Comments on Mothers in Medicine: Negative flexibility

What a great resource!

2010-01-09T07:07:55.901-05:00

What a great resource!

How much flexibility? I think it depends on the of...

2009-08-25T17:05:26.408-04:00

How much flexibility? I think it depends on the office/departmental/institutional culture as well as on the individuals you work with. The first you may be able to gauge while interviewing or early on in the job. The latter takes time - 6 months to a year.

Supportive environments do exist, however. I'm an academic hospitalist who following 9 months of fairly intense infertility evaluations and treatment is seven and a half months pregnant with our first child. Our great schedule has allowed me to get by without needing to ask for coverage. My infertility and OB appointments were/are within walking distance of the wards where my patients are and were/are easily fitted into my rounding schedule. I will admit that having your colleagues as your physicians may make things a little easier. I do have a great section chief who was very accommodating with the schedule once he learnt I was pregnant.

I am very grateful for my position and take none of this for granted. During my year as chief resident, just prior to taking this job, 9 out of 30 residents I was directly responsible for either were expecting or their wives were. Half of these were in the graduating class. One had a wife who was expecting twins, didn't drive and was on minimal activity and another wound up being put on bed rest at 29 weeks. It took a lot of schedule gymnastics to maintain a functional program! Having been on the other end I better appreciate the challenges those in charge may face but feel that they are not insurmountable given the right attitude and some "out of the box" thinking.

Things come up. Different doctors limit how much ...

2009-08-19T14:03:27.145-04:00

Things come up. Different doctors limit how much their real life and professional lives intermingle. I wouldn't hesitate to admit a patient for a fellow resident who needs to go to a doctor's appt or something with their child as long as it were rare. My hubby works in a job where he is extremely flexible.

I don't think having children "arrive post-residency" is the cure all. Pregnancy poses a problem in medicine for whoever you are working with at that time... for your partners or your co-residents. With plenty of non-trads entering medicine a little late, it also seems understandable why there might be more babies being born to mothers in residency than in the past. The 80 hour work rules make it more doable also. Yes, it causes headaches for residency directors (or their secretaries - who do the scheduling) everywhere, but I don't think my schedule will truly be easier post-residency. And I suspect that goes for many in internal medicine and surgery.

In my program, there are plenty of understanding guys. There are some ladies who give real grief - those who decided to delay (sometimes permanently) the decision to have children so they could pursue their career. The blokes - especially those with kids - stare in amazement.

Clinical medicine rarely is a 9-5 job. And simila...

2009-08-17T12:09:00.093-04:00

Clinical medicine rarely is a 9-5 job. And similar to "Anonymous" I have been in tough situations when my children were young. It helps if the children arrive post-residency, when there is a little more flexibility.
But from the position of the senior attending in my group, I now see the other side. I try to be sensitive to young mothers, and have hired two in my private practice, with the understanding that they will be flexible enough to cover each other when one has to be out. It has worked out very well in general, but guess what - this week, of a 4 physician practice, I'm "home alone". Said people failed to coordinate their vacations, and I'm left with all the urgent, can't wait appointments for the panel of 4 physicians! So when you ask for flexibility, know that it works both ways.

HOLY SHIFT LOOK AT THE ASYMPTOTE ON THAT MOTHER FU...

2009-08-15T15:29:02.557-04:00

HOLY SHIFT LOOK AT THE ASYMPTOTE ON THAT MOTHER FUNCTION

F -- He's actually in basic science.

2009-08-14T10:25:10.582-04:00

F -- He's actually in basic science.

Fizzy- ho wdepressing to hear htat it is the samei...

2009-08-14T00:01:33.230-04:00

Fizzy- ho wdepressing to hear htat it is the samein the States as it is here in Australia. Only the other residents with kids are fabulous, the blokes and those without kids just give you grief!

OMDG, I didn't know your husband was a doctor too?...

2009-08-13T20:22:10.767-04:00

OMDG, I didn't know your husband was a doctor too?

F, If you ever decide to leave medicine and work...

2009-08-13T18:03:38.355-04:00

F,

If you ever decide to leave medicine and work in the private sector in a related field, ask me where my husband works. They are awesome to parents who need to take maternity leave, who want to go part time, who want to resume working full time. They understand when people need to leave or take a day for child related reasons. They have on-site daycare.

Ok, they are in the private sector and job security is lousy. I just hope when my husband and I decide to have kids that he will take advantage of their flexibility. Because as a resident, I know *I* won't be able to.

Mommy Doc: I didn't mean to diss on my fellow resi...

2009-08-13T07:37:07.404-04:00

Mommy Doc: I didn't mean to diss on my fellow residents either because most of them were nothing short of awesome. I think part of it was my guiltiness for making others cover so I perceived that everyone was angry. Also, there WAS one resident I worked with closely who had this insane sense of fairness and felt that since I never covered for HIS ob appts, he shouldn't have to cover mine. His answer to my asking for coverage was always an immediate, "What will you do for me?" I could write a whole other post about this guy.

I had all my children post-residency, but I rememb...

2009-08-12T23:27:34.799-04:00

I had all my children post-residency, but I remember several women became pregnant while in residency (especially on the peds side) and would have to regularly ask someone to cover in the types of situations you mentioned, Fizzy. I feel like they rarely got any hassle for this, but maybe it's b/c they would generally ask the other women residents (even on the IM side, we would try to be helpful). I find it very sad to hear about such negative attitudes towards helping your colleagues out. Even now as a private physician, I have gravitated towards practices who have physicians who also have young children or have had young children. It seems that there has always been a sense of helping each other out in tough situations such as what you describe (especially when you do NOT have a spouse who can cover for you).

To Anon: didn't mean to imply I thought any attend...

2009-08-12T21:23:01.457-04:00

To Anon: didn't mean to imply I thought any attendings were holding out on me. I feel just as if not more guilty asking an attending to cover. The big difference is that as an attending, at least on our service, you have more flexibility about time. As a resident, you have to do things at the attending's convenience. It would have been impossible for me to come back later and do the admit, since the attending would then be stuck at the hospital much later too.

Sometimes I wonder about how we spend the entire d...

2009-08-12T20:59:44.591-04:00

Sometimes I wonder about how we spend the entire day caring for patients- and at times fall short when it comes to taking care of each other (our colleagues). As MiM we have SERIOUS pressure to find flexibility. If/ when we do create such an environment I believe everyone benefits. Good luck Fizzy.

I just gave up my job in advertising for the "nega...

2009-08-12T20:29:08.862-04:00

I just gave up my job in advertising for the "negative flexibility" there. I don't know how many jobs there are with the amount of flexibility that most moms need...crossing my fingers for you that you have found one!

i am a working mom in medicine with kids. i totall...

2009-08-12T20:26:36.319-04:00

i am a working mom in medicine with kids. i totally sympathize with your struggles, having been in the exact same positions my self. but, as an attending now, the buck definitely stops with me. if a fellow/resident needs to leave early, it means I stay late, and miss dinner or bedtime or doctor's appts with my kids. I know this is not what you meant, but i think it is important to point out for readers that it is NOT (or rarely) the case that there is someone with free time who is holding out on people in your situation or who is just being difficult. these are hard situations. my husband and I go out of our way not to have patients scheduled on the same day - and I would often go back to the hospital after OB appts when I was pregnant.