Why doctors shouldn’t have to choose between medicine and family

For the past few Sundays, the New York Times has published provocative op-eds involving physicians.

Why doctors shouldnt have to choose between medicine and familyThe first tackled physician bullying.  Next was the cost of medical education.  And, most recently, the phenomenon of part-time, mostly female, physicians.

This is obviously a live-wire topic, sure to generate passionate commentary.

In the piece, anesthesiologist Karen S. Sibert goes over ramifications of part-time physicians.  They comprise mostly of women, as 40% of female physicians between the ages of 35 and 44 reported working part time.

In the context of the primary care shortage, however, this presents problems to patients:

It isn’t fashionable (and certainly isn’t politically correct) to criticize “work-life balance” or part-time employment options. How can anyone deny people the right to change their minds about a career path and choose to spend more time with their families? I have great respect for stay-at-home parents, and I think it’s fine if journalists or chefs or lawyers choose to work part time or quit their jobs altogether. But it’s different for doctors. Someone needs to take care of the patients.

The Association of American Medical Colleges estimates that, 15 years from now, with the ranks of insured patients expanding, we will face a shortage of up to 150,000 doctors. As many doctors near retirement and aging baby boomers need more and more medical care, the shortage gets worse each year.

The United States isn’t alone in dealing with this issue. In Canada, for instance, the newsmagazine Macleans did a front-page story on the topic back in 2008. In it, the president of the Canadian Medical Association bluntly stated, “female doctors will not work the same hours or have the same lifespan of contributions to the medical system as males.”

Dr. Sibert is correct in pointing out that our health system cannot accommodate the incoming generation of physicians who prefer a better work-life balance.

She proposes that medical students be forced to choose:

Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especially — to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency.

Indeed, her wry advice to a medical student who valued work-life balance was, “If you want to be a doctor, be a doctor.”

In other words, medicine or family.  Not both.

If that’s truly the case, it’s unlikely that many medical students will sacrifice their family for their career.

And, to be honest, why should they?

Physicians today are often vilified in the media, as well as by health policy experts. As we reform our health system, it is the physicians who are often targeted as ones most responsible for soaring health costs, and yet their concerns often are ignored. The bureaucratic hoops doctors have to jump through to care for their patients continue to worsen.  To top it off, there is constant pressure to replace physicians with less expensive options.

Simply put, doctors, and the work they do, are becoming devalued by society. It’s no wonder that physicians’ commitment to the profession is wavering.

It’s one reason why physicians today, both male and female, prioritize work-life balance.  Those who don’t risk burning out. And as internist Robert Centor poignantly notes, “I would rather see a committed part-time physician than a burned out full-time physician.”

Instead of pointing the finger at part-time doctors, it is our health system that needs to change, and adapt to physicians who choose to place both medicine and their family on an equal pedestal.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitter, and LinkedIn.

Comments are moderated before they are published. Please read the comment policy.

  • http://www.davisliumd.blogspot.com Davis Liu, MD

    I would disagree with Dr. Sibert, who appears to be out of touch with the reality and the aspirations of the current generation of doctors. The demands of medicine have not changed. If anything, it is more challenging than the past. However, for those who do not simply want to be defined by their profession as doctors did a generation ago, I can assure you that Dr. Sibert only provides one part of view, and hopefully the minority view point.

    As a practicing primary care doctor, I work part-time and have many interests outside of medicine. However, I am only able to achieve this because of where I work. My medical group is large and uses the world’s most advanced electronic medical records. I have a salary so I can focus on caring for patients rather than running a practice. First year medical students are amazed to see that they can have it all.

    If the country is to solve the health care problem, then we will need the best and brightest, both men and women, even if they wish to work part-time.

