What does your husband think about you being a surgeon?

Not once during my eight years of medical school and residency training was I ever asked the converse of the titular question, what was my wife’s opinion of my career choice. Not while scrubbed into a case on my surgery rotations, not in the middle of an overnight call in the neonatal intensive care unit and never once by an attending, fellow or co-resident. Even those who knew me best and were aware of both my wife’s medical aspirations and our young son never once cautioned or questioned my career trajectory. In the current era of medical training with an increased focus on work-life balance and no place for open misogyny, it was presumed that no matter my career ambitions that things would work out. And yet, I’ve stopped counting how many times my wife has been asked that question.

We’ve made significant strides as a society in the past 50 years as we opened the American workplace to working women. Women now represent 47 percent of the labor force in the United States, and that number is projected to continue to increase. More than 40 percent of mothers provide the primary source of income for their families. This is clear progress from the historical gender roles cemented in place until the mid-20th century. These changes have happened in our medical schools and practice settings as well. Women represent nearly half of all U.S. medical school graduates, ranging from 47 percent to 49 percent each year since 2006.

Yet, as a society we still heavily rely on the extra labor of working women to keep the many facets of family life running smoothly. Therefore, it follows that the implication of that oft-repeated question was that my wife needed my permission because she wouldn’t be able to maintain the family and be a surgeon. One can only assume that repeated exposure to this thinly-veiled but obvious misogyny heavily influences career decisions. It’s no secret that there are fewer women in orthopedic surgery, neurosurgery or urology, and there are many more in pediatrics, family medicine and psychiatry.

We can all accept that certain career paths in medicine are more demanding than others. Training as a cardiothoracic surgeon is far more arduous than my own as a primary care pediatrician, and probably should be. Correspondingly, there will also be variations in the balance between the care of one’s patients and the care of one’s family. But if we are determined to continue along the road to gender equity, we need to address the heavily entrenched gender roles that remain in present-day medicine. To do so, we must not only recognize the substantial amount of work that most women do outside of their career, but we must also openly and actively shift some of these expectations and care-taking roles to their male counterparts.

Even within my own field of pediatrics, a specialty where approximately 60 percent of active pediatricians and over 70 percent of graduating pediatric residents are female, the ranks of academic leadership remain steadfastly dominated by men. In 2012, just 30 percent of full professors in pediatrics and 20 percent of pediatric department chairs were female. And while these numbers are skewed more equitably than medicine as whole (19 percent of full professors and just 11 percent of chairs), the implicit messaging remains clear about who leads departments and who doesn’t, even in a “female-friendly” specialty such as pediatrics.

As a husband of an accomplished professional woman, as a father to a son approaching adolescence and as a pediatrician dedicated to advocating for children and families, I firmly believe our country needs to pursue a more comprehensive set of social policies that benefit working families. And to be explicit, these changes are needed in medicine just as much as they are needed in other sectors. But amidst the push for universal paid parental and sick leave, increased workplace flexibility and better, more affordable child care options for all, the goal of gender equity shouldn’t be confused or lost.

To accomplish this, more men in medicine must be willing to take on the primary role of balancing family and career demands. This includes more than making school lunches in the morning and laundry loads in the evening. This includes more than taking an afternoon off for parent-teacher conferences, or even a day or two for the viral GI bug making its rounds at daycare. Men must be willing to work part-time, so they can manage school drop-offs and pick-ups for sports practice and band rehearsal. Men must be willing to not advance up the career ladder as quickly, or perhaps not even at all, in order to help provide care for an aging parent. Men must be comfortable playing a supportive role to a spouse with career aspirations, even if it requires a move across the country and a pause in their own career. Only when men in medicine routinely fulfill these roles will neither men nor women be penalized for doing so.

I don’t pretend these changes will be easy for most men in medicine or our greater society. Indeed, the opposite will be true. But gender equity won’t be achieved with only women striving for its implementation.

Even those who openly advocate for women in medicine should consider and re-examine their own latent biases and assumptions. As a recent example, when my wife considered residency training programs across the country, I was surprised more than once by close friends, family and even mentors who seemed more concerned about possible job opportunities for me than in fully supporting the next step in her training. I wonder if there would have been the same level of concern for her professional aspirations if our roles were reversed?

The lens of hindsight can be a revealing but convicting one. I now reflect with significant discomfort at how unbalanced the advice and support I have received from well-meaning friends and family over the years has been, all of it virtually independent of how it might impact my wife’s prospects. From the beginning, she has received and continues to field comments and questions about the good of our family and my happiness despite her own impressive accomplishments and career goals to be a cardiac surgeon. No one tried to convince me to not become a physician. No one advocated for me to train at a different institution with more appealing options for her. No one asked me about who would provide care for our son. She faced all of this and more.

Thus, in response to the original question posed, I fully support my wife’s aspirations to become a surgeon just as I fully embrace the need for change in medicine on the whole to be more gender balanced. But it is a question that shouldn’t have been asked in the first place and in being raised, exposes those asking as part of the problem.

Brad Herrin is a pediatrician.

Image credit: Shutterstock.com

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