My hope for the upcoming generation of physicians

My son has been accepted into medical school, we learned last week, and I must say I’m about as happy a mother and a physician as you could find anywhere.  For everything that’s wrong with the American healthcare system today, medicine is a wonderful profession and it’s still the greatest honor in the world for a patient to have faith in your skills and care.

It will be interesting to see how my son navigates the still controversial issue of how to manage family and “work-life balance”. How do you do justice to the trust that was placed in you when that invitation to medical school was extended?  That trust came from the college faculty members who recommended you, the medical school faculty who evaluated your application, the public whose tax dollars help support your medical training, and the patients–now and in the future–who will need you to take care of them.  No, that doesn’t imply that you’ve accepted a life sentence to work 80 or 100 hours a week until the day you retire.  But it does imply that all those people believed that you accepted the calling to make the practice of medicine one of the highest priorities in your life.

You’ll hear the argument that the desire for “work-life balance” is a generational thing, not a gender issue–that young men in their 20s and 30s today don’t want to work as hard as their fathers did at their age.  That may be true.

But from my vantage point, the young physicians I see in their 30s who are newly married, buying their first homes, and starting families, tend to have spouses who don’t work outside the home or who earn less money than they do.  These young physicians work very hard indeed, and take their professions very seriously.  And very many of them–not all, but many–are men.

Some people take offense at hearing the simple truth that younger women physicians as a group tend to work considerably less outside the home than male physicians. That data is well documented by the AMA, Medscape, and other sources. Anyone who chooses financial dependence on a higher-earning spouse must be an optimist with great faith in marriage and in the stability of the spouse’s job and health.  Perhaps I’ve seen enough marriages fail and lived through enough recessions to be skeptical. It may be harder to return to practice than you think, if you haven’t devoted the time to gaining expertise and building your career early on.

I have friends who practice medicine in Silicon Valley, and if you get a few drinks into them they’ll regale you with stories of young, attractive female residents who marry wealthy dot-com husbands and are never seen in the hospital again.  It will be interesting to see what Mark Zuckerberg’s wife, Priscilla Chan, does with her pediatric training.  She has a tremendous opportunity to do good, and I hope she follows Melinda Gates’ example.  I get tired of hearing from women physicians who use the excuse “I married a surgeon” (or any other busy, ambitious breadwinner) to justify backing away from their professions.

It’s fascinating to read the flurry of publications and blog posts in reaction to the opinions of Anne-Marie Slaughter, Sheryl Sandberg, and Marissa Mayer.  I agree with Princeton’s Professor Slaughter that you can’t have it all, though her solution–to make your schedule as flexible as possible, and work at home as much as you can–is woefully inapplicable to medicine.  I certainly agree with Facebook COO Sheryl Sandberg that if you don’t “lean in” to your career early, you may not have a career to lean into later on.  And I’m not reflexively critical of Yahoo CEO Marissa Mayer’s decision to stop letting Yahoo employees work from home at will.  Not everyone has the self-discipline to work from home, and it should be viewed as a privilege, not a divine right.

But enough about women.  Let the record show that I don’t think much of the current trend among young men or women to get joint degrees along with an MD in order to give themselves an escape route from the tiresome business of taking care of patients.  I’m not sure the world needs more MD/MBAs, and I’m quite certain it doesn’t need more self-designated “thought leaders” to tell the rest of us what to do.  To those who just want an MD as an entry ticket to a lucrative career in biomedical industry, to starting their own dot-coms, to a hospital corner office, or to a comfortable job with the Joint Commission–could you please stop and give your spot in medical school to someone who genuinely wants to practice medicine?

As far as work-life balance is concerned, I would be the last person to say that I handled it flawlessly.  Doing full-time work in high-risk inpatient anesthesiology in a tertiary care medical center means that you get to work very early and never know with certainty what time the workday will end.  I wish I liked outpatient anesthesiology better, but to me it’s boring, so night and weekend calls have always been a factor in our lives. I can think of a dozen motherhood challenges that I wish I had managed better, and I’m sure my children could think of many more.

My oldest child loves to tell the story of how she developed an earache at age 12 or 13 and I, distracted, kept telling her it would get better on its own.  When we finally made it to the pediatrician, he turned to me with some disapproval and asked, “How long has this been going on?  Her eardrum is perforated.”  My daughter said, “See?  I TOLD you so,” and gleefully has never let me live it down.

