American College of Physicians: Internal Medicine — Doctors for Adults ®

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Changes in medicine's mommy track

Shifting demographics and more physician mothers mean new opportunities—and worries

From the December 1999 ACP-ASIM Observer, copyright © 1999 by the American College of Physicians-American Society of Internal Medicine.

By Deborah Gesensway

If there is a fast track in academic general internal medicine, Lorna A. Lynn, ACP­ASIM Member, was on it. At 35, she was an assistant professor at the University of Pennsylvania Health System and had won a Robert Wood Johnson Foundation faculty development award to support her research.

Then, when her first child was born, she left the fast track for a self-styled "mommy track." First she took an eight-month, mostly unpaid leave of absence to care for her newborn. She then returned to part-time work at Penn.

Soon thereafter, Dr. Lynn quickly realized that her attitude toward her career had changed. "I wasn't prepared for my own emotional response to my baby, which was that I really didn't want to be away from her," Dr. Lynn recalled. "At first I thought it would be good for my baby for me to be home, and then I realized that it was good for me. Life is short, and this is what I want."

Five years and a second child later, Dr. Lynn's career has taken other unexpected turns. She first jettisoned her research duties, and then she cut her hours. Eventually, she realized that even her part-time job at Penn was pulling her in too many directions. This summer, she changed jobs and went to work for the American Board of Internal Medicine—part-time—as its director of recertification development. It's a post that fulfills both her professional desires and her domestic needs—at least for now.

As Dr. Lynn sees it, medicine doesn't have a specific "mommy track" into which the profession exiles people like her. Instead, she said, "there is a lot of possibility for doing things outside of the traditional track."

While there may be no formal career track for mothers in medicine, physicians trying to juggle work and family are a growing part of physician practices and medical school faculty. As more women join medicine—particularly internal medicine—growing numbers of physicians are following Dr. Lynn, designing their own personal "mommy tracks."

Not everyone, however, is as sanguine as Dr. Lynn about the opportunities they are encountering. Some women face negative attitudes from colleagues who resent having to pick up the slack, while others find that logistical concerns about coverage keep employers and partners from changing. But probably the biggest concern of all is the fear that once female physicians get on the mommy track, they may have trouble getting off and re-entering the fast track.

Limitations

A look at physician demographics shows how working mothers may soon change the face of medicine. While 20% of internists between 45 and 54 are women, 30% of the younger generation of internists—those between the ages of 35 and 44—are women. That dramatic demographic shift is set to continue: Women make up nearly 36% of internal medicine residents and fellows. This fall, 46% of U.S. medical school freshmen are women.

While male physicians increasingly share concerns about flexible work conditions, signs indicate that it's the careers of women, not men, that come second to child rearing. A study published in Annals of Internal Medicine in the fall of 1998 compared full-time women faculty with children to their female colleagues without children and to male faculty with and without children. Researchers found that on average, the women who had children worked fewer hours, were published less frequently, thought their careers were progressing more slowly and were less satisfied with the progress of their careers than any of the other three groups.

"There is a gender difference within the family track," said Phyllis L. Carr, ACP­ASIM Member, an instructor in medicine at Harvard University and author of the study. She said that while the careers of women in the study seemed to suffer, when men with children were asked the same questions, they answered much more positively. In future studies, Dr. Carr said, she hopes to examine possible causes of this trend, such as the amount of support—both at work and at home—working mothers have compared to working fathers.

That hypothesis certainly rings true for Deborah J. Ziring, FACP. For the last six years, Dr. Ziring has carved out a nontraditional post, working part-time as an assistant professor of medicine at MCP Hahnemann University in Philadelphia. She also is raising three children, ages 7, 5 and 2. Her internist-husband continues to work a full-time, traditional academic medicine job.

If a child gets sick, who cancels their patients? "My husband is more flexible than a lot of people, but I think it's been clear since I went part-time that my career is secondary to his," Dr. Ziring said. And although he hasn't been promoted yet, he was just rewarded with one of the top administrative positions in his group. She, on the other hand, does not even have the option of promotion and has not had a raise since 1993, when she first negotiated the terms of her part-time position.

While Dr. Ziring accepts the conditions of her career, she said she knows women who have dropped out of medicine altogether. They simply could not find a satisfying job that would let them work the hours they needed to be able to raise a family the way they wanted to.

Part of the problem, Dr. Ziring explained, is the attitude of other physicians. "I don't think medicine has come far on this front at all," she said. "In the beginning, I used to get a lot of comments about the 'mommy track,' like 'It must be nice to work part-time.' There's a perception that you're only working part-time, so you're out golfing the rest of the day. But it's not like I'm going home to put my feet up. I'm part-time because I have other responsibilities."

Despite such complaints, Dr. Ziring said she is certain that she made the right choice. "When I gripe about the fact that I haven't gotten a raise in six years or that people I trained as medical students are being promoted past me, I look at my 7-year-old and think I've spent so much time with him that I otherwise wouldn't have been able to," Dr. Ziring said. "It's well worth the tradeoffs."

One key: flexibility

Experiences like Dr. Ziring's raise important questions about how internal medicine will deal with the changing face of its workforce. Felice N. Schwartz, who wrote a controversial article in the Harvard Business Review 10 years ago that popularized the "mommy track" concept, argued then that businesses need to create policies to help mothers balance career and family responsibilities if they want to avoid losing the talents of their women in management. Women workers, she asserted, are not carbon copies of their male colleagues, largely because of their primary role in child rearing.

