I'm a female physician and could not disagree with this article's assertion that medicine is a family friendly profession for women. In fact, one of the only reasons I feel that I am able to devote my time adequately to this profession is because I do not have or plan to have any children. Every single female colleague I have who is a mother feels forever torn between their children and their profession. And your illustration of a female physician sacrificing the field she is passionate about for a totally different field in order to devote time to her family illustrates just that; if medicine were a family friendly field, that friendliness would permeate all subspecialties equally for all genders.
Female physicians rarely stop working when they have children because of (1) their commitment to and identity of being a doctor and (2) almost ubiquitous inescapable medical school debt. The culture and organization of the field itself is comically hostile toward prioritizing anything else over patients and work.
2
edit: the first line of this should read "could not disagree MORE."
I'd be interested in reading about how Europeans--most of whom are covered by collective bargaining agreements--have achieved far better work-life balance in many fields, professional and non-professional. THAT is the model we should be learning from.
3
What an absolute farce this article is. I'm a physician working part time in a primary care field. I have zero control over my schedule, can't ever leave early to see my children's school plays, special events, etc, can't do any administrative blocked time from home even though our clinic clerical staff and RN manager are allowed to, and work 12 hour days. I have to submit schedule requests 3 months ahead of time, meaning I never get enough notice from schools of those special events. 1 of our children started kindergarten this month and my boss's solution, when I asked to arrive later and cut back by 1 hour a day, so I could drop her off at school---take 1 hour of vacation time per workday. That's what I am having to do to drop my child off at school. Seriously. I come home to see neighbor moms who've been home at least 2 hours before me. I laughed and then became angry reading this. What an absolute joke.
17
@primary care MD that is so sad. Is there any option to change jobs or club together with others to either get the system changed or share lifts /drop off?
I am a male physician married to a female physician. As many have mentioned here, this is a disastrous piece. First of all, medicine in the US in general provides virtually no control over one’s time. And I suspect this will only get worse as medicine becomes increasingly led by big “hospital system corporations.” And the data is clear, women get paid less, have less grants when in academic medicine and less leadership positions. And work more at home than their counterpart male physicians. Medicine is probably a great example of a field pervaded by sexism. I work in a demanding sub specialty in which there are very few women and many of these are not married and/or don’t have children. In fact, I’ve read on a female colleague’s CV “unmarried, no children.” On the other hand, the vast majority of men in my field are both married and have children. Why, if not for sexism?
The term work life balance in medicine has long only been applied to women - as this article clearly shows. The title is totally misleading. My only hope for a change is the fact that younger generations of men are increasingly looking for work-life balance and willing to share domestic work with their partners. This, and only this, will provide a true work-life balance to medicine, especially for women. Unfortunately, just another change in human behavior that will be dictated by men’s desire, not women’s. Just another example that sexism will take yet a long time to be excluded from human existence.
20
As a now retired psychiatrist who practiced psychiatry in a number of venues, I’ve thought about these issues for years. When I was applying I was told by undergrad profs that I should be a nurse instead. During med school and residency I suffered from brutal sexual harassment. The PTSD lingers to this day.
I worked half-time after my children were born, in part due to having to deal w/ their complicated learning disabilities. I had a solo private practice, but gave up hospital work due to the constraints of managed care.
You do what you have to do and in my case, “balance” forced itself upon me. Children are little only once and the quality of parenting in those years is immensely important to their future MH.
While the notion of equality is nice, I didn’t see a lot of it, so I forced it on some issues but let the others lie. No woman or man can have everything. If you choose marriage and children, you won’t be able to work as much. But who, on their deathbed said that they should have worked longer hours?
I was paid equitably. I earned half the average income of a FT psychiatrist.
I also was frantic a lot. My husband earned approximately 7x as much as I did, and while that was nice and made it easier to buy help, face time w/ children and their needs fell largely to me. My husband travelled a lot, but he also had a flexible schedule which meant he could go to those numerous school daytime meetings and field trips.
You adapt to your reality or you don’t.
7
I have read all the comments on this article, and find it deeply fascinating and troubling. There is a depth of real,personal emotion and details of personal circumstance, that go far beyond most article’s responses. I think it shows the extent of burnout amongst our doctors, and persons who have to deal with this system.
Lord help us.
6
I read the piece with interest, and to the end, but was troubled by two statements that paint a more negative picture that the headline suggests and should have been highlighted at the outset. My suggested headline: "Female Physicians - Better Hours, But Still Less Pay & Possible Prestige Loss."
The first statement, citing the work of Claudia Golden: "Female doctors are paid 67 percent of what men are, but much of the gap is because they work less." The clause "but much" creates the impression that the gap nearly disappears. It doesn't. Even after correcting for part-time employment, female doctors only make 82% of males in the same profession. The piece cited comparable pay-gap figures for lawyers and financial analysts, seeming to say that, well, things are bad in all industries and medicine is no different. A more nuanced, and accurate, approach would have been to call out the lost income for women who do the same work as men. I don't consider 82% to be proportional payment.
The second statement: "There’s a downside when women cluster in certain specialties: In general, when a field becomes female-dominated, its pay and prestige drops." Again, one could have read half the article before discovering there are significant economic and career-advancement tradeoffs in working reduced hours.
17
Agreed, Carl. This article paints the portrait that women pick specialties based on hours, not based on systematic exclusion from learning or networking that goes on in many sub-specialties. As a female medical student in Seattle, what incentivizes me to pursue cardiothroacic surgery when I am not tall enough to see what the male surgeons are pointing at on the operating table, or when I am not interested in the Seahawks score or when I don't meet a single female CT surgeon? It's thought that women physicians want more family-work balance, but about women who want career success and ultramarathon running success? Stop the antiquated assumption that women's lack of success is related to their desire of babies and families. Let's continue to realize the disparities in medical education that women face along the way to being physician leaders and how we can fix them.
8
As many other commenters expressed I am extremely disappointed in this article. The very example of a women giving up oncology to go to "family friendly" specialty (nothing wrong with primary care of course, but it was this particular woman's second choice) and "halved her lifelong earnings" just shows how backwards we still are. As a women and mom pursuing a specialty, I can attest to how difficult it is and the barriers including no parental leave, long unpredictable hours, and difficulties pursuing academic medicine. There is a reason women physicians struggle to continue breast feeding (https://www.reuters.com/article/us-health-workplace-breastfeeding/even-doctors-struggle-to-continue-breastfeeding-idUSKBN1GV2M6) . Additionally, there are sex differences in rates of NIH funding. I hope we can move past a point where women simply "staying in the field" is considered good for women.
18
Is there any problem here that couldn't be fixed by getting profit out of medicine (except for reasonable MDs income)? OK, add reform of medical education finance. The impact that corporate metrics, drug advertising, lobbying, excessive CEO salaries (average $8M per WSJ last week), recordkeeping required for insurance, and non-negotiable drug prices has on the profession and us patients is so apparent, why isn't everyone supporting single payer? I am, and I'm receiving great federal retiree health insurance plus Medicare. I'm watching the reform proposals on the Kaiser Permanente Website and will vote according. I'm a retired federal attorney, but come on! I used to work PR for Blue Cross Blue Shield back when Medicare was enacted. We operated on 2% of (non-profit) revenue. Sigh!
6
I have been an aspiring physician my entire life as I feel passionate towards medicine- but the immense sacrifice (time, family) in training- to then not have any time for yourself or a family makes me sad. Why do I have to choose between passion and family? Why can't I have a well-rounded life that would fuel me to be the best doctor I can be? Or is this truly possible? Any responses would be greatly appreciated.
There are about 500 physician comments here that answer your questions, although apparently not with the answers you want to read. You are passionate about medicine in the same way as someone who falls in love based on an online dating profile. When you get deep into the guts of the profession, it takes a lot of commitment and flexibility and compromise to maintain anything resembling passion.
14
I’m very happy I chose this path, though it takes resolve and dedication. If you’re the same, it doesn’t matter what you hear here. You can do it.
3
@Another Doctor Thank you so much for your response and insight, this article has allowed me to make a better career choice
Where is Infectious Disease? And Research and Teaching and Director of the Department? And publication - writing 7 days a week? Paid less than other specialties but flying to Uganda clinics ( or elsewhere) to help ? Both males and females work equally doggedly and are close to exhaustion at night - this writer does not get it - Medicine is acdemanding , tense profession where all sexes work extremely harder than most of the rest of us while balancing a tightrope of ethical/personal needs. . A naive silly article - Rheumatologists are missing too ? ID Docs are only found here in this blog ! NYT usually does better.
9
@P L I didn't see my specialty (anesthesiology) either!
I'm a vascular surgeon. I went through 5 years of general surgery training (+1yr of research) and 2 years of vascular surgery training. I'm married and don't yet have children. This article made me cringe and it felt like a step backwards. Throughout my years of training, I've had male attendings refer to certain specialties and sub-specialties as "female-friendly" because they require less work and fewer hours. It took until Year 8 of my training to work up the courage to respond that no, these aren't "female-friendly" specialties, they're just specialties for people - women AND men - who don't want to work as much. The bottom line is, I should not have to dial back my career goals for what society expects. Society should rise to my standards. Then, and only then, can you refer to my field as "family-friendly."
33
Kira, you are right: you have made incredible sacrifice. But as an academic primary care pediatrician, I did not choose pediatrics because I “wanted to work less.” I chose this path in 1999 as a medical student pre-marriage and children, with a passion for pediatric medicine, caring for children and families, and reducing health disparities in underserved populations. I may not operate, but I work weekends, evenings, and holidays. I have been with families when their child died, I have diagnosed malignancy in young children, I grapple daily with depression and anxiety in teens, and the parents of children. I chose this field because of love/passion, not due to wanting to work less. Thank you!!
1
Oncologist and mom of 3 here. It's possible, but there's absolutely nothing friendly about it for all of the reasons mentioned by my colleagues in the comments here. Title needs an overhaul.
20
This may be in comments already but doesn’t this article make a clear argument that pay inequity is mainly due to time and commitment requirements and not gender? Once men seek the same flexibility at work in large numbers, we should see more of a balance. And with more women and minorities in positions of power and decision making, the less discrimination there will be.
3
I’m an oncologist who has practiced for over 30 years in different settings. In regards to a couple of issues raised in the article, I can say that physicians work for hospitals, they can lose their identity as healers. I have seen excellent doctors forgetting that patients are what matter most, not hospital policies and billing codes. Hospitalists by definition are at a crossroads. Their only job is to minimize hospital stays with complete detachment and lack of empathy. They are incentivized to provide minimal care. They have forgotten why they are doctors.
16
Please don’t label hospitalists as uncaring and soulless. I work as a locums physician at rural and urban hospitals. Last night, after transferring a critically ill patient out to a higher-level hospital and finishing my 48-hr shift, I drove two hours and went straight to the accepting hospital, met his parents, explained what was going on with their son while he was in the OR, and stayed with them until the surgeon came out two hours later, to give us the update. I work with an exceptional group at a large urban hospital and we care deeply about our patients. Yes we struggle with wretched hospital metrics, but we haven’t forgotten why we became doctors.
16
@Hospitalist, thank you. I work at a level 2 trauma center as an ACS/Trauma surgeon. Our Hospitalist group is wonderful. They are dedicated and and compassionate. No matter what our Healthcare system (for the record I’m a single-payer advocate), we need Internal Medicine specialist who deeply understand the inpatient setting, and we also need cost control. If you want to support the best intentions of their mission, try NOT labeling and judging, but supporting.
8
@ Hospitalist and Liz
Thank you for your perspectives, with which I as an experienced and now mostly retired physician agree. I have been grateful for the compassionate and competent treatment that my family and I have received from hospitalists. As a reasonably successful physician-leader in a specialty not primarily involved in hospital-based critical care, I would not want to be treated by someone less than fully involved in that aspect of care.
3
Ha ha ha ha ha! Family friendly! Hilarious! I’m a primary care doc and I’ve never worked less than 80 hours a week, between clinic work and hospital call. And that’s not counting the unpaid hours of charting at home. Plus the stress of worrying about medical errors. It’s a miracle I still have a marriage or any friends left.
26
I’m saddened by the article and I find it reductive. Residency is 100% standardized, from the number of calls you take, number of surgical cases you perform, to the exam scores expected of you. Same goes for medical school. Then all of a sudden we face a 20% reduction in pay and are characterized as just wanting more free time? Whether it be for family or otherwise, I find it sad to hear female physicians painted in this light. We are physicians after all, and chose this path for a reason. Also, we worked for it. I hear just one line about this change being “generational” - men want to be hospitalists too these days. And where have you mentioned the responsibilities of men to the household and children? I expected better.
21
Note how many hours these "reduced hours doctors" work.
Many women doctors work 60+ hours a week, and
ALL of them work over 40 hours a week. Having one or more partners willing to cover for you is crucial. That and not judging yourself by the amount of money you earn or the title on your office door.
Flexible work and reduced hours schedules are needed most during child raising years ( say birth to mid teens?) but women tend to live longer than men, and work output over a career probably evens things out between the sexes .
KW, Retired woman doctor
8
No, medicine is not a family friendly vocation. The fact that a woman can switch to a less lucrative, less desirable specialty and still work 50-60 “flexible” hours in a part- time position is not family friendly it is just exploitation. Discrimination and misogyny are still very much at play in medicine today. This is exemplified by the fact that there are now roughly equal numbers of men and women in medical school yet men continue to dominate the highest paying fields as well as academics and positions of power.
27
Not mentioned: the absolute misery of training with extreme hours and circadian swings. I love my work but let's be clear, I live a VERY different life than my non-medical similarly educated peers.
For example, I worked all week, then worked overnights in the ICU this weekend. Now I have to be back in the hospital tomorrow morning back on day shifts (after finishing my fourteen hour overnight shift around 8am this morning). Twelve days in a row with two full circadian flips is not unusual. My head literally hurts. Again, I love my work but this ain't pretty.
My female friends since medical school have wondered about how in the world they can have kids for years now.
23
Imagine a world in which the expectation for those who had completed their training was 40 hours per week in the office or hospital? For any profession, medicine or other. The expectation was both professional working parents could see their kids before school and for dinner?
Until we end our societal addiction to long hours I would argue that women in medicine may continue to choose between their passions and their personal/home life happiness. Or at least adjust their passions.
Fortunately, medicine is a field with often greater demand than supply, so those in the field are poised to direct some change if enough demand it.
12
I am deviating from the content of the article purposely to raise a point, which I feel is unnecessarily increasing the debt of medical students in addition to lengthening the course.
In India a student can join MBBS ( Bachelor in Medicine and Bachelor in Surgery ) soon after passing 12th grade with merit. They can get admission into this course after writing successfully a competitive test. They have plenty of advantage over American students in the sense that they not not pass any Bachelor degree in Science in order to get admission into a Bachelor degree in Medicine. This I feel not only burdens American students economically but also doesn’t have any added advantage academically.
By the way a number of my relatives from India are doing pretty well in America as Residents and Specialists even.
4
@Sivaram Pochiraju We, rightly or wrongly, have been conditioned in the U.S. to feel that having to go through a lengthy course of education - to become a medical doctor - is required in order to have the medical information/training needed to treat patients. I was shocked to learn that in India people could be become physicians so quickly; how can just a few short years of education be sufficient? Most U.S. trained physicians who begin medical school after a B.S. degree will be around 30 years of age before they are officially physicians. I personally would NEVER trust someone who had only four years of post-high school training to treat me. Can you explain more about the training they receive in India? How can it be enough to allow such a person to diagnose/treat people with confidence?
6
@Peyton Collier-Kerr : Thanks for your valuable opinion. This is the problem with Americans. What has a Bachelor Degree in Science, Commerce or Arts or Humanities got to do with Medicine ? We shouldn’t be adamant but willing to adopt better education systems.
In India, MBBS is a five and half years course in Medicine and Surgery, which comprises of one year internship. Later a graduate in Medicine can do a two year Post Graduation in any Speciality of Medicine or Surgery of his or her choice for bettering medical knowledge in that particular field of speciality be it Cardiology or Oncology for that matter. MBBS graduate gets to know a number of things related with anatomy, medicines, treatment of patients etc during five and half years of studies in Medicine and Surgery.
After joining as Doctor in hospitals, the medical knowledge gets expanded like any other Doctor in any part of the world through sheer experience and keeping upto date with the latest global developments in Medicine and Surgery.
For your information pre K.G, LK.G and UK.G are not all required for a child’s proper growth, which is not only waste of time but also waste of money as well . I never studied those things in my childhood. By the way I am retired Engineer.
2
@Sivaram Pochiraju I can understand a move in the direction of cutting back undergraduate education; tuition for four years of liberal arts is now astronomical and adding 4-8 more years of debt is a heavy burden. However I do feel the opportunities my daughter who will be entering med school after graduation has had have made her a more well rounded and profound thinker. While most of her rote course work in very difficult sciences has made her well prepared for her “trade“ it is the classes she would not get if she went straight to a 5 yr med school that actually have formed her into the exceptional person that she is and that will make her an exceptional doctor. Her studies in literature and poetry have made her think outside the box and understand the viewpoints of others; her field experiences during work in rural areas of Alabama have made her a more compassionate person attuned to the difficult circumstances of others. Her months abroad in Ghana and Cuba added to that and gave her an appreciation for other cultures.
Her courses in organic gardening and mindfulness have lead her to an interest in wellness and prevention. Her courses in ethics and religion will serve her well as she grapples with difficult life and death situations.
I guess it is true that these kinds of courses are a luxury these days. I for one am grateful that she has had these experiences as she will be a better doctor thinker leader and human
1) our loans are so large we can’t afford to not work.
2) if we can afford to not work there is still so much blood, sweat, tears and money invested in the degree that we can’t not use it.
3) medicine is a calling and is very rewarding so we do want to work.
4) being a doctor puts us in a higher SES so some have husbands with high power careers.
5) those high power careers force the woman to be the primary caretaker but do supply enough money to cut back hours.
I would not consider medicine family friendly considering I was working or studying 24/7 until my early 30’s. By the time I got married and had a child I was so old I could only have one but I am actually able to keep working vs some of my investment banking friends who are retired at 45.
20
Completing a rigorous medical education and then working part-time, to me, seems an unfair loss for many other talented prospective doctors. As a school, should I choose a bright young woman who will then work part-time after she graduates or a bright young 'anyone else' who will dedicate their hearts to their careers. It is not only the money that she spends or the debt she incurs, but the time, staff, materials, and space that she also appropriates that another person dedicated to a 'full time' commitment to medicine has been deprived. An army of part time soldiers or an army of full time professionals committed to defending your country--which would you rather have?
6
@James R Dupak
There is a cost, of course, to living in an equitable society - one where work/money and community building are both valued. The question is of values. If community building, which largely falls to women, is not valued, then your comment is true. Get the part-time moms out of doctoring as they're compromising the bottom line. Would be a shame, though, to lose such an army of wonderful doctor moms. But if we, as a society, choose to value community and the immense energy and care it takes to raise young children with a moral compass, then your argument doesn't resonate. Capitalism is sexist. What should we value?
Almost goes without saying that all these doctor moms also happen to be working 40 hrs/week or more in the overwhelming majority of cases.
1
@James R Dupak 40+ hours per week is not part time. Were the fathers doing their equal share and were the mothers paid, not 82% but, the (proportional) same amount, we would have less need of an army.
Based upon many of these comments, we could benefit from an article detailing the different average physicians’ lives factors with ranges of hours worked, salary, specialty, work setup (corporate, hospital, POD, independent, etc.), age, school debt, social status, career satisfaction, family salary, etc.
Also, how is the new practice of hospitalist actually working out? I worry about continuity of care and bedside manner.
6
@Joel H. Our family’s experience with hospitalists has been nearly disastrous — the lack of continuity of care, plus the lack of accountability was AWFUL for our three relatives at two different highly-rated hospitals.
7
I'm not a doctor and was confused by the rosy view of what women who have kids do to try and manage daily life and work life.
Among other things, the cost of med school needs to have a drastic overhaul. Between the amount of debt and the hours once you're credentialed, it sounds so punishing and unreasonable for such an honorable and necessary profession.
17
The elephant in the room: most of these highly-educated, wealthy female doctors are married to highly educated and often higher-earning men. Women tend to prefer to marry up the socioeconomic scale more than men do. The ambitious and professional young female doctor who is single knows that the time and effort she spends to climb the ladder will also damage her dating prospects (since in her league, family-minded men don't care about her income, but do care about her time and interest in family life).
If your husband is willing to grind 80+ hours a week and bring home multiples of the median American household income...why suffer the stressful grind yourself when you can optimize for better social relationships, community service, and family life?
Unless you're one of the true pioneers in your field, your patients and the world will be no worse off for your personal optimization of family life. And in fact, you probably will be having more impact through your family than you ever had professionally (that goes for Mom and Dad alike).
Does the NYT really think that it is the patriarchy forcing male pioneers and leaders into high-powered careers with the attendant dysfunctional families and social lives? Or is it more likely that true excellence in narrow domains requires grievous tradeoffs, and certain members of our white feminist Have It All generation want the status without the sacrifice?
22
I’m sorry, children need time, time for calmness and creativity and undivided attention, how is that possible working 80 hour weeks? Within the limited number of hours available to us, how you decide to spend them is your decision, and no matter what you say someone else will fill your place if you can’t or won’t give your precious time to your children during their oh so short childhood. Don’t be fooled, nobody will give you a pat on the back for ‘working ‘.
14
The article, while interesting and informative, does not take sufficient notice of the great debt burdens that graduating medical students now carry. A combined college and medical school debt of more than $300,000 is not uncommon, and average medical school debt alone is close to $200,000. Repayment, or even just debt service, can be difficult for physicians in lower paid specialties such as pediatrics, wherein they may have even a short-term debt greater than their annual income. If they are working part time, the pressure can be even more daunting. In my experience, most physician-parents in this situation have a spouse or partner with a sizable income.
Yes, physicians as a group make a lot of money, and many may be overpaid, in the context of the pervasive income inequality in this country. However, in the undersupplied specialties such as primary care, physical medicine, and psychiatry, there is a tight dollars-and-cents squeeze on people entering the profession.
11
I don't see how it's a win that this woman had to give up a promising career in oncology. Her not being able to do her first-choice fellowship because of kids is clearly indicative of the fact that medicine is *not* family friendly.
I'm in residency right now, and the idea that I would have to skip out on the fellowship of my choice if I got pregnant is heartbreaking.
38
@Camille
The point of the article is that medicine is family-friendly in that she had the choice whether to stay with oncology on to do something more “family-friendly.”
And that you are lucky to have that choice, that many careers don’t.
6
@Laidback
She drastically changed her career. That’s what this article misses. Being an oncologist is very different from being a geriatrician. We all have choices, it’s a matter of how much you sacrifice with each choice. Medicine isn’t the worst field, but it’s not an easy field for medicine.
10
@Kppatel
The article doesn’t miss that. That’s the point of the article. That she could choose to sacrifice the job for kid time, or the kid time for the job. And that medicine is allowing her to make that decision.
1
My wife is an internist/geriatrician who has worked,"part time", for most of her career. During that time she has birthed and raised two sons. It hasn't been easy, she has worked very hard. In addition to her office practice, she has taken hospital call, which can, as many of you may realize, can be very time consuming, onerous and stressful. Getting up at 2 AM, heading into our local, rural hospital to attend to a critically ill patient can be that way.
Fortunately, for us, she has had supportive colleagues, who will cover for her when she is away from her practice. Additionally, we have been blessed with excellent day care where we live. Her husband (me), who is also a physician has worked hard to do the things that have allowed her to work. Not infrequently, she is asked by folks, " so you only work part-time, right"? Well, putting in upwards of fifty five hours a week in a demanding, stressful job with tremendous responsibility and expectations is considered "part time"?
Not in my book! Additionally, two years ago my wife, who is a highly respected physician, obtained her MBA. Now, in addition to her regular duties, she is consulting with an accountable care organization.
She has proved that a woman physician can work a non-traditional schedule, provided excellent care for patients, make a good living and be professionally fulfilled.
20
I know more than a few physicians, personally, but I don't know any that would regularly populate the top half of the chart (= working more than 55 hours per week) that tabulates average workweek hours for various specialties. The chart footnote says that the data come from a "Community Tracking Study Physician Survey" and from the A.M.A., which I suppose means "from physicians." That WOULD fit my anecdotal observations that most physicians overstate how hard they work.
1
Many comments contradicting the theme of this piece. Many stories of the hardships of a medical career, corresponding debt, bean-counting masters.
Maybe the issue isn't physician motherhood at all. Maybe the problem is much bigger than that. Maybe medicine has evolved over the past 50 years like all other workplaces: as tools servicing corporate and political greed.
12
Your comparing medicine with its 6 digit annual salaries with other professions with average salaries under 60,000. Even part time these doctors make more money than the average American family.
4
@GUANNA and hundreds of thousands of dollars in debt.
6
@GUANNA
You’re comparing the average American worker with someone who got a college degree, then graduated from medical school, then completed minimum 3 years of residency. In addition, they paid with incredible effort, expense, sacrifice, never ending exams, etc etc.
5
I'm wondering why she had to change her specialty, but her husband didn't. Seems they both had equally demanding paths, but she was the one who stepped off her track, not him.
12
In general women are better caretakers than men. It is a genetic disposition developed over the history of mankind.
If this wasn’t needed it would have ceased to be so.
Despite what many would have you believe, men and women are not equal in terms of innate capabilities and/or desires. We create unneeded stress trying to force or think it to be otherwise.
