Does Being An Employee Confer Greater Flexibility For Female Physicians?

crispydoc Uncategorized 4 Comments

Mass media is a fickle entity. One minute medicine is approaching peak burnout and physicians are in crisis. The next we've never had it so good. The New York Times recently published the provocatively entitled article, "How Medicine Became the Stealth Family-Friendly Profession."

My first thought was that a journalist had decided to go rogue by rebuffing the conventional wisdom, but I tried to read on keeping an open mind.

The article profiled several female physicians who are also young mothers:

  • A former chief resident in medicine who pivoted from aspirations of academic oncology to part-time geriatrics on learning she was pregnant with twins
  • A pediatrician who works as both a hospitalist and seeing patients on ED shifts to retain more flexible hours than a clinic would entail
  • A teleradiologist who works from home and can turn off the spigot of emergent reads for hours at a time when family duty calls
  • A radiation oncologist who works 0.8 FTE

All of these physicians cited work-life balance and flexible hours as a their reason for choosing their particular career paths.

Supporting anecdotes from personal friendships abound, supporting the journalist's general impression:

  • A friend in OB decided to join a hospital-based group of in-house "laborists" to provide 24/7 OB coverage in exchange for predictable hours and increased flexibility. When she leaves the hospital she turns her pager off and her home life on.
  • Several female colleagues in emergency medicine have availed themselves of urgent care and per diem emergency work where they can pick up last minute shifts, maximizing flexibility to be present for family obligations.

The article goes on to cite data demonstrating that with occasional exceptions (notably OB/GYN) women under age 45 are disproportionately attracted to fields with lower weekly hour commitments (Dermatology, pediatrics, Allergy and Immunology, Psychiatry).

Finally, it cites the fact that millennial physicians are rejecting the physician workloads that prior generations were quick to accept, and that even male medical school graduates are self-reporting a greater emphasis of work-life balance in determining specialty selection. Whether the next decade of match results bears out this novel male preference remains to be seen.

Of the facts and figures cited in the article, the two that caught my eye were:

  1. 70% of doctors under 40 are employees rather than owners.
  2. The majority of female physicians are employees regardless of age.

This is a big deal, as it generally correlates with lower earning potential and reduced autonomy over a career. When given the choice between owning your business and turning the reins over to someone else, I've always favored the former since you are guaranteed to have your best interests at heart.

Why are women physicians, particularly the young mothers highlighted in the article, eager to serve as employees instead of business owners? A few explanatory variables come to mind.

#1: Female physicians face exclusion from physician-owned and operated groups due to bias.

We tend to hire those who look like us and share our interests, so women are often passed over when mostly male groups that have not created explicit paths to partnership are deciding whom to make the next partner. It's not that women physicians avoid owning their own business - they simply aren't given the opportunity at the same rate that men are.

In my specialty of emergency medicine, especially in desirable urban areas, there are numerous groups that claim to be "democratic" yet operate with no explicit path to ownership status. This may very well serve as a disincentive to seek employment at such groups, especially if few of the current owners look like you do.

Might there be a silver lining to working for Big Medicine Inc? Corporate medical jobs, like all big bureaucracies, end up devising sclerotic procedures and ten pound orientation handbooks. This same need to formalize process can work to benefit employees who have traditionally been excluded from old boy networks where hiring and promotional practices are not formally spelled out. Perhaps the major advantage of working at Big Medicine Inc is that after X years accumulating Y experience, you meet the requirements to obtain the promotion.

#2: Female physicians who raise kids carry disproportionate responsibility for household logistics in addition to their professional responsibilities.

The burden for making sure lunches are packed, sitters are booked and social obligations are met falls under the catch-all term mental load, and female physicians lift more of it than their male counterparts. In a typical heterosexual two physician household, it's usually the female doc who mails out mother's day cards, arranges carpools, ensures dinner is on the table and texts the piano teacher. When mental load is factored in, female physicians raising kids end up working 1.5-2.0 full time equivalents, they just don't get paid for their second job.

#3: Female physicians are following the millennial trend of wanting work-life balance at the outset of their career.

Employee jobs are likelier to offer a clock-in, clock-out work structure that private practices do not. Furthermore, many large corporate employers offer part-time positions, which female physicians accept with the understanding that part-time work will be less remunerative.

Is lower remuneration a deal-breaker? Not necessarily, although it doesn't feel that great to know you are being paid less. Many female physicians, especially those with families, place great value on flexibility. If they are "using" the job as much as the job uses them, it's a fair trade.

#4: Medical careers commence with crap timing, just as ovaries approach their suggested expiration dates.

Graduating residency is the time female physicians are likeliest to start a family and have young children at home. This is precisely the time when professional demands to carve out a career are also greatest. I recall hearing the radiologist Dr. Nisha Mehta recount on a podcast interview the awkwardness of explaining to her older male department chair at a new job that the reason she could not share an office with an older male colleague was that it would not be conducive to pumping breast milk daily.

