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The Mommy Wars, Medical Edition

Women: less worthy of the privilege of a medical education?

On June 11th, The New York Times ran an Op-Ed written by Dr. Karen S. Sibert entitled, "Don't Quit This Day Job." Everyone should take the time to read the piece in full, but to summarize: it laments the national shortfall in the physician workforce, and places the blame squarely on the shoulders of female physicians, who because of their proclivity to bear and raise children, are "less productive" than their male counterparts.

Dr. Sibert states that since 2005, an increasing percentage of the medical workforce, largely consisting of female physicians, is choosing to work part-time or leave the medical profession altogether. Dr. Sibert states that while it "isn't fashionable" to criticize the decisions individuals choose to make in their own lives to find a work-life balance, given the partial tuition subsidy for medical education by federal and state tax dollars, "we can no longer afford to continue training doctors who don't spend their careers in the full-time practice of medicine." She goes on to say, "Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It's fair to ask them--women especially--to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve." (Italics and bold are my own.)

Dr. Sibert is to be commended for her commitment to the practice of medicine, and for finding a work-life balance she feels was successful for her and her own family. However, I found the article a vast oversimplification of the issues it highlighted, simultaneously glossing over the difficulties and misplacing focus on an issue that beleaguers not only the modern medical workplace, but our society as a whole.

Like Dr. Sibert, I am an anesthesiologist. Also like Dr. Sibert, I have children, and work full-time in a busy and high-acuity private practice. But as a woman in medicine, I find her views sexist, inflammatory, and frankly discouraging, and I can only hope she has not turned a crop of bright, young potential doctors away from the field entirely simply in her assessment that, to be truly worthy, a life of medicine must exist to the exclusion of all else. The face of medicine is changing, and the culture of medicine must change along with it.

The medical field has only in the past few decades moved beyond an institutionalized gender bias. Dr. Sibert's own article states that while almost half of medical school graduates last year were women, men still make up 70% of the doctors in this country, a historical holdover from a time where virtually all doctors were men. These days, more and more women are entering medical school--bright, hardworking, sensitive students who entered medicine to help people and do good. Should these doctors be held to a different standard than their male counterparts, as Dr. Sibert suggests? Should women who choose to have children be thought of as less committed, less worthy of the honor of a medical education, or as a drain on the system? It's a slippery slope when you start penalizing people for the desire or potential to reproduce, and from there it's a short step to discouraging women from becoming doctors at all.

Instead of pointing the finger at women doctors for being the reason for the shortfall in physician numbers and productivity, it might first be helpful to examine the circumstances under which parents feel like they need to go part-time or leave medicine altogether--a decision which, after almost a decade of training (and sometimes more), I can't imagine anyone would take lightly. In medicine, you can treat the symptoms all that you want, but there is no cure until you can identify the underlying cause.

As a female physician myself, I have agonized my share over the decisions I've made both in and out of the hospital, and I can't help but sometimes feel that its an all-or-none proposition; that one needs to be either fully committed to medicine or fully committed to parenting, or else fail at both and flourish in neither. It's part of the pervasive societal shaming of women for the choices they make--mothers that work outside the home are abandoning their children, women who stay home to raise their children are cop-outs who have squandered the feminist victories of the generation before, and women who try to do both are doing a half-assed job all around. It's no wonder, really, that women, far more than men, feel pressure to opt out of one path in favor of the other.

Which brings me to the next, most obvious point: male doctors have children too, don't they? Obviously there are unavoidable biological underpinnings to the increased time commitment mothers face initially--men don't get pregnant, men don't require time to recover from labor and delivery, and men don't breastfeed--but after that first year of life, it seems that the time and commitment spent on raising a child should be about equal for the both parents. So why is it, in families where the mother is a doctor, that she is made to feel like the one who has to strike the balance, the one with the elaborate juggling act, the one who has to make a choice?

My husband is a doctor as well, by the way--we met in medical school--and early on in our training, when we had our first son, we discussed the idea of one of us eventually decreasing our work hours in order to spend more time at home raising him.

"Maybe you could work part-time eventually," my husband Joe suggested.

"Or maybe you could work part-time eventually." I countered.

There was a long pause. And then we both laughed, he heartily and I ruefully. Because...a male doctor working part time in order to spend more time at home with his baby? How unimaginable!

Quite simply, medicine needs to catch up with the rest of society, and as such adopt some of the models other industries have created to recruit and retain the best and the brightest, regardless of gender. All bets are off during the grueling training years of course, but already there are fields that present different structures to the workday and different practice models to recognize the full potential of modern physicians while also making the practice of medicine less inimical to family life. Some physicians work in a shift model. The evolution of hospitalist positions across the countries gives physicians more predictability in scheduling and hours. My first year and a half as an attending anesthesiologist, I worked a position with no night or weekend call, during a period during which my husband was completing a busy surgical fellowship. It should however be noted that the number of hours I worked per week was actually the same as for my male partners, and frankly, because of the quirks of my daily schedule, sometimes I worked even more. But this configuration of hours was what worked best for my family and career at the time, and when Joe finished his training two years ago and was able take on a larger share of family responsibilities, I chose to return to the traditional practice track and now also work occasional nights and weekends. But it was just that: my choice. And it's a choice I am grateful I was able to make.

For all the points in Dr. Sibert's article with which I took issue, perhaps it's one she made at the end that I found most disheartening. She shares the story of a college student--one presumably interested in medicine--who asked the writer a perfectly reasonable question for someone contemplating a career: whether anesthesiology "is a good field for women." Instead of sharing with the student her experiences as a woman in medicine, talking frankly about the difficulties in achieving a work-life balance but also sharing her particular approach to juggling her duties in the hospital with the demands of the home, she curtly told her, "If you want to be a doctor, be a doctor." If that student ended up pursing a career in medicine after all, I can only imagine it was not because of that "advice," but in spite of it.

To that student and others like her, I want to say this: yes, anesthesiology is a good field for women. Yes, medicine is a good field for women. Yes you have to be committed, and yes, it's a lifetime of hard work, but also one of tremendous satisfaction. And a life in medicine doesn't have to define your life. So come, join us, but pick your mentors and role models well. We'll be here, cheering you on, and helping you with your decisions along the way, whatever they may be.

Dr. Michelle Au is an anesthesiologist at St. Joseph's Hospital of Atlanta. Her first book, "This Won't Hurt a Bit (and Other White Lies): My Education in Medicine and Motherhood" is a memoir about the modern medical training process.

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