This holds true across the entire world in every society/culture.
Yes you can find individual exceptions and outliers but this is what has and continues to work not just for humans but nearly all species!
Each person while making their career choices needs to do their due diligence in knowing what the challenges are going to be and plan accordingly. Play to your strengths and what works for you.
I am NOT saying that “it is what it is” and that there couldn’t or shouldn’t be changes but stop confusing the many issues that are at play here.
I don't have to even read this. Student loans. This is why women doctors keep, or rather, must keep working after having kids. If you were saddled with $250,000 of student loans you'd keep working too. This is more about not having a choice than the profession being family-friendly.
12
Wait a minute. An "intensive radiology fellowship"? I'm a doctor. I've never heard of an intensive radiology anything.
4
If the fellowship was in Interventional Radiology, then it would definitely be intensive. Their hours are similar to surgeons, at least during fellowship.
11
Isn’t it easier to do a lot of things when you make 300 to 400k a year?
4
@Paul A minority of female physicians are in specialties that pay anything close to that amount. “Family-friendly” also tends to mean “about half the pay,” as with the case of the geriatric doctor who switched from oncology in the article.
4
@Paul
Most of us don't make anything close to that, certainly not in primary care
Blanket statement to all commenters here who are not doctors:
Despite what you think you “know”, you (probably) don’t know much about doctors salaries/lifestyles/education/jobs.
It might be best to save your comments for things you actually know about. I don’t go on articles about engineers or lawyers or whoever and give my ill-informed opinions about what they should or shouldn’t be doing.
21
@Laidback
Judging people's lives without knowing what it's like to live them is a common practice among doctors.
Nobody cares that maybe you can't eat a healthy diet because you can't afford it. Or maybe that you smoke because it's the only way you can get a break at work and be seen as a "team player".
6
@Viv
I am trying to understand what you are saying.
Are you saying that I shouldn’t be asking people not to judge a doctors life that they likely don’t understand it because doctors judge people’s lives??
I am just trying to be clear with what you are saying.
2
I have just retired from 35 years as an anesthesiologist and in my town, central Texas with quarter million population made famous by an obscure religious cult a few years ago, most female doctors worked part time, didn't work at all, or worked at non-clinical or outpatient care settings. Not all, but easily two thirds.
After years of 60-80 hour weeks, call schedules every third of fourth night, I decided to pull the plug and quit at age 68.
I trained back in the dark ages when "ships were wood, men were iron, and giants walked the halls." As we joked,"The problem with being on call every other night was that you missed half the interesting cases." The point of it was to teach you to suck it up and drive on, no matter your fatigue or personal needs.
As my old program director at Ben Taub said the first day of residency. "if you call in sick, you better call in dead. Your either intubated in the ICU or your at work."
Libby Zion was the catalyst for change and now residents can't work more than eighty hours per week and not more than 24.
If you were found to be wanting in morning rounds, a common question from the attending was, "Are you stupid or you just don't care?"
It was always better to claim be stupid.
Now we have "care teams' and no one is responsible for the outcome.
7
So...is this a good or a bad thing, the changes that have happened? Because this sort of reads like a rant against "those lazy kids today" who don't know the value of being ruthlessly exploited to the point where they have no life outside work. Sounds like a terrible system, to be honest
12
@Captain Bathrobe yep. The amount of Stockholm Syndrome in old school physicians is absurd. "I did it this traditional but asinine way and bought into the nonsense rhetoric that let them take advantage of our cheap labor, so it must be the only right way ". It's pervasive among contain specialists of an older generation
8
In most other countries, medical training is free or almost free.
Sounds like doctors in the US would benefit from such an approach.
10
@Mary
Actually no, it isn't.
Aside from Cuba, there are very few countries where reputable medical training is genuinely free for their citizens.
2
@Viv
Actually, no Viv. You are wrong about that.
4
@Mary Free tuition for aspiring doctors? Few medical schools could pull off that feat, By Daniel Thomas and Daniel Charytonowicz, August 28, 2018
The announcement that New York University is abolishing tuition for its medical students elicited surprise and joy from the incoming class of 2022 (and pangs of jealousy from students like us who had chosen to go elsewhere for medical school). Some pundits see this as the first of many tuition dominoes to fall. Given the financial investment that a school needs in order to forego tuition as a source of revenue, an analysis we performed suggests that many schools won’t be able to pull that off.
https://www.statnews.com/2018/08/28/free-tuition-students-medical-schools/
The rationale for making medical school free goes something like this: Tuition alone for four years of medical school is currently in the neighborhood of $250,000, for which the average medical student accrues more than $190,000 in debt. Upon graduation, these students become medical doctors, and can put M.D. after their names. But they then must spend anywhere from three to 12 more years receiving specialized training at below-market compensation before they can begin earning “doctor’s salaries.”
NYU’s blanket guarantee is the first of its kind.
This article takes a very strange point of view. Medicine is family-friendly because women can take lower paying specialties and work part-time?
Family-friendly jobs require more flexibility and fewer hours for EVERYBODY; women and men, doctors and tech workers, teachers and construction workers. We need laws laws mandating a 25- 30 hour work week, with a living wage and benefits for EVERYONE.
There is nothing magic about a 40 hour week - it is just what the last labor movement was able to wring from the Uberrich. And the fact white collar workers were exempt from labor laws has led every job being called "professional."
Medicine has been especially egregious in exploiting the young. Forcing residents to work 2 or 3 day shifts is simply abusive. And why would anyone want a medical decision to be made by a 27 year old who hasn't slept for 2 days?
Older doctors often claim the abusive schedules were an important part of their education. This is known as the hazing effect: the experience was so awful, it must have been valuable.
25
@Oh Please
Yep. It was pretty awful, but not as bad as the shame of admitting to the group the next morning on rounds why the blood wasn't drawn, or the X-ray checked, or the patient not examined, because you were tired and couldn't be bothered.
This article is too congratulatory towards medicine when in fact as it discusses, the reason that the field is possible for certain female doctors is that they have had to limit their practice area. Female doctors have demonstrated that they are equally capable in the whole range of medical specialties including neurosurgery, surgery generally and oncology. Rather than praise the existing medical structure for being female friendly compared to other professions, the article should have discussed what structural changes are needed to make all medical fields female friendly and where such efforts need to start and led by whom.
12
We just lost a great oncologist. End of story.
Support women and men in their choices. Many men are caring for children as well.
19
As a female physician, I would say there is some truth to this article but only because medicine is inflexible to begin with. Medicine is inflexible in that there is no work from home option, going in late/leaving early for personal appts is rare, a sick day to care for a sick child is a scheduling nightmare, and there is little lengthy maternity leave. My MBA and attorney mom friends can work from home if necessary and one got 2 year-long maternity leaves at a major corporation. These professional moms do not, however, have part-time work options. But, because there is some built-in flexibility to their jobs, they can make it work. Medicine does not have this day-to-day flexibility, so working less overall is the default option.
16
That may well be for some women doctors, depending on their specialty, but all of my Primary Care providers who became pregnant ended up quitting; Although I was the patient, would end up asking them how they are doing, between patients, skipping meals and children.
I have yet to meet any male providers who quit in the middle of their careers.
Perhaps women will indeed be able to return to their profession later, but child-rearing and work, particularly medicine, remains demanding.
11
The following quotation from the article says a lot about why having a fixed schedule could work in medicine but may not in other professions, “When my shift changes, I hand off my patients to the next provider, and that’s a really nice thing to not be on call when I walk out of the hospital". In finance and law and business, the delegation of tasks is possible and typical, but "handing off" is so much more difficult, if not impossible when one is leading a team in a negotiation, deal, or project.
5
Any correlation to working and paying back medical school debt?
7
Lawyers love to think they are sooooo important! No one else can do what I do for a client! I have to be in the office ALL of the time!! No one can take my place!! I remember one time when we had a huge snowstorm in our area and the local government begged everyone to stay off the roads except for "essential personnel" i.e. police officers, firefighters and medical personnel. Guess who also decided they were "essential" personnel? The lawyers! I know because I had to do a program for them. I had to fight my way Downtown through six feet of snow. The rest of Downtown was a ghost town. It was ridiculous.
9
This article sugar coats it. Being a mother and a physician is very very hard.
And the emr only makes the hours longer; to imply it helps shorten the day is ridiculous. The author didn’t get that from physicians, certainly not from those who worked pre-emr.
25
@mpb “ And some of the ways in which medicine has changed have made it harder to balance work and family — like the time consumed by electronic medical records ”
I think you misread it. The author made it clear that EMR makes things much more difficult!
@mpb agree. This article does not depict medicine realistically. I don’t believe the author researched this well. In a time where physicians have high suicide rates and burnout is a serious health and patient health outcome issue I think this article totally missed the boat. Painted a very rosy picture and did not address the thorns.
4
It’s surprising that there is still a discussion about whether it’s reasonable for a woman to be both ambitious and want a family. It may be worthwhile to consider Margaret Thatcher, Ruth Ginsburg, Benazir Bhutto, or Catherine the Great. I can’t say if they were all incredible mothers but they were all mothers of several children and history will remember them for their inspired leadership.
8
Reply to Julie,
Hahaha. That is so funny.
I don’t know much about Ginsburg or Bhutto, but I do know that we don’t usually hold up Catherine the Great or Margaret Thatcher as examples to little girls.
Politically speaking, neither Thatcher nor Catherine the Great were unalloyed goods. As mothers, though, they were failures. Catherine the Great was personally closer to a psychopath than a warm, caring person (she let her daughter-in-law die an unnecessary and horrific death in childbirth because she didn’t think the young woman would be able to bear a “live” child in the future).
Margaret Thatcher’s son attempted to stage a ridiculous coup and take over a third world country (not a great parenting result). And that’s to say nothing of her widely known inattentiveness to her children.
Whether women can be ambitious (or how ambitious exactly) and still be great (warm, loving and wise) mothers is still debatable. Some women certainly have more energy than others, and being a family doctor is not the equivalent to being a world leader. But to hold up Thatcher and Catherine the Great as examples of successful working motherhood is poor!
The flexibility provided to female physicians is made possible by the lack of flexibility provided to nurses who may also be working mothers but are expected to cope cheerfully with 12-hour rotating shifts and mandatory overtime.
23
@Cloudy
Cue the comments about nurses in an article about doctors. I’m surprised it took this long.
12
I’m not sure what you’re trying to imply with this comment. Nurses have nothing to do with a physician’s work schedule; it’s the ability to pass off patients to another doctor completely that gives my job as a hospitalist more flexibility.
16
@Lisa Hunt, MD
You mean you didn’t know that nurses actually care about the patients and do all the real work, while protecting the patients from the greedy uncaring doctors who rush through patient care cause they wanna drive their BMWs to the golf course?
5
Hooray for female physicians who go back or continue to work while having children. I am married to one, now retired, who made that choice back in the early 80’s. Our first child was born three weeks after she graduated from medical school. Fortunately the director of her training program in pediatrics was enlightened, and he insisted she not start for 6 months giving her time to bond with our son. The next three years she did not miss one of those “every three days on call” for a 36 hour shift because we had a young child. Our son and I spent many of those call evenings sharing a quick meal with my wife in a call room. Our son, now 38, has some distant memories of those evenings. Four years later our second son arrived. After the painfully short 6 weeks maternity leave, she was back at work full time. We were fortunate as I had a reasonable amount of flexibility in my work to take on what I saw as my parental responsibility. This was modeled by my father who as a middle-class, blue-collar worker helped at home washing dishes, doing laundry and cleaning house. V
I write this to say women can return to their professions at a high rate in all areas if they are given adequate support at home and by their professions/employers by providing reasonable time after childbirth or adoption like other industrialized countries do. And society needs to ensure that no stigma is attached to women who do take time off before returning.
30
@Kent; Bravo to you and your father.
5
I am a female physician. I have spent 35 years as a primary care physician. Over the years I had to make choices regarding my family or my work. I was the one who stayed home with sick children and briefly stopped working as a two physician work schedule was incompatible with raising a family. My specialty was lower paying and after I paid the nanny and my taxes I netted $5,000. Clearly not worth the stress and liability. Also in your article you mentioned the significant hit to income this doctor experienced by changing her sub specialty. This gives some insight as to the gender pay gap in medicine. Also with the corporatizion of medicine we see the male dominance of,the profession worsening. Nothing has changed. I work in corporate medicine and all of our senior management is white and male.
37
Why would someone that knows they want children invest decades of education for career that will require much of their time? Did they not realize the realities of being a specialist? This is simply making poor life choices and ignoring the realities of having children while also pursuing a very demanding career.
Sorry, but in reality you cannot have it all.
12
@Paulie
“Did they not realize the realities of being a specialist?”
What are you talking about? There is a very wide range of work in different specialties.
13
@Paulie Of course you are only referring to women with this comment, right? Apply your same logic to men, and it sounds ridiculous. Many men want children too, and many men choose to invest much time, money, and effort into nurturing a fulfilling career. No one blinks an eye. Crazy? Only when it's a woman? The gender bias is astounding.
17
There is a shadow side to this story. Doctors have patients who are their responsibility. The medical systems with set hours, et cetrera have consumers. The Computer systems allow a homogenous sort of minimalist approach, but I would challenge you to get your records and find any sort of coherent narrative that deals with a whole human anywhere.
It was a calling, now it is more and more a business as a compter technician. Who is to say if that is worse, if the outcomes are better. Are they? Maybe the computer systems in medicine have had a corrosive effect on doctor-patient relationship and subsequent care. Not expected. Much like Facebook gave us Donald Trump, as the Earth hangs in the balance.
That all being said, the more doctors of every background the better, diversity does bring better care. No doubt.
11
More and more we are turning to large corporate medical organizations to coordinate care and reduce costs. In many of these organizations, doctors are employees. At this point, doctors are still highly respected and prosperous; the need for doctors is still much greater than the supply. In the very near future it appears that with more women (and immigrants) in the medical field, prestige will drop, and administrators will begin reasserting control over hours and pay. This has already begun with the issue of extreme time demands in data collection. The women doctors in this article may be the last who enjoy this combination of regular hours, high pay, and autonomy, as those things interfere with corporate profits.
23
@Carmine
Prescient, and so true.n Thank you.
3
@Carmine This won't work at ambitious medical centers who expect their physicians to bring in more and more patients in an effort to bring in more revenue so as to raise their US News World Report Hospital rating. You can't buy Hulu commercials without cash.
3
The single largest difference is that doctors are paid so much money, they can afford to cut their hours in half and still make bank.
Sure there's sacrifices, such as not getting the new Mercedes SUV this year.
But you cannot compare a doctor's salary to a regular person's and claim is on the same plane.
I love reading of people who 'quit their job to travel the world and visit every country', but they don't tell you they are already millionaires. Same here, a doctor already getting rich can cut her hours in half and life goes on. Wish the regular folk could do the same, but we can't.
21
@AutumnLeaf, just a thought here, why do a lot of people comment on doctor’s salaries when they have studied for years and years and years and then have to pass rigorous board exams for the privilege of being our family physicians or surgeons But we don’t complain when football or basketball or baseball, etc. stars make millions upon millions with endorsements win or lose?
32
It is difficult for most people to grasp the definition of part time work for many doctors - cutting hours in half means going from an 80 hour work week to a 40 hour work week. That high salary means sacrificing family time, vacations, holidays, hobbies; the only down time is driving to and from the hospital in their “Mercedes SUV”.
16
@AutumnLeaf ”Regular folk” don’t study and train the long hours and years that physicians do, including nights, weekends, and holidays. “Regular folk” don’t stand ankle deep in someone else’s blood trying with every last fiber of their being to save a stranger’s life. Your stereotype of “not getting a new Mercedes SUV this year” reeks of petty jealousy. As a female physician, I can tell you that none of my colleagues get new cars, much less new Mercedes, yearly. We are all repaying student loans well into our 40’s and 50’s.
What I can tell you is that every one of us will work to improve the lives and health of our fellow human beings, day or night, in spite of their opinions of us.
25
There is a burden to society in providing these women nicely flexed schedules, in limited access to health care. We invest in their education and training (federally backed loans make up
a large part of their loan packages), with limited slots for trainees in, again, hospitals that are either indirectly or directly subsidized, to various degrees, by public monies. But yet the doctors we invest in seem all too often intent on limiting the service we expected to receive. We need to open more residencies to qualified doctors from overseas who seem more ready to embrace the rigors of the life of the doctor.
9
@Andrew
There are a few issues to consider, in replying to your post.
1. This is not just a issue for "these women." Many male physicians are working less than full-time, nowadays.
2. In terms of bringing doctors from overseas to train in the U.S., consider this deprives their home countries of sorely-needed, expensively-trained physicians in order to serve a population with a relatively abundant supply of doctors and resources to train more. Is that ethical? Is it not better for a rich country to simply train more of its own citizens to work in Medicine?
3. People (doctors, shockingly, are people!) are not property, or machines. They are not some object you "invest in," like industrial equipment. Those federal loans you mention are paid back, with interest. Interest often running higher than that on commercial mortgages. Additionally, physicians rarely default on their loans. Medical education has, financially speaking, been an excellent "investment" for the federal government!
4. Doctors also have children, aging parents, limitations due to age and their own illnesses, and community responsibilities outside Medicine. Expecting them (or anyone else) to exist only for work is unrealistic.
4. There is a price to be paid by patients in trying to get maximum output out of a smaller number of doctors, rather than increasing the number of physicians to meet needs. Do you want a fatigued, depressed, socially isolated, resentful person to be your doctor?
70
@Andrew
You have no idea who will or won’t be “ready to embrace the rigors of being a doctor.”
You propose to let more foreigners become doctors- you magically believe that they will never want to limit their working hours, unlike Americans who all do.
12
Medical students reading this article also need to keep on mind that autonomy and income are inversely related to ease of work schedule.
When you choose a field or a job that has "easier" hours, there is little chance that you will make partner or advance in that group. There is nothing wrong with that situation other than you become expendable. Large corporate medical practices are thriving because of this emphasis on "lifestyle" being promoted in medical school and training programs. Caveat emptor.
15
Physicians have control over their schedules in a way that other professions simply do not. Physicians can schedule vacation by working with each other to provide coverage if they work in a hospital, or simply tell their patients to go to an ER or another physician within their practice or group. If you give birth and your Ob is on vacation, well you get someone else covering for them. Attorneys, even partners at major firms, don’t have this ability. Their level of investment in cases, court schedules, and demanding clients (losing a patient to another doctor won’t hurt a physician, losing a major corporate client can really hurt a firm). This isn’t something that is easily fixed.
7
@Ken unless you work in a large corporate medical practice where you cannot control your schedule or office hours. The type of medical practice you are describing, the independent medical practice, is becoming exceedingly rare, especially in primary care.
12
@Ken On the other hand, private practice physicians frequently work 80 plus hour weeks, get called at 4 am for emergencies, on rotating weekend coverage you're covering for everyone in the coverage group - maybe from 5 o'clock Friday to 8 am Monday - non-stop hospital, nursing home, out-patient calls, care, and back to the office Monday morning. Physicians aren't billing per hour worked like lawyers. They're just working.
16
The majority of women physicians have been sexually harassed during training or practice according to a National Acadamy of Sciences report in 2018. Leadership in medicine actively excludes women. There is a persistent and growing wage gap unexplained by work complexity or hours worked. Parental leave policies either don't exist or provide less time off than recommended by physicians to their own patients. There is nothing female or family friendly about a profession where these realities are tolerated.
20
Being a parent and child rearing are two completely different things. A parent is someone who has custody over a child, and most likely contributed an egg or sperm to their fertilization. Child rearing is a job - it is the act and investment of caring for a child’s development and well being.
If a female wants to be a parent AND have a demanding career, they are required to have either a spouse who is willing to do the child rearing or have enough funds to hire outside support (I.e nanny, daycare). This is exactly how it is for men men who desire a family. Show me one male surgeon who also single handedly manages their children. Doesn’t exist. It’s called division of labor and it works brilliantly.
6
@Johnny
It's great for the parent who has a career AND a spouse who takes care of the family. There are some significant downsides for the stay at home parent.
2
@Johnny
Agreed. Yet many commenters here say that it’s sexist that women can’t have the demanding career and the free time as well!!
Ridiculous
I am a FNP, for the past 13 years. I am happy to hear that female physicians are getting to experience some leeway with working professionally and being a mom.
Since I’ve moved to Dayton finding a part time position has not proven easy. I have seen female physicians get to take advantage of being part time but it seems that the NPs are not given that opportunity at this time. Hopefully, there will be some trickle down.
10
Nearing the end of a (largely) satisifying career in medicine, raised 3 successful children, only possible with a non-working, amazing spouse and control over my work environment. We survived a tough call schedule but never had to deal with: huge debt load, EMR, insurance hassles etc until recent years. I have no idea how to rectify many of these issues but the consolidation of power in the hands of the government ,insurance companies, hospitals and medical corporations ( including medical employers) is not helping the situation.
15
@Wiiliam
Hear! Hear! As a spouse of a physyician,( who left her career ) to allow her husband to practice unencumbered medicine is the way I believe we achieved everything important to us. (child rearing; little debt; living life and navigating it) He is able to give his patients 100% of the attention they deserve; without worrying about the homefront. It is teamwork! Heaven help us as we march into the era of putting too much power into large corporations and government. Heavan help us as when we need care and it may be severly limited due "cost analysis and beneits"!
5
Your spouse was not “non-working”. Just not paid or recognized.
5
The nanny in the picture sure looks like she’s doing a good job raising the children!
6
Nanny is NOT raising children.
5
I like how you ignore the fact that part time in medicine is more than 40 hours. But don't bother to point that out. And that weekends are involved. Literally the bar you placed here was it became more family friendly because it isn't any longer a full 24-7. It is only 50-80 hours a week and SOME schedule predictability is involved. How does such a low bar translate into 'a family friendly profession'??????
You know why REALLY we more work even with children? The nature of our profession allows us to afford nannies and childcare. THAT is why more of us can continue to work than in other professions. Most female doctors who don't marry a male in a less stressful/more flexible position, who marry another doctor for example, have both a nanny AND daycare. If you have a clinic with patients scheduled, there are many situations where you will be expected to put those clinic patients ahead of your own child's or family's needs, and certainly your personal ones, because there is no one else to fill in for you.
So this article is pretty tilted.
45
I am so glad you commented. I am a nonworking spouse of a physician and I am in awe of the women I know who are working physicians. I am well educated, with two Masters degrees, yet my background is in nonprofit. I tried to work after having kids, but found that a nonprofit salary barely covered the childcare needed for me to work, and I was still the full-time parent. So I decided to stay home. I would compare myself to these successful female doctors and feel inadequate. Then I would find out about their nanny. I had to remind myself that compensation matters and that difference in salary is the real reason I don't work and they do. If I could make the same salary as even a part-time doctor, it would be worth it for me to work. I'm glad women in medicine are compensated enough that they don't have to sacrifice a family.
28
Two thoughts
First, all employers should be flexible with women and men. We all have families and responsibilities. Everyone wants work/family balance.
Why is family care still looked at like it’s only a woman’s responsibility? She and her husband had demanding jobs, so naturally it is the woman’s place to drop back?
28
@Marie that’s what I can’t understand is why few men want to do childcare. Is it biological? Is it for social stigma?
Do couples discuss this before marriage. I would hate to be a female physician and discover when the kids come that my spouse wants to work all the time.
4
@Marie
Like many other commenters here, you are trying to make an issue for sexism here where one does not exist.
As a full time academic ophthalmologist, I appreciate the potential ability to go part time wiht a pay cut (but still earning a very decent salary) if I wish to. I think about it nearly every week. Yes- there are big inequities in society (especially in the amount of time spent in childcare) and in pay for women but if women do not want to lean in- that is a choice too. Let Dr Herbert be! She wants to meet her kids at the bus stop- that is fine and admirable in a way.
9
So why can't other jobs become family/human being friendly? And why is there so much screaming from employers that they cannot find qualified employees? One big reason is because of age discrimination. Many employers are looking for 25 year olds with 30 years experience. Doctors may not experience the same age discrimination the rest of us do but the fact is that there is plenty of gender discrimination and other discrimination in medicine. Because women have the children they are often the ones to give up the more prestigious positions since research demands more time than most women have.
This country needs to rethink its concept of work, efficiency, living wages, and the life work balance. We are the only country in the developed world that doesn't have a minimum vacation for employees, guaranteed holidays, or any real protections for employees. No matter where we work or what we do we are at the mercy of our employer's whims.
30
@hen3ry
Agreed. We need to provide more education/training and opportunity for the un- and under-employed, and more flexibility for the already-employed so labor can be redistributed more evenly over the population as a whole.
Employers are sometimes unrealistic. Once upon a time, they expected to spend months to years training their workers to fit the job. Now, they expect them to "produce" on the first day. It's daft.
The only reason Medicine has improved somewhat in this regard is because the cost of pushing women out of the profession is so high--they have negotiating leverage because their skills are rare and expensive (and lucrative for their employers).
It would be wonderful if everyone could have more freedom and flexibility in their life. There is a solution--a strong organized labor movement. Without it, those with less rare, expensive skills will never have a decent bargaining position with employers.
Trying to squeeze more output out of fewer people while others are deprived of opportunity is a recipe for misery. It is a trap that makes both the marginal and the "successful" worker miserable.
The only people who benefit from the current system are those who live off their investment income rather than their labor.
