My favorite pastime growing up was reading. I was the kid that looked forward to the summer reading list. I usually made my way through the list and read a few more. Each summer, I would challenge myself to something different… How many books could I read? How fast could I read one book? How many books could I read at the same time? (I’ve done five, but 2-3 is a more workable number).
Generally, I have always preferred fiction since it allowed me an outlet from my everyday life. I enjoyed the sense of adventure, the sneak peek into others’ lives and their trials and their triumphs. If I have to pick a specific genre, historical fiction would be my favorite. But I’ll read just about anything. As an adult, I am always reading something, though depending on my work schedule it takes me considerably longer. During residency, it was not uncommon for it to take me the better part of a year to get through one book. I often had to go back and re-read passages due to the infrequency of my leisure-reading schedule. (I should be clear; I did plenty of medical reading!)
It should come to no surprise that when I found myself at a transition point, I turned to my old pastime for guidance. (Though an avid supporter of the public library, it became increasingly difficult to get the books back on time…) I went into a local bookstore chain and walked through the aisles, looking for a title that jumped out at me. I found several books, sat on the floor and leafed through them until I settled on 4-5. In the past two years, my tenacity for reading has been re-energized. I have not reached to 60 books a year (or whatever the number is that successful leaders are supposed to read), but I’ve enjoyed this part of my journey. As you can notice from the list below, more non-fiction has crept its way into my life… I think I lost track of a few and these are in no particular order, but here’s my reading list for the past two years or so.
Fiction
The Cutting Season Attica Locke
River, Cross My Heart Breena Clarke
The Twelve Tribes of Hattie Ayana Mathis
Lazaretto Diane McKinney-Whetstone
Happily Ever After Elizabeth Maxwell
Non-Ficton
Blink Malcolm Gladwell
I don’t know what I want to do, But I know it’s not this Julie Jansen
The Tipping Point Malcolm Gladwell
Drink More Whiskey Daniel Yaffe
The Bogleheads Guide to Investing Lindauer, Larimore & LeBoeuf
The Art of the Bar Hollinger & Schwartz
Lean In Cheryl Sandberg
Outliers Malcolm Gladwell
Real Estate Investing McGraw-Hill
The 4-hour Work-week Timothy Ferriss
The One Minute Millionaire Mark Victor Hansen & Robert G. Allen
1000 Dollars and an Idea Sam Wyly
When Things Fall Apart: Heart Advice for Difficult Times Pema Chodron
There are many articles/books on financial well-being. I am a novice and I don’t have anything earth shattering to impart here. I would refer to the experts to tailor a plan to your exact needs. However, for me transitioning to a nomadic existence required some amount of fiscal forethought and I wanted to share that part of my journey with you. Essentially, saving is not too unlike dieting. Diet = less in, more out. Saving = more in, less out. Both require discipline and a small amount of sacrifice for an ultimate long-term benefit. My habit of saving allowed me to have the confidence to feel comfortable pursuing a career doing locums and is also allowing me to volunteer in Kenya this fall.
I’ve always been debt adverse. I don’t like to owe anyone, anything. I’ve also known I wanted to be a doctor since a young age, so I started planning for college and medical school in middle school. (Yes, I know…) I knew my parents could not personally finance my education and I knew I did not want to accumulate a mountain of debt that was common with medical school graduates. So, I set a goal to apply for and receive as much scholarship assistance as possible. Therefore, I finished medical school with only a modest amount of student loan debt compared to the mortgages some of my colleagues acquired.
I enjoy saving. However, residency training does not lend itself well to aggressively saving. But, you can manage your spending to create minimal credit card debt. During my fellowship year, I started actively saving. Each month I siphoned off at least 25% of my check into a savings account. I deferred my student loans, but I paid off the ACOG HELP loan that I applied for and received my fourth year of residency and I made the minimum payment on my credit cards. I bought a car my first year of residency. I had a 60 month lease, meaning I paid it off the last month of my one-year fellowship. I did not then, nor I have I since, bought a new car.
After starting my first job, I continued saving. I was paid bi-weekly. From one check I transferred 25% to my short term savings account and from the second, I transferred 25% to my long term savings account. I set up automatic payments to cover the minimum payment to my student loans to avoid any fees or an increase in interest rates due to missed payments. After I covered my monthly expenses, I used whatever I had left to pay-off my credit card debt. Once I paid off my credit cards, I doubled, then tripled my student loan payments, making sure the additional amounts were applied directly to the principal.
