Tuesday, June 3, 2014

What Does "Lean In" Mean? Whatever You Want It To.

Genmedmom here. You'd think that as a doctor and a mother and a blogger with a focus on work-life balance, that I'd have been psyched to read Sheryl Sandberg's Lean In. Truthfully, I dreaded reading it.

I figured I'd have to read it sooner or later, given what I do, and I wasn't looking forward to it at all. From the bits and pieces I'd heard about it, I assumed that it must be a pushy, finger-wagging manifesto designed to make me feel more guilty that I already felt.

But I felt guilty NOT reading it. So one day, when I ordered a bunch of books on Autism (our son is autistic) and a few Barbara Brown Taylor essay collections, I also ordered Lean In. It sat on my bedside table for about a month. The other books got read (I read a lot), but Sheryl's smiling face looked up at me night after night, book closed, waiting.

Finally, one night, after the kids were down and charts were done and my brain needed some book reading for an hour or so, I realized I had nothing else to read but smiling Sheryl. I very reluctantly opened it...

And she had me at the second paragraph of the introduction.

She describes how she gained seventy pounds in her first pregnancy, and suffered from brutal nausea the whole time; how she struggled with simply walking, and realized that Google needed to have pregnancy parking close to the building, for all pregnant employees. So she made it happen. Wow.

Flashback to my pregnancies, where I gained, yes, seventy pounds, and felt awful, and struggled with simply walking... Like many employees of my big city hospital, I park at a garage about a mile away, and walk in. For my first pregnancy, my manager gave me a handful of parking passes that I used in the last ten days. That was great, but it was the last ten days, and there weren't any for my second pregnancy. I remember waddling painfully to and fro...

The point of her sharing the anecdote is to illustrate that she didn't realize how helpful pregnancy parking would be until she experienced it for herself. She wondered how no one brought it up before:

"The other pregnant women must have suffered in silence, not wanting to ask for special treatment. Or maybe they lacked the confidence and seniority to demand that the problem be fixed. Having one pregnant woman at the top- even one who looked like a whale- made the difference".

The book continues in this style, outlining the significant challenges women face in today's workplace, dotted with personal anecdotes and shared stories, humor, and problem-solving suggestions. There's plenty of data, but it's not boring. I was surprised at the praise, validation and encouragement for women at all angles of leaning in, including those who work part-time or stay at home. There is very little by way of exhortation; actually, I had to search for anything:

"I have written this book to encourage women to dream big, forge a path through the obstacles, and achieve their full potential. I am hoping that each woman will set her own goals and reach for them with gusto."

I actually enjoyed this book, and strongly recommend it to any woman considering a career in anything.

So, why did I dread reading it? Why did a book described everywhere as "an inspiring call to action" sit gathering dust on my bedside table for a month?

Well, as an internist who works part-time and mother of two young children, I've been exhorted, invalidated, even attacked. So, I assumed Sandberg's book would be another attack. It's not every day, but I'm sure I'm not the only part-time physician who has encountered this, the face-scrunching and "So, how does THAT work?" or a "Don't your patients get frustrated that you're not fully available?" kind of thing.

The attack most famous came from a senior female physician. I remember how sick I felt when I read anesthesiologist Karen Sibert's Op-Ed "Don't Quit This Day Job" in the New York Times (June 2011). In this essay, she doesn't just frown upon women working part-time in medicine: she crushes them. Worse, she crushes the aspirations of those considering medicine as a career:

"I recently spoke with a college student who asked me if anesthesiology is a good field for women. She didn’t want to hear that my days are unpredictable because serious operations can take a long time and emergency surgery often needs to be done at night. What she really wanted to know was if my working life was consistent with her rosy vision of limited work hours and raising children. I doubt that she welcomed my parting advice: If you want to be a doctor, be a doctor....You can’t have it all."

The death blow, however, was to people like me,

"Patients need doctors to take care of them. Medicine shouldn’t be a part-time interest to be set aside if it becomes inconvenient; it deserves to be a life’s work."

The... what do you call this? It wasn't an implication or an accusation, it was a sound dismissal of MY life's work. I have a small panel of patients, commensurate to my four clinical sessions per week. I work in a warm, nurturing environment, in a group practice of all part-time female internists. We have excellent clinical support staff. We enjoy great flexibility in our hours. We also are also regularly evaluated and rated by our patients, as well as our hospital, on various criteria ranging from patient satisfaction surveys to outcomes data comparisons between practices, and we perform extremely well.

