Why Do Women Leave Medicine? A Look at Pregnancy During Residency https://www.roshreview.com/blog/specialties/family-medicine/why-do-women-leave-medicine-a-look-at-pregnancy-during-residency/
14
Anyone who has gone to med school knows that 99% of female surgeons don’t look as good as Dr. Rangel or Shubeck.
Why did they pick two such attractive female surgeons for the stories and the photos?
55
As a male medical student I witnessed the lifestyle of the typical surgical resident and realized that I was not willing to have to make a choice between my career and family. Perhaps we can't always have it all. Im also concerned that a Resident who is sleep deprived could be putting patient at risk during surgery.
118
Aside from the physical toll of childbearing and the reality of pumping milk, shouldn't fathers as surgeons have many of these same problems? It will be very tough to achieve parity if it is only the mother who feels guilty for 12 hour shifts or for the daycare not knowing her name, and not the father. The quotes and facts presented in article are very telling of where the burden of parenting often lies and how it holds women back and not, as often, men. (I know that many fathers do feel guilt, and take on the childcare, of course!)
77
@Rebecca
Like it or not, mothers carry the children and are responsible for that majority or early childhood parenting. That’s just a fact.
84
Where was Dr. Rangel's husband or partner or the infant's father on the day she took her sick child to daycare? Men are not irrelevant, and yet he's not even mentioned in the article.
182
NYT keeps missing the mark on these women in medicine articles. They consistantly put the burden of parenting on women, maybe mentioning Dad for a single sentence.
I am a 4th year medical student and I am constantly frustrated how all the advice about being a parent in medicine is addressed towards women, which perpetuates the stereotype of childcare being mom’s responsibility. For once I would love to see an article about how everyone in medicine struggles with parenting. NYT please do better and stop patting yourself on the back for writing about women in medicine all the while you perpetuate sexism!
258
@Maggie Lee
It’s because women generally bear the main responsibility for early childhood parenting. That’s just the way it is, whether you think it “should be” or not.
66
My wife is an ENT surgeon. During EVERY SINGLE interview for residency and jobs, she was asked about her reproductive status, which is against the law. They would try to act cute, but she was always asked "Are you trying to have a baby? When? How many?" basically to see how much leave she would have to take. I know for a fact that if two physicians are considered for a job, one male and one female, the male will be picked because he won't miss work due to pregnancy and child care. That's a real thing that gets discussed behind closed doors when considering who to hire.
In her last job, her boss refused to include any language in her contract that discussed Maternity Leave because "California has you covered already." She already gets paid less because she's a female, but when the old male doctor basically says "I don't care, I'm not paying for you to have a baby", it absolutely affected how she felt about her role in medicine. My wife has said the phrase "Nobody respects me because I'm young and female" too many times to count.
230
My anesthesiologist mother in law would be 96 if she were still alive. It's more than sad that things haven't changed much in the 60+ yrs since she became a mother.
76
Having spent 40 years working in hospitals as A nurse, I know there is no more demanding job on the planet than being a surgeon. It requires extreme concentration, focus ,intelligence, and a high level of technical skill. Some surgeries are 8 to 10 hours long. So it requires good health as well.
The article mentions that in 12 years there will be a deficit of 23,000 surgeons in the country. The time pressure on all physicians, not just surgeons is increasing, not decreasing. And more than in the past physicians are choosing early retirement, or leaving the profession.
As is, these things will not change until we change our health care SYSTEM.
Doctors have always had a higher rate of divorce than the average population because of the deleterious effects of a 24 hour a day work load on a family. I know many 2 doctor families. They can afford big houses and can hire every job imaginable from grounds keepers to nannies as support staff. The one thing you cannot buy is time with your kids , family and friends.
This is the reality of choosing to be a surgeon. Flexibility in schedules for men or women will not happen until we change the system. And it looks like that will be a long time a coming.
135
Surgery is a brutal specialty and I admire anyone who has the drive and stamina to achieve their dreams of becoming a surgeon. I am a pathologist which has a much better "lifestyle" component and indeed there are many women in pathology, in part because the hours are more humane and call is taken from home (although middle-of-night trips into the hospital to perform intraoperative consultation services are not infrequent when on call). I personally put my training as the top priority in my life when pursuing my dream of becoming a physician scientist. I didn't meet and marry my now-husband until I was 34. I didn't see how I could be a resident and pregnant and attempt to raise a child all at the same time. And now, at 39, finally finishing my subspecialty training and eligible for jobs that will provide some financial security with which to raise a child, I am dealing with a potential lifetime of regret that I'm too old and it's too late. It is a painful situation that has no easy answer. I've had to work extra hard to prove myself in science and medicine, and see the way colleagues (even in pathology) look down on women when they dare to get pregnant. It's a no-win situation. I hope it will change.
132
Thank you for writing this article. I hope it gives our residents inspiration to realize that it's ok to take it easy sometimes & fight for change in our care of new resident mons. Don't perceive yourself as "weak". Nothing is harder than being a new mother & finding your right balance in the medical world.
25
There's an easy, effective way to make things easier on surgeon-moms now: Stop breastfeeding (or pumping), and formula feed instead. The pressure that society, and these women, are putting on themselves to work 80+ hours weeks and then ALSO spend hours pumping is just crazy. Formula feeding is perfectly safe, and it's a great option. Instead of converting call rooms into lactation rooms (and thus only adding more pressure and burden onto new moms), focus on educating these new moms on making the choices that really work for their families and lives.
83
@NYC1 Every mother should be able to breastfeed or pump for as long as she wants. Lactation facilities are part of the law. Do you really want to force highly educated doctors to make yet another sacrifice (and no, formula feeding is not the same as breast milk) just because they chose this career path? That's just heaping on extra punishment. No thanks.
104
I completely agree. Hospitals should have policies to encourage and enable breastfeeding, but we have to stop the demonization of formula feeding for working moms. A woman’s career, health, and sanity matter too - a lot.
