Thriving or Surviving with Dr. Stephen

“Google Calendar becomes another member of the family” - Dr. Stephen 

In this episode, we sit down with Dr. Stephen, a family physician and palliative care doctor, about his experiences with family building. We chat about the importance of locum coverage as a staff physician, balancing fatherhood with medicine, daycare waitlists, and the ins and outs of paternity leave. 

We appreciate your feedback - please leave a comment and subscribe so you never miss a new episode!

#PalliativeCare #FamilyMedicine #PaternityLeave #MaternityLeave #Locum #Fatherhood 

Transcript

Radha Sharma: Welcome to Season 1, Episode 4 of Family Planning for Docs - Thriving or Surviving. This podcast is an extension of our platform at www.familyplanningfordocs.com, a website created for Canadian medical trainees to highlight useful information about family planning and a medical career. Our group has a mission to inform medical trainees about their options regarding family planning. While navigating training, career, and personal life.

Radha Sharma: Our research has demonstrated that personal stories are really impactful, and we hope to provide access to a diverse number of stories, to current trainees on our podcast we hope to capture the stories of these professionals who have navigated the training process and a career while planning parented parenting and the supports along the way. In this episode we have Dr. Stephen. We are thrilled to have you on our podcast today. Thank you on behalf of our entire team for taking the time to share your story today.

Radha Sharma: So, I'm just gonna get started by asking you, what does a typical day in the life of Stephen look like? 

Stephen: Sure. So, I work in a a smaller city in Southern Ontario, and I essentially divide up my time half between comprehensive family medicine in a group practice, and half of my time in palliative care where I work as part of a team, and we do a lot of home visits, hospital visits, hospice work as well. So in terms of how I got to this point in my career. I did 4 years of medical school, and then I completed 2 years of family medicine residency. And then, during my second year, my partner was actually encouraging me to look for options for a third year. Just basically expand my options, in case of any government action against comprehensive family medicine in the future. I took her advice, and decided to do a rotation in palliative care, and I really loved it. I applied for and got accepted to some of the PGY3 programs in palliative care. I chose one of those and completed that. And I've been working ever since in a kind of a 50/50 mix of family medicine and palliative care. Typically, how I divide up my time is on Mondays and Wednesdays. I'm in comprehensive family medicine. And then Tuesdays and Thursdays, I'm doing mostly home visits for palliative care with my team. but I do respond to palliative care issues throughout the week. I get messages and deal with virtual care just in between patients.

Radha Sharma: That's incredible. So it seems like you're able to kind of do both and split up your time evenly. I know, for some family doctors that have done a plus one they choose to do, you know, one day a week. Do you enjoy doing palliative care as much as family medicine? What does your split look like? 

Stephen: Yeah, I'm really loving it too. Actually, I get a lot of inner satisfaction from my palliative care work, sometimes even more so than my family medicine work. It's really nice to see when patients have a life limiting illness, and we go in and assess them and see what their needs are, what their symptoms are. see how basically we can help. And sometimes within hours to days, they start to feel better. And they're really thankful for our team's involvement. Our team makes ourselves available by phone 24/7, and we work together with the visiting, nursing in the community. So if people's goals are to try to stay home towards the end. Then we do our best to try to make that happen. And usually families are very appreciative of this.

Radha Sharma: That's incredible. Like I mentioned earlier, our goal of the podcast is really to see how you've been able to fit your family plans while also having this amazing career. What inspired you to start a family?

Stephen: So starting a family was always something that my partner and I wanted. We had spoken about it before marriage, and then after marriage, of course we didn't specifically time anything. Necessarily. We just kind of waited until things felt right for us, that personally, that was just basically after we had the house and some stability in our work. but certainly everyone is different. So it really depends on their personal circumstances. But that was just how we felt. It was natural for us.

Radha Sharma: Amazing. And I think a lot of medical trainees are listening, think a lot about timelines, and I know you mentioned that you didn't really have a specific time, and it was more so based on the stability. What point in training did you have children at? Were you a resident, a staff physician?

Stephen: So both my partner and I were staff physicians already. 

Radha Sharma: Amazing. And when you were a staff physician and had your child, were you able to take paternity leave? How did that look like for your partner and yourself?

