Dear Anita,

My thoughts?

A smile – a big one.  The first one of the day.  And want to know what more? Small tears welling up in my eyes.

Why? Because finally through all this frenzy over the last week – I had someone (I trust – you) put it into concrete words! Oh I should have talked to you sooner (but wanted to think things out more, and felt burdening you with a “problem”)

—

Anita,

You said it so well.  I want to print this out and bring this to their home.  We may in fact be going over to their house (an hour and a half upstate from here) after work today or tomorrow.  Not to “rush” but time is of the essence to reduce distress.  There is no need for this distress to become insurmountable.  As I said earlier – I thought the following would be key.

A set of loving, supportive, not personally biased, not selfish/self oriented parents are important as mentors as well.  They have lived many lives and have always given the advice of : “we weren’t able to do all that you can, go and be free and live your dreams.” What’s more is that they are honest – the conversation you stated above is EXACTLY what we need, and literally word for word what I imagine! (oh my you are good at this!!).

This is exactly just what is necessary.  How about that…

—-

okay next thought more technicalities- away from above (as we will discuss this with his parents and I will fill you in).

The jobs.

So, you (maybe more than anyone) knows how much his job has affected him. When we discussed this over this week, and mostly this morning – he felt often that (I am paraphrasing)–>

“perhaps he is being too sensitive.” that before his eyes they are making changes for the better. how ironic! they are hiring additional staff and a physician’s assistant to make the daily life less burdensome.

to this we counter act – sure they may be doing these things, but will it really change the overall job and trajectory over the years? impossible to say.  But one thing is for sure.  The difficult patient population will always remain this way.  The difficult infrastructure of a hospital in this population will remain difficult. (not that San diego is simply a walk in the park).

Next,

Yes, I am not a mother yet.  But let’s for conversation sake go here.

We have a child in the next 2 years.

1) We are in nyc, he is now 2 years further in his job here and continuing to make a stable salary and moving up in many ways

2) we are in San Diego.  Brand new surgeon in a practice.  He is in the “ramping up” phase.  This means that he is salaried for the first year and supported.  After this he becomes a partner in an “eat what you kill”  mode.  AS in he is his own boss in some ways as long as he reaches the quota the practice would like (this is how it is everywhere in private practice all over the country).  Currently he is working as an employee at an hospital.  It is the difference between being an:

employed vs. private physician

employed: stable salary not as much of an impetus to become busier and busier

cons: not much room for personal growth, not much ability to change things like call schedule (weekend calls), not much ability to add on staff that you want (as the hospital administrators dictate this)

private: salaried for one year, after this more of a “risk” in the sense that it is “eat what you kill and thus there is an impetus to be busy enough.  ability to be as busy as you want once you meet your “minimum” as in the current spine surgeon who is out there is working half days on Fridays to spend time with family. (he is almost 50 and has been at this practice since his 30s so he has set himself up)

My husband said this morning:

We aren’t 25 anymore, not even 30.  wouldn’t we want to stay in an area where things are more “stable” at this age – the time of settling down.  Versus go to an area where I would have to start from scratch and ramp up?