Tuesday, December 13, 2011

Medicine: Not for mothers?

I have to be honest: I'm a little burned out on writing about what PM&R is and why it's so awesome. I've covered it before both on Mothers in Medicine and on my own blog. People email me questions about it frequently, which I'm happy to answer, but... it's just hard to motivate myself to write yet another post about it.

So with the permission of our lovely moderator KC, I'd like to address the topic week a little more generally, and say some things that have been weighing on me lately. Namely:

Medicine is not a great career for a mother.

There, I said it.

Since we were asked to address which aspects are not family friendly, allow me to do so:

1) Unpredictable

When you're dealing with sick people, you can't predict your schedule, whether you're doing inpatient or outpatient. You might think you're going to be done at 5PM, and then your last patient will say, "Oh by the way, I'm having 10 out of 10 chest pain." Imagine it's 6PM, your patient says that, and you know your daycare will close in 15 minutes. It can (and will) happen.

2) Unforgiving of illness

Have I written about this one enough? I think I have. When you've got two children who pass colds back and forth (and then to you), you realize how difficult it is to be in a job where you basically can't call in sick.

3) Must work part time to work "only" full time.

An attending I talked to at a VA (not exactly a rigorous working environment) said that she had to cut back to working 75% time in order to only work 40 hours per week. Between on call time, documentation, phone calls, etc, the hours on your contract don't in any way resemble the hours you work.

4) Will mess with your sleep/wake cycle

It's bad enough worrying that a baby will wake you up. Worrying that a baby OR a pager will wake you up is enough to drive you crazy. I like my sleep, so this is a big one for me. How many times have I wished to be in a job where I could sleep through the night every night... ah, heaven.

5) Residency is killer

Dare I say that no residency is actually friendly to mothers? Yes, I'll say it. I'm sure some of you will come up with exceptions, but I think it's pretty overwhelmingly true.

6) You can't take a break

In a lot of careers, you could probably take a year or two off after your child is born. In medicine, it's much harder. You forget stuff and are rusty when you get back... not a great thing when you're dealing with people's lives. Taking long breaks is also a bit of a dink on your "permanent record." I once tried to apply for hospital privileges through a computer system and the program would not let me submit because I couldn't "account for" the 1.5 months between med school graduation and the start of internship. If I had taken a year off, the computer probably would have exploded.

7) The consequences of a mistake are so horrible

When you're a doctor, you can't mess up. People's lives and livelihood are at stake. You can't be careless for the sake of getting out a little earlier.

Truthfully, I sometimes feel like the entire school system is lagging behind the idea that two parents might be working. I mean, the school day ends at 3PM, which is extremely inconvenient for working parents. Kids get random weeks off from school during the year and the whole summer. And if they get sick, they're supposed to stay home. What on earth are we supposed to do with them if both parents work?

OK, but here's the good news:

I work as a consultant, which allows me to have a lot more flexibility. While I can't just not show up, it's not as big a deal to shift my hours. And the base salary for most physicians is enough that we can work part time (i.e. normal people's full time) and still bring home a good paycheck. (If you want to read more about what makes PM&R a good specialty for mothers, you can click on the link I mentioned above.) And if you enjoy the work you're doing, presumably you're happier in general and therefore a better parent (maybe).

But it's hard not to get a nagging feeling that when you're trying to juggle both motherhood and medicine, you're failing a little at both.


  1. Whoa! Are you seriously saying that you think the school system should lengthen the school day to accommodate *your* work schedule? What would you propose? After school care provided for every child by the school? Shift work for teachers? I worked at a private school while in college at the school's after school program. It was low quality day care at a moderate price. Still, it was only available until 5:30. I would have died as a kid if I had to be at school from 7am-5 or 6pm.

    What are you supposed to do with them? I don't know. Isn't that kind of your responsibility?


  2. Susan: That's seriously your response to the hundreds of thousands of families who have 2 parents who work till 5 or later every day? Not helpful.

    When I was a kid, my parents paid extra for me to go to an afterschool program every day till 6 or later. And somehow I didn't die.

  3. Love reading your posts Fizzy and the fact that you're completely honest. It's a beautiful trait that is difficult to come by these days.

    I think you rock.

  4. Fizzy is absolutely right. It is very difficult to have children and be a doctor. Hours are impossible. My kids have gone on rounds with me because there was nobody to watch them at home (as have the children of countless physicians) and stayed in the office on sick days because I couldn't cancel an office full of patients.

    What's a Mom supposed to do?

  5. Can we possibly get someone to write an opposite opinion to this piece? I'm going to be 25 when I start medical school next year and I know I want to have children in the future which I never thought would be such a terrible idea according to Fizzy. Not to mention, I know many, many women docs with children - and both moms and kids seem totally normal and well-adjusted.

