A few months have passed since I wrote my last column article, so now it’s time to get back into it. What has happened in the meantime? Well, I had baby #2, which meant I was lucky enough to take seven weeks of maternity leave from residency. All my German friends will be shaking their heads in disapproval — how can I consider seven weeks to be lucky, when we can generally take at least six months, and up to three years, of maternity leave during residency in Germany.
I have been back to work now for almost three weeks, and it is amazing to realize how fast time passes. Since I spent only six weeks of my intern year before I went on maternity leave, I was a little bit nervous about how my return to clinical duties would be. Luckily, it was a lot easier than expected. My first week back was a week of outpatient clinic, so I was able to “practice” pumping between seeing patients and work out expected kinks, from forgetting certain breast pump parts, to not drinking or eating enough, to having to pump in the car because I forgot to pump sooner — you can see the list is long.
I was surprised, however, to see how many things I was able to forget within those seven short weeks, but fortunately most of my forgotten knowledge (mostly how to use Epic) came back to me quickly and I was able to continue finding my way to being a primary care physician for my patients. The field of internal medicine is interestingly diverse — you never know what the patient is wanting to talk about — and I am continually impressed by the broad knowledge my preceptors demonstrate.
There is a lot more to learn, as I have only done inpatient internal medicine in my previous life as a physician in Germany, so I do enjoy the challenge of outpatient medicine. And time will tell if I can see myself doing outpatient medicine long term, more permanently. Currently, my work hours are very fair and I do not yet see a lot of patients, so I enjoy the work-life balance that the clinic provides. And even though this might change in the future, I am trying to seize my available family time and the opportunity to have a more normal life, compared to inpatient ward rotations.
The only downside I have come to experience during outpatient clinics is how much shadowing we are doing in our program. When I am in the clinic, half of my days are in outpatient rotations, not seeing my primary care patients. We have certain required rotations, such as dermatology, allergy, women’s health, and ENT for example, during the first year. The reason why I call it shadowing is because it is very dependent on the attending if we actually have our own patients or even get to examine patients. Especially after having been working for years, it is a little bit odd to feel like a medical student again and follow another physician from room to room. But even there, I try to keep in mind that I have this wonderful opportunity currently to learn and refresh my memory and I try to make the best of it.
For the past two weeks now, I have been back on inpatient wards. The hours are the toughest thing about it in my mind. Being sleep deprived, and especially not seeing my kids everyday because of the schedule, is tough, so I am very eager to get out early on my short call days. But there is something specific to the speed of things in the hospital, and the amount of work that gets done to provide care for patients. I personally just love the interactions with all the different disciplines to treat hospitalized patients. And even though I honestly miss my kids throughout the day, I often don’t even realize that 12 hours have passed. And obviously, the learning curve in the hospital is much steeper, just because you have more patients and so much more is happening throughout the day.
I am happy to say that this ward rotation went a lot smoother than the first time. Realizing that I am getting faster and that attendings do not continuously criticize my progress notes anymore makes me feel better. I am also getting more used to having a rotating attending every week. In Germany, you would have one attending assigned to your ward and you would work with her or him throughout your entire rotation — which is usually six months in length! My pronunciation is still often not where it needs to be, and neither is my knowledge of American standard-of-care guidelines for the most common diseases and problems in the hospital — but I am trying to work on it. I am still struggling to stick properly to the SOAP or EAP format (whatever the current attending prefers), but even there I feel that I am making some progress.
Regardless of the pay cut compared to my previous job and the huge number of hours that I am away from my kids, I must say, I am just so very happy to be back in medicine!
In my next column, I am going to talk about the process of how I get through the Step exams and residency match — stay tuned!
I am an international medical graduate in internal medicine residency (IM/G), sharing my experiences with all of you. If you are an IMG, hopefully you can relate to some of the stories and feel encouraged, because we are not alone. If you are an American-based resident: I hope these stories help you better understand your IMG colleagues a bit better. And above all, I am hoping to hear from you as well: let’s share knowledge, experiences, and pave a path for the many other IMGs seeking to fulfill their dreams in the United States.
Image source: Courtesy of the author.
Resident Physician Columnist
Hillsboro Medical Center
Aline went to medical school at the University of Essen in Germany. She started training at the University Hospital Essen in Internal Medicine with the focus on GI/Hepatology. She then followed one of her former supervisors in 2017 to the University Hospital Magdeburg and continued her training for two years. In 2019, she started a two-year research fellowship at Johns Hopkins University with a scholarship by the German Research Foundation. During that time, she decided not to return to Germany and instead attempt to become a physician in the US. She has started her internal medicine residency this year at Hillsboro Medical Center in Oregon.
Surviving IM/G
I am an international medical graduate in internal medicine residency (IM/G), sharing my experiences with all of you. If you are an IMG, hopefully you can relate to some of the stories and feel encouraged, because we are not alone. If you are an American-based resident: I hope these stories help you better understand your IMG colleagues a bit better. And above all, I am hoping to hear from you as well: let's share knowledge, experiences, and pave a path for the many other IMGs seeking to fulfill their dreams in the United States.