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A recent guest post stirred up a surprising amount of emotions, assumptions, and accusations. Dr. Brent Lacey of The Scope of Practice ran the numbers and the opportunity cost of his wife choosing to leave her fellowship and stay home to raise a family, penning This Decision Cost Us 13 Million Dollars, But Was it a Financial Mistake?
While many of the concerns were addressed in the comments and replies, what was missing was a telling of the story from his wife’s perspective. Today, we have that.
A brief introduction and explanation from Brent:
Please understand that the purpose of the original post was to be an article encouraging people that getting out of debt early in your lives facilitates choices and limits financial constraints. It wasn’t meant to be a treatise on working vs non-working spouses.
I firmly believe that each family’s choice on which spouse (or both) will be working full-time is up to each family and no one else. No one should guilt or shame another family for choosing something different from them. This article and the original post are our story, but that’s not the right story for everyone. Enjoy!
Now, it’s time we hear from Dr. Catherine Lacey, the woman who completed medical school, residency, and most of a fellowship before making a particularly difficult choice.
My History
I had always planned to be a working mom…a full-time physician mom at that.
I grew up in a family of physicians—my father a nephrologist, my mom an OB-GYN, my stepfather a family practitioner. My parents struck the amazing balance of working full-time in medicine and still being incredibly involved in the lives of my siblings and me, so it never even occurred to me to be a stay-at-home mom.
It was a blessing that, while I had many physicians in my family, no one pushed me to enter the medical field. I was drawn to the patient relationships, the problem-solving, and the potential to touch lives that a career as a physician offers.
I met my now-husband in medical school. He was a year ahead of me, and I fell head-over-heels so soon after first meeting him that it could have been the plot of a cheesy romantic comedy.
Our wedding was only 10 months after meeting, and it was such a blessing to have my best friend struggling and striving along beside me during medical school and residency. Medicine was much more fun for me as a career since we got to do it together. We enjoyed discussing cases, attending conferences together, and the camaraderie that came from an in-depth understanding of the emotional ups and downs that we both faced each day.
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A Change of Plans
I am sure we ended up fueling each other’s passion for gastroenterology, as we both decided to pursue fellowships in this field—Brent as an adult gastroenterologist, and myself as a pediatric gastroenterologist. To this day, I still wonder if we would both have found our love for this subspecialty without the excitement of the other.
We dreamed of having children from early in our marriage, but we decided to wait to expand our family until we were nearing the end of our training. Our oldest son, Grant, was born half-way through my second year of (a 3 year) fellowship, which was the final year of Brent’s fellowship.
As I am sure is true for almost all parents, my whole world changed when I had a child. Like many moms from all career paths, whether working at home or outside the home, the priorities in my life outside of God and my family instantly shifted with the arrival of this tiny human. For the first time in my life, I began dreaming of life as a stay-at-home mom.
A Shift in Mindset
Once I returned to work after maternity leave, I also noticed that all day I was eager to return to my husband and new son. However, when I was at home, my exhaustion prevented me from devoting as much time and energy toward them as I wanted.
My husband seemed to arrive home from work with boundless energy and was constantly searching for new endeavors (hence his desire to start a website for financial and practice management advice for physicians!). On the other hand, I found that I was giving the best of myself to my work, rather than my family.
I felt as if I expended most of my patience, understanding, kindness, energy, and commitment at work, and would arrive home frazzled and short with my family, the ones I care about the most.
I was in awe of people like my husband and sister-in-law, who appeared to thrive as working parents, as their mental stimulation, adult conversations, work responsibilities, and accomplishments outside of the home actually seemed to energize them and allow them to more fully enjoy their family time.
For me, just the opposite was true. I loved my work, but my physician role was compromising my role as a mom.
Making a tough call
With these considerations, I made the decision that I would stop working as a physician after fellowship, at least for the years while my children were young and our family was being moved around the country at the whim of the military.
But the timeline of the decision actually advanced sooner than anticipated, as my husband got orders to serve on the other side of the country after finishing his fellowship (while I still had 1 year left in my own).