There were bigger crises too.  Our second child died when she was five months old, and I’m certain that going to work every day thereafter helped me carry on through that terrible time.  My oldest daughter had to weather the family’s grief at the same time she faced the onset of adolescence, and the younger two eventually had to deal with the consequences as well.  As they entered their teenage years, I told them without sugar-coating that there is only one rule:  Nobody else in the family gets to die before me.  When you think about it, that’s the perfect rule.  It covers reckless driving, drug abuse, unsafe sex, hang-gliding–you name it.  If anything you’re thinking of doing could possibly lead to your death before mine, I explained, you’re not allowed to do it.  This saves a lot of argument and negotiation. My son told me years later that as his car spun out of control  in the rain late one night, his first thought was, “If  I die, Mom’s going to kill me.”

My son survived that and other adventures.  Now, the occasion of his admission to medical school is time to celebrate, and allow myself a moment to think that I must not have done everything wrong.  Certainly I didn’t take care of the children alone; you need the right husband, and it really helps if he can cook. All three of the children grew up with the knowledge that “OK” isn’t good enough when it comes to work that matters, and you can’t quit until the job is done right.  All three took responsibility for their own successes and failures.  All three wrote their own college admissions essays.  My older daughter has a master’s degree in health care administration, a full-time job, a wonderful husband, and two little boys of her own.  Her younger sister graduated in 2012 with a degree in art history and faced the worst job market in decades. Through her own initiative she landed a full-time job–with benefits–in a design and advertising firm.

Here’s what I hope for the upcoming generation of physicians, men and women.  I hope you love and value your work as much as we did coming up through the system in the 1980′s, and that the Affordable Care Act doesn’t completely ruin American healthcare. I hope you spend enough time with your children to make your family happy, and not so much that your children feel smothered or start to believe that they can’t handle their own challenges without your constant intervention.  And most of all, I hope that when you celebrate your 30th anniversary of graduating from medical school, as I did last year, you have no regrets over how you have chosen to spend your life.  Best of luck.

Karen S. Sibert is an associate professor of anesthesiology, Cedars-Sinai Medical Center.  She blogs at A Penned Point.

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  • http://www.sidenotelife.com/ ken noguchi

    Hi Karen. Thank you for the nice post. As a first year medical student, the idea you brought up about work life balance is certainly one that is often discussed over coffee. It was nice to get a look into how you navigate that balance. Any advice for young medical students as we try to figure out our own balance?

  • http://www.facebook.com/shirie.leng Shirie Leng

    Wait a second Karen. I’m an anesthesiologist with three kids also, and I read all your posts here. I have to call you on a couple things. You say that a lot of young male doctors in their 30s work very hard, but that many of them have spouses who DONT WORK OUTSIDE THE HOME or make less money. I would point out that a lot of young female doctors in their 30s work very hard and not many of THEM have spouses who don’t work outside the home. You seem to imply that you can’t be a dedicated physician and “work really hard” if you work part time or have family and home responsibilities, and that it can’t be done without someone in the background supporting you. Is that how you did it?

    I agree that there are med students out there who are either there to make money or to get into industry or government. I agree there are women who “back away” from medicine if they can. My question is: why would young people look for alternatives to taking care of patients directly? Could it be because that is the hardest and most thankless part? Could it be because regulation and litigation have taken all the fun out of it? If young people loved taking care of patients and didn’t get frustrated by the system they wouldn’t look for alternatives.

    And finally, you say that young attractive female doctors get married and use that as an “excuse” to drop out of medicine. Again I say, why do they need an excuse? Do you think these women are lazy? Could it be that they have taken the “risk” of investing in their marriage and children? It’s not the choice for everyone but a woman shouldn’t be judged for it.

    Congratulations to your son by the way!

  • http://rk.md/ Rishi

    Absolutely wonderful post, Dr. Sibert! Congratulations to your son, and may his years in med school only reaffirm his decision to pursue this wonderful career! I’m so excited to begin my training in anesthesiology this summer and am especially thankful for your humbling insight.

  • Resident Husband Bob

    This is a strange piece that starts with the pride of a parent of soon to be medical student and ends with a wish for what his career will look like and in the middle appears to be an assault of young physicians, especially women. I agree, the younger physicians are not taking their obligation to medicine seriously enough. All young physicians should do things the way things have always been done. All primary care/internal medicine physicians should round on their patients daily at the hospital and nursing homes. If patients can’t travel to them, the doctor should do house calls. All physicians should play golf on Wednesdays and unlimited residency hours should be reinstated.

    To accost young physicians (male or female) for more desire for work/life balance is to deny that technology/society/work is changing. Perhaps you will experience through the eyes of your son how much medical school and residency have changed. If he goes to a state school like my wife, the fifth most expensive school in the country by recent reports, perhaps you will question how much tax dollars the public gave to support that education (I should add, or the county hospital that would not stay afloat without the cheap skilled labor).

