Because I just finished 5 days of Night-Float, my internal clock is off. So I woke up at 4:30am, and am posting to LJ. My Family Medicine residency is half over and I've realized I don't have a lot of time to decide on the rest of my life. I will have to start narrowing the path of my professional career very soon.

The ballots for Chief Resident were sent out this week, and I should find out soon if I made the cut. I feel that being Chief would be good for both the program and my professional development. I've realized that I've spent all of my life as a student of some sort, and a real leadership position will be a good transition for me. I feel that at the tender age of 28, I'm ready to turn into an adult. I have poor organizational skills, but I know that I would change before I would let down my colleagues. Regardless of whether I'm elected, this will be the year I will actually become organized because I really have no other choice.

I'm also becoming more confident in my clinical skills. This week I did 3 endotracheal intubations, 1 central venous line, and 1 delivery completely unsupervised. I also did 4 supervised deliveries. This is a big contrast from my intern year where the thought of doing any of these things frightened me to varying degrees. I'm starting to have to think long and hard about what type of medicine I want to practice. Most family physicians are drawn to the specialty because they want to be "real doctors," whatever that means. It's a term I hear a lot, from the pulmonologist who states "I'll leave that stuff to the real doctors." and the radiologist who said to a group of us as we left his office "Farewell to you, the last of the real doctors."

Right now, I'm doing a lot. I see kids, adults and teenagers in the clinic. I've admitted patients from one-week-old to 104-years-old to the hospital. I run codes. I alternately deliver babies, or resuscitate them. I see patients in the nursing home and the newborn nursery. The scope of medical care I'm learning to provide is shockingly broad. Medicine, of course, involves lifelong learning. But I realized that if I don't become competent any any given skill now, I may never learn to do it.

In a year, I am going to have to start looking for a job, and the jobs available to an FP are extremely broad. Some do only hospital work, while others work in ER's, while others only 8-5 in a clinic. One of the biggest decisions that an FP resident has to make is whether to do OB. Going into this, I had no interest in it. I didn't enjoy how every little thing was so life and death, or how one's schedule could be ruled by the dilation of a cervix.

But the last year and a half has provided me with a wonderful opportunity. I've seen pregnant women through their first prenatal visit, delivered their babies, and then cared for the babies through their well-child visits. The pregnant patients I got in 2005; I'm now seeing their nine-month-old kids. No other type of doctor gets to do this. OB practice as an FP certainly has it's disadvantages. The call sucks, the malpractice liability concerns are high, you have to refer out high-risk patients, and you can be looked down upon by OB/Gyn's, staff and patients. But I've realized, realistically, if I don't do OB during my first year in practice, I probably never will. I don't know if I can commit myself to so severely limiting my practice so soon in my career. The same goes for any other major practice area (newborn care, ACLS, gyn procedures).

It's both exciting and scary. Since Kindergarten, my academic career has been layed out before me several years in advance. Soon I will have to make very concrete choices about my career. I'm going to have to figure out what I want to be when I grow up.