MSHQ 099 : Balancing Family Life with Premed and Medical School

Session 99

In today’s episode, Ryan hosts the show along with Allison as they talk about juggling family life and being a physician. Being still new in the parenting game and working as physicians, Ryan and Allison share their thoughts, their struggles, and experiences in each phase of their medical path.
It all boils down to doing the things that you love, choosing the lifestyle style that you want, and finding that balance between family and school/career to make it all work out.

Here are some key points that Ryan and Allison discussed in this episode:

The premed world as a nontraditional student

How a traditional premed path can be hard if you have a family or children

Allison’s premed path:

  • Starting college at 17 years old in Canada
  • How Canada has a different culture especially in Montreal
  • Dealing with a rigorous environment at McGill University
  • Studying all weekend to prepare her well for medical school
  • Family life = none
  • Lack of balance with so much science courses

Ryan’s premed path:

  • Went to University of Florida (a high party school but has a good academic environment too)
  • Priorities in college and focusing on what’s important
  • Appreciating the hours you have in a day and maximizing them
  • A good resource on setting priorities in your life: Getting Things Done by David Allen
  • Looking carefully at what your program is going to be like

The Medical School Years

  • How residency is a beast
  • Not impossible to have children and be a medical student
  • The common theme from premed through residency: the need for support
  • Studying for so many hours vs. spending time with your baby and children
  • The challenges when you’re on your ward years
  • Third year as the most challenging year, not having the luxury of time
  • Fourth year as a big time for considering marriage or having a baby
  • The gaps and breaks where you can have more time with your family
  • Having a family while being a medical student is doable, but be prepared. Plan ahead of time.

Residency

  • How residency is a bigger beast
  • Why it’s the most insane time in Allison’s life
  • Things in residency that you’re going to be deprived of
  • The importance of residency
  • Managing your time given the average 80-hour work week
  • Factoring in the time you spend for eating, showering, sleeping, etc.
  • Factoring in the administrative things you need to deal with
  • Dealing with all the commitments
  • The changes in responsibility from being a medical student to being a resident or intern
  • Having a family at this stage is doable but you need support

Choosing your specialty

  • Specialties that require a bit less of your time
  • Think about the lifestyle you want to have
  • Specialties reported as having the highest scales of happiness at home and work according to the 2014 Physician Lifestyle Report by Medscape
  • Specialties that you don’t get called in often
  • Planning and thinking ahead

Some pieces of advice for premed students:

Plan, plan, plan. Figure out what you’re going to do and who are the people who are going to help you in every stage.

There are challenges at every single phase. You’ve got to love what you’re doing because you’ll find ways to make everything work.

Links and Other Resources:

MSHQ podcast episode 61 – Medical School Mom – Prioritizing Family, School and More

Getting Things Done by David Allen

2014 Physician Lifestyle Report by Medscape

Free MCAT gift – 30+ page report all about MCAT tips and strategies plus discount codes for some test prep

Listen to our podcast for free at iTunes: medicalschoolhq.net/itunes

Stitcher: medicalschoolhq.net/stitcher

SoundCloud: medicalschoolhq.net/soundcloud

Transcript

Dr. Ryan Gray: The Premed Years, session number 99. Yeah, 99.

Intro: Hey, this is Z-Dog MD; rapper, physician, legendary turntable health revolutionary, and part-time gardener. And you're listening to the Medical School HQ Podcast, hosted by the irredeemably awesome, Ryan Gray.

Dr. Ryan Gray: Hello and welcome to the Medical School Headquarters Podcast; where we believe that collaboration, not competition, is key to your premed success. I am your host, Dr. Ryan Gray, and in this podcast we share with you stories, encouragement and information that you need to know to help guide you on your path to becoming a successful physician.

Session 99. That's crazy. We're one away from 100 episodes. Now it's not quite a two year anniversary, obviously there's 52 weeks in a year so 104 episodes will be our two year official anniversary. But there's just something about the number 100. I want to thank everybody for being here today, especially my lovely cohost, Allison Gray.

Dr. Allison Gray: Hello.

Dr. Ryan Gray: If you're listening to us for the first time, you have a lot of catching up to do. Almost two years’ worth of podcasts to go listen to right now. Ready, go. You can subscribe to us, get our shows for free downloaded to your phone, to your computer, magically overnight on Wednesday, or during the day Wednesday when we release them. You can go subscribe for free in iTunes, at www.MedicalSchoolHQ.net/iTunes. You can listen on Stitcher which is www.MedicalSchoolHQ.net/stitcher. And you can listen on SoundCloud, we're slowly getting all of our content up into SoundCloud as well for those of you that like SoundCloud.

But today we're going to talk about an email that came in and asked about family life and being a physician. And we've covered this topic a little bit with different guests, but Allison and I are going to share our stories and our thoughts on having a family and being a physician; and we're still getting used to this whole parenting game and we're working as physicians and so we're going to share our thoughts on the whole process and what it's like.

But first I want to remind you, if you're getting ready to take the MCAT, go to www.FreeMCATGift.com. Again that's www.FreeMCATGift.com and download our thirty plus page report all about tips and tricks and things that you might not think about on how to maximize your score on the MCAT.

Balancing Work and Family Life

Now I'm going to read this email, and Allison and I will talk about it. So it came from Thomas who said the only thing he's ever wanted to do is be a physician. It sounds like he's a nontraditional student because he's saying he's getting older, hopefully he's not just talking about like being a junior in undergrad. But he says, “My question is how do you balance such an incredible workload with a family life? Especially with a newborn,” he's obviously listened to some of our shows. “Have you had any struggles with this? Is there any one specialty that is more lax or ‘family friendly' than another?”

So let's tackle this Allison.

Dr. Allison Gray: Mm hmm.

Dr. Ryan Gray: How are you doing by the way?

Dr. Allison Gray: I'm good.

Dr. Ryan Gray: I didn't ask you-

Dr. Allison Gray: I'm doing well rather. Thank you. How are you tonight?

Dr. Ryan Gray: I'm doing well, thank you. You didn't get to say, “Hello everybody.”

Dr. Allison Gray: Yeah, well I try to mix it up.

Dr. Ryan Gray: Oh, okay. Good.

Dr. Allison Gray: Sometimes I just say, “Hello.”

Dr. Ryan Gray: Awesome. So I thought we'd tackle this from a kind of systematic standpoint about each step of the process, and what it's like to have family at each step. Obviously we didn't have a child until we were attendings basically, so we are kind out of the training world. But we can talk about workloads and what the time commitments were like, and we saw friends go through the process with family. And so we can kind of talk to each one of those, and we'll go from there.

Dr. Allison Gray: Yeah and it's great because then if you are at one stage of the process and maybe not as interested in hearing about another stage you can tune in and we'll go very systematically- chronologically.