    Davis Liu, MD
    Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Healthcare System
    (available in hardcover, Kindle, and iPad / iBooks)
    Website: http://www.davisliumd.com
    Blog: http://www.davisliumd.blogspot.com
    Twitter: davisliumd

  • http://PediatricCareer.org @Kind4Kids

    Glad you posted about this, and pointed out that whether male or female, physicians consider the issue of #worklifebalance (oops, that’s another NYT piece today, on hashtags). I like what you quoted by the internist (Centor – committed part time vs burned out full time). And, I’d rather see both males and females sorting out the balance… that’d be more balanced than just one gender doing so.

  • J P

    I’m sick and tired of people blaming doctors–or anyone else for that matter. Does anyone care to see how much good they do? People point fingers at doctors, sue them viciously, and say how selfish they can be without realizing how much good they have performed for society. What selfishness? Is it selfish to want to enjoy life as in having a family and not just spending time with them but QUALITY time? No! Is it considered unprofessional and selfish to want to set boundaries between work and personal life? No. No! Sure, doctors have a responsibility to their patients, but they are just people in the end; they are not Energizer bunnies. They have their limits, too. We feel so entitled to everything we have, WE have become the selfish ones thinking doctors owe us their time 24/7/365. They are people, too. Deal with it.

    • stitch

      Thank you. Seriously.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    Far being from me to argue that people in any profession shouldn’t have a right to revisit their decisions, or to place their own family before any other concern. I did that myself.
    However, Dr. Sibert raises a valid point. If we are to assume that not all graduates will be working full time, we should rework the estimates for how many medical students we need and how many residencies we should fund in order to ensure an adequate supply of physicians. And perhaps the financial aspect needs to be revisited as well.
    We need larger percentages of best and brightest to go to medical school, and fortunately we seem to have plenty best and brightest wanting to do just that if there were enough room to accommodate them.

  • Fam Med Doc

    Much thanks to you Dr Pho on an interesting dilemma. Not mentioned in your article is the government cost in educating a physician. I do not have the stats, but my understanding is the cost of educating each individual exceeds the cost of tuition each medical student pays at a four year medical school (if anyone has those stats, it would be nice to hear them). So if society, thru taxes levied on it’s citizens, is partially funding the education of a physician, only to have that individual physician work part time is probably not the best use of federal tax dollars. Given the shortage of physicians, one might suggest that putting what limited tax money we have into physicians who will work full time is a better use of societal money.

    But how in the world, in a free society, do you fairly & logically enact & enforce that? Individual physicians, as do all citizens, have rights & free will after all.

    BTW, I’m sorta unconvinced of this primary care shortage so often discussed. In my large city ( I live in one of the largest cities in the US), there is NO shortage of of PCP’s. There seems to be a primary care clinic on every corner. All my primary care friends have capacity for more patients in their schedules. No shortage here. Maybe it’s the unbalanced distribution of physicians? Too many in urban settings & not enough in rural? One observation: I notice alot of foreign physicians in my city (J-1 visas I think they are called). Why are they allowed to practice in areas where there is no shortage? Shouldn’t they be only given licenses to practice medicine in rural areas where a documented shortage is truly present? But I am aware there are truly some urban settings like Massachusets where a shortage really exists. Or so Ive heard. Other physicians thoughts would be nice to hear.

    • stitch

      My city is considered to have the highest (or one of the highest) ratios of physicians to population; as a result, we have about the lowest reimbursement in the country. There are two major medical schools in my city and multiple primary care residency training programs. However, there does appear to be a shortage of docs in certain areas, including parts of the city itself and in some of the suburbs.
      There are multiple reasons for this: many of the physicians counted are still in training, and many of the remaining are in academics with limited clinical time.
      I also wonder, however, what the role of retainer medicine plays in this. Every year I get new patients coming because their long-term physician has decided to go “boutique,” and every time I think that this must be a saturated model I find that it is simply not true.
      I have come to the point, however, where I can absolutely understand where the physicians who go this model are coming from. See article above, for one. It also allows these docs to practice medicine as they and their patients need, without the ramifications of “check boxes” and patient satisfaction scores. It’s actually the ultimate in patient satisfaction measures: dissatisfied patients won’t pay the retainer.