    Regardless of the issue of money, medicine and society have changed greatly. Perhaps the desire for better work/life balance comes from the fact that many physicians do not derive as much pleasure from the practice of medicine as they once did and thus need to find other outlets to balance themselves. Perhaps it is because there has been a generational shift in attitudes that suggests there is more to life than work, and that while work will always have a role in defining an individual it is no longer the sole component that defines individuals, even physicians.

    Perhaps, such as the case of my wife and I, we started a family and I gave up a career and salary that more than doubled my wife’s current salary as a resident. Why did we do it? I averaged a sixty hour work week and my wife committed to four years of eighty hour work weeks. We could have paid others to watch our son all day while my wife and I said hello at the bedside and goodbye at the breakfast table; a scenario many have told us is the recipe of a happy marriage and the raising of a successful child. Call us crazy, we felt that scenario was far more likely to be a a recipe for unhappiness and a child with detachment issues. While on parenting, I will add that the most recent research in child rearing talks about how crucial the first five years of development are. Unlike research from decades past that declared rice milk must be good for infants because they sleep better or sceintifcally derived formula is better than breast milk, research today focuses on MRI and PET scan imaging and brain mapping to give insight into the development of young children in ways we didn’t know in past generations. It turns out, nurturing matters greatly in the first five years , arguabbly much more than we ever thought previously. This has to do with, among other issues, that children have ten times the amount of neuropathways than those of adults. This means they are highly maluable during this period and if you do things well in the first five years, the rest should come much easier. I bring up this issue because it provides proof that parental involvement matters greatly, and both parents need to play a role (thus a need for work/life balance).

    I would also encourage you to read and listen more to Sharyl Sandberg’s message beyond the title, “Lean In.” She is encouraging women to passionately pursue their careers, but hopes in so doing, that it will lead to more leadership across the country, across corporations and professions that are interested in finding more flexibility in how things are done to better accomodate work/life balance issues. Your piece reads like an “I did it this way and my family survived, so you should do it this way too.” It is an attitude that has always pervaded medicine (go back to countless essays arguing against limiting resident hours after “To Err is Human,” was published).

    So, as the spouse of a younger generation physician who prior to accepting a position as a stay at home parent, used to represent established medicine as a lobbyist for a state medical association, I thank the stewardship the elder generation has provided. There have been countless changes in just the last twenty years alone and your generation had to navigate through them. I will not begrudge your generation for buying EMR software companies designed to compete against systems that create systematic uniformity, ordering excessive labs from your own in-office labs, selling your private practices in droves to hospitals and health plans eliminating competition and choice in the process; or constructing any number of other developments that benefited your wallet as much as it benefited patients (despite the fact these decisions help misshape the image of rich doctors and contributed to the need to oversee and regulate medicine more than it already was), if you will allow the younger generation to set their own course.

  • http://twitter.com/HughKee Hugh K Witt-Dubois

    Medicine was a calling back when medicine meant you got a Benz and a summer home.

    Time’s have changed. Now, medicine is a job.

  • hopeint

    While I appreciate your service for the last 30 years, you seem to be out of the loop for what medical students/young physicians are getting themselves into by pursuing a career in medicine.

    ” I’m not sure the world needs more MD/MBAs, and I’m quite certain it doesn’t need more self-designated “thought leaders” to tell the rest of us what to do.”

    Your wrong on both points and it is because of such attitude from physicians who refuse to engage in ancillary aspects of medicine, politics and an ungrateful portion of society dictates our every move from training to reimbursement(which is a misnomer when your paid by CMS 60 cents on the dollar months after an office visit) and don’t have an inkling of the amount of time, sweat and blood it takes to become a physician.

    Until you are sponsoring residencies for med students or subsidizing tuition for students going into primary care, I would recommend reevaluating your view both on current state of medical education in this country and refrain from passing judgement on how medical students choose to use their medical degree. Combining an additional degree in the form of an MBA/MPH etc serves to equip physicians in making a larger impact rather than practicing 100 hours a week in a dead end clinic trying to combat the PCP shortage we all see everyday while getting burnt out after spending over a decade just to get the license to practice. While I would love to continue this and elaborate on my thoughts, I unfortunately have to get back to studying in order to successfully complete a degree in medicine and business while combining public policy to improve the way physicians navigate today’s health care system and especially to prevent burnout. I wish your son the best of luck in medical school. It’s been a helluva ride.

  • Guest

    Congratulations to your son! Thank you for sharing so many personal details about your journey as a physician and mom. I had no idea you lost a child – I can’t imagine how difficult that must have been.