The basic idea: doctors should not work part time or quit.

http://www.nytimes.com/2011/06/12/opinion/12sibert.html?_r=2&pagewanted=1&hp

"They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve."

That's a load of cr*p. Anyone who goes to a state U gets an education that is subsidized by the taxpayers. Heck, anyone who accepts a subsidized Stafford Loan or a Pell Grant is getting an education that is subsidized by the taxpayers. Does that mean that almost everyone who does to college has "a real moral obligation to serve"?

Everybody is depending on the tendency of physicians to "do the right thing" and their desire to serve their fellow (wo)man. They figure they can abuse physicians and take advantage of them and they will always do the right thing. If you are an MD and have joined Sermo, you know from reading posts there that those days are coming to an end. Doctors have had it with being abused and taken advantage of by the government, the insurance companies, the hospital admins, and the patients. This country is in for a SERIOUS doctor shortage, the likes of which has never been seen before. Docs over 50 are leaving in droves. The new maintenance of certification requirements are the latest thing driving them out. Whenever someone asks me what I think of ObamaCare or anything else that is happening in medicine these days, I tell them exactly the same thing. If you have a family doctor that you like and trust, be VERY nice to him/her. Be on time for appointments, pay your bills, bake them cookies. I'm just sayin'.

Interesting. Of course, she fails to note that for many doctors "part time" is 40+ hours per week. I suspect the general public doesn't know that. She also doesn't make suggestions on how precisely women are supposed to bear children without taking any of the so-called "extended leaves". I personally think it's a pretty good idea for intelligent, highly educated, goal driven people to contribute to the next generation. I don't agree that medical school is a privilege, either. There are few enough people willing to commit to suffer for 8-10 years without implying that the unworthy people who want to also raise children should be denied admission based on their need to be real people. Being a doctor is no longer the "higher calling" it once was, with the almighty doctor making house calls and keeping whole villages alive and healthy, no matter what the hour. That is simply not inkeeping with our current environment. I see her point that "part time" physicians and those who quit contribute to the shrotage of doctors... but I don't think forcing unwilling people to work greater hours, or replacing those people with less-qualified but available bodies is the solution. I don't have one, but that is not it. I don't care if my doctor is available 24 hours a day 7 days a week, if they are less qualified than someone who works "only" 4 1/2 days. As a side note, I argue with her statistic that women physicians are "less productive" in primary care. Or I guess, not so much with the statistic, but with her implication that women must not work as hard. There is evidence that the reason women see less patients in a day is because they spend more time with each patient, forming a closer bond and ultimately solving a problem in one longer visit rather than several shorter visits. I can't tell you how many patients I have had transfer to me from a male physician because I was willing to take extra time to be sure that everything got addressed and to listen to their story. I think it is pretty easy for a specialist who, by definition, does not have continuity patients, to tell those of us in primary care how to be more productive, and that we should work full time if we are "real" doctors. I bet she wouldn't last 5 minutes in one of those primary care fields, no matter how many middle of the night surgeries she has shown up for.

Hee hee, I knew you guys would rip her to shreds.

I really don't understand why the public isn't ripping women nurses and social workers to shreds for working part time and (gasp) also prioritizing their families. They provide patient care, their education is subsidized by the government, there is a shortage of them, and most would consider their jobs a calling.

Honestly, so many physicians in power use the very few women who are "checked out" (and who use their families as an excuse to duck out of medical obligations) as examples of why *mothers* are the cause of inferior medical care. Please. I'd rather be a genuine, hardworking human being than try to keep up with some facade of martyrdom. I'll let my actions (part-time or otherwise) speak for themselves.

I think the answer to your question is an unequivical yes! I was able to earn 4 college degrees in part due to access to low interest loans, and if the "price" I have to pay for that privilidge is "serving" than so be it. There's NO free lunch in the world no matter how many a perosn may have
grown up with or feel entitled to.

As for the idea that social workers and nurses ect, work part-time, I say you can't have it both ways and maintain any modicum of legitimacy IMHO. You want the "right" to work part-time as some nurses do, yet are angry DNP's want to be called doctor on the floor? I think it's hypocrital to pick and choose you either want to be treated completely different from those lower on the hospital totem pole or you don't.

Part-time Docs in ANY surgical specilaity is a terrible idea IMHO. And Docs who quit outside of some medical personal/family health issue or other extenuating circumstance like being married to an military stationed in Iran, SHOULD have to reimburse the Gov't for their training again, NO free lunch. Making the decision to have 2 kids in diapers and not being able to "handle" it as a Doc doesn't cut it in my book.

FYI, I bet someone is wishing they had put this thread in the Doc only forum, huh?

Nah, I knew you would find a way to reply to it anyway, even if you had to start your own thread about it.

Would you also say this to a social worker, teacher, or nurse?

Also, what about the surgical resident who decides to do a research fellowship (no call, minimal clinical duties, and funded by the government) for two years?

There are many reasons that physicians are notorious workaholics, to assume that physicians of the good old days worked so many hours solely for the human good and personal competence seems a bit myopic, although flattering.

Path, I would tread carefully on this topic, since I think it is safe to say that a doc who only has 10-15 years of useful working years left by the time they complete their training is also a "waste of training money" by this standard. So, all you "older" med students would also be excluded. Still think its reasonable to tell people they don't "deserve" a medical education unless they promise to work X imaginary worthy amount?

People have the right to BE PEOPLE, regardless of the field they choose. EVERYONE contributes to the greater good, no matter what their career, no matter how much they paid for their education, no matter how many years they "waste" in other pursuits. Physicians are not gods, we're not martyrs, and we don't owe anything to anyone besides to do the very best we are able to do at our jobs. JOBS. Not our lives.

I would also add that choosing to work part time/ not at all to ensure that our families are healthy and happy is not a privilege that should be reserved for the uneducated. Sure, I COULD (and did) work full time (50-60 hours per week) and support a spouse who works 90-100 hours per week, but I don't have to, I'm not going to, and I don't have to justify prioritizing family over work (again, work is not life!)any more than anyone else does.

I have over 500,000 in student loan debts from mostly private loans and have sacrificed a lot to get where I am. While I agree that I have the best job on the planet and that it trully is a privilege to be a physician, the only people I owe anything to share a bathroom with me or have somehow supported me over the years. By the time my loans are repaid, I will have paid more than double what I originally borrowed - not to mention the great deal the Feds are getting while I'm a resident.

You want the privilege of having a high demand job, working part time doing something you love, and put up with everything else that comes with the privelege? Go to med school.

I don't think I would love this job in 5 years doing a "full-time" md schedule, which is well over 40 hours. I need to love what I do or I couldnt possibly keep coming back for more - there is too much heartache, bullshit, and futility in what we do for me to be able to flagellate myself above all else. I refuse for anyone to make me feel somehow less of a human/citizen/contributor to society because I seek balance and recognize the importance of self-care. If I can work 40 years part-time, that's better than 10 years full time hating my job, resenting my patients, and "repaying" some ridiculous "debt" I never signed up for. You want doctors who owe society something? Fund them through med school. Maybe you could call it the national health service core or something...

LOL!!!

Who says I only have 10-15 years to practice? Because if you're "God like", please email me the winning numbers to the next Mega millions lottery drawing since you seem to know exactly how long I intend to practice.

USING a skill for only 10-15 years is VERY different from quitting medicine for "family" reasons IMHO. There's NO danger I'm gonna quit because I had too many kids and couldn't handle being a physician also. There's NO danger I'm gonna quit because my husband who also has a stressful job, can't chip in more around the house and I'm burdened with too much, trying to balance raising kids, working, and being a wife. I won't need accommodations for breast feeding or a delayed tenure track because I'm a wife and Mom.

I've said it before, med schools should admit FEWER women for reasons I've mentioned before. Actually, they should admit fewer women in their prime of child bearing years because when they quit for "family" reasons which essentially boils down to their poor/bad decisions, ALL women pay the price.