I knew I could always serve as a general pediatrician if I decided to go back to work as a physician, but I would not be able to work as a pediatric gastroenterologist without completing the fellowship. After a lot of prayer and discussions with trusted family, friends, and colleagues, I decided to walk away from fellowship.
At that time, I knew I wanted to be a stay-at-home mom, and for me, the unlikely possibility of returning to work as a sub-specialist was not enough, in my mind, to justify separating our family for my final year of fellowship.
My Husband’s Support
The most incredible part of my decision was my husband’s complete and unwavering support along the way. He had certainly not imagined when we married that I would decide to quit working outside the home, as I had not anticipated that desire myself.
But, throughout our conversations, I could see his commitment to making my goals possible, even though our family’s lifestyle and income significantly changed when I left fellowship to solely work as a mother.
Fortunately, we had made wise financial decisions in the preceding years. By getting rid of all of our debts and living on one income while saving the second, I could afford to stop working without compromising our family’s financial security.
We have since maintained my medical license so that I may go back to work should I ever desire to do so. We also maintain adequate life insurance and disability insurance so that in the event something should happen to Brent or me, our family will still have financial security.
Final Thoughts
It has been such a blessing to have had the opportunity that many women don’t have. I was neither forced to work outside of the home for financial reasons, nor was I forced to be a stay-at-home mom due to limited career options.
For that reason, I find so much joy in my day-to-day activities, even the menial details of sweeping Cheerios and packing lunches, as I recognize this is right where I have chosen to be. I have never regretted the decision to step away from a career in medicine.
My husband is incredibly supportive of me and our family. I am blessed beyond measure. It’s such a joy 13 years later to still be married to your best friend.
To all the physician moms out there, whether you are working full-time, part-time, or not pursuing a career at all, I respect you and your decision. I know you’re supporting your family in the way that’s best for you. Everyone’s choice is different, and I hope you’re as happy as I am in whatever path you’ve chosen.
Dr. Catherine Lacey is a board-certified pediatrician who is currently working as a stay-at-home mom. Besides spending time with her children and husband, she also supports her husband’s website/blog, www.TheScopeOfPractice.com, where physicians and dentists can go to learn to manage their businesses successfully and master their personal finances.
[PoF: I am grateful to Catherine for her willingness to talk about the decision-making process. I can’t imagine it’s easy to step away when so close to the finish line, especially when coming from a family of physicians.
As I alluded to in the picture of my firstborn son in the post, my wife also chose to stay home to be the primary caregiver for our children. She didn’t have as much time or money invested in her career, but she did have two undergraduate degrees, a masters degree, and a 9-month internship under her belt.
It was the right decision for my wife, the best decision for our family, and neither of us has any regrets. I believe the same to be true for the Lacey family, and I am happy for them.
Soon, we will hear from a mother of three as part of a two-physician couple who made the choice to continue working in her chosen field. Doing so has turned out to be the right decision for her and the best decision for her family. I look forward to sharing her perspectives, as well.]
Have you or your partner been faced with a similar choice? What did you decide to do and why?
33 thoughts on “Why One Mother Left Her GI Fellowship to Raise a Family”
Thank you for sharing your personal story, I find myself thinking about what to do, I’m just completing my intern year of internal medicine residency, and I’m an IMG from venezuela, where I completed my gi fellowship, and later came to the US. I have a 20 month old baby girl, and it has been a struggle, I feel like you did, I can wait to go home to be with her and my husband, bit it also feels like I’m grieving my past specialty, for sure I don’t feel like puting in the work to get into GI but it is sad, I’ve been praying about it, and feel peace with staying with family, and work as PCP, just dealing with the “career grieve” I guess
I am glad that we have the freedom to choose what is best for each of our own lives more than ever before in history. I find that when one enjoys true happiness it lends to objectivity and no need to be negative about others’ lifestyles that bring them joy, peace, and fulfillment.
Alysia-
Indeed! I’m all for celebrating each other as they make the best choice for their family.
-Brent
Congrats on making the best decision for your family!
Boricua-
Thanks for the support!!
