Options for non-board certified physicians
Still unempowered, I kept my secret to myself and the chosen few I had opened up to and prepared to take the exam again. I partnered with others who like me had not passed and we studied together and supported each other during the lows of doubt and insecurity. I worked full time, studied when I could, and was a mother the whole way through; and I failed.
Wow, that word even now as I type it hurts. I had taken this test a total of 3 times and had yet to pass. I began to spiral down a dark hole. How was I going to support my family? How was I going to pay back my massive student loan debt? As a single parent, I am the sole provider for me and my son. In one year I would lose my board eligibility; essentially my career as a physician was on the brink of being over as well as my means of supporting my family!
There are few options now a days for physicians who do not have the desired title of Board Certified. Hospitals privileges are unattainable, insurance companies unwilling too “allow” you to be a provider for their patients. Practices refrain from wanting you if you are not BC/BE. Four years of medical school, 3 years of residency, MCAT, USMLE exams all completed, state licensure obtained, DEA license purchased, and still one exam preventing me from the career I long desired, dreamed, and dedicated my early youth for. There was no other choice—something had to change. I contacted the ABIM to see what my options were as this was my last year of eligibility. My prime question centered around my options if I didn’t pass this year. On the website there was a statement:
“A candidate who is no longer Board Eligible may nevertheless apply for a certifying examination, but only if the candidate has: (i) completed at least one year of retraining in the relevant specialty after the expiry of the candidate’s period of Board Eligibility, but no more than seven years before the application; and (ii) met all other requirements for Board Certification in effect at that time. Retraining will require the successful completion of at least one year of additional residency/fellowship training in an ACGME-accredited U.S. training program or an RCPSC-accredited Canadian training program and an attestation from the program that the candidate has demonstrated the requisite competency for unsupervised practice. Candidates and diplomates remain subject to other ABIM policies and requirements for certification, such as the Re-examination policy.”
I nevertheless followed their instructions because I had no choice and reached out to my former director. She to her dismay had no concrete information about what a retraining year looked like either. She assured me she would contact the ABIM and see what she could learn but advised me not to give up; since I had one last year to take the exam. She suggested that I get in touch with the Testing Center on campus to see if I had a testing or learning disability. Could that be it? Did I have an undiagnosed learning or testing disability that evaded me for years only now to rear its head? She doubted it but it needed to be evaluated. Speaking with the counselor it became clear that she agreed; it was highly unlikely that I had a learning or testing disability that had not previously shown up. So what was the issue? Well one of the pieces that the counselor helped me discover was that I have a hard time trusting myself and taking a leap of faith in myself. Another issue was that I have a tendency to answer the question that I think I’m being asked not the question that is being asked.
So armed with this I decided I needed to take a step back and focus solely on this exam and being a mom. So I did. I quit my job, neglected my friends and devoted myself to my son and my exam. I fought through self-doubt constantly. I second guessed myself on every question. Thinking I was missing something. Fearing that I somehow did not learn what I needed to in 8 years of training. Why did I feel this way; because others before me had seemingly passed this test with ease. Here I was on the brink of failure with no safety net; nothing to fall back on. Despite years of caring for patients and living my dream I was in jeopardy of loosing it all. I doubted my calling. I never doubted God, but I doubted that I heard Him correctly. I doubted that I was on His path for my life. I was ashamed and alone. I bore this shame in secret because to do otherwise was considered taboo and a marker of weakness.
As the exam grew closer my anxiety increased and my confidence dwindled. In the last month of the exam I lived and breathed nothing else. My parents looked after my son while I studied. With each question I answered correctly my confidence grew and with each question I missed it was shattered into a million pieces. The few people that I opened up to about my failure would ask how the studying was going...others would offer prayers and well wishes. I felt inadequate, fraudulent I couldn’t figure out how I was able to take care of patients but still was not deemed worthy based on a test. I then came across three quotes from Michelle Obama:
“When you are struggling, and you start thinking about giving up, I want you to remember something that my husband and I have talked about since we first started this journey nearly a decade ago—something that has carried us through every moment in this White House and every moment of our lives—and that is the power of hope. The belief that something better is always possible if you’re willing to work for it and fight for it.” – Michelle Obama
“Am I good enough? Yes I am.”– Michelle Obama
“If my future were determined just by my performance on a standardized test, I wouldn’t be here. I guarantee you that.”― Michelle Obama
The day came and I sat for the exam and as I was logged in by the proctor I prayed. I thanked God for my calling and vocation and began my exam. When I finished I felt spent; I truly had done all that I could. If this was not enough I had no idea what the next step was and apparently neither did those at the ABIM. But what I knew for sure was that no matter what the test said I was enough. While I seemingly had to pass this test in order to continue on the traditional path of medicine I would not let it determine or limit my future. I am a doctor and I always will be.