    • H. Lecter, MD

      ” One observation: I notice a lot of foreign physicians in my city (J-1 visas I think they are called). Why are they allowed to practice in areas where there is no shortage? Shouldn’t they be only given licenses to practice medicine in rural areas where a documented shortage is truly present?”

      Foreign physicians on J 1 visas are not supposed to stay in the USA after residency at all, unless they go to an underserved area for 3 years. After that, they get their green cards and can practice anywhere. Not all foreign physicians go for J1 visa residency, because of the aforementioned restrictions. Some already have green cards, others apply for H1B visa, which does not restrict you to an underserved area for 3 years after residency. I deliberately stayed away from the J 1 visa and applied for the H1b visa, because I did not want to get stuck in an underseved place with an employer that I might not like for 3 years as a condition to stay in the country. There are reasons that some places are under served. I ended up in an underserved area anyway, but by my own choice, not mandated by anybody, which is a big difference. I can move anytime I want, do whatever I want, even not work as a physician if I don’t want to. I value my freedom and also the freedom of others, including women who don’t want to work full time, because they want to raise their kids, go fishing or whatever. As far as shortage is concerned, it is not the physician’s problem. It actually gives the physician advantage, more opportunities, higher pay. Shortage is not my concern when more that half of the states don’t have caps on malpractice and we see jury verdicts for 5- 10 million $ for “emotional damages”.

  • @drpercy

    Forcing women to choose between a balanced family/work life and practicing medicine seriously limits the role that women can play in medicine, and devalues what female physicians and mothers in particular have brought to medical practice.

  • buzzkillersmith

    It is a law of human nature that, in the long run, most people usually do what they think is in their best interest. As Kevin pointed out so well in this post, the rewards of doctoring have diminished over time and so the relative attractiveness of time not spent doctoring has increased. And so doctors want to work less. Complaining about this will be about as productive as complaining about the sun rising in the east. If society wants to change physicians’ behavior, it must change incentives.

  • http://coldgirlfever.blogspot.com PGYx

    I’m uber-committed to my work and am comfortable with this immersion as I am just finishing an internship in internal medicine before I start specialty training. Living and breathing medicine has allowed me to learn more than I imagined I could in a single year. I truly love working as a member of an effective health care team and am proud of my efforts to provide excellent care at a hospital committed to the same.

    However, I’m coming to terms with the fact that if I stay similarly committed over time, I’ll have little life outside of work, fewer active relationships to sustain me, and nothing to fall back on if I have to leave my career for any reason. I encourage my patients to structure their lives to achieve work-life balance, but it should strike them as hypocritical that I am far from doing this in my own life.

    • Fam Med Doc

      Hang in there PGYx! Internship year is a rough year. It’s supposed to be that way. What you learn will be invaluable for your future.

      And your future won’t be as chaotic as residency. Many docs just work 40 hrs/wk. Some 50. Some 50-60 hrs/wk. I don’t know your specialty but constructing a 40 hr/wk job is not impossible & easy in some ways. In other words, you can have a life outside of medicine if you want.

      Heck, if you want you can even work part-time like this article says.

      • http://coldgirlfever.blogspot.com PGYx

        Thanks for your encouragement, Family Med Doc! I’m willing to take a large pay cut to schedule my life so I can get adequate sleep and a little time for family, friends, and recreation. Making sleep my biggest priority outside work this year helped me to perform better and enjoy my job more, but I have zero life outside of work.

        Some of my co-interns chose to use very limited free time to live a few precious hours of life rather than pay back some of the profound sleep debt. These folks were chronically grumpy and miserable overall. The vast majority of interns and even the upper year residents in my program exhibited signs of at least prolonged situational, if not clinical, depression this year.

        It would be unhealthy to maintain such a high duty hour load (often >80 h/week when you count dictating discharge summaries or doing other work from home) over the long-term.