-Brent and Catherine
Stop saying you work as a mother. It’s not a job. You do not get paid.
So you would rather stay home with your kids than work. No kidding it is easier than dealing with work life. Duh!
If you were completely happy with your decision there would be zero need to justify. You are just another woman who can stay home because her husband can afford it.
Many of my medical girlfriends married to another physician do the exact same thing. And they get upset when other woman do not vaunt their lifestyle. Um, we all could do it as well. We just would rather not.
I don’t really care what other woman do. But your story is rather pedestrian. Many woman who have young kids and have a good earning spouse do the same thing.
Society accepts that it is okay for woman to do that. Men are definitely looked down upon. All the stay at home husbands of my girlfriends never call themselves that. For good reason. They are embarrassed by it.
I worked for my own financial independence while having kids, raising kids and am married to a physician.
It is sad to need a husband to help when you are a physician. As a physician I am very glad I could easily earn my own way.
I hope you will be happy with your choice. I surely would never be.
There is something very fulfilling about knowing that you can take care of yourself and your family. And that includes financially.
At least pretend to have a career like so many of my female colleagues. Many have only ever worked 1-2 days a week during their entire career. They could barely support themselves.
It is a travesty. They really should never have gone to medical school.
Also you will likely notice that when your kids are grown they may have less respect for you. I have certainly seen that amongst these work-lite medical ladies.
Being an equal team mate means both of us can work AND take care of the family. You have not shown that you are able to do that.
The problem with your situation is that you will find it very difficult to ever return to work.
Emily-
Thank you for reading. It seems as though you’ve found a situation that works for you, which is great. As both my husband and I said in our posts, we don’t judge or seek to guilt anyone for the choices they make. The goal of our posts was to show the value of making wise financial decisions and becoming debt-free early in our careers which provided flexibility in career options. Our goal was to encourage people that are seeking to go part-time or retire early that it’s possible with wise financial management.
Your comments that demonize a fellow physician’s choice are disheartening. Many male and female physicians (including Physician on Fire) have gone part-time or retired early. Are they wrong to have done so?
This kind of shaming that you’ve provided here is a big part of the problem. I don’t judge you for your choices, and I would ask that you do the same. As women, we should be supporting each other, not seeking to tear each other down.
-Catherine
Wow, Emily!
I couldn’t disagree more. Parenting can be a very challenging job. So can medicine. They’re very different, and yes, one can choose to do both, but that’s not a choice everyone is going to make.
Is there something fulfilling about tearing others down for exercising their free will to live the life they feel called to live?
I think our medical training steals some of our compassion and empathy. Some people are clearly affected more than others. I don’t know how else to explain the frequent doc-to-doc shaming I see, and I don’t like it.
Best,
-PoF
Emily, I couldn’t agree more! That’s a spot taken from someone who could have contributed more to society in medschool, residency and competitive fellowship while reducing access in a high need specialty. What a privileged position to be in to walk away from it and flaunt the I did it for my family card!
Catherine, do you work in any capacity, volunteering at all, etc in the medical field? How do you plan to keep your license to practice again if you are uninsurable? Is your plan to go back to residency? Or do you plan to not practice again? Either is completely valid (and I’m glad we got to hear from your perspective), but you left a large elephant in the room by not addressing how you realistically plan to return to medicine if you have not practiced for several years. Best of luck to you and your family.
Christine-
Honestly, I’m thinking I probably won’t be going back into practice. I just don’t think it’s what I want for my life. You make a good point about insurability. I think it would be tough to go back without having some level of active clinical practice over the previous few years. For now, I’m thinking I’m probably not going back into medicine. Thanks for your encouragement!
-Catherine
That seems to be the core of it – you don’t want to go back. You no longer love your career and you have the means to not have to continue. Nothing wrong with that. We only have one life to live, you can take that experience and re purpose it somewhere else when you are ready to dive into either working, building a business, or guiding your kids.
Thank you for following up with the other side of the story. And I look forward to hearing from working mothers in the future as well! I am a working mother, and the breadwinner in my family. We all face different, and sometimes difficult choices along the way. Good to hear about the choices we didn’t, or couldn’t, take.