Written By: Kharia J. Holmes
This article was originally published on WomenInWhiteCoats.com
The only personal example I have of the SAHM life is my cousin Bethany. First let me say If you aren’t following her on YouTube you are missing out on a treat, she’s on a slight hiatus right now with her new babies—2 little girls and her new business—Texas Reign. However when she is back on YouTube you will find that she’s hilarious, a bit country, and very resourceful. You can check out her previous vlogs here. After I had my son and had to return to work my jealousy of her only increased. At first I was jealous of her for 3 reasons:
Now I had to add a fourth reason: She has the ability to be a stay at home mom while I don’t. I would love the be able to stay at home and raise my son, however that is not a possibility for me long term as a single mother who is not independently wealthy. I would dream that her days at home were better than my days at work. I would imagine that she was cooking delicious meals from scratch for her family every day while I was reheating food precooked on the weekend if I was lucky or getting fast food if the meal didn’t cover the whole work week or I didn’t have time to preplan. I imagined that she was more rested than I was and was able to engage more with her child.
I realized that subconsciously I was guilty of making assumptions just like the “Transformed Wife”. While the grass appears greener on the other side it wasn’t. I soon realized from the brief conversations that she and I were able to have with both our hectic schedules that we have a lot in common in adapting to our new roles as mothers. Often there is a pitting of SAHM (Stay At Home Mothers) against WOHM (Working Outside The Home Mothers). Motherhood is not a competition; it’s a journey to be shared with others. As I have temporarily changed my role from a WOHM to SAHM I am blessed to enjoy this new season of my life and I truly cherish the gift and opportunity realizing the grass isn’t greener on the other side it’s just different and has to be cared for differently.
The one constant in life is change and I’m making a big one. It’s hard to be in the position of realizing that what you love to do is negatively impacting your loved one--ME! I have always grown up believing that as a woman I could have it all—and foolishly believed that meant at the same time. I don’t know where is got the idea from—certainly not from my mother! But someone planted that seed and I allowed it to grow unfettered and unchecked and it became an overwhelming weed in my life garden. As black women we are held up to be this pinnacle of strength; we can handle whatever comes our way. We are considered impervious to harm and HER-oic when facing adversity.
As I have aged I have realized that I having it all at the same time is not realistic for my life in this instance. While I feel horrible abandoning my patients it is a matter of self care. If my cup is empty how can I continue to pour into them? I need to put my own oxygen mask on first! What this all looks like—I have no idea. What my plans are—the Lord will reveal. But as a planner I do know what is on my schedule for March 11th—my son and I are going to Krispy Kreme so he can experience his first doughnut! 🍩.
As a doctor we are there for the lightest moments and the darkest moments of someone’s life. No one lectures or gives classes on how to tell patients about good news, however “Breaking Bad News” is often the title of our lectures on techniques and tools on how to be that voice of dread. In those moments of preparation before telling patients life changing diagnosis we are left alone with the information and the extensive knowledge of the devastation, heartache, and turmoil our words no matter how carefully chosen are going to inflict.
Setting the atmosphere, telling enough information without overwhelming the patient, preparing for awkward pauses to allow the patient time to process, handling the emotional response, handling no response, the crystal ball question and how to respond, and on and on sessions and
practice simulations with standardized patients; none of it prepares you completely for the reality of the situation. In all the attempts to prepare you not once have I ever had a class or talk or lecture on how to deal with the aftermath as a human being. In school and residency how to be a doctor is first and foremost but in a situation with such devastating impact no one has ever discussed how to handle the emotional rollercoaster you feel as a provider.
In a climate of physician burnout not enough of us attendings are discussing how we balance our scales of life. In residency the beginning of every year the topic that’s talked about is avoiding fatigue and burnout and taking time for oneself. The residency paperwork always includes the Employee Assistance Program (EPA) psychiatrist contact information for 3 free sessions—the rest you are responsible for at a discounted rate. You are introduced to chiefs, given a brief lay of the land, and then thrown you into rotations and your 80 hour work week life begins. A little bit of an oxymoron right? Work life balance is stressed however never taught. We learn how to take care of our patients but not ourselves. We hold on through 3+ years eagerly awaiting the end when our life as an attending can begin all under the expectation that Attending Life will be easier than resident life; and then the sad reality rears it’s ugly head that life is not always greener on the other side. In some respects and some fields yes things might be slightly better however for most of us, particularly those in primary care, the shock comes packaged with insurance coverage, prior authorizations, DME paperwork, billing, etc. We have gone to school to become the glorified secretarial pool of the health insurance world in addition to our role as healthcare provider. This was not the life we envisioned, not the plan we had for ourselves, at least it was not for me.
