By Rebekah Apple, MA
In 2013, Jennifer Packing-Euben, MD, was in her first year of the Florida Hospital Family Residency Program, and feeling somewhat dazed by the experience. Fast forward to July, 2016. What words of wisdom does she offer? “Priorities,” says Packing-Euben. “It is all about getting priorities straight.”
Not all residents have the same priorities, of course, but for Packing-Euben, most challenging was balancing family and work time. In truth, there can be no balance, she says. “You’re going to try to balance what you know is your focus – training – and the people you care about the most, those who need the most from you. But they’re going to feel the lack of attention from you, and you won’t be able to do anything about it.”
For Packing-Euben, the importance of family affected everything, even before residency began. Finding a program based on location was key, so she could be close to her husband. It required that she take a serious look at the way programs are evaluated. Many students, according to Packing-Euben, believe prestige is most important. “A big name isn’t going to necessarily affect the quality of your training,” she says, and sacrificing close proximity to loved ones would have had a negative impact on her life. It was hard enough to know she wasn’t able to give her family all they needed from her – to be far away physically wasn’t an option.
Her family made sacrifices on her behalf throughout residency, however her intern year required the most. Making it through this difficult evolution in relationships is predicated upon preparation – identifying new rules for communicating needs and having expectations met. Packing-Euben’s husband, also a physician, had realistic expectations when she began her residency. “He knew what to expect,” she says, and believes that is definitely a part of what kept their relationship strong. During his residency, ⅓ of physicians divorced. Of the twelve residents working alongside Packing-Euben, two experienced major breakups.
It isn’t always a lack of attention to relationships that causes strain. There are, according to Packing-Euben, genuinely dark moments during residency. “Not only is it the least amount of sleep you ever thought you could have,” she recalls, “but it’s a huge amount of brain power, physical and emotional energy, and you have to constantly perform.” The pressure is enormous, and there is no let-up.
She found strength by identifying physicians she knew she would want to emulate in the future. “You have to mold yourself in the moment,” she acknowledges, “based on whomever is in charge of you that day.” But she recommends starting out residency by seeking characteristics worthy of adopting in the future. “Everyone has their own way,” she says. Look for the way certain physicians handle themselves, and learn how to best comport yourself in the future. “Find role models.”
Those role models are especially apparent in stronger programs, so Packing-Euben recommends looking for them during the interview process. “Within the first hour or two of the interview,” she says, “you’ll know if it’s a malignant program.” She describes such a program as one which does not include interns in the process, or if everyone appears unreasonably exhausted. (In spite of legislation and rules, there are “grey zones,” according to Packing-Euben, with regard to how many hours residents work.) “You want to look for how authoritarian people are, the way they talk to one another,” she asserts. It requires a bit of sleuthing. “Read between the lines, and take notes – of negatives and positives.”
The presence of interns during the social interview was most important to her. “If they’re not there, unable to give feedback and an assessment of their experience, that’s a red flag to me.” Packing-Euben also tried to ensure her goals and agenda aligned with the program director’s. “They want a strong program, of course,” she acknowledges, but the definition of strength can vary between director and resident.
Looking back, Packing-Euben genuinely liked how much “it all came together in residency … in the fourth year of med school, you’re starting to get it, almost functioning like an intern.” But she was shocked at the difference between first and second year of residency. “The system really does work. Yes, you’re crushed, but the reason you do it is because you see it, and see it again, and again, and you remind yourself, and all of a sudden, it makes sense.” Packing-Euben remembers beginning to feel the nuances when it was time to make decisions, and feeling happy about what she was going to do for the rest of her life. “What I was doing really came together.” That had been a slight concern, since she’d been “one of those in med school who liked everything. I ended up in GM because when I went to residency I wasn’t exactly sure what I wanted my daily life to look like. But then it all came together when I felt like I was actually becoming a doctor.” Reflecting on how she felt upon residency completion compared to when she first donned the white coat at the start of medical school, Packing-Euben says there is no real comparison. “I shun the whole white coat,” she says with a laugh. “Not only the connotations, but the infectious disease side!”