Finally, older med students make better doctors and EVERYONE knows it!

lol...I guess that everyone feels they have chosen the better path I think that med schools should continue admitting women in childbearing years because I think that women make excellent physicians and bring a lot to the field that men don't.
However, I do think there should be a more easily accessible path to work PT for women who are in the family building years of their lives so that women aren't pushed in to quitting all together.
I have a job working PT right now, and I plan to work PT for 15 years or so until my children are just about to leave home. That will put me at 45-50 with 20 or so years of FT doctoring ahead of me. (I will probably start working FT at the same age as Path.)

I personally think Doctors should attend med school for free, especially if they want a career in primary care. And doctor's training IS currently being subsidized by the G'ovt. So if you quit due to YOUR own poor family planning/decision making, then you should pay back double what was invested in your training.

Here's a question. In what other profession can a woman quit for say 5 years, then be able to easily reenter her profession without missing a beat? NONE, so why do women physicians feel entitled to perks other working women don't get? Better yet, why do women physicians feel entitled to easily reenter when other working women don't have such privileges? Because you choose to invest a half-mil in your education? You work 100 hours/week in the hospital?

You made a CHOICE to do those things, so suck it up and be thankful you have a career with the most amazing job security in the entire world!

I'm going to add just one comment to this thread:

I've only done two years of medical school and I just took Step 1...needless to say, this means I've only just started this path. It is freaking hard as s%^$. It's exhausting, tiring, exhilarating, and exciting too. That said, NO ONE will tell me how to live my life when I'm done with it. My moral responsibility is to my God, my family and myself. And I dare anyone else to tell me otherwise. I'M the one that studied from 7am to 11pm for the last six weeks. And anyone trying to tell me I have a responsibility after all this is over can kiss my butt. Seriously. I chose this journey, and I will choose how my blood, sweat and tears serves after it is over and the real world starts.

Now, I plan to do mission work, volunteer work, and all of that. That was always part of my plan. But if my husband and I want to move to a rural ranch in Idaho where I work 25 hours a week and we raise horses - after working this hard for so many years - you better believe I won't lose sleep at night listening to my cows and horses in the ranch beside my house.

The only obligation I have to the taxpayers is to pay back the money I was loaned. That's the contract I have with my funding source, and I don't have any other contract with anyone else. Anything else is simply nobody else's business, and they can kindly keep their opinions about my life to themselves. And it IS just an opinion this "person" in the NYT has. I doubt she has much of a following with this opinion.

As for the more argumentative members of mommd..... I'm so happy for the "ignore user" button.

I LOVE this quote from that article:

"Patients need doctors to take care of them. Medicine shouldn’t be a part-time interest to be set aside if it becomes inconvenient; it deserves to be a life’s work.

And I'll reiterate for the folks who ride broom sticks, like ignore buttons, yet lack basic reading comprehension skills that IMHO, part-time work should not be available to Docs in SURGICAL specialities only, but available to ALL others.

Interesting thread...I also feel like the only one that I owe anything to is God. I also feel that working full time is not necessarily working for the greater or moral good. I know tons of people that work part time and use their "free" time to serve the underserved in free clinics and with mission work. I served with someone on a mission trip to Haiti and she has never held down a full time job-- instead she has worked with Doctors w/o Borders and served all around the globe. I have always worked full time now almost 7 yrs post residency-- but that is my choice and I think I chose this field with those options. Now working in a private practice I feel that there are tons of patients that are excluded from my panel-- I can only take a small percentage of medicaid, no HMOs, few self pays, etc. So how is this for the moral good and giving back? The only one who is benefiting from my work is really the private hospital, insurances, etc. Believe me, I give back to the government every month double what they gave me- when you look at interest rates, etc. I personally don't see part time in my future, just because I think in some ways part time docs work harder & longer for less money & benefits. They are always trying to catch up and doing work from home, but that's the nature of our beast. Both my husband and I did mission & volunteer work during our training and after and hopefully we'll continue to do it when our children are older (and maybe take them with us) and also long after we retire. I also resent what the author said about male physicians seeing more patients than female physicians-- if you want to make money you could see 60 patients a day, but is that good patient care?! Also are these physicians doing this because of the moral obligation to serve or is it more for the bonuses, etc that is involved in productivity? That's fine if we were making cars, not when we are dealing with life and death. I also am pretty peeved that an anesthesiologist can make such remarks about primary care when she doesn't even do primary care-- one could say she is contributing to the primary care shortage problem, but that would be another thread.
This just reminds me of that TV show "60 Minutes" and how they did a segment on Harvard educated business women that were dropping out of the workforce to raise their children. The journalist asked the dean of Harvard's business school what he thought of the trend & if he was angry about the "lost" investment of their education. His answer surprised me-- he said that this was a sign that society and the work force needed to change so that women could use their training and their degrees without feeling like they were compromising their obligations to their children. I think it's just a sign of the times- we'll see more part time jobs, flex jobs, work from home, child care on site, etc. & it's a good thing! I think patients will appreciate it, too. I would rather have a well rested, happy doctor taking care of me than an angry, overworked doctor. I remember working 12 days in a row and having the patients I round on ask me if I was ok-- not a good sign.

In many academic institutions, full professional effort for some surgical subspecialties means only one day a week in the OR! I mean, "part-time" is such a nebulous term to begin with....



What is this "WHEN women quit" business, and how can anyone presume that one's choice of having children during training is a bad decision? I'm proud to have had children during training, and I'm a good medical student (better than most by all objective standards). How could anyone have decided that I didn't deserve a spot in medical school because of my age and gender?

Oh path, I wish I could convince you that not all physician-mothers are entitled brats who were born with silver spoons in their mouth! In the bigger picture, the economy is bad, and the public is even accusing teachers of being overpaid and underworked, so this is nothing new. But the great thing about America is that if you can't beat us, JOIN US! Now go rock that MCAT and matriculate posthaste!

I find that article totally offensive. How dare she, as a specialist, tell me how to live my life as a PCP? So, by her reasoning, the large percentage of women in primary care who are working part time shouldn't be able to do it. Well, then, who will??? There aren't exactly people lining up in droves to be primary care docs, let's face it. She can sit there from her perch and salary 3-4x mine and criticize all she wants. But I'll bet she doesn't have to have the same emotional investment and conncetion with her patients. The main reason I started working part time is that it was waaay too draining to give that much of myself every day. And it wasn't something I realized until after I had started practice and became attached to my patients. The main thing that makes you a good doc, actually giving and caring about your patients, is what is taken out of you on a daily basis. So, you need to replenish. I don't owe jack sh*t, thank you very much. I have spent my entire career in a community health center and volunteering. I give plenty. I deserve a life. How dare she.....

I also agree part time is relative- are we talking a total amount of clinical hours here? How many, exactly? I know some full time academic surgeons who work in the OR 1-2 days per week. Is that enough?

Path, would you include delivering babies in your 'surgical' specialty qualification? There is a lot of debate in FP about how many babies one needs to deliver in a year to stay 'compentent'. And whether or not that is catching the baby, or includes labor management. I would also reply to your question about what other professions people can quit and reenter-teaching, for one-I have several friends who are going back now after 8 plus years off to raise their children. Nursing, for another, if you keep up your certifications. And it isn't easy to quit medicine altogether for 5 plus years and then just go back, check out some of the reentry threads. I think working part time for as many years is a good trade off. You aren't losing the person altogether.


But, seriously...part time for us is a normal job for most people....and that doesn't include the countless nights, weekends, and holidays that have been given up or interrupted. Yes, I signed on for it. But I damn well don't owe anyone anything.