Stephen: So so for myself, I wanted to be able to take some time off at the time of delivery, so I wanted 2 weeks off the time and delivery. But then I also wanted to take 6 months of paternity leave in total and I decided to do that in combination with my partner. So my partner took the first 6 months of baby's life, and I took the second 6 months, and personally for me this was very important, because I wanted to develop a very close relationship with my child, and it was very important to me as a development as a father. 

The goal for both of us, for our child was to have the child in daycare at around age one. So we did have a set time where we were hoping to go back to work. So 1 piece of advice I would like to pass on to the listeners is that it's very important to secure daycare or childcare well in advance. In our situation, and probably in many others throughout the country, it may be necessary to get on more than one daycare waiting list, because the waiting list can be quite long. Sometimes we may be told that a spot is available, or that it’s pretty much guaranteed. But that's not necessarily the case. And if you do have a set time that you do have to get back to work then it's really important that that gets solidified. So that was one of the main things that we basically did very early on, even while my partner was pregnant.

Stephen: So before delivery we got on several waiting lists. We went on tours of daycares and expanded our options, not just in the city we live in, but also the city that I work in and other places surrounding. So we basically tried to set that up ahead of time.

Radha Sharma: So, you can’t really ask the day before? That won’t fly. 

Stephen: No. Otherwise you may have to extend your leave even further in order to to care for your child.

Radha: And, when you were kind of going through the process of figuring out which daycare to choose, what resources were accessible to you? How did you figure out which ones you wanted to kind of apply for?

Stephen: So my partner took the lead on taking a look at all the various daycares in the area, we basically made a huge spreadsheet and listed all the pros and cons of various daycares. We spoke to colleagues, other friends, people in the area, visited as many daycare, went to open houses or set up appointments to go to each one to basically get a sense of what a day to day life in the daycare would look like for our child. So that kind of helped us narrow it down a little bit, and then, basically, we just put ourselves on as many weightless as made sense, and some of them did require deposits, but thankfully they were refundable deposits if we opted not to go with that daycare. So we we were, financially, thankfully able to do that

Radha Sharma: Awesome. I'm going to go back to the paternity leave a little bit and ask you about that if that's okay?

Stephen: Yeah, for sure. 

Radha Sharma: So in terms of policies for staff physicians or you know things that are set in place, Is there a place for parental leave already built into the sick days? How does it work when you want to take time to spend time with your baby?

Stephen: Yeah. So it's a very good question. So Ontario specifically does have a pregnancy and parental leave benefit available through the Ministry of Health. I, personally, did not qualify for this, because the way my family medicine is structured, I was getting capitation payments. It was a rostered based system. So even while I was away, I'm still getting money directed to me. So because of that I did not qualify, and in addition to that, during my paternity leave, I still opted to work a little bit in palliative care just to keep things up, and also not having to hire a locum for palliative care. So I was still getting some income that way, so I I did not qualify for the official leave money, but I did have income still coming in towards me, so I was able to self fund my paternity leave.

Stephen: Basically, just to simplify how I did my paternity leave, I got a locum to cover my family medicine practice during those 6 months. Things have gotten very difficult, unfortunately, nowadays, to secure a locum just given the state of family medicine and the lack of government investment in family medicine. But at the time when I was looking for my locum, I was successfully able to locate a locum thankfully. So I basically got my clinic to help me develop a locum agreement. They had some experience with other locum agreements that they had done in the past. So we got that set up and agreed to cover my family medicine practice. Again, it was basically just 2 days a week that they had to to cover my practice, given my smaller roster size and then, as mentioned previously, my palliative care practice, I decided to still work that during my paternity leave, but I cut that down to just one day, a week in person, and then I was available for virtual management the rest of the time just during the daytime kind of during my downtime with baby. So whenever I had a free, spare moment, I would be able to pick up the phone and deal with some things virtually that way.

Radha Sharma: Thank you for clarifying that, because I know it's a question that myself and definitely others have when planning or thinking ahead about what time off really looks like and what the consequences might be. Yeah. Did you face any challenges taking paternity leave with finances, really anything during this parenthood process?

Stephen: So definitely, the income does go down during paternity leave just by nature of lack of clinical work. So for example, my capitation payments for family medicine. primarily, we're going towards the locum for coverage during that time, and because my roster is smaller, I was getting less capitation, to begin with, so a greater proportion of that was going towards the locum. But I was very happy to have a locum covering me.