71
@Alice
Plus it’s also absolutely none of NYC1’s business what each mother decides to do regarding breastfeeding/formula.
39
My aunt supported my uncle through medical school and residency, taking on ALL responsibility on the home front, including raising their 3 kids. He was hardly around. Then he left her for his office secretary, had 2 more kids, and then that marriage fell apart too; she eventually resented his absence and the expectation that her sole purpose was to support his career ambitions. Turns out the extreme demands of the medical field aren’t always compatible with family life for men either.
84
I looked at residency (5 years in Orthopaedics plus one year of fellowship) as a period of indentured servitude. Immersing oneself in learning the craft of patient care and surgery while doing research required every bit of my attention. My wife and I deferred children until our last year of residency, really out of necessity. I have ultimate respect for those who choose to have children during medical school and post-graduate training, but I was overwhelmed by the experience.
57
I have mixed feelings about this as the mom in a dual-career family. I’m glad to see families are making it work (somewhat) and admire their drive and desire to enact change. But now that I’m 6 yrs into motherhood, I better understand that kids do require some minimum amount of presence from a parent ( or very involved grandparent or other caretaker who will be a constant presence).
I found myself putting on my toddlers shoes instead of letting her learn, or cleaning up her messes instead of teaching her to do t herself. It was because she took too long and we were rush rush rush all the time. As she got older, I needed to be there daily to help her work through social situations. Also, our favorite memories were spontaneous events, not anything we could plan in advance.
We couldn’t be the parents we thought we could be, so we cut back on our hours (to detriment of our career), and feel comfortable with our current situation of working 70-80 hours COMBINED. I don’t understand how couples do it when EACH partner is working those hours.
63
Fellow working mom who has cut way back on my hours/responsibilities!! I stand in awe of families that have 2 ‘big career’ people. Did not work for us. My oldest has learning differences that require therapies and a lot of monitoring...and the constant being on a schedule and rushing didn’t work well for us...and amen to the spontaneous good stuff that can’t be scheduled...I’m all for anyone pursuing their career dreams but unless you have remarkably easy and flexible kids it’s tough to outsource their care to the extent necessary to support 2 big careers!!
31
Part of the problem, in my opinion, is that residents are so poorly paid. If I were paid a salary commensurate with my degrees and hours, being a mom and surgical resident would be much more feasible. I could have a nanny bring my baby to nurse when I have time for lunch or a long enough break between cases, pay someone to prepare and clean up after meals, and spend quality time with my kids when I am off. Instead, I work 80 hours a week for $65k a year (that’s $16 an hour - the PAs I work with make 5x that an hour) and spend my free time on laundry, cleaning, food because I can’t afford to have someone help with all of that. I feel that surgery is my calling and I know that being a parent makes me a better doctor, but I wish I could afford to offset some of the burdens of parenting.
218
After reading this article I am left with a feeling of trepidation. Why you may wonder....My son a I-6 thoracic surgical resident with another 3 1/2 years to go and my daughter-in-law; a urology surgical resident who has her chief year first coming in June 2020 are expecting in June. Neither of their parents (aka future grandparents) live anywhere near them to help out with any regularity. My son says "They will make it work-no one said it is going to be easy" Perhaps that's the same drive & perspective that led them to become surgeons. I hpe & trust they will. The day care closest to the hospital which would be somewhat helpful, has a waiting list even now for June. Even if they do find room there,it is only a partial solution because the day care has conventional hours while surgeons do not. Why hospitals do not have day care to accommodate their employees who give up of themselves too many hours and personal well being to care for patients; is beyond me. To those who say why have children now....Parenthood is not solely a logical one and it involves many factors, not the least is the biological clock and the wish to carry one's own baby. The tone and comments of some but by no means all of the respondents indicate they have no idea what it takes to become a Doctor let alone a surgeon.
66
I spent 2 years as a surgery resident. The hours are much longer than what is listed. 24-30 hour calls, straight, in the hospital, followed 8 hrs later by a 12 hour night shift (first of 4 for that week)...repeat for 4 weeks. Hours are a MINIMUM of 70-80 in residency - often up to 100. You get one day off per week, averaged over 4 weeks. So to get an actual weekend, you have to work 12 days straight.
There are often no shifts. You are on for days or weeks at a time, and you can always be called about your patients even when home. Some hospitals have started to switch to shift work but it is still far from the norm.
I have NO idea how anyone manages to have children in residency, let alone surgical. It was all I could do to take care of myself.
134
I am a physician and resident in pediatrics in Boston. I had a baby at the beginning of intern year, a life-altering and maddening experience. Obtaining MD and PhD degrees took almost a decade, and I could not postpone childbearing any longer. I cannot describe in words the stress and heartbreak of trying to breastfeed and raise a child while being a resident. I too experienced my daughter's rejection when I came home from 28-hour calls, difficulties finding spaces to pump (using bathrooms most of the time as I could not afford waiting in line while other mothers pumped as I had to take care of patients), and jumped hurdles trying to store my breastmilk in the hospital. The system is not designed to support our training or early careers, surgeon or not, and there is little hope for change. If you want a career as a physician scientist, hope and pray you are lucky and have a big break early, otherwise the odds are against you. I started to discourage my female patients from becoming doctors, and advice them to become nurse practitioners instead (less training, more money, and more flexible schedule). We go into these careers because we truly want to help humanity, and end up hurting ourselves and our families. It does not make any sense.
456
There are a number of professions that require years of training through one's reproductive peak and a large number of work hours indefinitely. Anyone with a PhD or who works in tech knows this, although a surgical residency is an extreme example of this. The trade off is less personal time for more money, and hopefully an intellectually engaging career. It doesn't hurt to get to be a professor at Harvard or Michigan. For people whose career trajectories are not quite as meteoric, perhaps the calculus is not as clear. Relentless 12 hour shifts might not be necessary, but there will always be some trade off. Perhaps putting off child birth to the late 30s.