3
The point this article misses is that, while there is some degree of flexibility in the broad practice of medicine in terms of hours and ability to be at home, there are trade offs in terms of specialty choice that female physicians who want to have families make that male physicians who want families just don’t have to think about. If you WANT to be a pediatrician and work in clinic from 9-5, great, but if you want to be a trauma surgeon then that’s a different story
31
if you work from 9-5 you're still writing notes all night.
23
@Kaylee Frye
I"m a pediatrician. I work 8-6 then spend 2 hours a night charting and commute 1 hour each way. My female colleagues are all hanging on by their fingernails to balance family and work even working part time.
Fake news.
Love, a female physician whose 7 year old just told her “I feel like I haven’t seen you in a year.”
35
Why are people trying to be superhuman and then complain about not being able to do it all? We can't do it all, and not well - kids, $, great career, long work hours and upward mobility. There are so many hours in a day and so much energy.
There is a a sense of entitlement woven through this article, that comes across as whiny first world problem snobbery.
15
@Brooklyn
Agreed. The sense of entitlement is in the comments- people saying that it’s sexist that this woman can’t be an oncologist AND raise the kids.
It’s sexist!!
1
The title of this article is insane. It is routine in our family for my internal medicine hospitalist wife to go 2-3 days without seeing our children on shifts that are supposed to end at 3pm. While it is true that doctors might have more flexibility than most in how they group together their days on we're still looking at a profession were 60-80 hr work weeks are not just the norm but expected by employers. Further more, any time spent working is completely inflexible. There is no such thing as leaving an hour early to make it to soccer practice in time and finishing from home. There is seldom the guarantee of leaving ON TIME from work. If you are sick, you must make a choice between calling your back up physician and destroying his/her family time or sucking it up. I've never once heard a doctor describe their profession as "family friendly". More common are stories of missed family time and strained marriages.
100
@AB
The whole article feels like it was written by a PR department of Kaiser’s. A shiny eyed vision of corporate perfection. Thank you for your observations.
9
This article is enraging and terribly misleading. While it may be true that a minority of female (and male) doctors can find ways to work fewer hours, most graduate from medical school with enormous debt. If they have a child(ren), that adds greatly to their expenses. Let's not assume that everyone has a rich spouse or wealthy parents to pay that debt off. My daughter has $300,000.00 of debt. She is a third year resident, 7 month old baby, 6 weeks maternity leave. Husband a resident also. Yes they will have good incomes, but they have done the math and nobody is going to be working part time anytime soon. As an MD myself, my observation is that this is far more common than the scenarios portrayed in this article. Yes we are fortunate to be able to be doctors, but it often comes at a high price- emotionally, in time, work and usually financially.
73
@Cynthia-Cynthia thank you for reflecting an experience I am living through as well. I am not a woman, but I am a doctor who just graduated residency. My debt is approximately $300,000 as well at an average 7% interest rate. It was one of the primary causes of one three and a half year relationship ending. My current one? I really struggle with the idea of proposing, marriage and having kids with my current girlfriend (she is a graduate student with very limited income) at this point in time due to my debt. I just moved back in with my parents to help pay it off, and despite being in my thirties will continue putting off my life because of it. Solely for the reason of student debt, becoming a doctor is not a family friendly profession; not to mention the hours and years studying/ training to get to that point.
49
@Cynthia: I want to be sympathetic, truly I do. But I have two questions:
1. Why did they decide to have kids during residency? I can't imagine a more difficult time to become a parent. I understand if your daughter is nearing the end of her fertile years, but most residents are much younger than that.
2. Did your daughter do the calculus before she applied to medical school? The numbers haven't changed that much recently, so I'm sure she could figure out what was coming.
I guess I've seen enough early career physicians with delayed gratification issues that many of these comments suggest that people want it all: their favorite specialties, a great salary for working limited hours, and kids.
In my experience as a physician married to another physician, medicine offers a very rewarding career for those who plan carefully, choose specialties wisely, live modestly in the early parts of their careers, and have kids at such a point as they have some control over their lives. I realise that not everyone has these luxuries, but many do.
18
@Alex
I totally agree with you. Thanks for sharing your experience as a man. I think the issue is that the cost of medical training is unsustainable, is part of the reason for our shortage of primary care specialists, and is going to create (if not existing already) another elite class in our country- only the people who have enough money can afford to go medical school.
16
This has been my wife's experience. Our first child was born when my wife, a maternal-fetal medicine sub-specialist, was working at a major academic medical center. She was expected to carry a full patient load, teach medical students and residents, and do research. It was up to her to find enough hours in the day to do her job. She lasted there less than a year after we became parents.
She took a job at Kaiser and has never looked back. Her hours are very regular, and all her teaching and research responsibilities are included in those hours. There are occasional periods when she works late, and she takes in-house call a couple of times per month. But mostly she's home by dinner, weekends are free, and with comp time she gets eight weeks off per year. She couldn't be happier about her work.
Meanwhile, I left clinical medicine for private sector R&D/business after our first kid was born, so my hours are very flexible. I took on most of the transportation responsibilities when the kids were at home--music, sports, etc.--and I did most of the cooking. I loved it!
We've had such a great life as a couple and as parents. Now in our early sixties, we have no plans whatsoever to retire.
21
if we all leave clinical medicine for the true flexibility there will be no one left for the patients
10
This article paints medicine as much more family friendly than it truly is. I am a female emergency medicine physician. Women in medicine are still expected to do almost all of the work to maintain a family at home and then grow our careers as well. Why did the first physician profiled in this article have to leave the field she was most excited about (oncology) and switch to part time work in a field that is less prestigious and less well compensated? Because she is a woman. A man would never be expected to make a similar choice.
We need to work to make all fields more family friendly by providing affordable, high quality, child care, and having legitimate family leave after the birth of a child. Neither of those exist in medicine, or our country, on a large scale.
43
@AK: "Women in medicine are still expected to do almost all of the work to maintain a family at home and then grow our careers as well."
Perhaps. But who exactly expects women physicians to do this? Not me, a man married to a woman physician. I'm not alone, either.
I don't dispute your claims, but it's not written in stone, not a law of physics that prevents men from taking more responsibility at home. We did it; my wife and I. Many of our couple-friends did it. It can be done. And it's not the job of the medical profession to do it for you (though I can't disagree that we need better childcare options).
It's not unreasonable to expect people to make some compromises to allow them time to be good parents. Parenting takes a lot of time--or it should if it's done right. I gladly set my surgery dreams free once I became a parent. Best decision, professionally at least, that I ever made.
9
@hammond My late husband, who rose to a high position in an interventional field, would have said the same thing that you wrote. But it wasn't true. He did less and less at home so that he could excel and convinced himself that I was making up all the things I asked him to do. I had been positioned to have an excellent career as well, but it petered out because I just wasn't available as much as needed.
26
@CassandraM: Your husband sounds like a lot of men. I apologize on behalf of my gender. I truly don't know why this seems to happen in so many relationships.
I've had a policy for years with my employees: Take whatever time you need for your family. I have no set amount of paid time off. Very few men ever take me up on this. Very few. One guy even called me an hour before a scheduled meeting to tell me he was going to be a few minutes late. "My wife just had a miscarriage."
7
As a female engineer in a technical profession, this approach doesn't always hold water. Treating patients is a very task based job function. Decisions are primarily made in the moment, documented, move on to the next task. A highly skilled profession, but task driven. As long as you manage the hand offs between doctors well (a huge if) someone else can handle the next task with that patient, with primary decisions being made by the main doctor. The nature of the work makes it easier to balance workloads.
Contrast that with jobs that are more research and project oriented. I am working on a large scale project that will change how my company approaches a kind of risk. I can't download the design and code nuances to someone else. If my kid gets sick, my project work stops. If these doctors where research scientists, they'd be in the same boat.
Kudos to the doctors who can make this work, but it isn't a silver bullet.
14
@Jen You clearly have not practiced medicine, and I say this as someone married to a computer scientist. People are not widgets and don’t follow protocols and task lists in how their presentations unfold. All these nuances you talk about in coding? They exist a hundred or thousandfold when you are
talking about the functioning of the human body. This is why it is called the art of practicing medicine. There are things about the patient’s disease process, and the interaction with the patient themselves, which only the physician who has been following along may be privy to. And there is the human factor as well- people are vulnerable and make connections to their physician and don’t want to feel like they are being abandoned or passed off.
9
@Durham MD
Thank you and Amen. Your patients have been/are very lucky.
1
Jen,
I am floored by your lack of understanding of what many doctors do. I am an academic oncologist who also collaborates with basic scientists on translational research. My job is by no means one where I can accomplish a “task” and move on. Do you think I can possibly outsource an end of life conversation for a patient I have known for years? Or simply “hand off” dealing with a frightening complication of chemotherapy? These issues arise any time of day/night as contrary to your statement, caring for sick patients is not a compartmentalized task—completed and charted. Your assumptions of how we can manage a child sick at home are inane. (Do you think I can easily cancel 30 patients scheduled to see me and receive treatment?! What about the patient who has flow around the world for expert advice for potentially life saving treatment?). Compassion and empathy are not equations. This article is an absolute joke but what is perhaps more frightening are the comments.
9
It is incredibly disingenuous and irresponsible to claim that “non-physicians” are to blame for “worsening health outcomes, maternal mortality rates, and the rising cost of care” and provide absolutely zero data to support that.
Stop trying to blame others for the failure of your profession and its supposed advocates (AMA) to protect its own.
I’m one of those “non-physicians” who is working side by side with you in the trenches taking care of people all day long. In other words, I’m not your enemy, and I could be your ally if you afforded me an ounce of respect. We can go much farther together to rewrite the rules for working women than we can separately.
9
This article is unbalanced. biased and flawed. I am a female physician. It seems the author did not even consider the fact that female physicians may be more likely to work after having kids because they HAVE TO, in order to pay off overwhelming educational debt that they have after years of schooling (and then years of low paying residency).
Additionally. To suggest that female physicians have more control over their hours is misleadin. In fact, the most common window for child bearing occurs during the same time period when most physicians are in their Residency. When in Residency training, physicians have almost zero control over their schedule or their hours.
Lastly, it is well known that female physicians are paid less than there male counterparts for the same job,/same number of hours worked, so to suggest that they are “being paid proportionately” is misleading.
In the future, I hope this author interviews a wider swath of female physicians to get a more balanced understanding of the factors at play. And please do better with your titles!
53
I would like to see the definition and analyses of family friendly to include care for elderly parents or disabled family members. Not everyone will have children, but everyone has parents.
20
Notice the "floor" is > 40 hours / week. My father, when he went part time as a radiologist at age 70, negotiated for a 47.5 hour part time work week. I work 75% at a 40 hour work week in my practice, including call. Part-time in medicine is frequently Full-time or more out in the rest of the world.
45
I thought this was satire when I started reading. Just because Medicine is more family-friendly than in the past hardly means it is a profession to highlight as an example. As a female attending physician, I have no work hour restrictions. Patients need care 24/7 so unlike my old career in an 8-5 job, I work nights, weekends, holidays. Charting and other work seamlessly spills into every part of my life. I love what I do but I tell prospective medical students: don’t do this if you think there is ANY other job that would make you happy, because it is a hard, hard road. Female physicians have much higher rates of depression, suicide, and burnout in virtually every study done (the author ignored all of this). Male docs are much more likely to have partners who stay home or only work part-time. And as a female doc—we get paid less for the same work. What exactly are we celebrating?
109
@K Gold
Thank you!
10
@K Gold Amen. The author clearly wanted to create a certain narrative that doesn’t reflect the reality of most female physicians. Even when working similar hours for lesser pay, we have the added stress of gender discrimination from fellow physicians, administrators, and other health professionals. This discrimination runs rampant and deep in our profession and often unchecked. I know there are exceptions but the life of a female physician is not as rosy as depicted. Fortunately, we can take satisfaction in the care we deliver and the improved outcomes that we achieve as borne out in recent studies.
3
Every time there is an article about (relatively) wealthy or upper middle class people, someone invariably writes about how that is a first world problem and what about the working class. I am sympathetic to the issues facing the working poor, farmers, refugees, students, military personnel. But there are stores about those people, too. If the article about which Hamptons town is best doesn’t seem relevant, move on, and let the folk who are interested read it.
8
Being a pharmacist in a hospital offers good pay, regular hours, and generally less stress than being a doctor. Also, there is usually no work to take home, you are paid an hourly rate for every single minute you work. Plus the training is not as long or as intense.
22
But it’s not the same as being a physician. Being a physician is a calling.
8
@Ms
" Being a physician is a calling."
Being a physician is a job. Like being a pharmacist.
17
the pharmacist who works in the hospital is not the same as the pharm tech who dispenses your meds at the retail pharmacy, and those who do that job are also skilled.
2
the author and the commenters are mostly female one percenters whining about not being able to make more money in their chosen career. meanwhile, there are millions americans who cannot afford to have or raise children.
I hope all the combat soldiers are learning from this kvetching and demand more work-life balance time and equality in their profession, where only the males die.
11
@8i I think you may not understand the amount of money and hard work that goes into becoming a physician. The reality is that physicians have an extraordinary amount of student loans and work >80 hour work weeks to keep our patients alive, often sacrificing many of our own personal life events. It is often extraordinarily stressful and the vast majority of physicians, especially in primary care fields, are not well compensated for what we do and the amount of responsibility we bear for our patients. I know many households with 2 physicians who can’t even afford to buy a home because of the student loans and inability as a result to save for a down payment. While there are some in high paying specialities, the vast majority of us are definitely NOT the whining 1%.
47
The “one percent” is not made up of people who worry about a salary. It is made up of people who have huge investment portfolios and, if they work at all, giant bonuses every year, which dwarf their salary. The top 1% is those earning over $700,000 per year. The women physicians in this article are not earning anything near that, and what they have to say is valuable.
We should wonder why so much of our population has such poorly paying jobs, instead of belittling each other.
54
@8i: Point taken.
But how many soldiers and other working people spend 12-18 years in training after high school, most of it costly, and the few years that include a salary, pay very poorly?
Physicians don't just appoint themselves to this profession. And besides, there are many more highly paid professions that require much less education and training.
And women soldiers die too.
16
We have one "hospitalist" group of mostly female physicians who aren't even in the hospital at night. While they are home at night with their families, the ER admits patients to this so-called service and we nurses have to place multiple calls to their answering services to get them to call us back to place "telephone orders," which we nurses have to enter into the computer. l came to work one night and met a newly admitted patient who said his attending physician had just seen him and was going to order all his home medications. This was at 7:30PM. Well this female hospitalist DID NOT order anything for this patient and left to go home to her family. I spent the next 4 hours calling this "hospitalist"'s service while also trying to take care of 5 other patients. Sorry, I understand that doctors want family time but they need to do their jobs and have practices that offer in-person 24/7 coverage so patients get proper, timely care. This is why nurses are constantly running around so much and why patients have to wait so long. Another hospitalist service has doctors in the hospital 24/7 so their patients get much better, more timely care. The system is ridiculous but if you don't want to work nights, don't be a hospitalist and no hospitalist group should be allowed to admit patients at night when they're not even there. Nurses make a LOT less than doctors,. but we're the ones with the patients and we're the ones the patients complain to.
51
@NjRNn you also go to school for a lot less time, have less training, and less debt.
18
@Louis P And yet she’s doing a physician’s job. The system and society are still highly hierarchical, so much so that Louis feels comfortable with nurses (and patients) being treated badly.
17
@Grittenhouse that is untrue. Physicians have specific credentialing requirements in order to stay licensed. It just so happens that nurses have a ton more time and freedom to take more courses, which is great for career advancement.
2
I think high fertility among females in medical profession has more to do with the nature of profession than the flexi-hours. Having in-depth knowledge of human physiology, various diseases, their cure and preventions give them added confidence. Studying medical literature early on helps them come over many fears that other less exposed females may harbour. Furthermore, being closer to medical service network give them other privileges such as having better information on the quality of choices they have, better awareness of emergency care, better awareness of pre and post pregnancy care options. I doubt that flexi-hours would enhance fertility among non-medical professionals at the same rate as it does for medical professionals.
6
@CA
This is completely incorrect. Female doctors do not have high fertility rates because they know more about fertility than non-doctors.
29
This is the single most ill-informed article I have ever read on the NYT. As a female physicians, I am just flabbergasted to read that making compromises in specialty choice and/or being forced to work part-time is somehow is positive thing. What's worse than that is the ill-informed comments the non-physicians are making.
69
Couldn’t agree more!!! I was shocked to come across such a flawed article in the Times!
6
@Doc
" What's worse than that is the ill-informed comments the non-physicians are making"
100% agree. People who are not doctors need to stop making comments on things they don't understand and know nothing about.
The number of comments about doctors' lifestyles/salaries etc that are completely wrong in this article is astounding.
Yet every one of those people thinks they "know" what they are talking about. Ridiculous.
10
@Doc: Okay, I'm a doc too, as is my wife, so I've earned the right to disagree.
Why on earth do you think being a parent is not important enough to make professional compromises? My wife left her academic position, with its relentless hours and demands, for a much more rewarding job at Kaiser. I abandoned my surgical aspirations for private sector R&D with very flexible hours. Both choices were very, very positive.
In my twenty-five years of being a parent, compromise was the second most important part of the job, after love.
7
The job market rewards skilled workers and Physicians are highly skilled. I was a Computer Programmer. When my children came along my employer offered up part-time work because they needed me. It worked out for me. Acquiring scarce skills is a key to being a working mother with flexibility.
11
I didn't see any mention of the decidedly high salaries no matter how many hours a doctor worked. that has to be a leading factor in affording child care, living in an upper middle class area, much, much more confidence in your child's school.
heck, a waitress who makes a six digit salary is going to have a difference dynamic as well
I'm not saying doctors don't warrant or earn the economically privledged position they hold in society, just be sure to mention that when you say the medical field has become the family friendly family profession.
3
Doctors are absurdly overpaid and contribute to health care costs through their laziness.
3
@John M
When your having your heart attack, massively bleeding or cancer, you'd better hope one of those lazy, overpaid doctors is available to help.
34
I am an internist with years of experience and 12 years of training post high school, and I am outstanding at my job. When I average in the number of hours outside work that I spend returning calls, reviewing results, documenting charts, filling out forms, calling insurance companies, I make $50 an hour.
21
This is a useful and powerful metric. As an adjunct professor in the graduate school at a top-20 university, my hourly rate is about $12. The “elite” work hard for their money too.
8
Doctors can afford to work part time because they get big salaries. I speak as a mental health patient who has to put up with pseudoscientific psychiatry.
2
The article talks about Dr. Britni Herbert who was going to be an oncologist but changed her specialty when she found out she was pregnant: she CHANGED her career path so that she could be a doctor and a mother. That is not the definition of family friendly. She had to make so many sacrifices.
The article states that women in medicine are less likely to leave their jobs compared to women in law or business. Let’s not forget the high student debt many physicians have so they financially can’t leave medicine. The other argument is that for doctors, medicine isn’t just a job. It is a calling. It is what they were meant to do. It is a career. Leaving is simply not an option.
The danger of saying “oh women can just work part-time or they can do shift work (such as ER or hospitalist medicine) and then they have work-life balance” is that it pushes women away from specialties where part-time or shift work is not an option. Additionally, female physicians make less money than male physicians (even when accounting for their decreased hours)- one of the reasons is that by working less hours, they are being passed over for grants and leadership positions. There’s barely any mention of men working part-time in this article.
There’s no easy solution. But we have to make all specialties in medicine be family-friendly. Going part-time can’t JUST be the answer. We have to support both mothers AND fathers so that they can be excellent parents and physicians in all specialties.
43
Yes, it's nice that female doctors can continue to work after having children. However, why is it that they have to pursue specialties with lower hours to do so? The article makes it sound like a good thing, but it's not. For example, why didn't Dr. Hebert's husband, the radiologist, switch to a less intensive specialty when *he* found out he was having twins? Why does Dr. Hebert bear all of the responsibility of childcare while also maintaining a full-time job as a physician, when her husband can pursue the specialty he has always wanted to pursue and have a housewife/doctor-wife to boot?
41
It’s kinda hard to find a less intensive specialty than radiology.
9
@Riley2
Are you joking? You think radiology is not an intensive job?? It requires nonstop intense concentration.
It's probably hard to find a MORE intensive job than radiology
6
Radiology pays more especially an interventional position!
The reason these physicians in the article can get flexibility in their work hours is because they practice in underserved specialties (e.g. Geriatrics or other primary care) or have quit practicing medicine altogether. Physicians in other specialties, men or women, do not enjoy this perk. Mismatched supply and demand in these underserved specialties allows people to get what they ask for.
It is grossly offensive to claim that a woman shouldn't take up a medical school spot and "will want to work part-time" when a man "would've worked full-time". First of all, men want part-time too. Please don't compare to one or two generations ago.
And notably, part-time physicians are filling a sorely needed shortage in primary care. Instead of blaming these physicians for the long waits, they should be thanked for choosing to train in these important primary care specialties and shortening the infinitely longer wait it could've been. The care patients get from "part-time" physicians (who still work 35-44 hours a week) is better than getting none at all.
25
Hospitalists: another name for a doctor who knows nothing about you, but saves your actual doctor from having to come to see you when you are in distress. The same doctors who say you shouldn't use Urgent Care centers because of their concerns about "continuity of care." Maybe some hospitalists are good, but the one I experienced with a hospitalized friend was useless. And again, when you are in the hospital, you want to see YOUR doctor.
11
I am a primary care physician, but prior to working in clinic, was a hospitalist for seven years. The knowledge set for clinic vs hospital medicine is much different and I strongly feel that hospitalist are better able to care for complex patients. Further, in the days when PCPs saw their patients in the hospital, they were not available for emergencies, as they were in clinic. I have seen both sides of practice and firmly believe hospitalists are a good thing!
21
@Anne Hajduk
What does “your doctor” mean? If you’re hospitalized, it may be for a sudden acute problem for which you weren’t consulting any physicians previously.
3
If you get pregnant, have heart problems, have a skin lesion, have glaucoma, etc, you see a specialist. If you need hospitalization, you see a specialist. I did hospital medicine for years, and after being out of the field for just a few years, will be out of date and out of skills to manage some severe hospital conditions. Plus YOUR doctor is either taking care of patients in clinic or doing all the paperwork that is required outside of clinic. YOUR doctor is probably pretty busy.
8
What about us global health docs travelling and focusing on fulfillment in OTHER ways, both career and personally?
2
@L. Yes, why is it that the focus is on having children as the primary outcome for a woman's happiness and fulfillment and way to spend all free time? There are many of us in medicine who prefer work-life balance within our emotionally and intellectually demanding profession to pursue other interests. In the words of a good friend, it is disappointing that even a in liberal echo-chamber, media is focusing on having children as the only reason women could possibly seek a balanced career.
16
Physicians do a better job when they take time to listen to their patients, when they are up-to-date on research and best practices, when they care deeply about and enjoy their jobs. I see this first-hand as a nurse at a teaching hospital. Some passionate doctors were attracted to the profession because of a desire to take care of others; that desire extends to their families, as well. I feel this is natural and support the idea of a doctor whose work role allows them to feel comfortable in their family role. I also feel some doctors who are already parents have an easier time relating to patients, as health, sickness, and family bonds are deeply intertwined.
27
I wonder if part of the problem for American doctors (female in particular) is their age when they finish medical school, residency and fellowship. In most of the countries you can start med school just after high school, finish med school at 22-23, residency at 27 and fellowship at 28-30. Here in US many doctors finish all the training after 34-36 or even older and some with huge debt. I read in the post many residents or fellows complaining about long hours, but for residence and fellowship that is the norm and part of the training. So I think the problem is more complex than just to choose an specialty with flexible hours and many of the complexity was no discussed in the article.
15
As a female physician nearing the end of a long career, having raised two kids and working the whole time, I have to say I agree with this. I’ve noticed that most of the cries of outrage here are coming from women MDs who are still in residency or early in their careers. Yes, that’s an extremely tough time. However, later on you’ll have opportunities to shape your hours that attorneys and high level management professionals, for whom part time work is rarely possible, never gain. Plus, travel is not part of the job. That alone is a huge advantage.
Having said that, it is of course much easier if you have a wage earning spouse. But at least, the options are there to reduce your work commitments without stepping off the career track entirely. And the job can be dialed back up once the kiddos are in college. That’s a luxury many of my women friends in other professions did not enjoy.
20
@Riley2 I'm in academic medicine and done with my training. There is more flexibility (I can do more work away from my office, which is a blessing and a curse) than during training, but I do not work fewer hours per week. Travel is also critical to my job.
I share in the outrage. Even if you agree with the premise (that part-time work is possible in medicine), the framing of this information is completely tone deaf and situated in a gender stereotyped context that seems blind to the issues this journalist has written about extensively.
FWIW, as an academic, I'm definitely not paid as well as private practice physicians and there is no part-time option available to me.
13
@JH
Sure, academic practice as you describe it is not family friendly. I think you missed the point of the article, which is simply that there are ways to practice medicine that are.
1
@Riley2. agree totally. stepped way back for the baby/preschool years which were after residency,-working 1 day a week just to keep up my clinical skills (not a surgeon) and am now back full time (in time to pay college tuition).I did make a point to keep up my Board certification. and luckily had a spouse with a good income. I see moms that were lawyers, MBAs, engineers who had no options whatsoever to work part time and opted for full SAHM role. now, even if they wanted to work full-time, few can go back to their old careers.
