As I entered my final year of residency and one chapter of my life was ending, I felt that my education was not yet complete, and decided the next chapter for me was a toxicology fellowship. Another chapter was also just beginning as I prepared to welcome my first child that spring. These two circumstances would eventually collide when my child was barely three months old, leading to the consideration of a number of key points while interviewing and ranking programs.
- Location, location, location. While I would like to say that the merits of the program were the most important, being closer to family and friends was very important (or somewhere with an easily accessible airport). With the first grandkid in my family coming, I may have been disowned if I lived too far away, especially after spending residency a mere 23-hour drive from my folks. Also, these are the people who help out when you have a sick kid at home but need to see a patient on call or have trouble finding childcare over the holidays. EM-based fellowships are not as numerous as other specialties and you may have to compromise a bit.
- Program structure. A program with a schedule and structure helps maintain focus and hit all of the information necessary. But with a child nursing round the clock, flexibility is also key. The program I ultimately matched to has structured mornings, for about 3-4 hours, and a conference day, but afternoons are free and flexible to pursue academic activities as seen fit. I used this to do work early in the mornings or late at night when my child was sleeping and maximize my time with her while she was awake. The added structure helped keep me on task.
- Moonlighting and shift policy. Some fellowships are GME funded with the option to moonlight, but others require fellows to work a certain number of shifts to pay for their fellowship. The number of shifts will impact how your off-shift time is used and how much is left for your family. While the base pay may be better for the latter, the former will allow a new mom to step back from shifts and moonlighting, at least until “sleeping through the night” has been largely achieved. I chose not to moonlight until the end of my first year, and then did so only two Saturdays per month to help maintain my primary skillset.
- Attitude of the program. This can be hard to gauge. As women are beginning to outnumber men in medical school graduating classes, many programs are receptive to needs of pregnant and breastfeeding residents and fellows. But it can be uncomfortable to ask outright . . . and it’s one of the questions that the program isn’t allowed to ask about. Regardless, I think it is important to mention during interviews with faculty. A fellowship that doesn’t want to work with a new mom wouldn’t want me, and I don’t want them. I also found it helpful to ask the fellows “Do you think it would be possible to have a child during this program?” The responses are telling. I heard everything from “Yes, Dr. F had a child last year and will graduate on time” to “Wow, I just can’t imagine being able to manage this busy schedule and a baby.”
- Childcare availability. Some institutions have round-the-clock childcare available, or programs to help on snowdays or sick days. Others have very limited or no childcare options, but may have a childcare savings account incentive. Asking about these helped me know my options, but ultimately did not factor largely into my decision. Overnight childcare is provided by so few programs, that you may also need some plan for nighttime shifts or call, such as a family member or nanny. (Many people may be able to use a spouse during these times, unless they, too, are working a night shift).
- Spousal support. I am lucky that I have a very supportive spouse that has tolerated late night phone calls, helping with cooking and cleaning, and a lot of childcare responsibilities, despite working a hectic ED schedule himself. Before applying though, a long discussion with your spouse about what a fellowship life with small kids will be like is definitely necessary.
Ultimately, I was able to match and complete my toxicology fellowship, even staying on as faculty. Board preparation with a toddler is a discussion for another day.