Remember my two savings accounts? Once the short-term account balance equaled my student loan balance, I paid it off in a lump sum.
Voila! Debt-free!
I continued to grow my long term saving account until I felt it could cover me for at least 6 months if I were unemployed.
Take Aways:
Establish a habit of saving.
Pay off timed loans first, high interest/credit card loans second, low interest/student loans third.
Be a Realist. Understand your financial strengths and weaknesses.
Minimize non-essential spending, but still enjoy life.
For the past year, I have had a recurring assignment in Norway. Norway, Maine that is…. Norway is a small town about one hour northwest of Portland. It’s nestled in between other European treasures like Poland and South Paris. The people here are genuine and inviting. Last July was my first time spending any time in the state of Maine. I was promised that the summer would lovely and that it would be beautiful in the fall. A promise fulfilled.
My first impression of the practice here was that everyone liked their job and liked their co-workers. Now remember, one of the benefits of locums is that we often get to stay outside of the office politics and personality dynamics. Nevertheless, in the year I’ve been here, I continue to feel the same positivity I felt on my first day. I imagine some of that cohesiveness is due to the longstanding leadership of the department. The practice is busy but works to provide the ever elusive work/life balance for all the employees. Everyone seems just as happy in their home life as they do in their work life. The people here seem to be living their best lives.
One such example is Carolyn Costanzi. Dr. Costanzi is a compassionate, no nonsense Ob/Gyn, wife, mother and rock star! She knows all her patients and their families by name, gives straightforward and honest care, loves to hike, knit and sing! The Cobblestones formed in 2015 and have been playing together across Southern Maine ever since. She is the vocalist for this band composed of a guitarist, bassist and occasional pianist. As physicians, we often wonder how we can accommodate our interests outside of medicine when our careers tend to consume all of our time and then some. Today, we’re going to find out how Dr. Costanzi makes it work.
Tell us about yourself.
I met my husband, Carl Costanzi, while working as a lab tech. He was completing a PhD in biochemistry at Hahnemann University (now Drexel). We had two children together (Nick, during my first year of med school…oops and Daniel, during my second year of residency). Carl has a son from his first marriage and so I am also a stepmom to a third son, Ben. I completed my medical training in the Philadelphia suburb of Abington, PA and stayed there for over a decade as an attending. I really wanted to return to New England and so my whole family moved here in 2004. I searched for a rural practice with good quality of life and Norway, Maine was everything I wanted. My husband graciously gave up his career as a researcher at University of PA to start a new life in rural New England. He is a native Pennsylvanian, so this was a huge change for him. He loves Maine now and neither of us can ever imagine leaving.
When did your interest in music start?
I grew up in rural Massachusetts in a big family. The focus of our family was on academic excellence and not so much the arts. Music was a “hobby” that took a back seat to athletic and academic success, so my love for music and singing was confined to school projects and community theatre. I actually didn’t make the try-outs for chorus in the third grade because I wasn’t a soprano…when I tried out the following year they felt bad for me and let me in. I sang with the boys frequently and took boy’s parts in musicals! Music took a huge backseat from college until about six years ago. Suffice it to say that’s a LONG time! I completed college, medical school, residency all while raising a family, and that left no spare time for outside interests like music. I have always been appreciative of music and as a family we valued going to musical events, listening to music at home and nurturing our sons’ desires to learn instruments.
Please describe your band and its members.
Over the past few years I would attend open mic events in the Norway area with friends and sing from time to time. Very casual and nothing too formal. I met Mike Plourde (my guitarist and co-founder of The Cobblestones) in 2015 at an open mic at the former Tucker’s Pub in Norway. We both just happened to be there to listen to music and to play a little. Mike has been a musician since childhood and has played from time to time in various bands. He spoke to me at the open mic after I sang with a friend and after he performed solo. We started communicating via e-mail and that was the beginning of our music collaboration. We just seem to have voices that blend well, we like the same music, we are both perfectionists and he is an amazing guitarist. We thought we would just mess around and go to the occasional open mic, but we started getting asked to play and things just took off from there. We now have a keyboardist (Danielle Tran, a pediatrician), a bass player (Ken Lloyd) and a drummer (Mark Plourde). We all have “day jobs” but somehow find a way to squeeze in second careers in music. Probably because it’s addicting and keeps us sane! I never thought I would actually form a band and get paid to do something I love so much. It’s like a dream come true! We have started writing original music, which is something I’ve always wanted to do. I write the lyrics which is right up my alley since I love poetry. We also made a demo CD together at a recording studio in 2016. CHECK another thing off my bucket list!