3
Unfortunately, the patient is again left out of this healthcare discussion.
While female MDs are standing up for their hardships, we must remember that the flexibility comes at a price for others.
it inevitably creates more work for colleagues (male and female), adds to scheduling nightmares, and can mean a lack of continuity / follow up for patients as everything gets delayed.
Real life is a patient who has to wait 2x as long to see their female MD becuase the physician only works part time. Until you’re in that patient role, you can’t imagine the turmoil it can lead to.
We graduated the 15th MD in our family 4 yrs ago. The advice that goes around the table when someone (male or female) considers medicine as a career is summed up in this analogy “unfortunately, if you don’t want to be held up by weather, or be away from home, or don’t Like heights, don’t be a pilot. Some things are just part of the job”
7
@Nlinden
There is currently a shortage of primary care physicians. If you take all part time primary care physicians and say they should not be practicing medicine, then the wait time for getting a primary care physician, let alone seeing one for a particular issue, will get much longer.
Do you currently practice medicine full time? If not, you also cannot comprehend the hours/burden of EMR work that primary care physicians handle everyday, including nights and weekends. Seeing patients 20 hours weekly means 40-50 hours weekly of work, with those additional hours done from home on “days off.”
2
This article is so misinformed. I’m a full time general pediatrician who admits my own newborns at two hospitals, which causes very unpredictable hours and wreaks havoc on my family. Also... more flexible hours and schedule control as an employed physician? Rigghhhtttt...
Female physicians keep working after having kids because we don’t have any paid leave! I’ve seen female physicians return to work just one week after giving birth. I returned after 4 weeks with my first son, and 6 weeks with my second son - during which time I also graduated, moved to a new city, and completed 2 weeks of training prior to starting my new job. We have to start paying back loans the day after we graduate. How nice that the physician highlighted in the article can alter her schedule because her husband is also a high earning physician. This is the exception, not the norm. No woman chooses medicine for the flexibility of the profession 🙄. The suicide rate of physicians is higher than other professions because medicine is demanding, exhausting and we are overworked. There is so much wrong with this article.
40
@SDS
Couldn't agree with you more. Medicine in general definitely is in need of improvements. Patients and doctors suffer because great care seems to be at the bottom of a very long list of requirements. It is essential to me to listen to my patients and to empathize and try to understand their concerns for their kids. It is why I love this field of Pediatrics and it is how I have the best opportunity to give sound medical care. Honestly though, with 5 minutes per patient and requirements for numbers of patients per day and huge documentation nonsense and billing, we really need to understand that so much needs to change. I too returned to work with 2 week old babies at home and no time or place was available to pump. Doctors need to join together to reclaim our field and make it sustainable for ourselves and our patients.
8
So female doctors still get paid less than men (as in almost all other professions). What form of twisted logic keeps this system in place? Full-time female med. students, interns, residents, and "attendings" work just as hard and equally long hours. Their med. school loans are just as huge (often $300-500,000). They are equally skilled. The absurdity of this is baffling and infuriating. (PS: I am not a woman.)
29
There is so much complaining on this thread.
First people should realize they cannot have it all. Secondly, why are any surgical residents or practitioners surprised by their hours?
People need to seriously think about what is important to them, what they are getting into, and adjust their lives accordingly. It’s called life.
The only item that clearly is a problem in my eyes, is unequal pay for the same job, working the same hours.
5
@Ellen Campbell
We are complaining because the job we do as female physicians has been grossly misrepresented in this article. It’s maddening.
19
As a female surgical subspecialty resident, this article is very frustrating. There is zero mention of surgical specialists in this article. All the examples are of medical or radiology specialties. That is not a coincidence. Secondly, this article celebrates that female physicians can work part time in order to have a family. This while they are still compensated less than their male counterparts for every dollar earned. If this author had spoken to surgeons they would have realized that in the era of RVUs, working part time is the kiss of death in any large hospital system—not to mention in an academic system. And lastly, this article does not provide any further solutions or systemic changes to get at the root of the problem.
37
This article is extremely frustrating. I am a female trauma surgeon less than 10 years of of training, and there aren't many of us. I am a single mother of three, two of whom I had prior to or early on in my training. On average I work more than 80 hours a week, including overnight call 4+ times a month with full days of work after a night's call. I work dozens of hours MORE than many male physicians. I clearly did not choose my job to suit my life as a mother. And I STILL get paid less than my male counterparts. I cannot afford to cut back my hours just because I have kids, because no one else is going to pay my over $250k loans that I struggle to repay even now with cost of living and kids' school costs. If even tried to do that, I would get terminated. Oh, and I divorced because my (male) ex earned less than a quarter of what I did and STILL complained about working too hard and made me feel guilty about doing what I was doing, because I should have been in the kitchen. Why did I choose this life? Because I'm good at it, and I can help save lives. And a woman can do it just as well as a man can, without the support, and with popular opinion due to trashy articles like this contributing to an archaic impression of moms needing to stay at home with their kids. Thanks, NYT for making me feel like an inadequate doctor AND a selfish parent. Why am I publishing this anonymously? Because as a matter of fact, I can still compromise my job/salary just by voicing these truths
91
@AP Female MDs have to overcome so many more obstacles because many of their husbands won’t step up to the plate and support female doctor-wives like wives support male doctor -husbands. The patriarchy says men should earn more and women should take care of the kids. So you have to be a superstar to do everything you do as a trauma surgeon and mom and do it all on your own. Religion traditions and patriarchy are difficult to change even when females achieve fantastic careers.
23
Only certain highly paid professions, that don’t mandate financial or career penalties, for working less can do this. Even if an MDs salary in half won’t mean living in a rental in poor neighbourhood. Especially since the article mentions that the female MD is likely married to another highly paid professional.
And while It’s not politically correct to say, this indeed contributes to the problem of doctor shortages and patients getting less care. If you to graduate 2-3 female MDs to replace one male MD in terms of patient load capacity, we need to open up more medical school and residency spots and ...gulp.... scale pay appropriately. In the private sector, commitment to your career is rewarded.. rightly or wrongly. And let’s be frank... medicine in the US is a business.
By the way, I’m a career woman with a fall and have many MDs in my family... and have had an elderly relative have long wait times for appointments because her female MD only work 3.5 days a week....so I’ve seen it from all angles.
4
If that doctor worked 5 days a week, they would just have more patients. The wait is because there aren’t enough doctors. Patient care is complex.
2
"Jobs increasingly require long, inflexible hours, and pay disproportionately more to people who work them."
Regardless of what you call it--Capitalism, Moneyball, Feudalism, whatever--it's an incoherent value system.
If people have a right to have families--a natural goal--then it's wrong (should be prohibited) for employers to set job requirements so high that only those without families or those neglecting their families can meet them.
Besides--forcing parental neglect, just passes on the costs of unhealthy, uneducated kids to the public--much like pollution costs.
All this while undermining Planned Parenthood and public education is insane--illogical in the extreme.
10
Whenever I read things like this I’m more convinced than ever that the world is divided into the haves and have nots.
1
Hey ladies, guess what! We make 82 cents for every dollar our male colleagues make! Aren't you proud of our progress? I wish I could roll my eyes at this ridiculous "upshot". The upshot is, female physicians choose specialties with better hours because 1- working your butt off is still only going to get you 82 cents of what your physician husband in the same field will get for those same hours (we aren't stupid, we can do the math), 2- someone has to be flexible to manage the kids/household, so it might as well be the one who's earning less regardless, 3- we don't want to work with a bunch of men who will just complain about us needing time off for kids so we join workplaces where the other women already are. AND despite all this writer's research, she never felt it would be beneficial to point out that women physicians provide better, more cost effective care- ie, your chance of dying in the hospital is significantly lower if a female physician is taking care of you than if a male physician is.
One last thing- stop perpetuating the myth that only men want to be cardiologists. We NEED female cardiologists so that we can decrease the gender disparity in cardiac care.
41
Downsides: not enough time for the children, not enough male doctors. That's a problem.
So does this mean that the reason we have a shortage of doctors in the country is because half of all medical school graduates tend to work part-time?
1
@Deborah, note that "part time" is often more than 40 hours per week. Doctors in my extended family working full time rarely work less than 60 hours per week. One doctor I know considering "part time" would be working 33-44 hours per week. In my profession, "full time" is 35-40 hours per week.
13
@Deborah. The short fall in U.S. trained docs is long-standing.
These docs are most represented in specialities and locations that American trained docs are choosing at low rates, e.g., psychiatry, rural/small town internal medicine.
The shortfall in American docs reflects a failure to invest in the training of all of the physicians we need, with the result we parasitically draw docs from other countries that have invested proportionately more of their country's less abundant resources than the U.S. has in training, but who then lose them and the return on their investment in training. There are implications for a variation in foreign aid in this.
4
This article has angered me in many ways. Luckily for those reading this, I am a Pediatrics resident with barely enough time to get groceries and do laundry. Otherwise, this would’ve been a 5-page critique.
I think the author missed a HUGE point about physician women returning to work. This is not just a job, it is a calling. So many years of hard labor, tears, and sweat cannot be given up just like that.
And we are still giving up important things! Choosing a speciality over another because of family planning rather than personal preference, is wrong in so many ways.
It is clear that the author is a non-medical person given she missed all the things that make our profession (medicine, nursing) so unique and incomparable to other jobs.
On another note, one of the readers brought up maternity leave during residency and I agree: It is appalling. As residents, we might be able to negotiate up to 6 weeks including our vacation days, sick days, and personal days.
Meaning that once we are back from maternity leave, we won’t have any vacation time left in the academic year nor personal days available.
Right away, we are expected to go back to our regular schedule -working up to 80 hours a week and doing 27-hour long calls.
Sadly, it goes like this for most residency programs in the US given ACGME regulations.
36
@BB what is the solution then? Increasing the duration of training ? That would make residents non competitive for fellowships that start in July. It is a complex problem in time bound training programs
1
A lot of comments imply these part-time doctors are forcing their work schedule on hospitals and patients. But clearly, if part-time work didn’t benefit the hospital, the hospital wouldn’t allow it. The majority of businesses have to be massively coerced into allowing part-time work from professionals.
Separately, I don’t understand why every profession has to be family friendly. There are a lot of ways for talented people with children to contribute to society. It’s not a great tragedy if a smart woman becomes a nurse or biology teacher because she prefers a more family friendly lifestyle. If doctors working part-time because of family obligations isn’t benefiting the hospital or patients, then there are millions of other childless doctors, doctors with stay-at-home spouses, and doctors with round-the-clock childcare who can take those positions.
4
Many good points below. I will just add that it is not only female physicians who want life-work balance. Most of the young male doctors I talk to are also looking for a relatively more predictable schedule and ability to take time off. Perhaps less so than female physicians, but again males are under less pressure to take care of the children and household.
6
In addition to the need to balance work and home by selecting flexible specialties, etc., women doctors also continue to work to pay their sizable education debt. That is not a free choice, to work or not work.
I like all of my women physicians.
5
What I have missed seeing in the comments is that medicine seems to be one of the few professional jobs where mothers can scale down (and later scale back up) their hours without seriously damaging their career. If you are a senior professional or manager in another industry, try doing this. My peers and I had to stay at the job full time or risk losing it altogether, and then try to start over. I asked for reduced hours for one year, or even six months, when my first child was born, and was told no (I was a department director at bank holding company).
It’s not ideal, doctors, but its way better than the alternatives available to female professionals in other careers with very few part-time options.
10
This article is ridiculous. Female physicians that work part-time are automatically ineligible to become chairman of a department or the director of a department program. You absolutely lose any chance of career progression once you become part-time. The women in this article essentially sacrificed their careers for their children, which is not a bad thing, but something that should have been acknowledged in the article as many female physicians do *not* make that same choice. I have encountered many female surgeons with stay at home husbands/wives.
8
This article is not a cause for celebration.
Maybe the old days of doctors putting their patients first and their families suffering because of that ensured better healthcare for patients?
The monetization of health care undermines all of this; the "haves" gaming the system as its set up instead of questioning it; picking a category of medicine not because of passion or interest but because of perks; nurses picking up the slack and the de-professionalization of nursing while nurses do the night time shifts and try to chase down these doctors (who are with their families) to get the patients the care they deserve.
ALSO please stop complaining about medical school debt as a justification for furthering this dysfunctional system.
5
This was not an inspiring article despite what the title suggests. So really it's the same old even in a prestigious profession like medicine - women routinely give up higher pay for work with less respect in order to work fewer hours to spend time with their children. People who wish or can afford to give their entire lives to their work make it to the top.
14
Not sure why this is "news." We cannot have it all.
Raising children requires time and attention. Work requires time and attention.
Why is it so hard for people to accept that sacrifices need to be made to raise children. My husband and I are both lawyers. Early on we recognized that we both could not stay on the partnership track and give our kids the time and attention necessary. I changed from private practice to an in house counsel job, took off a decade to be at home with our three sons, and ultimately took a job in state government. I made far less than my husband, but neither of us have any regrets. I worked far fewer hours than my husband and made a fraction of what he made. I never expected proportionate pay, my work was less challenging, less stressful, and frankly, I always felt I had the better more rewarding path.
3
Just wondering: Did Dr. Hebert’s husband alter his career path in radiology ? It’s still a man’s world..
18
@AW
Radiology is a specialty that really lends itself to variable shifts. Perhaps her husband did alter his career path, perhaps he didn't.
That would be their choice.
5
Actually, radiology can be outsourced. To other countries in most cases.
At some point reading films will be done by radiologists in India for example and only radiologists who do interventional procedures will remain in the US.
It used to be considered a dream job as it doesn’t involve the messiness of direct patient care but I am thinking it might become an endangered specialty.
5
@Amy More likely reading films will be done by A.I.s. Already plenty of evidence that A.I.s can do this as well as people, and unlike most humans, A.I.s are pretty good at learning from errors. I wouldn't be surprised to see health insurance providers pushing this in the near future.
2
I'd concur with other commentators on a wide range of points. Family-friendly misses the point. I would add, where are these women's husbands or partners? Are they all single parents that they alone are changing their career focus to accommodate the needs of a family? This is totally the elephant in the room of this story. Since when is it only a woman's responsibility to take care of her children? Isn't the point of a family that they make choices to serve the needs of the family unit, which includes taking care of themselves? Too many elements missing from this story from my perspective.
21
@MerylK I see a woman come home from work to their husbands who are minding the children. The husband is attentive, but bored and understimulated. The wife immediately tries to take charge and be super-mommy, while transferring her stress load onto him, even on weekends. This is also happened with a friend of mine. Either you are a career person only, or a dedicated parent. But you can't do both in a primary role. Most women are simply more innately suited to child-rearing, that's nature's way. They also do better at starting careers after children are grown, where men tend to be winding down. It balances better that way, I say. Have children, work part-time and keep your hand in, then start going back to work when they are in high school.
This article, especially the title, is so misleading. Saying that medicine is somehow a “family friendly” profession for women misses the big picture. Of course more women in medicine continue to work after starting a family because they are saddled with student debt (often $250k ) so they are left with no choice. Furthermore, most hospitals and physician groups have nonexistent maternity leave policies so the best you can expect is FMLA and using your disability. Compare that to most law firms and corporate America, who give very generous paid maternity leave. The female physicians in this article also have had to pursue other specialities (or in one case, have given up patient care altogether to be an administrator) besides their chosen one in order to strike some sort of work-life balance. What message does this send? That medicine can be “family friendly” for women, but only if they pick specific specialties?
20
This article misses a huge point. Student loans. The salaries required to be a professional working mother.
6
Medicine may seem like it is ”easier” for women physicians with children to continue working when you compare it to other high paying fields such as law. From personal experience as physician and a mother, I know that there is still a huge price to pay. This article captures a shift in the medical profession that has taken in the forty years since I entered medical school. We've still got a long way to go. Just ask my younger female colleagues.
We need to work toward accommodation for all working mothers.
10
@PBW This article ignores the ugly parts of the field completely.
And yes, comparing doctors to the one other field that devours its young is not saying much....
7
Medicine is a calling and a love and not just a job. For many women physicians the idea of not continuing to work after having children is unthinkable. I've been a vascular surgeon, in private practice, for decades and have also raised two wonderful children. They know I love them, and they know I love medicine, and that sometimes I had to go out at night or on a weekend because of an emergency. They are proud of the work I do. I know many women surgeons. Most have children and also work full-time. Each has worked out a system that's right for her family, be it shared parenting responsibilities with a spouse, help from family, or paid childcare. It can all work, and you don't have to pick up your kids at school to be a good mommy.
That doesn't mean there aren't real problems. Today's medical school graduates owe too much money; much more than what I did years ago. This has to be addressed, and I'm proud of my medical school alma mater, NYU, for now being tuition free.
Today's young doctors, both men and women, want more flexible time. New paradigms of medical practice, including shift work, and large practices are making this possible in new ways, and patients are accepting that medicine can be a team effort. However, our patients always have to come first.
Recent studies have shown that women in ALL specialties make less money than men in the same specialty even if they work the same hours. This is a real issue.
53
Despite the slant on this article doctors are no different than any other occupation. The balance between work and personal life responsibilities are issues we all face.
Some doctors are very dedicated but most are money driven and spend very little time on patient care as they try to see 200 patients a day 15 minutes per patient because their group practice and/ or employer requires that to make office overhead. I was recently told a story about a doctor working in a Cardiology practice who was asked to live when she said she wanted to work part time because she had to take care of her kids.
The fact that doctors work in shifts and hand off patients to whoever comes on the shift is a serious disruption in the continuity of care that can really be a great disservice to the patients. But once again, it’s all about the doctors, their lives and their monetary and personal issues. Patients are just billable commodities.
5
I think the difference is that pay is proportional to hours worked, and the number of hours is controllable. In many business and law jobs, the expectation is that full time workers will work vastly more than 40 hrs a week, and will be on call 24 hours a day.
2
@old lady cook
Feel free to go ahead and blame your insurance company and the government that protects them for the state of medicine. If the doctors aren't going to be compensated for providing care, why not hand the responsibility off? I agree it makes for fragmented, more expensive care in the long run, but reimbursement patterns have driven much of this trend. I don't think your doctors should have to work for nothing out of the goodness of their heart.
3
@old lady cook yes. when i was in private practice i saw a lot of patients. I was forced to do so by my employer who was somewhat forced to do so by the insurance company. I left around 5 or 6 every night and then spent until 11 or midnight every evening catching up on all my charting, checking all my labs, calling patients back and spent my weekends this way also. This was the only way I could see the number of patients I was required to see, jump through all the hoops the insurance companies put up for us to jump through and give quality care to the patients. I worked way more than 40 hours a week and was not paid appropriately. I left that practice and now do shift work, but i miss my patients very much.
3
My wife is a pediatrician who cut back her hours after electronic health care became a requirement and took a big chunk of her day to enter her charts.
You can do it in medicine because it is a piece-meal profession. The work is divided into consistent and finite 10-20 minute appointment, or 3-hour surgery at a time, depending on your specialty. It makes it easy to schedule personal time around work. Each doctor also is assigned a medical assistant who meticulously plan their days.
Not so in my line of work, where you have long term projects that require constant communication and collaboration with other team members and customers spread across the globe.
If I had a personal assistant (or a bot) that can plan my work day according to my priorities across the multiple projects I juggle at any given time, and put the finite chunks of time on my calendar as I work through them (and reschedule as needed), I too can work part time.
4
@Wesley Go sorry you are incorrect. Many physicians work without a medical assistant planning their day. I am one and I do my own planning of my day etc
5
@Wesley Go
I'm sorry but you have no clue of how a doctor's day-to-day life goes. No physician I know has an assistant to to "plan" their day. I am constantly running 2 hours behind because I take care of complex patients so the 20 min slot is pointless. I have never been able to "schedule personal time" around my work. I haven't been to a bank in years, I am routinely not getting the medical care I need, and I miss birthdays all the time.
7
@Wesley Go
As a physician working for 20 years, if you could get me the name of my assigned assistant I would sure appreciate it.
1
Ask resident physicians in all fields how much maternity leave they get. It’s appalling. I would say 6 weeks is standard. I take issue with saying physicians are an example of gender equality. We have a long way to go.
32
@Laura 6 weeks! Where did you get that number from? I know a few residents who had children, and the most they got was 4 weeks, which was their vacation time for the year, not maternity leave.
8
@Laura
LOL 6 weeks?! you lucky duck. I got ZERO, and that was just a couple of years ago. I used 4 weeks of my yearly vacation time, two weeks of elective time (where I didn't get to actually do an elective), and then extended my training an additional 4 weeks just to get 10 weeks at home. And the whole time I was pregnant I had to listen to my male coresidents complain that I was getting a vacation. Do you know what it's like to not have any vacation time off in training for a year so that you can save up 4 weeks? Trainees work weekends routinely, maybe you get a saturday/sunday off every 4 weeks, but otherwise you are there 7d/wk. It's inhumane.
4
@Lilly I had to use my vacation as well, and had several supervisors slip and call my maternity leave “vacation.” I did at one point after I came back say something about having had more fun vacations than having an 8 pound human yanked from my stomach while I watched all my inner organs get arranged on my abdominal wall on the outside, but hey, I was grouchy from pumping by then.
1
I have to agree that this is not a well researched article. There is no mention of female physicians carrying the load not only for their husbands and children but also elderly parents. In addition, the stress of having hospital/clinic administrations second guess every clinical decision with the sole purpose of increasing profits at the expense of patient's safety and well being pushes many physicians to the brink of depression, hopelessness and sometimes suicide. Physicians drug use, alcohol use, anxiety, depression and suicides are on the rise, specially among female physicians. The data are all in, is someone going to write an article about it?
60
Not celebrating the fact that the examples given are all of women who decided to take a major hit in lifetime earnings so they could be with their families. Yes, more women are in medicine, but they are (like the woman in the story) opting for lower paying specialties and working part time.
Don’t get me wrong, I did that personally, by working part-time most of my career, and have no regrets. But the fact is, my physician husband’s retirement accounts are a LOT bigger than mine. We both benefitted from me being more available to the family and since we are still together after 35 years, we both think that it was a good investment. That said, I might not feel the same way if I’d made that choice and then been the one to be financially disadvantaged as a result of us splitting up or him having some issue that impacted his earning capacity, such as disability or death.
As long as “flexibility” is framed as a “women's issue” and is attached to gendered lower wages over a lifetime, there may be increased happiness but not increased equity. I hope that someday men too will “choose flexibility” (and the associated lower pay) for their families more often, so their female partners might be able to be full time neurosurgeons (or cardiologists :-))
104
@Sharonne Hayes
PREACH. Are you THE Sharonne Hayes, btw? Folks, Dr. Hayes is cardiology legend.
6
Did I miss it or was childcare not mentioned.
It is gratifying to at last see more and more women in medicine. The young physicians just starting out and also beginning their families have an income curve as do most young professionals. Add in overwhelming debt. It will be awhile, if ever, before these women can afford nannies, and housekeepers.
Without help, who will be carting these kids around and preparing the nutritious meals they need. A solution of course is to work less hours at the expense of advancing a career in what is considered
the boys club of subspecialties.
11
Ugh. My husband is a physician. I have flash backs to the residency years when several of his fellow female residents went out on maternity leave, pushing back their own graduation dates and bringing about a rewriting of the night float schedule that required everyone else on the team to cover more overnights, thus leaving many childcare voids at home for *those* residents. That wasn't ideal for anyone involved. There is still much room for improvement.
12
@LM YES! You don't see male physicians finding themselves in those types of circumstances!
1
I think there’s a bit of self-selection involved in the stats that show more female doctors keep working after entering medicine versus those who go for professional degrees like MBAs or JDs
Those who go to medical school are committing to a minimum of 7 years of school and training versus only 2 or 3 years required of those who pursue those other 2 degrees. I found that many women in my MBA class at Columbia opted out of the work force after having kids, but they only invested 2 years of their lives in that program
Committing to 7 years of additional education likely attracts a person more committed to her career
37
And a bigger student debt to pay off!
6
I'm a female family physician who has worked part time since graduating residency, when I had my first child. I never planned it this way, it was just how my life played out. Part time employment for both men and women in medicine can work if employers provide this type of supportive environment. I am super blessed to be able to work and raise my children. I am so grateful and honored to be involved in patient care. At the end of the day, we all have one short life and we must choose the path that makes us feel whole. Thank goodness a career in medicine allows for some of this.
13
What a painful article.
I have two kids under 5 and am a general surgeon who is officially "on for myself" 24/7 unless I arrange for coverage. I am never off.
Operated til 5am saturday night. operated til midnight sunday night. operated til 1am last night.
Every time my phone dings I know it could be disaster.
I can never promise my kids I will be there for anything.
If you think I should have known I suppose you're right. But the 80 hour work week leaves residents unaware of the stress of being constantly on.
I am, unsurprisingly, burnt out and contemplating leaving medicine because there is SO little flexibility in surgical subspecialties. I would be laughed at if I tried to work 0.8 FTE. Who would protect the day off? What if my patient needed a take back that day?
Patients unfortunately have very little concept of the life I lead - routinely I have patients in clinic who have to wait because I am called to do an emergency case or seen an emergent consult, and they are upset about the wait time.
Although I used to take pride in not being a "shift worker" and being what I thought was a "real doctor" I realize that this kind of career is unsustainable and definitely not worth the pay.
I had a college student shadow me today. I encouraged her to go to PA school where the salary per hours worked is far better.
