For female physicians, balance is an ongoing struggle
From the January ACP-ASIM Observer, copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.
By William Hoffman
When Susan Thomson Hingle, FACP, finished her training four years ago, she dreamed of becoming a residency program director and having an ambitious career in medicine. She got off to a promising start when she joined the faculty of Southern Illinois University School of Medicine in Springfield, Ill.
Since Dr. Hingle settled down and married, however, she has found balancing work and family more difficult than she ever expected. As she considers having children, she wonders how motherhood will affect her ability to do her job—and advance her career.
Dr. Hingle's anxiety illustrates the worries many young women internists say they face. While all doctors are concerned about increased workloads, burgeoning overhead, clinical autonomy and career growth, female physicians say they face unique challenges.
Women have made tremendous headway in a profession once completely closed to them, but many still struggle to balance their professional and personal lives. Female physicians are expected—and often expect themselves—to be the primary homemakers and caregivers in their families, according to Linda Hawes Clever, MACP, chief of occupational health at California Pacific Medical Center.
Dr. Clever and others noted that many women doctors start their careers by trying to give 100% to both work and family. The problem, many discover, is that very few people can sustain the effort to have it all.
Faith T. Fitzgerald, MACP, a professor of medicine and assistant dean for students at the University of California, Davis, in Sacramento, said that she has seen sea changes during her 30 years as an internist. As female physicians have grown in number from 10% of the UC system in the 1970s to approximately 40% today, she noted, sexist jibes have become a thing of the past.
"Militaristic" residency schedules of 100 to 120 hours a week eased as women's numbers increased, she explained, and both sexes benefited from the more humane work conditions. "Women have in a sense feminized medicine as a career," said Dr. Fitzgerald, who is a former ACP-ASIM Regent and Governor. Women's growing influence in medicine is in part due to simple demographics. Workforce figures show that women now make up 43% of the nation's medical students, 37% of residents, 27% of full-time medical school faculty and 23% of practicing physicians.
For women doctors, the good news is that many say they personally experience very few instances of outright bias. The downside, however, is that many have felt held back or conflicted by the demands of family and home.
Figures from the Association of American Medical Colleges, for example, show that 11% of women professors have earned full professorships. By comparison, 31% of male professors have earned full professorships.
Because a career in medicine is so demanding, it exacerbates the tensions between work and family for male and female physicians alike. But for women, who traditionally have played the role of family caregiver, those tensions can be even more acute.
Women faced with the competing demands of career and family say that choosing personal priorities is key not only to career success, but also to their sanity. "I don't think you can feel as committed to one thing when you are committed to two," said Sarah Warren-Asbill, ACP-ASIM Member, a general internist with Carolina Internal Medicine Associates in Asheville, N.C.
But making those choices can be difficult—and unpopular—in a profession that values single-minded devotion to medicine. Cecily Peterson, ACP-ASIM Member, planned to leave her job as director of intern training at Madigan Army Medical Center in Tacoma, Wash., last summer to follow her husband to North Carolina so he could finish a urology fellowship. "I never had pressure from my husband to come with him," she explained, "but from colleagues to stay behind without him."
Women are often the ones who make compromises to better balance career and family. When Dr. Warren-Asbill learned she was pregnant last September, she decided that her career—not that of her physician husband's—would take a hit. She volunteered in part because her husband works at a busy, nearly all-male cardiology practice that they felt would be less accepting of a physician taking parental leave.
Looking back, Dr. Warren-Asbill said she was happy to be the one to stay home. "If both of us had an even choice, with no sacrifice of salary or career, we might have had a fight," Dr. Warren-Asbill explained. "We both wanted to stay home" with the baby.
While many female physicians interviewed for this story said that they were glad they had put family ahead of career, they nonetheless wondered how their decision will affect their careers. Dr. Warren-Asbill, for example, said that while she has no regrets about her decision today, "three or four years down the road, I may feel very differently."
And physicians like Dr. Hingle from Southern Illinois University who have not yet made the choice said they often wrestle with similar conflicts. Though Dr. Hingle said her colleagues have been supportive of her desire for family so far, she worries about letting her colleagues down.
She wonders if having children will erode her commitment to giving "110%" to her medical career. She also worries that she won't be as good a role model to younger women if she doesn't advance her career.
A different environment
Back in the early 1970s, when she was a fellow at Bellevue Hospital, Martha G. Regan-Smith, FACP, professor of medicine and coordinator for faculty development at Dartmouth Medical School in Hanover, N.H., heard stories about women physicians who got pregnant. Colleagues counseled them to have an abortion, residents shunned them and job opportunities suddenly evaporated.