Family Life During Premed

Dr. Ryan Gray: Chronologically. So obviously the first step of the game is the premed world. And we can talk nontraditional as well, because you're technically a premed as a nontraditional, and you're getting your credits just as a traditional student was- maybe a little bit slower, maybe in a little bit of a different environment. But in your mind when you were going through the premed process, what kind of time commitment was school for you, and thinking back could you imagine or did you know anybody that had children at that point?

Dr. Allison Gray: Good question. Well and our experiences and stories and reflections are going to be so different, because I was at a school in Canada, you were at a school in the US; which are just by nature two very different universities. And yeah, so it will just be different. So that's good. So I'm going first?

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: Alright, let's see. So for starters I started college, or university, when I was seventeen. I was at the- I was really ready for school when I was four. So-

Dr. Ryan Gray: Nerd.

Dr. Allison Gray: No there's this picture of me when we were- this is just kind of a cute story. When we were in school, and we were five years old, this was kindergarten I think or it might have been first grade. Anyway, the point is we had a picture where we held up a little sign saying something that we love, we just had to pick something that we loved and write it down and hold up the sign. So there's a picture of me, all-

Dr. Ryan Gray: I want to- like most kids maybe had like a puppy or a kitten, or their mommy or dad, or brother or sister.

Dr. Allison Gray: Right. And mine said, ‘I love school.'

Dr. Ryan Gray: She's a neurologist, people.

Canada Versus US Premed Education

Dr. Allison Gray: Yup, yup. But no, it's true. So in my town growing up, I grew up in Brookline in Massachusetts; yay Brookline, love that town. The school regulations were that if you were turning five by I think December you were able to start kindergarten. So instead of keeping me in preschool my parents said, “Okay,” I had to have a year of preschool, “off to school you go.” Because I was so excited and eager to get there. So anyway I then therefore started college when I was seventeen. So I was young, and I was also going to school in a different country, and Canada, they're our dear friends up north. And the culture some might think is, “Oh it's just Canada, it's just the northern United States.” It's really not, and Canadians will attest to this. It's a different culture, it's a different- it's different. We share a lot of similarities but I will tell you living in Montreal, French Canada, it's very different culture. And people ask me, “Did you go abroad in college?” And I said, “Well I felt like I was abroad.” So I was in school with really all young people. I mean I don't know anybody at that time who had children, to answer your question, Ryan. Everybody was about that age, was seventeen, eighteen. And-

Dr. Ryan Gray: Are you saying seventeen and eighteen year olds can't have babies?

Dr. Allison Gray: No, but having a baby and being at McGill was- I don't know how you would do that, quite frankly.

Dr. Ryan Gray: So that's your answer.

Dr. Allison Gray: So my answer is because- and again it will be interesting to hear what Ryan's college life was life. But for me, I went to McGill and McGill is very much in the European school of thought that it's very self-driven and I remember very vividly the Dean of Science getting up at the beginning of our college career and saying, “Look,” he held out a bunny hat and he said- like a magician would, and he said, “I'm going to put my hand in this hat,” and then he said, “who thinks I'm going to get a bunny out of it?” And people would raise their hand and then some people didn't, and he said- and then he took his hand out and he said, “Well there's no bunny.” And people said, “Why?” And he said, “Because I didn't put anything in.” So his whole point was if you don't put anything in, you're not going to get anything out. And it was very much at McGill sink or swim. Everything you got out of your college career was what you put into it. And there was nobody there to sort of hold your hand, there weren't- I mean you had an advisor assigned to you, but it was very much here is your schedule, good luck to you, we'll see you in four years. And that worked for me because I was a very ambitious, very- I loved school, I was super excited to be studying and be there, and I was in science classes which I was very excited about having I really loved AP Bio and I was pretty sure I was moving toward a career in medicine. Even at that point I was really- I picked human physiology even my first year, that was what I wanted to pursue. Anyhow, so McGill, my point is it was a very, very rigorous environment. And I vividly remember pretty much- I mean a very high percentage of my weekends at McGill were spent studying. And I mean all weekend. I mean you would get up on the weekend, I'd have breakfast with my roommate, we lived in a dorm the first year and then we lived in an apartment in Montreal for the next three years. And literally we would get up in the morning, and have breakfast, maybe watch a little bit of TV and then that was it. You were showered, you were off to the library or in your- I loved to study at home, and that was it all day. And then you know, you'd eat, you'd do things, and at night, yes. I mean we did have somewhat of a college experience, we'd go out. But again in Montreal drinking age is eighteen. So we'd go out to the bar, or we'd just have a drink. And some nights we wouldn't, some nights we would just study.

Dr. Ryan Gray: Study all weekend.

Dr. Allison Gray: All weekend. Particularly around midterms and definitely finals, forget it. I mean that was what you did. So it sounds maybe to some of you out there who are in high school or college like, “Oh my God, what the hell.”

Dr. Ryan Gray: Or to me.

Dr. Allison Gray: Or to you. But I will tell you that while I did not have the sort of traditional college experience, and probably in some ways you could say that I missed out on some of that. You know meaning the traditional American college experience, American United States college experience because I wasn't tailgating, I wasn't going to a lot of dorm parties. I mean I remember sitting in the hallway with friends and doing typical college things in some way, but it was very different, it was just a different- we went clubbing because that's what you did in Montreal. It wasn't about having like a big kegger, you would go to the club and just dance and do stuff. So just different. Anyway, I'm going on and on. But I'm reliving my college days, geez. So it was just a different life. But my point was it prepared me very, very well for medical school because what did we do every weekend in medical school?

Dr. Ryan Gray: Sleep.

Dr. Allison Gray: Study.

Dr. Ryan Gray: Oh yeah, did that too.

Dr. Allison Gray: So that was me. So family life-

Dr. Ryan Gray: So none.

Dr. Allison Gray: Really none. But as a last thing before we switch gears to you, there were definitely students Quebecois students who were from Montreal who were in school there and didn't live-

Dr. Ryan Gray: You want to translate Quebecois?

Dr. Allison Gray: Quebecois, so students who are from Quebec. Montreal is part of Quebec, it's in the province Quebec. Anyhow so there were students and one of whom I knew fairly well and she lived with her family in Montreal and she was a student and she would commute. So she had family life in a different way, right? She was still living with her family as some people do who are commuters.

Dr. Ryan Gray: She has support, she wasn't supporting.

Dr. Allison Gray: Correct exactly.

Dr. Ryan Gray: A little different.

Dr. Allison Gray: She was still a dependent, she was not- yes.

Dr. Ryan Gray: Depended upon.

Dr. Allison Gray: Right, exactly. So you know it was nice in the sense that her food was there, her laundry was there.

Premed Paths

Dr. Ryan Gray: So I think everybody's premed, traditional premed path will be similar to yours. Yes, the studying was probably, or most likely a lot more rigorous at McGill compared to where I went at University of Florida, which is always seemed to be ranked as a relatively high party school. McGill probably isn't. McGill is always ranked high academically. University of Florida is too.