  6. To Anon:

    Being a working mother is challenging, period. I don't think Fizzy said it wasn't worth it or she regrets her career; I think it's refreshing that she's blatantly honest about the challenges of medicine and motherhood. You absolutely can do both, but that doesn't mean that every day will be a cake walk.

    Don't second-guess your decision to go to medical school because you also want to have children. Just know that you have some schedule juggling ahead of you.

  7. To 25yo Anon:
    Of course there is another side to the story. There are many amazing things about being a physician. I think however, you should also realize that everything Fizzy is saying is true. There is no way around it, it is the nature of the beast. You need to go into this with your eyes open and really think about what it means not only for you but for your future family.

  8. 25 yo anon: It's just the nature of having a career -- ANY career -- and being a mom. It's really difficult to be that mom who goes to all the kids' events, does all the schlepping herself, is class mom and girl scout leader, and spends long afternoons making cookies AND be a doctor because there are only so many hours during the day.

    For some of us this wasn't a difficult decision to make, since we knew we never wanted to do those mom activities as well. For other people it's tougher since a) sometimes you start med school and realize you hate what you're doing, and b) sometimes you realize you love being a mom and doing all those other activities much more than you thought.

    Either way, if you're a doctor, you're going to work very hard with or without kids. With kids, something will have to give, and/or you will need a spouse who picks up the slack. I still believe you can be a great mom and a great doctor, and have a happy and fulfilled life with both things. You just might have to concede perfection on the way there.

  9. Of course it's not a terrible idea - but there are real challenges that mothers in medicine face, hence the creation of this blog.

    If medicine is your passion, you need to find a way to make it work for you your family situation -you find the balance that you need.

    Doing meaningful work should not be underestimated as a driving force despite the challenges.

  10. Fizzy:
    I love your honestly. I was working part-time (60%) and still putting in close to 40hrs in primary care (I'd often log back on to the computer after my two went to sleep to finish my work). And yeah, I got those crushing chest pains as my last patient of the day and had to pay extra to the daycare for showing up late. After I had two more, I found I just couldn't keep up. Furthermore, I found (to my surprise) that I loved doing Mom things as much as I loved being a doctor. I just could not do both and be as good as I wanted to be. So I cut back significantly - I now work 10hrs/ week with the option of picking up Urgent Care shifts when I want to. It's an amazing compromise that I could not have done had I not been a primary care physician.

    And to Susan: after Fizzy lays out her vulnerabilities and concerns regarding her career and children, your response was amazingly uncompassionate and mean.

  11. VIPeds-

    It's mean to suggest that the people who make children are responsible for their care? Especially educated people? Yeah, what a crazy thought that sick kids stay home from school. I think it's mean to think otherwise. Kids are not adults (duh). I know you've all chosen your lifestyle, and it's worth it to you to work while sick, etc. But kids should be at home when their ill. Not to mention, I don't want your febrile child at school with mine. Maybe the school could get a little infirmary??

    My husband I made our own choices about our jobs, and roles and children. Fizzy and other MIM have to make their choices too. Clearly most MIM are going to have to make contingency plans for evening childcare. It's out there. I'm just asking why on earth that would be a school's responsibility? Schools are to teach, not babysit.

    I'm shocked that Fizzy's post is such a revelation to so many people. And Fizzy, I'm at a loss as to why I would owe the two-income households of the world an "answer" to their daycare conundrums.

  12. im just curious what profession that a person (mother OR father) is working full time at, that can pick up their child from school at 3 pm every day?!

    Anon(Susan), while we ALL make choices regarding our careers and children, it is your attitude that creates a rift between working and non working parents (pardon my assumption you are not working if i am wrong). You don't owe anyone an answer, but being a supportive voice (or maybe none at all) might be a better solution.

    Personally, my husband and I both work full time (not in the medical field). We have a nanny full time who is there for our kids when they get home (1 pm-preschool, 4:15- elementary school). In a nice turn of events, our elementary school partnered with a community center this year to provide "after care" from 4-6 pm to help parents who cannot be home at 4:15, recognizing that more and more families are dual income with hours that exceeed the typical school day.

  13. Whoa.

    I think all that Fizzy was saying is that the school system is designed for families with SAHMs rather than two working parents, and that this is a challenge when both parents work. The system was designed back when most people lived on FARMS, which is why kids get out in the early afternoon and have summers off. It's kind of an obsolete arrangement. It's not just doctors who have to arrange for after school or sick care for their kids, it's lots of families, many of them far from rich. I don't think she once said that teachers or anyone else should have to pick up the slack or "owe" her free childcare or anything else. How bizarre that you read that in this post.

    In any event, I know some people find the tone of her posts to be offensive, but excuse her for not being effusively happy and unconditionally enthusiastic about everything that being a MiM entails. I find her outlook honest and refreshing. And it seems like despite some ups and downs, she's made it work for herself, her family, and her career.