136
@surgeon
Medicine is tough in that it’s unrealistic to go back to train for another specialty if it turns out that you don’t like or want to continue in the specialty you that you chose. People occasionally do this, but if it came down to doing residency again versus quitting medicine and finding something else, I would choose the latter in a heartbeat.
So what to do in your position- it’s a tough place to be. Although I am in a specialty that is nothing like yours in terms of hours or demands, I will still strongly discourage my 2 kids from going to medical school, because I agree with you that it’s not worth it to become a doctor.
19
@Laidback as someone who quit medicine, went to law school, and does NOT work in medical malpractice law, I totally agree
13
this sounds horrible I'm so sorry. thank you for being in the trenches of medicine.
3
I think the big point missing in this article is that physicians are forced to keep working because of large amounts of student debt. Being a stay at home parent for a period of time, male or female, is not an option because student loan payments, which may be thousands of dollars a month, are still due if you are employed as a physician or if you stay at home. I am currently in my last year of training and pregnant, and while I would love to quit work for a period of time and stay at home, this is just not feasible because my husbands salary alone cannot cover both our living expenses and my student loan payments.
59
The fact that multiple studies have demonstrated women physicians have better clinical outcomes than men should also be a consideration.
23
So female doctors who have children work fewer hours often in less remunerative specialties - Why? Do male doctors who have children do this too?
27
Aside from the fact that this article seems to be based in mythology, why do we care more about the relatively few female physicians, compared with the hordes of women struggling in under-paid jobs, with zero flexibility, zero time off and zero job security? Congratulations for the privileged few. They manage to work and have kids.
12
@cgg
Writing about the struggles of women in medicine trying to juggle their weighty, i.e., life and death, work related responsibilities with the needs of their children in no way minimizes the struggles of working class women. If you think It's important to have women physicians (as I do), the job has to be structured to make it possible for them to have families.
41
I think the idea is to identify what is working for women in these fields more than other women, and perhaps try to bring some of these features to all working women.
4
fascinating such a family friendly profession has a suicide rate ten times that of the general population.
63
On a parallel topic, why do we pay twice as much per person for healthcare than the rest of the first world industrial countries.
11
Because we are a rich country. We pay all employees more.
1
Because you don't have a single payer system.
5
@James Dude, if you think our health care costs are high because of doctor pay, you have some more reading to do.
11
This article reinforces in an appealing way the gender stereotype that women are meant to be the primary caregivers of the children/ household managers. Also, how can the author, with a straight face, call medicine “family friendly” when the first 3 paragraphs describe one woman who literally gave up their dream specialty and another who halved their salary to care for children. Literally a disgrace NYT.
195
@Jessica
The mean internal medicine physician makes $276K, the mean oncologist makes $446K. Yes it's a big salary cut but it is still incredibly wealthy either way. The sacrifice is downgrading from a Bentley to a BMW, or a 7 bedroom home to a 5.
My women physician colleges choose "family-friendly" specialties out of their own volition, not out of the desire to conform to gender stereotypes. Most are quite happy with their decision.
6
@Jessica
Well said
1
@Jay
“Incredibly wealthy”
Bentley vs BMW
Lol. I’d like to think your comment is a joke but I actually believe it isn’t.
3
Part time mentality is indeed shifting more and more of medicine to "shift work". This means is is harder to maintain continuity of care, deep patient doctor relationships, and investment in how the system works. What is not at all clear is if this is good for patient care on the individual or systemic level. On a side note I know a number of mothers who won't themselves or let their kids see part time docs, because of access reliability issues. As others have pointed out, society is now getting many less hours of doctoring out of dollars spend educating them. Politics isn't part of this, it's just resource utilization. It's also true that you get better at something the more you do it. Think about that.
13
@Doc, and yet, the old school structure was several appointments left open for urgent issues. Now, you're lucky if a practice leaves one appointment open per day for a patient load of 500 patients/MD.
Access isn't working four days per week, or leaving at 3 pm. It's practices that no longer leave sufficient open slots for urgent issues. Instead, they direct patients to urgent care.
I've expereinced this with full time and part-time docs in different practices. Best approach: schedule getting sick two-six weeks in advance.
3
The biggest point that's missed here is that doctors are in high demand almost everywhere, so to a degree, they're able to negotiate flexible hours. Those of us in other high-wage jobs don't have the same leverage.
19
Precisely.
2
This sounds so good.
Here is the problem:
People get sick 24 hours a day, 7 days a week 365 days /year.
The majority of women physicians will not work full time, the majority will not take night call or weekend call. Now, I have real respect for that decision, as I believe family comes first.
My concern, when my generation of physicians retire in the nest 5-10yrs, who will be available to care for sick patients.
I have taken night and weekend call my entire career, as have all of my partners. Today, the women who work as part of our group either take no call, or only occasional call.
My question stands: who will take care of the patients.
This is not an issue that lends itself to political correctness, it is a real issue, and will become more acute and apparent in the years to come.
27
“Majority?!” Not true. Proud to work at a tertiary care level one trauma where I see many female faces at all hours of the day and night. Part time isn’t an option at all for many female physicians, despite what this article suggests. And those of us who do choose to cut back often do so temporarily, while our children are very young. Not to mention the fact that many female physicians do not choose to have children at all. Women provide excellent patient care to critically ill patients, as one recent study comparing outcomes of patients of female physicians to male physicians suggested. Time to retire if you can’t get on board with supporting physicians of all genders.
51
@Shp
In my group, women take the same night and weekend call as men. In my 23 years i have been with my group, it’s been the men who have opted out of night call. It’s not politically correct to call you out as wrong or making assumptions based on your limited experience, but I will. And I’m sure you saw the article in the NyT last year about the study showing better medical outcomes for patients who were cared for by women physicians compared to men. So I’m not too worried about the future if the future is female.
54
I suspect you will see more men of the younger generation making similar requests. Nobody (men and women) wants to take call all the time at the expense of their families.
Stop making this a “women choose not to do the work” issue. It’s also a “many men choose to work 100 hour work weeks issue.” Your practice could choose to make different choices about hospital coverage that would affect both your salary and your grueling lifestyle. The women in your practice were sensible and brave enough to draw boundaries and say “I will work on my terms,” and are probably better physicians for it.
22
While this may be too rosy a picture, as others have said, it’s important to remember that it’s relatively easy to provide excellent employee benefits when your service — health care, in this case — is priced five times the rate that it should.
4
@Justin Koenig The cost you are referring to is hospital cost, not physician.
12
@Justin Koenig
Yes, Karl hattensr is correct. The “five times” rate is for hospitals and other costs, not the physicians. And the article does paint too rosy a picture, not taking into account the 14 plus years doctors go through in medical school, residency, and fellowship making far less money than their counterparts in other professions. And when they finally start earning, they have to pay back their huge student loans which makes it hard for them to take breaks like the article suggests.
12
@Justin Koenig
Yes, Karl hattensr is correct. The “five times” rate is for hospitals and other costs, not the physicians. And the article does paint too rosy a picture, not taking into account the 14 plus years doctors go through in medical school, residency, and fellowship making far less money than their counterparts in other professions. And when they finally start earning, they have to pay back their huge student loans which makes it hard for them to take breaks like the article suggests.
1
This article is laughable, given the realities of working in today's health care field if one does not have an MD, as I would imagine 90% of the workers don't.
Outside of MD's, who may or may not have a schedule that allows for a schedule more convenient to them (and probably less convenient to their patients), or management, the medical field is made up of 3 basic groups;
Unskilled physical workers: housekeeping, transport, etc.. Who knows whether their schedule is flexible as they don't make enough to support a family anyway?
Medical Clerical Workers: Coders, insurance form clerks, etc. A group that helped make the schools where they took the courses required to snag a $14/hr job rich. Displaced and obsolescent workers grab at such jobs and either are paid to get almost worthless degrees or get suckered in to borrowing the money.
Skilled Techs: Nurses, x-ray and other techs. Have taken the brunt of "bending the cost curve" of medicine. Flexibility means flexibility for the management. And the increase of temps and per diem work. Or having to be on call as much as some doctors.
BTW, most of these jobs; maybe 75% are staffed by women.
7
Exactly!
1
Nurses are not “techs,” we are part of a hundred plus year old profession. Many of us have 4 year degrees and mire than a few of us have masters and doctorates in nursing.
As a nurse I will say that there is a massive disparity between what nurses have collectively negotiated for in terms of maternity leave (standard at my hospital is 4-5 months of sick leave and short term disability after each childbirth, which allows the nurse to take the time they need to bond with baby and maintain close to normal income) versus what I see the female residents and attendings getting (4-6 weeks of unpaid leave that if they are trainees just adds 4-6 weeks of extra training to their program). I see this partly as an unfortunate consequence of the fact that physicians have been slower to organize and agitate for better working conditions, whereas nurses have been doing this since the 70s.
But it still feels really inhumane to ask women who want to be successful on their careers AND parenthood to take a very short amount of unpaid leave in order to nurture their own babies. This isn’t even getting into the partners of those female physicians if they happen to be physicians as well. A new attending I know got zero paternity leave when his wife gave birth to twins earlier this year. He was forced to borrow against future vacation time and of course only took a few days because he really couldn’t afford more than that.
2
I know this isn't the point, but I can't get past the fact that we're celebrating Dr. Hebert's ability to continue to practice medicine despite starting a family ... and yet she was basically made to give up on oncology and work part-time in a different area of medicine, one that I'd be willing to wager has less prestige and a smaller salary..
37
@Sarah ...I think, actually, that is exactly the point.
9
@Sarah
She wasn't "made to give up on oncology."
The point of the article is that a benefit of being a doctor is that she had the choice to do so.
3
Female doctors are paid 67 percent of what men are, but much of the gap is because they work less. After considering their hours, their specialty and the years they’ve been doctors, the gap shrinks to 82 percent
I think you're over correcting here. The idea of correcting for chosen specialty is that women just have different interests that's why they go into pediatrics instead of surgery (for example). But the entire crux of this article is that women are specifically going in to lower paying specialties because the high paying ones are hostile to mothers.
What this quote is basically saying that when you account for the fact women aren't going into orthopedics it narrows the gap. Whereas the actual story is women aren't going in to orthopedics because the specialty is hostile to women.
38
@Matt - it seems you may be excluding the possibility that certain jobs in healthcare demand a certain schedule - something one might expect if one is the patient, btw - rather than being "hostile to women"?
4
Twenty years ago as a medical student in Oregon, I was actively encouraged by faculty to apply to their orthopedics residency. The chief resident at that time was also a woman. I chose internal medicine, but definitely did not feel any hostility based on gender.
1
The two of you are making opposite points.
@M. Of course some jobs are allowed to be more demanding but that doesn't make them family friendly, rather the opposite of the common understanding of the phrase.
@Sherrod Shiveley I was being a little glib so I apologise. But when my wife was applying to residencies (she had no interest in any surgical specialties) there were whispers about certain Ortho programs taking applicants to strip clubs (this was in 2016). But aside from that it was very common to hear of programs telling applicants they shouldn't apply if they planned to get pregnant. Which is actually illegal outside medicine.
But I'm afraid that my tone distracted from the point I was trying to make which was that the article is simultaneously trying to say that women are self selecting themselves into lower paying specialties and if you correct for women not choosing the high paying specialties there wage gap closes. By that logic we could close the gap entirely just by getting all women out of high paying areas of medicine, and then paying a few male pediatricians and obstetricians less. Which is true in some sense I guess. But is it equal pay if women are all still choosing not to enter the high paying fields? (Whatever the reason)
5
So many thoughts
As a female physician I should be happy we earn all of 82% of what male physicians make (when working hours is eliminated as a factor)?
I have chosen to work part time my entire career, yes it is a great benefit after 4 years of college, 4 of medical school, 3 of residency prior to the much needed 80 hour week "restriction, to be able to work part time. But part time meant I was paid for 32 hours, worked about 45 per week. Had I been full time I would be paid for about 40 hours and worked over 50.
I love what I do. It is an honor to practice medicine. I am well paid for it. But full time physician work is physically, emotionally and cognitively exhausting. Nobody should have to do it. I worked part time not only to be with my children more but for my own mental and physical health.
72
@Janet Freedman Totally agree. Let’s also not forget that full time work in my medical center is actually >50 hours per week and is so grueling that few physicians are actually even able to stay at full time within 5 years of practice. There is so much unpaid work and time that is spent. Many of us work during the day, do bedtime with our families and do additionally charting/paperwork/academic activities for several hours each evening.
5
@Janet Freedman - Had the same thought - part time here is full-time most anywhere else, especially when charting at home is taken into account.
1
At a school function decades after graduation I met a female breast surgeon who told me that she couldn’t stand how all of the female radiologists she knew worked part time and that when she needed a scan read it was not acceptable to hear that the radiologists did not work Tuesdays. Another female doctor, an internist, told me that her group had so many part-time women that it was like they had their own union. By the way, I have of course seen female doctors. It is also true that many of them essentially run boutique practices. Having kids is a huge time commitment. Of course, these part time arrangements are possible because employers, whether yourself or an organization, are willing to let doctors work steady shifts, or get certain days off. Hey, if you can make a good living working part-time, go for it. And most of their husbands do.
5
I work in a multi-hospital healthcare system. Physicians are definitely our VIPs. One reason physicians can control some of their working conditions is because they are so vital to their employers; they are rainmakers. Hospitals figure that a physician working part time, odd hours, or "only" 40 hours is better than none, or better than having her/him work at another system and taking revenue outside the system.
5
@wts
LOL, physicians are not VIPs. Well, maybe the highest producing physicians who perform highly compensated procedures, such as neurosurgeons or cardiologists are VIPS. But your average physician- be it hospitalist, pediatrician, neurologist, primary care- are just viewed as cogs in the money making machine that is corporate medicine. Doctors are just another resource to exploit for the hospital. That is why we are now called providers. We are so expendable, NPs and PAs will soon take over the majority of our care to cut costs. And I say good for them. I would never recommend my kids go to medical school. PA or nursing school is the way to go.
18
@SC
As a patient and a consumer of health care I am concerned for myself and all others when doctors reduce themselves to being labeled providers to patients who are considered billables. PA s and nurses are not the same as doctors. As a patient I resent being fobbed off to a PA when I have made an appointment with a Doctor.
3
@old lady cook
Well take that up with your politicians who let that happen.
1
It is just great that women are able to become physicians and then chose to work part time. I have great respect and admiration for their willingness to put family ahead of work.
There is just one problem: who is left to take care of the patients.
50% of physicians are women, and more than 50% chose to not work full time or take weekend or night call!
Patients are sick 24 hours a day, 365 days/year.
The lower salaries or incomes reflect hours worked not gender, pure and simple.
I would love to not take call, I hate working weekends, if I had that option, my salary would be cut by 40% ( there is a premium for those requirements)
This is not a sexist issue, or a gender issue.
This will quickly become a patient need issue. There are not enough doctors now to provide care, what happens in 5-10 yrs when my generation of physicians retires?
12
@Dan B
i agree. but most nurse practitioners and physician assistants do not work nights or weekends.
And the majority work with an md.
my question still stands
5
@Shp: all medical work is shift work, and there are nurses and other professionals working at far higher #s than doctors throughout the day.
There is no single person available 24 hours a day, 365 days per year and there never has been in history.
Staff members change shifts and hand information down to the new shift. That more staff members take fewer shifts in a given week is more of a scheduling issue for whoever puts together the schedules. But it doesn't change the nature of hospital care.
3
You say that, but none of the men in my medical school class got these little “talks.” Yet each of women did. We got told how selfish it would be if we would ever decide to work less than full time, or retire early to spend more time with our families, because we were robbing a young man out there of his spot in this class, who would dream of doing such a thing. I finished residency this century, too. So, I’m not alluding to some dark age.
2
The main example in the article described having to completely change specialties, resulting in a pay cut of 50%, in order to accommodate having children. How is that a win?
And saying that women in medicine “choose” not to go into cardiology or orthopedic surgery because those aren’t family-friendly is an incredibly naive way of describing the ongoing discrimination women face when considering specialization.
66
@Chris L. It was a change in earning potential, not an actual pay cut. If I chose not to go into investment banking, I didn't lose 50% of my pay.
1
@Chris L. Because working full time as an internist making more than 200k is still a win. Even with working 80%, she was probably making upper 100k. How is that not a win?
I am a medical student and I can tell you that it really is one of the biggest factors women consider when picking a specialty if they want to have kids in the future. Many women wait until after residency to have kids. This makes a lot of women physicians at least age 30 when they decide to have kids. In addition, many don't want to go through a rigorous residency only to end up working 60+ hours weeks as an attending while attempting to have children. It has definitely factored into my decision and the majority of the women classmates I have talked to that want to have kids. Correct me if I'm wrong, but I'm pretty sure residency match rates for women and men are very similar in each specialty. This would show they aren't being rejected more from male dominated specialties, they just aren't applying to them. If anything, women now have the upper hand when applying to a male dominated specialty. Similar to how men have the upper hand when applying to OB/GYN since it is so female dominated.
5
@Chris L.
No it isn't about discrimination towards women.
It is about having an idea of what the reality will be like of a field, and choosing whether or not to pursue it.
It's ridiculous that you try to make a discrimination case out of it.
2
The cold hard reality of medicine is that part time work is not available in most fields. The problem is that most practice overhead is fixed (or nearly so), yet fundamentally physicians are paid by the patient. Most practices have a profit margin of around 15%. If a physician chooses to work 80% of full time, that physician won't generate enough revenue to cover rent, payroll, and insurance, much less have enough money left over to take home a salary. It doesn't matter whether a physician owns her own practice, works for a group practice, or is employed by a hospital-- the fundamental math remains the same. To stay afloat financially, the physician has to see enough patients each week to cover overhead. As you can see from the graphs in the article, this is typically least 40 hours per week. Certain fields are the exception- things like emergency medicine and hospitalists- which are purely shift work. If you want to be a physician and work only part time, you have to pick your field carefully starting in medical school.
9
@Roger I am a medical student and I have yet to have a rotation in a specialty where I haven't met a physician that works part-time. Maybe it is more difficult in very sub-specialized physicians, but your statement(looking at it from only 3 years of experience in training) is just not accurate.
4
@Roger-Thank you. I am an old time pediatrician, took call every 3rd night while raising two children born when I was 32 and 37. One of the remaining private practices, we (my two partners and I) get paid after staff, mortgage, etc. When I take a week of vacation, I not only take a hit for not seeing patients (no income) but also have to pay overhead. Might be easy if volume was a priority, but some of us still believe in giving the patient (and mother) adequate time. Try doing that working part time. I have always loved what i do, I’m on my second and 3rd generation of patients, but that can’t be done with shift work.
3
@Hannah
I don't know what rotations you have done if you're constantly meeting doctors who work part-time. But probably not surgery, internal medicine, OB/GYN and many others.
2
Once again we set our sights so low. Why are we celebrating that in medicine women are able to work part-time? Part-time work becomes necessary financially and/or logistically for many women in order for them to be able to stay sane and fulfill their personal needs and family responsibilities. Not everyone wants to make that “choice.” The proportion of part-time work is one of the things that explains the pay gap among genders in medicine, disparities in promotions, and lack of women in leadership roles. Ironically it’s the non-clinical/leadership roles that physicians serve are better in terms of work-life balance.
18
"Female doctors are more likely than other professionals to have children and keep working."
There are many kinds of doctors across all disciplines and areas of study. How about female "physicians"?
6
Yep, women win again as they move strongly into a profession that used to be highly paid.
11
The caption on the last photo give the name Dr. Haynie Smart for the physician depicted in the photo. Her lab coat, however, identifies her as Dr. Aisha Haynie.
2
@Famdoc - It looks like her full name is Dr. Aisha Haynie Smart, but the lab coat just lists Dr. Aisha Haynie.
2
If I had a dollar for every time I heard a Doctor whine about only making 400k and working 80 hours for it, I could work part-time too.
5
@Kevin
I agree - we ALL should stop whining, and also exaggerating.
1
@Kevin you came here to say this?! Seriously?! And sure, lots of people can work 80hr/wk, but can they do what needs to be done to be a good physician 80hr/wk? I sincerely doubt it.
2
@Kevin
Most doctors aren’t making 400k. Certainly not the primary care doctors in this article.
I’m a pathologist and I make 200k. It’s still a lot of money but it’s half of what you quoted.
Oh yeah, and I have 350k in debt and made $60k for 5 years of residency and fellowship before finally making this 200k.
I don’t complain, because that’s ridiculous considering my privilege, but you’re just wrong. Sure, some doctors make 500k or even a million a year. But not primary care, and not most academic doctors.
15
A pediatrician takes care of the most valuable patients to society and should be paid so.
9
Very interesting no one thinks of the costs of women physicians to the public. Women should take up the profession and no, they should not be "discriminated" against. BUT, available slots in medical schools are finite in number. When those slots are taken by an individual who will work significantly less over their lifetime of medical practice, the availability of physicians to the public is reduced. This happens in spite of the fact that the public cost to train a physician is the same for both women and men. In a period with significant physician shortages, this must be considered. Society will have to recognize the additional costs to train many physicians who will work only part time - women or men.
8
Or we could raise the number of med school and residency slots to address the shortages.
40
@A physician
On this note, would also have to analyze and target who is most likely to go on mental health leave. Who is most likely to leave medicine for business. Who is most likely to leave medicine for research or consulting. Efficiency/ societal worth is complicated.
I sort of agree but to think like this, without being really thoughtful and all-encompassing, can become a real discriminatory issue.
13
@A physician
Or we could decide that as a society we value parental investment in children and make it financially feasible for parents, regardless of gender, to invest themselves in both their careers and their families. There are bountiful examples of this in many functioning health systems in developed and developing countries. We should be talking about the cost to society of lack of parental leave for every single profession, not the cost to society of a women physician.
36
As a psychiatrist working in private practice, I set my own hours. If I work, I get paid. If I don't work, I don't get paid.
I love the flexibility of my job and the ability to be with my family.
7
There are only a few hundred thousand female physicians in America, a tiny percentage of females overall. While overrepresented in certain specialties, the median income would be in the top percentage points. A more accurate labor article would detail the hours, income and life conditions of women doing work outsourced by said physicians, child care, household workers, support staff, etc.
7
@glorybe
I don't understand - this is an article specifically about medicine. A labor article about other workers would be different and interesting but not 'more accurate'.
7
@glorybe
It’s not a “labor article”. It’s an article about female doctors. Your comment makes absolutely no sense.
Supply and demand must play a role here, too. Some specialties are in big need of doctors, others not. I imagine someone in geriatrics will do really well for themselves in the coming years, for example.
3
@Larry Dickman
You'd imagine wrong. Geriatricians don't make much money.
3
A "stealth family-friendly profession"? After 4 years of medical school and over 200,000 in debt, 5 years of combined residency and fellowship 80+ hour work weeks, 9 years of deferred retirement savings, while simultaneously raising a child? So stealthy was the family friendliness that I didn't notice it.
When a career choice with these beginnings diverts women AWAY from most subspecialities and toward a minimum commitments of 10-15 work years simply to pay back what they owe to banks and universities is hardly a win. The author points out some of the ways these career choices are survivable for women. Surviving is not thriving.
260
@Alice THANK YOU FOR SAYING THIS! As a third year medical student, I cannot tell you how frustrating it was to read this article. It completely ignores the training required to become a physician. Furthermore it makes it seem that women have two purposes - to work or to have children. And it makes it seem that reason we seek balance is to have babies, which is a JOB in its own right.
31
@Alice 100% agree my wife was in one of those 'family friendly' residencies and she got 2 weeks maternity and every mother in her program had an underweight child because they were so stressed from working all the time (for next to no money). More than one spouse had to quit their job to do child rearing while the resident continued working.
But yeah they were also so deep in debt they can't stop working like lawyers or management consultants so success?
Aside: Google tells me that oncology is a 4 year residency with a prelim year. The doctor at the top of the article also was a chief (another year) and then had to do another residency to switch to IM (a 3 year program)? So she was 9 years out of medical school when she started as a hospitalist? This also doesn't sound like a success story. I shudder to even imagine what other professions are like if medicine is the family friendly option.
29
@Matt Tabulating my own experience thus far in medicine. Yes, for highlighted physician, it sounds like a circuitous route through oncology and internal medicine would be even longer! Thanks for pointing this out.
3
I've read that physicians spend, on average, about 27% of their working hours meeting with patients. In comparison, roughly half of every days is devoted to insurance issues and electronic health records -- and that those mountains of paperwork are a major source of burnout in the profession.
I wonder why we don't see a far greater push by physicians for a single-payer system.
25
@Scott Because physician reimbursement rates for Medicaid are so low that many doctors do not accept it as an insurance (1). The fear with single-payer is that all patient visits will be reimbursed at these rates. This is financially untenable for doctors, I will graduate med school with 400k of debt.
1. https://economics.stanford.edu/sites/g/files/sbiybj9386/f/alexander_schnell_2018.pdf
9
@Scott
What makes you think that a single-payer system will change that?!?
2
@Elizabeth B.
The solution is to provide free medical training. It's a win win. Then Docs don't need such high incomes. And if we have Medicare for all, docs won't have to pony up for health insurance.
Stop paying interest to banks for Medical school and stop paying dividends to investors for health insurance. Just stop. Instead: take care of our people.
9
One avenue of work life balance available to physicians (of either gender) is geographic arbitrage. The highest paying jobs in business and tech are generally in the highest cost of living areas. Some of what Google is paying to the engineering earning $200K is required based on the location of the job.