Stephen: It's also very important to set clear expectations of the locum beforehand. So for example, how many days you'd like them to cover for you if that works with their schedule. What's being done with the inbox, because a lot of what family medicine is dealing with things that come into the inbox in terms of documents, labs, reports from specialists that sort of thing, and these come in day, day in, day out, regardless of if the the family doc is working that day. So it's important to set up expectations for who's covering for that, and who's dealing with the urgent issues that pop up on days when maybe the locum is not working.

Radha Sharma: And I know I spoke about challenges, but what were your biggest support systems to propel yourself through this time, because I can imagine being a new parent, and then also dealing with all this, you know, change in your practice and having the locum can probably be difficult. So yeah, what were your support systems at that time?

Stephen: So definitely our families, were very supportive of us and we’re very thankful for them. Definitely after delivery my partner's mother has bailed us out on numerous occasions when both my partner and I had to work, and it didn't work with our schedule to be doing the child care. So we are very thankful for that. Definitely some other supports that we utilized were Google Calendar. Basically Google Calendar, becomes kind of another member of the family. So basically, we utilize that even up to a year in advance to kind of plan out our schedule, see exactly which days we're working. Who's who's doing what? When? Sometimes I have to work after hours or on weekends, similar with my partner, who does shift work. She has to work at various times. So it's very important that we ensure that someone is around for child care.

Radha Sharma: I love that idea of Google Calendar being your family. I feel like it's already a member of my family, so my partner will have to get with that. So, you have one child right now?

Stephen: Yes, yes, so they're 4 years old right now. 

Radha Sharma: Four! And how has it been parenting a 4 year old?

Stephen: It's definitely a journey. But it's a very happy journey. Nonetheless. It's very encouraging to see how they're growing and developing, and how their minds are developing. They're picking up things, learning things queuing in on, on things that we teach them. And they're asking really interesting and intriguing questions, and then building on that to develop more knowledge and just seeing how they're exploring the world around them. It's been an amazing journey so far.

Radha Sharma: I know the listeners can't see your face, but I will just like to say that you are beaming with this smile when you're talking about your child. It sounds like it's truly just a joy. That’s amazing. Were there any unexpected challenges of being a new parent that you didn't really plan for that kind of came up while also balancing your career?

Stephen: I would say the main challenges, as mentioned before, was the scheduling. So again, using Google Calendar was key because we had to make sure someone was around for daycare, drop offs, take care of pick ups, after school activities, weekend activities, that sort of thing. So it's really important to be flexible. So for me, my schedule happens to be more flexible than my partners in being working mostly daytime hours for my work. So I was able to reschedule things, if need be, or try to move around, and after hours, clinic, if one didn't work for our schedule. and for some things I do serve on some leadership boards as well. So for some things I've had to organize them really late at night, after my child goes to bed that sort of thing. So it's just important to be flexible. And and again, Google Calendar has been really integral.

Radha Sharma: So to all the listeners, the biggest message is Google Calendar, please and thank you. And don't try to get on the daycare waitlist a day before your child is born. To all the procrastinators. I know you said that being a parent is just to join in and of itself. What would you say is the best thing about being a dad?

Stephen: I  would say just what I said before, essentially, just what? Watching my child grow and develop over time and seeing the relationship that he has with me and the sense of humor that he has, and he really loves spending time with me as and I, and likewise I with him. So we've had a really great journey thus far, and I'm looking forward to many years to come.

Radha Sharma: Amazing! I ask all my guests this: If you had a magic wand, and could somehow go back in time and change something about your life, would you or would you not. And why?

Stephen: Hmm! Interesting question. I would say I probably would have traveled even more. So I did travel here and there before having a child, but there's so much of the world I have not yet seen, and it's definitely much harder with a small child to be doing a lot of traveling, especially crossing time zones. So, we have done the occasional traveling here and there, mostly within Canada, a bit in the US and a bit to Mexico. That sort of thing on small vacations here and there. But definitely, I'm looking forward to when he gets a bit older going to things like theme parks, perhaps even even older, going on bigger excursions, maybe journeys to other continents, that sort of thing. But definitely, if you have the financial ability to do so and the flexibility in your schedule, I'd advise everyone to travel as much as you can before having a child.

Radha Sharma: As you reflect on your own story here, is there any piece of advice you would give to your past younger self, maybe as a resident or as a medical student, even that you would have liked to hear?