  • Ortisue

    It should be pointed out that Dr. Sibert is an Anesthesiologist and therefore has no responsibility for patients on an ongoing basis. As a specialist, she also makes a great deal more income than a PCP and does not have to deal with all the crap involved in getting referrals and medications authorized, etc. Anyone can work full time as a physician if they are doing shifts and have no ongoing patient care and no office to manage. Let’s hear from some of the doctors in the trenches.

  • Samantha

    Regarding the use of tax payer money for education
    Is it not true that students that attend state schools regardless of their field of study thus fall into the same category? Tax dollars pay for their education or at the very least greatly subsidize and while I don’t know the percent I’d imagine society sees a far lesser return per dollar when paying to educate a hospitality major or a PHd studying the clothing of the the first era of the renaissance. Last I checked neither of those took out $250000 in loans with interest in the hopes that they would make it through the 8+ year process of becoming a physician and hoping to one day have a job.
    And besides, what does it mean for a doctor to work “part time” anyway? It means a 40 hour work week. According to the recent Bureau of Labor Statistics summary of American jobs and salaries, physicians only work 40 hours anyway. (They calculated the hourly rate of a physician using 40 hours per week which is far from true).

    • JPB

      I have wondered about the so-called “subsidized” education as well. If medical school tuition does not cover the actual costs of a medical education, I would like to see some documentation for that statement! With medical students leaving med school with more than $150,000 of debt, how can this be? As the old saying goes, “Follow the money!” I hate the overuse of the word “transparency”, but we could use some light here!!

      • Fam Med Doc

        I don’t have the stats, like I said I would like to know them. My understanding is that the FULL cost of training a physician which INCLUDES residency exceedes the tuition medical students pay. But many medical schools are publiclly funded. For example, many students try, if possible to get into a state school where they have “residency”, and get cheaper, and in some instances significantly cheaper tuition.

        In regard to documentation, I don’t have specifics BUT I know for a FACT (cuz they told us in residency) that the government pays per resident to the residency program. So already there we know that the cost of training a physician from medical student to physician costs the tax payers.

        • MedStudent

          While the government pays hospitals that host residency programs for resident stipends, ultimately the government benefits. The use of residents to provide a large part of inpatient care keeps costs lower. Since the government is also funding medicare which pays for a huge number of inpatient stays in this country, this keeps medicare payments down. Again, I cant remember where I read it, but ultimately paying for residents is cheaper for the government than not. I think its important to keep this in mind before guilting medical students into thinking the government is supporting their education and implying extraordinary obligation for this contribution.

          • http://coldgirlfever.blogspot.com PGYx

            I forgot that we residents are incredibly cheap labor! For an intern, I am reasonably paid. My pre-tax hourly wage is conservatively $12/hour in an area where rents for a 1-BR apartment run $1000-1400/month + utilities depending on how far one wants to commute. I have accounted for work hour variation as on a few rotations I worked less than 80 hours per week.

            Residents in more rural areas can earn less than $10/h. Surgical residents also have a lower hourly wage because they do more rotations that force them to work at least 80 hours per week. It is very common for residents in all fields to log only 80 hours per week when they actually work more. The work must be completed and we are the ones who must do it.

            So we’re paid $10-12/hour to both do a ton of work few others would want to do (a.k.a. “scut”) AND take responsibility for people’s lives. When a patient develops life-threatening flash pulmonary edema or an acute myocardial infarction in the middle of the night, I’m the one who shows up to assess and treat him. A big mistake made during the profound sleep deprivation of early training could spell the end of a young physician’s career.

            So tell me: Exactly how much more do laypeople who think doctors are spoiled want me to give of myself for this job? How much less stipend do they think I deserve from the government?

    • Joe

      well said! this argument that any artificial means by which more productivity can (theoretically) be squeezed out of physicians is inherently justified by the money states pay for higher education or medicare pays for residency training is so, so tired. by that same logic, it would appear that only applicants 22 years of age or younger should be considered for medical school admissions or that those with a potentially productivity-decreasing chronic medical condition need not apply, etc. etc.

