Illustration by Barry Falls

The conversation continues in response to Dr. Karen Sibert’s op-ed piece wondering whether women should be doctors if they also want flexibility in their working lives.

There is a collection of Letters to the Editor, some of which strongly agree while others just as strongly disagree.

There is discussion around the Internet, like this on the Working Mother blog by Dr. Jen Canter, and this on the Web site ScienceBlogs.com. Both posts suggest that the problem is not that women seek flexibility, but rather that Congress limits the number of doctors that teaching hospitals may train. On the Science Blogs, “Isis the Scientist” writes:

Blaming doctors, especially laying the blame fruitlessly on women, for lack of commitment is simply shenanigans. Asking physicians to be solely, morally responsible for providing medical care is unfair at best, cruel at worst. Investing in health care and creating enough well-trained medical professionals to sustain our future is the “moral” solution. I think everyone, not just physicians, deserves a life’s work that is gratifying and that serves to improve the world around us. Patients deserve quality of care and physicians deserve quality of life. But to suggest that women decrease their practicing hours because they are not committed or are inconvenienced is shameless.

I have also been hearing directly from readers as well.

Some, like Dr. Megan Duffy, were women who seconded Sibert’s warnings:

Thank you for the well-written, insightful, and provocative article that now has my female physician friends whipped into a Facebook-reposting frenzy of indignation. Sadly, even these brilliant and highly educated women fail to grasp the implications of their actions on their patients, taxpayers, and ultimately, themselves and their families. Like many skills, one’s diagnostic acumen wanes with disuse. Keeping up with the endless barrage of medical literature can be a part-time job of its own. Do I want to see a physician who practices part time, or who has just gotten back from months or years off? No. But then, I choose a physician based on his or her skills and track record, not on personality, shared interests, or knack at small talk. I have chosen to nurture my own medical career in lieu of children. I cannot even fathom spending ten back-breaking years and a quarter of a million dollars on my post-graduate education, only to put my lucrative career on the shelf to play patty-cake and expect my partner to foot the bill. It’s a staggeringly selfish move and a tragic waste — one that our society accepts in its obsession with the Revered Child.

Others were men, like Dr. Steven Neish, who though Siebert’s views were a disservice to all doctors, regardless of gender:

While I wholeheartedly agree with Dr. Sibert that service to our patients is an imperative, I also agree with you that a large part of the problem is that we have many archaic viewpoints about how we structure our work. I celebrate the changes that women have brought to medicine. They have allowed conversations to be rational about our schedules and they have empowered the men in medicine to be committed to their families, too. I cannot imagine losing women in medicine. One of my most important influencers in my thoughts about committing to my children was Dr. Frederick Battaglia, a pioneer in neonatology and in research in fetal metabolism who spent the majority of his career in Denver at the University of Colorado. My first job after fellowship was in Denver, and at a holiday party, I believe in December 1991, I had the opportunity to sit with him for a few minutes. I suspect that he was in his in his sixties, or perhaps even past seventy. One of the first things he said to me was, “Tell me about your family.” Later in the conversation, I asked him, “Dr. Battaglia, what advice do you have for me as I begin my academic career.” Realize that Fred Battaglia was one of the very most successful forces in academic pediatrics of his era, and I was asking him for advice that was focused on my professional life. He said, “If I could change one thing, I would have spent more time with my children as they were growing up.” I don’t know if I would have done anything different in my career had I received different advice from Dr. Battaglia that evening. At many decision points in my life, though, I made choices to spend a day or a week or an evening with my kids as opposed to spending time on a professional pursuit. I made those choices on purpose. I have never felt like those decisions made my career less and I have never felt like my successes have been smaller because I made certain choices. Dr. Battaglia gave me a great gift that night. He gave me permission to be an involved father.