  14. Hear, hear. I'll have some additional thoughts on this same issue later in the week.

  15. I'm a physician, and my husband, an engineer, works longer days than I do. We have 2 small children and are constantly juggling work and home demands. I would like to work part time, but I have too many medical school loans to pay off to do so. My parents, a farmer and a teacher, couldn't help me pay for medical school.

    I appreciate Fizzy's candor. To the med student who might want to have children: I love what I do, but it is exhausting. I do have days when I feel like day care staff are raising my children. This is reality. The work is exciting and often exhilarating. I am humbled but also grow and learn more every day as a physician. I feel blessed to be part of my patients' lives. I have learned many life lessons as a physician, by watching people handle challenges with tremendous grace.

    And Susan's comments are shockingly mean-spirited and far more offensive than anything Fizzy has ever written.

  16. Same anonymous as above...I remember having a male family medicine physician tell me once as a med student: "I should never have gotten married and had children. My job is too demanding. I can't be a father and a doctor and do both well" He was married to a SAHM. My point being that I think many physician parents, regardless of gender or circumstance, have these feelings.

  17. I thought about med school when I was newly married and opted for an MPH instead, in large part b/c I knew I wanted kids and I wasn't sure I/we could handle life with all that being either a med student, resident or MiM would entail. I have worked in PH for over a decade and have loved it but now that my kids are old enough to stay home alone sometimes and I can communicate with them by phone & text and they can understand abstractly that I am doing something that is very important to me that does often take me away from them, *big breath* I am going back to the plan to become a physician. I don't think it will be easy to have tweens and teens as a med student and resident, but I think it will work better for my family this way. If all goes as planned (don't laugh!), I should be done with residency when my youngest is 18.

    Fizzy - I think there are a lot of people who don't see the social structures of school and work and family. They just aren't going to understand how society might bear some responsibility in constructing institutions like school & day care to serve the needs of 2 parent families. When we did get it as a nation (WW2) there were all kinds of social support structures - 24 hour day care, concierge services delivering meals and laundry. When the GIs came back, the services all shut down. We've been on our own ever since.

    Thanks for your honesty.

  18. I think it's very easy for people like Susan to say that because they personally don't require a service, the people who need it should be left hanging, even if those people are the majority of the country. I'm sure there are tons of people who think women should have to pay out of pocket for all childbirth expenses... after all, why should a woman who doesn't have kids have to fund women who make the CHOICE to have a baby? People like that lack empathy and can't see beyond the tip of their nose at the greater good. Not really worth arguing with a person like that.

    I'm not saying women who want to have children shouldn't become doctors. Just to go into it with your eyes open, knowing there will be challenges.

  19. Living in a town based around a university, most of the families around here are 2 working parent families. The after school programs were filled. So we had to get a nanny for our children, but even that doesn't cover everything. I have taken my children to the hospital with me, letting them play games on a computer in a call room while I see consults. I spend all winter worrying about them getting sick. I only have three more sick days for next 9 months. I'm with you, Fizzy. I feel that there should be more options for us, not just as MiM, but as working families.

  20. I am originally from another country, one where all people were reuqired to work. Options for childcare were endless - 24 hour day cares, afterschool, summer, winter camps at school for exeptionally low fees. I will probably cause an outrage but I will mention: daycares had nurse, cooks (5 freshly prepared meals a day),caring loving teachers (I personally called my daycare teacher "mother"), accountants on staff equipped with bedrooms, playroms, cafeteria, spacious playgrounds, sometimes swimmingpools.

    I am finding myself in this progressive country feeling this country does not care for new generation. Everything is a parent's resposnibility. And parents are squeezed tight, with few safe options.

    This individualistic approach "I don't care because I do not need this service" is shocking. When I have to work full time to support my family (so my kids hopefully have some education funds ready for them on time), do I neeed to worry sick about my kids basic needs, when I see a very ill patient? Do I need to worry every day because aftercare options are all temporary and change based on nanny's own preferences, my husbund schedule, school early dismissal? Do I need to juggle 2-3-4 people caring for my kids/family needs? I do it, but is it good for society? Afterall, I am trying to raise responsible society members (kids) to contribute back to this country. Someone somewhere said, society value is how well it cares for its young and for its old. Currently this society does neither.