13
yeah but people aren’t going to live or die based on your work as a PhD candidate. and, perhaps you know, that fertility isn’t assured in a woman’s late 30s? This isn’t a sustainable situation - do we really want the loss of parents not being surgeons?
37
@middle american The problem is that by the late thirties, fertility is dropping and a rising percentage of those women will not be able to get pregnant. I see quite a lot of that these days when it is so difficult to get established in jobs that provide enough money to raise a child, much less a hot-shot career in surgery or tech. We criticize women who have children that can't afford them, and then we criticize women who will eventually be able to support them. Not to mention women who are too "selfish" to interrupt their lives with children. Damned if you do and damned if you don't.
321
@middle american
the trade-off for residents not working 12+ hours is that they do not become doctors. 12+ hours for a PhD and tech personnel mean they get more money and progress in their career.
10
In 2032 we will be short 23,000 surgeons. I don't think banning women with children from being surgeons is the solution to the problem.
133
@Dennis K. I believe its a shortage of MDs overall. People just don't want to be $200K in debt.
21
I firmly believe I received better care during my pregnancies and births because the OB field has so many women in it. Women used to be told to just live w incontinence and pain during sex; now we know there are many physical therapy and other approaches to deal w these issues. Episiotomies and the barbaric “husband stitch” used to be commonplace. It took women entering the field to question these practices.
We do lose out if women choose to not enter these professions.
84
Our medical group which is working for big hospital, have now around 50% female doctors.Some are in childbearing age, some not. This is now a trend that more and more woman work as physicians, frequently in surgical specialties.
According to some studies around 40 % of females either leaves medical practice or goes part time 4-6 years after completing residency program. Some studies also indicate that woman doctors have higher rate of physician burnout than their male colleagues. Our group tries to accommodate some needs of our pregnant or breastfeeding colleagues by giving them more brakes and later in their pregnancy not scheduling overnight calls for them.However unfortunately our hospital is less sympathetic. We had child care here, but it was closed by a hospital, because it did not bring income. All system is set to bring maximum profit, not to take under consideration needs of people working in the industry.
Surely surgeon needs to primarily take care of his or her patients and have to be available to address those needs.I think though that healthcare institution can and should find ways of helping pregnant physicians and young mothers, by scheduling different duties for them, like working more in a clinic than Operating Room. Building childcare units or subsidizing childcare for mothers of young children would be another step.Changing attitudes is though the most important factor. I might be a dreamer, but I hope I am not the only one.
35
"Why can't the system accommodate motherhood?" What about fathers? Why can't fathers accommodate motherhood?
71
Perhaps we need do it like other parts of the world? Why do US doctors need an undergraduate degree in any major of their choice anyway? A waste of time for most students. You'd be saving 4 prime years. We should admit high school graduates directly to med school and on to residence.
64
It's time we scrapped the residency program, which serves nothing except to haze new doctors and make them hate their work.
It's no coincidence that William Stewart Halsted, the man who invented the residency program, was addicted to morphine and cocaine.
18
@Todd are you in the healthcare field? I am a physician. Residency is essential to learn how to be a physician in your specialty. New medical school graduates are NOT prepared to practice medicine independently.
63
@Todd
Residency serves a much bigger purpose than to “haze new doctors and make them hate their work.” It teaches them how to be a doctor and to properly and safely practice their field of medicine.
42
I dropped out of anesthesiology residency after I gave birth to my second child. Before this I felt like a totally inadequate parent as well as an inadequate resident. I missed every single milestone and my daughter knew her teachers and grandparents better than me. I pumped in dirty public restrooms when I had time to pump at all (more often I was suffering from painful engorgment). When my second child was born I saw the whole horrible parenting picture about to happen again and I just couldn’t do it to myself or to my baby. It would be nice to think that one day women will not have to make the same painful choice that I did.
206
WHy dropout?? the 39% number astonishes me.
There is another choice for female surgeons that not discussed here.
Find a surrogate to carry the baby. It is not perfect, but at least you are at par with your male counterparts.
If you think about it, a lot of stress is from the hormonal change around preganancy. It adds too much stress and even leads to depression. That is the fundamental differences between male and female, and something not cultural but biological which makes it harder for women to pursue a professional career.
Surrogacy can be one way out. I'm not advocating that on a massvie scale, and I believe that the system should change to better accommodate a personal life. After all, I don't see a point of exhausting every surgeon: Who wants a burned-out surgeon operating on you, regardless of their gender? why not produce more surgeons??? more happy surgesons?
It is not easy to reach euqality from institution design. Look at the tenure system in universities. One year extension for both male and female professors. Regardless of the kind intention of facilitating child raring and promoting equality, at the end, the male benefits more: I bet you've seen male professors that spend that time writing papers but not raring children.
I'm surprised at the 39% number of considering dropping out. I believe we should advocate for changing the system, but meanwhile, if the change comes slowly and the burden is so unberable, it is worth considering.
4
@Z Just how many surrogates do you think are available for all the female surgeons out there? And how would a resident afford a surrogate on their $57k salary?
60
Surrogacy is more exploitative than surgical residency.
44
I am a male doctor. Not a surgeon, though. I did not even consider the idea of getting married during my residency, let alone having kids. Got married right after completing residency, and had my first kid a few years after that. Residency is bad enough without actively trying to sabotage yourself.
That being said, residents are being used as cheap slave labor by most hospitals and have to work ridiculously long hours. I routinely did 32 hour shifts twice a week for the entire duration of my training, in addition to working seven days a week. Most of the time I was a hazard to my patients because of sleep deprivation. Working hours need to be sane for all residents, male or female, single or married.
