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:
- 70% of doctors under 40 are employees rather than owners.
- 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!