Dr. Allison Gray: And you always hate that, you hate seeing when Florida is ranked as a party school because you know that it's a good academic environment, too.

Dr. Ryan Gray: It is both, it is both. Yeah. So I think what ultimately we're both in agreement that premed- a traditional premed path, while not rigorous like medical school, can be hard and depending on the type of student you are, how much time you need to study for a test, or if you're a good crammer, or whatever it may be. It's going to be hard to raise a child and have a family as a traditional premed student. But what about a nontraditional student? So a lot of people that listen to this podcast are nontraditional students and their situation might be a lot different. They might have a family, have a career, and then go, “You know what? I'm out of here, I want to go be a doctor and follow my initial dreams and passions and go to medical school.” And that again is another totally different situation because typically- and we've heard all these stories of people going to night school at a community college to get their premed, their pre-req's, going and switching gears and going back to undergrad and kind of piecing together a do-it-yourself post-bacc or going to a post-bacc with children. But I think that it's different in my mind because there's some sense of stability because you're there with a family already. As a traditional premed student you're still a kid.

Dr. Allison Gray: Right and your priorities are different. So when you're in college for a lot of people it's your first time away from home, it's your first time that you can experiment with different things, and I don't mean-

Dr. Ryan Gray: Drugs and alcohol.

Dr. Allison Gray: I don't mean that. I- well for eighteen year olds who are at McGill, I mean I will tell you I was never a big drinker, I just wasn't.

Dr. Ryan Gray: Good to know.

Dr. Allison Gray: But I'm just saying a lot of people got there and be like, “Wow there are beer Olympics on campus, this is awesome.”

Dr. Ryan Gray: What are Beer Olympics?

Dr. Allison Gray: Basically you would all get together- I don't know because I never went, okay? I was pretty much, you know, I was upstairs studying probably. But people would get together on the grass in the middle of campus and they'd have tents up and ice sculptures and big like- what are those things called? Oh my God, where you pour alcohol down- ice luge? No.

Dr. Ryan Gray: Funnel?

Dr. Allison Gray: Funnels, yes.

Dr. Ryan Gray: Not a big drinker.

Dr. Allison Gray: And people would just go nuts and they would have games where people would try to win, and it was all about alcohol. But this was campus endorsed because this is Canada, it's just different.

Dr. Ryan Gray: So the high school students that are listening, David you in particular, to ignore everything we're saying.

Dr. Allison Gray: No seriously, ignore it. But I didn't participate in any of it, so I'm not saying you had to. The point is though for some people when you get to college your priorities are, “Oh I want to have fun, I'm with all these young people.” And part of the real challenge is staying focused in your classes, right? Now if you're a nontraditional student and you have a family, and you have two children at home or one child and you're married, and you have a significant other, and you have a job from nine to five or whatever your hours are; you are going to be no nonsense.

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: If you're going to be getting your studies done because you're trying to do your pre-req's, it is no-

Dr. Ryan Gray: You're focused.

Dr. Allison Gray: Yes, it is you are focused.

Dr. Ryan Gray: And that's something back in Session 61 which you can listen to at www.MedicalSchoolHQ.net/61, that's something that came out talking to Rebecca who is a fourth year medical student now and has three kids, if I remember correctly. But she went through the premed path with those kids as well, and she's a nontraditional student. And she talks about that, about cutting out basically all the fat in her life. Kind of figuratively. And focusing on what was the most important to her and only doing those things. So www.MedicalSchoolHQ.net/61 you can hear that great story with Rebecca.

Dr. Allison Gray: And I think part of it too Ryan, is that a lot of people- us included, don't necessarily always appreciate how many hours there are in the day. Because we think, ‘Okay well I have such and such time.' Let's say you work nine to five like we do now, and then you go home- we'll talk about this in a bit. But there really are quite a number of hours at the end of the day. If you really tackle each of those hours as though they are crucial to getting things done, it's very different than, “Oh yeah, I'm busy all day and then at night I make dinner,” I mean there's a lot of time in there.

‘Getting Things Done’

Dr. Ryan Gray: So you mentioned getting things done. And this is a book that I've read, and I know I've suggested it to you to read before, and you haven't tackled it yet but I'm actually going to re-read it here pretty soon so maybe we'll read it together. But if you're listening to this and you're wondering how can I get better at juggling all of these commitments and everything that I have to do, go read the book ‘Getting Things Done,' by David Allen. As we're recording this it's October, 2014, he's actually coming out with his second edition. This is a book that's been around for fifteen or twenty years. And he's coming out with the second edition in- no it's been around ten years. Anyway he's coming out with a second edition in March of 2015, so if you're listening to this around then hopefully you get the second edition but I wouldn't delay it. Get it now, read it, it's a relatively easy read. But it's an awesome book about changing your thinking and giving you some tips and tricks on how to prioritize everything in your life.

Dr. Allison Gray: Yeah, it's great advice and I do need to read that book. One other thing I'll just mention too before we move on to the med school years, is that part of what's important I think is looking carefully and what your program is going to be like. So let's say you're in high school and you're thinking about college, and you're looking through some of the course syllabi that a school offers, and let's say you have an interest maybe in physiology or biochemistry or something science- human science related. Take a look at what- because oftentimes or all the time the colleges will show you what does a freshman year, what does a sophomore year, what does a junior year, senior year look like and you can get a feel for it. So at McGill for example, it was all science. And that was part of what made it challenging, it was- I mean I was taking in my junior year physiology, intermediate level physiology. I was taking integrative neuroscience, I was taking courses that were really rigorous and intense, and as I've said in other episodes, I did not have to take any English if I didn't want to. I sort of insisted upon it for myself, I took a history course, I took English because I didn't want to forget how to speak English or write in English. But that was part of why I had such sort of lack of balance in my life I think; because it was so much science and so many rigorous courses just back to back to back. And so I think that's something just to make note of. Now if you're a nontraditional student and you're trying to pack all those in and get them done, one of the things that people do to try to deal with some of that back to back-ness, because that's what you're kind of faced with if you're doing a job nine to five and then you need to bang out those pre-req's. But one of the things Ryan and I get asked a lot is well, “Can I just do one class here, and then next semester I'll do one class,” and part of the tricky thing about that is that again don't forget as a premed you need to show medical schools that you can handle multiple, rigorous classes in the same semester. Because fast forward to medical school, it's drinking from the fire hose. You're going to be doing just studying, taking in information at light warp- light speed. Anyway.

Dr. Ryan Gray: You're the Trekkie, you should know this.

Dr. Allison Gray: I know. Sheldon from Big Bang would be disappointed. Anyhow, so it's just something else to sort of think about that it's hard- balance is always hard, I think at every stage of your life it's all relative, whatever you're dealing with. But trying to find balance is really important.