I have never noticed any difference in the level of competence between my male and female colleagues, and strongly support any reforms that would make it easier to balance work with family. One option would be to let new mothers take a few months or even a year off from the residency program without pay and join back without any penalty. It is better than forcing them to drop out.
A new born infant really should not be away from his/her mother for prolonged periods of time during the first few months after birth. By forcing women to choose between their career and their baby, we are failing at basic human decency.
300
This can change. Change is slow in medicine, but big, cultural changes do happen. Work hour limitations are one example, but also 40 years ago this article could have been written about any physician specialty. How did the change happen? Women entered the field, had families, and rose to leadership positions so that everyone could see it was possible. Hang in there, surgery sisters - you can do it! You'll change the rules eventually and when you do we will all be better off.
18
I see this as a repeated issue in our country and culture. When there are structural inequities, somehow the individual — in this case, a mother-surgeon, doctor or resident — is made to feel it’s somehow a deficiency in themselves when in reality there is something wrong with the structure. We need more supports for parents in all professions. We lose out when we cut out half the potential pool for surgeons, doctors or any other profession. There’s a lot broken with our current healthcare delivery system and training and it needs to be addressed. I felt so fortunate to have three women surgeons recently when it was necessary (an attending, fellow and resident). I hope the CEOs of hospitals, residency program directors and the AMA and professional societies that set policy for residency programs are reading this article.
24
The crucible of medical school and residency is, by its very necessity, designed to forge better doctors. As a few such doctors have already commented on this story, it is a system---despite its aches and pains and sleepless shifts---that works.
Perhaps there is a way to do a soft-track option for women whom become pregnant at some point in their training, or plan to. If so, it will have to be an option open to all students. And then, how do we distinguish between the full-course-regimen MD from the soft-track one? And then there's the stigma of falling behind the rest of your peer group.
No. Sometimes life just plain has its realities. A blind person cannot drive a bus, and a pregnant woman cannot (or should not) be an NFL linebacker.
24
@David Bartlett
Agreed
3
@David Bartlett
I could not agree more. As Michael Porter likes to say "Strategy is about choices." The myth that we don't have to make choices and we can 'have it all' needs to be busted once and for all. Sorry, mom, but you can't be a surgeon.
14
@me
It is ludicrous to suggest that motherhood and surgery should be mutually exclusive. Do you really want the entire body of surgeons to be individuals who have never been a parent? What sort of bias does that introduce?
59
Reading the responses to this article is excruciating and infuriating. There is no crisis in patient care in account of negligence on the part of pregnant surgeons and young mothers. The fact that commenters fixate in this is yet another example of how doctors, female doctors in particular, are held to a higher standard compared to individuals in other service professions and in comparison to their male counterparts in medicine. Females physicians (surgeons perhaps most of all) learn to juggle hugely demanding personal and professional lives and SUCCEED at it. Past studies have demonstrated that female physicians make fewer errors and in many cases, are preferred by patients. Give no these facts, we should be looking for ways of retaining women in the specialty, not discourage them. There are systematic issues that are purposefully perpetuated in order to prevent this, to maintain a frankly unhealthy culture and a history of hostility to women in medicine and surgery in particular. No one benefits from this, not physicians or surgeons and certainly not patients.
90
"Do no harm" the motto of the medical profession.
What does this mean when the grueling 48 hr work day schedules of residents and interns makes the practice of medicine unbearable. Patients suffer when their doctor hasn't slept 8hrs the past day. Old men making up the rules has to end. Young parents who happen to be doctors are better at the profession than those without a family. Being parents is a humbling experience for any profession be it medicine, education, or plumber.
29
It wouldn’t fix everything, but taking off the pressure to breastfeed/pump would help a lot. The benefits of breastfeeding exist but are generally pretty exaggerated. A baby would benefit from a mom who is a little less stressed and exhausted trying to pump all day. I don’t think work places or schedules should be forced to accommodate breastfeeding, and women should embrace formula—it’s freeing! My kids were all eventually formula fed, and I promise you you can’t tell the difference. It was such a huge weight lifted from my shoulders when I ditched the pump and made balancing career and motherhood easier.
44
@Itsy I agree. The pressure to breastfeed is too high. I'm a physician and returning to work without the extra stress of pumping was a lifesaver. My kids are fine. It may not be a solution for some but I found I was a much better mother and physician with rest.
40
Motherhood is a full-time occupation. Handing it off to a nanny doesn't cut it. Expecting your husband to do your job doesn't cut it. So female surgeons don't cut it unless they are never having children. Feminism is destroying families. Or men. Women find fulfillment in raising children and keeping a home, men do not. There are some exceptions, but not many. Men need external challenges. Women can resume careers after the children are grown, which is also when men start to coast and tire out. So let men have their careers and build up while young and energetic, have children, and start your careers after that. It works.
14
@Pank
The most competitive and highly paid careers don't allow for significant time away, unless for advanced education, research or launching a startup. Something that will enhance a resume.
13
@Pank
Wow.
So for a woman who wants to be a doctor- they should take years after college to stay home and have children, go to medical school AFTER having children?? Like in their 30s and 40s?
Does that actually make sense to you??
33
@Pank Amazing you were able to find access to a computer, living in the 1800s.
127
Maybe don’t have sex and have children while in med school? Just a thought.
14
@Jonathan Abernathy Um, because if you wait until after med school and residency to have a baby, you’ll have to wait ELEVEN YEARS. We’re only fertile for so long...
26
@Jonathan Abernathy I have met several couples in med school who deliberately have babies during school or residency because their needs are catered to.
6
@Jonathan Abernathy
What a great idea!! No sex or children during the 4 years of medical school.
Don't you also think this should be extended to the 7 years of surgical residency?!?
(sarcasm)
7
do it like male surgeons, who have a stay-at-home-partners who supports HIS career and takes care of kids. The problem is not about being a female doctor. Female doctors usually have partners who also want to have succesful careers. And two parents with ambitious careers can´t handle it, when kids are coming. So every succesful female doctor needs a stay-at-home-daddy
45
Totally agree. These women should marry men who want to stay home. Or get a live-in nanny. And they should feed their babies formula!