There's absolutely NOTHING wrong with quitting ANY career and returning later. The problem is when women expect to, for example, quit for 5 years then expect to get tenure at the same time as the woman who did NOT quit. Said woman then gets pissy and blames the "system" for her being denied tenure and not her choices for the delay. Those types of attitudes are selfish, self-centered, and make the work environment difficult for ALL women.

Also, how many women here have had a bad surgical outcome from a part-time surgeon? I have, so my position on this is valid IMHO.

Would 1-2 days/week in the OR be enough if your kid had a tumor in the brain stem? Can you honestly say you'd be Ok with a "part-time" surgeon in this case?

I'd say the answer to this question depends on how much your decision inconvenienced your colleagues. I got pregnant in grad school but my 4 week absence didn't in ANY way adversely effect my labmates. But if I had had a 3 year old at home at the same time, it likely would have.

Thing is, I didn't start this debate about women becoming pregnant during residency AND expecting special treatment, and I obviously won't end it.

But it's clear I'm not the only one who at the very least questions these types of choices when the people who depend on you can't, because of your CHOICES.

As for entitlement issues among women Docs, I've spoken on that for as long as I've been participating on this site, and quite frankly it seems to be getting worse as the "me" generation comes of age. Actually, I think the moniker Princess MomMD is more than fitting in a few cases, LOL!!!

BTW MCAT, August 2011!!!

Just....wow.

I suppose if by "entitled" you mean entitled to have children during training and not regret it in the least, then you can call me Princess Sunshine. <3 <3 <3

<struts past piles of junk to read two journal articles, shower, and pack lunches/pump before getting up at 4am tomorrow>

Well if the tiara fits................................

And you KNOW you've taken what I mean by "entitled" out of context, unless you expect to be Chief Resident, but have only been there half-the time.

Ok, so I lied.

Second comment! Perfect timing, Kevinmd.com!

http://www.kevinmd.com/blog/2011/06/doctors-choose-medicine-family.html

I actually had a few comments from admissions staff on the decreased years of practice I would provide society (keep in mind I am actually less than 10 years older than a traditional student!). My response was that with me, I had already done the work-family balance, and felt much more comfortable there versus at home.

I saw many people trained in SW who worked just long enough to pay off their loans (or until their partner could cover payments) and then leave the field. Sometimes it was to care for children, other times it was simply d/t the burn out of the field. I also saw people come back to the field after several years without a problem- part of that is likely due to the fact that SW has traditionally been dominated by women, and therefore has a much more realistic perspective of work-family balance in a challenging field.

But this article is offensive. I will be paying back my loans, with tons of interest. I do not owe my life to the field of medicine. If I choose to see three less patients per day than a male (or female counterpart with a different personality) so be it. My patients deserve the best care I can provide, IMHO, and if it makes me 'less productive' to do so, so be it.

Yes, there is a double bottleneck, both at med school admissions and residency positions. So should those with family histories significant for early MI or colon cancer be selected against during the process? They certainly have the potential to have a decreased number of 'productive' career years compared to an individual whose family members tend to live over the age of 90.

This is an interesting thread. I actually feel like there are quite compelling arguments on all sides, but I don't balance it out the way the article does, certainly.

I do think she does a surprisingly crummy job of arguing her case, missing what I think is the most critical component: while lots of professions involve people who received subsidized education, medicine is one of extremely few where our training not only costs the public money, but we learn on their very bodies, with their health, their lives, in our hands as we learn. This is true not only for those patients who patiently waited through my first 5 times starting an IV, doing an LP, delivering a baby, breaking bad news, suturing a hand wound... it's also true for everyone who eg had their critical, high stakes surgery done by a first year attending rather than the person with 15 years experience who just finished training that person. There is a very real, completely human cost to every physician who goes through training, and I think a lot about that as I consider my career options.

That said, I also think that she does a poor job weighing the reasons that it can be important to allow women to work part time at times. As others have said, the "full-time" work week of a physician is way over 40 hours... and, for all of her grousing about middle of the night surgeries, she is still in anesthesia - a much less grueling specialty in terms of total hours than many (can I just mention how much I *HATE* the "well, I was able to do it, so... that just proves everyone can!" argument when superficially cited??). But if you work as many hours as is currently expected of full time... it really can be near impossible for many people to be highly involved in their kids' lives. Especially if, say, they happen to find that they have a sick parent who needs care just at that time, too. And maybe they do a bit of volunteer work just every now and then. And perhaps take a few hours a week to read the paper and try to have an occasional say in our political process. And just imagine if they every now and then tried to take some time to step back and think about what actually matters in life for a few minutes a week, too, on top of that!

The thing is, though, if we say anyone who wants to be able to be there for their sick parent and their young kids at the same time just shouldn't have been in medicine in the first place... well, I think it's pretty easy to see that a lot of people might not find the people who are left in the profession the people they really want beside them or their sick and vulnerable loved one the day they're terrified, hurting, and making painful and difficult end of life decisions. Just for example.

If our profession is seen as a technical field where you are to accomplish over and over ad naseum certain difficult skills that you learned via repetitive training, then it is completely clear that the best system for society is to do everything it can to train the smallest number of the most capable people who can possibly cover the required workload if they do NOTHING in their lives but work. Nothing at all. This is the perfect ideal! There are three reasons, however, that doesn't actually make sense: (1) You have to have a deal that is capable of actually attracting the people you want to have working for you. (2) You have to allow those people to live lives that don't turn them into bitter or empty or hopeless or completely out of touch individuals who will not be able to relate to their patients even if they want to. And, I would add, (3) it's just wrong.

All of these things are a balance. Yes, I think there's some very real loss to society when someone goes all the way through training and then decides early on to leave the profession entirely. Yes I think that probably if that person had known from the start that was their plan that they probably shouldn't have trained in the first place. But no, I definitely don't think that we'd be better off (1) not ever letting anyone with any shred of doubt that they might ever end up having other priorities in their life into the field of medicine or (2) forcing a bunch of people who ended up realizing this wasn't right for them keep practicing while miserable and resentful (I wouldn't want that person for my doctor!).

Also, I wanted to mention that I think the teacher comparison is actually a very good one. There is a huge shortage of teachers, especially for younger students. Clearly this is a critical profession. Because of this, our society does very purposefully work to fund training of new teachers. But it is completely accepted that eg a very large fraction of elementary school teachers will end up taking a maternity leave or two, and often cutting to part time for a little while or job sharing for a bit here and there. Yes, this is in some very real ways a loss for society when they do so. Nonetheless, we tend to think it's pretty obvious that we just can't afford to say "hey, anyone who wants to ever make their own kids a priority in their lives shouldn't go into teaching". Similarly, I think saying that noone who ever wants to be able to make their family a significant priority in their lives should ever be a doctor is making JUST as fundamental an error.

As far as taxpayer support of medical education goes, the state support of the state U I graduated from has declined to the point where folks are starting to question why it still bears the name of the state. Who supports medical education at that school (besides the students who pay tuition)? The academic docs who see patients, some of whom actually work *gasp* PART TIME!
A doc over at Sermo pointed out earlier today that we all pretty much "gave back" by just completing a residency. Residents work their butts off for less than minimum wage if you calculate it on a per-hour basis.

Anna M-well said!!!!!

No one I know chooses to have colon cancer, so if I sick Doc expects "special treatment" due to their illness, most people would agree it's warranted.

But choosing to enter a surgical field with say 6 children and expecting the same professional privileges as someone who made a more feasible work/family choice when you know for a fact your career progression is going to be adversely affected, is selfish.

"Would 1-2 days/week in the OR be enough if your kid had a tumor in the brain stem? Can you honestly say you'd be Ok with a "part-time" surgeon in this case?"

And I'd really LOVE a reply to this question from ANYONE, especially a Doc.

If my kid was having delicate brain-stem surgery, I would want a surgeon who is well-rested, not one who is stressed, sleep-deprived, overworked, and overwhelmed.

We limit work hours and mandate rest periods for residents, truck drivers, and airline pilots, but not for neurosurgeons.

