Tuesday, September 2, 2008

Guest Post: Vigilance 101

Several decades ago I began medical school as one of five women in my class. Medical school was followed by internship/residency at a tough city hospital in the days before 80 hour work week restrictions. So I considered myself a non-pampered full-fledged member of the medical profession. But after fellowship finished I was elated with the offer of a half-time job at a university clinic. The hours would prove perfect for raising young children. Of course, half time in medicine means 50% pay for at least 75% time. I worked 5 days per week, 6 hours each day, straight through lunch, so I could finish the workload and get home at a reasonable time. Outside of the regular clinic hours I was also responsible for any of my patients that were hospitalized and for every other week 24/7 on-call. But it was all tolerable because of the flexibility. I essentially job-shared with a near retirement age physician who had raised a large family and he was welcoming of my bringing children to work on the occasional school holiday or child care emergency day.

My rude awakening was the chance spotting of a young male physician at the shopping mall one mid-week afternoon.

“Hi – are you on vacation this week?”

“No – Wednesdays are my discretionary time”

“Discretionary time???????”

“Yes – the day I don’t see patients. It’s the time I write my book, review residency training curriculum, do phone conferences…”

OK, I calculate. He’s my age, same amount of training, hired by the same university division. I work 5 days x 6 hours = 30 hours in clinic for 50% pay. He works 4 days x 8 hours = 32 hours in clinic for 100% pay. I did register a complaint which did nothing but label me troublemaker, but I was attached enough to my work hours that I didn’t pursue legal action. (That’s another story for when children were older).

Fast forward to August 3, 2008, The Outlook Section of The Washington Post. There’s an op-ed article by a physician bemoaning the current state of patient care in primary care medicine. No argument, primary care medicine is dying for a variety of economic reasons. But wait – our author has an answer. He claims there’s a “silver lining” in that many more women are entering medicine. Women tend to migrate to primary care fields, and they are documented to spend more time with patients even if they don’t get paid more. So there we go – cheap, undervalued labor is still with us!

Dr. Nana is a private practice internist in a suburb of a large east coast city. She has a physician son, a medical student son, and a physician daughter-in-law. Besides her clinical work, she is active in political action/legislative lobbying/educational efforts to preserve the practice of medicine, which is currently under assault on multiple fronts.


  1. I left my previous practice of all women partly because I was tired of being their work horse and not being paid accordingly. I have traded one set of issues for another in that I've gotten a good dose of the business side of medicine - we're lucky to get 65% of what we bill. What other profession accepts being paid part of what they bill? The gas stations don't! My point, like yours, is that you have to advocate for yourself because noone else will. I'm learning the hard way not to give away my skills and services or else you become an overeducated doormat.

  2. This is a brilliant, sad and truthful post. I've watched primary care decline in both prestige, pay, lifestyle and work satisfaction over the past 25 years that I've been in practice. We are now reaping the unintended consequences of devaluing both the specialty and the women physicians. It will be a terrible rude awakening to the country and just watch costs go sky high.

  3. i just found this blog, and as an aspiring female physician I really appreciate the honesty of all the posts so far. I look forward to reading more!

  4. I'm sad to see the posting from momwithastethoscope.
    We hired a young mother physician for my practice who left her prior position, employed by female physicians, because she didn't make enough money to pay her nanny. In her case it was lack of good business sense rather than greed by the physician employers, but same outcome. There has to be more business training for the private practice of medicine.


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