For physicians, the opposite is true. For some specialties, high cost of living areas pay less. This can be seen in ER salaries in the Denver area. ER is shift work, has no call, and allows for a lot of free time in daylight hours (offset by working weekends and nights).
For someone who likes to ski, this is perfect. You can work weekends (when the slopes are crowded) and ski Tuesday mornings. Great lifestyle, attracts a lot of outdoorsy people (who may self select into Emergency Medicine so they can travel without call demands). But ER salaries in Denver are below average.
Compare that to rural Iowa. Medicare, which also sets rates for private insurance, pays more for rural areas to attract physicians. So, the ability to have a large house, stay at home spouse, and even an ou pair is better for a rural doc.
Many will argue, as we have, that living in a city is important to them and they aren't willing to leave, despite high costs. Which is fine, but the family life for a busy surgeon working 60 hours in Iowa could be better than a less stressed, but lower paid ER physician in NYC (small house, nanny more expensive, spouse has to work).
3
@James
the problem with that theory, not enough physicians are available to cover the off hours, so you end up working more nights and weekends, or simply not being available for your patients
1
Gee! How about being a mom in U.S. Military service ,sent of to a foreign country for a 2 year tour of duty far away from home, husband and family , now that is really tough.
6
@Carlyle T.
Yes true. Also hard. Women are doing hard, good work - in many walks of life. No need to compete, what does that do?
6
@Carlyle T. And little kids are dying in Africa. What's your point? Somebody always has it worse.
This article seems to gloss over the fact that one of the doctors in the article reduced her lifetime earnings by HALF in choosing both reduced hours, but also a less well paying specialty. Given the high salaries of physicians, this is likely millions of dollars. Some of this is due to fewer hours, but much of this is because of the chasm in salary between internists and neurosurgeons. Maybe is it hard to feel too sorry for rich people, but this issue of "paying less for women's work" substantially contributes to the pay gap between men and women across all industries.
49
@A mom
As one of the few male pediatricians left, this is the trade off I've made (less money, part time work available-good job satisfaction)
Before that I was a teacher, same trade off.
Its worth it, but it is sort of a bummer that working with kids has meant I'll always get lower pay.
24
@A mom Precisely. Separate but equal. They are trying to do this to lawyers across the country, creating a 'super-paralegal'. 80% of paralegals are women. Most get sucked into the hours of being a paralegal, which is about the same as teacher pay, and never have time to go to law school.
2
@A mom
oh please, this is not paying less for women, this is paying less for less work.
Most of the women in my group work work 50-70% of my hours, that is why their total salary is less, not because they are female.
Enough of this already.
3
what about those of us in medicine who are women and work part time because it keeps us sane? I work in pediatrics at .8 and my fiance and I do not have kids. I use the time off to decompress, cook healthy food, exercise, and be creative (working on a writing project)--things that do not happen much on work days. I think these reasons are just as valid as having a child but the focus in the article is mostly on women as mothers. having a child is not the only reason to work part time - the elephant in the room is how toxic medical and many other jobs can be when life is unbalanced (such as training, when work hours are much more oppressive). I don't think anyone should work 40 hours at any job - work culture needs to change so people can spend time doing what they really enjoy most - which is usually being with family and friends and NOT being at work. (exception would be people who strongly or over-identify with their career).
96
@MD
your job is no more demanding than litigators, then construction workers, and they work full time.
I do not begrudge you making a life style choice, i actually envy you.
You make a choice, and it is great that you are allowed that freedom.
The problem is if all women make that choice, and they are 50% of the medical field, who will take care of sick patients.
3
@MD
well said. I wish I could shout this from the rooftops.
You are over-simplifying this issue. If you are a physician, you’re also well aware that “part-time” still means working over 40 hours a week due to charting and the general inefficiencies of clinical medicine. Most non-physicians likely don’t realize that key fact.
17
This is what life is about. Parents invariably have to find certain ways to manage the family in the interest of the children in order that children are taken care of properly and have a nice and affectionate growth. Otherwise money oriented people can never become good parents. Children will have all the money in the world but most importantly none of the parents will be available when the children need badly even to talk to them for few minutes a day.
7
My husband is an academic physician, and both my kids have chosen surgery as their specialty. They see that the academic lifestyle is worth the sacrifice in compensation as compared to a strictly clinical practice. As part-time clinicians, academic physicians are considered the leaders in their field, and have an acceptable work-life balance. You just need to survive the brutal residencies to get to be an attending physician. There is more to being a physician than strictly patient care: administration, teaching, research. When you have the variety in your schedule, it appears to lead to less burnout, and greater satisfaction.
11
@ctsrp Do you see academics as even more competitive, and therefore less family friendly, than clinical practice? We have a friend with a PhD from University of Chicago, who struggled to get a Post-Doc position at an Ivy league school. Ultimately ended up in a teaching position at a CUNY school, which puts one on a drastically different course (no consulting opportunities, harder to publish, less research funds available).
This an example of the tournament theory of wages.
In the business world, JP Morgan (for example) has thousands of vice presidents contending for the future CEO position (and the jobs along the route). The probability of actually winning the CEO slot is so small, so it by itself isn't a strong enough driver to get someone to work 80-hrs a week for 20 years. So, the CEO salary is raised so high that, on a probability adjusted basis, the expected value is now sufficient.
In academics, the CEO position is an Ivy professorship. But, unlike the contenders at JP Morgan, the academics who don't make the cut are paid a very low rate (VP at JPM will still earn $200k/yr even if they don't become CEO).
Based on our friends story, academics seems very competitive and brutal to those who don't make it to the very top.
5
@James
Academic medicine isn't like this. It's the opposite.
6
@James it’s the opposite! Clinical work is more grueling. Having a combined role where you do leadership/med Ed/research provides better flexibility and work life balance, but harder to land one of these roles if you are working part time to begin with
5
This is nothing new. As a law student, I remember the discussion comparing the ruthless billing hours of associates with the upcoming medical careers of the women in med school that wanted it all i.e. husband, children, personal time...
I graduated nearly 20 years ago.
6
@Lekeya We lawyers at least got paid more than minimum wage. The difference is that when women are done with their 7 years of associate-dom (getting well paid), they are dropped like hot rocks in favor of men. Doctors might have a chance. Strange huh?
This entire conversation stinks.
Time to reframe the conversation about some of the actual issues at hand:
-inflexible working conditions and unrealistic expectations for ALL physicians, making it difficult to have a family
-the fact that in the majority of ALL families (regardless of occupation), the vast majority of unpaid work, including household maintenance and child care, is performed by women
66
@Concerned
i agree with the last sentence.
as for working conditions, that will not change, pts are sick at odd hours, and someone has to care for them, regardless of work flexibility.
Currently and in the future there will not be enough physicians to create that flexibility
3
@Shp I disagree! There are many many things that employers could do to make the job less grueling and things we can do as a society to make things easier for women outside of the work place.
1
How stupid is this? A doctor can keep working? No kidding, they make sufficient money, the system kowtows to their needs with institutions at the ready to provide all manner of services.
Doctors work study hard, and pay off is there as they do and after they do. As a part of the giant disaster of American medicine, they're total cost to the public certainly assures that they will be able to work after kids, no kidding. And it's not about gender, it's about institutionalized advantage. Doctors, as "holders of the secret knowledge" like lawyers, have been prejudicially benefited by all societies for many centuries.
My view is that the prejudicial benefit should be extended and changed, to choose doctors for med school with an emphasis on service to humanity over ambition to make money. There are as many well qualified med school candidates in the ranks of the less aggressive and less driven, who would work as doctors for less cost, if they were preferred over the aggressive grade seeking rat racers who now fill a significant portion of the ranks. In the end you'd more of a doctor at the expense of less of a businessman which would be better suited to the single payer system destined to put insurers out of business in the next few years.
15
@CK
"My view is that the prejudicial benefit should be extended and changed, to choose doctors for med school with an emphasis on service to humanity over ambition to make money. There are as many well qualified med school candidates in the ranks of the less aggressive and less driven, who would work as doctors for less cost, if they were preferred over the aggressive grade seeking rat racers who now fill a significant portion of the ranks"
a) do you know about medical school admissions? Do you have suggestions on what can be changed based upon how it's done now? b) do you want a 'less driven' person to be YOUR doctor?
If you are, as a patient, at all participating in this imperfect medical system, how about take a step back, see if there is some room for respect, and make some actual suggestions for positive change.
5
@CK
If med students didn't graduate with crushing debt loads, they might be more likely to choose less lucrative but more needed practice areas like family medicine or geriatrics. But our system sets young doctors up to be desperate to make large salaries as soon as possible so that they can work off their debt and consider having families, etc. Other jobs open to smart young people do not demand the same up-front investment in education and a long delay in large compensation: people who choose medicine are already likely going against their own financial self interest by doing so.
6
@CK
Now there is an enlightened and well thought out generalization!
The majority of the physicians i work with did not chose this field for the money! All of us are smart enough if that were the case we would go into finance.
The work is hard, it is long hours, and demanding, and yes it pays well.
I am curious, how much would you pay someone to operate on your heart and perform a bypass operation.?
3
This article is total nonsense, I am especially amazed that the first MD cited is an internist; obviously one of the lucky escapees. Family practice (where I used to work) grinds you down and spits you out, and the IM doctors were always turfed the oldest and sickest.
The wonder of the internet?! Allows charting, labs, patient portal contact deep into the night. And one best not leave charts undone...what was the laterality of that onychomychosis? Don’t think that I really remember when you were one of my thirty patients three days ago.
You won’t see your own PCP, you’ll get pawned off to the Nurse Care Manager who is dealing with three providers 1800 patient panels, and the MA will remind you that it’s only one problem per 15 minute visit.
No. These are the reasons I left family practice and saying the profession is kindly and family friendly? Please!
68
Like employees in many other fields, employed female physicians endure the following
- scant maternity leave (often at best only FMLA plus short term disability — less if still training)
- no or little sick or personal time (health systems have scant back-up systems, and can’t pay for “resources that aren’t completely utilized”)
- long, physically demanding “at work” hours, often without meals or bathroom breaks (everyone’s needs come before yours)
- significant uncompensated additional administrative burdens (at home charting, unpaid lectures for students, unpaid continuing education requirements)
- no bonus pay for nights, weekends, holidays, or extra shifts
- no time ability to use “benefits” - eg) $ toward an additional degree because hours too inflexible and long to attend
- well-documented health risks: those who do heavy lifting, eg. surgery on obese patients!!! (partial or full disability from back, shoulder, other musculoskeletal injuries); those who are shift workers (increased rates of cancer, dm, heart disease, dementia), all physicians (depression, suicide, substance abuse) from burnout, lack of autonomy, secondary trauma, sleep debt
- no control over workload (patient volume&acuity) with penalties for “low productivity”
- restrictive convenants that prevent changing jobs
- educational debt
- deeply sexist behavior from patients, staff, bosses
- unequal pay! (compare between fields, control for years training/pay ... similar procedures in urology vs ob/gyn)
72
@Family Friendly Compared With Whom?
oh please, most of what you described affects both men and women!
The unequal pay is the result of unequal hours, nothing else and you know it.
@Shp
I’ll repeat what I said elsewhere: I know two doctors in the same department, hired at the same time, who do approximately the same amount of clinical work except one also spends significant time with residents, publishing interesting and clinically relevant papers, and speaking at national conferences. The latter makes 75% of the salary of the former. Oh, and SHE also requests coverage for childcare reasons lest often than HE does.
When rigorously controlling for time worked and many other factors, women still make less than men. I used to be somewhat skeptical myself, until I met more and more women working full time and making less than their male colleagues.
3
Hi Claire:
PAs also are licensed medical practitioners and have gone from a predominantly male dominated profession to 70% women over the last 30 years. Most of the programs are quite hard to enter and you must have very much the same background as you would for medical school. Why have women chosen the PA profession? Quality of life and ability to have families is often cited by many. Just wanted to point that out.
13
@Dave Mittman, PA, DFAAPA
all the above, they also do not work the schedule of a doctor, and most often do not bear the responsibility of the final decision on patient care.
They are invaluable addition in my world, but it is a different world.
10
@Dave Mittman, PA, DFAAPA If it is so great, then why is it so dominated by women? Paralegal/lawyers have the same dichotomy. Separate but equal for moms...
As a lawyer from a long line of doctors (both parents, all aunts and uncles, most cousins, etc) I couldn't agree with this article more. I have been struck over the years how Drs have little control over their time when they are in training (though it is improving -- in my experience, for instance, fellowship holiday schedules are set a few months in advance, etc which allows one to plan better) once they are done there are multiple ways they can continue to practice in their field while still fully using their skills and having some degree of schedule predictability. It has been my experience this is harder to find in the world of law or finance. Further, this point from the article is 100% consistent with my personal experience and critical to why medicine might be more "family friendly": "While a part-time lawyer makes disproportionately less than a full-time one, doctors who work reduced schedules tend to be paid more proportionally.
7
I am not sure about the accuracy of this article. The pay gap does not take into account that male doctors' panels are often smaller than female doctors' panels. So male doctors get paid more, for full time work, even though their panels are at 80%, while female doctors get paid 80% for 80% panels. I think the reality is that the wage gap is bigger than the 20% reported here.
8
Who says that we need to do things in a "family friendly" way? I am very happy that I was able to structure my career in such a way that I spend a lot of time at home, but it took a lot of effort to get to that point, and I do not make as much money as I would if I worked differently.
Some fields of medicine allow tremendous flexibility. Others allow none, because continuity of care really matters.
Take gender out of this.... it applies to all of us.
11
Though highly-paid and educated, medecine is an evidence and skill based job - doctors follow protocols that have pre-defined that they are trained to do. Like airline pilots or therapists, they can show up for a shift, execute and then hand off to another equally qualified person. Professions that are more open ended, variable over time, and involve more creativity and innovation are harder to split into shifts or between people.
5
@katweetie
you are wrong, handing of the care of a sick patient is what causes most errors, and failed treatments.
taking care of a patient who is critically ill is not like flying from Buffalo to Baltimore
6
@katweetie
I hope you are not a doctor. I do not do shift work. I form relationships and take care of people. You have a very limited idea of what we do.
5
@katweetie
Boy, oh, boy. You are so very, very, wrong.
I don't know anything about airline pilots' work, so I won't comment on that comparison, but you really have no idea what working in Medicine (or as a therapist of any sort) is like if you think health workers just follow pre-defined protocols.
Physicians/surgeons (and therapists, nurses, etc.) exist to solve the problems when the models/protocols/pathways of care fail (they sometimes do!).
When I am in the OR, you had better believe the situations I confront are variable over time and open-ended!
I know payers and hospital administration would love to reduce health care to algorithms and protocols and AI's, but one of the reasons we are around is because that approach just doesn't work.
A Fordist, assembly-line model of health care would be a human disaster. Protocols have their place, but they can't do the whole job.
1
A lot of so called scientists here countering statistics with anecdotes.
Overall, doctors generate money for their employers through piecework (pay by procedure) therefore the structure of medicine is the equivalent of a very high paying gig economy job and therefore allows for individuals to make work/life balance choices. (you make the money you want to make by working the hours you want to work, but overall, you don't have to work all the much to make lots of money)
If you made Uber pay at $1000/trip, I'm sure more Uber drivers would drive less and others would drive more.
3
I am a male geriatrician. My wife is a full time radiologist. Before kids, we both worked full schedules. With kids I cut back on my hours and stopped hospital work to drive carpool, cook dinner, and be the cross country/track parent for their school. My wife continues her full schedule. Our roles developed for many reasons: she is the primary bread winner, my specialty is more flexible, and we ignore gender roles assigned by society.
35
@MD
And a big thank you from this senior citizen for specializing in this very needed care ,as my own gerontologist MD states "It is not a major choice of medical care that young Dr's are prone to choose" such as the more popular pediatrician's internships" ..and much needed .
9
@MD you are an amazing human being.
1
I really don’t quite what to make of this. My husband is a research scientist at a major medical school so I am well aware of the long hours people in medicine work. But this summer my husband was also a patient receiving both radiation and chemotherapy. Both his doctors were women and mothers and I can unequivocally say we were grateful for their time and availability. I don’t know how they balance their work life. I do know that a patient wants and needs to have an ongoing relationship with a doctor who knows them and is aware of the progress of the disease. I have no idea how this is reconciled with a parent’s needs. This article is all about a mother’s needs but says nothing about what this means for their patients.
24
@ann
As a patient, I'm giving up a lot -- my relationship with my personal doctor.
One Sunday evening, two years ago, I was sitting on a hospital gurney and a resident had just diagnosed appendicitis. I had to make a quick decision: surgery or antibiotic treatment?
I like my doctor. He knows how I feel about things. His office hours were Monday through Saturday, 9am to 7pm. After that, I get a covering doctor who doesn't know me and varies greatly in competence.
I did antibiotics. Afterwards, I asked my doctor whether there was any way I could reach him in an emergency after hours. He said no.
I said, "That means, after 7pm, I no longer have a personal doctor."
In the NEJM, a doctor wrote about hospitalists: When a person has to make the most important decision in his life, he will be alone, dealing with strangers.
I recognize the inconvenience of having a doctor answering his pager during, say, a family dinner, or the theater. It better be an emergency. However, children of doctors seem to be proud that their parent was always getting called away. They were doing something important.
There's no way to gloss over it. The doctor-patient relationship was important. It's gone. That's bad.
11
@Norman, as a nurse, I agree with you. I worked night shift for several years on my OB unit. At that time, all the doctors were in private practice. It meant that when one of them got a call in the middle of the night about one of their patients, when the nurse gave report to him or her, more often than not, the doctor knew the details of the patient history and anticipated many of their needs quickly. It was quite often better for that patient and their care. With hospitalists, the physicians as well as the nurses are usually seeing the same charts and patients for the first time.
That said, you could see it also took a toll on the doctors’ health and family time as well. Finding balance can be difficult.
3
So you’re basically saying that you think doctors need to be available to you 24/7 because it would be reassuring to you. That doesn’t seem fair to the doctor, and in my opinion it’s an unhealthy attitude that anybody in the world should ever be available 24/7. Doctors deserve to be humans and have families and lives and to stay healthy. Who else in your life do you expect this kind of availability from? Maybe a spouse? Well that spouse has only you and possibly children to be so obligated to. A doctor may have hundreds of patients. She should be so obligated to every single one of them?
You were provided with good medical advice in the hospital. Yes, we do need to change the paradigm that we must have our own personal physician in order to make medical decisions. But that’s not a bad thing.
19
I'm so glad to hear that if I want work-life balance, I can quit my job as an oncologist and take up a different specialty! What a relief. I'm sure my grandmother (MD 1941) and mother (MD 1973) would be so proud.
37
The reason medicine works in the proposed setting is because of the nature of the profession. Physicians typically see their patients in 15-30 minute sessions and importantly the patient's file can be passed onto to someone else if needed. There is no need for continuity of care even in the short term. Other professions for example like teaching or doing scientific research require long term commitment to be effective and are not particularly amenable to banking hours. Medicine by the way selects for people who are very good students , but I would not say that they are the brightest or the most ambitious out there.
14
@Irene Cantu
"There is no need for continuity of care even in the short term."
This is completely false and shows me that you don't understand what physicians do.
Yes, it can be flexible and the salary is nice, but often the stress and demands don't make it worth it. But because of student loans and expenses we are now stuck in a profession. I would rather be home on nights, weekends and holidays, but I have bills and loans to pay. If I could go back in time and pick a different career, I might.
7
@Obdoc I calculated the NPV of a Chicago cop's wages at age 20 and a physician (ER in this case). It turns out that 6 years of no pay (finish college and med school) coupled with debt, followed by 4 years at $50K/yr (residency) and finally $300K at age 30 (for this example) has the same NPV as a cop earning $60K/yr at age 21, and growing their salary to $100k/yr over 5 years. Cop has no education debt, doesn't need to save for retirement out of their take home pay, and has a 10-year lead of earnings.
NPV of a cop and a doctor lifetime wages, at age 20, are the same. The only way a doctor, in this example, comes out ahead is working to age 55 or older.
10
@James Wow, gotta work to 55. Life it tough. What about making more than 300k? A cop is bound by contract with a maximum salary that is unlikely to go much higher (especially one without a college degree). A physician has more options to make more money.
The OPTION value of a physician is much, much higher than a cop.
And who says cops are underpaid for what they do? That's another cushy profession. Try being a regular college educated working stiff with no pension.
1
The problem will holding up medicine as a paragon for work-life balance is that the field selects some of the brightest,most ambitious students to begin with. Anyone who can complete that daunting process would excel in any field.
11
@Randeep Chauhan Exactly. This is my response to the claim that "doctors are paid too much." They aren't, they earn roughly the same as an Investment Banker, management consultant, and other competitive fields. Plus they have a shorter earning life (most start earning their professional salary at age 30, a Bain Consultant has been earning $100k/yr since age 25).
Physician wages are high because the field needs to compete for talent with all of the other high paying fields.
11
The more important point is: why are females choosing jobs with fewer hours? Is it because females ARE STILL EXPECTED TO BE THE PRIMARY CARE GIVER? This does nothing to alleviate gender bias in our practice as humans.
46
@Kassidy
In my experience, which obviously is anecdotal, as a female physician, women choose jobs with fewer hours because we want to. Because we want to be the primary care giver. The women I know who do not want this have husbands who work fewer hours, or stay at home entirely.
Feminism gave us the right to choose. That includes the right to choose to be primary caregiver, and in my experience, again with the caveat of anecdote, this is more commonly desired by women. Whether this is cultural or biological is up for debate, but it's still our choice given the options.
Of course, in my family I chose a specialty with fewer hours AND my husband works significantly less than me and does more day-to-day caregiving. Most modern educated couples make these decisions consciously and not out of a sense of gendered obligation.
6
Man doctor here, married to a woman doctor. A few comments:
1. Medicine is an exceedingly nasty job. Being an employee gives some flexibility, yes, but it comes at the cost of control and humiliation from corporate masters, many of them with the brains of a turnip and all the humanity of Donald Trump. Plus the workload is simply impossible.
2. A little chunk of truth (Why not, you don't know who I really am). What is woman's work? Jobs that men refuse to do. The feminization of medicine is happening because it is an exceedingly nasty job (see above).
3. The rate of women doctors killing themselves is much, much higher that the rate among other women because the job is, uh, exceedingly nasty.
4. Women enter medical school with psychological health comparable to that of age-matched women. Sooner after entering medical school their psychological health deteriorates (on average).
5. The reason, the only reason, that part time is possible was not touched on by this superficial article. It's that there is a huge shortage of doctors. If the demand-supply dynamic were different, the women doctors would be working 12 hours Monday through Friday, plus a lot of weekends.
6. My daughter, smart girl, smart enough to be a doctor, has seen the ringer that medicine has put my wife through. She has crossed medicine off the list.
275
Vbering,
I’m been having a health problem and I get the feeling my doctor/surgeon doesn’t hear me when I speak. He gives off a vibe like he wishes he was working in a shoe store.
You don’t keep a satellite office in Philly, do you? I think I might have been your 9:20 am appointment last Monday.
I’m trying to be a ‘good’ patient here. Could you at least fake a little concern? You’re tier three on my insurance. That means 140 dollars a pop for an appointment plus the $6,000 up front before the surgery.
There’s a little suffering going on here. I apologize if that messes up your day. What did you think medicine would be like?
20
@itsmildeyes
No, I'm not in Philly.
As regards how I thought medicine would go, I never envisioned becoming a businessman's serf.
The model of doctors as employees has been a disaster. Remember that the idea was increased efficiency and lower costs. Those things have not happened. And the morale of the profession, at least in my field of family medicine, has been gutted.
If you are a professional who values autonomy and personal responsibility and you lose control and ownership, then you lose your will.
Look at the National Health Service is the UK. Doctors are slaves and the NHS is in free fall, patients can't get in to be seen, the doctor shortage is horrific.
I'm sorry to hear about your health problems and sincerely wish you the best of luck.
19
@vbering Medicine is very rewarding for my family. And my kids are in surgery, which can be pretty gross, but they get a charge out of it. My husband is a psychiatrist, and probably deals with more nasty family situations, but thrives in the profession. THe key is that they do other academic things, and not just churning out patients.
3
And yet Dr. Hebert's husband still didn't change his hours once, despite being an equal parent of their three children.
When I read this article, I am not impressed by the "family-friendliness" of medicine, ESPECIALLY because she herself said her lifetime earnings were probably "cut in half" by the choices she had to make.
I urge us to find a better definition for "family-friendly," and to expect BOTH parents to make sacrifices for the children they choose to have.
This article misses the point and tries to gloss over greater circumstances of inequality in family life.
96
@Fran
Maybe she wanted to and he didn't, and they were both happy with that arrangement?
2
If you want to know why women earn less than men for the "same" job, compare her potential earnings as oncologist to her present earnings as a family practitioner.
8
@O'Brien
Dr. Hebert was an oncology fellow, so she's a board-certified internist who probably went on to do a geriatrics fellowship, and likely took, and passed,and maintains her board-certification in both specialties.
3
@Louise
What?!? It says she changed her mind as chief resident. Where does it say that she was an oncology fellow??
2
And, coming soon: The specialties dominated by women physicians will be the ones devalued in society and compensation by substution through nurse practitioners, physician's assistants, and so on.