I also have two small children, ages two and three, a working husband who is a wonderful partner, and family close by. I'm almost always home for dinner, and enjoy most weekends with my family. Yes, we carry pagers and are on call for ourselves Monday through Friday, with weekend calls shared, and there are occasional calls at less opportune times (bathtime, bedtime..). And, with the advent of the patient portal, where patients can communicate with providers online (kind of like email), they can send me a message basically anytime. But overall, clashes between work and family are few and far between.

My gut sense is that what I have going works. Most of my patients are working women, and I'm open and chatty about being a working mom (can you tell?). My kids' photos are up in my exam room, regularly updated, and patients eagerly ask about them, just as I inquire about their families. We trade stories. I receive solidly positive feedback from patients and colleagues alike. (I feel weird putting it on paper, all this positivity, but isn't that what we women do, is downplay our achievements?)

THIS is my "leaning in". I do not aspire to be a department chair, to publish in the peer-reviewed literature (though I have), or to have my own office with puffy leather chairs. I have made the considerable achievements of graduating from medical school, surviving residency, and thriving in a highly regarded primary care practice. I want to be a good doctor and a good mother (and to write about it!) I believe that you CAN have all this, because I do.

That is the beauty of the message from Sheryl Sandberg: "leaning in" isn't a one-size-fits-all formula. As in the quote above, she hopes that women set their own goals and reach for them.

Sandberg also talks about how women need to help other women achieve their goals. I agree with that, and it starts with pregnancy parking! It also includes calmly ignoring even senior female docs like Karen Sibert when they try to force a one-size-fits-all, my-way-or-the-highway approach onto a career path as variable and malleable as medicine. Sandberg discusses the phenomenon of senior women not only being unhelpful, but even hindering the progress of the up-and-coming women:

"Critics have scoffed at me for trusting that once women are in power, that they will help one another, since that has not always been the case. I'm willing to take that bet. The first wave of women who ascended to leadership positions were few and far between, and to survive, many focused more on fitting in than on helping others. The current wave of female leadership in increasingly willing to speak up. The more women attain positions of power, the less pressure there will be to conform, and the more they will do for other women."

So, read the book, and either make your way up, or reach a hand down. Set goals and "lean in" any way you choose, because only you know what is right for you, and if it's right for you, it's all right.

And I'm interested to hear what others think of smiling Sheryl's book.


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  2. I was scared to read "Lean In" because my expectations were the same as yours. How refreshing that it sounds more supportive of those of us who continue to contribute in a way that suits our lives, rather than using a harsh and judgmental approach towards non-full-time working mothers. I think I'll read it thanks to your review!

  3. Agree, I found the book very readable and relatable. I absolutely agree with the idea that the women on top (and as attending physicians, that is US in many ways) need to look out for those below---to not forget our struggles and really try to make things easier, instead of the old "well in MY day, we didn't have blahblahblahblah"

  4. I really enjoyed this post and I appreciate your perspective. I had some of the same concerns about "Lean in," and had avoided it as a result too!

    The only possible downside I see to women working part time is that employers will assume that ALL women desire to work part time, not climb the career ladder, not hold leadership positions, etc., or worse, that women *shouldn't* want these things, and not offer advancement opportunities to women as much as to men. That said, I completely agree with you that everyone must find their own "it all" -- even men -- many of whom would surely benefit from having the option to work part time as well! True feminism is being empowered to carve out the career you really want for yourself, not working yourself to the bone for career advancement you don't really want.

    I think it's hard as a doctor, since we've all had our foot on the gas pedal and have been conditioned by everyone around us to win win win all the time. In the end, the only thing there is to "win" is your own personal balance.

    And Ana is right about the prevailing culture of, "In my day we did blah blah blah. Young doctors today are so much weaker/less committed/worse than we were back in the day." It is truly noxious.

    1. Employers already have that assumption, especially about women with kids. So we get paid less and we don't get promoted and we don't get recommended for certain kinds of work in our organizations ("oh, she wouldn't want to do that...") and we all expect to be the ones to do the child care and elder care and sick care, and we do it for free, so nobody pays for it, and the whole messy cycle continues.

    2. Yep, but it could be worse (see -- Italy).

      That said, nobody should feel that they have to pursue a career just because it is "bad for women" not to.