A primary care provider working "part-time" these days probably works as many hours as a pathologist working full-time.

You know Anna, I think it's pretty pathetic to bring the subject of folks caring for sick relatives into this discussion, when you know that's NOT what this discussion is all about. You're purposely "confusing" issues, throwing in ANY argument which supports your point of view, but all it really does is weaken your entire argument.

Also, maternity leave should ONLY refer to that time needed for your body to heal from child birth. It should NOT include ANY time after that for "soft" reasons like you don't want to send your kid to daycare all day, or you're going to miss your baby.

When a woman delays returning to work after child birth for more FAR more time than is needed to heal from child birth and calls it "maternity leave", it screws us all!!! "Soft" reasons like these are why when women really need time off for something legit like a special needs child or sick spouse, they can't get it.

IMHO, if future female Docs want to know a MAJOR reason the medical field is so anti-woman, one need only look at the comments in this thread. Most of you obviously couldn't care less about those who have to come up behind you as long as your own lives are groovy. And THAT is sad!

Pathologists in academic settings, work between 50-60 hours/week on average, which by your definition, is equivalent to the average PC who works 120+ hours/week.

Geez, no wonder no one wants to be a PC.

Viva La Pathology!!!

Hi, Path.

Some of your questions, in addition to their incendiary quality, are thoughtful and deserve answers ;-)

I think this an accurate summary of your main points (please correct): You DESCRIBE a problem of having a privileged training, owing something to someone (morally) and then needing to take time away. (Interesting point-- discussed by Anna M and DocMomof3 and others in finances/ time spent in residency, community health burden, etc.) Your OPINION is that women (or men, although no one has mentioned them) who start medical school knowing they are likely to want off time / flex time / part time / accommodations due to CHILDCARE are DIFFERENT than others who discover during any part of their training or career they need accommodations for any other reason.

I think this is where your argument moves from logic to opinion. Is the issue the moral obligation, or not? If it's the moral obligation, then points by residentmom and others that later-life students, or trainees with known medical conditions, or even family risk of developing med conditions, anyone with parents who might need care (foreseeably or not), etc. during any of the practicing years are at high risk of "defaulting" on the obligation.

Singling out Moms in training brings forth a bunch of anecdotes, doesn't it? Most of the women who post in these forums seem to have made it through with minimal effect on their co-trainees or patient care. Are they less dedicated? Perhaps. Is anyone sure that obsession with medicine 24 -7- all years of training or beyond is a better physician. No. Maybe-- more surgical time = more surgical skill (?). But I think it's clear that Moms and others with family/ social skills from outside medicine have an easier time establishing rapport, empathy, and perhaps multitasking on behalf of patients. Perhaps the way you envision older students having an advantage over immature just-out-of-college-no-life-experience 1st years. ;-)
If you're going to single out moms as derelict in duty to medical training/ payback, you MUST balance what that duty (motherhood) brings to medicine.

You commented "no one I know chooses colon cancer, so if a doc expects "special treatment"... okay with you; you contrasted this with a woman with family obligations who wants the same professional obligations.
Again: 2 arguments/ opinions mixed together. You're suggesting that Moms are definitely going to need accommodations, vs someone who might have a mid-career crisis and need more drastic accommodations. I'd argue that someone who knows their challeneges going in is much more likely to achieve balance and leave less patients in a lurch.

Philosphically, I suspect that women who are disgruntled about tenure track / less than equal professional status are not quibbling about putting in 4 years half-time to equal 2 years full time; I think it's about needing alternative views of academic and leadership achievement. That men and women view success differently is not a surprise, is it? It's probably more often that women (part time or full time) are likely to spend time teaching, mentoring, doing other non-compensated activities, and in most places, less likely to be considered as evidence for tenure.

One might argue that since most women settle for lower salaries and less benefits than men in all sectors, they're paying back any accommodations they've received along the way ;-)

Finally --- would I want a fulltime surgeon or a part time surgeon for my child? AS LONG AS the surgeon were still in the prime of mental and physical health combined with dexterity, of course I want the one with the highest case load and best rate of good outcomes. But that doesn't mean that someone 10 years parttime is lesser than someone 10 years full time. There is an point of diminishing returns, even in surgical technique. I suspect the difference is greater in earlier career. (And, yes, I am actually considering the peds neurosurgeons I know -- I'd seek out the chair who taught me for advice -- but that doesn't mean he still the best option).
I know you had a bad surgery outcome from a part-time surgeon, and I'm sorry. You're totally entitled to your opinion, and I'm not trying to change it.

A colleague of mine points out in his bio that he's been a full time psychiatrist for x years (since so many of us, i guess are part time). I think he SHOULD claim that to his credit. However, I'm sure, based on my part time status, that I have faster turnaround for outside-hours-patient-request and letters, etc. I'm more flexible to let someone go over session 5 or 10 minutes (when therapetuically appropriate of course!) b/c I don't feel compelled to full schedule my days.

Okay, Path. Hats off to you. I've spent so much time defending the pursuit of balanced life-and-medical practice to the women at earlier stages that I'm way behind a house-cleaning project.. but I have already returned all my patient calls. ;-)

OhioMD, I've been a "outlier" opinion wise on this site for years but I can assure you by the PM's I get, I'm not on an island alone when it comes to many of the points mentioned in this thread.

However, I'm done defending my perspective on this topic especially when so much of what I've said has been misconstrued. If you guys want to think I believe NO women Docs should be able to work part-time, take time off for family, or take care of sick relatives, then so be it.

But it's the inability to NOT understand or consider a perspective different from one's own that probably contributes to so much of the professional angst present among so many of the women on this site. Sure we ALL have issues in our career that make it less fulfilling, but I choose to accept full responsibility for mine, do the best I can with what I have, and NOT place the blame on anyone else if it doesn't work out the way I planned. If someone doesn't like something about their career change it, but the constant bitching about what ultimately comes down to OUR choices, combined with the aura of entitlement is just so extra and unproductive. It also makes the path more challenging for those like us, who come behind us.

I've always believed that the answer to most of life issues lie in a mirror. Clearly, I'm one of few people not afraid to take a look on a regular basis.

I have to say that I have a big problem with this article. The fact is that women should be somewhat accommodated because 9/10 times the reproductive labor of the home is not equally shared by both spouses. Like others said women are needed in medicine period. Lucky for male physicians they have a wife who is taking care of everything in the home.

I think it is total crap that women are given s**t bout needing a day off to take care of a sick child etc. Most civilized countries in Europe allow for 1 year of maternity leave. I m sure those docs are doing just fine.

Another thing About "wasted" training on women who take breaks from medicine. There are those who believe that training older folks who will only practice for 10-15 years is a waste of training as well. I would rather take the former than the latter. A woman who finishes training in her late 20s to early 30s can take off 2-5 yearsand be okay. She would return in her mid 30s to late 30s when she would still be practicing with a sharp mind. On the other hand someone who is practicing during their twilight years may not be as sharp. Of course these are only my opinions but the bias against older students in the medical school process must be due to something. In reality neither should be discriminated against because both groups are willing to sacrifice a lot of time and effort.

Path, I think the reason so many of us take offense to what you have to say is that it seems exactly that, that you are not understanding the other perspective-maybe it is just the way it comes across in writing, or something. And no one said we aren't accepting full responsibility-I fully accept that working part time has probably led me down a different career path, but I am totally ok with that-it was my decision to make. I just don't feel I owe explanations to anyone about what I choose to do with my life post training. I also don't think it makes me a worse doc, or less dedicated. More well rounded, perhaps?

Also, I would be interested to see how your opinions change once you get into medical school and start going down this road. It is often easy to comment on things before you actually experience them. Think about how you would feel if I were commenting on path lab things-having had no experience in that area whatsoever. There is no substitute for actually having gone through it, even if you are a close onlooker.