9
I don't want ANY doctor, male or female, operating on me who "may go eight to 12 hours without eating, or even drinking water."!! That is just nuts.
This is just one more aspect of our TERRIBLE MEDICAL SYSTEM that needs change, from top to bottom.
I wonder how they do it in other countries?
Whoops, excuse me - we're Amuricuns, we're The Greatest, we don't look elsewhere (or anywhere) for possible ideas! So, our medical system stinks.
143
The anecdote at the beginning — where was the baby’s father/why couldn’t he help out?
43
My daughter, who has grown into a remarkably intelligent and compassionate woman, decided a few years that being a “Burner,” running a micro-brewery, and dedicated to whatever attracted her wasn’t enough in life. “I realized I really need to do good so I’m going to be a doctor.” I knew she was capable of this and even suspected she might choose medicine at some point.
As is her bent, she did it the hard way. Pregnant in her 4th year then giving birth during her internship. I’d always known that the medical profession was run by idiots, and that they saw the intern phase as a massive frat initiation, but the things she put up with would make most pledge masters cringe.
She’s done it on sheer will and also, critically, because she has a man who is tough, compassionate, has no stupid issues about being a man, and loves his woman and daughter. I suspect he - even with a full-time job - does more of the day to day child care and housework than she does. Never heard him whine.
There’s no doubt, in my mind, that the medical establishment does everything possible to limit the number of physicians simply to insure their economic plenitude. They could and absolutely should support a pregnant student/resident. (Isn’t that what the “Oath” means?)
I watch the children of the ‘60s dreamers and their children’s children and their passion to make this planet better for all. Makes me feel incredible. The dream is alive, and I still have hope because they believe and do.
207
40% consider, but how many actually quit?
4
@rick Considering doctors are on average 200k in debt, probably not many. By the time you finish medical school, they've got you trapped and you're too old and too specialized to pick up something else
16
@rick
I don't know about surgery particularly but roughly 95% of those who start medical school finish. (I googled this for some other reason).
3
Its too bad there are costs to these women's choices to be mothers and surgeons. But as a potential patient, I want someone who is competent and concentrating, so the solution is to ban pregnant women and new mothers from the operating room.
6
@No Great, lets ban pregnant and new mothers everywhere. And actually let's ban new dads too since they might be getting woken up by the baby or thinking about picking up their kids or sick because their kids infected them with the 6th cold this year.
25
@No what makes you believe that a pregnant women isn't competent? Should this logic also be applied to males who are also having things going onto their personal lives or you just looking for another excuse to make fun of women for deciding to have children
15
@No
What a truly ridiculous comment
19
It's not just the medical profession. Our nation as a whole has great difficulty accommodating motherhood, from breast feeding in public to public childcare. Indeed, our response to pregnancy is to encourage abortion. This, IMHO, is a crime against humanity.
15
@Antoine
Thanks for making your stance known for anyone who was wondering
3
Becoming a surgeon can be greatly beneficial to the world. So can refraining from having children. The best course appears to remain child-free in the medical field: freedom to serve with all of your energy while not contributing to population growth.
18
It can accommodate pregnant women and mothers. It chooses not to.
40
The simple solution is to set up a fair system that doesn't overwork and abuse surgical residents!
Who wants a fatigued frazzled surgeon operating on yourself because the "system" is organized that way?
47
@Wilson Woods
If you think that is a “simple solution”, then you don’t know the first thing about anything
3
For years male Med students and Residents have had wives who sacrificed to support the demands made on these men. They worked to pay for their husbands’ Med school and then stayed home to care for their children when they were born. The problem women doctors are facing doesn’t just lie with the Med school or residency programs, but also with the fact that their male spouses are not expected to make the same sacrifices to support their student wives. It’s extremely difficult for anyone who is married with children to go through medical training without the support and sacrifice of their spouse.
I am the daughter of a Med school professor whose wife put him through his PhD at Columbia and then stayed home to care for us as my dad’s career rose in stature.
93
My mother graduated from medical school in 1933 and eventually wound up teaching and practicing at Harvard and the MGH. She spent her lifetime fighting for funding and recognition of her research.
Much has changed since her time but there is still a long way to go for women in medicine
40
15 years ago...As a patient I experienced a young intern who'd gone without sleep for a very long time due to work and family schedules. In my experience he shouldn't have been allowed anywhere near a patient to diagnose anything. When my family doctor contacted the clinic because she couldn't see what my test results had to do with what I was referred for, the clinic claimed I had described a problem that required the tests they'd given me. My health insurance didn't want to pay full coverage for prescriptions for what I had because of the lacking test results. Probably none of this would have happened if medical students and interns did not face ridiculous demands based on 19th Century traditions of medical training.
it would good for everyone's sanity and health if doctors in all phases of their careers had time for private as well as working lives.
30
I think I’d be pretty upset to learn that my surgeon’s attention was more focused on picking her baby up at daycare than, say, the open-heart surgery she was trying to perform on me. Or scrubbing out of surgery to pump.
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@Possum way to miss the point
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@Possum
So you expect "your" surgeon to sacrifice all other aspects of her life to care for you.
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@Danica - I don’t think it misses the point at all. Medical residencies - and medical practice in general - requires extensive time and focus. It’s not a job you can just phone in. That’s not to say that residencies programs don’t need to be overhauled. I’d much rather see new parents in residencies be given a year off with pay, then feel constantly torn between work and their families. However, when a someone is in the OR, they cannot be distracted by anything else.
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As a patient, I want a surgeon who is experienced, focussed and alert. I don't want a surgeon pre-occupied or exhausted from caring for a child.
