On 8/21/2019, The New York Times published an article by Claire Miller entitled, “How Medicine became the Stealth Family-Friendly Profession.” The article, linked here, which touted medicine as a field with flexibility essentially due to female physicians’ ability to spend more time with their families by changing to a different specialty or reducing their hours (and pay), has garnered significant feedback and criticism. As a staunch advocate for gender equity in medicine, Dr. Ariela Marshall joins us on the blog to add her own comments to the discussion.
The story starts with a female physician training in an intensive specialty who becomes pregnant. Per the article, “she couldn’t imagine 80-hour workweeks with two newborns at home, while her husband was doing an equally intensive radiology fellowship. But she didn’t leave the profession. Instead [she] decided to practice internal medicine and geriatrics, with more control over her hours…medicine has changed in ways that offer doctors and other health care workers the option of more control over their hours, depending on the specialty and job they choose.”
This frames the issue as one of “choice” – either leave medicine all together, or choose a specialty with fewer hours. However, this doesn’t seem like much of a choice to me – either give up the specialty one is truly passionate about or give up medicine for good (the latter likely impossible due to huge student loans). And also the gender equity elephant in the room: nowhere did the author discuss that another “choice” could have been for this physician to continue her fellowship while her husband changed from an “equally intensive” fellowship to either leave medicine all together or choose a specialty with fewer hours. The additional issue here is the idea of “control” over one’s hours. This is erroneous, for the most part. Research demonstrates extremely high rates of burnout amongst physicians of both sexes – and indeed higher rates in women than in men – and one of the key drivers of burnout as proposed by Shanafelt and Noseworthy in their 2017 paper is “control and flexibility.” Medicine in general is not a specialty that lends itself to control over ones’ hours – especially for those in non shift-work specialties but in reality for all physicians. The illusion of “more control” is erroneous.
The author reports that, “specialties with shorter hours and fewer emergencies, like dermatology, attract more women; those with long, inflexible hours, like cardiology, have more men.”
[Note: Part of this response was quoted in Forbes, available at: https://www.forbes.com/sites/miriamknoll/2019/08/23/female-physicians-reject-good-enough/#3adf59f963ca]
Factually this may be true. However, this is again an incomplete exploration of the current status of women in medicine. First, let’s look at the graphic comparing hours worked versus percentage women in the specialty: the “lowest” tier of hours worked is 40 hours/week, and the numbers increase to 80 hours/week or higher. For almost any other profession – especially professions where workers are paid a salary rather than paid by the hour with bonus pay for overtime (there’s no overtime in medicine!), 40 hours/week is standard. Saying that physicians who work ONLY 40 hours/week have a “family friendly” benefit of shorter hours discounts the long hours that all physicians, both male and female, devote to their responsibilities. Additionally, the statement that it is the number of hours in a specialty that is responsible for attracting women versus the men to the specialty is a prime example of correlation without causation. In fact, specialties dominated by men are likely to attract more men because of increased access to mentors and sponsors, career development opportunities, and support for “like-minded” individuals. There is no question that medicine is rife with sexual harassment – most often committed by men towards women – and both harassment itself as well as the “bro culture” and lack of female mentors and role models is likely responsible for a good percentage of career decisions that women make about what field to enter, rather than the hours the specialty requires.
One of the most troubling statements in the article: “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.”
The author seems to congratulate the medical field for shrinking the pay gap to “only” 82 percent – but the way I see it, a woman being paid 80 cents to a man’s dollar for doing the same work is completely unacceptable. There is almost no further discussion to be had on this point.
Significant evidence argues against medicine as a “family-friendly” profession, and I would like to address just a couple of additional points using some of the excellent research in gender equity in medicine.
A study by Shanafelt et al published in 2016 found that both male and female physicians were significantly more likely to report that their career had a negative impact on their relationships with their children than non-physician members of the United States working population. And specifically for female physicians, research by Buddeberg-Fisher et al in 2010 found that female physicians are less often to have mentors and less often to aspire to senior hospital or academic positions than male physicians (and, as in the New York Times article, consider part-time work more often) – and that “any negative impact on career path an advancement is exacerbated by parenthood, especially as far as women are concerned.” Additionally, even for those female physicians who remain employed full time, Jolly et al reported in 2014 that then spent 8.5 hours per week more on domestic activities than men (after adjusting for work hours and spousal employment). It seems to me ludicrous to claim it is “family friendly” for a female physician to suffer from lack of mentorship and career advancement, spend an increased amount of time on housework compared to her partner, and suffer from the negative impact of her work on her relationship with her children.
Additionally, nowhere did the author mention the many female physicians who wish to have families but are unable to do so. Whereas infertility affects approximately 1 in 8 women in the general population, work by Stentz et al published in 2016 found that almost 1 in 4 female physicians suffer from infertility – a rate twice that of the general population! This may be due in large part to the long years of training required to become a physician (with accompanying delay in trying to start a family) as well as other factors related to maternal/child health for those working long hours while pregnant. To call a field associated with a twice-normal infertility rate “family friendly” is (oxy)moronic.
Medicine is a wonderful profession in many ways. It offers a chance to help individuals and society at a high level while providing continuous intellectual stimulation. However, we must recognize that the picture is not entirely rosy. Medicine is also demanding, time-consuming, and places physicians at risk for burnout and lack of satisfaction with work life integration – especially female physicians. While we hope that in the future medicine will be “family-friendly,” at the current time it is difficult to claim that it is.