Also among my correspondents was the author Mary Gordon who writes:

Thank you so much for your response to Dr. Sibert’s op-ed piece. I was gratified to see your addressing of the assumption that part-time doctors are less good for their patients than their “full-time” counterparts. I know from my daughter, a medical student and biostatistician, and my closest friend, an anesthesiologist, that there are good statistics to support this. I am somewhat concerned, though, that what seems missing from the larger discussion is the point that child care is not just the responsibility of mothers, but of fathers also. There is only a very brief period in the life of a child when the physical presence of the mother is more important than the physical presence of the father. And your respondents who speak of the benefits to women that accrue from balancing professional and family life need, I think, to extend this to men as well. And so, my argument is two-fold: it is both the ethical responsibility of fathers to do their share of the work of bringing up children, and it is to their benefit as psychologically balanced, indeed happy human beings to do so. This is an important place to discuss this issue, as often the argument is made that, the wage differential between men and women being so great, it makes sense for the woman to cut back on her job. But in fields like medicine where training for men and women is identical, this doesn’t need to be the case. A man making the kinds of professional sacrifices that many women make would probably have the same career trajectory.

And, finally, there was this, from Dr. Jenni Levy, and internist in a Pennsylvania hospice who says:

I’m a third-generation physician. I followed both my grandfathers and my father into medicine because I grew up believing that it was the best possible career. I am privileged to work, as they did, in the heart of human experience, and to be trusted by my patients and their families. My father said, “You’ll never have a routine day, because there is no such thing,” and he was right. My father was my model in many ways. I have tried to emulate his ethics, his commitment, his empathy and listening skills, and his intellectual engagement. I have not tried to emulate his work hours. I take vacations more than once a year. I don’t work seven days a week. I’m not on call every single night. And for eight years after my daughter was born, I worked part-time. According to Karen Sibert, that makes me a less valuable doctor than my father was. Sibert says the government subsidized my education, and I am not fulfilling my part of the bargain. NSF subsidized my husband’s Ph.D. in geology with a coveted, highly competitive fellowship. He’s no longer an academic geologist, but no one has accused him of betraying society. You could argue that there’s no shortage of geologists. The projected shortage of doctors is not a shortage of all doctors – it’s a shortage of primary care doctors, and it’s not going to be evenly distributed. The areas that are currently underserved (rural areas and inner cities, for the most part) will become even more critically deficient, but the wealthy areas will still have plenty of subspecialists – more than they need. As women have entered primary care in large numbers, salaries for primary care have dropped compared to other fields, and prestige within the profession has followed. What women do becomes “women’s work,” with all the stigma to go along with it. The procedural subspecialties don’t accommodate maternity leave well in residency and they don’t encourage job-sharing or part-time arrangements. If we accept Sibert’s framing of this as a “woman’s issue,” then those fields will remain boys’ clubs. If we step back and look at the toxic culture, the high rates of burnout and substance use, the intense loneliness and isolation experienced by residents an early-career physicians, we might actually realize that it’s the profession that’s ill. Women don’t need to work more; many men (and other women) need to work less. No, we can’t walk away and leave our patients without care. We need a team to support us. We need a more straightforward reimbursement system so we don’t waste time dealing with insurance hassles. We need excellent computer systems that make clinical information available to everyone involved in the patient’s care. We need training to communicate with our colleagues. We need to be able to go home and leave our patients in capable hands. Everyone will be better off. When my daughter was about 3, I took her to visit her grandparents for a weekend. I worked my usual half-day on Friday before picking her up and driving north. My last patient that morning was very ill, and I wasn’t entirely sure what was wrong. I arranged for her to be admitted to the hospital, spoke with the covering physician, wrote orders for medication and lab testing, and called the ambulance. She was in the back of my mind for the rest of the day, and that night, when Mom was putting her granddaughter to bed, Dad and I sat in the kitchen and drank a glass of wine and I told him all about it. We talked about possible diagnoses and treatments, and then I said “I think I’ll call the hospital.” My dad said “You have good partners. You trust them. Let them take care of her, and relax.” I said “When you were my age, you would have called.” He smiled at me and said “Honey, when I was your age, I wouldn’t have left town – but you’re smarter than I was.” I learned a lot from my father over the years, and I think he may have learned a thing or two from me.

Yes, doctor. Those are lessons we should all learn.