So, Yes, by all means have residencies that make accomodation for mothers and parents (female or male) with child-caring responsbilities. But to ensure they have the requisite experience, this means that shorter hours or parental leave will have to be offset by a longer residency period.
I am a female PhD scientist who went through graduate school and postdocs.
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@MBR
Just to be clear - you are advocating for a longer residency for surgeons?
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Another important aspect to consider is that program directors and attendings may not respect or implement (or - as is often the case - may blatantly disregard) the parental leave recommendations/requirements made by overseeing organizations. Significantly, programs often fail to implement or communicate any policies addressing how residents (male or female) should handle leave — this matters because without official policies, individual residents are forced to reinvent the wheel, are not confident of their rights, and often are faced with judgment by their superiors and co-residents, who are forced to cover for the absent new parent since there are not formal policies in place to accommodate parental leave.
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Strange that the dads barely get a mention. The one Dad mentioned is a lawyer. Does any family need a surgeon and a lawyer and babies all at once? Maybe just settle for a smaller house for a few years. I took a few years off to raise kids while my wife pursued her medical career.
I would be more interested to read about the kids who are being raised by strangers. As a parent it infuriates me to know a doctor would sent their 3 month old to daycare with a fever.
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@Sean, my husband is a surgeon, I am a lawyer, and we have a baby. I don't see how having a smaller house would mitigate our issues. Neither of just have a profession where we can take off a few years, but moreover, we actually enjoy our work, so we have no desire to take off a few years.
Also, kids cared for by nannies or day cares during the day are still being "raised" by their parents. And plenty of single parents and non-high earning parents are put in a position where they have to send their ill child to day care -- so I don't understand the particular ire directed at physicians. The lack of leave for ALL parents when their child is sick is the issue.
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Appreciate the challenges faced by female doctors, but the hours put in by physicians in general, and surgeons in particular, are necessary to provide good patient care. Why should patient care suffer because a physician wants a more comfortable lifestyle? If family considerations are paramount, choose a medical specialty where continuity of care is unimportant, such as radiology, pathology or emergency medicine. How many commentors here who advocate that we should change the system to accommodate maternal duties would be pleased if they were told the surgeon that has been caring for them is no longer available so she can take care of those duties? Speaking from inside the field, the best care is delivered by those who are devoted to their profession and who alter their life to accommodate their patient's need instead of their needs.
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Speaking from inside the profession, caring for the patient and having a family are not mutually exclusive.
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@Dr B
Are 80 hour weeks, with the potential for fatigue-driven errors, really good patient care?
Is the training regimen set up to serve the patient, or the hospitals’ desire to maximize OR utilization and revenue?
Does a shortage of surgeons lead to good patient care?
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@T Just recognize that there's a trade-off. If you want your surgeons to work 9-4 bankers hours, then be prepared to find an unfamiliar face operating on you when you have a post-op complication from a prior surgery.
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OB/GYNs are surgeons, and today's OB/GYN residents are overwhelmingly female. OB/GYN programs manage fine with many of their residents getting pregnant and caring for young children. Surgery programs can manage, too, if they try hard enough. There's no excuse.
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@Jay Not really. In the "bad old days" your ob/gyn was ALWAYS the one who did the delivery. Now it's 50/50 at best. With modern medicine turning into 9-5 shiftwork, when women are actually deliverying their babies it's often a stranger who shows up to do the delivery instead of your regular ob/gyn.
Maybe some people don't care who delivers their baby -- but I care and I want my ob/gyn to do it.
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To each her own, but there a lot of benefits to being cared for by a practice of OBs, rather than one specific one. I did it with all three of my pregnancies, and didn’t mind that The OB who delivered my babies was one I met when I was ready to deliver. I had long labors and never felt pressured to do unnecessary interventions bc the doc was tired or wanted to get home for something. I knew the docs had advance notice of when their shifts would be, so I wasn’t rousing them from sleep or taking away from a family event to attend my labor.
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In addition to supporting young mothers and fathers, better support for the other residents is equally important. If one resident is away, the work and call shifts must be divided amongst the others; this can lead to resentment and is likely the source of the many comments we see saying “you made this choice to have children, deal with it”.
Another huge culture shift would be if men actually took parental leave and destigmatized it.
One of the more senior male physicians (successful, hard worker, well respected) in my practice actually calls off or or leaves early when his kids are sick. It’s so refreshing and sets an excellent example for younger faculty and trainees.
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I had a child born at the University of Michigan hospital just a few weeks ago. It was a traumatic birth, one I’m still recovering from physically and emotionally. My surgeon and my entire OB team was female. I was grateful for this — it felt right to talk to other women during such a harrowing time.
Patients like me lose out when women aren’t supported in medicine. Kudos to the path breakers in this article who are making the way easier for other women. I hope your institutions step up and meet you at least halfway.
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I finished medical school in 1978. I wanted to be a plastic surgeon, specializing in treating burns and infections, but at that point in time I couldn't square having a marriage and a family with the long residency, fellowship, and demands of such a practice. It's too bad that I couldn't use my talents to serve in that way. The loss wasn't just mine.
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Hooray for the women who wish to be surgeons and moms! Excellent to hear that there is an identification process going on to see what work conditions need change and administrators willing to make changes.
The old saying is that a surgeon only needs "good hands" -- and that seems to be an innate attribute, not entirely trainable. Let's not toss out half of the pool of medical students (and it is reported that at least 50% of medical students ARE women) from a much needed class of doctors who are surgeons.
And the system of internship and residence still needs to change and be governed by more humane practices, rather than endurance contests. Let's hope that the pace of change picks up!
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Deciding to have a child is a choice...and it can be a wonderful choice. Deciding to return to a job that has long, inflexible hours that limit a parent's time with their children also is a choice. But these are choices that everyone is faced with. Should employees who do not have children be given time off/reduced schedules because they want to pursue things that are important to them? Being a physician is a privilege and one of the most difficult and important jobs out there. It requires significant training. If a woman or a man wants to pursue that training, they should give serious thought to the impact it will have on their home life and whether their spouse is willing to shoulder a bigger part of the home responsibilities.