The track she proposed—which detractors proceeded to call a "mommy track"—would be characterized by flexibility. Women who took advantage of this flexibility, she said, would have to accept that the rates of pay and advancement would be "appropriately lower for those who take time off or who work part-time than for those who work full-time." As professionals, they would also have to agree that half-time means half of the time needed to do the job, not simply half of 40 hours, she said.

There are signs that some in medicine are giving physicians with children this kind of flexibility. Martha Gerrity, FACP gave birth to her second child in May and was promoted to associate professor at Oregon Health Sciences University in Portland last July. She has been able to juggle full-time work with child rearing largely because her bosses at the hospital agreed to limit the amount of time she spends seeing patients. That way she can continue writing, teaching and remain active in administration—duties that could lead to a promotion

"There had been talk about increasing the clinical amount, but we talked very frankly about my need to have flexibility and that I'm not going to be as productive for the next year or so with a young baby as I had been, and they completely understood that," Dr. Gerrity said. The other thing that has helped is that her husband, who is not a physician, does the bulk of the housework while she brings in the lion's share of the family income.

The fact that Oregon's medical school does not have an up-and-out promotion system, in which faculty must be promoted in a certain number of years or lose their job altogether, also helped—at least psychologically—to take the pressure off and help her succeed, Dr. Gerrity said.

Other medical schools are also working to accommodate physicians with home responsibilities. Some have created clinician-educator tracks where physicians don't have to generate funded research in order to qualify for promotion. Others, like the University of Pennsylvania Health System, allow physicians with children under age 2—or who have to care for a sick relative—to request one-year extensions in their tenure or promotion deadlines.

Penn instituted its policy in 1997 in response to the federal Families and Medical Leave Act, explained Vicki Mulhern, director of faculty affairs. She noted that she has been surprised that some male physicians have been afraid to ask for this type of extension because of worries about how the tenure or promotion review committees will react. "Women come right out and ask for it, but a couple of men have called and asked whether it will be considered a weakness," she said.

In private practice, being both a mommy and an internist requires different solutions. When Sandra Adamson Fryhofer, FACP, a general internist in Atlanta and the College's President-elect, gave birth to her now 10-year-old twins, there was no maternity leave. But because she was in solo practice, she could choose not to schedule patients when she had a parent-teacher conference or another home-work conflict. The result may have been that she earned less that day, but it was her choice.

Now that her practice is owned by the hospital, she no longer has that kind of control over her schedule. For a while there wasn't even flexibility about the time of physician staff meetings, which used to be held at 6:30 a.m. That was when she needed to be home getting her children up and off to school.

One of the keys to successfully juggling private practice and family, Dr. Fryhofer said, is having support. She recommends internists spend their money on good nannies or housekeepers and share call with an understanding group of colleagues. They also need to make sure they do their fair share, says Dr. Fryhofer.

"What goes around comes around," she said. "If you try to help other people be flexible, then they will turn around and do the same thing for you." She recalls fondly the baby present her call group gave her when the twins were born: no call for three months. "Some of them were fathers," she said, "and they knew what it was like."

Getting off of the mommy track

While some institutions are making changes to accommodate working mothers, Dr. Fryhofer's experience is a good example of how many individual physicians looking for flexibility have to invent it themselves.

"It's still left up to the individual to figure out individual solutions, which is very inefficient," said Janet Bickel, assistant vice president for women's programs for the Association of American Medical Colleges. "There are very few institutions that have taken this on as an institutional responsibility, recognizing that this is going to increase retention and productivity in the long term. I'm convinced a lot of the women who leave [jobs in academic medicine] do so in order to have more flexibility and time with their families, and more men leave to advance their careers."

And because medicine in general has been slow to adapt to having mothers in its workforce, many women worry that if they take some time to care for their family, their careers will suffer.

One female internist working in academic medicine said that because there is so much resentment against women physicians who don't work the same types of schedules as men in her department, she tries to do her job and not talk about perceived slights like pay inequities or scheduling problems. Another wondered what might happen sometime in the future if she wants to get off her self-styled mommy track and back on the regular academic track, competing for grants and bucking for promotion. (Several women internists contacted for this article asked that they not be named in this article, fearing that their careers would be damaged.)

Terri Tuckman, MD, chair of the American Medical Women's Medical Association's personal development committee, is a radiologist at Thomas Jefferson University Hospital in Philadelphia who works part-time and has two children. "I would hope that as my children get older, if I wanted to switch back [to a full-time, academic track] I wouldn't have been cast in a way that I could never get out of," said Dr. Tuckman. "But I don't know."

Because of such concerns, physicians who have successfully left the mommy track are often viewed as role models by younger physicians. Virginia U. Collier, FACP, vice chair and residency program director in the department of medicine at Christiana Care Health System in Newark, Del., took just such a path.

After training at Johns Hopkins, Dr. Collier followed her physician-husband to his dream job, not hers: private practice in a very small town on Maryland's Eastern Shore. There, she ended up in solo practice as the only board-certified internist in a three-county area. She had three children, now 18, 16 and 14.

In time, however, she was able to get back into academic medicine—the career she might have chosen if she hadn't had a family—and to work her way up that career ladder to her present post. She is also Governor-elect for ACP­ASIM's Delaware Chapter.

"In my case, career decisions were influenced to a greater extent by whether or not I had children than my husband's were," Dr. Collier said. "But I don't think there is a formal 'mommy track' in medicine. One of the good things about medicine is that, in general, you make your own decisions. At least from my perspective, you are not being channeled into it. Whether that is a 'mommy track' or not, I think women are in charge of it."

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