How do you balance your medical career, family and your commitment to music?
My children are grown and my nest is almost empty. I have no little ones to cook for (most of the time), and my husband and I are free to pursue our own interests now that the boys are grown men. I can selfishly use all my spare time pursuing music, and I do it without guilt; I have earned this opportunity. I practice with the whole band once a week and try to sing almost every day on my own for an hour or two. We play gigs two-three times a month and most weekends. I also manage the band financially and book most of our gigs, so I spend a lot of my spare time on these tasks, which I do with pleasure.
Singing is something I can do into very old age. Music brings such happiness to folks’ lives and lucky me if I can be a small piece of that happiness. I plan to be 100 years old and singing to all my peers in the nursing home.
What advice do you have to other physicians who struggle to maintain interests outside of medicine?
I was not great at balancing when my children were young, especially because I chose the specialty of OB/GYN. It is a career of chronic exhaustion, which makes it not for the faint of heart. My husband is incredibly supportive and we have always co-parented equally and without any gender lines. I have had to learn the importance of taking whatever time I can for myself in order to stay healthy and to protect myself from the stress of medicine. I truly endorse that scheduling time for yourself has to be of the same priority as taking the kids to doctor’s appointments, cooking meals and caring for patients. If we as physicians, we constantly put ourselves at the bottom of the list of priorities, we suffer. I have also learned to say “no”. No to family stresses, excessive work-loads and social obligations that are more than I can handle without compromising my health and well-being. It took me years to decline work or tasks that I thought I would be judged for not doing: once I got past that guilt of disappointing someone, I felt pounds lighter.
This is my advice…take care to place yourself occasionally at the top of your to-do list. Eat healthy and go after your outside interests. Do not let medicine consume you. Let it be one part of who you are.
https://www.thecobblestones.net/
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I recently posted about physician burnout and what role the system plays in our overall satisfaction with our careers. As professionals, we are trained to handle complicated medical situations, as Ob/Gyns we often deliver news that affects two patients. Counseling a woman through a stillbirth or fetal demise never gets easier. In discussing one such patient in a meeting a few weeks ago, the office social worker asked, what do we do to cope? To whom do physicians talk to manage their stress and emotions during difficult times? I must admit, as a group we do not prioritize this area well. Too often, we hear of physicians who abuse drugs and alcohol or even commit suicide when the pressure to perform, to strive toward perfection gets too great and the support is not enough.
While doing locums full time, my friend graciously offered to house my belongings in her basement. She is a psychologist working specifically with undergraduate and graduate students. With any highly regarded university, that produces excellent graduates and professionals, students arrive on campus highly motivated and prepared to succeed. To say the least, the demands of college curriculum can be daunting. Across the country, medical school admission standards are high and require disciplined study habits. As physicians, most of us were once these same ambitious college students who kept late hours, ate erratically, exercised infrequently, not placing enough emphasis on our personal well-being. These habits we create while training are often the habits we continue when practicing. These habits are not always healthy or easily broken.
Today, we talk with Dr. Leslie Leathers about the mental health conditions she believes are particularly pertinent to young professionals, warning signs and viable coping mechanisms. As we spend most of our days caring for others, it is just as important to dedicate the appropriate time and attention to ourselves.
Tell us a little about yourself.
I am from North Carolina originally, and growing up in my Black American, middle-class, Christian family, certain values were instilled in me. Values most pertinent to our topic today include the pursuit of formal education, collectivist ideals, and helping others. These values were a natural fit with the field of Counseling Psychology with its emphasis on helping people improve their quality of life while acknowledging and respecting multicultural realities. I moved to Baltimore for my job doing psychotherapy with university (undergraduate and graduate) students. This position entails a specific focus on supporting students of color. It’s a privilege to be able to support students as they begin to navigate young adulthood. As a woman of color who benefited from wisdom and guidance of professionals who came before me, it is particularly gratifying to be able to provide support to students of color as they pursue their higher education goals and work to improve their quality of life, both in the short and long-term.
In counseling professional students, are there any common themes that you can address?
One theme that leaps to mind is the pressure to succeed and secure employment in academia where job applicants far outnumber available positions. Another theme is learning to manage (what are often) new levels of stress adaptively.
For friends and loved ones, are there any warning signs that indicates someone needs professional support?