Onlooker my booty!!! I also don't need to experience being a neurosurgeon to know that it's difficult to have that job and have a husband and 3 kids. So I resent the idea and think it's a complete crock of $hit that my thoughts on this lack credibility because I haven't been enrolled in an MD program or worked as a neurosurgeon. I've got 10+ years as a Black women Scientist and 25+years in research. You think you've got career issues? Try being a woman of color in ANY field that requires a half a brain but am I on the net, bitching and moaning ad naseaum about it? NO!

FYI, I spent 2 summers ENROLLED AT A LOCAL MED SCHOOL and, one summer I did it while I worked FULL-TIME. And I did that because I wanted to gauge for myself, my ability to "handle" med school with a family. Well, I got a "B" in Medical Biochem, Molecular Biology, and Endocrinology (while working full-time) and an "A" in Cell Biology and Medical Histology. IN THE SUMMER! So maybe this doesn't "count" for much to you as far as my having a pretty good idea about what I'm about to get into with med school, but there's a couple med schools that think it demonstrates quite a lot, so I'm good with THEIR opinion.

Finally, my attitude which I think is strongly rooted in me being a Black woman in America, probably won't change much at all when I matriculate as a degree candidate in med school. And not just because my womb is closed and my kid will be in college by then. I'm not from an "entitled" group in this country, so my expectation is that I'm gonna have to scrape/compromise for everything I get plus some in med school and beyond.

I actually DON'T think I have career issues, #1, and #2 FYI I am a Puerto Rican female, first generation to finish High School and college, and NOT from an entitled group. I put myself through college and med school, thank you very much, I just don't walk around with a chip on my shoulder. You aren't the only one here who has had tough things happen to them. We just all don't flaunt it all of the time.

AmmaMD, I think your post is very well thought out and clearly expressed. I should work on those characteristics in my "free" time.

I certainly think that it is dangerous to judge people's reasons for needing time off for how valid they are. One person's valid reason for leave is another person's "crock". Those who undervalue women and mothers in medicine are free to choose single elderly male physicians for all of their care... I am sure that somewhere there will be one of those with good bedside manner and empathy for routine complaints. Just because I haven't met one doesn't mean they don't exist. (Kidding. Kind of.) I will continue to be very popular with patients specifically BECAUSE I live a real life, I sympathize, and because I recognize that one person's regular day is another's life crisis. Also because I clearly love my job, I spend the time necessary to address patient issues (75 minutes in one case today!), and I am not so burnt out that I don't care. I don't NEED to spend half my time with my children (despite certain assertions that working part time is a sign one can't cope with the demands of job and family)... but I WANT to. And I worked hard, made brilliant undergrad grades, rocked the MCAT, and scooted right through med school and residency so that I could have the right to CHOOSE. I'm not lucky, nothing was given to me (my family did not contribute a dime to any of my schooling), but I earned it and I will not apologize for it.

And Michelle Au from the Underwear Drawer rebutted that article too:

http://www.psychologytoday.com/blog/wont-hurt-bit/201106/the-mommy-wars-medical-edition

Love this. Waiting on her book. Can't wait to read it.

I responded to your comment from MY point of view, not knowing or caring for that matter, what group you're from! So if my post did NOT apply to you, FANTASTIC!!

As for those other comments, my response is a simple "meh", to each their own.

Just want to point out that the passage you are objecting to here was written by AmmaMD (that's Amma with two m's), not by me, AnnaM. Just want to set the record straight.

We don't have any academic pathologists around here, so I'll have to take your word for that. The pathologists tend to work fairly regular 9-5 type hours around here, maybe 40-50 hours/wk. A lot of PCP's I know work 80 hours a week or more. When I worked "part-time", it was more like 40 hours/wk. I have no problem with a doc in a time-intensive specialty wanting to work less than 60-80 hours/wk so they can have a little balance. My PCP works part-time and job-shares. I have no problem seeing her partner if she is not available.

Here is a great rebuttal one of my friends (a pediatrician married to an FP)found and posted on facebook.
http://parenting.blogs.nytimes.com/2011/06/13/should-women-be-doctors/?src=twrhp

I have no qualms at all about one of my daughter's surgical specialists being her doctor- her doc is split between 3 days research, 1 day clinic, 1 day OR (more or less). Why does that one day/week NOT bother me? Simple- they are the best and most knowledgeable, skilled, and up-to-date on research regarding her medical conditions.

Actually other than the residents, not a one of her surgeons is in clinic/OR every day of the week. They all have a combination of research/education/clinic/OR.

Could she have a bad outcome? Absolutely. But that is the risk with any surgery (or any therapy).

I also have had the privilege of working with an absolutely awesome primary care doc who job shares- between the two of them they cover a full-time schedule and a full-time load of patients. She is happy, her patients are happy, and if I end up in FP w/OB, it will mostly be because of the experiences I have had with her.

Whether I end up in primary care or some ultra-niche subspecialty, I hope to bring the level of enthusiasm, empathy, and knowledge she does to the profession.

Thanks for the response articles, southern- I think Michelle Au's title says it all: "The Mommy Wars, Medical Edition".

Southern, I appreciate the link, Dr. Au always writes intelligently and entertainingly.

That's one interesting thing about being anonymous online - wonder if she is secretly a poster.

Sorry about the misident!

My PCP works part-time too and she's a gem.

This doesn't "bother" me either since it still amounts to working full-time in the exact way I plan to work one day.

For reiteration, this isn't what I'm talking about when I refer to a "part-time surgeon" since most of the great ones do research, teach, AND do surgery amounting to a full-time schedule.

Those are great rebuttal articles, southernmd and residentmom. There were so many good points, but I thought this quote from Michelle Au was especially apt for MomMD. It is a reply to the medical student who got a curt response from Karen Sibert:

"To that student and others like her, I want to say this: yes, anesthesiology is a good field for women. Yes, medicine is a good field for women. Yes you have to be committed, and yes, it's a lifetime of hard work, but also one of tremendous satisfaction. And a life in medicine doesn't have to define your life. Some come, join us, but pick your mentors and role models well. We'll be here, cheering you on, and helping you with your decisions along the way, whatever they may be."

This quote is what I have experienced from my mentors- and almost all women I have encountered in medicine. To all of those women out there, of which I know a few are regular posters here- thank you.

So because you disagree with Dr. Sibert, she is neither intelligent nor entertaining? Passive aggressive insults are so very extra in a supposedly "intelligent" debate.

And how "intelligent" it is to essentially dismiss ALL the other VERY good points Dr. Sibert made in her article, due to disagreeing with a few other points? I certainly do NOT agree with everything she wrote, but I was certainly able to look past that to see many other points which did make sense. I also agreed with some of the points made by Dr. Au.

Like it or not medicine is changing. And at the end of the day, all many of you are doing with what I often think are unreasonable demands is making it easier for PA's and DNP's to take over YOUR spots. Think about it, a Doc who wants to work part-time or a DNP who works full-time? They're both "Doctor's", but the DNP works more and earns less and I'm guessing has less malpractice liability. She/he is AVAILABLE, so which would you hire if you had your own practice? 2 part-time PCP's or 2 DNP's?

I've recently my career into the computer side of medicine and research, bioinformatics/computational chemistry, to make myself more of a "player" in the future as a Physician/Scientist. A lot of you guys seem to be making it easier to justify being replaced by someone lesser trained than you.

It'll be REAL interesting to see how this all played out 5 to 10 years from now and what your feelings are then about the choices you made.

I fail to see how complimenting one doctor's writing is an insult to another, passive-agressive or otherwise. I have found Dr. Au entertaining for years, long before this article or debate were around. I do find YOUR passive-aggressive comments on my intelligence insulting, but then, I am used to that at this point.