  21. You're right. It is extremely hard to juggle motherhood & medicine. Training is intense and extremely difficult to juggle with pregnancy, let alone young children, but if you wait to get pregnant til you're a consultant you may not be able to get pregnant or your pregnancy may be high risk. It sucks!
    I had my first child mid way through my specialist training - still had 3 years to go. I did take a year off which in Australia is pretty normal. I was a little rusty when I started back, but not too bad. The main new issue was my mixed priorities and that I couldn't spend out of work hours time on projects, extra reading, etc, etc with ease - far from it actually! It was frustrating that I was expected to work a 45 hour work week, do some oncall, attend early morning & evening meetings (at least once a week) AND spend countless hours in study outside of work.
    Thankfully it wasn't til my 3rd year back at full time work that we needed to put my son into childcare (previously he was with family). It was crazy! Suddenly being 5 minutes late to pickup was not acceptable. Problem was I was working over an hour from his childcare (and in traffic that could easily become 1.5 hours with no warning) and I was doing a busy job. The first day I had to collect him from childcare I got referred a patient having an Addisionian Crisis ... I made the diagnosis of Addison's and had to initiate treatment and he was semi-conscious. Somehow I treated him, arranged urgent transfer to a bigger hospital and then fought through traffic & collected my son with 5 minutes to spare til the childcare closed. Thankfully my husband was able to do most of the childcare pickups and that was my only disaster pickup for the year.
    I'm now a consultant and it's much easier, as I work very part time (only 5 hours a week last year - currently on maternity leave). But there's heaps of unpaid work - research, reading, paperwork, phone calls from other doctors, patients, etc. I find it all very intrusive & I'm somewhat daunted by how to minimise this intrusion when I go back to work in the new year with a newborn. It's a very real challenge and although I love my job I sometimes wish I had a job where I could go to work, work set hours & come home and forget about work, focusing only on family.

  22. I identify so strongly with a lot of the sentiments in this entry. I am a surgical podiatrist, an associate in private practice. My son is one year old. I have gone to work sick, I have brought my sick son TO THE OFFICE because he couldn't go to daycre with a fever, and all of our backups fell through. On weekdays, I get to spend all of about 4 waking hours with my son soup to nuts. And this is on "normal person" (as the author said it) full time/ doctor part time. I work with diabetic wounds and limb salvage as a significant part of my practice, so the unpredictability also rears its ugly head for me. Bottom line, I appreciate the realistic, balanced honesty of the author on this topic. I love being a doctor. I love being a mom. But there are aspects of that combination that never get easier.

  23. if ya'll think that non-doctor average work weeks are only 40 hours, you are sorely mistaken.

  24. I have found that having a husband/partner who is committed to being fully a co-parent [whether that was his original intention or not :)] has helped me with some of these issues. I feel less divided, he and our daughter have a great bond and we have walked in each other's footsteps so we are more sympathetic on those not so easy days. (most importantly for me I am not the default parent who is responsible for everything kid related....)

    He is not in medicine (he is in the Trades) and I am a 7 on/7 off hospitalist who did an internship in Peds and residency in Family Medicine.

  25. Fizzy,

    I love this post. I love you for being so open and saying some things that I am afraid of saying (out loud).

    Thanks for being insightful. Thanks for having the courage and confidence to bring this up.

  26. I agree with that second last anonymous post. For my family, it's crucial that I am not the default parent. My husband is just as capable of packing lunches, finding mitts, getting kids out the door or in the door, bedtimes, attending events...there are certain things we're each better at, and things we each prefer, but if one of us is gone for our 24 hour shift, the other one manages no matter what. For me it's incredibly freeing to know that all is taken care of at home, and I can concentrate on work 100%.

    I refuse to be guilty that "mom" is not at events or bedtimes because you know what, Dad is there (or occasionally a grandparent or babysitter), and those people deserve to see the play or read the story just as much as I do. I really encourage my med students to have this attitude, it saves you much grief in the long run and I think it's healthier for everyone.

    We are both family doctors -- I do OB call shifts, he does anesthesia call shifts. We have three kids 5,4 and 1.5 who we had after residency.

    Fizzy, I hear you, but it's not just the job -- it's your attitude towards how your family works as a whole and who needs to be present. If you're happy with your job, you can make your family work. If you don't like your job, move on.

  27. It's very interesting, the attitudes toward childcare and parenting and the balance with career/jobs. a few years ago my sister-in-law told us that we were irresponsible parents and shouldn't have any kids if we couldn't have one parent stay home to care for our kids. Needless to say, there's been a bit of a rift/distance since then.

  28. Sandra -- I think Fizzy does like her job. She has written about this extensively. Further, most people don't have the luxury of "loving" their job, and do have to make compromises in their lives. This post was about those compromises. Does every blog post have to be completely balanced positives vs. negatives? Does every blogger have to be completely Polyanna about what they do at all times, or risk being told they have an attitude problem?

  29. Anon: Thanks for standing up for me. I took Sandra's "you" as the general "you" and I wasn't at all offended.

    I'm actually surprised and pleased that aside from that initial comment by Susan, everyone who commented seemed to "get" my post and there weren't many haters.

  30. Nice to hear others feel the same way. I am a fellow with an 8 months old and a 2 year old and struggling with the same issues in addition to a deployed husband.


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