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Making young surgeons adjust to the suboptimal status quo is not a solution. Working towards a new status quo in which ALL parents, regardless of gender, are better supported in the workplace is a better solution.
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@Steve There is a societal benefit to having children. It should be encouraged. Or do you plan to live forever? We should particularly encourage women who are intelligent enough to become doctors to have MORE children -- we need more smart people, not less.
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It sounds like you’re saying that a system that exists shouldn’t be fixed...a system created by men who couldn’t get pregnant and likely had stay-at-home wives.
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I’m a female physician 4 years out of training. The culture of self-flagellation in medicine is well exemplified by conflicts around maternity leave and parenthood, but extends to even more time-limited life circumstances such as severe illness/injury. I’ve known surgical residents — both make and female — who went into work with flu or GI illness because they feared retribution for calling out. Imagine being a patient or a co-worker in that situation. Culture needs to shift so that doctors of both genders are able to take care of themselves (and offspring) within reason. Maybe then there won’t be as much resistance and grumbling from male physicians when their female counterparts need provisions for maternity.
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@BN Indeed an accommodation that is good for one population (working women) will undoubtedly also be good for other populations. Think about what ADA did for people with non-disabling injuries - they also appreciate the accommodations. Seems that the people who don't want to accommodate are as usual old white men who don't want to lose their status or "dilute" the prestige of their titles. It's such a predictable response. .
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As a now-retired male surgeon, I can affirm all that is in this article. Nevertheless, life for surgical residents is better than was the case 40 years ago, and the ACGME now requires residency programs to make accommodations that were unthinkable in the past.
The challenge for all genders is being a parent and a surgeon. So many aspects of practice conflict with family responsibility: Handling emergencies that conflict with childcare availability. Dealing with your sick child. Carving out studying time for preparation for board exams. Need to complete continuing education credits. The medical system demands productivity, so family issues frequently reduce hours for patient care. Setting aside time for research and publication is very difficult. Finally, there is the inevitable need to complete documentation during off hours at the expense of family time.
It is absolutely true that young surgeons with children, especially women, face great challenges, which are most easily addressed by having a partner, spouse or parent step up to help, at their personal sacrifice. Double-doctor couples often have little support, and their clinical associates often want nothing to do with supporting young parents. I can only state, as a parent, that the sacrifice is worth it. Women surgeons must be supported because all of our families are better for it.
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@Jeff a challenge most easily addressed by a partner or spouse "stepping up to help"? Do you mean them essentially forced into be a single parent for a decade at a time? This system is not at all fair to the surgeons' spouses or the kids. It might feel "worth it" to the surgeon getting the support, but I think few members of their family think that this choice to live without their loved one--which is usually thrust open them--is a sacrifice that is worth it.
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I married my freshman sweetheart when we were 22. She had our 1st child during graduate school. She had our 2nd during medical school (she took a year off to do a post-sophomore fellowship in Pathology), and then had our 3rd during her 4th year of a surgical residency. I was working full-time during all of this. It took some creative scheduling, and some familial help. But we did it, the kids are emotionally healthy and productive, and we've been married for 25 years now. She is a general surgeon, and the breast surgeon for two hospitals. Our oldest is now 22, the middle child is 20, and the youngest is a freshman in high school. It's tough, but it can be done.
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@Neal We know it can be done, but it can be done better is the point.
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Only 40 percent consider dropping out?
When I was getting my PhD at a top program, I was one of three students who got pregnant at the same time. Highly unusual and the first pregnancies among the students in years.
100% of us considered dropping out and two of us actually did.
Considering dropping out when life is hard? Meh. That's called life during grad school.
I think these residents are largely managing to finish. I am not suggesting it is easy, but I do find that these med school articles are all missing the mark. Life is hard for all of us. Those of us with advanced skills can consider making changes.
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@Lydia
I'm sure these situations are difficult for everyone no matter the field, but a unique aspect of surgical and medical residency is the significant degree of debt on board (not the same in most other professions, especially not PhD) and many more years already invested in the field. Today many of us take gap years before and after medical school to compete for residencies, making it >10 years in the making to the point in time of these residents.
The fact that "these residents are largely managing to finish" is not proof that it is more doable, but may reflect the greater pressures to finish, no matter the consequences.
Though all training programs are grueling, especially for parents of young children, surgical training presents unique challenges that are long overdue for reform. Minimizing the experiences bravely reported in this article is only counterproductive.
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@Lydia The point is you shouldn't have to drop out because the system can easily make changes to address the very obvious reality that women of childbearing years give birth.
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I‘m sure grad school is hard. I also bet you have no idea what it‘s like to be a medical student, surgical resident, or attending physician/surgeon so your assertions that all these articles are “missing the mark” and “meh” are both completely unfounded and completely unhelpful. It‘s not a who’s-had-it-worse contest, and asking to make residency easier for surgeon-parents in no way stops you from caring about or trying to make grad school easier on grad students, or for anyone else in any walk of life for that matter.
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These issues are not the exclusive domain of female surgeons. All medical specialties, such as my wife’s (pulmonary critical-care medicine) have been deficient in providing the support systems necessary for practitioners to thrive. The grueling physical and psychological challenges facing mother physicians are the stress test that highlights our failure as a country to provide affordable child care for families that have limited options. We brag about our medical care being the best in the world but our child care for the practitioners in this system are rewarded by being left to fend for themselves, often at a significant price, either professionally or personally. I do not know why it is taboo to discuss these shortcomings and challenges with female physicians in training or medical students because,although disheartening, no one is doing them any favors by withholding the numerous anecdotes of doctors experiencing the exact same challenges over and over. Knowledge and understanding are key components to proper family and career planning.