And to address your point: there is NO chance I would be willing to see a so-called "nurse doctor", no matter how available. The research shows that they are incapable of passing even the very easiest licensing exam administered to physicians (USMLE Step 3). Goes back to my original point that I would prefer a dedicated, well-qualified part time physician to a less qualified doctor available 24 hours a day.

I think it's interesting, Path, that you continually harp on the inferiority of part time physicians, but then elect to see one yourself, and apparently like her. You really need to go one way or the other on this- either part time physicians are less competent, less dedicated, and less qualified, or they aren't. I already know my answer to this question, and I have no concerns about my qualifications- I am a board certified physician.

There are mid-levels in pathology, too.

I know because I seriously considered it (pathology assistant), but how many of them are signing off on autopsy's? Testifying in court cases? Reading frozen sections during surgery? Signing out cases? None that I know of.

It seems that most fields of medicine have mid-levels, but how many are in danger of being replaced by them? I'd say a good number of folks in primary care specialties should be VERY concerned. Especially if they work part-time.

There are mid-levels in every specialty, it seems. Some of them are further along in the process to independence than others. But it seems that sooner or later, they will all push for more autonomy and less supervision.

Did you know that optometrists can do laser surgery in Kentucky now? Their leadership argued that people in rural areas do not have access to ophthalmologists. So the politicians voted to allow them to do it. The same story plays out over and over again in specialty after specialty. What mid-levels are allowed to do is a political decision that has little to do with their qualifications and experience. And I can predict that somewhere there is a pathologist who is teaching a mid-level how to do autopsies.

So yeah, you are right that we are competing not only with other physicians but with mid-levels as well.

In Dr. Sibert’s article, the core of her argument seems rooted in the productivity value of the physician. By her argument, the numbers of hours devoted to medicine or the numbers of patients you see in a given day are the primary factors that define your worth as a physician. I agree with the postings by many of those on this thread: the quality of encounters with patients is equally if not more important than these numbers.

For the vast majority of medical specialties, patient rapport is vitally important. In medical school, you learn that the majority of information you need to make a diagnosis comes from the history. This becomes blatantly obvious as you begin your clerkships, realizing that so much of the information you need comes from the patient opening up and sharing his or her story. When patients come to you, they trust you with some of the most private parts of their lives. This information dictates our studies, influences our diagnoses, and eventually directs our treatments. You can see 100 patients in a day, but if patients don’t feel comfortable sharing information with you I would argue you are not going to be a very effective physician.

By the same frame of thought that Dr. Sibert follows, why accept any applicants who have the potential for lower “productivity?” Why accept a student who is over 40 years old, with less time left to retirement than a 21-year-old? Why accept someone who already has a family, which may threaten to take away time from medicine? Why even consider applicants who have physical limitations, which might make it harder for him or her to see the same number of patients? These are important applicants, because so much of medicine is about connecting with people. When it comes down to it, life experiences within as well as outside of medicine matter. Having a family, hobby, pet, group of friends, community role, or outside life in general helps makes you someone patients can relate to. These experiences help you to be a better doctor.

Based on many of the "counter arguments" presented in this thread to Dr. Sibert's article, it's obvious that medicine should ONLY be a career for single men between the age of 21-25.

Well I guess Mommd can shut down now!

Among the many ridiculous and offensive things stated or implied in this article, it Is most amusing that it is coming from an anesthesiologist who does not understand what primary care entails and whose entire h&p consists of: any allergies? Open your mouth...


(disclaimer--not meant to offend anesthesiologists- they are great at what they do, but it is not primary care!)

>whose entire h&p consists of: any allergies? Open your mouth...

Not exactly! Some of us do like to know what is going on with our patients.

sahmd - I had no idea you were an anesthesiologist! LOL. I still don't know what all the docs do on this board. Except that no matter what ya'll do - you tell me not to go into OB! (ha)!

really, I exaggerate.

But I still find it absolutely ridiculous that she practically blame the pcp shortage on women doctors with children when she is not even in primary care herself. WTF?

I saw an article last year that showed that the physicians most likely to work part time were BOTH women of childbearing age AND men near the end of their careers. Interestingly, women near the end of their careers were NOT as likely to work part time. So maybe it all balances out in the end.

http://www.mothersinmedicine.com/2011/06/dont-give-up-on-women-in-medicine.html

KC (professor at George Washington) and the woman who runs Mothers in Medicine rebutted...

Loved this.

WBUR did a piece on this on On Point today. You can find the podcast at www.wbur.org, look under podcasts and On point. Dr. Seibert was on the show.

Southern, that is a good read. She has that same stat I did about men leaving practice later in life for part time work. That looks like an interesting site all around.

A quote from a doc in the WBUR comments. I was laughing so hard I almost woke the baby!

"I'm a somewhat shocked about the strong reaction to this article. I have been a member of the bat sh*t crazy club of MDs for what is considered to be a very short time, yet I very early on came to terms with the fact that this field is permeated with the egotistical madness that drives people to write essays filled with the pomp and unjustified indignation as Mrs. Silbert has done here. I'm not saying that everyone is like this, but if you really went to medical school you cannot say that you're surprised to find that there is a physician with marbles loose enough to honestly believe she's better than everyone around her and that she would scream as loudly as possible from atop her cyber podium in order to make sure that you all knew. God I hate doctors..."
-MD from MA

<still laughing>

I'm only premed, but it seems to me a little irresponsible to bring into quetion the government funding of med schools in this particular political climate. I live in the south, so maybe I have a different perspective than some, but here it seems people will jump on whatever anti-government bandwagon available. Suggesting that government funding is being wasted by training women as physicians seems a little reckless.

This is absolutely precious. I'm tucking this gem away.

@asunshine: Fabulous!! Thank you for sharing this!

Hmmm what a very sad perspective Dr. Siefert shows. We spend most of our lives competing to get into medical school and most of our future earnings paying for this job. Unfortunately there is no test and no preparation for our biggest job as parents. A full time physician in my field works 60-80 hours per week leaving very little if any time available for family. Last I checked we had the highest divorce, drug abuse and suicide rates of any specialty. I have lost many colleagues to drug abuse. The idea that we should some how give up our lives in service of others does not make us better people/physicians it makes up more detached more angry more exhauseted and less likely to be empathetic with our fellow humans.
I have been a part-time physician for many years and I am the anesthesiologist most nurses and physicians request. I am able to be totally availabe to my patients only when working 20-30 hours per week. I know from my own personal experience that working fulltime makes me unhappy and "unavailable". I know myself and have found a balance that allows me to be the best physician I can be. No one would want me as their physician if I were expected to work more. I believe in quality always over quantity in my work and personal life.

Dr Siebert bases a lot of her argument around the physician shortage, without ever acknowledging that the whole thing is government-created. Why don't we get rid of the cap on residency slots and train as many physicians as we need?

Blaming physicians who are mothers for the doctor shortage is beyond ridiculous.

I have not had the time to read all the posts but I do agree with some of the points in the article....I think that taking time off for your family is totally appropriate *but* what is happening now more so than in the past, is folks going into medicine KNOWING from the get go that they will *not* ever practice full time and will most likely leave when they have a family.

Now, I do have problems with that. Why go into medicine in the first place if you KNOW you will not practice for the majority of your productive years?

I see all the time the problems patients have getting into see their PCP because *she* is PT only and hence works x/y/z days. Those folks end up in the ER increasing the costs of healthcare for something minor. Now, I am NOT saying that taking time off for sick family members, pregnancy, and life changing events is something to look down on, but I do have problems with the plethora or PT MD's most females...

Let the flames begin.

BTW, I would feel the same if there were PT soldiers, etc and then the regular FT folk having to pick up the slack...not a good position to be in.

THIS!

And I'll be that since Efex IS a Doc, she'll NOT need a double flame resistant "suit" to speak HER mind.

Hrrumph!

We will see about that Path...

