How Medicine Became the Stealth Family-Friendly Profession – The New York Times

By | August 22, 2019

Britni Hebert was chief resident, on track for a career in the highly demanding field of oncology, when she found out she was having twins. “Everything kind of just tilted on its head,” she said.

She couldn’t imagine 80-hour workweeks with two newborns at home, while her husband was doing an equally intensive radiology fellowship. But she didn’t leave the profession. Instead, Dr. Hebert, 37, decided to practice internal medicine and geriatrics, with more control over her hours. She has been able to change her schedule three times as her family’s needs have changed (the twins are 6, and the couple has a baby), and now works about 85 percent of full-time hours.

Medicine has become something of a stealth family-friendly profession, at a time when other professions are growing more greedy about employees’ time. Jobs increasingly require long, inflexible hours, and pay disproportionately more to people who work them. But if one parent is on call at work, someone else has to be on call at home. For most couples, that’s the woman — which is why educated women are being pushed out of work or into lower-paying jobs.

But medicine has changed in ways that offer doctors and other health care workers the option of more control over their hours, depending on the specialty and job they choose, while still practicing at the top of their training and being paid proportionately.

Women are now half of medical students. In some specialties, like pediatrics, geriatrics and child psychiatry, they are the majority. Female doctors are likelier than women with law degrees, business degrees or doctorates to have children. They’re also much less likely to stop working when they do.

Flexible, predictable hours are the key — across occupations — to shrinking gender gaps, according to the body of research by Claudia Goldin, an economist at Harvard. As American employers struggle to adapt to the realities of modern family life and as younger generations of workers demand more balance, medicine offers a road map.

Dr. Hebert, who lives in Lafayette, La., estimates that forgoing oncology halved her lifelong earnings. But she’s grateful that she had other options for practicing medicine — and can still meet her children at the school bus most afternoons.

“I don’t want to pretend there aren’t sacrifices that come with the path that I’ve chosen,” she said, “but I just don’t think I could be employed at this time if not for being able to decide my schedule.”

CreditEmily Kask for The New York Times

Most of what changed in medicine had little to do with making it easier for parents, especially women, to work; family friendliness was a happy consequence.

A generation ago, the typical doctor owned a private practice, and saw patients whenever they got sick. Today, doctors are much likelier to work for large group practices or hospitals and be on call at predictable times. Seventy percent of doctors under 40 are now employees, not owners, according to American Medical Association data. So are the majority of female doctors of all ages.

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Large group practices are more profitable because they can share resources, like clinic space or physician assistants, and more easily negotiate with health insurance plans.

But the setup also gives doctors more work-life balance, because there are more people who can serve as substitutes and divide night and weekend work.

“The old market expectation that your doctor will be available at all hours and is entirely flexible was beginning to fall apart as the work force became more diverse,” said Robert Wachter, chair of the department of medicine at the University of California, San Francisco. “New generations look at the work-life balance of older generations of physicians, and I think many of them say, ‘I don’t want that.’”

Dr. Wachter was responsible for naming one of the jobs that exemplifies this shift: hospitalist, the physician who sees patients who are hospitalized and coordinates with the specialists caring for them. They also make doctors’ schedules predictable, because hospitalists work in shifts, and primary care physicians don’t have to go to the hospital when their patients do. Other occupations have also come to rely on substitutes, like pharmacists and real estate agents (and in rare cases, some lawyers and management consultants).

Sara Gonzalez, 37, a pediatrician in Dartmouth, Mass., works as a hospitalist and in the emergency department, another shift job. She usually works 10 eight-hour shifts a month, with a few 16-hour overnights. When she’s off, she’s responsible for anything that comes up with her 1-year-old daughter; when she’s at the hospital, her wife, who works in marketing, is the on-call parent.

“When my shift changes, I hand off my patients to the next provider, and that’s a really nice thing to not be on call when I walk out of the hospital,” Dr. Gonzalez said. “It gives me a great deal of control over my schedule, especially since I have these other interests, which were initially travel and have now shifted to family.”

The internet helps. Electronic medical records enable any doctor to see a patient’s history. Some use telemedicine to see patients who don’t require a physical exam. In the case of radiology, the entire job can be done remotely.

Julia Dry Knarreborg, 42, a radiologist in Edmond, Okla., and a mother, works from home, reading scans from patients in several states. She is paid by the day, and can add shifts when she wants. If she needs to leave midday, she can request that no emergency scans come through for that period, and catch up on nonemergency scans when she returns.

“You have total freedom to do what needs to be done for your family,” she said, “without the stigma associated with a working mom — ‘Oh, she’s got to go again, her kid is sick or she has another prenatal appointment.’”