Nichole-
As a full-time working dad and primary breadwinner, I agree that we should all be able to make the choices that are best for our own families. I’m glad you were able to make the choice that was right for you. Way to go!
Thanks for reading!
-Brent
That’s great you were able to make those moves. I have 2 daughters and I made them consider the life they wanted as mothers and wives. I have always worked and loved the balance of working and home – however, I made a major career shift to a more flexible career that allowed me opportunities to work at home, flex in office house and change jobs within the same career field. It was life altering for our family. Thankfully, you didn’t have loans or could afford to make the shift. We had 4 kids and flipped our schedules to not only care for them but homeschool them with great success. Therefore, anything you want to accomplish there is always a way to do it if you think outside the box.
Nita-
Great points! Sounds like you guys found a great way to make things work for your family. Good for you guys!!
Thanks for reading!
-Brent
Good for you! Making that choice was hard and you are brave to face the naysayers. I too found that staying home with the kids made the most sense for me and our family. After medical school, family practice residency and working in the ‘real’ world of medicine, becoming a mother eclipsed all. My husband and I met in medical school, trained together and worked together at an IHS situation. It was great. We thought we would hire a nanny or au pair and continue in our careers but when our son was born, I very quickly realized that I didn’t want to miss one more minute of him then I had to. And I, too, found that the work/home emotional balance was such that it left less for me and my family. My husband niched in family medicine toward the ER and loved his new emphasis. He stayed full time and I went part time. His shift work allows blocks of time off for family time and I’ve worked fill in or intermittent jobs ever since, once taking a “family sabbatical” of 3 years when our 4 kids were young. We are a team, each contributing differently to our family, bringing our unique perspectives and gifts: financially, emotionally, intellectually, as role models and the thousands of other ways families are in the world. Yes, we missed out financially. Yes, one could say my education is underutilized and there’s a “lean in” career that I missed out on. BUT….as we are about to become empty nesters this fall, we don’t regret the choice we made to raise our family the way we have. These years have flown and we won’t ever get them back. $13 million can’t buy that.
Stella-
Sounds like you guys made a tough choice. Good for you!! I’m glad you had the opportunity to live the life you want. I hope more people will support each person’s choices with regard to their careers.
Thanks for reading!!
-Brent
Thank you so much for sharing your perspective. I admire and respect your decision and as the son (and husband) of a stay-at-home wife/mother, believe that it is the most important career. I think that the feminist movement did a tremendous disservice to women and the country at large by downplaying and degrading the role of a stay-at-home mother and convincing a generation of women that a career would provide them more satisfaction than family. Many women, as did you, discover down the road that they actually would prefer the fulfillment of raising a family.
According to the research, within six years of completing training, 22.6% of women physicians were not working full-time compared to 3.6% of male physicians. Some studies suggest an even higher rate, such as the University of Michigan’s Intern Health Study, which shows that almost 40% of women physicians scale back their medical practice, or leave the profession altogether, early in their careers. This happens to also be true of female lawyers and business school graduates. According to a Harvard study of graduates of the University of Chicago Booth School of Business, a decade after earning their M.B.A.s, women were twenty-two per cent more likely than men to have experienced at least one career interruption. Thirteen per cent of women weren’t working, compared to one per cent of men. Although an equal number of women graduate from law school, over 70 percent of them have left the profession by the seventh year, says a report released by the National Association of Women Lawyers.
Many point to this as evidence of systemic sexism, but I think the truth is that many women feel like you and make the choice willingly and even eagerly to place their family first. Sadly, our culture sold them a false bill of goods by convincing them that true fulfillment lies only in a professional career.
My question for you (and I intend this in no way in an accusatory manner) is what you think, in light of predicted physician shortages, about the fact that you took up a medical school spot, a residency spot, and a fellowship spot that could have been filled by a male who statistically speaking was more likely to work full-time for his entire career? Should this be taken into account by admission committees? While wildly politically incorrect, is this an area requiring further thought and research in order to better optimize the use of societal resources?
