The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, March 15, 2006

I am Woman... Does it Matter?

I think I'm lucky to have been born when I was. I'm way too contrary and stubborn to have been submissive and subservient, the way most women were expected to be in the past. And I was lucky to have been raised by parents who believed that women could do whatever men could do. The sky was the limit. I was never encouraged to go into any of the more traditionally female professions. At no point did anyone suggest that I become a nurse rather than a doctor, even after two unsuccessful applications to medical school.

So after growing up in an environment that taught me that I was just as good (if not better) than any man, I've often laboured under the mistaken impression that gender doesn't matter anymore. I had heard the stories about the glass ceiling, read the statistics regarding pay inequalities between men and women, but always explained them away. Glass ceiling? That's mostly in business. Unequal pay? Only because women still chose 'pink collar' jobs over higher-paying ones still dominated by men. But today gender doesn't matter. The inequality has lessened significantly over the past few decades, and will soon be history. Naive? You betcha.

Medicine is changing. The current crop of medical students in Canada is over 50% female. At my medical school (in the interest of remaining anonymous, I won't name it but it's safe to say that it's on the cutting edge of tradition) I was a member of the first medical class in the university's history where women outnumbered men. So the future is bright for women in medicine.

But we're not in the future. We're in the present. And women are still painfully underrepresented in medicine, particularly in academic medicine. Through the course of my medical career I've been interested in three specialties. I started off wanting to do reconstructive surgery. Then, my interests shifted to emergency medicine. Currently, I'm a family medicine resident. Interestingly, I started off in a male-dominated specialty and ended up in a female-dominated specialty.

Surgery often isn't an option for female medical students. The hours are long and hard, and it doesn't let up for the 5 years of residency. Even after residency, many surgeons complain that they don't fell that they're in control of the hours they work. And that's a lot of hours. On my surgical rotation it certainly wasn't unusual to see staff surgeons rounding on their own patients late into the evening or on weekends. And I'm talking about the weekends and evenings that they're NOT on call. I have yet to meet a female role model in surgery. The very few women surgeons I've encountered have either been workaholics or complete bitches, and I have yet to come across any of them that seem to have anything even remotely resembling a balanced life. Which then begs the question-- perhaps none of these 'balanced women surgeons' are around simply because such an animal does not exist.

Emergency medicine was a little better. Although the old guard was still primarily testosterone-driven, the spread of young doctors and residents is now close to 50/50. This is probably because of the 'lifestyle' aspect of the specialty-- if you're the kind of person who copes well with shift work, the idea of throwing your pager out the window for the rest of your career is awfully tempting.

Although family medicine is much more female-heavy than other specialties (with the possible exception of pediatrics and obs/gyn) it's not immune from some of the old school ideas. My preceptor, who isn't all that much older than me, actually said to me that "the problem with physician recruitment targets is the fact that they count women physicians as equivalent to men". Mind-blowing, isn't it?

His point was that women, because they have children, will work less over the course of their career. So if you're looking at replacing a retiring male physician, it would take more than one female physician to pick up his workload. I tried to point out that male physicians are also more interested in life beyond medicine, and are much less likely to subscribe to the 80-hour workweeks and 24/7 call that have traditionally been the hallmark of the family doctor. Many men today aren't content to make lots of money at the cost of their health and family life. What's the point of making lots of money if you don't have time to spend it? Your wife barely knows you, your kids hate you... it's just not worth it. My preceptor was unmoved.

"It's biology," he explained, "women have the children and act as primary caregiver. It's unlikely to change any time soon."

I was horrified, but bit my tongue. My soon-to-be-husband was brought up in a family where mom and dad split child rearing and household chores down the middle. There was no 'men's work' or 'women's work', it was just 'work' and it needed to get done. And it was. As a result, he and I are able to plan a future where we split our allowable parental leave down the middle, and share childrearing responsibilities equally. Maybe I'm underestimating the surge of maternal hormones that will make me want to give up medicine for diapers and Dora the Explorer, but this is the plan we've discussed at length. In fact, if anyone is going to do more than the other it will likely be him. Why don't people even consider this as a possible alternative?

I've started to worry that the assumption that my career will take a back seat the minute I procreate will make the legendary glass ceiling more real than I've ever believed.

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Anonymous Anonymous said...

I hate to say this but even as a female medical student I tend to agree somewhat with your preceptor.

The reality is that if you are a woman and want to have children you will likely be inclined to take some time off around the pregnancy (even if it is only a week-like one staff doc I know). I think a lot of female physicians work normal work weeks 40 hours/week or so, but the old school docs and our health care system expect 60-70 hours/week.

Someone has to take care of the Whether we like to admit it or not society as a whole sees women as the primary caregivers for their kids. So if you don't stay home part time to raise your kids some people will say: "what's wrong with her, why'd she have kids if she doesn't want to be there for them". And if you do stay home part time others will say "what a shame, smart girl, all this training to be a doc and now is wasting it on having children."

It's a shame but I don't think we have really figured out a good way of dealing with this double standard.

1:46 PM

Blogger Couz said...

What I'm saying is that MEN in our society aren't willing to work old school docs hours either. I don't know any family doc, male or female, that still puts in the hours (or is available to their patients 24/7) that the old school docs did.

So why are women singled out as the slackers?

And please... men take paternity leave too.

