As a female physician-to-be, I know that I will face some tough decisions. Medicine is a competitive and demanding field that requires unwavering devotion and constant sacrifices. On the one hand, I want to be a top-notch clinician who puts her patients first; on the other hand, I want to be a mother who plays an active role in raising her children. Although many women have navigated this territory, it remains challenging because of the tremendous pressure and time demands on women working in medicine, particularly in the competitive, male-dominated specialties like surgery and cardiology.

For women like me who want both a medical career and children, the options are limited. I expect to be at least 30 before I finish my medical training. During the four years of medical school, there is precious little time to have children and doing so requires diligent planning and preparation. Medical students usually have the summer after their first year off, and this is the best time to have a child without the risk of dropping out. The second year is more intense than the first and culminates in the first exam for the boards (which helps determine residents’ fates). Since the third year consists of an intense series of clinical rotations that begin immediately after completion of the second year, it’s a terrible time to try to have a baby. The next viable opportunity doesn’t really present itself until Spring of the fourth, and last, year of medical school. By then, students have completed their residency interviews and required electives and there is more flexibility with schedules, and even a few weeks of vacation time.

After medical school, the next stage of training is a residency program that varies in length, depending upon the physician’s specialty, from 3–7 years. Half of all female medical students who get pregnant have their first child during their residency, according to the American Medical Women’s Association (AMWA). This seems like the best time for me to do so, as well. However, I am concerned by the lack of maternity leave policies at the majority of medical schools and residency programs. According to AMWA, it is common for pregnant residents to conceal their condition until it becomes unambiguous, due to their fear that they would be dismissed or harassed.

Female physicians who are just starting out in their careers often face harsh criticism when they decide to have children. When a woman takes time off during her residency, her fellow residents often have to cover her shifts, and may resent or harass her because of it. Attending physicians, who tend to be male, are not likely to empathize. Since coveted positions such as Chief Resident are based on performance during the residencies’ early years, a woman who has kids during this time may be disadvantaged against receiving such promotions.

This struggle does not ease up once a woman completes her residency, either. Equal number of men and women currently graduate from medical schools, but there is still a severe shortage of female physicians in academic positions. Women comprise only about 12% of professorships in academic settings, a number that has remained stable over the past three decades, despite the increase in the female physician workforce.¹To obtain academic tenure and advancement, a physician must invest a significant amount of time in conducting research, treating patients, and teaching students – leaving little time for much else. Female doctors frequently state that their interest in academic medicine is reduced due to concerns about balancing their multiple work and family responsibilities.² One study found that, when considering numbers of papers published, levels of research funding, career satisfaction, and self-reported career progress, female physicians who have children have far less success in academic medicine compared to men and childless women.³

There are other, less obvious, obstacles for childbearing women who choose to enter certain medical specialties. I am interested in the specialty of cardiology. On a networking site for health professionals (www.studentdoctor.net), I found a post about being pregnant during this specialties’ catheter rotation. The blogger commented that, “Having cath rotations doesn’t mean you absolutely can’t be pregnant” but there is a danger that as a fellow, “you are often right up front [during procedures] most of the time, which makes your radiation exposure risk higher.” You would not want to be pregnant and subject your fetus to the potentially hazardous risks of radiation exposure. These risks apply to other medical specialties as well, such as radiology and oncology.

I am afraid that my own guilt will become an additional, albeit less quantifiable, obstacle. If I have a child during residency, for example, and decide to continue with the grueling schedule of 80-120 hours per week, I would have to put my child into daycare or with a spouse, if that’s possible. I would inevitably feel guilty about not being able to spend quality time with my kid. I would much rather have my fellow residents resent me than my own children do so years later. At the same time, I am highly ambitious and resent having to compromise my dreams for anyone. I disagree with the situation — deeply engrained in our society to this day – in which working women are not supported to continue their careers, and that women are forced to sacrifice their careers for the children’s sake before men do.

Becoming a doctor — just like being a mother — requires sacrifice and there’s no perfect way to get there. There are steps that the medical field can take, however, to make this juggling act less difficult for women. Efforts should be made to decrease the stigmatization, and increase advancement opportunities, for doctors who select part-time or slower progression tracks. To attract and retain more female physicians in academic positions and clinical specialties, one expert recommends that women receive “stronger support from the medical community, including increased availability of childcare in academic settings, flexibility at work, strong mentors, and decreased ‘good old boy’ cronyism.” As I anticipate entering this difficult arena, I hope to achieve a work-life balance that is fulfilling to both my roles as a physician and mother. Perhaps I will not be able to pick my children up from school, but I will be there to read them a bedtime story and tuck them in at night. I may not be able to cook my children dinner most evenings, but I will be there at their baseball games. It really comes down to setting priorities and knowing that you can’t have everything, but with a lot of effort, you can have everything that matters.

 

By Khendi White

Khendi White is an admitted medical student for the Class of 2012. She graduated from Swarthmore College with a double major in biology and psychology in 2007. A native of Silver Spring, MD, her career interest includes serving the medically underserved in hospital settings.

 

REFERENCES

1. Verlander, G. 2004. “Female physicians: Balancing career and family.” Acad Psychiatry 28(4):331-6.

2. Carr PL, Ash AS, Friedman RH, et al. 1998. “Relation of family responsibilities and gender to the productivity and career satisfaction of medical faculty.” Ann Intern Med 129:532-538.

3. See http://forums.studentdoctor.net/showthread.php?t=462211. “Women in cardiology.” Anonymous blog postings. Accessed May 6, 2008.