43
@CKM
That is already happening. As a sub specialist, somehow my 4 years of Med school, 4 years of residency and 2 years of fellowship can be learned online with a few certificates and 500 hrs of clinical time. Make no mistake, that derm (viewed as pimple poppers and Botox givers), peds (vaccines and ouchies!), primary care (sniffles) and psych (Prozac!) are viewed as “easy” and low hanging fruit by non physicians providers. These are female dominated fields where physicians are being replaced by non physicians to Offer “the same services.” Yeah right. Welcome to the realest divide between the rich and the poor - who actually has access to an MD.
16
@VanessaMD Don't worry about the divide between the rich and poor...NPs are lobbying for the ability to practice independently and for pay parity. Their slogan has been "heart of a nurse, brain of a doctor."
Soon, NPs will be richer than a doctor, since the NP didn't have to complete 4 years of residency and 4 years of medical school, but will be paid the same as those who did.
4
@James
Yes...until they start to bear the brunt of their independence via malpractice lawsuits.
1
New York Times, you left one of the most family-family specialties completely out of your article and completely out of your graphic!
I chose to go into pathology both because I find it fulfilling and because it allowed me even as a resident to have the vast majority of weekends off and to be home for dinner almost every night. It's still a hard job, with occasionally long hours, and it isn't shift work. But I started medical school after having three children, so I knew from the outset that whatever I chose would need to allow me work/life balance.
It isn't easy, choosing to go into significant debt, choosing to spend long hours away from my family. And to some degree there is sacrifice involved in choosing the less-intensive specialties. Like the woman profiled at the beginning of the article who wanted to be in oncology but is satisfied with her career in geriatrics, I wanted to be in a pediatric subspecialty but am satisfied with my career in pathology.
Anyway, please don't forget pathology!
18
@ES, Interestingly, when my father had cancer, I had his pathology slides sent for a second opinion by a different facility. I got to know the pathologist by phone when he reviewed my dad’s original diagnosis. As it turned out, he was the physician who took the most time with me reviewing my dad’s diagnosis and was more supportive and kind than my dad’s oncologist.
His empathy and kindness were a bright spot in that difficult situation. I never met him in person, but will be forever grateful.
8
They left out pathology because it didn’t occur to them to include it in an article focused on women MDs since it’s not a “caring” or “people” specialty. I’m very tired.
7
When I was young, I never saw my father was rarely home because patients need their surgeons. Now that I am a surgeon, I don't get that excuse. My husband, a lawyer, is rarely home, because his clients need him.
27
Cry me river. Most people would jump at the chance to have the career options that female doctotrs have.
15
They work hard for their options. 4 years heavy- STEM undergrad and then 4 years med school MINIMUM, plus residency and fellowships. That much work affords you many options.
7
@DRR so then let "most people" do the work it takes to become a physician. I can tell you "most people" don't want to do what it takes. It's enormously difficult, the hardest thing I've ever done.
7
@DRR
No one is crying in this article.
3
I honestly thought this was satire when I read the headline. I had two children going into residency. I am an OBGYN. Family life has been a constant struggle. Would be medical students cling to every piece of data that suggests that medicine has evolved into something that is supportive of a work life balance. Nothing could be further from the truth. Contrast this to the myriad articles on physician burnout and suicide. That’s where you will find your truth. Opportunity for “flexibility” is inversely proportional to student loan debt burden.
Now, back to charting for 2 hours before my clinic/OR day starts. (Haven’t seen my kids today but did manage to text one about toast.)
202
@Meg McSorley
That's at least partly due to the specialty you chose
1
@Meg McSorley I had an OB/GYN practice that I managed, and we had some MDs working part time while their kids were young. Their choice. They still did some partial call, but it was all shift work, with predictable hours.
This was as an attending though, all bets are off during residency. That is meat grinder for certain specialities.
2
@Meg McSorley I had an OB/GYN practice that I managed, and we had some MDs working part time while their kids were young. Their choice. They still did some partial call, but it was all shift work, with predictable hours.
This was as an attending though, all bets are off during residency. That is meat grinder for certain specialties.
Now let's talk about that "charting". Spending a few hours learning how to use templates and other time savers, instead of complaining about the EHR may lessen that burden.
My experience with having a woman doctor with children has been a double edge sword. They are among the best doctors I have had but there have been numerous times when I could not see my doctor, have the continuity of care I desired, because of child care issues, children being sick, school issues, etc. It seems that these women are still the only parent that deals with family emergencies and their patients suffer.
15
@Pat So women shouldn't be doctors? Or can't do both? What's the solution? this is why many are in group practices so that another doc can cover, I doubt the patients are "suffering." Perhaps patients should change expectations of having their dr. available 24/7, we have lives too.
13
@Pat I think continuity of care is grossly overrated. I am happy to see anyone in an academic clinic who has time, so I don't wait weeks for an appointment.
To think that a doctor who carries a large load of primary care patients "knows" you is slightly suspect, however, the only true benefit is they do know how to read their own notes.
I see an oncologist at an academic clinic, and when he is not available, I see his colleagues. Even with a life threatening situation, most specialist are competent in an academic setting to keep the treatments moving along. Most evidence-based medicine is effective when you have others looking at your case too.
7
Times reporter Claire Cain Miller claims that large group practices or hospitals, for which 70% of doctors under 40 now work, "..are more profitable because they can share resources, like clinic space or physician assistants, and more easily negotiate with health insurance plans."
"More profitable" for whom? Not for doctors, who are losing the power to negotiate rates, and are increasingly at the mercy of massive hospital groups in which they are just cogs in the machine.
Doctors have become replaceable parts and at the mercy of big medicine, just as the American people are.
Doctors need advocates for them, as do patients. That's what national healthcare would do. But The Upshot refuses to examine, let alone advocate for, national health care, though most Americans support it.
Where's the balance in this column, New York Times?
50
@Sean
Thank you for this comment. The public is being lied to in the name of “access to care,” and the only ones profiting are the MBAs. Doctors are suiciding at the rate of 1 per day and replaced by a non physician provider who “does the same for less,” and yet look at our worsening health outcomes and maternal mortality rates and rising expense of care. The only winners in this game of life or death are the people who have never taken care of a patient before.
12
@Sean
so true.
the majority of employed physicians have non compete clauses, that effectively prevent their patients from seeing them, if the physician chooses to change who he or she works for.
In addition to impacting patients, it makes physicians indentured servants.
The employers believe they " own " the patients.
6
@VanessaMD absolute truth
2
I am a recently retired male physician who trained and worked with many women physicians over the course of my career. They made a variety of choices, and, like the men, were of varying excellence.
Medicine is almost unique in its compatibility with part-time or limited schedules. My daughter is a Los Angeles police officer and has always had to work full time, including night and weekend shifts, with the only accommodation being not working patrol while pregnant (though no paid maternity leave). She likes her work, and serving others, and is paid well, but the risk and stress and the trauma she observes are costs.
5
On a darker note, the changes mark the proletarianisation of medicine. As more and more doctors, mostly female, work as staff in walk-in clinics, as hospitalists, and in area where emergency call-outs and extended hours are unlikely (oncologists, gerontologists, etc.) they are, well "staff" -- employees of some corporate entity. Some walk-ins are physician co-ops, partnerships of the doctors working in them, and thus a degree of independence is maintained. Otherwise, the trends mark de-professionalization, limited autonomy and lower remuneration -- all the price of predictable work allowing the work-family balance many women want. Also, the piece overemphasises the predictability of the work (it's not true that long hours and call outs are avoided) and paints the developments as win-win, which they definitely are not. More women in medicine has been part and parcel of its de-professionalization, loss of status, and decline in earnings. Patients in this new world must be mindful of "for whom do the doctors work?" -- as corporate employees, they are no longer in a nice clean doctor - patient relationship. For all intents and purposes, they are no longer autonomous professionals.
57
@Cephalus
Easily the most intelligent comment on this article.
1
So as the newest “proletarians,” learn from those of us who have been peons in this system for a much longer time and ORGANIZE.
2
@Cephalus In med school in the early 70's, as 1 of 6 women in my class, I predicted that as medicine became more female, doctors would become less respected. What I had in mind was sexism, which I experienced in both blatant and subtle forms, not deprofessionalization, which I did not see coming then. I agree with you about the proletarianisation of medicine and see it happening in other professions as well.
1
Many of my female physician friends have practical reasons to work: student loans, ability to afford childcare by making a low to mid level 6 figure income and having the professional drive. Many of my friends do not have large families and their spouses are also in the medical / dental field making an equal amount of money.
7
Not to be a spoilsport but these family friendly policies (and not just in health care employment) do not come without cost: the additional work that their colleagues and other workers must often shoulder and the administrative and logistical burden of filling more positions and providing sufficient quality care. In many ways, an updated version of the old nuclear family model where 1 of the 2 parents works out of the home and the other cares for children and takes care of the thousand other responsibilities we all have, would be better for all concerned. Nothing is perfect, but an approach that provides children with quantity time (as well as quality time) and doesn’t drive all of us crazy and angered and frustrated by the non-work responsibilities parents need to accomplish after working our cumulative 80 to 120 hours a week, would be better.
6
@ehillesum
This sounds like it offers opportunities for more mid-level admin positions if what you posit is true.
Not everything will work for everyone, including having a two-person adult household, given the divorce rate; or a married mother with professional goals.
The question is always: who should bear the 'costs' of families determining for themselves how to balance family and professional needs.
In a pluralistic society, especially one that increasingly limits access to birth control -- I'd say the government does.
2
My daughter is an ER physician with 2 Children.
She has, compared my job, an amazing flexible schedule, trading off with other physicians.
That approach would not work in my job - there is no pool of other persons to substitute.
She also can, earning $ 300 000 + per year, afford child care I never could. And cleaning crews, that come and clean the house, top to bottom, when needed.
At less then one third, my family could never afford this.
9
@Carla Did you complete 13-15 extra years of schooling after you graduated from high school--effectively assuming a huge amount of debt, and putting off earning anything for many years? If you did, then I can understand why you seem to be upset. If not, try to understand the sacrifices in time and earnings that she made.
13
@Saralucia the expected lifetimes earnings of anyone in the medical profession dwarf those of "regular folks". Even if you discount the extra years of schooling and training (which is paid, if not paid extremely well).
When I meet a poor doctor in the US for the first time, I'll be more considerate of your argument.
4
@OneView
The problem with your argument is that you have your own definitions of "regular folks" and "poor".
1
One of the few occupations with salaries that permit quality child care, and that allow flexible schedules at all, unlike many professions like law or corporate management. Also most jobs don't permit job sharing, which is essentially what medical groups practices are.
14
This article feels a little clueless. Flexibility and fewer number of hours/week does not paint the whole picture.
As an ER doctor, I work less hours than some other professions, but I consistently work overnights, weekends, and holidays (and will continue to do so for the rest of my career). Missing dinners, birthdays, holidays, and family time all together does not exactly make it "family friendly."
87
@Liberated almost feels like the people who write articles about medicine have no ideas idea what’s it’s like to be a doctor. Hang in there :)
That is a really sweet photo of Dr Herbert with her children.
Now, here is another image...
I’m a female attending surgeon, just worked 36 hrs straight doing cases. I’m lying on my couch in my scrubs, too tired/sore from standing to take a shower and I haven’t had time to do laundry in days. Family friendly? I don’t think so. I wouldn’t even call medicine physician friendly.
This article totally misses the point. There are many different women who chose certain medical fields because they are talented in that field. Would I love to have time for a family? Of course! Would I give all that up to be a geriatrician if that is not what drives me and what I’m skilled at. Never!
237
@Exhausted Female Surgeon
It must be noted that for doctors in general, and surgeons, in particular, a major determinant of expertise is experience and hours of work in the barrel. There are ample data demonstrating this. A surgeon who does not work long hours simply will not be as good as one who does. No ifs, ands, or buts.
14
I absolutely agree and I love my job despite these hours. If it were not for all the hours and dedication put in, I would not have the skills I have today. I do believe that this article certainly does not paint a fair picture of women in medicine and also is purporting that women sacrifice their passion in order to have a family and be a physician.
There are many hospital systems that provide great, inexpensive and flexible child care. Many provide affordable housing options near the hospital (since many of us are still well in debt). I don’t expect my life to be easy as a female surgeon, but there are many things that can be done to help easy the burden slightly without sacrificing skillls/ training.
26
@Exhausted Female Surgeon
Then you have made your choice. If you wanted more free time, you should have chosen another specialty than surgery. You have to sacrifice something.
8
I'm a doctor and generally agree that medicine is pretty good about flexibility with schedules but, as the article concedes, it comes with sacrifices including overall compensation as well as the ability to obtain prestige in academic medicine settings (obviously there are exceptions). The ultimate reason for this flexibility is that doctors are in short supply as there is essentially a cap on the number of doctors in this country predicated on the number of medical school slots as well as residency positions. This gives the provider far more bargaining power than in other professions where the supply of labor is relatively higher and more responsive to demand, and therefore there is more competition among workers. As a result, I think it would be hard for other professions to duplicate this flexibility unless there is specific regulation that allowed for and protected the earning potential of part time workers. Disentangling health insurance from employment would also have a huge impact as employer based coverage is a huge disincentive for employers to hire people at 70-80% if they still are seeking full benefits).
16
I feel frustrated by comments that the fact women chose different types of jobs in medicine is still problematic.
Do we really believe there should be no tradeoffs when you have kids? My husband and I both made career tradeoffs when we had kids so we could be more available. It's ridiculous to pretend that kids don't or shouldn't affect one's career choices. There's a wide array of jobs out there with varying degrees of difficulty, training and experience required, time commitments, and pay. Somehow we don't mind when people make tradeoffs on any of those things in accordance with their desires or life choices - unless those people are mothers.
Is it unfair that the tradeoff burden disproportionately affects women? Sure. Is the article overly rosy about what things look like for all doctors who are mothers? Yes. But I don't think we need to be worrying about the fate of highly educated, well paid professionals who are making tradeoffs that they according to the article are happy with.
27
@Sarah
I absolutely agree. I am a female physician who made career decisions largely because I wanted to have time for my family. I would have been happy in many other specialties, but I chose one that I would both be happy in and was more family-friendly. Yes, I occasionally have moments where I wonder what my career could have been like had I chosen another specialty, but I consider that part of the deal I made when I chose to both go into medicine and to be a mother.
I still work more than most other mothers I know. The article is definitely misrepresenting the "family friendliness" of even the less time-consuming specialties.
23
MD and mother of two here. I kept working because both my cardiologist husband and I had huge medical school debt, so stopping work in early thirties, even for a few years, would not have been smart. I went part-time, and doubtless am earning less than I could be now because of it. However, I've never looked back. It was great having a few days a week to go to the playground while they were young. It's really such a short time in their lives. But when my ex decided he wanted a divorce, I was doubly glad I hadn't quit!
I'm sure educational debt in late twenties and early thirties informs a lot of parents' decisions about work.
51
Being a female critical care physician and having just come off a 4 night stretch, I’m probably grumpy and I beg to differ. Medicine is generally not a female friendly career path. I have seen my husband for all of 30 min per day for the past few days and since I don’t have control of when my shifts are, we find it difficult to even start a family (you have to actually be in the same place at the same time during a specific few days of the month to make a child). Also, if you work in an academic hospital like me, you are expected to do other tasks for your department- med student lectures, teaching residents/fellows, research- that eats up a ton of that extra time you could be spending w family. And many of us don’t have the option to leave the cities in which we are rooted because we need to be near our parents for eventual child care (who can afford a nanny after finishing training at 33 with no savings and over $200K in debt?)! Plus good luck getting someone to hire you part time as a physician in New York. Anyways, I understand the writers point, but this idea does not hold true for most of us female physicians.
148
Having reached my 78th year I have had dozens of doctors, most of them men, some of them women.
I choose my doctors based on their training and experience, not their gender or race.
I entirely understand that some doctors, especially women, may need or choose to work part-time. However, if I learn a prospective doctor works part-time I immediately cross him/her off my list. This is because I want a doc who devotes full time to his/her practice and if an issue arises at home will not shunt me off to a substitute who is not familiar with my case and may not have the same qualifications and experience as my regular doc.
This approach has allowed me to receive very good medical care and I see no reason to settle for less. I wouldn’t take my car to a part-time mechanic, so I certainly wouldn’t want to entrust my life and health to a part-time doctor, much less the almost-doctors (e.g. physician assistants) who seem to be popping up everywhere.
13
@Mon Ray
While it is great that you get good medical care from your physicians, you cannot know that it is because they work full time. Correlation does not equal causation. Working full time, as I do, has its own perils including making errors because of fatigue. All other things being equal, a well rested and happy part time doctor can deliver excellent care.
21
@Mon Ray Shame on you for having reached an advanced age without learning or trying anything new. Have you heard of group practices? Did you know nurse practitioners and physician assistants are likely to give you BETTER care for most complaints? My daughter's part-time pediatrician was a talented diagnostician, and the other medical professionals in her group practice were excellent as well.
2
@Mon Ray, those "almost-doctors," physician assistants or nurse-practitioners are becoming more prevalent as the medical industry becomes more consolidated, like all industries. The CEO or executive administrators of a hospital have a handsome compensation package--especially if majority shareholder--vs the employed medical practitioners. Also, if the self-employed physician decides to retire, s/he has a practice to sell. Employees don't. Living in KS, a state that is primarily rural with a population that skews more elderly, medical practices can't be so choosy as larger population areas, where it may be harder to find practitioners who accept patients on Medicare--or even worse--Medicaid. Better get used to it. You and my mother are in the same "silent" generation era and the majority in future generations won't have it as good as yours'.
5
A promising future oncologist switches to geriatric medicine to have a family life. This isn’t a great compromise. This is squandering the human potential of a woman. Why you can’t be an involved parent and an oncologist is not a matter of lack of women doctors’ individual efforts, it’s a failure of the system and the men who made it.
94
@Farina
Serving geriatric patients isn't "squandering" anything.
20
@Farina
Well this is offensive. Why is being a geriatrician squandering anything? The science side of medicine is pretty straightforward - it is increasingly algorithmic - and oncology is particularly true in that regard.
11
@Farina
Certain jobs and specialties are very demanding. It is impossible to "be there" for your patient if you are not. Other specialties allow for this. Would you want your oncologist to be "part time" when you had a major issue or question come up?
3
Why on Earth are we celebrating raising kids and 80 hour work weeks? This should be a repudiation of the system, not a ringing endorsement. As somebody who was once accepted into medical school I chose against it for this very reason.
25
I graduated from med school in 1978- yes I am old. But I had no debt. I have 2 grown children and have been married 37 years. I always worked full time and took far less vacation than my partners in medical oncology. I worked because I loved it and felt an enormous obligation to my patients. My husband traveled constantly for his work so it was extra hard, but we paid for a fabulous retired teacher to be our Nanny and I had a family down the street with 4 daughters and a generous heart who made sure I had a sitter on the weekends on call when I needed them there at 7 AM. We had dinner together every night at the table- though I was usually on the phone. I was cookie-mom for the Girl Scouts one year, a soccer coach another year and room mother twice.
It can be done but it is hard work. I wouldn't change a thing I did. There are thousands of women MDs who have done and continue to do this.
31
I found this article very interesting and I am personally glad to see more woman in medicine and that they are able to find a work life balance. I am a retired primary care physician who practiced as a solo physician in a large urban setting for 37 years.I have one question and I suspect that I will be tarred and feathered for it. BUT WHAT ABOUT THE PATIENTS??
Arnold Relman the late editor of the New England Journal wrote about the decline of professionalism in medicine. He used in his articles the definition of professionalism from an ethical perspective that they "put the needs of
patients ahead of personal gain." That "personal gain" need not always be monetary. it may be time off or time to spend with one's family. But if physicians are truly to maintain their status as professionals they must remember to put the patient first. By operating in a health care system which has become corporatized, where large academic medical centers are more interested in the money than the mission, where physicians have become shift workers rather than true professionals I again ask "WHAT ABOUT THE PATIENTS? I could cite examples where I have seen delays in diagnosis and treatment because of fragmentation of care but it would be inappropriate for me to do so. I don't claim I have answers here but there is more to being a physician than just being a technician. As Sir William Osler said “The good physician treats the disease; the great physician treats the patient who has the disease.”
25
@els
i agree.. i have often said, there are no part-time patients, how can one be a part -time doctor.
8
@els
I disagree fundamentally that doctors must always put the patients first. This is a martyr mentality that leads to burnout, high suicide rates, and pushes fantastically talented people away from the career because they also need to have a life outside medicine. Thankfully it is changing, slowly but surely, as younger people without dated mentalities enter the field, people who understand that their own health is just as important as their patients'.
The real reason why patients feel as if they are not cared for the way they used to be is the commodification of medicine, making it into a lucrative business for insurance companies and hospital systems, who then force doctors to double book 15-minute appointments and spend half that time charting for the purpose of billing. It has little to do with the fact that doctors are now allowed to also be people with satisfying lives outside the hospital.
Doctors are not gods, not superheros, and not superhuman. This is a dated mentality. Nor are we simply technicians, not in the least. The doctors profiled here are likely beloved by their patients, and likely care deeply about them. They simply understand that in order to be healthy themselves, they have to have a balance between their professional careers and their personal lives.
87
My doctor has clinical hours only on Fridays. The rest of the week my doctor is key staff in one of the most respected medical schools and teaching hospitals in the world. If I need an appointment Monday to Thursday, I see the nurse practitioner. My doctor can and has called me after hours during critical times to coordinate my care. If you think that I am suffering because I have a part time doctor, you’re crazy!
It’s not the doctor’s schedule that matters. It’s their presence when they are providing care - paying attention and listening.
30
I am one of those old-fashioned doctors who was on call 24/7 for his patients. It’s great that these modern doctors can have work-life balance, but it’s not so great for the patients who get treated like objects on a computer screen rather than people who are suffering.
The challenge is for the modern patient to learn how to step up their game and demand decent medical care in a system designed for the convenience of the doctors, nurses, and hospitals, rather than the customer who is not at their best in the encounter.
19
@Louis Constan MD
It is not the doctors' fault that insurance companies and healthcare systems are requiring 15-minute appointments with at least 10 minutes of charting for billing purposes. This is the fault of the business-model healthcare system.
While this article points to the changes in the healthcare system as a causative factor in why shift work is more common and hence why women are able to work more flexible hours, I do not think it is fair to suggest that working flexible hours is somehow responsible for patients feeling like objects on a computer screen. Place that blame on the insurance companies and hospital systems that put overwhelming charting obligations on the physicians.
42
@Louis Constan MD -- I wouldn't be so quick to assume that a doctor who decides to have a healthy personal life isn't providing decent medical care. Why are you (and others) making this leap?
9
Recent studies indicate doctors spend less than half of work hours with patients; the rest is in front of the EMR doing admin work. I spend more than half my time being the MA, transcriptionist and secretary. We are drowning in population health management and dealing with the insane insurance requirements. It is not a patient centered system for many reasons; not just physicians seeking some balance.
12
I was a Girl Scout leader for many years. When I started, I wanted to know how to be a good leader so I got together with an experienced leader to get some tips. She had lots of good experience and spoke candidly. She told me I should avoid taking in to my troop the children of doctors. This was Because of the long hours doctors work, they were unable to participate as volunteers or co-leaders. Also, in her experience by the time the children of doctors got to middle school the girls either dropped out or had difficult behavioral problems. She thought this was related to the lack of time these parents spent with their children. It seemed wrong to me and I had several doctor parents over the years. From the perspective of today, I would have to say she was right. The doctor parents are very difficult to work with. Because they are on call, they cannot be relied upon to pick their kids up on time. They are very reliant on others to do the work of caring for children and seem to feel other families should understand their work is more important. Also, I was really amazed that the doctors could not seem to recognize when their children were too ill to participate. Maybe they were used to serious illnesses and downplayed keeping their children at home with typical childhood ailments? Anyway, over time I figured it out and steered these parents to other groups. I admit this is a biased anecdotal report, but I had over 100 girls over the years. I’d give the same advice
5
@Carol Yazzie
What a sad sad statement about the Girl Scouts and leadership lessons.
I was a Girl Scout for 10 years.
I am a physician.
I am a mother to three young children.
When I google Girl Scouts the motto: "Building Girls Of Culture, Confidence and Chararcter" -- it seems to me that leadership would include reaching out to girls that had less time with positive role models (as you argue is frequently the case when girls' parents are physicians), facilitating self esteem that may be lacking in the case of the onset of behavioral problems and recognizing that every child and parent has something to offer and is worthy of inclusion even if it makes ones' role as a leader more challenging. Doing the right thing is regularly the harder option and the only option-- that was the kind of leadership I saw and absorbed in medical school, residency and fellowship.
41
@Carol Yazzie interesting. I have been my daughters Girl Scout troop leader for 6 years, and room parent all 6 years and as a single mom while working full time as a doctor. Things that make you go hmmmmm
11
So doctors kids - girls in particular- are social misfits who have unsupportive parents and should be avoided being a headache to manage ? Hmmm
3
Residencies "capped the hours" but at what level? I think residents are still on the hook for 80 hour weeks and 20-hour shifts, right?
But other than that, it's a valid story. Same thing is true for nursing. A nurse's work week at a quality hospital is typically 3 12-hour shifts. So a two-nurse family, if they can juggle their shifts, can definitely have time for kids.
9
@Tom B. 80H max averaged over 4 weeks, and daily shifts of 24H plus 4H for transition of care (just no new patients), so 28H max. I gave a talk to our residents on “Fatigue Mitigation” (required by the ACGME) just yesterday and it was tough because the answer is Time to Sleep.