  • Joe

    In a way, I’m reminded of the fairly recent (Dartmouth?) paper which basically concluded that as the earnings per hour decreased, physicians worked fewer hours. There is, of course, a growing generational difference in values, a certain degree of learning from and not wanting to make the same mistakes regarding family life that were prevalent in previous physician generations, but there is also the point that buzzkillersmith made quite well – relative value of time.

    When it comes to healthcare, our society really, really wants to have it both ways – all of the benefits and none of the sacrifices. I view all this physician vilification by politicians, wonks, and down to the general public as no more than the juvenile kicking and screaming reaction to this basic truth. This sexist, unsubstantiated, short-sighted hours worked proposal, like every other proposal of similar ilk, but short of outright slavery, simply will not work. Individuals work to benefit their individual best interests, always have and always will.

    • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

      I think, Joe, that to a certain extent physicians also want to have it both ways.

      Somewhere towards the beginnings of the previous century, medicine has acquired a special status in society. People relinquished health related life and death decisions to physicians, and it wasn’t always that way. The reasons were two: 1) medicine was becoming more and more capable of producing results and complex enough to put its understanding out of reach for most lay folks, and 2) doctors promoted a singular ethic of their profession, which was to selflessly heal people regardless of worldly compensation and many times regardless of their own personal well being

      These two aspects of the medical profession created that pedestal on which lay people placed physicians (right or wrong) and it is this pedestal that created the trust and the respect and the associated (comparatively) large financial benefits that people were willing to make available to their doctors.

      By constantly raising financial concerns, particularly in times of distress for most people who cannot sympathize with the hardship plight of those making 5 to 10 times what regular folks make, and by insisting that there is nothing special about medicine, and doctors, just like everybody else, work only to benefit themselves, you are in effect destroying that hard earned pedestal, along with the trust, respect and high compensation that were a given only a decade or two ago.
      It matters little how well educated and how best and brightest physicians are. There are other well educated, best and brightest professions out there. What set doctors apart was something else, and that something else (or its perception) is slowly disappearing.
      Perhaps that’s how it should be.

  • Kristin

    I’m an older (post-master’s) student, taking the last pre-reqs before applying to medical school. I’m getting married soonish, and if all goes well, the wedding will be the summer after he finishes law school and before I start medical school at age 28.

    Yeah. That’s awkward.

    What it means for me and my fiance is that, since we both want kids and we both want careers, we’re going to have to do a pretty crazy juggling act. Since I ended up in an opposite-sex marriage, there’s no question about who’s going to do the child-bearing. So when should I do it? Certainly not now, when we’re barely making ends meet while my fiance’s in law school and I’m working and going to school. Medical school? Not when there are labs with formaldehyde–it crosses the placenta readily and is teratogenic. So late medical school, maybe. And what about the second child? Not intern year, but by the time residency is over I’ll be pushing 35, so I’d better fit a pregnancy, birth, and maybe some amount of leave time in there somewhere.

    There is nothing wrong with wanting work-life balance. My generation watched two generations before us as they worked and aged: our parents, the Boomers, and their parents. We looked at the decisions they made, the sacrifices and trade-offs they accepted and endured, and we said, “No.” The same way the Boomers before us looked at their parents’ generation and said “No.” We’re figuring out, as a species, how to live in this rapidly changing modern world, and what compromises we’re willing to take.

    It’s particularly ludicrous that many of the people charging the younger generation with being less committed and caring less are also the people who complain about falling earning potential, decreased autonomy, and decreased respect for the physician in society. So it’s terrible, and the rewards you got into it for aren’t there anymore–but we should do it the same way you did anyway?

    No, thanks. We’re experimenting, on a massive scale. But if the current system doesn’t work, then it needs change. The experiment is necessary.

  • a. schroll

    The era of doctors who give their “all” to medicine was also the era of high rates of divorce, alcoholism, drug addiction and suicide; issues which remain a concern for the physician work force. The tendency to over work did not allow much time for exercise, healthy eating or stress reduction. I commend phsycians who seek to find a work -life balance, hopefully we will model healthier lifestyles to our patients and the community.

