Sunday, December 4, 2011

The Mommy Card

     I'm not exactly sure why I went into medicine. I did not grow up, dreaming of being a nurse or a doctor. In high school, my dreams were more along the lines of being a "starving artist" in Paris or becoming a chef. The series of events which launched me first into nursing, and later into medicine, are almost too convoluted and unbelievable to enumerate: if you knew me back in the early 80s, you would be surprised that I was alive today, and even more surprised that I had become a physician. Despite this seemingly remarkable accomplishment, I don't view myself as a doctor first, and then as a mother or wife or artist. I am all of those things, together.   
     With females comprising about half of medical school applicants, the topic of physician-moms in the American workforce has generated a great deal of speculation and controversy, especially with regard to those who choose to work part-time. It's a very touchy subject among us. One of my former anesthesia residents, a new mother who has recently gone back to work, shared with me an article concerning women who doctor part-time, entitled "Don't Quit This Day Job." The article, written by Karen Sibert, a female anesthesiologist and mother of four, was hard to stomach. On a superficial level, she addressed aspects of the purported U.S. doctor shortage, citing governmental policy, such as Medicare spending cuts and the subsidy caps Congress has imposed on medical education, along with physician attrition resulting from decreased reimbursements and the lack of tort reform, as major influences. On a deeper level, however, she conveyed a troubling sense of contempt for women in medicine who choose not to be defined by their careers. She suggests that since salaries during residency are funded by Medicare dollars, physicians who work part-time are robbing American taxpayers of their investment. She alleges that female physicians are less productive than their male counterparts, seeing fewer patients and working about 4.5 hours less per week, regardless of whether they work full or part-time. Elaborating on this disparity, she sanctimoniously asserts that the shortage of primary care doctors in under served areas, and the ensuing increase in utilization of emergency services, preventable hospitalizations, and deaths from treatable conditions, is a function of physician part-timers, who by and large, happen to be women. In summary, she suggests that women who practice part-time are somehow less committed to our profession, and that they are shrugging off their moral duty to take care of patients.
     I found much of what she had to say insulting, demeaning to women, and inaccurate. She omits any discussion of the fact that close to 50 million Americans have no health insurance, and that this lack of access, along with few incentives for physicians to practice in medically under-served areas, are the real reasons why people go to emergency rooms when they are sick, generate unnecessary hospitalizations, or die because they've waited too long to have that fungating breast mass evaluated. Her emphasis on physician productivity does not seem to take into account the crumbling infrastructure of the American health care system, rife with bureaucracy, bought out by big business, and gradually folding under the weight of the costly medications, equipment and interventions, which are so vital for the damage-control style of medicine we have been forced to practice. She wants us to just suck it up and fulfill what she considers to be our 24/7 moral imperative to serve. She does not quantify how many hours of service it would take for a physician to achieve a satisfactory return on the taxpayers' investment, nor does she mention that residents work up to 80 hours per week for a relatively meager salary, often exiting residency with several hundred thousand dollars' worth of student loan debt. She neglects to mention that women tend to spend more time with their patients, a trait which could be interpreted as having a greater priority on quality of care. One could postulate that the female doctors who work a few hours less, but have managed to achieve a happy balance in their lives might actually be more productive than an unhappy physician who works more. Choosing to work part-time implies motivation other than money. I've had plenty of colleagues who genuinely seem more interested in making money than they do about patient care, as well as colleagues whose primary focus is centered around patient care and advocacy, with income being a secondary concern. Looking at it from that perspective, which group seems more altruistic? She admonishes that "you can't have it all", and the innuendo suggests that female physicians who engineer their lives to spend more time with their families are somehow playing the mommy card.
      We have come a long way, baby, but we've still got a long way to go. We still have a tremendous gap in gender equality at home and in the workplace. In households where both husband and wife are professionals and are both working full time, women are still performing twice the amount of housework, and three times more childcare. We continue to be saddled with the burden of responsibility for care-giving at home, regardless of how many hours we put in in the workforce. There's the proverbial "bitch" factor we all have to deal with: success and likability are positively correlated for men, and negatively correlated for women, and this is no different in medicine. We're damned if we do, and damned if we don't. And, perhaps most alarmingly, new female physicians are being paid less than their male colleagues, a trend which has quintupled since 1998, and cannot be explained by their choice of medical specialty, the number of hours they are working, or the type of practice setting they choose. With fewer women entering primary care specialties, this trend is especially disturbing. What we need right now is some advocacy. We need strong voices from within the profession telling us, "you CAN have it all!" We should not have to sacrifice our unique roles as females for the sake of our profession; our profession needs to welcome us as the brilliant mothers, wives, significant others, and physicians that we are, and for all that we bring to the table. Compared to our male counterparts, we tend to underestimate our own abilities, giving credit to everyone but ourselves. We have to start owning our success and negotiating for what we want, need and deserve. What the world needs now is more of us, because whether we choose to work full-time or part-time, our contributions to our patients and society at large are invaluable. Sisters, we need to occupy!
Dr. Femina
       When I was 17, my father told me "You are who you choose to be." I truly believe this. I am the architect of my own life, and I own my successes and my failures. I refuse to accept the status quo, or the notion that "it is what it is, and it's not gonna get any better." Being someone's mom has definitely made me a better doctor. Let's begin embracing and celebrating our womanhood within this amazing profession we've chosen, accepting nothing less than equality, and use our female superpowers to transform the world of medicine into a better place for the next generation of Dr Feminas.

Don't Quit This Day Job
     
Why We Have Too Few Women Leaders

7 Arguments in Defense of Women Who Work Part-Time

Gender Gap in Physician Salaries is Growing
    
   

3 comments:

  1. I'm glad you respond to Sibert here bec I think you make all the points I'd want to make. Compassion is what helps create a healer and her comments seem cold and hostile toward anyone who wants a full and rich life. GREAT art, too!

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  2. Thanks, Helen...I appreciate your feedback! I painted "Dr. Femina" when I was in medical school; the painting is on permanent loan to my big sister, Edina.

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  3. No way, there is no way that the article you are refering to was written by a physician. It's so keyhole like view. Poor thing seems to be so isolated, no children, no significant other, no parents to take care of or community to be part of...
    You got it, Kris, it's all about balance. We all have responsibilities to multiple receivers: patients, family, ourselves and community. The key is to give it all you have, mental full time if you will. Love the painting!!

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