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Report from Burnoutville: Flexibility creates families out of teams

As I inch towards a peri-retirement, I am grateful for the long-standing flexibility my on-call group has used for many years—to the benefit of practitioners at many different stages in their careers.

In a follow up to my last story, I decided to stop taking obstetrics call.

I was very touched by the universal support from my on-call group, who agreed to let me not take call but to still come in to deliver my own patients, and maybe do some formal teaching for the residents and fellows. This allows me to continue working at the clinics where I care for Hasidic women and refugees. In both these places, there are also the hipsters; the musicians, filmmakers and video game designers who are now gentrifying the neighborhood.

As one of my friends wrote to me, “This is the beauty of our OB group; we are flexible in a way that supports the needs and desires of our members across every stage of their medical life cycle.” Perhaps this is why we are one of the largest and most successful teams in FM-OB in the country and have one of the highest recruitment rates for residents into OB practice. The secret of our success is this flexibility.

When I started in this group, in the early ‘80s, back before the dawn of time, we were five people. We had barely 100 deliveries a year between us and we took call for a week at a time. I was the second woman in the group. In the next few years we grew our numbers and added a few more doctors. Almost from the very beginning we have valued and prioritized the individual needs and life stages of our members. At first the zeitgeist was very much that people should and would deliver their own patients, but we soon realized that was impractical for some of our members. Instead of the very rigid “one size fits all” approach most groups have with hard call, which I believe is often “one size fits none,” we have allowed our members the flexibility they need to practice OB throughout their lives.

We developed our system of “guilt-free sign out” where we came and went for our patients as we could: accommodating doing obstetrics without jeopardizing our sanity or family lives. When my children were young, middle of the night deliveries were easy for me. I often signed out during the “arsenic hours” of five to nine in the mornings and evenings when dealing with getting four kids either up and ready for school or fed and into bed required my presence and teamwork with St. David, my long suffering but very capable husband. I see that pattern continue with this younger generation, where they often prefer to do only nights, although most now do hard call and only come in when they are on the schedule. People with no children, or older children, often prefer to do 24-hour calls, so they’re on call less often and their lives are less disrupted. Some prefer to just do days, like me, now that I am in my peri-retirement. We accommodate all these preferences (thank you Barb for making that happen by managing the crazy scheduling). As Barb said when we discussed this, “I probably would have given up OB the day I had my kids without this flexibility.”

“But this is not fair!” I hear some people crying out. If people are coming in for their own deliveries they are taking money away from the group. Perhaps, but it keeps our Birth Junkies happy. They’re often the people with the highest patient numbers. So even with them delivering a lot of their own patients, their contribution is positive. The young mothers can keep doing OB at a slower pace without quitting completely and maybe never coming back. And now, I’m able to keep doing a few deliveries and teaching without killing myself.

I’m reminded of a very salient part of A Wrinkle in Time, the wonderful book by Madeleine L’Engle, which for some reason, is now on a lot of banned book lists. In the book, Meg Murry, the heroine, confronts It, the disembodied brain which has her father imprisoned. It is arguing that he has created a utopia on the Planet Camazotz, which has succumbed to the Black Thing, the evil which is spreading throughout the Universe. “Everyone is the same,” It says. “Everyone is equal.” Flying into a rage of righteous anger, Meg fights back. “Equal and the same are not the same things!”

So to echo Meg and the author, I wish to make a plea for call groups of all kinds, and family medicine obstetric call groups in particular, to embrace the diversity of their members and replace uniformity with equity, and sameness with a more realistic and humane definition of fairness.

As I sit on my couch watching Daniel Tiger with my grandson, I think that Mr. Rogers’ values of kindness, recognition of needs and emotional intelligence are our very strength and I hope will be part of my legacy. As another member of our group said, “This is a call for call groups to work not only as teams, but as families, because in functional families, each member’s needs are appreciated and met.