Balancing Family Life and Medical School

Dr. Ryan Gray: Yeah. Alright, so that's the premed path, and probably the least relevant, and I dare say that because there are plenty of premeds out there with children. But probably more significant is the medical school years when people are starting to decide to have families as a student in medical school. They want to- again I dare say get it over with but they want to have babies before they start residency because then it's a totally different beast and we'll talk about that. But we went to school and several of our med student friends and classmates had children. So it's not against-

Dr. Allison Gray: It's not impossible.

Dr. Ryan Gray: It's not impossible to have children. And what I want to talk about-

Dr. Allison Gray: And be a med student.

Dr. Ryan Gray: And be a- yes. It's not impossible to have children, and be a med student. But there's probably an underlying theme that will continue on from premed through residency and fellowship and attending; and that's support. I think is huge and we can't underestimate that part of it. The students that we knew, the classmates that we knew with children had amazing family support from their spouses and family and other people. So- but you'd mentioned-

Dr. Allison Gray: And each other too.

Dr. Ryan Gray: And each other student-wise.

Dr. Allison Gray: Yeah, I don't know if you remember- sorry to interrupt you Ryan, but I don't know if you remember there was sort of almost a little- not a barrier but there was a difference between the students- the sort of traditional med students who were coming in who were single or maybe in a relationship but weren't settled down in any way, and then those who did have families. And I noticed they used to get together and they really bonded over the fact that they were all in this together sort of. They were med students who had families and children, and their significant others, and everybody would get together and be at these picnics and other events we would have. And it was cool, they would show up with all their kids but you could just tell that they sort of- they were very much sort of a tribe if you will.

Dr. Ryan Gray: Their own little clique.

Dr. Allison Gray: Well and rightly so because they were dealing with things that we had no comprehension of and they- as I said before, I mean I think even moreso now, it was just focus, focus, focus. And I remember asking one of our acquaintances in med school, one of our other classmates about how she did it all, and she would say that her husband would just take the kids and she would just go to the library and study and that was what they did. But anyhow we'll talk more about it. But I just remember that, so some of you out there who might think, “Oh I have kids, if I go to med school is it going to be all like 23 and 24 year olds who can't relate to me at all?” Survey says there will probably be-

Dr. Ryan Gray: Survey says.

Dr. Allison Gray: There will probably be other- and find that out when you interview and when you look into school. But there will probably be other students out there who are older and have families and are in the same boat you are.

Dr. Ryan Gray: Yeah, definitely. So the lifestyle in medical school. You had mentioned drinking from a fire hose. Med school is not easy. So think of your premed years, if you've gone through them already or are in the middle of them, and multiply it by a factor of what? What would you multiply it by?

Dr. Allison Gray: Oh 1,000, I don't know. I mean again it all depends on what your preparation is.

Dr. Ryan Gray: For somebody like you who went to McGill it was probably even.

Medical School Lifestyle

Dr. Allison Gray: Well in the sense that I was used to studying every weekend, no joke it was. But it's not so much that, it's again- it's the speed and the amount of information that you're being asked and required to learn, is again very, very fast. It's just different than anything else.

Dr. Ryan Gray: And it also is a huge change in lifestyle and what you're doing on a day-to-day basis. So again, we always talk about the typical curriculum at a medical school is two years of classwork and then two years of rotations at the hospital. So nonclinical and then clinical years. And those clinical years are going to be nothing like you've ever done before. So when I did my surgery rotation, you're there before the sun comes up and you leave after the sun comes down. If I had a child at that point, that child probably would be sleeping when I left and would be sleeping when I got home. And you better have the support, and I hope you do, to handle that because it's stressful. And it's not just stressful for you because you're missing your child, it's stressful for your spouse who's taking care of that child and feeling abandoned while you're off lollygagging in the hospital.

Dr. Allison Gray: Hopefully not.

Dr. Ryan Gray: Yeah, but those are-

Dr. Allison Gray: No it could be, it absolutely could be. I mean and we didn't go through that at that time so- but yeah. I think as you said, whether it's your spouse, your significant other, whether it's a parent, whether it's your grandparent; somebody who can watch your child. You know honestly even in the first two years for most traditional medical school classes, you'll be studying so many hours, it's probably easier in that you can study and then your break is going to see your baby, or your toddler- or however old your children are, maybe they're even older. Going to spend a little time with them, have dinner with them, and then you go right back to studying. But as Ryan was talking about, once you get to the ward years, you're in the hospital and unless you live- I mean right down the street or something and you can- sometimes you don't even have that luxury honestly. But some rotations, some rotations-

Dr. Ryan Gray: There's a pager on your hip.

Dr. Allison Gray: Oh there is absolutely. But some rotations you might be able to get away for a little bit just to run home or run over, grab something-

Dr. Ryan Gray: Oh you mean like go shopping during your dermatology rotation?

Dr. Allison Gray: Hey, that's-

Dr. Ryan Gray: That was during residency, sorry.

Dr. Allison Gray: And you know that was internship, and that was an elective, and don't you start. That was different, we'll get there. Elective is an interesting thing, we should talk about that because that's- in med school that's an important piece of this. But definitely, so third year is probably the most challenging I would say for all of us because remember that when you're in your first and second year, yes you have class, you have problem solving sessions, you study for the majority of the time, almost all of the time. But you have a lot more control over your schedule and how- for example not every medical school requires you to go to the classes and some you can sort of go and just study; study the material yourself if that works better for you. Every med school is a little bit different. You do not have the luxury of owning your time when you're in third year for the most part.

Dr. Ryan Gray: Yeah.

Dr. Allison Gray: And so if you're on your surgery rotation and you have to be there before God and you're leaving at the very end of the day when the sun is down, remember it doesn't end there, right? So you go home and then you pick up your books again because you need to be prepared for the case tomorrow. You need to be prepared, you need to read what you saw today, read about what you saw today so that if somebody-

Dr. Ryan Gray: And still studying for the shelf exams.

Dr. Allison Gray: Yup, there's studying for everything. You know knowing what you're learning on a daily basis and yes, you always have to be preparing for the shelf because there are things you won't see, and that shelf is waiting at the end. Also it's called something different in DO schools, it's the shelves-

Dr. Ryan Gray: I forget.

Dr. Allison Gray: But yeah, so it's a lot. And I have so much admiration and respect for those classmates of ours who had families during that time and were able to power through and I would imagine maybe if your kids are younger- like when they're infants, it might be easier, maybe although I don't know. I'm just thinking because it might be harder to get away from like your six year old versus your six month old. But I think it's probably hard any time. I think I would have a very- I think I would have struggled with that. Family is really important to me and a lot of us, obviously. So you have to have a lot of emotional and I think just a lot of strength in general to be able to power through all of that and know that your children are going to be fine if you're really, really busy, and that you'll be back.

Dr. Ryan Gray: These are all new emotions for you.