That's why she was surprised when the hospital's male chairman of medicine started hinting that she and her husband should start a family. Dr. Regan-Smith is still grateful for the rare help that chairman offered—flexible scheduling during her difficult pregnancy, a gift for the newborn—at a time when motherhood often equaled career death.
While federal law today gives both men and women rights to parental and family leave, Dr. Regan-Smith said she still urges women to be cautious about mixing family plans and career ambitions. "Whatever you do, don't go to interviews pregnant," she advised. "Don't give it a chance to make a difference."
Not everyone takes that tack, however. When Dr. Warren-Asbill was negotiating a part-time contract last year with her current practice, she immediately told management she planned to start a family. The group was understanding, she said, and she felt that she got off to a better start because she was up-front about her plans.
Practices are also struggling to adapt to changes in the laws and physician attitudes regarding family leave. Consultants in Internal Medicine, a group practice in Norfolk, Va., pays 50% to 60% of pre-maternity income for 42 days after birth. But because some doctors took maternity leave and then left the practice, the group is reviewing the policy's potential for abuse. It may change that policy to avoid similar problems in the future.
While most women doctors interviewed for this story said that overt discrimination was rare in medicine, many complained of more subtle forms of bias. The lingering notion that women are somehow not as serious as their male colleagues, female physicians say, increases the tension between family and work.
"It's a lot harder to deal with the subtle issues than overt discrimination," said Lisa K. Madren, ACP-ASIM Member, a general internist at Sentara Norfolk General Hospital in Norfolk, Va. "I sense—but can't prove—that female nurses are more comfortable taking orders from male doctors than from female doctors."
In radiology, she explained, male physicians get their X-rays processed first, even if her order was placed earlier. Nurses address her by her first name, while they address male physicians as "Dr." "It's a very subtle sign of disrespect," Dr. Madren said.
Women say some institutions still don't take female physicians' suggestions as seriously as men's. General internist Jeanne Densmore, ACP-ASIM Member, remembers when Martha Jefferson Hospital administrators persuaded satellite offices (including her four-doctor practice, Blue Ridge Internal Medicine in Charlottesville, Va.) to open on Saturdays on a trial basis.
When a female physician suggested rotating Saturday hours among the practices, the idea was dismissed. When a male doctor who had not attended that meeting later made the same suggestion, he was applauded.
On the flip side, affirmation has replaced discrimination at some institutions. "When I was recruited, they couldn't come out and say it, but they were looking for female physicians," Dr. Densmore said of her experience with Martha Jefferson Hospital. The bottom line was that patients wanted to see women physicians.
While Jefferson had one female primary care physician, a competing university hospital had four. That competition may have influenced Jefferson's willingness to negotiate after Dr. Densmore and a female colleague rebelled against what they considered intolerable hours and workloads. While two male colleagues left for private practice, Dr. Densmore and her co-worker won shorter hours, more staff help and reduced on-call duties at Jefferson's only in-town practice.
William Hoffman is a freelance writer in Fairfax, Va.
To make tough career decisions, women physicians need support from others who have been there. The problem, women physicians report, is that there are still few female mentors in medicine.
Martha G. Regan-Smith, FACP, professor of medicine and coordinator for faculty development at Dartmouth Medical School in Hanover, N.H., said that women are only slowly advancing into positions of power in the medical community. As a result, she explained, it may take generations before the supply of female mentors meets ambitious women physicians' needs.
Some women doctors feel the absence keenly. Cecily Peterson, ACP-ASIM Member, director of intern training at Madigan Army Medical Center in Tacoma, Wash., said, "When I find a woman mentor, I glom on tightly." She recently re-established contact with a female dean who mentored her during medical school, and felt refreshed by the experience.
"I think it's really important for me to have some gender balance in my mentors," Dr. Peterson said. "I'm still early in my career, making decisions about career and family, and it's nice to see someone who stayed in academics, had five kids and really did it all."
For many younger women, however, the reality is that most available mentors are men. Jean Toferri, ACP-ASIM Member, an internist at Washington's Walter Reed Army Medical Center, said that only one of her six mentors is female.
So how can young women find a female mentor among the relatively few available colleagues? Finding a female mentor is a simple function of networking, Dr. Regan-Smith and others advise. Women's medical associations and local medical societies can sometimes help.
Invite a senior colleague to lunch and ask for her advice, Dr. Regan-Smith suggested. Also stay in touch with senior colleagues who might one day be able to lend a helping hand. Most people are eager to help once they are asked.
But what's really needed, most women agree, is a bigger pool of potential female mentors. And that will come only as women gain experience in the profession, move into positions of authority and offer their junior colleagues a hand.
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