Eager to hear all thoughts!
Truth is, staying at home as a mom, wasn’t a reality for many people of color. Women had to work and I grew up with a single, working mother who negotiated childcare with her sisters who also were either widowed or were married – but all who had to work. The feminist movement allowed the opportunity for women to have a choice and equal playing field to care for and contribute to their families. My mother was a Head of Household, but never was paid equal to that of men. Now, even myself, I made the most money between my hubs and I starting out in our careers, and we work as a team. I personally love the freedom to be able to do so. The feminist movement was a benefit.
The answer to a physician shortage is not to train fewer female physicians.
I “took up a spot,” too and had a 13-year working career post-residency.
The best ways to address the physician shortage is to make a physician career more appealing (decrease burnout) and increase the number of medical students and residency spots for them.
We also addressed the “you took someone’s spot” argument in this post: Is it Wrong for Doctors to Retire Early? None of us signed up for indentured servitude.
Best,
-PoF
AL-
You make some interesting points. The decreased number of physician-years caused by physicians who retire early does cut down on access to care. However, how could we predict in medical school which people would be likely to retire early or go part-time early in their career? How would we set up a system without being discriminatory or infringing on individual’s choices?
What’s the minimum number of years a physician would be required to work before being “allowed” to retire?
It’s a great point, and you’re right that the trend of people retiring early will further contribute to the doctor shortage, but I don’t think there’s an easy or obvious solution.
Thanks for reading!!
-Brent
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I’ve just red both posts and I appreciate the spirit of each and think each is a compelling testiment to the freedom that comes with proper financial planning. I commend this family for their planning and insight into their own satisfaction. As a taxpayer I wonder if the system could not be structured to recoup some of the tax dollars that go into training, especially in residency and fellowship, physicians who choose not to practice. This could still allow for the same decision but at a slightly higher cost (some form of repayment) while both providing resources to train a replacement and removing any burden the unpracticing physician might feel about the significant public resources that went into their training. Few other careers one might decide to opt out of are so heavily subsidized by the taxpayer.
HC-
You make a compelling point. From a societal standpoint, there is some legitimacy to the idea that there is a trend where physicians are working fewer years, going part-time, and retiring early (FIRE, anyone?). That means that society is “getting less work out of physicians.”
Unfortunately, very few people can predict while they’re in medical school how many years they’re likely to work after graduating. Unless we impose some requirement on minimum number of years that graduates are required to work after residency (which is impractical and probably fascistic), I don’t know how we solve that problem.
Also, how do we determine the minimum number of years to require physicians to work? Should it be the same for someone who graduates at age 30 as for someone who graduates at 40? How about for someone who does a subspecialty vs someone in primary care? I acknowledge the problem, but sadly I don’t think there’s an easy or obvious solution.
Great discussion! Thanks for reading!!
-Brent
It doesn’t seem like too difficult a problem. We just make explicit contractually what was previously implicit–the government funds physician training expecting the physician to practice. There are plenty of models for this at DOD, PHS, that relate to the medical school funding aspect of training where time practicing and or repayment are expected. These models can be shifted to work with regard to fellowship and residency training for everyone. Of course, there would be no age discrimination in the calculation it would be simply: x amount of training= x amount of practice or x amount of repayment. All this would do is fairly express and allocate the tradeoff of public expenditure to private gain. Of course, the equation could easily be modified to accommodate any differences in specialization as it is based on the cost of the training. Also, as in the case of the military academies and other programs, exceptions would exist for those too disabled to practice. The intention would be to properly price the decision to not practice and place those costs where they belong…with the nonpracticing physician. This is a fairly basic concept. This type of approach would provide freedom for physicians and be fair for the rest of society which does not consume extensive government resources in training without some form of repayment in effort or money. Basic allocation of time and resources to optimize outcomes…. not at all fascist. An argument against this approach is that you might have physicians practicing that are not motivated to practice and thus should not be practicing but that argument is much more potent in the light of high student loan debt or the military service programs and we seem to have dealt with that problem at least minimally sufficiently because both those conditions still exist. How long can we afford to train the 20% of physicians that choose not to practice shortly after training and the replacements we need for those non-practicing physicians. Again, I don’t critique anyone’s individual choice. People are optimizing for their life under the current scheme. I just think the scheme will need to change.