Am I the only person in the world who sees parenting as a two person job?


5:09 PM

Anonymous Anonymous said...

I agree that parenting is a two-person job...but you may also have something when you say that you're underestimating your maternal instincts or hormones or whatever. I also think women are seen as the primary caregivers, and the truth is, women who work full-time and have kids often don't get any breaks at home either.

I'm not in medicine, but in another male-heavy field where people are expected to work long, arduous hours to succeed. Unfortunately I know a lot of guys who are willing to do so, but not as many girls who are... and I don't blame either for their choice, but I think there are still professions where men will "dominate".

Should women bear the brunt of making this parenting choice, or is it society that must adapt... you'll never change the views of your preceptor, though.

7:31 PM

Anonymous Anonymous said...

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12:54 AM

Anonymous Anonymous said...

this blog totally hit home for me. i am in a completely male dominated profession. at my company, of 207 active professionals, there are 5 women. and one of them is the boss's wife. so the whole issue of having children is very difficult. the boss's wife did, and walked back into a plum position. are the rest of us going to be able to do that? i don't think so.


12:54 AM

Blogger Carina said...

I'm a doctor's wife who's stayed home with the kids. It was my choice long before having kids, something we'd planned on.

You know what, though? My husband doesn't want to work those long hours, either. He's torn, as he was trained to sacrifice everything for medicine, but he also wants to be an involved father and actually have a wife #1 at home (as opposed to a cycle of wives, as so many doctors do).

I've had bad health for years but really bad in the last year, and he's had to face needing time off and doing laundry and helping more around the house than usual. It hasn't been easy, but we're working on it.

I totally disagree with that preceptor--many men take time off for family, too. Even here in the States. Many women docs are right back in there and have stay-at-home husbands.

My son's in a play group run by two doctors' husbands who stay home for their kids (one's a general surgeon, and the other's an oncologist). These are guys who had a lot of "potential" but made the choice for their families. One's a businessman, and the other's a Ph.D. Their wives are working hard to balance things, and it's working for their families.

Times are changing for doctors. Less pay, changing work loads, mid-level providers, and doctors wanting better lives outside of the clinic or hospital. That preceptor just doesn't like change.

10:05 AM

Blogger Kim said...

I'm in a totally female-heavy profession: nursing.

My husband is an attorney. But not a big,fancy firm. He chose a small private practice of simple cases and helping the elderly because he did not want the pressures of "The Law Firm".

So, for the last (almost) 27 years, we have worked our schedules around one of us being with or available for the kids. We're still doing it as we have a 16-year-old at home.

But my kids have a relationship with their father that my husband could only dream of having with his and one that I didn't have until I was an adult.

Parenting is a dual-person job.

It can be done. I'm proof.

3:37 AM

Blogger keagirl said...

You can do it all if you want to. After all, you are a woman!

I am a female urologist, and let me tell you, there aren't a lot of us out here. Hopefully, I'm neither a workaholic nor a complete bitch (just occasional temper tantrums), but I may not be the best judge. Better ask my husband...

I have lots of friends who are both girls and surgeons, and they are NOT mutually exclusive. Most of them have kids and a full time practice (both private and academic in urology, Head & Neck surgery, transplant surgery and general surgery) and they are all able to find a good balance. Of course, it helps that their partners and families are very supportive, and don't adhere to the "barefoot and pregnant" dictum. But it can be done, and done well.

For that matter, I know an awful lot of female doctors in general who have found that balance. Your preceptor is behind the times and needs to be educated.

11:20 PM

Anonymous Anonymous said...

Frankly, I have more trouble convincing my kids that their father can do it than I've ever had convincing him. Both of us work a 40-hour week and right now, I am doing most of the schedule flexing when one of the kids needs it because he has just started a new job and doesn't have any time off built up yet. I have also chosen to stay in a job that pays less than I could make otherwise because of the flexible schedule I'm allowed to work (within reason) and because I really enjoy the work. Some days, I'm not sure which is more important to me. The point is, you can do it. Just don't let anyone else talk you out of it.

10:35 AM

Anonymous jojo said...

Well, as a female physician (pediatrician), I have to agree somewhat with your preceptor as well.

I think on an individual basis it's not fair to say that YOU or any particular female physician will work fewer hours than your male counterpart just because you're a woman, but on a population level, there are good stats that show that women physicians DO work fewer hours and it makes sense to take that into account when looking at physician resources.

I currently work in a group of eight physicians. All four of the women work part time. All four of the men work full time. Now, granted, the women are also younger, and maybe I'll be working full time too once my kids are all in school. But of all the physicians of my age with whom I trained, I can't think of a single man working only part time. I know some who took a few months paternity leave, but none who chose to stay home with the kids part time on an ongoing basis.

I don't feel bad about my decision. I spent the last fourteen months of my residency hating the weekends I worked because I was away from my daughter, and trying to pump breastmilk in my free time, which she wouldn't take from a bottle anyway. I love that I can work fewer hours for much more money now that I'm finished my training.

And my husband and I both feel that parenting is a two-person job. My husband spent many, many nights and weekends with my daughter while I was finishing my training, and still does, as I still do work some weekends even though I'm not working full time during the week. He does all the daycare drop-offs and pick-ups on the days that we do both work. It's working for us and all three of us are happy.

9:57 AM


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