This past week I had the good fortune to be able to sit down over a good beer and some great Mexican food in my new hood with a classmate from midwifery school.
We haven’t seen each other since she went down to Texas to work at a birth center and since I have entered the working world.
We caught up on life, being a new grad, and coming into our own as providers. We laughed about difficulties in making the transition, and figuring out our own style. We talked about pros and cons to each experience, each of us quickly realizing that even a “dream job” has its drawbacks.
My former classmate is considering taking a job with the same organization I’m with, and we discussed all of it, the good and the bad, and, per usual, getting all my feelings out, either in words or down on paper is always clarifying.
So, especially for those of you contemplating full-scope work versus GYN, here are some of my ups and downs, the good ol’ Ben Franklin , pros and cons of where I am right now
Pro: I am an expert in GYN and have mastered* birth control and family planning. That giant Contraceptive Technology textbook that I never opened in school? It’s now my right-hand gal, ear-marked and we’ll-read and memorized.
*with the knowledge that I have still so much more to learn, but I feel confident in being able to find the answers.
Con: Sometimes I fear I’m forgetting a lot of my antenatal and intrapartum (labor and birth) knowledge. But then someone reminds me that they’re still coming out the same way.
Pro: In a high volume site with a vast majority of my patients uninsured, underinsured, on Medicaid, and many with high risk behavior and low health literacy I feel like I can adeptly talk about IV drug use, all kinds of substances and substance abuse, and risk reduction in a way that deals with the emotions of it all while also providing a non-shaming environment that allows for frank discussion of these topics, something I did not feel I mastered in school at all.
Con: Because I am in such a high volume environment, I often wish I had more time to counsel and get to know my patients.
Pro: Because I am in such a high volume site I have to be judicious with my time and know how to address a variety of topics in the most effective and succinct ways.
Con: Sometimes I miss feeling like a real midwife. I have written on the topic of full-scope versus non-full scope practice before, and intellectually I know there is nothing “less-than” about the work I am doing, but it’s hard not to feel that way sometimes.
Pro: I have seen/heard it all. There’s obviously still so much for me to learn, and I feel challenged every single day I’m in clinic, but all those pictures in the derm books you never thought you would see in real life? I know what those look like in real life. You can’t say there isn’t variety. And you certainly can’t say it’s boring.
Note: I also have developed the world’s most accurate bullshit detector.
Con: Sometimes my male patients do/say inappropriate things and I’m reminded that sexism is everywhere in very tangible ways.
Pro: I’ve found that I actually really enjoy providing health care to men, and most of the time they are kind, nervous, hilarious, and all around great to talk to about reproductive health.
Pro: I have learned to trust my gut and know when something is not so serious, moderately serious and needs follow up and when I actually need to send someone to the ER. Sub-pro: I have gotten really good at giving report to ER charge nurses and docs.
Pro: I get to be a teacher all day, every day. Whether it’s teaching a young woman that, yes, I know you’re embarrassed to buy it, but honey, get some lube, or talking to a perimenapausal woman about all the changes in her body, I love teaching women about what’s normal and what’s abnormal, and how amazing their bodies are.
Pro: Sometimes I actually do get to teach other providers, mostly medical residents, whom I get to pass on a bit of my midwife philosophy on women’s health care to.
Pro: I get to be an abortion provider. This is hands-down one of my favorite things. Sometimes it feels like an act of dissent in itself being an abortion provider, but, actually, these visits are where I most feel like a midwife. I talk through the emotions, support and reassure, counsel and hold hands. I celebrate that final ultrasound that shows a no-longer pregnant uterus, and hand women the reigns in their own lives. There’s nothing like it.
Pro: The community support. Sometimes I don’t feel like telling strangers where I work. But most of the time when I do, the stories of support come pouring out. Many people tell me that my clinic was /is the only health care that they can/did access for a long time, they thank me for doing important work, and for fighting the good fight day in and day out. I have to admit, the stories that people tell me, I remember each one, and it helps in a monumental way to keep my motivation strong for when the job is hard.
As I got down this list, I was trying to alternate pros and cons, but then ran out of cons, which I guess is a good sign. I have been feeling a little overwhelmed lately (see last two weeks of posts) but yesterday had a really chill day. I didn’t feel rushed. I got to explain things fully. I got to councel about diet and exercise. I got to take my time with a woman’s first pap smear and explain her body to her. It was exactly what I needed to remember the joy of it all and that when it’s good, it’s the best.