“Why did you wait to schedule this meeting until September, why not July or August?” Candidly, I replied, “I have a family and being on nights, spending those 90 minutes with them a day is very important to me.” It was then, behind closed doors, in an office where he held all of the power that he said: “You know, I don’t think women with families make as good of doctors as those without.” I was shocked. My head pounded. Is this really happening? Surely he’ll stop there, I thought. But he continued:

“I can offer you two things — a lawyer for a divorce from your husband and also to give up custody of your son.”

I laughed nervously as I contemplated a dozen scenarios, all wagering the power that this man with all of his accolades and decades of institutional backing could wield against me. I made the, albeit unsatisfactory, decision to brush past and redirect the conversation back to the project. What followed left me without recourse, “You know, I can make getting into this field [fellowship] very difficult for you, or very easy.”

It was just my third month of residency. A freshly-minted doctor, I was ready to network and build research experience. I had heard stories like this before, but I naively thought it would never happen to me. Shame crashed over my shoulders as I walked to clinic that afternoon. Who do I tell? What do I do? Maybe this is just the way things are?

Normalized and silenced by leadership, I felt isolated — like somehow I had done something wrong. I spoke to friends, to my partner, to family. Those closest to me echoed outrage and disbelief. What I would soon learn is that the disbelief was in vain: this is medicine.

Inner turmoil ensued — a cognitive dissonance where my identity as a new mother and a new doctor seemed incongruent yet required for daily function. Depression enveloped that first year of doctoring. I questioned my career in medicine daily — something I had worked toward literally my whole life. Something that, as it turns out, is not structured to support physician-mothers, much less offer them tangible protections particularly in training.

What kept me in medicine are the very things that were threatened: my family, my identity. Above all, I am a mother. That alone negates any attempts to destroy my self-worth. Motherhood, to me, is the absolute privilege of being everything to a new person who is everything to me. It is guardianship over their early worldview in the hopes of creating a more brilliant future. The infinite, visceral love therein is all consuming and self-sustaining. It is the reason I choose to help mothers and their babies in the field of women’s health. The irony of the struggle of being a mother in a field dedicated to caring for mothers is not lost on me. And when my child asks me what I did to make space for mothers in medicine, I intend to have concrete answers.

Despite the increasing proportion of women matriculating to medical school, 51 percent in 2018 compared to 7 percent in 1960, and those graduating (7 percent to 47 percent in 2018), women remain marginalized in both medical practice and in leadership. It is important to critically consider the 4 percent attrition rate and the role that stressors like being unsupported in motherhood and womanhood play. While 46 percent of U.S. resident physicians are women, they only represent 38 percent of academic faculty and 15 percent of department chairs. This funnel effect leaves gaps in, and opportunities for, representation that could provide a voice in spaces of power. Greater than two-thirds of women physicians report gender discrimination, and 80 percent of those who are or will become mothers report maternal discrimination.

Maternal discrimination is a form of gender discrimination that is rooted in patriarchal fragility and perpetuated by the perceived threat of fertility and/or an established identity as a mother. In a qualitative study by Halley et al., the persistent, frequent and blatant discrimination faced by physician-mothers is described unlike ever before. Of the 947 study respondents, 75 percent were white women, with only 8.4 percent Latina and 6.3 percent black women. The further compounded experience of physician mothers of color remains to be amplified. Please note, the work to dismantle maternal discrimination must be intersectional.

Medical culture can be characterized by great expectations flanked by dehumanization that serves to empower toxic hierarchical norms. Maternal discrimination is a reflection of these ills and is exacerbated by a sentiment that women, particularly mothers, do not have a place in, and do not add value to, medicine; that their responsibilities and identity as mothers are a detriment. I rebuke this sentiment. Matresence, the identity shift into motherhood, is physiological, physical and spiritual. It is hard work; for some, the hardest and most beautiful work we will ever do. Transitioning into the role of doctor is also transformative, and it is familiar territory to the mother. Our ability to mother enhances our ability to doctor because it expands our humanity: to remain empathetic, multitask, and find harmony in a multivariate life.

Finding my voice has been arduous. The voice of a trainee is contractually silenced — we lack full labor rights, are bound by institutional policy and must abide by interpersonal rules that, if broken, threaten to derail our entire careers. If I could walk beside my past self that afternoon, I would tell her: you feel powerless, but you are not, and yes, this is medicine — it is the way things are, but it is wrong.

To institutions, departments, residency programs, and medical schools: you are accountable and bear the weight of responsibility. First, you must recognize maternal discrimination as a real, violent problem. Then, understand that it is perpetuated as much by the harasser as it is by normalization, complacency, and institutional neglect. Above all, this requires accepting that the reproductive choices of women in medicine do not disqualify our intelligence and that we are unequivocally valuable. Therein lies the real challenge. Therein lies the work. Remember, centering the voices of those who are marginalized only ever uplifts the system as a whole. When their voices are heard and their conditions improved, the whole collectively benefits. Medicine is not an exception.

To my fellow mothers in medicine:

I am sorry for everything you go through and that our profession is so unkind. I encourage you to take up as much of your own space as possible. Realize that your presence alone makes those who are woven into the dominant frame of medicine very uncomfortable. They see no space for you, yet here you are. Find power in that and if you ever find yourself with an opportunity to advocate for another mother be intentional and brave. Do not be discouraged by the work it takes to find your voice. Understand that you may be silenced by proper channels in your efforts for justice, but also remember to trust patterns — not apologies or excuses.

There will be times when sharing and centering your experience will feel like screaming into a void, or times where you give up parts of yourself or your story for the sake of making them palatable to the majority. In these times remember that you are worthy. I see you. I hear you. I am you.

The author is an anonymous physician.

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