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September 3, 2019

Has medicine secretly become a 'family-friendly profession'? (Not quite.)

Daily Briefing

    Employers today often demand more of their employees' time, but in the New York Times' "The Upshot," Claire Cain Miller writes that medicine has evolved in ways that's allowed it to become "a stealth family-friendly profession"—a viewpoint that many female physicians are pushing back on.

    A newfound flexibility

    In some ways, what's traditionally been an extremely demanding profession is becoming more flexible, in part because of changes in the physician market, according to Miller.

    In the past, it was more common for doctors to own a private practice and see patients whenever they got sick, Miller writes. Today, however, the majority of doctors work for large group practices or hospitals where their hours are far more predictable and there's more flexibility in when physicians work, Miller reports. She cites data from the American Medical Association that found 70% of doctors under 40 are employees rather than owners.

    As a result, Miller writes that women in medicine today are more likely than women with law degrees, doctorates, or business degrees to have children and to keep working once they become mothers.

    Robert Wachter, chair of the department of medicine at the University of California, San Francisco, said, "New generations look at the work-life balance of older generations of physicians, and I think many of them say, 'I don't want that.'"

    That flexibility is especially appealing to women, who now make up half of medical students, Miller writes. In fact, Miller cites research from Harvard University economist Claudia Goldin that's suggested flexible, predictable hours are the key to reducing gender gaps across professions.

    Sara Gonzalez, a pediatrician in Massachusetts, works as a hospitalist in her hospital's ED, where she's able to work predictable shifts. She's also able to hand off patients to other doctors at the hospital, allowing her to handle anything that comes up with her one-year-old daughter when she's off work.

    Part-time work

    Another way female physicians are finding flexibility is by working part time, Miller writes.

    Yee-Yie Fogarty, 45, is a mother of four and a radiation oncologist who works 80% of full time and is paid 80% of what she'd be paid at a full-time load. "When I'm here four days a week, I feel I can work at 100% of my abilities," she said. 

    Compared with part-time workers in law, for instance, part-time doctors tend to be paid more proportionately to their full-time counterparts in law, Miller reports.

    According to Miller, Goldin's research at Harvard has found there's financial benefits to working reduced hours in medicine as opposed to other professions. "While a part-time lawyer makes disproportionately less than a full-time one, doctors who work reduced schedules tend to be paid more proportionally," Miller writes.

    Some specialties offer more flexibility—but at a cost

    Some women are finding flexibility while still working full time by choosing specialties that have more predictable hours, Miller reports.

    Research shows that women are more represented in specialties that have shorter hours and fewer emergencies, such as dermatology. Meanwhile, specialties that have higher weekly time demands, such as orthopedics, tend to have more male practitioners. 

    For instance, when Britni Hebert was a resident and learned she was having twins she decided to change her medical specialty from oncology to internal medicine and geriatrics.

    However, that flexibility can come at a cost for women, Miller reports. Research has shown that specialties that are dominated by women see a drop in pay and prestige. In addition, Goldin's research has shown that part of the gender pay gap in medicine could stem from women reducing their hours earlier in their careers.

    Aisha Haynie Smart, 41, a hospital medical director near Houston, noted, "There are so many sacrifices that women physicians make in order to remain in their careers, remain working, things that aren't taken into consideration when looking at how wonderful and flexible it can be."

    Some female docs push back

    After Miller's article was published some critics questioned whether the women profiled in it were actually paid fairly and able to practice to their full potential.

    Some pointed out that the women in the article had to make trade-offs that their male counterparts never had to. For instance, in the article, Hebert acknowledged that, by changing her career as she did, she effectively halved her lifetime earnings.

    Arghavan Salles, of Washington University in St. Louis and founder of Time's Up Healthcare, said the article's "cheery picture of work for women in medicine" was "very frustrating."

    She added, "Compared to other workers, we are lucky to have options. But if the only way to have a family is to choose to be underemployed, that doesn't really sound 'family-friendly' to me."

    Miriam Knoll, of Hackensack University Medical Center, said that actually making the field of medicine more family-friendly would be difficult, but a good first step would be to create a standard parental leave policy for medical residents.

    According to Salles, "The goal should be for us to not have to compromise our careers if we really are aiming for equity" (Miller, "The Upshot," New York Times, 8/21; Fiore, Medpage Today, 8/22).

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