So how do we achieve the life we envisioned? For each one of us the goal is different because our visions, dreams, expectations, desires are as uniques as we ourselves are; however there are some tenets that I have learned along the way that I employ to keep myself sane and evenly grounded.
Be graceful to oneself
Cut yourself some slack. I have realized that I am not perfect. While I continue to strive for perfection I find the beauty in errors and lessons that I learn along the way.
Break it down before you do
I stay vigilant about my attitude. When I start resenting patients coming for their appointments and/or I start withdrawing into myself, I take a break. Better I take a break than let the system break me. As my dad once told be during a winter snow storm when I was planning on driving to the hospital for my shift…”If you have an accident and wind up in the emergency room they will find someone to cover your shift—right? So you can’t be that essential?”
Accept incompleteness: Its a Marathon not a Sprint
PACE YOURSELF! It’s so easy to keep working and working and working to get all the messages in your in basket completed; however I realized after many moments of disappointment that my in basket will NEVER be 0—there is always that patient about to request a refill of medication or that patient messaging me about a concern they have. It’s a far better thing I do to pace myself to win the race.
Honor your time
No one else is going to honor your time. Where I work patients are to be seen essentially no matter when they arrive for their appointment. This took some getting used to and still does at times. As my clinical assistant tells me often “That is why you get paid the big bucks” (it’s funny how no-one ever mentions the house note amount of debt I am in but that is a different post). Being a salaried employee does mean that you put in hours outside of work to make sure you get the job done; but that does not mean that my time is not valuable. I have set a hard and fast rule of 7pm. I even went so far as to set an alarm that rings on my phone and my watch because it’s easy for me to get caught up in the work. For me all work stops at 7pm and I go home to be with my family, to rest, and to prepare to engage another day. While some of my colleagues work on the weekends I choose not to. Does that mean I get behind in tasks...yes at times I do but my time is precious so I am very deliberate in what I give my time to.
Find your love and connect daily
What is your “Juege” as I like to call it? What do you live for? What gets you up in the morning? For me it’s my family and music. They make me smile and make me happy on the dreariest of days. I like to start off each day with a kiss to my LO and on tough days I make sure I have music in my ears when I enter the office. Hearing my playlist pumps my blood and elevates my mood. I tap into that fun part of myself that can get lost in dealing with minutia and drama. Whatever your juege is connect to it daily and if needed try to make a connection during the day when your days get hard.
Celebrate moments of acting in your calling
I take time to acknowledge when I feel I have made a positive impact in someones health. That is my calling, the reason I because a primary care provider, the reason I’m in hock up to my eyeballs (again another post for another day). On those occasions where I see the manifestation of my calling—I celebrate it! Weather it’s with my happy dance in my office, celebrating with a patient, or calling my best friend to tell her what just happened I take those moments. So much of my work seems to be faxes, reporting labs results, and dealing with the administrative side of medicine that it’s easy to forget the calling on my life so I take moments to celebrate it’s manifestation.
Work smart not hard
“I’m not your superwoman”~ Karyn White (circa 1988). I know I’m dating myself 🤦🏾♀️ but I can’t do it all. I have learned to delegate. I used to have a hard time asking for help and asking others to do something that I know if given enough time I could do. I have had to realize through time that I must work smart not hard and working smart means using ALL resources at my disposal. It does not mean that I am lazy but it does acknowledge that my time is finite and ties directly into—Honor your time
Are these tenets fool proof? By no means! Are there days when it all flies out the window? Yes, but those days have become fewer and farther between the more I adopt these tenets.
Being a primary care provider is not at all what I thought it would be like. Medicine has changed and is forever changing. As technology expands transformation of my beloved career continues to speed up faster than medical training can catch up. It leaves us attendings who are on the front lines of medicine to be transparent to those coming behind us about our struggles, valleys, hills, and achievements. Not only is it imperative that we acknowledge them to ourselves but we must also share with others how we make things work. So often when we have medical students or residents working with us and shadowing us we place a glossy staged photo over the reality of our day to day existence. We must reveal the truth, show the underbelly of our career path and then reflect our imbalanced balancing act so that the next wave have a leg up in blanking their scales of life.
Embracing my imperfection and striving for perfection through grace.