Significant changes in ones’ behavior may indicate the need for extra support. For example, increased irritability in someone who usually is easy going or social isolation from someone who typically is outgoing and social. Someone could begin shirking responsibilities or, alternatively, one could start taking on more commitments in an attempt to distract oneself from one’s experience of distress. Additionally, one could experience distress somatically and emphasize physical aches and pains. A more complete list of potential signs may be found at
Different cultures intersect with mental health differently and recently, conversations around racism, mental health and self-preservation have been more common in popular media and on college campuses. How has your work contributed to increased awareness and strengthened relationships across campus?
There does seem to be a groundswell of momentum to acknowledge and redress patterns of inequity. My own direct work with, and indirect work in support of, students who represent diverse backgrounds has benefited from this momentum. One thing we know from research is that students who feel marginalized within a campus environment can benefit immensely from having distinct spaces that are affirming of their marginalized identity/ies. My work contributing to such spaces on my own campus have been among my most valued work experiences to date.
What resources do you recommend for someone who is feeling overwhelmed?
Well, being a psychotherapist, who at various times in my life has also been a therapy client, I wholeheartedly recommend therapy. A couple of good resources for assistance identifying a therapist are
That said, there are a number of other strategies one might try. For instance, engaging in regular self-care that nourishes the important parts of oneself is often helpful. Prioritizing commitments and determining the limits to one’s control within a specific circumstance may help alleviate excess pressure that can lead to feeling overwhelmed. Although it is often hard to do so, it can be very helpful to remember that we are all human and doing the best we can considering the resources and knowledge available to us at a given time. If we’re feeling overwhelmed, that may just be a signal that we need to improve our existing resources/strategies or try to acquire some new ones. Here is a link to a list of apps that could be useful in bolstering or adding to existing strategies for managing distress:
Finally, social support, whether from one’s best friends, gym buddies, spiritual group or leader, family, etc. can help one feel connected to a community and/or to something(s) greater than oneself. None of the aforementioned resources/strategies are mutually exclusive and there often is a process of trial and error in figuring out what works best for you. So, if you find that one strategy or combination of strategies does not work for you, know that it may take some time to identify your own unique path to good mental health maintenance.
When you envision the classic American TV doctor from yesteryear, what do you see? An older man, with silver gray hair, dark suit, white coat and doctor’s bag right? He was a solo practitioner who worked long hours, made house calls, neglected his home life and garnered respect by the entire community. Popular culture depicts a younger, more diverse workforce in medicine, with complicated personalities, drama filled personal lives, who save the day at the end of every episode.
The constants across the decades remain; doctors feel called to do work that requires self-sacrifice. Most physicians I know, will always put a patient’s needs before their own (yes most, not all). We stay late, come in early, miss lunch, skip bathroom breaks in order to take care of our patients. We take charts home (now, electronically), read medical literature in bed and neglect our own physical health. The reward of this self-sacrifice is creating the ideal environment for patients to seek and receive the best care. Another constant that draws us into medicine is the possibility of autonomy. Having autonomy is at the core of being a physician. Many of us are natural leaders. We want to be the pilot, the quarterback, the conductor. We thrive from being captain of the team. We want to make the final call, have the difficult conversations and shoulder the responsibility when things go awry. Every captain requires a good team. And, we all know team work makes the dream work… 🙂
The changing landscape of medicine is altering the composition of the team. I’m not the biggest fan of the word hierarchy, however we cannot ignore that it has historically been a large part of medical culture. This changing landscape is far removed from the solo practitioner who only answered to his/her patients to top down decision making from large health systems and accountable care organizations. I hear more and more physicians describe increasing requirements of outpatient office visits and surgical cases. Complaints of complicated coding and long nights charting after hours in the EHR (electronic medical record). Meetings discuss decreasing overhead and maximizing reimbursement. Don’t get me wrong. These things are important. Our national healthcare expenditures have to be reeled back. However, in this transition, it seems our title as captain has been stripped away. Many feel more like factory worker #226, as there are days when we feel like cogs on a wheel churning out patient encounter after patient encounter. These are the days when we return home feeling defeated, feeling burned.
I feel incredibly concerned about our profession as younger and younger physicians describe the symptoms of burnout and contemplate leaving medicine. As I travel around the country, the shortage of physicians is palpable, what happens if we cannot retain or recruit future physicians. The system needs to change. Change is not bad. Change is necessary. This change requires us to redefine ourselves in this new system. We have to reclaim our title as captains. We need to harness our innate abilities as teachers and leaders. We need to use our voice to advocate for our patients and ourselves.