There's also a good chance that decisions you make as a 20 year old may not be right for the person you are at 30. Friends in and out of medicine experienced major changes in their desire to have children that often altered their professional trajectories during their peak earning years. The most fortunate were able to create opportunities where they minimized the financial penalty for pivoting.

Employee physician jobs may be the right fit for female physicians who, like Dr. ATC, find themselves unexpectedly driven to increase their face time with their offspring.

Perhaps female physicians simply value their time appropriately at an earlier stage, while male physicians only learn to properly value time many years later (Girls mature faster than boys! I recall my sixth grade teacher lamenting aloud in class many a time).

Could my strong preference for owning your medical business simply be a function of having been born with testicles?

I'm not letting corporate medicine off the hook that easily, but I've got some serious thinking to do on this one.

Chime in and let me know what you think!

Comments 4

  1. Women want what they want, men want what they want. They don’t want the same things. In the course of my group we had several female partners and none of them wanted to do the job. It was a 7 person group split 7 ways going and none of them wanted to do their 1/7th of the work. They wanted to do less. This is common in law firms as well women join and when faced with the 80 hr/wk partner track they bail. It is what it is. The job is the job. There is no reason to presume you should get a better deal of less work for equal pay, because you have ovaries. This the advantage of medicine you can make out of it what you want. You want to do less expect less compensation. It’s a choice. The grievance industry turns it into a political vendetta that mean ol white men are screwing you. Nonsense. Your phony narrative is not my problem and I incur no guilt for running a fair business, You want 1/7, you do 1/7. You want kids that’s your choice.

    We wanted kids and my wife quit her practice and chose to home school, turning us into a 1960’s leave it to beaver family. I was good with that separation of responsibility and choice. It meant I had to work harder and smarter, but my family prospered and my children grew into the adults we hoped they’d be and I marvel a that every day how well that investment worked out. My wife lost no status in her decision because the self worth of our lives was not denominated in dollars it was based in outcomes and mutual respect, and as a unit we achieved the desired outcome, in good time. We didn’t rush it we didn’t fade it, we made it happen according to our rules, not some NYT columnists rules or some wanked sociology professor’s rules. Screw them. We chose like minded friends and supported each other. We lacked nothing in terms of society.

    You want what you want, get off your dead ass and make it happen. The last few years of my career I switched from owner to employee so we could abandon our group whenever, and not disrupt the center we were working at. My partner and I felt that to be immoral since the center had provided us a lucrative place to practice. We provided stellar reliable anesthesia, so it was an even deal. I also wanted the health care the “employer” provided for a few more years before I pulled the trigger. I wasn’t a fan of being an employee, but I was a fan of achieving my end game. It was the same job I had as an owner, so the workload wasn’t different. The compensation was less, the vaca was better, the bennies were better so all in all it was tolerable more or less. When I hit 65 and 6 months, I ticked the last box of my plan (one more year of social security eligibility in the bucket) and I moved from employed to unemployed so I could Roth convert my pile.

    That is the only narrative that matters, the personal narrative, not the pissing and moaning of some journalist.

    1. Gotta wholeheartedly disagree with Gasem on this one. I’m not in medicine, so I don’t comment on CD’s posts (I just read them with delight because there’s plenty for non-docs here). I’m a partner (owner/operator) in a large multinational consulting firm, and we face the same challenges. The problem with Gasem’s hardcore approach is that we end up with a society where half our population doesn’t have the opportunity to follow their dream if they also happen to want to have children. And I think we can find a solution that is a bit more nuanced than work-the-same-or-forget it.
      My firm has actively attacked the issue and is very committed to the effort, from the senior partner on down. AND we are still struggling to move the needle. We have plenty of opportunities for flexible arrangements, scaling up or down based on commitments outside of work, etc. But in professions like consulting, law, banking, etc., partners are responsible for bringing in new business and this often means being on the road most weeks, or dinners with clients, etc. My point is, the solution is elusive even when everyone is intentionally focused on it and rowing in the same direction.
      But the difficulty has not swayed our partners from believing that the goal is worthy and to keep trying. And to be clear – our goal is not a world where 50% of our partners are women. As Gasem points out, some women happily self select out, and that’s totally great. Our goal is to create an environment where anyone who does want an opportunity to become an owner has a fair chance.

    2. I’m an stunned at this comment. To use your personal experience with women in your practice as a way to make disparaging generalizations and assumptions about “women” is sexism of the worst kind. Most women I know, including myself, want exactly what a man wants. A fair paying job and time with our families if we choose to have families – which is not a ovary specific desire.

  2. The problem with the question is that it cannot be answered in a logical/statistical manner.
    There are 2 questions in one: a ) flexibility as employees b) employee as woman.
    Hence the confused answers from the consultant.
    I’ll add the implied bias that kids are the woman’s territory and we end up with a nonsense “move the needle” attitude leading to nowhere.
    But coming from the New York Times we didn’t expect any logic nor intellect.
    Just an attempt at scoring points.
    Against the unmentioned true target of the article : straight older white males.
    Transparent.

    For those who would still like to read the shit, use brave.com and you can read it for free forever. No need to pay for trash. This applies to virtually any publication. FIRE your paper.

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