“Didn’t you just have a baby? When are you going to stop?”
Those words weren’t directed to me but to a colleague by a patient’s parent who was frustrated that they wouldn’t be able to see her for follow-up. Yet, they could have easily been uttered by another physician in our group discussing coverage during her planned maternity leave. These are words as a male physician I will never be forced to answer, never forced to laugh off as a half-joke, never forced to feel guilty for burdening patients and colleagues by choosing to have a family and a career. Despite the recent focus on addressing gender discrimination and #HeForShe, translating these discussions and Twitter trends into action is lagging. So, this is addressed to my male colleagues seeking to help reverse these ingrained gender roles through the lens of parental leave.
Much has been written on how we penalize women for having children, and how this impacts the gender pay gap and opportunities for advancement. This is evident throughout medicine, in both academics and clinical practice. And despite increasingly espoused progressive viewpoints calling for closing the pay gap and elevating opportunities for women, medicine has stubbornly retained its patriarchal hierarchy as well as any other industry.
If you have the privilege of being both a parent and physician, reflect on the almost certain unequal distribution of how much parental leave was taken by each parent. From birth, we disproportionately rely on the extra labor of working women to raise families, and this sets expectations and caretaking roles for years to come. Can you imagine if these responsibilities were split evenly? Can you imagine if it was routine for a father to take the majority of parental leave?
Perhaps a good starting place where medicine might lead by example would be at our academic institutions. Yet, recent publications have demonstrated that among our top health care training facilities, most fall short of providing three full months of paid family leave as endorsed by the American Academy of Pediatrics. Some might suggest these policies represent improvements over prior decades, but it would be a mistake to label this a success given the continued gender disparities in pay and professional advancement. And unfortunately, this regressive messaging is instilled in our trainees, both implicitly by what they observe from their attendings, and explicitly by the even more restrictive leave policies that are in place for trainees themselves. And thus, the status quo continues to reinforce itself, forcing a choice between family and career that is heavily borne by women. So where does that leave us? What can men in medicine do?
1. Examine your assumptions and biases. How have the career choices you’ve made impacted your spouse/partner? Has there been a discussion? How do you distribute the workload of balancing family and career?
Do you hold your male and female colleagues and their respective family obligations to the same standard? Do you make assumptions about one’s dedication or career potential based on your biases? Do you excuse your male colleagues when they leave early but penalize women when they do?
2. Use your parental leave to the fullest extent. By not using your parental leave, you’re reinforcing the status quo and stigma associated with using it. You’re also establishing future roles for your family while simultaneously influencing your children’s views of gender roles and work obligations.
3. Support your colleagues’ parental leave choices. Provide coverage, care for their patients, welcome them back upon return, support them as they transition back to work, celebrate in their successes and empathize with their challenges.
4. Advocate for robust paid family leave policies at your employer and push for state/federal legislation that guarantees paid family leave for all. There is currently no federal legislation that requires employers to provide paid parental leave. This effort will certainly reach beyond medicine, but we can play an important role in advocating for societal support for this change.
Finally, as a man in medicine, you must openly stand up for your female colleagues and call out the misogyny and gender bias they face from both patients and other healthcare providers. This includes choices about parental leave, but extends to many other daily occurrences — half-jokes made in passing, blatant “locker room” talk that still occurs, gendered stereotypes we allow to be perpetuated, missed mentoring opportunities, promotions that still prioritize being in the “boys club.”
For too long, many of us who support women in medicine and advocate for gender equity have not been willing to speak up in these situations. This needs to happen with increased frequency and urgency. Don’t be afraid of disrupting the patriarchal hierarchy that remains. Don’t hesitate to strongly refute patently gender-biased comments. Don’t refrain from telling a colleague their half-joke isn’t acceptable or their “locker room” comment isn’t welcome. Your voice and actions matter. So does your inaction and silence.
“Why did you say that to/about our colleague?” Or something more direct: “Would you have made that comment/joke about a man?” It doesn’t have to be intensely critical or belittling, but it does need to happen in the moment and call attention to the behavior. And if it makes you uncomfortable, you now have a little more insight into what many women experience every day.
As men, we must recognize the privilege we’ve always held in not being forced to choose between family or career. To present, the majority of us have had both, and we are heavily lauded for any family responsibility, no matter how trivial, that we participate in. Gender bias and discrimination will continue to play a prominent role in medicine and in our greater society as long as we allow it to.
Perhaps the struggle for gender equity wouldn’t be so steep if both men and women had access to this same luxury, the privilege of not choosing between family and career but getting both by default. Although if that were to happen, it wouldn’t be a luxury, it would just be fair.
Brad Herrin is a pediatrician.
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