  5. I really liked the book and found it inspiring/affirming to my career as a mother in medicine. I also think it has important things to say to the younger women just starting in medical school/residency; not to pull back from their career too early because of future "maybes."

  6. IIRC, the only negative reviews I've seen on the book were from people who hadn't read it before it came out. Of which there were a lot.

  7. Thanks for the review! I'll add the book to my "last summer vacation ever" (between MS1 and MS2) reading list!

    I think that society needs more women at the top and more men to work flexibly - as part time workers or SAHDs or what have you. When we have balanced options for both genders, our whole society will be in better shape. To me, it isn't about "making it like a man" and it sounds like Sheryl's got some great ideas brewing.

  8. I love love LOVE this book. A lot of criticism of it from folks who just don't get it and probably haven't read it. Oh a woman in power huh? We'll lets just criticize her in public and prove the point!!!!
    Lean in means whatever you want it too. it means being tough, knowing yourself, and sticking to your guns.

  9. And I want to kick the **** out of Karen Silbert. Hope she doesn't have kids. Sorry to be mean but I can't stand her.

  10. ANd BTW I can get more done in half a day because of my mega efficiency than most men I have ever met. You can lean in and be a stay at home mom, you can lean in and work part time, you can lean in and work part time but LEAN in. Ok I'm done. I LOOOOOVE this book! The one thing I would argue with is I've seen a lot of women wait to have kids then struggle with infertility so I tell them if you are ready, DO IT NOW! Asking women to sacrifice their health is not reasonable.

  11. i also loved this post - had the exact same reaction to hearing about the book.. I don't want to be made to feel bad for not wanting more (esp when I was bowing out of academics at the same time), and ended up loving the book. I love the example she uses of men and women starting a marathon at the same time. While the crowd cheers "keep going! you can do it!" to the men, they cheer "You don't have to do this!" to the women. Not a huge surprise who finishes first.

  12. Today, I visit your website and after reading your blog i realize that it is very informative. I'm highly impressed to see the comprehensive resources being offered by your site.

  13. I'm just getting through the book now. I also avoided it. I'm involved with the Academy of Women in Academic Emergency Medicine. If anyone out there is interested in EM, this is a good group to join. We discuss everything, from work/life to how to get promoted/publish.
    Thank MT, I continue to think you are amazing!

  14. Thank you for writing this. This was the encouragement I needed. I am a pre-med student with two small children and a husband in the military. Balancing studying for classes, studying for the MCAT, taking care of children, and taking care of the home has been challenging. Especially since my husband has been used to me being a stay-at-home mom and holding down the home when he was deployed. I was recently told by a retired Navy physician and faculty member at my university that I shouldn't pursue going to med school because it was very difficult for women with kids. I was then given articles about how miserable being a doctor is by an acquaintance who is finishing up her residency. So, I was sitting at my computer with the voices of all these naysayers in my head, saying, "You can't do this. Your children will suffer. Your family will suffer. You are making a mistake." and I found your blog. Thank you for the encouragement and showing me that it IS possible.

  15. I got the book as a birthday present and still haven't read it for the same reasons you didn't. There are a couple of preggo parking spots at a grocery store in town. I loved them. As a pregnant resident times two I could have used much better parking. I'm sure running around in the multiple training hospitals all day were helpful in keeping me at a 50 lb. and 35 pound weight gain, respectively (Jack was premature and I'm tall so 140 is my current weight and was my starting point then). You've convinced me to put this on my summer reading list! Great post.

  16. As an 8 month pregnant resident I was asked to transfer a vented patient to Columbia Hospital from NJ in an ambulance going across George Washington Bridge at rush hour traffic. When I asked my male OB for an excuse letter his response was if my daughter a surgical resident can operate so can you do the 4-5 hour drive without a restroom break! Takes a woman to know one sometimes... It was his junior counterpart that gave me the letter to release me from the torturous prospect.

    My employer asked me to send my autistic son to my parents so I could focus on my career and bring in the money when my son was diagnosed with ASD at age 3. Needless to say I went into solo practice for the next 11 years juggling home, kid and hospital work. Yet it was fulfilling because I was flexible, open and my patients knew they could count on me. Rigid systems constrain performance. Allow breathing room and people thrive. My son is now 17 and I still work full time but have given up hospital work.

    Yes, lean in to what feels right to you


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