Family comes first for some who have finished residency

by Dr. Whoo, MD

I have met several women who have completed residency and maybe even practiced beyond that, but decide to quit and stay at home with kids. I wonder – why would a woman who has gone through all of that training just quit? It would seem like the hard part is behind them and I am perplexed by their decision but, of course, I don’t want to be so rude as to ask that question to them.

From,
A lawyer and mother of two in Seattle.

I am going to try to tackle this question, even though it is not my current personal experience or decision.

I actually went through residency with a woman who did this very thing. She went through medical school, a strenuous OB/GYN residency, and then worked in private practice for a couple of years. She was married to another physician who eventually completed an interventional radiology fellowship.

During residency, she had two children, and then had a third when she was out in private practice. Once her husband finished his training, she quit practice to be a mother full-time. When people would ask her why, her answer was simple: “Because I want to, and financially, we can do this, so why not?”

I know she loved her career, and she was a very skilled, caring, and compassionate physician, but she just wanted that time with her family more, and they were in a position to swing it. She didn’t think of her choice as “quitting medicine,” she viewed it as choosing her family. It is no different than the other career women (lawyers, executives, teachers, bankers) who make the very same choice. She always planned to return to a GYN-only practice once her children were school-aged, and she became board-certified, and kept up with the field via conferences and CME.

I have since lost touch with her, but I have no doubt that she was very happy with her choice. While most physician-mothers are not as extreme, I see varying degrees of women choosing “lifestyle” specialties or different levels of “part-time” practice after residency.

Even though medicine does require more rigorous training than most careers, it does not necessarily change the way you feel about how your family life should be structured. There have been many times that I have considered cutting back practice hours, myself, in order to enjoy more family (and me) time.

I recently made a move that enabled me to still work full-time, but greatly reduced my time on-call, and therefore, my time away from my family. Currently, I am the bread-winner, and I still have some student loan debt that needs to be paid, so up and quitting is not a viable option for me.

However, if I am able to become a partner in my current practice, reduce my in-office time, and still manage a decent living, then I will likely choose that path. There many different ways of finding a work and home balance for women today, and I am thankful that we have the ability to “choose medicine” and we can also “quit medicine” if this is the best thing for us and for our families.

Dr. Whoo is an obstetrician-gynecologist who blogs at Mothers in Medicine.

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  • http://drpullen.com Ed Pullen

    About 15 years ago I made a choice to scale back my hours, and be able to participate more actively as a parent with my two school age kids. My wife also had a business, and we wanted to both be able to pursue our careers, be active parents, and have time for each other. I was able to practice about 2/3 of full time, spend some more flexible time as the managing partner of our group, and work better with my wife to provide active parenting to our two children. This “cost us” some income, but earned us a much better homelife. With both kids out of the house now, we work a bit more, but those were important years. I think both Dad and Mom physicians can find ways to be involved in their family lives if we make that choice.

  • http://www.blog.greatzs.com ZMD

    This is one reason why there is such a shortage of primary care doctors. Women disproportionately choose the primary care fields like Medicine, OB, and Peds but they are more likely to drop out of the workforce to care for a family. It is politically incorrect to say so, but commonly shared by my male colleagues, if more men were admitted into medical school there would be less of a deficiency of PCP’s. With women making up half of medical students there is going to be chronic shortage of practicing physicians, no matter how many more schools and residencies open up.

    • Ann

      Men don’t become PCPs. You just said it yourself. And studies have shown it. It doesn’t pay enough to suit them, apparently. So your argument lacks face validity.

      And not only is it politically incorrect to write what you wrote, it’s ignorant and small-minded of you to think it. Women have just as much right to practice medicine as men do. And, frankly, women do it better. I know. All of my doctors with one exception are women because I have fired most of my male doctors. They lack compassion, patience and personality. They are much more robotic and business-oriented. Medicine is about people. Primary care, especially, is about people. Your argument is moot on so many levels…

  • westeasterly

    The problem with this is that each and every year thousands of pre-med students are turned down because of limited spots in medical school. So while it may be well and good for one woman to make that choice for herself- medicine isn’t about you. You’re choosing to selfishly horde training that could have instead gone to someone who would not have made that choice. And they in turn could be helping so many people during the years you choose to help no one other than yourself. If women truly want to attain equality this is exactly the kind of behavior that must be stopped. It’s great that women have the freedom choose to stay or leave, but why is it that medical schools aren’t free to choose students more likely to stay in the field of medicine for their entire adult lives? The price for your “freedom to choose” is one that our entire society pays.

    • Todd

      This line of thought, while reasonable, has its flaws. If what you do with a medical career should be determined by social need and not personal preference, why should you be free to choose pathology over primary care? We’re thought to have an oversupply of the former and shortage of the latter, and medical schools could have admitted someone with more of an interest in becoming a pcp (and many of them are through rural/primary care programs).

      Instead of saying that its selfish to drop from the workforce, how about incentivizing staying in the workforce? Higher PCP salaries (women disproportionally go into primary care/OB), more flexible work schedules, loan repayment programs contingent on working for X years, better child care facilities, etc. are all ways to increase parent-physicians work activity. Asking prospective medical school applicants to choose at the age of 21 whether to have a family or pursue medicine seems unreasonable.

