The Million Dollar Decision

The first day I started my job as an attending neurologist, one of my mentors told me the most difficult part will be balancing work and personal life. I didn't believe him. Just 1 month out of residency, I thought the challenge would be making difficult medical decisions, being able to see a large volume of sick patients without letting the stress overwhelm me, and managing complicated disease states. I thought the challenge would be doing a good job.

When I reflect back on my life, I've always been motivated to do well, and I've always worked hard. I've been successful in a lot of different areas but I have of course often dealt with rejection and failure. After residency I interviewed for 3 movement disorders fellowships and was rejected. But I've taken the same motivation and intellectual curiosity that I've applied through high school, engineering school, medical school, and residency to my first "real job" as a general neurologist. When things are challenging, I ask more experienced physicians for help, make phone calls, and review literature. Neurology is not an easy career, but I've been able to be successful because I bring knowledge, an inquisitive nature, and hard work to every patient. It's a bit cliche, but I like to approach every patient as a puzzle that needs to be solved, although often there are not answers.  My success has been recognized and I was unanimously voted in to be offered partnership in our private group after my first year. Accepting this would double my salary to at least half a million each year, maybe more.

I've been able to slowly earn the respect of many patients and physicians. But then there are the puzzles I can't solve; patients who are progressively getting weaker with no explanation, the intractable headaches of unclear origin, the rapidly progressing dementia in young patients. At times I feel powerless to change the course of events.

And of course there is the challenge of balancing work and my personal life. There are the nights where I work till 8 or 9PM. I probably average at least 60 hours a week, more like 70. The days I am not working, I am often driving to see my fiance in Columbus. I know my absence is hard on her sometimes, and she is not happy when I'm late. On our second or third date, I had planned to make a nice dinner for her, and unfortunately had a Spanish speaking clinic patient added on at 5PM which delayed me an hour. In my haste, I ordered pizza hut instead. My time is in high demand, and I know she works as hard or harder than I do. She has moved to cloudy Ohio when she would have preferred a sunny beach somewhere else some days. My parents and family also would like to see more of me.

I recently interviewed for a neurophysiology fellowship at Ohio State in Columbus, Ohio for 1 year. At the end of this training, I'll become proficient doing EMGs and better at reading EEGs.I'll have exposure to a few of the rare causes of neuromuscular disorders. It's hard to walk away from my hometown, my patients, and a very lucrative partnership offer.  If I accepted my partnership offer, my salary would increase to around $570,000. By leaving, I may be losing  approximately $800,000 in salary over 2 years although it would actually be a lot less than that accounting for taxes. However, I'd be working quite a bit less in fellowship with no weekends and no call and I'd be able to spend more time with my future wife. I've thought about this a lot.

The decision to leave is based on a decision of love for my fiance and optimism that I can be a better neurologist by doing extra training and learning more. I do not think that I'd be happier making more money since the most important things in life can't be bought, although I would like to give that money back to my family and the community. I hope to return to Cincinnati with my wife after finishing this fellowship. But I suppose I should mention the minor detail that I have not been formally offered the fellowship yet, but I expect to get it!