When I was in my second year of ID fellowship making that decision not to pursue a third year of training, I diligently read about what to look for and what to avoid when searching for that first job out of residency/fellowship. I did not want to make any grave mistakes.
Ha!
After carefully researching, searching, and clearing things with my lawyer I found myself with a three-year contract to offer infectious disease consultation services at a midsize trauma center community hospital. I began to mentally prepare myself as the geographic location, what I would thenceforth call “my village” or “the tundra”, was not at all desirable to me. My goal for those first few years out of training were to “get out there, meet people, socialize, date, marry, etc”, things that had been on the back burner. It ended up being the nightmare I feared not only because I didn’t desire to be there, but also because nothing went according to contract.
Where to begin?
They were two hospital employed physicians looking for a third. It was to be mostly hospital based consultations. There were some rehab centers in town, I was told, but I didn’t have to go if I wasn’t interested as they were not part of the hospital system employing me. There was a wound clinic if I was interested. They dabbled in it a bit. There was also infection control with a nifty data mining surveillance program which they truly hoped I would get involved in. None of this was on paper. There wasn’t a lot of HIV but if I were interested, and I was, they would arrange for me to have office hours at the Ryan White center in town. This I made them put in my contract. That was the story as told by the one physician who interviewed me.
I wasn’t keen on being on call every 3rd weekend. That’s just too frequent. I learnt inadvertently that they were actually looking to hire two physicians so I read in between the lines and understood I could potentially be on call every other weekend for a while. I made my peace with that thinking I was so clever in decoding that which was not explicitly stated. I even made them spell out in my contract my one-in-three weekend call. I wasn’t keen on infection control, but if that’s the one thing they kinda really wanted me to get involved with, I guess I could start learning infection control, I figured.
So imagine my surprise when come June when I go back to apartment hunt and get credentialed I get welcomed to my “solo practice” by the occupational health physician and other strangers. I was so disappointed when later on that visit, I inquired and found out that since signing my contract two months earlier they had lost their two physicians and I was indeed solo. I was angry that all this time, nobody had the foresight to let me know. In hindsight, I never forgave them for the deceit. There was no foundation of trust. At the time though, I was just unhappy knowing that I couldn’t do much as it was already June and I needed to start working pronto. My private student loans previously in deferment were increasing now in forbearance and I needed to start making payments. My immigration status also did not avail me the luxury to look for a different job this late in the game.
So, I convinced myself that God wouldn’t put me in situations I couldn’t handle. But honestly, me? Solo? Right out of training? I was not pleased. I lost any bit of trust I may have had in the administration right away. And trust me, I already knew from my research not to trust the bigwigs in any hospital system.
Before I started the job, the hospital had found an infectious disease physician from about two hours away to come periodically to handle some of the infectious disease consults in the interim. The rest of the work fell on the hospitalists and pharmacists. This visiting ID physician oriented me then came no more. He had his own busy private practice to attend to. I can’t blame him.
For the hospital, my arrival was much anticipated. I was a very welcomed sight. Immediately, I was bombarded with requests for meetings from pharmacy, various nursing staff, and various medical committees. Not to mention all the infectious disease consultations that were coming my way. I was overwhelmed to say the least. Initially, I pushed back informing all that my priority was taking and passing the boards slated for October. After that though it was a free for all.
Essentially, I found myself the medical director of infectious disease and the chief of the infectious disease department. In conjunction with pharmacy and infection control, I started an antimicrobial stewardship service and recorded many successes. The responsibilities and the meetings just kept piling up but I took it all in stride. At least I think I did. The hospital rushed to hire a second physician who ended up being so very different from myself. Sigh! Together we hired a third a year later.
In that first month of finding myself solo the hospital administration had the audacity to ask me if I would be willing to go see patients at some of the rehabilitation centers in town. Mtcheeew! I respectfully declined. Were they honestly seriously asking me to do more? I shook my head and let things roll.
In the first few weeks, I was pressured to see a few pediatric consultations because there was no-one else. I felt bad for the children so I saw them in consultation. But after being asked to see a 3-week-old formerly premature baby in the NICU I let administration know enough was enough. I wasn’t a pediatrician after all and the bottom line was that it was my license at stake and I had my whole career in front of me. You would think that would have been the end of that. But no, I spent the whole three – four years that I was there defending my decision not to perform consultations on children.