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From personal experience, professional education and children mix like oil and water. I don't care; sometimes, the water needs some olive oil before you boil the pasta. If you accept the absolute need for compartmentalization, embrace the struggle, and live for the joy of the one and the honor of the other, you can make it.
Perhaps most abstract lesson is learning to build your support structure not with coworkers or students (professional schools exude the need for networking), but with humans you can rely on from any walk of life. It's actually simple when you think about it: If they like your kids and are dependable, keep them as close as you can. If they're the president of whatever association but can't stand your kids, find ways to keep them as a professional acquaintance, but don't expect much more. Maybe more simply, value your friends dearly.
On that note, date nights. Dear lord almighty, if you are still with your significant other, treat them well. I almost life my wife through the process.
And again, know that it is intense, insane, but doable.
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The author brings up really good points, but there is another huge problem not being explored here.
"She may go eight to 12 hours without eating, or even drinking water."
"The average resident earns $57,200 annually, a fraction of what their higher-ups at the hospital make."
This is daylight robbery. Residents work the longest hours and deal with constant abuse. Most are hundreds of thousands of dollars in debt. Yet, they're paid minimum wage when you factor in how many hours they work. How does the medical system get away treating them like this? The abuse needs to end.
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@LG Abuse? If you factor in how much a physician makes during their working career, they make significantly more than minimum wage. In fact, by the time they retire most physicians have made it into the notorious top 1% of wealth, and almost all are in the top 10%. Every student entering medical school knows this, which is why they willingly work the hours. Further, the hours are needed to be properly trained, and for years now have been much less onerous than just a decade ago, which was less onerous than the decade before that, which was less onerous than the decade before that. And constant abuse? What is the basis for that statement?
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@Dr B
Physicians do end up earning a good salary, but the benefits are so delayed and there is so much upfront cost that unless you go into the most lucrative specialties, you can usually do financially better with a lot less stress with 'normal' jobs. I have seen analysis of public school teacher salaries that come out ahead of primary care physicians.
But the final wage is besides the point when it comes to hands-on-patient care. It is abuse if you subject the least trained physicians to the longest hours, hardest patients, and most responsibility with least backup (after hours). This is good for NOBODY except the hospital owners/CEOs, who continue this practice not because it is good for patients (it is obviously the worst!) but because $50k/yr is 8x cheaper than an on-call surgeon at $400k/yr (which in my opinion is actually underpaid given the stress and responsibility of a surgeon)
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@agarose2000 I'm afraid you are unaware of the actual conditions under which residents are currently trained nor are you familiar with the degree of supervision required. For decades now, surgical attendings have had full responsibility for the care of their patients and supervision of their residents. The days of unsupervised care by overwhelmed medical residents are long gone (thank God).
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Another perspective: if you want a career that truly requires long hours and allows little flexibility, and you want to have children, find a wonderful spouse who loves children and can't imagine anything better than taking care of them...and you. All day, every day. For life. Don't worry, they're out there.
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@KLTG Many (most?) female surgeons don't want to marry stay at home dads.
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@KLTG There are not a lot of men who fall into that mold.
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In med school, decades ago, we found this riddle funny, and far from obvious:
"A father and child were in an accident. The father died, and the child was brought in to the operating room. But the surgeon took one look and exclaimed 'I can't operate on this child. He's my son!' - How is this possible? - - - drumbeat - - - The surgeon is the child's mother."
Not so funny anymore.
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@BGZ123 Dear God, I remember that riddle! Except it was a mind-bender and not a joke the way I heard it: Like, if the father died HOW can a surgeon be the parent? The father/surgeon is dead! Oooh, wow, it's the mother! (As a girl, I remember even I didn't think of the possibility.)
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@BGZ123
Yet to this day, the riddle still stumps many!
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I don't really see a problem with acknowledging that certain aspects of life aren't compatible with one another; I know many surgeons, and for the bulk of their time, surgery (and saving lives) is their top priority. The physical and emotional requirements of motherhood are often incompatible with those requirements. Why act as if that's a crime? No one is guaranteed the right to "have it all."
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@PW there is a real shortage of qualified surgeons. Why not provide more support to those pursuing that field? WE need these women in medical practice. Talk to the wives of the male residents and I bet you’d find another struggling population. They need to act as single parents - I bet access to some of the similar supports would ease the minds of their med student husbands too. It doesn’t have to be this hard. We choose to make it so.
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@PW
This type of thinking is short-sighted, and has been proven wrong repeatedly in the field of medicine.
This was the mentality back in the old-boys club, where no women were allowed, definitely no moms, and if you did somehow get in as a woman or minority, you were hazed relentlessly just to prove your worth and toughness.
It was only by not allowing this abuse and bullying that the system gradually changed over decades, and for the better. In fact, most of medicine is now at parity of male-female pay and prestige, and a model for other professions, which is remarkable for such a male-dominated field previously.
There is no reason why similar humane advances in training cannot be applied to surgery to facilitate childbearing.
But ultimately, the best, most compelling reason to do so, is that it makes the doctors more humane, caring, and better providers to all walks of live. This is undeniable, and it is our folly to ignore this just due to a closed mind to new approaches.
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Why? Because there is considerable evidence that having gender and racial diversity in physicians improves outcomes. Because physicians with better emotional and physical health, which does include having family and social ties, provide better care. Relegating women to second-class citizenship and locking them out of certain professions because you don’t value their contributions may not be a crime, but it certainly isn’t the society that some of us wish to live in.
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The surgeon who saved my life actually went into labor as she put me back together again. This was her second or third child. She was brilliant, no-nonsense, determined and more. She had to be twice as good as everyone else because she was doing something that few people can manage to do. The stress is horrendous. It is so terribly unfortunate that our system can not accommodate women who both want to excel at their chosen professions and be mothers. Having practiced law in NYC for 25 years while raising two children, I know how it feels.
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