When I had my phone interview for my assignment in Guymon, OK, I was told the patient population there was very diverse. Now, I had never been to Oklahoma before, the panhandle was especially foreign to me, but I must admit that statement caught me by surprise. When I arrived, I was surprised again. Guymon is home to a very large, very diverse immigrant population. Seaboard, a pork packing and process plant, has attracted an influx of foreign-born workers into rural America.
One of the teachers I met at the YMCA (I try to join a local gym when I can) invited me over for dinner one evening. Not only did she teach fitness classes, she also taught at the one of the elementary schools. She discussed with me how much the demographics of the town had changed over the past twenty years and how those changes impacted the local educational system. For me in the clinic, we treated women from Guatemala, Laos, Eritrea, Ethiopia, Somalia and Sudan. Most of us who have practiced in any of the major cities have encountered a growing Spanish Speaking Obstetric population especially, however in Guymon, some of the Guatemalan women didn’t speak Spanish, they spoke Keche, a native Guatemalan language.
In addition to negotiating the language barriers, which at times required two interpreters, each culture approached interactions with medical providers in a different way. Some women embraced the historical patriarchal framework of medicine, they did not participate in decision making, said yes to all recommendations, never missed an appointment and seemed genuinely grateful for the care they received. Others felt our way of practice was rigid, rejected most recommendations and appeared more bothered with our care than appreciative. For example, on the first day of my second stint in Guymon I was briefed about the patients due in the next month. One patient, by our dating was at least 2 weeks past her due date and refused any intervention. She arrived to her appointment with me, I again reviewed our recommendations and detailed the possible consequences to expectant management (i.e. wait and see…). Her husband responded, “it will be fine, don’t worry.” So I wrote my note, prayed on it and tried not to worry. And guess what? It was fine. She delivered a healthy baby a week later with no complications. Will this always be the outcome? Of course not. However, it reinforced my role in the situation. My role was to explain the options and then respect her autonomy.
Today we talk to Megan Furnish, one of the staples of the medical community, a labor and delivery nurse turned midwife in Guymon, OK.
Tell us about yourself.
Originally from Walsenburg, CO I came to Oklahoma Panhandle State University (a small college in tiny Goodwell, OK just 10 miles outside of Guymon) and started the nursing program. I graduated with my ADN in 2002. During my time at OPSU, I met my husband Jake of 12 years, whom was born and raised in Guymon. We were married in 2005, at which time I also graduated with my BSN. In 2007, we had our daughter Claire followed by our 2 sons Cooper in 2010 and Colten in 2014.
How did you decide to go into Nursing? Midwifery?
Starting college @ 17years old I wasn’t really sure what I wanted to do in life, but becoming a doctor had always sounded like a good plan. So my first year of classes were focused on fulfilling the Pre-Med pre-requisites. During this time, I realized the extensive requirements to becoming a doctor. I could not at the time see how these would fit in very well with my goal to get married and have children some day so I decided on Nursing instead. The 2 year program was appealing & it was along the same line as my original plan. I had no idea what it really took to be a nurse or the in’s & outs of this position.
With this being said, I absolutely hated every part of nursing school except for L&D. I probably would have quit but I’ve never been a quitter so this wasn’t an option. I toughed it out and made it my goal to work anywhere I could in L&D. This proved quite challenging because most hospitals want L&D nurses with prior experience and are very reluctant to take on new nurses in this area including the hospital in Guymon. So I drove 1.5 hours to Dumas TX to get my year of experience then returned to Guymon as an “experienced” L&D RN. I went on to complete my BSN in 2005 while also working full time.
As an L&D nurse I got to see the good, bad and the ugly. I was amazed at the variation of care provided by different doctors but one thing always seemed to be lacking, patient autonomy. Very rarely was the patient asked what they wanted their experience to entail, mostly they were told this is what we are going to do. It bothered me…. a lot. “We are going to break your water now” or “You need an epidural”. So as a nurse I strived to make the patient experience as autonomous as possible yet I could only go so far. You see there is great power in a provider saying this “is what you need”, so I decided to go back to school. With two small children (Claire 3 & Cooper 1) going to Medical school was not an option so an online Masters in Midwifery it was. Another driver to my going back to school was the constant challenge of maintaining OB/GYN providers in our community. Over my years here we have seen 9 delivering providers come & go.
How has Guymon changed since you’ve lived there?
Over the 17 years of living in Guymon, I have watched it continue to grow with unique populations of people from all over the world. More and more restaurants and stores are offering diverse foods, products and supplies. Although I did not live here prior to the packing plant, community members frequently converse about the changes Seaboard has brought. Some embrace the thriving growth while others reminisce of the old days.
