There are so many shifting tides in the practice of medicine in 2019. I have just learned of another milestone. For the first time, employed physicians outnumber physicians who are self-employed. This data is reported in a Policy Research Perspective from the American Medical Association by Carol K. Kane, PhD. She reports that younger doctors (under the age of 40) are more likely to be employed physicians. Women are also more likely to be employed physicians. I made the shift from an academic elite private practice to join a large multispecialty medical group at the age of 40, just as I was about to leave this demographic of “young woman.” And I continue to have so much to say about this shift. I am an Orthopedic Surgeon. I have been a doctor for 2 decades now. I became a “surgeon” the year I turned 25, when I graduated from medical school and began internship. The year was 1997, and when I left New York City for Houston I wasn’t even sure what time zone I was entering. The humid southern climate was as foreign as the southern accents and the world renowned medical center called Baylor. My late father, who was also an orthopedic surgeon, moved me into my apartment and crushed the oversized bugs with his size 14 feet (mostly by accident). I was confident in all of the wrong things, and was completely unprepared for the independence expected of an unsupervised intern in surgery. I survived year one, persevered year 2, learned in year 3, struggled in year 4, and finally hit my stride and thrived in years 5 and 6. I moved on to Los Angeles to one of the top pediatric orthopedic fellowships in the world. I entered the mecca of my specialty and surprised myself with my success. I was lifted by my mentors. I was brought into a fold that I never knew existed. I was asked to serve on the Board of Directors of the Pediatric Orthopedic Society. I believed that this honor came because of my academic hospital home. I shocked myself in 2011 when I left the glory of Children’s Hospital Los Angeles and all of the accolades that went along with it. I assumed that I would no longer be embraced by the academic elite. But I had my 3 children to think of. I had sanity to consider. I had predictability to embrace. I was then elevated to the Board of Directors of the mother society of all orthopedic societies, the American Academy of Orthopedic Surgeons. I had underestimated myself, and I had underestimated Kaiser Permanente. My leadership experience from the orthopedic world grew. I was asked to mentor in an elite orthopedic program entitled “Leadership Fellows Program”. Applications are accepted for mentees in this program through age 45. I was 44 when I was invited to mentor. I was elevated to oversee the Communications Council of the Pediatric Orthopedic Society. I was appointed to the Board of Directors of the Ruth Jackson Society of women in orthopedics. My invitations to speak and lecture throughout the country did not slow down. In the 8 years since joining Kaiser Permanente, I have worked hard clinically. I have become respected by my department and was promoted to the position of assistant chief the year after I became partner. I am the Regional Clinical Lead for Pediatric Orthopedics. I am part of the Clinician Patient Communication team, in which I get to do deep work with my partners about how to best connect with our patients with integrity and remain true to ourselves. I take great pride in this program that bolsters our physicians. I am part of the regional team that leads perioperative services, and my niche is in culture. Regional Perioperative Leader for People, Practices, and Systems. My long-term work on this team will focus on diversity and wellness among our surgeons and anesthesiologists. I do all of this while maintaining a full orthopaedic practice. And when I close the door to share a visit with a patient and their family, the room is absolutely no different than the one I inhabited in the mecca a few blocks away. My 12-year-old daughter remembers the days when I rarely returned home in time for dinner, the days when I left for work before she woke up. But happily, my 9-year-old daughter and 7-year-old son do not remember these days. I am an active mother with full support and partnership from my husband of 15 years. I love being a busy surgeon physician, and I believe that whatever I have accomplished as a surgeon and a mother is enhanced by my shift. It is not for everyone. My ego is often checked at the door. But I wouldn’t have it any other way.