2
This article and its title are so very misleading. Medicine is a not a "family-friendly" profession. I do think it might be accurate to say that compared to how it was practiced in the past, (maybe) it has become more family friendly. But Im not sure how you could claim that a profession that requires trainees to work 80 hour weeks is family friendly. The article even mentions that the average physician who is out of training works almost 50 hours a week. Most women physicians are not part-time allergists or dermatologists. And while its true that some shift based jobs such as hospitalist have alternating weeks off, the weeks "on" can comprise 7 days in a row of 12 hour shifts-(thats 84 hours in a week) - not a family friendly schedule at all.
76
@MHA There are very few high paying jobs that are not 50 hour work weeks, the difference is that these doctors have set
schedules, that is what makes it family friendly.
@DJM That is almost 50 hours AVERAGE, so many are working more. I dont know that I would say that any job that requires so many hours at work (and possibly many more outside of the office) is “family-friendly.” I guess it depends on your definition of that term. I dont know that “set schedules” applies to doctors who must be on call or available to patients outside of regular hours. Also, “set schedules” can also translate into inflexibility (because they are set).
The intent of this article was purportedly to comment on ways to make workplaces more family friendly. I feel like the result of this article however was to drum up an us versus them mentality between female physicians and other female professionals/workers and to perpetuate the notion that women need to consider the “mommy track” in their fields. I think all women with families (kids, elderly or ill relatives etc) who work are faced with a struggle to meet sometimes contrary expectations in their work and home lives. I think that using physicians to exemplify family friendliness was a poor choice as the many non family friendly aspects of the profession were not adequately accounted for. I think this article could be better framed as a discussion of how the medical profession has changed compared to itself without trying to set it up as an example to other fields.
4
@DJM
Could you give a few examples?
This is mostly an identity issue.
Being a doctor for some women is a badge of superiority.
For some , Staying home with children is now looked down on.
Sad reality.
12
This article is discouraging to women in medicine and perpetuates a sexist trope that limits women in their ambitions. It suggests that we should be grateful to have the opportunity to compromise our career and ambitions for a family without any mention of the opportunity for men to curtail their careers or contribute to balance. It is very disappointing that "family-friendly" in this article means "female compromise friendly."
299
@FemaleMedicalStudent
Sounds like wife in medical school. 400k of debt and going past your child bearing years to become a specialized cardiologist with 80 hour weeks will change your mind in your 40s.
3
Nailed it.
- Jaded “old” doctor (and single mom)
2
This piece could be more inclusive by saying that “in most couples,” A woman takes on child care duties—not THE woman. Not all couples include one woman.
13
This is a discussion that is going on all over the developed world. Women now consume a bit over half of medical school slots and within a few years of graduation start working part-time (23% - JAMA Network Open Aug 2019) while most male Dr's (97%) slog away full time.
You can't get an appointment to see your Dr? This might be the reason.
16
@SteveRR oh thanks for pointing this out. I’m so sorry I took a med school seat from a more-deserving and harder-working male student. I’m sure a man would be more devoted to his patients and more available than I am, but c’est la vie. Ok back to my life of leisure.
95
@Hmm.
Simply reflecting on the fact that people who consume a highly subsidized public good might incur certain obligations to the public that subsidized them.
This is even more important in socialized medicine programs like the NHS, Canada, Germany or the upcoming Medicare for All.
10
@SteveRR The market will respond (kind of). Wages for those who stay in the system will rise (true for both male and female physicians who stay) and the allure of higher wages will create a larger supply of future physicians. Of course, the number of residency slots are fixed so this makes medical school/residency slots more competitive and the mediocre medical students will be weed out.
Also, PAs and NPs (aka physician extenders) will fill some of the supply.
This is the great thing about capitalism and the free market, everyone is able to make the optimal choice for themselves and the market will respond.
1
Another item not mentioned: medicine is not a profession that you can leave for a few years, then return - too much is changing, and you will never catch up. (Science is very similar - women with PhDs don’t drop out to have families.)
61
@mcnerneym Depends on the specialty. Emergency Medicine, for example, would be easier to re enter after a few years off. Oncology would be tougher.
In reality, everyone who intends on keeping their license will keep up on the Continuing Education requirements and work a few shifts per month to stay sharp.
For those employed by a hospital group (rather than own their own practice), there wouldn't even be a wage penalty for taking a few years off. ER and IM wages are the same whether you are 2 years out of residency or 20.
1
Oh yes they do
Two of my female doctor friends, one ob-gyn and the other orthopedic surgeon, chose to marry men who enjoy role of stay-at-home dad and are strongly supportive of their professional spouses. Works very well.
62
As a female physician, I feel this article completely misses a major point. The author interviews women in primary care, administration, and one who is working part-time. Several of them mention having given up career opportunities (a preferred subspecialty, direct patient care) in order to find a job that offers flexibility. The article seems to suggest that physician mothers should be relegated to certain specialties and limited pathways to achieve work-life balance, when in fact we should support women having *greater* career opportunities in a diversity of subspecialties - with the possibility of work-life balance for all.
404
@AB. Another female physician here and I totally agree with your comment! Cherry-picking a few specific, supportive examples do not mean the thesis is valid.
51
@AB Also a woman physician and I agree! Work-life balance should not be characterized as a specifically female concern. And the examples provided in the article do not describe the reality for most women physicians.
23
Absolutely. Spot on. Sends completely the wrong message. The most shocking line was the suggestion that when there are two working parents, naturally the women makes career sacrifices. Not the case in my household, and not reflective of modern society.
17
The author would have been wise to examine the outlier in her graphic — the overwhelming majority of OBGYNs (85% of graduates are women) who are female and yet who work some of the highest number of hours on average. As one of those women I can tell you that work and family balance are incredible challenges, that burnout is high, and because surgical volume is essential to mastery, there aren’t always easy flexible schedule changes that accommodate the needs of profession and family. The surgeon’s comment below nails it as well.
121
Yes, and surgical subspecialties are not even listed in this graph, which is a commentary on how grossly underrepresented women are in these fields.
4
@Jane van Dis
I met an OBGYN with some friends at a bar. We ordered drinks; she ordered a ginger ale. I realized she might be called at any time for an emergency.
If I were a pregnant woman, and I found an OBGYN I trusted, and I had a difficult delivery at 2am, I'd want my doctor to be in on the management decision.
3
I’ve noticed that all of the neurologists I have seen in my life are male. So after reading this article I looked up the gender division in neurology, and discovered that it is one of the practices with the highest pay gap between men and women! Some areas of medicine just skew male (orthopedic surgery, neurosurgery, cardiology...), but why would neurology, in particular, be so biased in pay scale? Maybe if more women went into it the gap would shrink. It seems like a profession in which a doctor could have regular hours, or even a short work week. And, at the risk of sounding terribly sexist, I have found neurologists to be exceptionally caring and empathetic people (not so true of neurosurgeons, though), which suits many women to a tee. So why is it not among the “family friendly” professions favored by women?
12
This article is misleading. Medicine is family friendly only when looked at through a very restricted lens. Burnout is a huge problem, impacts the family and is NOT alleviated by better "work life balance"—in fact two of the shift work specialties mentioned in the article, hospital medicine and emergency medicine, have among the highest rates of burnout. Medical debt, often over $200,000 on graduation from medical school, can give doctors little choice but to continue practice after kids.
74
When I moved to this beautiful area many years ago, a friend recommended his primary care physician. Carefully investigating this Doctor, as much as possible, I found they were board certified, in practice for 10 years. GREAT! I thought.
The female physician is booked weeks out and impossible to book an appointment ; being told: doesn't work Fridays, gone over all major holidays, etc.. Many times I have ended up in the local Doc in the Box; thinking of the beautiful painting of her three young boys hanging in the waiting room.
Better for whom? Time to search for a new one
20
News flash . Your doctor is competing her EPIC charts on Fridays
15
Or she’s just a really good doctor who is in demand.
11
@Karl
Better for her. It's her life. She can determine how she wants to live it, not you.
I agree, time for you to search for a new doctor if you have a problem with how she practices.
7
The other benefit that medical women get is not having to face age discrimination. A qualified, competent doctor can still find work at 50, 60 and beyond.
23
As a female neurosurgeon, I am a but disappointed at the message in this email, and find it somewhat misogynistic. Most female physicians work full time, and continue to be available for patients and residents 24/7. Surgeons work 80 hours a week, and we are trying to increase female representations in this field. However, doing this depends on a societal shift to support physicians who are mothers, and more equity at home to allow their partners to share the burden of caring for children. That is the future, not relegating women to “lifestyle” specialties in medicine that are not in line with their training or career aspirations. If women choose these fields for personal reasons, that’s wonderful, but making it seem like that is the choice caring mothers should make to maintain the status quo in this unequal society is irresponsible and very disappointing.
338
Unfortunately, this article was not very well researched. The majority of female physicians work full time, and thousands of us are mothers who have not chosen primary care. I belong to a mother-surgeon group numbering 2100 members, a multi specialty female oncology group with 1400 members, and the American Society of Breast Surgeons which is now becoming majority female (all of us have done a 5 year general surgery residency working 80 hrs/week and many of us did an additional 1 year breast surgery fellowship). The article is misleading because it gives the impression that most physician mothers make it work by either choosing a primary care field or working part time, and this doesn’t represent virtually any of the thousands of specialists who are also mothers. Most specialists work 80 hours, take call nights/weekends/holidays, work up until delivering our kids, take short unpaid maternity leaves, frequently deliver better care and yet are still underpaid. Why do we do it? Because we love the hard work, and because the industry won’t change until we make it change. If you’re going to write an article on this topic, please make a better effort to do the research. It’s a bit embarrassing to see a female writer make this kind of mistake.
500
@Dr Sangeetha Kolluri. Spot on! I am also a female physician, and as I was reading this I kept thinking...this writer clearly does not understand this subject!
89
@Dr Sangeetha Kolluri Now this is the kind of example I want to see. I’m a scientist, not a physician, but reading this article made me really sad and disappointed about all the female physicians I know who do or do not have children but do work full time in difficult specialties. I want to hear how high performing individuals do what they so do.
31
Exactly. The new "mommy track."
11
Very interesting! I for one would like to hear more about how responsible child care is provided when both parents must be at work, how much it costs, and how abrupt need to stay home (for example during childhood illness) is arranged. How is this arranged where people work in teams and substitutes, unfamiliar with the team practices, try to fill in?
Who, that is adequately trained, is willing to remain unemployed and uncompensated, while waiting to be called in as a substitute?
We certainly need to learn more about how this is done, because our current system is not working well in a world where more women have invested dearly in vocational training that does not fit our existing work pattern.
19
Responsible child care is found by paying a premium for it. I am a physician married to a physician. My kids go to half day preschool. We still have to pay for a full time nanny- our schedule does not allow us to do drop offs and pickups.
Kid sick at home? I get the flu from my kid? My nanny is sick? We sometimes have to do what the rest of the world does- call in sick. In this situation, the lack of empathy from our patients can be pretty demoralizing. I understand that it can be frustrating for patients to be rescheduled. Trust me- I would rather not call off sick. Calling off sick = overbooking patients, extended hours on other days to make up that time and work. But physicians are people too, and sometimes we get sick.
9
@Concerned: Thank you for that informed reply.
Good luck to you.
2
Whether due to nature or nurture, what I see all around me is that professional women want to stay home with their children for at least a few years. The next best thing is part-time, and medicine lends itself to that. Doctor-mothers can work set hours and, if a patient needs care at other times, urgent care clinics and emergency rooms are available.
Patients benefit as well. Just by luck, many years ago I was treated by a young doctor just out of residency. She impressed me and has been my PCP ever since. Soon after I met her she joined a practice that was all women (there must be some legal violation there, but I don't care), and most of them worked part time. Having opted for a lower pressure environment, they take more time with their patients and really get to know them. They are very bright and committed doctors, but they have more time and more head-space for each patient. And, no small thing, they get enough rest. The result, I am firmly convinced, is better medicine.
Could men do this? I suppose so, but they hardly ever do. They're guys, after all.
16
I literally no of know female physician acquaintance from med school, surgical residency, breast fellowship or clinical practice who has chosen to stay home with her kids. Anecdotally there are a few out there, but typically the $300,000 debt keeps them working. Meanwhile, quite a few of my surgeon-mother colleagues have stay at home husbands, including my former surgical chief resident. Unless you’re actually a physician yourself, you don’t have a very good sample size of encounters with physicians from many specialties (and in many regions) to make this kind of generalization.
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@Dr Sangeetha Kolluri
I completely agree. Myself and my physician husband still work full-time, despite being parents. It’s not only the debt, but also, the commitment to our patients. My female colleagues from medical school and training work full-time while having children. Thank you for your response above.
20
Your viewpoint is interesting. But I literally laughed out loud about your statement that part time physicians get enough rest.
Sincerely, a 4-day-a-week physician who holds a leadership position at her hospital and who does the bulk of-
Costco runs
Grocery shopping
Birthday party planning
Car maintenance
Going to the bank
Cooking
Planning kids’ activities
6
I prefer female doctors and am so glad I can see women now. I also know from watching my husband's private practice that the once women become mothers they almost always want to reduce work hours. The problem is that they often do not want to take a salary cut nor do they like the reduced input in the medical practice that comes with part-time work. Physician prestige and pay has been based on extremely long work hours and being available for patients. If physicians opt not to do this, then the pay and prestige is going to go down.
14
@Elena
Don't worry about --those women won't be getting unearned money . read about the gender pay gap on the ACP website . The women make less to start with and even when we work full time the pay gap grows . IF you really care about why women work harder and make less read google emotional work of medicine
3
I have multiple conditions. My primary care, women's health, and gastroenterologist practitioners are women. My rheumatologist, neurosurgeon, neuro-ophthalmologist, endocrinologist, and otolaryngologist are all men. I am also a clinician myself, but I perform research. I have predictable hours. In the specialties where you perform surgeries, that is less the case. However, the practice where my rheumatologist works, the practitioners are men and women. There is a salary disparity among the different fields of medicine. But when surgeries are planned in certain fields, the hours can be more predictable, and departments can do more to properly mentor interns, residents, and fellows so that they will not leave.
3
I kept working in medicine after having children because of a commitment to make use of my training. I did this to help others. The $350k in debt also made it hard to drop out of the work force. At no time would I label my residency training as "family friendly" and I had the opportunity to train at what is considered a supportive program. Try working a 30 hour shift with a 6 month old at home. I couldn't have done it without grandparent support.
164
@Laura
Ninety percent of obgyn residents are female, because males are discriminated against in the field. If women and men are equally competent, and half of the talent pool doesn’t go into the field, then the hiring has to be done from a smaller talent pool and employers dive down to the lesser talented to fill positions. So ob gyn physicians WILL be less talented. This is one problem with all discrimination: it hurts the final product as well as hurting those discriminated against.
Women in medicine often have an advantage that is only mentioned in passing here, they are more likely to be married to other doctors. Her radiologist husband is on tract to make well over $500,000 per year. Her "sacrifice" to move from oncology to geriatrics will mean the difference to her family between a vacation home in Destin and one in Seaside. And the same can likely be said of the other women in the article. Doctors used to marry nurses and many still do (I did). What proportion of female doctors are marrying male nurses, not many I suspect.
44
@Carl FeindI you’ve got to be kidding. 89% of female physician spouses work outside the home compared to 49% of male physician spouses. Women physicians work on average an additional 8 hours per week on household and childcare chores compared with their male physician colleagues. I wouldn’t call the gender pay gap or the household work gap “advantages” for women in medicine. SMH
33
Men married their nurses because it was very difficult for a woman to become a doctor two generations ago. Times change thankfully.
8
@Jane van Dis
Gis point is hey ae not supporting a family and chose a different schedule . I do support a family and I can't chose a different schedule
2
There is an aspect for MD's needing to stay working due to the hight costs of liability insurance that they are unable to maintain themselves. Also, it's nice to hear about doctors ALL the time in the NYT, but please remember "medicine" and "healthcare" is made up of so many other types of practitioners that are never asked for their opinion or discussed in articles in the NYT. The reason I mention this is because most healthcare jobs allow women and men to work flexible hours not just MD's.
14
@Tracy Wright DOs are physicians too. Same MCAT & USMLE requirements, and same residency programs.
I suspect Nurse Practitioners and Physician Assistants aren't discussed because it is medicine's dirty little secret that a patient is increasingly more likely to be seen by these professions (PMG blog has urged everyone to stop using the term "provider" since the term fails to distinguish the level of education and training different professionals receive).
It will make it harder to achieve national healthcare if politicians are honest and explain that more NPs and PAs are going to be used to achieve the goal. The patients will be seen by professionals with less education and clinical training, oh and by the way we will finally fix the tort system and it will be much more harder to sue the NP when they misdiagnose you.
I agree it would be good to cover the efforts by NPs to achieve Independence (practice without physician oversight) and pay parity (get paid by Medicare, which sets the rate for private insurance too, the same as a physician despite the differences in training). Then discuss the online diploma mills, I mean NP training programs, that are minting NPs with the attitude that they have "the heart of a nurse and the brain of a physician." But i know why I won't see these article.
2
I am an old man, age 79, who has been in a position to observe, over a long time, many aspects of the changes in the US health care system.
I remember giving a talk, long ago, to the AMA Executive Conference in the first year the majority of physicians were employees rather than solo practitioners and the president of then AMA was a woman.
What a day!
How things have changed since then.
Yes, we have a very long way to go.
Whatever its systemic defects, one of the things I have seen is the near miraculous improvement of the situation of intelligent and committed women in medical care delivery.
God bless you, women in medicine. You are precious.
My position as an observer?
I am a retired voluntary asst. professor in preventive medicine and retired Director of health care financial analysis.
I still get my health care as a voluntary patient in health care education at many levels.
I love what I see at RUMC.
22
The article starts out by saying she had to switch gears and change from an initial choice of doing oncology. THAT in and of itself is a change she had to make due to inflexibility. So no. Mothers dont have it "easy" in this profession. An equitable situation is one where she can do oncology AND be a mother.
513
@Deeed, that is quite sexist. How do you see that working? You think the practice of oncology should change to suit mothers? Do you realize that not all women are mothers, and that men raise children too (I mean men with male partners or spouses)?
Some professions and some areas of medicine are not family friendly. People make their choices, and some choose work over home life. Some even prefer it that way. No one criticizes a man for choosing grueling work schedule.
23
@Deeed
"Family friendly" really means women can choose another option even though it's not their first choice, and they can choose to take a different partner/seniority track with different remuneration.
This is considered better than having to give it all up or not having chosen that profession at all. The options are not ideal but rather only ideal within the construct of Motherhood.
23
@Deeed
I don't see anything in that article that implied that she was forced to change specialties. I know several mothers who are practicing oncologists. Dr. Hebert CHOSE to go into general medicine and geriatrics because she thought it would be best for her overall and for her family. That's actually a privilege that many lower-earning parents don't have.
27
This was a bit too rosie. There was no mention of student loan debt motivating women to continue working. Young doctors are walking out of medical school with crippling debt. Dropping out of the work force is not a financial possibility for most young women starting their careers, having babies, and thinking about retirement planning ten years behind the general working population.
Moreover, the country only needs so many dermatologists and allergists. There is a systemic issue with lack of gender diversity in many of the more demanding careers in medicine. Patients and doctors need women in these fields as they are half the patient population. These fields need to address the long term, unrealistic expectations on their physicians for the health of the patients and the physicians. Your cited cases are a prime example of how most fields continue to lose top female talent.
189
@Emily, The higher education industry is capable of training as many generalists as needed to saturate the market. It will drive down medical costs, avoid burn-out among doctors, and provide more women doctors than needed in any field.
1
As a woman in medicine, I feel like this paints too rosy of a picture for the profession. This completely glosses over the 80 hour work weeks we have during residency, with absolutely no control over our schedule. And let’s not forget the debt - you’ll eventually get to the proverbial six-figure income after residency but many have an immense amount of debt to pay off with it. You may get flexibility with some specialties/positions but it takes a lot of work and a long time to get to that point.
337
@LM At least that's a better outlook than most other professions. Teachers face 80 hour work weeks for the duration (Actually I'd estimate 5 10-12 hour days during the week and sometimes 10 hours grading and prepping on weekends--probably 70 hour weeks frequently). All with no end in sight. Summers gone also, with school meetings and trainings. And no hope for that six figure income.
22
@Chico. I have a great deal of respect for teachers and think that teachers who devote themselves as you are describing should be well paid as an educated populace is of vital importance. I don't think however, you can equate teaching with the demands of the medical profession. My kids teachers take off when their kids or they themselves are sick or have some important event to attend (pretty rare for a doctor to call out sick). You get off major holidays, and the consequences of making a mistake are nowhere near what doctors deal with (hence malpractice insurance for medicine but not for teaching). I commend all those teachers who are committed to their profession...but this article is about doctors, and it does a poor job explaining the true experience for the majority of female physicians. It is NOT a family friendly profession contrary to this portrayal (most female doctors are not dermatologist or allergists!).
54
@MHA While you may see teachers taking off when their children are sick (In my state we are penalized for that) you do not see the pressures teachers face every minute. Rarely can you be casual (which my doctor is often) when you are managing over 30 students. Touch a student wrong and you lose your license. I've had doctors make plenty of mistakes with some of my ailments with no consequences. You make a mistake with a student and you get consequences right away. Plus you are continually being evaluated from every angle--test results, administrators on site, etc. I understand the pressure for doctors but actually rarely see any consequences. Do over half the doctors leave their professions before 5 years?
13
Not talked about in this article is the imbalance at home (women doing more than 50% of the housework/childcare) that creates the pressure for women to make professional sacrifices more so than men- surprised this wasn't mentioned.
259
@Madhav, That's between the women doctor and her husband/wife. Would be counterproductive to send the slacker to prison. Don't marry a slacker.
1
@Madhav - Not talked about in this article is the imbalance at work (men doing more than 50% of the income earning) that creates the pressure for men to make sacrifices with their children, their own siblings and parents, and their personal lives more than women - surprised this wasn't mentioned.
2
Let’s not forget that in medicine the supply of labor is small, and as such the labor force has a lot of control over what it can demand. This wouldn’t be the case if hospitals could hire doctors as easily. If your employer isn’t flexible to your needs, you can always find a job even at a clinic across the street.
36
Not true. Most contracts have strict non-compete clauses, so expect to sell your house and move your family to another city for a new job.
18
True in a very narrow sense. I am related to several women who attended medical school but who chose not to practice because it was too demanding or didn't afford them as much time with children. Those few women who are left in the profession have the determination to make it work at any cost. The bulk of women in difficult specialities (i.e., neurology, oncology, or which require an extensive fellowship) quit the profession.
22
Definitely true, but don't forget that a doctor working 10 shifts per month can make $200K+, depending on location. So yeah, it's easy to cut back your hours when you're still making that much money.
Also, this article puts quite the rosy spin on the fact that the majority of female doctors self segregate into the less demanding (non surgical) professions to have these perks. It's a good thing, but leave the "status" specialties - ortho, etc - still a boys club. So it's good, but it has downsides.
109
@kas
Can I move then ? That $200K sounds awesome
2
@Concerned Citizen. agree. I was estimating near the low end for a hospitalist working 10 twelves/month.
@Lynn B Inta-specialty wage variation is higher than inter-specialty variation. Meaning there are some hospitalists and even family practice physicians who earn more than the average Orthopedics salary.
Medscape has a lot of data, showing the mean as well as compensation along the distribution for the 10th, 25th, 50th, 75th and 90th percentiles. A cardiologist in the 10th percentile (lowest earning 10% of the total cardiologist population) will earn $213K/yr. A pediatrician in the 90th percentile (top 10% of all pediatricians) will earn $457k/yr.
In summary, if you want to earn more, you don't need to change specialties and do another residency. You can move to a higher paying area. Some of the difference is due to owning your own practice vs working for a managed care organization.
Salary data are on Medscape (need account). White Coat Investor discusses also. The data are all broken down to hourly rate to account for differences in hours worked.
5
Nurses do not have the same flexibility. Long shifts make child care difficult, if not impossible. Day care options abound for 9 to 5 administrators but not 7 to 7 health care providers.
196
@mc
There are a million job options for nurses other than being a "7 to 7" hospital-based nurse
4
@mc Nurses can complete their education with a Bachelor's degree, do not go to a 4y medical school, or complete a 3-10y residency/fellowship. Nursing shifts can be 5 x 8h, 4 x 10, or 3 x 12h. Physicians often work 6 or x 12h.
10
@mc. That's just not true. I know many hospital nurses and they all have their own schedules. Some work 4 tens, some 3 twelves, etc. Some are kind of on call and only do 1-2 shirts per week, sometimes 12s, sometimes 4s. And that's not even delving into the myriad opportunities outside hospitals.
6
This is a great and growing trend. Issue not discussed is the income that physicians can make in PT or less than FT work. Very few , if any professions can offer that level of income so it is difficult to replicate.
62
There are a couple of things going on here. The first is that anybody who makes it through medical school is not meek or wimpy and is more than ready to say "this doesn't work for me". The second is that there is a shortage of doctors which gives these mothers leverage. And third, it works. And once people see that things can be different, can be more family/people friendly, everybody wants that for themselves. And the norm changes.
90
This situation isn’t unique to doctors. It’s a basic life decision that couples and individuals with family obligations make no matter their career choice.
16
@Eric but it is an example of a profession whose paradigm has changed--and that is a big deal. Lawyers next!
7