What are the unique challenges and rewards from working with such a diverse population?
The unique population and differing patient cultures are just two of my favorite things about my job. It is so intriguing to me to learn how women & families experience childbirth differently. They bring extreme variations of beliefs around why things happen and who, or what is ultimately in control. The views of religion, hot/cold, witchcraft and superstitions, just to name a few, are huge factors brought to the table when caring for Non-American patients. Sometimes, these beliefs, conflict with, and even contradict modern medicine proving to be quite challenging and eye opening for our practice.
Is there anything you wish you would have known or would have done during your training now that you’re in practice?
Having worked with the diverse population here in Guymon for many years as an RN prepared me well for the challenges I would face as a CNM. I have learned to become somewhat fluent in Spanish which has proven very helpful. If there is one thing that I wish I could have learned, it would be to speak the 25 other languages used in our communities 🙂
Sunsets in Guymon:
Sunset Park, Guymon, OKSunset from the Hospital ApartmentLeaving Guymon, headed to my next stop
*** As part of blogging, I will highlight people and places that have been important to my journey. Here’s my first “interview”.
New Orleans, LA
New Orleans has been a city near and dear to my heart since the spring break my family drove the ~12 hours from Louisville to visit an aging aunt in Tangipahoa, LA and stopped in New Orleans for a few days. Though at the time I had sights on attending another college, all roads led back to Xavier University of Louisiana. I made life-long friends during my time there and gained the foundation I needed to be confident about pursuing medical school. When one of these life-long friends called me upset and crying during my Emergency Medicine Clinical Rotation in September 2005, Katrina became even more real for me. She was fortunate; she made it out to her family in New Roads, LA. But, as the nation watched, many had nowhere to go and no means to get out the city. When I first started doing locums, I attended a conference in New Orleans, where Lt. Honore, the commander of Joint Task Force Katrina, gave a keynote address in which he addressed the helplessness of the people of the city and lack of infrastructure to support them.
Photos from the NAHSE (National Association of
Health Executives Meeting) New Orleans, LA 2015
My goal here is not recount the events of Katrina, but to set the stage for my interview today. When we discuss the social determinants of health, one of, if not the most important one is education. For the past eleven years, my friend whom I mentioned above, has worked in New Orleans as a social worker in a nationally recognized charter school. She is also raising a six-year old, which also challenges her to exam the school system in a different way.
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Tell us about yourself.
My name is Patrice Hammond. I am married and a mother of a beautiful 6 year old girl. I’m originally from the small town of New Roads, Louisiana (112 miles west of New Orleans). My first move to New Orleans was in 1998 to attend college. I lived there for 4 years and moved after graduation. I moved backed to New Orleans one week before hurricane Katrina (2005) because the city had stolen my heart. I am a school social worker at KIPP Believe College Prep.
You were affected by Hurricane Katrina, how did it change your life personally and professionally?
I didn’t know a hurricane was coming because 2 days prior, no one was really talking about it. I happened to catch the news on a whim Saturday morning before the storm hit. I have always been terrified of bad weather. Once I saw the mayor of the city on TV asking people to evacuate, I immediately packed a bag with two days worth of clothes in it (these things don’t last long right? At least that’s what I thought). I went and filled my car with gas. The lines weren’t long. I made the 90 minute trip to my hometown with no traffic on the road. As the day went on, the predictions became more dire. Monday the storm hit. It didn’t seem to do much damage. People in the city thought they had dodged the big one once again. Some hours later the levies broke and that’s when all hell broke loose. The images of the city whose people I loved were horrific. Cell phones were not working. I didn’t know if my friends were alive. There was so much misinformation about violence. In my small hometown, there were rumors of New Orleans “refugees” robbing people and it was a lie. I went to Walmart to get more clothes because the two days worth that I had packed clearly weren’t enough. My debit card did not work because the banks weren’t functioning. Although it seemed like a small thing considering I was alive and safe, I broke down and cried. A stranger paid for my things. Finally, I was able to communicate by text messages. My friends were all alive, although some were evacuated to different states. Some lost their homes. Others were not as fortunate.
People always question why some choose to stay when there’s a prediction of a hurricane. There are several reasons one must take into account: 1) there have been plenty of predictions about the big one coming and it hadn’t, some people were not convinced 2) evacuating is expensive, especially when your entire family lives in New Orleans thus finding funds at a drop of a dime for hotel, gas, food, etc. is difficult in a poverty stricken city, 3) many people travel by public transportation, therefore many people didn’t have a way to leave.
