How should the workplace accommodate women physicians?

A dichotomy has emerged as we consider the best way for women physicians to realize both their potential and their dreams in the service of patients and society.  One position states that women have to internalize behaviors that are known to result in success and are based on a long history of professionalism, albeit developed for and by men physicians over the last 100 years.  This is more along the lines of Sheryl Sandberg’s “Lean In” approach.  Give the gal the chance and she, too, can rise to the top.

The other position states that the workplace, and in this case, the healthcare workplace, has to be more accommodating to the needs of women.  Attitudes, expectations, schedules, and work models have to be reconsidered and re-designed so we can harness as much as the woman physician has to offer.  Ann Marie Slaughter’s writings are most aligned with this approach.

Clearly, both have legitimate and useful points of view.  Of course, both have to happen—women have to learn the secrets and be let into the club, and the club has to have doors that open for women.  While the numbers of women physicians have burgeoned, just being let in is not enough.

The healthcare workplace is like no other.  In most situations it depends on the creation of multiple intimate relationships mostly between the doctor and patient.  Time constraints are unpredictable.  The energy and talent that is needed to absorb the stress of people depending on you to be smart, caring, available, and affable are super-human at times.

So back to the original question.  How much should the healthcare workplace change to accommodate women physicians?  Only as much as is needed to preserve what is the best in medical practice and only as much is as needed to curb what is the worst in medical practice. The “trick” is to look at what we do, its aim, and how it is done.  Can it be done differently with the same or dare I say, better outcomes?  And what is it that we are going to look at?  Anything that improves clinical care and gives us what we need–more energy to do better work through flexibility, predictability and control of our work and our lives.

But just because it is a difficult task, doesn’t mean it shouldn’t be done.  And not just for the sake of women, but for the sake of all physicians and their patients.  We are currently faced with the perfect storm for mass physician exodus from the physician workforce.  Increasing regulations, decreasing rewards (both financial and personal), devaluation of the healer, and the explosion of endless hours spent in useless tasks that create work that takes us away from patient care.

The healthcare workplace should change.  For women the situation is more acute as they have other societal burdens and life challenges that leave them with less reserve.  The healthcare workplace should not take any more of that reserve away unless it is focused on patient care, with identifiable positive outcomes.

So while we are all bulking up our inner strength to lean into one tough job, each one of us, both male and female, should commit to focusing on one area to make the jobs of women physicians easier.  Close the gender pay gap, eliminate the hostile work environment, create flexible scheduling , build systems that have more predictability, and grant us greater control, to name a few.

Some say that the feminization of medicine has devalued physician worth.  Women ask for too much accommodation and when granted they trade off excessive financial and other incentives.   Whether you believe this to be true or not, the present working conditions cannot be sustained.  The healthcare workplace can and should accommodate all physicians the power and energy they need to be the best healers we want to be.  Share your stories about how your workplace has accommodated to your needs and how everyone is better off because it did.

Linda Brodsky is a pediatric surgeon who blogs at Women MD Resources.

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  • adh1729

    “Close the gender pay gap”: I certainly believe that a woman should earn equal money for equal work. Nevertheless, shouldn’t Dr. Brodsky know that the same CPT code is reimbursed at the same rate, whether the provider is male or female? In light of this fact, the private practice of medicine should have no gender gap at all. If the issue therefore is that women are more likely than men to accept lower-paying salaried positions, then it would seem that Dr. Brodsky is trying to blame these women for this behavior. Salary and benefits are between an employee and the employer; what third party does Dr. Brodsky propose should additionally get involved? The government?

    • Margalit Gur-Arie

      “Salary and benefits are between an employee and the employer;”

      Not entirely. If it can be shown that any female surgeon (for example), generating X revenue for the employer (based on CPTs that are indeed gender agnostic), is systematically paid less than a male counterpart generating the same X revenue, then this is gender discrimination, which is unlawful just like all other discriminatory practices (e.g. race, ethnicity, age, disability, etc.).

      In private practice, this should indeed not be a problem, so I wonder if there is a total pay discrepancy there as well…..

      • adh1729

        If there were an employer who was systematically paying female MDs less than males, for equivalent productivity, call schedules, etc; then I agree with you that the government could have a case. Problem in the real world is, many of these comparisons end up being apples to oranges. (You could even throw in patient satisfaction, years of experience, etc to muddy the waters.) I think in general that, up to the present, men have typically been more aggressive in negotiating pay, and hence the gender gap.

        • LBENT

          Reply from L. Brodsky: Yes, men are much more aggressive in negotiating pay. However, the research shows that when women negotiate they are seen unfavorably and lose out on the job. We have a long way to go. See comment above about LoSasso Article in Health Affairs 2011 and you will change your mind about apples and oranges.

      • LBENT

        reply from L. Brodsky: There is a definite pay discrepancy in private practice, especially when the junior colleague starts out salaried. Read the article by LoSasso and colleagues in Health Affairs, 2011 for some eye opening research and much needed information.

    • LBENT

      Reply from L. Brodsky: Please note that the opportunity to earn that CPT rate rests with how resources of a practice are provided. How much clinic time and when? How many assistants? What OR time you are given and who staffs your room? All of these can affect productivity and women are consistently short-changed in these and many other arenas. And by the way, the same CPT code may not be reimbursed at the same rate depending on the deal that has been negotiated with the third party payers.
      Women need to get educated and get the skills they need; the healthcare workplace needs to be re-engineered.

      I definitely do not think the government should be involved. Women and men physicians need to stand up and face these inequalities and demand that changes be made. It’s possible and it is beneficial to everyone.

      • adh1729

        good points

  • Elvish

    “create flexible scheduling , build systems that have more predictability”: In medicine, that is nearly impossible, you must be on call, and emergencies will happen. Other partners need as many days off as you need, regardless of their gender.

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