Dr. Allison Gray: Well sure, because I haven't been a parent that long. But I can now sort of start to relate at least thinking about it, trying to walk in their shoes.

Dr. Ryan Gray: Yeah. Yeah so medical school I think is a beast, but we saw plenty of people do it, again with support. It's going to be something where you're going to need support; whether it's a babysitter that is living with you, a full time nanny while you're doing rotations if you don't have a significant other or family member nearby to help. But it's doable. But be prepared.

Dr. Allison Gray: But plan ahead, definitely, definitely.

Dr. Ryan Gray: Yeah. Let's talk about residency.

Fourth Year Medical School

Dr. Allison Gray: Well and don't forget fourth year though, because fourth year is very different.

Dr. Ryan Gray: Fourth year is different, but-

Dr. Allison Gray: No but I think it's important for people to know, right. Because there's a lot of travelling for residency applications and then you have- you do have elective time so that's a chance that you can actually kind of-

Dr. Ryan Gray: Some people plan to have babies around that time.

Dr. Allison Gray: Yeah, absolutely some people plan to get married in fourth year; it's a big time to sort of check off those family things, those life rites of passage, those moments, those- yeah that you want to tackle. So I think a lot of our friends got married in fourth year. We were just at a wedding this last weekend for one of our friends, and the two of them got married in fourth year. So it's an exciting time and it is a break. It is a break for a lot of people because you have- a big part of that year is applying for residency, so you do have gaps and breaks where you can have more time with your family, and that's sort of a light at the end of a tunnel for once you've been in this craziness of third year. So just to throw that in there, I think it's important.

Dr. Ryan Gray: Yup, which is why a lot of schools and there's a lot of thinking out there that fourth year is a waste of time, and we should cut it out. And some schools are trying.

Dr. Allison Gray: Well and that's true, and there are a couple other podcast episodes where you talk about that with folks.

Dr. Ryan Gray: Lots of people. Alright, you want to talk about residency now?

Balancing Residency with Family Life

Dr. Allison Gray: Residency. So it's funny because you just- we just finished talking about how medical school is a beast.

Dr. Ryan Gray: And residency is even a bigger beast.

Dr. Allison Gray: It's so funny though because when you look back- I mean I just remember so vividly at the time (I think I've said ‘vividly' like three times in this podcast already, sorry). But it's true, I look back and I just remember these things so well. In college I remember thinking, “This is the most insane time of my life. The most insane,” I was studying so much, it was so busy. And I was in another country, it was just crazy. And then I'm in med school and I'm like, “This is the most crazy. Like the most crazy, how could anything get more crazy? I'm studying all the time, I'm learning so much, there's so much information.” And then you get to residency. And hahaha. So yeah, so there's this thing called intern year, which many of you have heard about, and by the way I should first say that I look back on residency with great fondness. It was the most insane time in my life, it was also the most crazy time in my life by far. I think it will always be. And many, many physicians, many physicians if you ask them, will tell you that residency was the most crazy time in their lives.

Dr. Ryan Gray: Which if you're a medical student or a premed student thinking about medicine, don't ask a resident if you should be a physician.

Dr. Allison Gray: Well, some people might say, “Oh yeah, it's amazing.” But I think, again you're going to be asking that question of a human being who is A) very sleep deprived, B) food deprived-

Dr. Ryan Gray: Dehydrated.

Dr. Allison Gray: Dehydrated, probably a little bit of renal failure.

Dr. Ryan Gray: Stressed.

Dr. Allison Gray: Yes, they've actually done studies on that, it's scary. And very stressed. And what's the difference? So the difference is that you're still acquiring information at lightning speed, you're learning so much, but what we've talked about before in other episodes is that you're learning how to be a doctor. Medical school prepares you for the sort of what it is to be a doctor, it teaches you about what it is to be a doctor, it teaches you the foundation of knowledge you need to practice, to be a physician. But actually the learning how to practice medicine, learning to be a doctor, is not something that you learn until residency. And so it's just a different kind of beast.

Dr. Ryan Gray: Yeah. So let's talk about work hours. So for- man, how long have we been out?

Dr. Allison Gray: Well out of what?

Resident Weekly Hours

Dr. Ryan Gray: The eighty hour work week started right before we started internship and residency. So this was around 2009, 2008, 2007- somewhere around there. They implemented eighty hour work week regulation. And that means- it doesn't mean that you're only working eighty hours a week. It means you're working on average, eighty hours a week over I think it's a four week period. And so that means one week you could be working 100 hours in a week. That doesn't leave much time for much else if you're planning on sleeping a little bit.

Dr. Allison Gray: Yup.

Dr. Ryan Gray: And so again it's just- it takes everything to the next level as far as commitments of your time and how you're dividing up your time. So obviously we need to eat, and a lot of people don't factor in the time that it takes to prepare food, and eat, and everything else, and that could be quality time with your family or it could be running through the cafeteria line at the hospital. But you have to eat, you have to go to the bathroom, you have to shower, you have to sleep, you have to-

Dr. Allison Gray: Right, at least the bare minimum because you will become clinically insane if you're up a certain number of hours.

Dr. Ryan Gray: Yeah. You have to obviously work the certain number of hours that you need to work, and then the rest is alone time, family time, whatever else time there is.

Dr. Allison Gray: And board review.

Dr. Ryan Gray: You have to study. Hopefully you're exercising.

Dr. Allison Gray: Well and there are in what we call in-service training examinations. So like when I was in residency it was called the RITE; the Residency In-service Training Exam. And so these are yearly exams that you do have to study for and prepare for. And they're in preparation for your board exams after you complete residency and you go and you sit for your boards. So there's always something there that can take time, and by the way I looked up and at least this reference is saying that the eighty hour rule was instituted in '03, so maybe a little before we thought. But it is averaged over four weeks, it's eighty hours of weekly limit, you're supposed to have a certain number of rest- hours of rest after each in house call. And another key thing in my residency that was a big deal is that- and it was true all over the country, that you could work 24 hours and then there were six additional hours that you could work in which there would be basically a transfer of duties.

Dr. Ryan Gray: That was non-direct patient care.

Dr. Allison Gray: Right, so that's intended- intended to be.

Dr. Ryan Gray: 24 hours.

Dr. Allison Gray: So let's say you started a shift at 6:00 AM, that meant that by 6:00 AM you were done with your clinical duties- the following day I mean. Done with your clinical duties but you had until 12:00 PM (another six hours) which was taken up by transferring duties, and that means presenting at rounds and where you would basically talk about your admissions and patients you took care of overnight and present them to your attending and the other residents.

Dr. Ryan Gray: Finish notes and check labs.

Dr. Allison Gray: Finish notes, exactly. All of your charting, everything. But it's not always that perfect and sometimes there are emergency situations and sometimes you're-

Dr. Ryan Gray: How many times did you fudge your hours just so you didn't get your program in trouble?