After Katrina, some suggested rebuilding New Orleans was a waste. Some suggested it was a blessing and the city could be “cleansed” of certain residents. I was not sure of a career path, but I knew I wanted to help rebuild my city. After all, New Orleans is so rich in culture. It’s unlike any city in America.
How did you find out about KIPP? How long have you worked there? What do you like best about KIPP?
During the rebuilding process, I searched for jobs to help others find their way back home and came across an ad for a middle school social worker in April 2006. That’s it! I thought. It was hard to find an operating school in the city. If we build schools, families could come back. I liked KIPP because they were hands on from the start. We had to go door to door searching for families. If a house was standing, we knocked on the door to ask if a 5th grader lived inside. Teachers helped families move into FEMA trailers and participated in the cleanup of destroyed homes. KIPP has always been hands on with kids and families. I have been there 11 years. My students are my family.
As a middle school social worker in New Orleans, what makes you the happiest and what makes you the most disappointed about the education system?
I’m happiest when I see students work through struggles and persevere. My kids have been through things that no kids should have to experience and their resiliency teaches me so much about life and what is really important. My first class will graduate college next year, most will be the first in their family to graduate. The thought of it makes me tear up. I’m beyond proud of the work I do.
The most frustrating part of working in the education system is seeing the disparities and segregation that exist within the public charter school system. Playgrounds at one public school can look completely different from playgrounds at another. Some schools don’t have school buses to restrict access to those without transportation. Kids are on an unequal playing field and it’s intentional.
For those who are interested in changing the state of our education system in this country, how would you recommend getting involved?
Become a mentor. Volunteer. Donate time or reading books to your local school. Kids and families are very relational. If you can volunteer to become a tutor and spend quality time with a kid, even if it’s one hour a week, it could mean all the difference in the world. It could change a kid’s trajectory.
Have I expressed my love of travel? One of the motivating factors in deciding to work as a locums physician was the ability to have more time to travel. My friends took two international vacations that I had to decline because I didn’t have enough vacation days!!! Not only was I disappointed, but as a single woman in my 30’s with no children, and adequate resources, I questioned why did I feel conditioned to delay this type of travel to retirement age. The days of delayed gratification are over.
After choosing to transition to locums, I also made the decision no longer maintain a permanent residence. I packed up my apartment (more on that later) then headed off to New Orleans. I had time to hang out with friends, spend time with my goddaughter and attend a conference that I believe will have a long lasting positive influence on my life. Next, I flew to Nashville to reconnect with mentors from residency and see my Nashville crew. Afterward, my mother picked me up to drive me to Louisville. It’s always good to go home and spend time with family. My dad then dropped me off in Cincinnati so I could catch a ride to Chicago with one of the homies to hang out and then attend the APHA annual meeting. After a productive meeting, I hopped on Southwest to go back to the east coast to re-pack, network with contacts in DC and prepare for my trip to Anguilla. Ahh, Anguilla. I’m pretty sure I belong there. I’m pretty sure I’ll go back there soon. I’m pretty sure I have a future life in the islands…
Having a few months off to travel on my own schedule definitely reinforced my desire to incorporate more travel in my life. I had made the right choice… Living La Vida Locums!
New Orleans, LA, Canal Street
Nashville, TNLouisville, KY, BABY!Chicago SunsetChicago, IL Photo Credit, Kenneth Martin
Locums…is it true what they say? How do you choose the right company?
Usually by the time you’ve practiced for a while you will start to get emails from locums company representatives asking if you would be interested in locums work. For residents, odds are at least one of your attendings has worked for locums company at one time or at least considered it. The first time I heard of locums was during my third year of residency. One of our attendings mentioned it as a good option to explore different practices before committing to a final hospital or location. In my first year of practice, I received a random email from a larger locums company, I filed it away at the time. I was happy and I didn’t have the time for additional clinical responsibilities. But, when I decided to revisit locums, I went back to that email. It was as good of a place to start as any. Things to consider:
Big Company vs Small Company. There are a multitude of companies out there. From my experience, the bigger companies are consistent, they have great support staff and usually work hard to maintain a favorable reputation with their facilities. Their representatives are available 24 hours a day for any issues that may arise while you’re on assignment or traveling to an assignment. This also means they have more standardized (and possibly lower) pay rates. Small companies will have less support staff and therefore less overhead. They may offer higher pay rates, but you may have to be a little more flexible. As with anything else, each company may have local or regional preferences, may work with government facilities or be geared toward clients that are seeking temporary to permanent positions.
