Physicians "opting out:" gender and medical education as a privilege, not an entitlement

Karen S. Sibert, MD, a Los Angeles anesthesiologist, raises the alarm about the looming shortage of doctors in the U.S., and notes that this is especially alarming given the trend among younger women doctors to work part-time at a moment when they’ve become more than half of all primary care physicians in the U.S.  (H/t to commenter Susan for this one.)  Sibert writes in the New York Times this morning:

[I]ncreasing numbers of doctors — mostly women — decide to work part time or leave the profession. Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time.

This may seem like a personal decision, but it has serious consequences for patients and the public.

Medical education is supported by federal and state tax money both at the university level — student tuition doesn’t come close to covering the schools’ costs — and at the teaching hospitals where residents are trained. So if doctors aren’t making full use of their training, taxpayers are losing their investment. With a growing shortage of doctors in America, we can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine.

It isn’t fashionable (and certainly isn’t politically correct) to criticize “work-life balance” or part-time employment options. How can anyone deny people the right to change their minds about a career path and choose to spend more time with their families? I have great respect for stay-at-home parents, and I think it’s fine if journalists or chefs or lawyers choose to work part time or quit their jobs altogether. But it’s different for doctors. Someone needs to take care of the patients.

I think she makes a number of great points, but I wonder why she casts this as purely a problem of female fecklessness?  For example:

Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especiallyto consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.

I recently spoke with a college student who asked me if anesthesiology is a good field for women. She didn’t want to hear that my days are unpredictable because serious operations can take a long time and emergency surgery often needs to be done at night. What she really wanted to know was if my working life was consistent with her rosy vision of limited work hours and raising children. I doubt that she welcomed my parting advice: If you want to be a doctor, be a doctor.

You can’t have it all. I never took cupcakes to my children’s homerooms or drove carpool, but I read a lot of bedtime stories and made it to soccer games and school plays. I’ve ridden roller coasters with my son, danced at my oldest daughter’s wedding and rocked my first grandson to sleep. Along the way, I’ve worked full days and many nights, and brought a lot of very sick patients through long, difficult operations.

Have we completely given up on the idea that men have a role to play in creating a fairer and more just world?  Or is all revolutionary change up to women alone?

I agree with the thrust of her commentary, and I really like her point about the moral obligation to use one’s medical education in the service of others.  But why do we see “work-life” issues as constructed as something only teh wimminz need to worry about?  Why isn’t anyone asking college men to think about the impact of their career ambitions on any future spouse or children they might like to have?  Maybe more importantly, why isn’t anyone asking men who want to marry doctors to think about the consequences of their spouse’s career on their future possible family lives?  Why aren’t they expected to step up and pick up the slack on the domestic front, the way that “doctors’ wives” are assumed to do?  Medicine is not like just any other job–the hours are often long and inconvenient (especially in primary care). 

An unspoken cause of a lot of these defections is that a large number of the heterosexual women in primary care are marrying male classmates who are aiming to train as specialists in higher paying sub-specialties.  At least, that’s my guess based on the number of women pediatricians I’ve heard of in the past decade who have quit because they’re married to cardiologists or surgeons who need to move to this or that major metro area, and primary care docs are in general more needed outside of major metro areas.  This means that these pediatricians end up in places that tend to be oversaturated with docs, and they’re not free to take jobs in the rural and underserved places in the U.S. that truly need doctors.

Once again, we’re told that “you can’t have it all.”  But which “you” is the author addressing–is this generic advice for all young aspiring physicians, or just for women docs?  (Why is this old cliche always aimed at elite women, when really it’s elite men who’ve been having “it all” all along?  Of course, I forgot:  ambition in men is aggression in women.  Expecting your due is fine in a man, but it’s selfish in a woman.)  In short, I wish that Sibert had encouraged just as much reflection on this among men as she’s urging on young women, because I think the issues she raises about that “real moral obligation to serve” should be considered by all medical students.  The cardiologist or surgeon who expects his pediatrician or family practice wife to trot along behind him to follow his career is at least equally guilty of the cavalier use of public resources as she is. 

What do the rest of you think?  (I should think some primary care types might take umbrage at being lectured by an anesthesiologist!)

56 thoughts on “Physicians "opting out:" gender and medical education as a privilege, not an entitlement

  1. Nicoleandmaggie, you’re conflating hours of experience with years in practice, when the entire point is that they are not the same.

    Sure, doctors who are up on modern technology are better than those who aren’t. Fine, recent med school grads have advantages over doctors who don’t resolutely stay on top of advances, in that respect.

    The question is that *within each cohort* who do you prefer, those who work more or those who work less?

    Recent grad who has 1 year post-residency at 20 hrs/week, 40 hrs/week, 60 hrs/week, or 80 hrs/week? That’s the question.

    You say that because babies don’t remain babies forever, this is a short-term decision women are making. Of course that’s true for some. But the “short-term” (how many years is short-term?) aspect of this decision is certainly not true for MANY women who opt out, including those who originally intend for the arrangement to be short-term but find out later that opting back in isn’t as simple as they assumed.

    I’m all for making it simple. But I think it’s a joke to pretend that it IS already, or to assume that there’s no substantive difference between working a full time paid job and…NOT. The mommy track is the mommy track.

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  2. Pingback: These… are the Links of our lives. « Grumpy rumblings of the untenured

  3. I’m still scratching my head over this one. Do NO male doctors choose to be part-time when they have young fsmilies? is this because their partners give them a choice? Having never been part time for one second, I’m just envious of people who do have that choice!

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  4. I am a medical doctor who has left clinical medicine.

    Just because someone completes a medical degree does not mean that they are endebted to anyone to continue in the field. Many factors influence people to study medicine, and factors change over peoples lives they give priority over career! Career is not everything. Family and relationships have been shown to be more important than career in most studies.

    Their is no debt to society for having a medical degree anymore than a lawyer must practice law, or a political scientist must be a politian.

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  5. I couldn’t have said it better myself. “you go girl, dr. sibert!”

    I’ve been complaining for years that our society has been misleading women about the fairy tale of being able to have a “power career” (yeah, we’re doctors, not secretaries, teachers, or nurses), be a great wife, and a great mother. it just doesn’t work that way with doctors. some aspect will invariably suffer.

    blah, blah, blah, the part-time doctors are part of a team or deserve a “balanced” life. in my practice, the part-timers take the same amount of call as us “full-timers” lest they be seen as slackers.

    sorry, but when it comes to medicine, women need to PULL UP THEIR BIG GIRL PANTS AND JUST BE DOCTORS.

    S

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