the parents don't speak English. Maybe mom is too busy working to pay the bills to be able to quit her job and assume full-time responsibility for caring for an autistic child. So this child gets left completely at the mercy of the system. And depending on how adequate this system is- as that child gets older, he may never get the help he needs...which may then lead to these horrible scenarios like we've been hearing in the news.

So...I'm not sure exactly where I was planning to go with this post...and it's getting late and I'm starting to ramble...but I just wish there were something I could do to prevent these horrendous headlines from ever appearing again. I wish parents of autistic kids everywhere could get the services they need to help their children. Maybe not all autistic children will turn out to be as high-functioning as my son...but it would be enough if their quality of life improved enough to be able to function in this world, to be happy and enjoy life with their families, and to lesson their burden on their families. I wish every child with autism could have the same opportunities for recovery that my child has had. I am so thankful for my son and I wish every parent could say the same for their child.

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9 years 2 months ago #76662 by SAHMdoc
Lots of things running through my mind right now...and it's late, so I'm probably not going to be very coherent...but let's give it a try.

First off...I miss medicine. I had to take my kids to the pediatrician this week and I really HATED having to take them in...A) because it's a hassle B) because it costs money C) because that office is FULL of germs and D) because I know I could diagnose and treat them on my own anyway (and yes, I KNOW that is poor form...) I could plainly see the beefy red tonsils on both kids, the whitish exudate on one of them, plus the history of a recent playdate of a child dx'ed with strep. If I were a practicing physician...I could have ordered their rapid strep screens, sent out their throat cultures, and calculated their respective Duricef doses. But instead, since I am NOT a licensed physician, I had to do what all the other SAHM's do...drag them in to the crowded pediatrician's office, spend half the day in the waiting room...only to have someone else bill me to tell me exactly what I already knew had to be done. It's almost like...I don't know...almost insulting that I have to go to all that trouble when I know exactly what needs to be done.

And the pediatrician...I like her, but I am not her intellectual peer, at least she doesn't treat me as one. Because I am NOT her colleague and probably never will be...I haven't done a day of residency training and probably never will. Yes, I've passed Step 3, which supposedly evaluates a physician's ability to practice unsupervised medicine...but in the end, passing Step 3 is meaningless without at least a year of internship. And that year of internship is brutal under the best of circumstances...so out of the question for us.

My best friend from med school...the one who went through the trenches with me in Gross Anatomy? She's now in practice earning $400K per year. I was thrilled to hear that my old bosom buddy had made it into the big-time... We spent one late night chatting online- but since then she hasn't replied to my emails anymore...I feel like she's in a whole different world from me and no longer views me as her colleague either. She did mention once that I should at least do an internship and then get a part-time job in an institution...she gets paid $150 per hour to moonlight as a prison physician on weekends. But again, that's 80 hours per week- so internship is out of the question.

My medical school is sending me letters requesting donations, now that I'm supposedly a rich physician in practice. I have 2nd year medical students calling me asking me to donate to their scholarship fund. I got a "Dear Dr." letter from a local bank addressed to me personally, inviting me to apply for a new account "reserved for our affluent customers..." (LOL! NO idea how they got that idea! Obviously, they didn't look at the balance in my bank account. Maybe they somehow saw the balance on my student loans and assumed only a physician could possibly have so much debt?)

And here I am...SAHM, MD, barely making ends meet. Well, not exactly...we're not poor or starving, my husband has a decent job, we have health insurance...and our kids are growing up with far more opportunities than either of us ever had...but we will never be anywhere close to affluent. Not that I've ever cared about having money...it's just kind of surreal seeing how all my friends from med school are now part of this whole new world and only I am on the outside looking in. So I skipped my 5-year med school reunion...it wasn't just because I can't afford to pay the registration fees, but also- because I feel like a complete and utter outsider now. Frankly, I feel like an impostor anytime a student addresses me by my Dr. title.

So...I don't know exactly what prompted me to write this post...I certainly have no regrets about any of my decisions over the past 5 years. I'm soooo immensely thankful that I've had the opportunity to be here for my son all these years...and for all the incredible progress he's made and how far he has come. Every day, I give a silent prayer of thanks that my son, after all he's been through, is now a happy, loving, thriving child.

I guess I'm just feeling a bit wistful about "what could have been"...there is still a whiny little part of me that is wondering why I don't get to be a physician, too. And it's not the money...it's something about having the quiet confidence and authority that my children's pediatrician has...I just can't quite explain it. Becoming a physician was my dream for so long...and I accomplished that goal on paper, but was never able to truly live out the dream.

I guess the problem is no one really understands how I feel. I have lots of SAHM friends who gave up their careers to homeschool...one was a teacher, one a nurse, one was even an attorney- but I am the only MD. I have one MD friend in full-time practice...she actually DOES treat me as a colleague- she has 3 kids and is very happy in her specialty....we have coffee together on occasion...she is always very supportive and encouraging, but of course, she is in full-time practice, so can't really relate to how I feel. So...no one can really understand how conflicted I feel. My SAHM friends completely understand why I would give up a career as a physician to stay home with my children...they made similar choices themselves. But I suspect most of them haven't given up a career quite as promising as medicine. My former med school friends know exactly what I've given up by not practicing medicine...and they think I'm utterly insane for doing so...but they just can't understand the depth of my commitment to my special needs child. So there we are...

OK, enough rambling now...thanks for reading this pitiful jumbled mess of random musings! I'm going to mull over this some more and see where it takes me...good night!

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8 years 10 months ago #78439 by Dr.I
Read the whole blog and really this would make a great book. So many moms of autistic and regular children would benefit. I also was a SAHM for 16 years! Plus you are REALLY funny!
I just returned to work this year after noone would hire me for forever. I found a job doing disability exams. You could easily do this one day a week and make $1000 in a day. Anyway, just wanted to throw that out there for any other SAHM MomMD's who are looking to return after having dropped out for years.
Anyway, looking forward to reading your book (ebook?) and then get movie options....ok, getting carried away here. Also then you could do lectures with even more credibility: MD, experience AND published author.

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