You are a contract employee of the locums company. You will have to complete credentialing application for each locums company, in addition to each facility you apply. As with any company, pay frequency may be weekly, bi-monthly or monthly. You may receive paper checks or direct deposit. Make sure you confirm with the company.
If you are seeking employment within a small geographical area, then you may want to research which companies place more physicians in that particular area and plan to sign up with at least 2-3 companies.
All companies generally offer to cover transportation to and from the site, including ground transportation to the airport, airfare and baggage costs. They cover or arrange lodging and rental car if needed.
They may or may not cover additional state medical licenses, DEA applications and/or controlled substances certificates.
They do not cover meals.
They do not cover health care benefits or other benefits usually associated with full-time employment: disability insurance, retirement investments or CME reimbursements.
Malpractice. They cover your malpractice while on assignment. You will receive a copy of your malpractice coverage agreement when you start each assignment. You will be responsible for your tail if you need it when leaving your current practice situation.
If you have the time, talk to a few companies and build a rapport with a representative in your specialty area before you commit. Explain your reason for pursuing locums, what length of assignment you prefer, where and how you would like to work. This relationship will be very important as you move forward. Remember that the representatives talk with each other and facilities talk to multiple locums companies. Your reputation is important. It can help you get or keep an assignment, be asked to return to an assignment, be considered for a permanent position or negotiate a higher pay rate.
Be very clear with the representative if you would like to be “presented” to an organization. There are rules as to how often you can be presented to the same organization. This detail can get tricky if you’re working with more than one company. Once the company has your CV, it is possible that they can present you even if you’re not credentialed with them. I now only send my CV to companies after I am confident that I plan to work with them.
I started with one company. One of the larger ones. For me it made sense to sign up with a company that had a solid reputation and great online resources. Most locums physicians that you meet along the way, will tell you that if you do locums long enough you will add on additional companies. One doc told me at one time he was up to 9! I just added my second company, a smaller physician run company. I imagine I will add a third next year.
Take homes:
Ask around. See which companies have the best reputation in the area(s) that you want to work. Forge a relationship with a representative before accepting your first assignment.
Be clear about the type, location and/or length of assignment you are looking to find.
Do not let the representatives talk you into anything you’re not comfortable with doing. There will be another assignment. You are in control.
Use this opportunity to build the life you want to live!
There are multiple ways to approach locums work. I decided to go the nomad route. I signed up with one company and made myself available to go anywhere. My only preference initially, was short-term assignments, typically 2-3 months in length. That means I was covering gaps in time when hospitals were in the hiring process or maternity leaves, etc… How you approach the type of assignment you want depends on your short term goals. Questions to ask yourself:
1. Are you supplementing your full time job? Is this a short term option to bridge your time between jobs or training? Do you plan to continue locums for more than 2 years?
2. Do you want to travel around the country or stay close to a home or family?
3. Do you want full-time/full-scope practice opportunities? Would you like to work 2 weeks out of a month? Would you like shift work as a laborist/hospitalist?
4. Do you want to work continuously or do you need to take breaks in between assignments?
5. If you plan to continue a full-time job and work locums on the side, you can find weekend work in many practices. Practices in small communities use locum physicians to round out their call schedules. A “weekend” in the locums world usually means Friday 8 am to Monday 8 am.
If you need to stay close to home or family, I would recommend signing up with at least 2-3 companies to give you more options. Try to find locums physicians in the area and find out what companies they use. Another option would be to approach facilities that may be short staffed and offer your services in a locums capacity.
Things to consider when taking a position as a laborist: 1) Are you first call or second call? 2) Who is first call if you’re not? I have now worked as 2nd call for midwives or for family medicine physicians. I have also been the laborist in academic programs that required residency teaching. Taking positions as a laborist or hosptalist gives you the flexibility of shift work. However, you will be only be doing inpatient work. If you’re not ready to give up your generalist skills, I would suggest only taking laborist work to supplement a full-scope assignment.
If you don’t plan to take continuous, full-time assignments, I would suggest making your calendar at least 6 months in advance. That way you can let your company(ies) know your true availability and plan accordingly.
When I first started, I was nervous that I wouldn’t be able to find enough work to keep me busy. And it is true, that I have had a few assignments fall through. However, with proper planning, staying flexible and forging a good relationship with your locums representative(s) will usually prevent any unwanted gaps in work.