I don't particularly care if someone is a doctor, a premed, a med student or the Purple People Eater - my opinion is the same that I stated earlier. I just don't have much else to add, though. Everyone is still entitled to their opinion - I just disagree with the original article writer.

I can't imagine anyone going to med school these days PLANNING to quit in a few years. I suppose there might be a few who are independently wealthy and can pay the entire tuition out of pocket, but when you come out a couple of hundred G's in debt, I'm not sure how you expect to pay that off if you're going to quit in a few years.

The Physician husband maybe?

We see the threads ALL the time, many from premeds at least as it relates to working part-time. Folks are already trying to figure out how they're going to work part-time in medicine, a fact I'm sure was left off from their med school interviews.

I see very frequently. Many female MD's are married to an MD and hence really have no significant vested interest in needing to work to bring the bacon. I would say where I trained at least 50% of the female attendings in Primary Care are PT.

Again, part-time in medicine can be as much as a full-time job in many other fields.

Again, a statement I've many many times in the past, NO ONE I know well earning over 6 figures, works only 40 hours/week.

So not only does there need to be some clarification as how we're going to define "part-time", there also needs to be a CLEAR understanding that Docs aren't the only folks on the planet working more than 40 hours in a "full-time" job.

But with physician husbands, you all have to understand that it works both ways. The physician husband often wants the physician wife to work less and take on all the domestic tasks so that his career can proceed without any obstacles. He may not say that, but he will make himself unavailable for these tasks and will insist that things related to his job are not negotiable. You can't place all the blame on the physician wife.

I know lots of people earning six figures and working 40 hours a week (or less). Most of them are public school teachers.

My main objection to the original article was the phrase "moral obligation to serve". No way.

Why is the solution to patients not getting into see their female pcp (we all know it is not just female docs pts can't get into) to essentially discourage women who think they may want kids in 5-15 years (essentially all females) to forgo medicine?

Why don't we increase the number of physicians?

Or...How bout we increase mandatory physician work hours to 60...80...100 hours a week? (when is enough enough?)

Why don't we make specialists see their fair share of uninsured or medicaid or medicare... Shoot, why don't we force them to convert back to primary care? Certainly we have enough of them, right?

In case it doesn't come across via computer, yes I am being sarcastic.

I think we should mandate hours when women are allowed to see their children and not see patients. If we regulate that, perhaps we'll have enough coverage for patient care.

Maybe we should add that to the new residency work hours

Or how about making it clear to patients that a particular MD works only part-time and may not be available every time an appointment is made.

In the past, I've had doctors that were in group practices and if their schedule was unavailable when I needed to see them, I made an appointment with someone who was available.

One can have an opinion of agreement in part or full with the article, but I dare those people to try to mandate my career IRL, whether I plan to work full-time or part-time. The issue for me is freedom to choose, and like I said before, my only obligation is to pay back my loans.

Why are we letting capable physicians retire, too? I mean, what a waste of resources right? Where is THEIR moral obligation to serve?

And where is this particular Beverly Hills anesthesiologist's moral obligation to the primary care shortage?

I think most of these points have been covered, but they bear worth repeating. It's kind of like telling people what cars they can drive, what houses they can buy, what food they can eat, what geographical area they can live in, etc. If I wanted to live like that I would move to North Korea or Russia c. 1980.

This sounds pretty one sided to me.

Note to daughter. Don't marry a Doc.

Hmmm.... Moral obligation of specialists to provide primary care... Interesting concept. If every trained md provided one half-day a week of primary care I wonder what that would do to the shortage? And how many specialists do you all know who work full time? With the exception of the surgery specialists I know (most of whom work way too much) many of the specialists I know work less than "full time"... Because they want to, because they can, and because it's none of my damn business how they choose to use their education.

Many patients who see full-time doctors have to wait a long time to get in to see them, too - so now what, 24-hour clinics run by exhausted, compassion-fatigued doctors? No thanks.

How many people who work in clinic saw a patient today with a uri that probably didn't need to be seen? The emergency rooms aren't the only place our "health care" system is flooding with misdirected use of resources. There are a lot of other areas of this broken system to focus on without attempting to blame all the problems on physicians who want to be able to sustain a healthy career by working how and when they want.

Jonesie, that reminds me at my prior job we used to joke that you never called a specialist on Friday afternoon, because they were all closed. Really, it was just not that funny.

I called a urology consult today at 430... Not well received

Look, I was a kid in the 80's. People told me I could be anything I wanted to be, and I believed them. Now, I'm becoming who I want to be, and I hear (often from the same people) that if I happen to have a husband and children, too, well, that "you can do anything" promise is void.

What I really think is that there are few images more powerful than a HAPPY woman who has a career and family, and other women--consciously or subconsciously--are threatened by that. I plan on working a high-powered job, and I also plan on prioritizing my relationship with my family. I do not plan on apologizing to my children for having an important, time-consuming line of work, and I do not plan on apologizing to my partners or patients once I have negotiated a contract for less hours than "full time". Apologies, in my book, are for when you have done something wrong, and (ahem) there is nothing wrong with having a career and a family.

It seems like women would rather live with guilt and resentment than risk sticking our necks out there to do what we really want. I don't want to be like that. My goal in life is to be the best doctor and mommy/wife I can be, however I need to do it. Because, seriously, I DO "have it all" and I'm going to dare to be happy while doing it, too.

"If you do not hope, you will not find what is beyond your hopes." -- Saint Clement

Asunshine....love that post. So well-worded.

I'm also an 80's kid, and that was certainly the mantra. I was just watching some old school Sesame Street that was singing that the other day.

Well said, asunshine. You will often run into people who are threatened by your success, whether because you're young, or well off, or (gasp!) happy with having it all. I like your no apologies policy, and I am adopting it today.

http://www.mothersinmedicine.com/2011/04/with-your-head-held-high.html

To answer path's earlier question, I would hands-down, absolutely let a part-time surgeon operate on me. I would let her do my Whipple if she were specialty trained to do so. I think we're confusing "part-time" here with "uncommitted"--in my book, that is like confusing "fish" with "bicycles". One has nothing to do with the other, and we'd do well to recognize that once and for all.

The part-time Whipple probably isn't a good idea:

Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003 Nov 27;349(22):2117-27.

Some jobs just shouldn't be part-time. President comes to mind. Pancreaticobiliary surgeon may be another one.

Actually asunshine, I think you pulled the "uncommitted" thing from out of no where.

Maybe that's the impression you got from Dr. Siegbert and maybe that's what she was insinuating, but that's certainly NOT what I was trying to imply.

It's real simple to me," what you do most is what you do best" whether we're talking about my MCAT prep or tennis game or skills in histology.

What I was thinking about was the general surgeons in the community hospital in which I was rotating who were trying to convince a patient that they could do the Whipple, and that this patient didn't need a referral to an academic medical center. They had done at most a handful before, which may or may not have been done in residency. I would absolutely still take a part-time surgeon to do a big surgery like that if the week she was on service, she was doing Whipples, and I was convinced that she had everything else I was looking for in a surgeon. So yes, numbers are important to me, too. I'm sure other people might choose otherwise, and that's fine, too.

I agree that you can't dabble in medicine--your head has to be in the game. But it goes both ways--there are people who work a lot of hours who really aren't improving their skills with experience, and vice versa. Of course it is possible for someone to work part-time and be a bad doctor, and maybe they are being set up to be less skilled than a full-time worker. But that is the challenge, and I think most women recognize that and bust their butts to provide high-quality care in every other way.

We all know that there are surgeons out there who are terrible communicators, who go into self-destruct mode when a disaster happens, who are distracted by administrative tasks or personal problems. And there are some who just don't have the hands for it. These characteristics are much harder to quantify in a single study.