CreditAnnie Mulligan for The New York Times

There are other things that can make it easier to be a mother and a doctor, like earning enough to afford good child care and household help. But the rise in predictable hours is a major reason more women have entered medicine, and young women are opting for lower-hour specialties more than in the past, Ms. Goldin’s analysis of data from the Community Tracking Study Physician Survey and the American Medical Association shows. Specialties with shorter hours and fewer emergencies, like dermatology, attract more women; those with long, inflexible hours, like cardiology, have more men.

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Women under 45 also work fewer hours than men in the same specialty — an average of 48.1 hours a week compared with men’s 58.5, she found.

Yee-Yie Fogarty, 45, is a radiation oncologist at a large health care system in Northern California, and a mother of four. She works 80 percent of full time — and is paid 80 percent of what she would if she worked full time.

“When I’m here four days a week, I feel I can work at 100 percent of my abilities,” she said. “I do feel in my heart it is sacred work.”

Female doctors are paid 67 percent of what men are, but much of the gap is because they work less. After considering their hours, their specialty and the years they’ve been doctors, the gap shrinks to 82 percent, Ms. Goldin found. (Also adjusting for hours and age, full-time female financial analysts make 77 percent of what men do; lawyers make 82 percent; and computer engineers make 88 percent.)

While a part-time lawyer makes disproportionately less than a full-time one, doctors who work reduced schedules tend to be paid more proportionally. (The remaining pay gap, she said, is partly because women’s reduced hours earlier in their careers might have long-term consequences, like being passed over for grants or leadership positions).

Hours — and not other factors like women’s preferences for certain specialties or employers’ preferences for whom to hire — directly influenced female doctors’ career choices, found another economist, Melanie Wasserman at the University of California, Los Angeles. In 2003, medical residencies capped the number of hours residents could work and mandated time off. In response, more women entered specialties that had been more time-intensive, like surgery and neurology. (Men did not make different choices because of the change in hours). She also found evidence that fertility rates increased for women in specialties with shortened hours.

The findings offer a broader lesson, Ms. Wasserman said: “If employers are serious about improving gender diversity in their work force, they might want to think seriously about how they are structuring their jobs.”


CreditAnnie Mulligan for The New York Times

Female doctors face the same challenges that other female workers do — including sexual harassment, discrimination and inadequate parental leave — and some specific to medicine. Even doctors with predictable schedules may work nights and weekends, can’t easily leave midday and often feel a drive to be available anytime their patients need them.

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Training is arduous, expensive and long, and usually overlaps with the prime childbearing years, so many female doctors struggle with fertility and carry onerous student debt. Some might choose a specialty before they have children, then have a hard time switching to a more flexible job if they want to. And some of the ways in which medicine has changed have made it harder to balance work and family — like the time consumed by electronic medical records — so doctors are experiencing increasing rates of burnout.

“There are so many sacrifices that women physicians make in order to remain in their careers, remain working, things that aren’t taken into consideration when looking at how wonderful and flexible it can be,” said Aisha Haynie Smart, 41, a hospital medical director near Houston.

For her training, she said, she moved far from her family and delayed marriage and pregnancy. In her current job, she misses directly caring for patients. But she can leave midday or work remotely if needed — and unlike when she worked as a hospitalist and emergency doctor, she never misses a family dinner or her son’s Saturday swim lesson.

“I feel lucky in the sense that there were different options available,” she said.

There’s a downside when women cluster in certain specialties: In general, when a field becomes female-dominated, its pay and prestige drops. The risk of creating alternate, stunted career paths for women is “an issue that’s plaguing the labor force and companies in general,” Ms. Goldin said. “It is a risk throughout that solutions today become a problem tomorrow.”

One possibility — which could help alleviate this problem — is that more men will also choose less time-intensive specialties and ask for predictable hours. There’s evidence that’s happening. This year, 80 percent of male medical school graduates said work-life balance had a strong or moderate influence on their choice of specialty (up from 70 percent a decade ago, when the question was first asked), according to the Association of American Medical Colleges’ annual survey of graduates.

Doctors who teach in medical schools say the desire for work-life balance is generational, not just for women.

“Men are asking for time off, too,” said Lydia Pleotis Howell, chair of pathology and laboratory medicine at the University of California, Davis. “It’s changing the workplace, and employers have to respond to that.”

In many professions, employers insist that the work is so important that one lawyer or consultant, for example, must be available for a particular client 24/7. But if doctors have figured out how to work predictable hours and substitute for one another — for things like delivering babies, diagnosing diseases or saving lives — couldn’t other occupations, too?

Dr. Hebert, the internist in Louisiana, said for her and her physician husband, substitutes have been the key to making it all work — both at home and in their practices. They moved to her hometown, where extended family live nearby and can help with the children on short notice, and a nanny watches their baby. Almost all her partners at work have children, which she said is crucial because they understand what she’s dealing with.

“We jump at the chance to help each other, because we know we might need help,” Dr. Hebert said. “This enables me to meet the needs of the patient population I love, while being able to care for my family.”

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