Dr. Allison Gray: Oh jeez, I'm going to get myself in trouble. Well I don't want to throw anybody under the bus, but I mean really so you're talking though, right? So 24 plus 6 is 30 so it was a 30 hour shift, okay? And sometimes I would be there 32 hours, 34 hours.

Dr. Ryan Gray: Sometimes you would stay longer so you could sleep before you drove home.

Dr. Allison Gray: Yup, sometimes I was so tired that I would go back to the call room and take a nap. I mean there were many nights in residency that the thought of even entering the call room was not even a question. I mean there was no way I was ever going to see the call room. And part of that was that I was-

Dr. Ryan Gray: The call room meaning a place to sleep.

Dr. Allison Gray: A place to sleep, a place to sit, a place to eat, sleep, et cetera. And part of that was because- you know so in my junior year of residency was actually far more intense than my internship ever was, and it was my first year of neurology residency because I did my medicine internship for a year, and then I had three years of neurology residency. And so as a junior resident running around 24 hour, really 30 hour shift plus, I was seeing consults in the emergency room, I was helping my patients upstairs, I was responding to emergencies, and running all over the hospital, and the emergency room, the ICUs; it was really, really busy. And-

Children During Residency

Dr. Ryan Gray: Did you know any residents with children?

Dr. Allison Gray: I did. And so what's amazing is- I mean that was the most challenging year of my life. It was physically exhausting, psychologically, emotionally taxing just in every way. And I look back on it with a lot of fondness because it made me so much stronger as an individual and I take great pride in that, and powering through all that. But I mean I did go through some dark times during that year, part of the reason because I was living away from you and that was my first year-

Dr. Ryan Gray: ‘You’ meaning me.

Dr. Allison Gray: Yes.

Dr. Ryan Gray: Not you listening.

Dr. Allison Gray: No, “I was living away from all of you!” I was- Ryan and I were separated by geography that year because it was his first assignment and he was in Dover in Delaware and I was a very busy junior resident up in Boston, and it was very, very hard because as Ryan's been saying that support that you want and need so much- even for yourself, never mind for your family and for children, is so important and I was actually living with my parents because we didn't want to pay for rent in one place and then have your apartment in another place, it just seemed silly. And my parents are living in Brookline so I lived with them which was weird as a married person. But we did what we had to but it was- I was really, really blue. I mean it was a hard, hard time. And so then I think well I had a hard enough time taking care of myself, even living with my parents, and people might be like, “Oh my God, why is she complaining?” But it really just more emotionally, it was just hard. But then I think about yes, there were friends who had and continue to have children even during that year as a junior resident.

Dr. Ryan Gray: So they were getting pregnant as junior residents?

Dr. Allison Gray: Yup. So one woman I know she was running around doing that job that I spoke about as a junior resident, you know she was seven months pregnant doing that. I mean unbelievable, unbelievable. And then yes, went on to have her baby and had her baby as a junior resident, and yes you do get some time and you'll get all your vacation time as your maternity leave but I mean just even things like taking care of all the things you need to do if you want to be a breastfeeding mom and pumping milk, and how to do that, I mean you're trying to respond to a stroke page and you're hooked up to a pump.

Dr. Ryan Gray: Did you ever have conversations with her about how stressful and hard, or whatever it was?

Dr. Allison Gray: I haven't. I have talked to a good friend who had a baby in her third year of neurology residency, so it was her fourth year total, last year of residency. And she talks about how challenging it was to-

Dr. Ryan Gray: And that's the easiest year.

Dr. Allison Gray: Yeah, I mean in some ways. Well, I mean every year- yeah I don't know that there was an easy year really in my internship. What was easy- the easiest time in my entire residency was the one month of derm elective as an intern.

Dr. Ryan Gray: Where you went shopping.

Dr. Allison Gray: Yeah, there was one day, oh my goodness. I'll never live it down. They told me I could go, and you know just kind of hang out and wait for consults and it was a light day. But that's very exceedingly rare and that never happened once I went into my neurology residency, my God. But the point is my friend, she- yes she had a baby in the last year of our residency and even then I mean she talked about how it was really challenging to keep up with breastfeeding and doing everything that she really wanted to desperately to do as a mom while also trying to balance these commitment; these major commitments that she had. And that's the other thing that changes, right? So when you go from being a medical student to being an intern, being a resident, you have true responsibility for patients and their lives. And so part of why I wanted to wait until I had completed my residency to have a child was that me personally, I just- I think I am someone who tends to sort of put my needs last. I tend to sort of- and that's part of by the way why it took so long for my Crohn's diagnosis to be made, because I was rushing around, taking care of my patients and I was just so not in touch of sort of what was going on with me physically, I was too busy quite frankly.

Dr. Ryan Gray: And we talked about that a lot- or I talked about that a lot with Dr. Drummond about burnout, and we are either taught or that's just our personality in general, the physician's personality general to put others before ourselves.

Dr. Allison Gray: Right and so the thing is if you have a child at home, you don't really have the luxury of putting- I mean I guess you can put your patients first if you know somebody is there taking care of your child. But I just didn't think I had it in me honestly, to try to figure out how to do that and so I have such enormous respect for my colleagues and friends out there who have had children during residency. And it absolutely can be done. I mean if there are people who used to say, “Well I'll take my elective to have my baby, or I'll take my elective as my maternity leave,” and that happens. People do that, people wait until they finish residency and then spend part of their fellowship having- doing their maternity leave or paternity leave. We shouldn't leave out paternity leave, by the way too, and it's very important and a lot of residency programs do give paternity leave as well for a couple of weeks just as they do in a lot of- in attending jobs and throughout the states, a lot of places do provide paternity leave. But- and a lot of my friends in my class from residency, the guys- their wives had children, their significant other, they had children. But it was a tough thing. None of my class- none of the women in my class had kids, and I think we just- a lot of us shared the same concerns that it's just tough. It's tough, you know?

Dr. Ryan Gray: Alright. So again doable, but hard. You need the support.

Dr. Allison Gray: You need support, more than any other stage I think in your medical training, you need support.

Dr. Ryan Gray: Your time commitment will be the greatest during residency versus medical school and premed.

Resident Responsibilities

Dr. Allison Gray: Absolutely. And again it's that responsibility. As a med student you're responsible but you're really not in a way because you're helping in major ways and contributing hugely to the team, but it's not your name on the line, it's not your- you're not the person ultimately responsible for that patient. And even you could argue as a resident, well it's the attending. But you have a very real responsibility day to day, moment to moment as a resident. Like you said you carry that pager. It's just- it's a key difference. So doable, doable. And if you're out there and you already have kids and you're thinking, “Oh my goodness, they're freaking me out!” Don't be freaked out because at every single stage of our careers we have seen people who are having children, about to have children, already have children who have successfully done this, and it is absolutely doable. It's just I think as we've been saying now a few times, it's planning, planning, planning. Figure out beforehand what you're aiming to do and what you're going to be- who these people are that can help you at every stage.