I think in the coming years, we will be more cognizant of minimum threshold experiences that make someone competent (not excellent, just competent) at a certain task, and we will place more emphasis on other elements that result in better outcomes, such as good communication, thoughtfulness, personal wellness, attention to detail, and knowledge of current research. If someone needs to work part-time (while still keeping their numbers on par) so they can also excel in these other spheres, I think that is laudable.

ps-part-time to me means >30 hrs/wk.
(Not to pick on surgeons--we all do those things to some extent--it just seems to be where the topic is meandering....)

It's exactly the impression I got from her article.



And thank goodness there are term limits to that job. Interesting thought, though, if we had term limits for doing high-risk, delicate surgeries, but in exchange, that person gave their everything during those 4-8 years. In some ways, I could see that structure being more woman-friendly than the current one.

To put it another way:

If someone is going to [mess] with my pancreas, they'd better be eating when they can and sleeping when they can!

Okay, you can all groan now. I'm really done....

This is totally how I interpreted your comment, and it makes sense to me. I have a family member that had a bad outcome from a full-time but small town general surgeon who misrepresented how familiar he was with the operation he was doing and I am still angry and hurt when I think about it. No question a "part time" (but still quite a few hours) specialist who was honest and dedicated would have been infinitely better.

Inexperience is inexperience however it happens either from not performing a procedure because you don't have enough patients with that particular medical issue, or because there ARE enough patients, but you're not working enough to see these patients.

Personally, I think it's pretty sad that in order to prove a point, this thread has now resorted to "hair splitting" over what's essentially the same issue, Docs NOT having enough experience in a particular procedure for whatever reason.

Holy crap. This scenario never crossed my mind. People DO THAT? What? I'm blown away by this.

That was my first reaction, too! But then I remembered back in the dark ages when I was a nurse intern....and that community hospital also did a handful of general surgery Whipples a year. (!)

Keep in mind that the data on Whipples and high-volume centers is fairly new. So in the past, there was not as much of a perceived need to refer every big case to an academic center. Surgeons probably wanted to do Whipples whenever possible so as to keep up their skills. Referring them out instead would be like burning that bridge and acknowledging that they would never do Whipples again. Some might be happy never to do another Whipple, but some would like to keep it in their repertoire. Now it seems that fewer and fewer surgeons will be able to do them. The same kind of subspecialization is happening in all specialties. It is hard to say whether it is good or bad.

I have to say I am conflicted, too. When I was a nurse, our unit did maybe one open heart per week, which, in my opinion, was not nearly enough to have strong nursing care in that specialty. But at the same time, the open heart program kept the interventional cardiology program at the hospital, which was, IMHO, extremely high quality and did wonders for the community. I have no doubt that it saved lives.

So yes, still conflicted. I agree, volume is a big deal, but there are other elements.

And in case anyone didn't skim E's great article, Whipples were stratified into <2, 2-4, and >4 per year per surgeon (p2122). In this pathetically drawn out hypothetical situation, then, I think a part-time pancreaticobiliary-trained surgeon would hit that number rather quickly, and presumably be pretty good at Whipples, and get you even better outcomes if the hospital was also high volume. Presumably. (Commence groans. Again.) You can start throwing things at me now, path!

asunshine - great post. Another 80's kid here. Big hair and all.

I'm out of tomatoes, maybe next time!

Wait -- that was per year? I thought it was per month. Clearly didn't read my own reference very carefully ...

The government doesn't want to waste money on older people either. I ran in to ridiculous amounts of age bias in my first round of state-funded allopathic school interviews. The question asked at all three schools was a version of, "do you think you can keep up?" I feel that it was poorly veiled age bias. I backed up and revamped. It seems that being a little older and heavier are fatal for med school so I lost weight. I can't do much about my birthday though I am getting a second degree in biology.

This time I'm only applying to private allopathic and DO schools. If the public universities don't want me, then there are plenty of private ones that do. The sad thing is that I'm as competitive as a 22-year-old and finished raising my kids.. It seems to me that those factors would make me more desirable and not less. Really, I would be more positive about the government if they would just I've me a reason to be more positive. Who legislated what a productive life-span is exactly? I'm in my 40's, but was treated as downright geriatric by one school. Women in my family have lived into their nineties for several generations. My dad just retired at 83. I plan to practice for 30 years. How can a state school not justify educating me? I am including the inspiration of Leila Denmark in my current essay. She retired from pediatrics at 103...

latcatin, is there a downside to applying to state schools as well during this round of applications? I know people who were denied the first year and accepted the second year by the same state school.

latcatin, I agree w sahmd. It is ridiculously hard to get into a state school (esp where you are not a resident), no matter who you are! You might find the second time around that not only you are successful, but you might prefer the state school. Worth the extra couple bucks to give it another shot.

Here's an opinion on work-life-balance from a male EM physician:

http://allbleedingstops.blogspot.com/2011/11/being-physician-and-how-it-impacts-your.html

Nice.

Very interesting to be back here in the MomMd forums. I have been away "working" for the past few years and just now found my way back. In the three years since graduating residency I will tell everyone that I have quit 3 permanent jobs and have filled the void on many locums assignments in between. There are many reasons why people quit, and although I have an obligation to patients, I have an obligation to myself to be happy and stay healthy, and to ensure my family is happy as well.

1st job: I LOVED it. My family hated where we moved to. I was on call all the time and had to live at the hospital during call because I covered ER and lived too far away to be home. The schools were terrible. My husband was miserable, my kids were miserable. We couldn't find housing. The student loan repayment never materialized.

2nd job: I was a SLAVE. On call one week at a time doing full day clinic and full hospitalist service. No leeway from clinic manager if overwhelmed at the hospital. Was screamed at profusely for cancelling one-half day of clinic due to patient needing emergent care and transfer to bigger facility, etc. I could go on. Student loan payment portion of the contract was not fulfilled by employer. Left without notice for their breach of contract.

3rd job: I was a worse SLAVE. Took over a retiree practice. Office runs with 4 staff members, corporate gave me 2 and said deal with it until you show us numbers. Patient's extremely angry when their doc left. I ended up working 12 hours a day trying to help staff keep up with paperwork and was reduced to a typist. Eventually lost all find motor function in my hands. Was screamed at if the staff got any overtime. Nurse broke down crying on a daily basis. I was reduced to getting up with dry heaves every day and walking around the office with ice packs on my hands. What a nightmare. I saw my kids less than when I worked locums which defeated the whole purpose of taking the job in the first place.

So after all that, I am super leery about jummping into another permanent position. Seems I am destined to be a locums doc forever. All my assignments I have been on I totally loved but the locations were terrible and I can't afford to repeat what happened juring job #1.

Thanks for listening. I agree that the article is crap. You have to do what is best for you.

Welcome back, Kathie, DO! It sounds like your family has been very flexible in moving with you to the different locations. I think a lot of people end up stuck in a particular location because of a husband's job or a child's school or an unsellable house and then they have a limited choice of non-ideal jobs.

Yes, I understand about being stuck. I still have a home in texas that is unsellable. I have one of my inlaws living in it taking the loss on taxes which helps. My poor son is in his third high school in 2 years so I will not be moving him again. He has managed to maintain an A+ average despite the turmoil. My husband stays home so whether I am away at a locums site, he is the constant and takes care of the home front which makes my life so much easier and I don't worry. When I am away I talk with my kids on facebook instant message since each one has a computer and I help with homework over chat lines. It all seems to work out and while I wish I could just find a job that was agreeable and happy, I have peace knowing that the kids are settled and doing well whether I am there in person or not. I try to co-ordinate locums assignments so they are no longer than 8 weeks and I tend to take a month off at least inbetween. We have done well. Nice to take extended vacations and not have to ask permission.

Wow, Kathie, DO, that is really unconventional but it sounds like it is working out well for everybody.

Wow, I just skimmed through all of the posts on this topic. Kathie, DO, thanks for sharing your work stories. SAHMD, thanks for being such a steady voice on this website.

Hi Kathie- good to see you back!