  • http://www.silvercensus.com/ Steffan Lozinak

    It seems simple enough to understand really. Most people would like to spend more time with their children. Even if you love medicine and love your job, your kids are only young once and if you miss being with them, you won’t ever get that time back. It’s all about remaining true to yourself and knowing what is really important to you.

  • Ed

    Every situation is individual and things that influence decisions cannot always be foreseen…so I don’t mean for this to be an attack on anyone (or sexist because men could leave medicine as well for whatever reason including family) but shouldn’t the general question come up in more premed discussions about the intention to work full time especially during a time of physician shortage because a seat at medical school could have been filled by a maybe less intelligent, but more likely to work more person than someone with less serious intentions of practicing full time but wants to attain a medical degree for some personal form of personal satisfaction.

  • jsmith

    Young, idealistic physicians-to-be like to be picture themselves as rescue heroes, helping grateful, clean, attractive and not-foul-smelling deserving pts to change their lives for the better. Then reality hits. The reality is that a lot of doctoring is basically a slog, an endless passing parade of unhappy humanity, a sea of paperwork, hassles unimaginable to many outside the field. But it pays the bills. The thing is that this OB/GYN already had someone to pay the bills, so she bolted. Not surprising to those familiar with normal human behavior. People, and that includes doctors, might not do what you want them to do, but they usually do what they think is in their own best interests.

  • Max

    And by the way, radiology, especially interventional, is way way overpaid. If her hubby was a lowly family doc he’d be home with the kids.

  • Anonymous

    This very phenomenon is why I’ll never hire a female associate… and I’m female. Many of my friends, some female with children, feel similarly. It’s a business decision: why bother investing 2-3 years in integrating an associate into a practice only to have her leave? We’ve seen it happen again and again, and it’s devastating to small practices, no matter how generous the maternity leave or accommodating the practice in allowing time to parent.

    • Ann

      It’s too bad your post is anonymous. That is the most blatantly illegal discriminatory statement I’ve ever heard an employer make.

      • Business

        The individual’s thoughts, while may be illegal, are on target when working not with women, but Generation X and Y/M. I developed as a shared workspace in my home tome, and have a number of dedicated workers that consume the space. Why? The younger generations all want balance. They don’t want to be in the daily pressure mill tied to their job. The are bankers, lawyers, teachers, nurses, etc. who want intellectual freedom and not tied to a desk or institution.

        As a woman, outside of medicine, I am sick of being told I am a woman “And, we will not hire you.” Illegal? Yes, but I am not going to file suit; it would be too time consuming.
        For myself, I invested myself in a serious of business start-ups, including multi-million global factories. And while I am still laying out plans, and trying to secure income for myself, I find it interesting that I have tried to obtain a job in more than one hospital. I’ve been turned down for working another job. Crazy, I know! Working an 15-18 hour day is mandatory to survive in today’s economy. Funny thing is that one of the positions, I applied for, was filled by a young lady who got pregnant in the first few months of her job. She is due any day now. Let’s see if she keeps her job. I bet she will not.

  • gerridoc

    Your question presents a difficult dilemma for me. When my generation interviewed for medical school in the mid 70s, one of the arguments used against accepting women was that we were taking slots away from men. I was fortunate to receive my education from a unique place where women physicians were the norm. Many of them juggled careers and family, quite successfully. Sometimes a professional has to completely “opt out” of her/his career, but given the barriers that needed to be broken for women to gain entrance into professional schools, dropping out should not be taken lightly.

  • Max

    And by the way this same scenario is playing out in veterinary schools. The female/male ratio in those is upwards of 70:30. It’s fine for animals. Fluffy can wait a week or three.

  • Outrider

    >>And by the way this same scenario is playing out in veterinary schools. The female/male ratio in those is upwards of 70:30. It’s fine for animals. Fluffy can wait a week or three.>>

    Fluffy and Rover can wait.

    Trigger the horse and Bossy the cow can’t. It’s a major issue in veterinary medicine.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    ZMD, I’m sorry.

    I’m a female physician who went into primary care . . . and even came back home to serve the community where I grew up . . . only to be professionally left for dead by the Teflon-coated executives running the mill-town “non-profit”.

    To build the practice that was pulled out from under me by administrative misconduct, I spend almost every waking hour of 3 years covering Pediatric critical-care call of all of the other doctors in the community (a whole lot of those manly-men you’re talking about) – and taking care of other women’s children – while foregoing any of that personal happiness myself.

    And then there was the protracted legal battle (which included fighting off a SLAPP-suit) that I technically “won”, but really didn’t – because once again, those executives could do anything they wanted and not answer to anyone. Local law enforcement doesn’t care. The state of North Carolina doesn’t care. And the Feds do not care.

    Now it’s too late to have the little girl I always wanted.

    I got a great big dose of “doctors are a dime a dozen” and “medicine isn’t about you”, and I can tell you that that notion is just plain bogus.

    So more power to the younger crowd of women who have figured out that you MUST put yourself and your needs and your family first.

    I wish I had. I am now.