Stephen: Yeah. So that's I'd say, that's something that I've learned in the palliative care world is that no one at the end of life wishes that they spent more time or mental energy at work or worrying about work. But what seems to be quite common is that they all wish they spent more quality time with the people they care about. That's something that when they're looking back at their life they either are happy about that, or wish that they spent a bit more. So I'd probably have told my younger self not to worry so much about the small details and small stuff that we, as in the medical field, worry about on a day to day basis. I even still recall worrying about all the little things in undergrad and medical school and residency. And now, when I'm looking back, it's not those small details that really mattered. It was more the bigger picture how we felt overall and things really do have a tendency to work out in the end. So you know, we're all in the same boat. We're all kind of very stressed out at all times and in the medical journey. But things do work out and support, and just kind of enjoy the ride, and know that things will work out and not worry so much about the details.

Radha Sharma: That's beautiful. I have to take all these piece of advice myself, because I'm so early in my training. I feel like I'm still on that perspective of every little thing that matters, and if I mess this up, then I'm going to mess up my career. Take the wrong move. So it's really nice to hear you're well versed into your career now, and you have those perspectives. I think medical trainees will really appreciate hearing those things. So thank you for sharing your wisdom. Is there any other advice that you have for medical trainees? Maybe about paternity leave or planning to have a child?

Stephen: For sure. So I'd say that there's a few things I can think about that I'd like to pass on to medical trainees. So first of all, if you'd like a partner, do pick your partner well, because a good partner will support you and encourage you. You folks will grow together and a good partner is good for your mental health. So I'd say, That's first and foremost, if you want a partner, and not everyone wants a partner, but if you do, then do pick your partner well.

Stephen: Secondly, I'd choose your career well, so choose something you're really passionate about. It's something that you'd enjoy going into work for. And it doesn't mean that you'd be stuck in that job forever, because medical careers can be fluid, especially, for example, something like family medicine, where we can adapt ourselves to so many areas of the healthcare system.

Stephen: And thirdly, I'd say, take it upon yourself to learn the basics of financials, because many physicians do not have a pension or benefits, and many of us are self funding these, self funding things in the community. If you're working in the community like our own clinic or staff, our EMR, that sort of thing. So it's important to master these financial aspects early and investing early as well, so that you take advantage of compounding.

Stephen: And then, lastly, with respect to leave like paternity leave or maternity leave, I'd say it does take some planning, but it can be done. So you can use my example, for, for example, that I did want to take 6 months off for paternity leave, but I had to intentionally plan that, I had to hire a locum. I had to reorganize how I was doing palliative care. I had to organize how I was going to be doing each day and seeing if that could logistically be done. But it can be done if you kind of plan early.

Radha Sharma: Amazing. Thank you for sharing those words of advice. There's a lot of information in this podcast and we'll also link some resources about the things you mentioned in the show notes from today for anyone's purview. And lastly, Stephen, we ask every one of our guests this; As in the name of the podcast, are you thriving or surviving?

Stephen: I would say it probably depends on the day. So, some days I do feel like I'm just surviving. I do make make lists to keep track of what I need to accomplish, and sometimes the list just grows and grows, and I don't feel I've made made any headway in my to do list, or I don't feel like I've accomplished anything positive at work, or I'm feeling just really grumpy, and I don't feel like I'm being a good enough, dad, and I think that's something that's quick common amongst all all human beings, really. But then, when I look at the big picture I realize in my personal case that I am thriving in the grander sense of things. I do have a happy life with my partner, a very happy, healthy child. We are in the careers that we've fought for, for years throughout undergrad medical school, and so forth. And we finally achieved those careers that we wanted. we're making positive impacts for our patients in the field of medicine. Both my partner and I do take on some leadership positions as well, and we do try our best to help out our colleagues as best we can, and overall, I'd say we're just happy.

Stephen: I'd say overall, we are thriving.

Radha Sharma: So it depends on the day. But the big picture, as you said before, would be thriving. 

Stephen: Yeah. 

Radha Sharma: We want to give you another thank you, Dr. Stephen. It was an absolute pleasure chatting about you today, about your perspectives on pat leave and what goes into planning for daycare and just being a parent overall and balancing an amazing career in palliative care and family medicine.

Radha Sharma: This is Radha and Stephen, signing off.

Stephen: Thank you so much.