Seriously, didn’t I make that decision in medical school when I decided to pursue internal medicine and not pediatrics? At one point, a couple of years in, I was sat in a meeting with a couple of physicians turned hospital administrators. In a humiliating session, they drilled me about my refusal to consult on children. These old white men puffed and huffed that they weren’t trained in pediatrics either in their various specialties but back in their day they “saw all comers”. Mtcheeeeeew! I reminded them that it wasn’t the 1800s anymore. Okay, well I didn’t use those exact words.
But seriously, as a young younger-looking dark-skinned Black woman with an accent I’m already being received with skepticism when I approach adult patients and tell them in as many words to trust me in what is my area of expertise. Why then would I ever want to place myself in a position where I truly have no clue? Why would I want to tell the parent of a three-year old child with fever that I am “the infectious disease specialist”? Even if I gave the disclaimer that I’m an adult physician with no pediatric training, the parent is still going to hear “expert” and that’s what they deserve. It is 2013. Pediatric infectious disease specialists exist. The hospital should invest in one if they care about their patients!
I was stubborn about many other things too. These were not the things I negotiated in my contract, see?
I continued to refuse to go to rehabilitation facilities. In my mind I took this job, despite it being in the tundra because it was a single-center hospital employed position. My contract said nothing about other facilities except for the Ryan White HIV Clinic that I had requested office hours in. I gave up job opportunities in sunny southern states simply because they required driving around town rounding at multiple hospitals in a single day. Why would I now choose to round at multiple hospitals here in the tundra risking my life each time I hit the icy roads? Am I crazy? Mtcheeeeeeeew!
Early on, physicians including the hospitalists expected me to admit patients. Apparently, the infectious disease physicians who preceded me, who had been there for decades, did so at times. No! I was here for consultative infectious disease and consult I would do. Most infectious disease positions do not include admitting duties so again, why would I come to this village tundra to admit my own patients? Mtcheeeeew!
I did not appreciate being asked to be a dermatologist relentlessly. Mtchew! But I would see those patients, offer my best opinion as infectious disease, and add “get a dermatology consult”. The option of being involved in the wound clinic began to be posed as less of an option. I was constantly being asked to start a hyperbaric oxygen program. Not only had I no experience in hyperbaric oxygen, I have never had interest in learning wound care nor hyperbaric oxygen. Neither was part of my scope of training. Both would have required taking additional courses.
Then, the gastroenterologists decided they no longer wanted to run the hepatitis C clinic. They rather do procedures. $kaching$. So they laid hepatitis C at my feet. And again I resisted. Like many ID physicians I did not know hepatitis C. Furthermore, I was not interested in self-learning hepatitis C and experimenting on patients. By the way, what happened to the HIV clinic promised to me that I was yet to step foot in to see patients? Mtchew!
Then there was the administrative duties. Writing and rewriting policies that nobody was following. Mtchew! Meeting with people doing things wrong in an effort to correct them and nothing changing. Addressing the education gap needs of the medical staff by spending countless hours on Grand Rounds presentations that less than 1% of medical staff actually attended and then being asked to repeat a presentation over and over again because “it’s not getting out there”.
Ah-ah, I cannot keep repeating myself like a record player, oooh. We are all adults right? Why can’t a physician wash his hands before and after seeing a patient? Why do we need to spy on them? Why is a physician arguing with me as to whether he can wear his disposable booties from the OR to the bathroom to the cafeteria? Yes indeed, your poor surgical skills truly are related to your high infection rate. Abah! All these grown men acting like babies with their whining and moaning. When did I sign up to be a kindergarten proctor? Mtcheeeeeeeeeeeeeeeeeeeeeeeeew!
It was just all too much all at once. It felt like they wanted to bleed me dry as fast as possible. It was just a battle day in and day out with the good days being the ones where I was just allowed to take care of patients.
I haven’t even begun to scratch the surface in retelling the story of how diligently searching for a job landed me in this mess. I haven’t even mentioned the part where I was paid the equivalent of $250 per weekend call, yes Friday noon to Monday 8 am, that I did extra because I was solo and then one in two, rather than the one in three weekends spelled out in my contract. Can you imagine? NONSENSE! Not even a cash strapped medical resident would accept that pitiful sack of pennies for a weekend of work. Mtcheeeeeeeeeeeeew! I felt no respect. ZERO. And then they honestly thought they could convince me to stay when I announced my resignation? I wouldn’t be surprised if they find themselves with zero infectious disease doctors again.
All this to say that in searching for my next job I couldn’t care less about what was in the contract. Clearly, it didn’t matter!
Mtchew!: “sucking one’s teeth” or “kissing one’s teeth”; indicates annoyance or disapproval
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