HC-
It’s a reasonable point. As long as we continue to train physicians and have them work fewer years, we’ll continue to see a deepening of the doctor shortage for the country.
Unfortunately, I don’t trust the government to come up with a system for fixing this without limiting freedom and choices. I agree it’s a problem, but I would vote for a different solution. Thanks!
-Brent
Recoup any tax dollars because someone chooses to leave medicine? No way…regardless of how long the individual practices after residency, unless you’ve gone through the residency process yourself, one can never full understand or respect the amount of time physician trainees put in during residency or fellowship. Have you tried to stay awake for 27 hours straight, and still present your overnight admissions to the attending on post-call rounds? When one takes into account the amount of money residents and fellows earn for hospitals and clinics in relation to the hours worked, one could see that they’re seriously underpaid.
It would be unfair to penalize trainees who choose not to practice after residency and fellowship. Those 3 years are impactful (and stressful) enough. Some people are so burnt out (and traumatized) from their training experiences, that choosing to pivot in a different direction is a matter of self-preservation and self-discovery. No one should be penalized for that. If we’re being honest, I think a large percentage of us probably would pivot outside of medicine if we didn’t have hundreds of thousands of dollars of debt hanging over our heads, and families to support.
In addition, during training, they are often taking care of some of the most sick, disadvantaged and marginalized populations. Sure, the government is funding training, but physicians are working their tails off to provide good patient care, and in the process also serving the communities we work in. As a taxpayer, I would be proud that my taxpayer dollars are going to that. Who exactly is recouping tax dollars going to help??
Finally, if we try to “recoup” tax dollars, it’s inevitably going to disproportionately effect some physician populations more than others-particularly women, many of whom now as I write this several months after the original post, have had to leave the work force due to the impact of COVID-19.
So I applaud Dr. Lacey family for making that difficult decision. As a product of a stay-at-home mom, I know it’s not easy, and that if we monetized all you do to keep the family functioning, truly, no one could afford you! But no training or education is ever loss, and medicine will always be there if you ever decide to go back 🙂
Hello! Sounds like the correct decision for you and your family!
Search some of the PMG posts on stepping away from Medicine because if you are gone for >2-3 years with no clinical experience, you are “uninsurable” by malpractice carriers and it is very difficult to return to part time or full
Time practice. A few PMGs that became stay at home moms while their kids were young and now want to return have run into this. They had to repeat a residency ?
Many people recommend volunteering at a health dept or free clinic a few days a month to keep up clinical skills and credentialing
Jill-
Great points! Yes, very important to do what it takes to maintain insurability and also just to keep up-to-date with the latest in clinical practice. Thanks!
-Brent
I am triple board certified, MD/PhD and currently taking time to be with my family. I echo the same concerns of mental, physical and emotional exhaustion.
My only comment is that you need to do more than maintain a license to re-enter medicine. Each state has its own rules and it will be virtually impossible to obtain malpractice coverage if out of practice for many years. My suggestion is that those who leave find a way to work 1-2 shifts a month if they desire to go back to direct patient care.
Congratulations!!
BP-
Great points! Definitely important to maintain skills as well as licensure. I always advise people to do what they need to do in order to maintain their clinical skills so they have the option to go back to full-time work.
Each state has different laws in terms of insurance coverage, licensure requirements, CME, etc. For cost-savings, in many states you can downgrade your license for part-time work and that can be a major cost decrease.
Thanks for reading!!
-Brent
Congrats to you guys for making the decision that makes you the happiest and not being forced into a less enjoyable life (to you) by financial constraints.
Couldn’t agree more with the general sentiment that financial planning can open up all sorts of options. Be it take some time off or plunge deeper and take a risk.
Enjoy the babies!
Kpeds-
Thanks for reading!! Debt-freedom offers choices. That’s the best part of financial independence: autonomy.
Thanks!
-Brent