  • gerridoc

    Dr Mary, you have a good point. Whoever holds the big stick runs the show. But don’t these women have educational debts to pay off?

    • Max

      That’s what interventional radiologist hubbys are for.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Gerridoc, I think it’s for those women to decide how they’re going to deal with those loans. And with the shortages that are coming, I don’t think that practices/hospitals anywhere in the future are going to be able to pick and choose between men and women. They will take what they can get – for as long as they can get it and be grateful.

    Indeed, the smarter hospitals and practices will start treating physicians better – and doing more to resolve problems – rather than fire/destroy people and start all over. The recruitment money isn’t there to throw away anymore.

    I, for one, wish I had NEVER done public service to pay my loans off. I would have been MUCH better off going into a local private Pediatric practice in a near-by town as opposed to being the unappreciated peon cleaning up all the messes of the male Family Practitioners that controlled the medical landscape in my hometown:

    http://drjshousecalls.blogspot.com/2010/02/national-health-services-corps.html

  • Hospitalist

    I was trying not to comment because I feel emotional about this topic. I am a female hospitalist. When I first applied to medical school, I didn’t imagine myself getting married and having children. Even through medical school, when there were “Women in Medicine” interest groups, I stayed away thinking that they seemed sexist – we should be equal. Even through residency, I didn’t plan on marrying and having children. Now in my early 30′s, I have met someone and am getting married and planning on starting a family. I may or may not be the one who stays home with the kids. I have the higher income, but I “selfishly” want to have a hand in raising my children. I plan on working part time – maybe both of us will. Yes, I have loans to pay off, but I can live on less and still enjoy my life.

    First, without being completely sexist and just denying women admission, there is no way to tell who will want to work full time and who won’t. There are more men in my group working part time than women. Actually, no women are working part time – we are all full time. There are more men though, so can’t really do a direct comparison.

    Second, women who wish to continue to work and have a nanny raise their children are considered selfish. Women physicians who choose to reduce their hours to raise their children are considered selfish. Seems like we can’t win.

    Third, maybe we should get rid of this notion that men and women are “equal”. Physically, we just aren’t. But making broad statements about one gender or group is exactly what discrimination is. As far as I’m concerned, I did more than my share of covering paternity leave for my male colleagues and if I decide to work less to raise my children, they can return the favor (and as far as I know from them, they are happy to do so).

    • jsmith

      Hospitalist, Sometimes you have to decide between doing what you want to do and doing what others want you to do and then live with the consequences. I realize this is often harder for women, who generally care more than we men do about making other people happy. But you’ll figure it out.

  • Outrider

    >>maybe we should get rid of this notion that men and women are “equal”. But making broad statements about one gender or group is exactly what discrimination is.>>

    Actually, I think an even more critical issue in veterinary medicine – and probably for human medicine as well – is the influx of wealthier veterinary students/new graduates, who for whatever reason do not have to work full-time. Students whose families were able to pay a substantial portion of tuition and new graduates whose spouses (regardless of gender) are high-income seem to be more likely to work part-time and eschew ambulatory large animal practice. Of course, many veterinarians with higher-income spouses happen to be women.

    I’ve seen many new graduate equine veterinarians from wealthy families or married to high-income spouses leave full-time general ambulatory practice within 5 years. I’d be extremely leery of hiring a veterinarian of either gender whose spouse happened to be, for example, an interventional radiologist. In contrast, I know an ambulatory large animal veterinarian who has three children and worked (including taking emergency call) up until her due dates. Her income is larger than her husband’s and cutting her hours to part-time, which would have decimated her practice, was never an option.

    I’m sure this phenomenon has parallels in human medicine, especially in the lower-salary specialties like family practice and pediatrics. Money is gender neutral, after all. Besides, who wouldn’t want to work part-time, if it were financially feasible? As Hospitalist said, it’s possible to live on less and enjoy life.

  • gerridoc

    Hospitalist, your points are well taken. It is never easy to combine a medical career and a family. Obviously, a great deal of thought and planning must go into making decisions that involve the two spheres. My comments have to do mostly with previous generations “opening the door” for younger physicians. We paved the way to make it more acceptable for physicians to work “part time” and have some flexibility in their schedules. Being a physician is a calling, not a “job.”

  • josephknechtdvm

    Professional education for veterinarians or physicians is a public good that in most cases has a substantial subsidy from government in establishing and supporting the schools. I think the idea of economist Milton Friedman in eliminating subsidies for all higher education and especially for professional schools is a good idea. Professional students should be responsible for the full costs of their education in light of the greatly increased earnings they will receive in the future. Having the responsibility for the entire costs of your education may impress upon the aspiring professional the need for professional committment (within reason) over committment to a personal lifestyle choice. Everyone needs balance between professional and personal lives but a “part-time” professional in human or veterinary medicine is not the answer. I would love to know how much “underemployed” professionals cost the US in lost services that then have to be supplied by training other professional providers to make up the difference. I certainly did not become a veterinarian to work in a part-time profession , but that is what the influx of women into veterinary medicine is producing. I truly admire those women who take their profession seriously as a committment and not just a part-time job and part of their “lifestyle”.

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