Dr. Ryan Gray: Yeah. So in the question that Thomas asked, he asked, “Is there any one specialty that is more lax or family friendly than another?” And I think that's how we'll tackle more of the attending side of the question and the story. And there are, there are specialties that are a little bit more lax, and require a little bit less of your time. And I think that's something that a lot of people think about, and something we've talked about. When you're choosing a specialty, is think about the lifestyle that you want to have. Do you want to be on call all the time and need to rush into a hospital to perform surgery or to do a stroke protocol, or do whatever it may be that you're being called in the hospital for, and be pulled away from family possibly. And so I actually pulled up Medscape, we've talked about Medscape before. They have a physician lifestyle report from 2014 that was published in January. And the two most obvious ones on here; ophthalmology and dermatology are the highest reported happiness- the scales of happiness at home and at work. For the ophthalmologists and dermatologists, almost 70% of them are happy at work, very happy at work. And so that kind of makes sense, right? They're typically office based jobs, they do do surgeries- ophthalmologists do, but they're still practicing in the office.

Dr. Allison Gray: Derm too, yeah.

Dr. Ryan Gray: Yeah. Dermatology will do procedures as well, but they're practicing in an office, they're probably not taking call. There are ophthalmologists that take call-

Dr. Allison Gray: But they don't usually have to come into the hospital. They find a way they don't have to come in. It's always hard getting an ophthalmologist to come to the ER, I'll tell you.

Dr. Ryan Gray: Because there are very few- obviously there are ocular injuries that an ophthalmologist is going to come in and need to see. But the lifestyles that you're going to see are the ones where you don't have to go into the hospital. Be called in at a moment's notice.

Dr. Allison Gray: Right like an endocrinologist, I mean there are few endocrine sort of emergencies. There are some, but sort of an endocrine emergency would be like diabetic ketoacidosis. That's a situation where a diabetic- their blood sugar is through the roof and it's very, very dangerous and it's life threatening. But that's something that a medicine- an internist, a trained medical doctor who has like a foundation of internal medicine can do, can handle.

Dr. Ryan Gray: So there's a whole gamut of specialties obviously, we've talked about a lot of them before. But that's where the happiness is going to come in and the family friendly side of the house is going to come in. Is are you practicing in a hospital, are you in a clinic practice, what is your call responsibility, are you carrying a pager or are you going to have to be called in at a moment's notice? And so that's really the ultimate questions there.

Dr. Allison Gray: Well but are you saying then that you can't be happy as a physician unless you have that kind of lifestyle?

Dr. Ryan Gray: No, not at all. I'm saying the question is, “Which ones are the family friendly ones?” And so a lot of people will judge that based on being with family, and also being stressed that they have a pager on their hip and is it going to go off? Are they having the phantom paging feeling and they're like, “Oh, is my pager going off? Oh is it going off?”

Dr. Allison Gray: I remember- actually that's just funny, remember we were in a drug store, this is like a year ago now and a pager went off and I was like, “Oh my God,” and I looked down at my pants and I was like, “Where's my pager?” and I wasn't even on call, my pager was somewhere else, it was signed out to someone. But it was a pediatrician in line behind us whose pager was going off and like, “Oh, PTSD pager.” But I think one other thing- so some of you out there I know are interested in emergency medicine, and some people really like that because it's shift work.

Dr. Ryan Gray: It's shift work.

Dr. Allison Gray: Right and so you know exactly when you're going to be there, you know exactly when you're going to be going home, and-

Dr. Ryan Gray: But shift work is stressful in of itself.

Dr. Allison Gray: Right so shift work- and that's the thing that you know they have these personality tests and actually at medical school they offer those to try to help you figure out what type of specialty you want to go into. But I encourage you to really try to really get to know yourself well and figure out what makes you happy. Because some people are going to love that adrenaline rush and being the one that can get called in, and know that, ‘okay well these days of the week I have protected time with my family, but these days I am absolutely there to practice and that's my focus and everything.' The burnout sometimes can be just that kind of work and an ER can be very physically, emotionally, psychologically very taxing and very stressful. But I think- and then there are things like home call. So that's something else to really understand, that certain specialties have- by nature they're in house call. And then others are home calls. So you might be called from home to urgently come in. And also it really depends on where you are in the country. So if you're in a very rural area and you're the only doctor around, well it's a very different life than if you're in a major city and there are 25 or 30 physicians in your department alone and you share a call schedule. It can be just completely night and day. Maybe, like in my specialty of neurology, maybe you're at a hospital where you're a neurologist on call but you're not going to get called for strokes because they have a stroke specialist who gets called. So there are so many intricacies and things to think about that-

Supporting Team

Dr. Ryan Gray: There's another big one that I thought you were going to hit on, is do you have the support of residents.

Dr. Allison Gray: Oh, 100% yes. And that's something that I learned about recently as an attending, that I came from a system where I was obviously in residency and so had a very team-based- well a team, we had a team. And then as an attending I found that, “Oh, it's just me.” And how different is that? And so my team-

Dr. Ryan Gray: There's still a team with nurses and other people.

Dr. Allison Gray: No, no, no and I don't mean that at all. I mean there's always absolutely in healthcare- you always have a team. You can't- and I say this all the time, you really can't get anything done in medicine and surgery without a team, 100%. What I'm really meaning is sort of the team of doctors working together, because when you're in residency depending on the program, I know in mine you would go out as a team and there would be someone who was handling consults maybe in the ER, and someone who was handling consults in the floors, and partly because they were just such big hospitals that we were at. But maybe you have several residents, and an intern, and some med students, and then an attending; and then yes, all the rest of the team, the healthcare providers you're working with. But shrink that down to one, and sometimes that's the case. If you're the consultant and you're the only person, everything is going to come to you. And that can be very challenging, it's a lot stress and a lot of responsibility, but nobody to also share the exciting parts with. Let me tell you, if you have a really cool case and you look around and everybody around you is like an ER doctor, an ophthalmologist, they really don't care about how you localized a lesion or how you figured out what was going on.

Dr. Ryan Gray: Such a nerd.

Balancing a Specialty with Family Life

Dr. Allison Gray: Well it's, you know. I mean you could say that for anybody. If you're an orthopod and you have this really cool case, and you turn around and a bunch of neurologists who don't know what the hell you're talking about or really don't care. So- but it's I think the major point is when it gets- about your question, it really behooves you to learn as much as you can about a particular specialty, and about where you might be interested in practicing that specialty before you sort of rule it out or decide against it. Because in terms of lifestyle, if you look at it simply as, “Okay well when am I going to be least in the hospital?” Then that's a pretty straightforward answer. But happiness is determined by a lot of factors, and us as physicians we're all different and we all have different needs and different things that kind of make us happy and fulfilled in life. And so that's why the most important thing is figuring out what's going to make you happy?