  • http://www.drjoe.net.au Dr Joe

    The value of a doctor is in the quality not quantity of their work. A part time doctor doing their best is better than a full time doctor going through the motions. Time spent practicing per week is not a measure of the value of a doctor.

  • ralph

    Interesting read. I work about 60-70 hours a week. I could probably work another 10 hours a week just to accomodate my patients demands. The “old days” of primary care are gone. Now its all productivity based. I do very well compared to other primary care docs. I see the problem in that the newer generation of Dr’s dont understand that to do as well financiallly now as in the past it is all productivity based. I cant see how you can have it both ways. The current system is set up to overwork you unfortunatly. I feel sorry for the new generation of Dr’s if they expect to have it both ways.

  • Dr Nanda

    Nobody ever told or expected drs to choose between medicine and family. There may be outliers among drs who want to dedicate their lives to medicine. But among the majority of drs that I have come to know through the course of my period during medical school and work, all are ‘normal’ human beings who look forward to having a normal life with family and work. I, for one, took the choice long time back and decided that family is much more important than work. At the end of the day they are the ones who will stay with you through your happiness and troubles. Being a dr is just another job in the system. If countries are facing shortage of drs, it’s a choice someone made in the system some time back and suddenly woke up now realizing the decision. It is definitely not the defect of the new “breed” of drs.

    Another thing I have noticed between the earlier breed of drs and the new breed is the fear of litigation. Earlier, drs enjoyed treating patients due to the benefit they were giving-reducing pain and promoting good health. But these days 9/10 times drs are focused on saving their backs from any mishaps. During such a situation, being a dr is just like any other job. Come and do your job and go home. I wouldn’t blame many of them to do part-time and take care of their families. Every dr I see these days just sticks to the rule book and does not use his heart.

  • Saire

    This is one of the reasons I became a nurse. In 1988 after completing my BA in psychology I returned to school to pursue a BS in Nursing. It was a disappointment to my parents whose friends were doctors & lawyers. I knew I wanted the flexibility to walk away. Ironically I am still working full time and my husband is home with the kids. Sometimes we plan for the life that we think we will have and get an entirely different life. It’s a good life.

  • M2

    I find it unsettling that a woman would encourage such direct reinforcement of gender roles. If you are going to ask medical students if they have considered the implications of choosing the demanding career of medicine, you have to ask everyone. Men also feel the effects of poor life balance. Many physicians of the “old rank” watched their marriages and relationships with their children deteriorate from inside the OR, clinic, or lab. I think that the fact that a disproportionate number of female physicians work part time illustrates quite clearly that there is still an incredible inequality in the responsibilities of child rearing in America. The women and men who choose medicine dedicate the same amount of time and energy to their educations, yet the males are not equally willing to sacrifice time in the clinic for familial responsibility. The value judgement that is an undercurrent here is that it is acceptable for men to work to the point of personal destruction and that it is unacceptable for women to split time between work and family (as the division of time leaves both neglected). This attitude negatively impacts everyone. It forces people to choose between being parents or physicians, with men historically choosing work and women family. Specifically questioning women about their dedication to medicine reinforces the gender roles that are already in play here. The implication is that only the women should be considering reducing their hours to meet the needs of their families.

    • LDTOR

      Yes not only that, but the author assumes that physician families are all husband/wife and fails to consider that not only women physicians might want to spend with their family, but also male physicians. And god forbid we ever consider about same-sex families, I mean who has to “play” the woman and stay home in that case? Seriously, can we move past the 50s mentality, Dr. Sibert?

  • http://www.mdwrites.com MD

    There is nothing wrong with working part time as a physician. I hate how medicine constantly makes you feel guilty for not committing yourself 100% to the field and to your patients. We are workers just like plumbers, electricians, etc, just with more training. Nothing wrong with working part time. The difference between us and other workers is that our reimbursements can be reduced at a whim.

Most Popular