The American Journal of Psychiatry is a fairly important publication. It has an impact factor of 12: this is about four times that of similar general journals.

Their introspection column is about the experience of being a shrink. This month a young, entitled, and angry psychiatrist let rip.

Sure enough, I had passed part I of the boards. I have never been great at standardized tests, generally just squeaking by. This time I had done uncharacteristically well. I was relieved to have passed part I and excited about completing part II and leaving the last hurdle of training behind. Still, I could not help but reflect on my months of preparation, weekend mornings spent at the library, my son’s naptime earmarked for memorizing DSM-IV criteria, and babysitters hired to entertain him while I completed hundreds more practice questions. With the security of that heavy envelope in my hand, I wished that I had studied less, missed fewer pancake breakfasts, and taken a few naps myself. I went to my calendar to record the date I had been assigned to take part II of the boards: Sunday, May 9, 2010. Mother’s Day.

Well, yes. I train people for the local fellowship: that exam is harder. Thirty percent of those who sit — and these are people who have satisfactorily completed at least three years training in psychiatry and are at least four years post medical degree — fail. About twenty percent never pass. And… unlike the US, you can’t work as a specialist without a fellowship.

Postgraduate exams are designed to be stressful. Because, sometimes, when you have been up all night worrying about your kids — you will walk into unfounded accusations, serious events and enquiries. Psychiatry is all about managing that level of stress.

The intensity of my reaction shocked me: I was angry. Really angry. Initially my anger was puzzling, as I’ve never been overly invested in holidays. My husband and I joke about modeling holidays on Hanukkah: our gifts to each other trickle in over 8 days since neither of us is sufficiently organized to meet a deadline that lasts only 24 hours. Before I had a child, I considered Mother’s Day a “Hallmark holiday,” another entry on my endless to-do list, a time to call my mom and corral my younger brothers into doing the same.What upset me about my board exam being scheduled on Mother’s Day went deeper than missing a chance to be served breakfast in bed; it encompassed my experience as a woman in a still largely male-dominated profession. I was angry at a system of medical training that actively recruits women without honestly preparing female medical students for the gender-related conflicts they may face while training to become doctors during their childbearing years. I was angry at a system of residency training that lacks an infrastructure to provide women flexibility in completing residency at their own pace, often forcing female residents to choose between devoting time to their careers and caring for their children.

People at 18 make a decision to go into medicine (by entering the pre-med programme or medical intermediate). They then compete to get in. They do not think ahead to what it is like raising kids and running a marriage when medicine (and psychiatrists are doctors. We do call. On Christmas, on our kids birthdays, on Fathers and Mothers day…) takes the same emotional investment as a mistress.

And most of all, I was angry at psychiatry, a discipline that should have insight into the emotional and practical challenges facing female physicians yet still seems to lack an appreciation for the conflict between being good-enough mothers and good-enough doctors.

via Happy Mother’s Day, With Love From the ABPN — LaRusso 168 5: 464 — Am J Psychiatry.

No, you are angry about being in America. The need for presenteeism in America and investing in your career comes at a cost. I’m aware that in the rest of the world, part time training is available — extending the time to specialist practice from around seven years training to ten or eleven for many women.

Some of the people I trained with looked at that cost — and chose not to take it. One became a staff physician on a chronic ward, and let his wife be a family physician while he did most of the child care. One chose to be an executive wife (which is  a full time job) and part time staff physician.

But the author needs to harden up. Psychiatry is difficult. Raising kids is difficult. Getting angry over petty things like missing a commercial holiday is a waste of energy. Stop resenting the cost you have paid and start enjoying the trade you are now a member of.

Or choose to do something else. But this  solo father, who is a psychiatrist and academic, has limited sympathy for this exercise in self pity.