Dr. Ryan Gray: Yeah, and that goes to his question, “How do you balance such an incredible work load with family life?” And that's so dependent on each person. I myself like to be alone and decompress, and Allison loves spending time with family to decompress.

Dr. Allison Gray: And going running.

Dr. Ryan Gray: And exercise, we can't stress the importance of exercise and sleep as much as you can. So there's a ton of stuff to help balance. Now he also asks, “Have you had any struggles with this?”

Dr. Allison Gray: Wow, and sure. I mean-

Dr. Ryan Gray: Running is one of those struggles, right? Finding time to exercise.

Dr. Allison Gray: Finding time to exercise, making sure- finding time to really prepare food and plan in advance about how- and that seems like a silly thing that you should figure out when you're twenty, but it's not.

Dr. Ryan Gray: You shouldn't be coming home every night saying, “What's for dinner? What's for dinner?”

Dr. Allison Gray: Right, and we have many times have run into- and we'll have period where- and we still do now, we did before our baby, that we'll have times where we're great and we have everything- every meal, every lunch, every dinner, we have planned out and we have Tupperware and we're so proud of ourselves. Then there are nights where for a week we're like, “Oh, shoot.”

Dr. Ryan Gray: Where are we ordering from?

Dr. Allison Gray: Yeah, like which takeout place tonight? And that's never good for you and makes you feel kind of crummy.

Dr. Ryan Gray: It's delicious, though.

Dr. Allison Gray: But you know what, and Ryan and I have been talking about this. Once your child gets to a certain age, they rely on you to feed them food, real food, right? So- and I mean like chicken and fish, and stuff like that. So the idea of, “Oh let's get takeout every night for our baby,” no, no, no, no. Right? So then it's a matter of- at least in my mind, and every parent out there is different. But- so I'm not trying to sound judgy or anything. But I just mean when our child is old enough it's going to be important to me that we try to prepare a wholesome meal, and blah, blah, blah. So again it's that planning, that thinking ahead, that Ryan always tries to drum into my head. And I'm not always the best at it, but it's important. And so yes I think there are challenges at every single phase, but- and as an attending you're dealing with what we didn't mention too, is the last point in my mind, you're dealing with other things that as a resident you haven't really. Which are things like billing and making sure that all of your notes, your clinic notes, are done and making sure that all of your orders are in, and you've talked to the insurance companies, and you've answered all your patient emails and phone calls, and everything else. There's just a lot of different sort of administrative things that you're dealing with. Maybe your teaching duties, you know and I would be teaching a medical student when I was in the hospital working as an attending and have to make sure that they got what they needed. So at every stage there are just different things, and so yes we've had challenges with it but I think you've got to love what you're doing because you'll find ways to just give it all when you're at work and then be able to give as much as you can at home with your family- give it all there too. If you're not happy, if you're not fulfilled, then that's not going to be as easy.

Final Thoughts

Dr. Ryan Gray: Yeah. So Thomas, I hope this podcast and our discussion tonight answers those questions for you, and I know it's an important discussion for many people out there that are interested in medicine but don't think that it will allow them to have the family that they want. And it's not true. It's hard work, but you can have both.

This is probably our longest podcast, but it's an important topic. We're almost at an hour long. So hopefully you're still listening to us. Next week is Session 100, and Allison and I will be talking about some stories that you have emailed into us. We got several stories from listeners like you about their struggles along the way, and possibly how our podcast has helped them, and what they did to overcome those struggles. Because believe it or not, your struggles are likely not unique. There is somebody else out there going through something similar, and hearing what other people are going through and what they did to survive will help you as well; and that's what we hope to do in next week's podcast.

Dr. Allison Gray: Yeah, we've got to break open some champagne, too.

Dr. Ryan Gray: Maybe. Have some bubbly.

Dr. Allison Gray: Episode 100.

Dr. Ryan Gray: Part of why we do this is knowing that we're reaching people. And we get emails all the time and we get reviews, and we just hit 208 five start reviews and ratings in iTunes for the US, and seven in Canada now, that's awesome. And if you haven't yet, go to www.MedicalSchoolHQ.net/iTunes, it takes literally two minutes to go in and leave a rating and review. And it just brightens our day; Allison and I will say, “Oh did you see that review that came in?” because we get an email from it when we get it, and it's just amazing. So I want to thank a couple more people here that left us reviews, five star reviews here.

Jermxhtfdrh says, “A guiding light. I've been listening to this podcast for the past year and it has done so much for me. I am more confident, less confused and more motivated to conquer my dreams. Thank you so much.” That's awesome.

Dr. Allison Gray: Yeah, thank you.

Dr. Ryan Gray: That's exactly why we do what we do.

Dr. Allison Gray: Absolutely.

Dr. Ryan Gray: Not_an_angry_bird says, “Ten out of ten, would recommend.” That's awesome.

Dr. Allison Gray: I love that name.

Dr. Ryan Gray: Not an angry bird.

Dr. Allison Gray: And thank you for that review.

Dr. Ryan Gray: Is that copywrite infringement?

Dr. Allison Gray: I don't think so. I don't know, I don't know anything about that.

Dr. Ryan Gray: EastCoastPremed says, “Awesome podcast, I love listening every week.” That's from one of our Canadian friends up north.

Dr. Allison Gray: Yay!

Dr. Ryan Gray: Maybe he's from Quebecois.

Dr. Allison Gray: No, maybe he's from Quebec.

Dr. Ryan Gray: What's Quebecois then?

Dr. Allison Gray: Quebecois is someone who is from Quebec.

Dr. Ryan Gray: Okay, now I get it.

Dr. Allison Gray: I need to take Ryan up to Montreal, I will. He needs to visit.

Dr. Ryan Gray: MClark1988 says, “Helpful, great podcast. Would be nice if there was more Canadian information, but otherwise awesome.”

Dr. Allison Gray: And we need to just say very briefly that we are working very hard to try to really bring that information to you in an updated way. So we have not forgotten that request, we've had that request a couple times, and we are really trying to get that together for you guys. So keep your eyes open, or keep your ears peeled- eyes peeled.

Dr. Ryan Gray: Eyes peeled. Ears open, eyes peeled. Eyes open. Either way. So those four five star reviews are awesome, thank you. www.MedicalSchoolHQ.net/iTunes to leave a review.

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What else do you have Allison? A parting word of wisdom?

Dr. Allison Gray: Parting word of wisdom? Well I guess- actually so Episode 100 comes out before Halloween, I was going to say have a safe and happy Halloween but I'm like way too early. It's only the beginning of October-ish. No I'll just say my parting advice is good luck to you, whatever stage you're at on your premed, medical school, residency journey toward becoming a physician. And keep plugging.

Dr. Ryan Gray: Yeah, and as always, I hope you join us next time here at the Medical School Headquarters.

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