This is the kind of post I'd usually make on Mothers in Medicine, but someone has already posted there today and I'm overeager, so it's going here instead! Plus it's probably been discussed there ad nauseum anyway.
A while ago, I was involved in a vicious forum discussion about how women are ruining medicine because "work 20% to 25% fewer hours than their male counterparts."
Women doctors in the U.S. work less—47 hours per week on average, versus 53 for men. They also see about 10% fewer patients and tend to take more time off early in their careers. "It's pretty much an even bet that within a year or two of entering practice they will go on maternity leave," says Phillip Miller, a vice-president of the medical recruiting firm Merritt, Hawkins & Associates. "Then they are going to want more flexible hours.
(Sorry, I'm too lazy to find the reference.)
Yes, I know women are lazy bums because we only work 47 hours per week. On the other hand, women are more likely to pick specialties men don't want, like primary care, pediatrics, or ob/gyn.
Anyway, without further discussion, here are a few choice comments from the discussion that still really grind my gears:
"If a woman wants to get pregnant, then she should have a job where she knows this is possible and convenient for the company. If someone wants a job with less hours, they should go find one, not try to get less hours in the job they're in."
"It's a matter of economics, not sexism. You wouldn't hire a heart surgeon to scrub the floors, because it's not a proper utilization of their skills - it would be a major waste of training and resources. You hire someone with a less developed skill set, and free up the surgeon to do what they, and only they, can do.
Likewise, it's a waste training and resources to have a heart surgeon raising babies, something that, to be honest, people with no formal education can and have been doing for millenia.
In the end, it has nothing to do with sex or gender. If the heart surgeon is a woman, and has an au pair or husband to raise the baby - bully for her. But if doesn't use her skills to do what only she can do, then she's wasting the time of the people who trained her and the money of the taxpayers who funded her training."
"This is not an issue because women take six months off for pregnancy and delivery. This is an issue because they take a decade off to raise children.
There are a fixed number of medical-school positions, and this number has changed very little over the past two decades while the population has increased by nearly 30%. Assuming that most doctors work 30 years or so (a little after age thirty to a little after age sixty), a woman who takes a decade off from work to raise children serves as a physician for only 2/3 of the time that a non-child rearing colleague would.
It may not be fair, but for some reason, most of the people who leave work to raise children are women.
Yes, it's hard to be a mother (I imagine, I don't and will never, know), but the reality is, there are a lot more women in the world who can raise children than can repair an obstructed bowel, and part of pursuing any advanced degree is a certain social obligation to actually use that investment for the betterment of humanity. If you've taken a medical school slot (and a federally funded residency) you should use it. If you're just going to squirt out kids you could have done that with a tenth grade education.
I'm an asshole, I know. But with a finite number of med schools, and a finite number of slots, accepting people who will practice only a fraction of the time of their colleagues is a net loss. This in one reason that it is so hard to get into medical school."
As long as the country has MD shortage it should produce more medical schools. And account for those who will drop out of practice (women for child rearing and men who prefer non -clinical jobs, non clinical options becoming very popular due to stresses of legal environment and increasing customer service demands). It is hard to get to med school everywhere, even coutrnies that pay doctors taxi-driver salary (I happen to be from one of these). Many developed and (surprize) undeveloped countries allow their women dignitiy by providing extended maternity leave (3 years paid in my country, most women choose one year, and optional 6 years, last 3 years unpaid) with job garantee. In other words in my country they cannot fire you because you had a baby and took time off, plus years of maternity count in for social security as if you were working and contributing taxes. So these years do not affect your pension. In short, this is a not a problem for individuals to vent on, but rather something each country defines, regulates, and well...helps child rearing process. Many countries have the vision - helping woman to raise her offspring provides healthy new generation for the country, makes this country vibrant, viable and strong. We should not throw stones at each other, because someone chose to help their chidren grow well. We all know it is individual parental task here, not societal task.ReplyDelete
The number of medical school spots doesn't matter, it's the number of funded residency spots that determine how many practicing physicians there will be and that number has been capped since the late '90s. We could enroll 100,000 medical students next year and still only 30,000 would be able to find residency spots to become independent practitioners.Delete
No matter how it's done, it's clear that more physicians should be trained. The answer isn't to work the physicians we have to down to the bone.Delete
Fizzy, I will respectfully disagree with you. As you know, I'm OB-GYN. For 6+ years, I did the full-time thing as an attending (had my babies in med school & residency, so no time off for me!). I even did several years as a solo-practioner.ReplyDelete
It was not worth it for me. Not because I hated my job, but because I was burning the candle at 15 different sites and I couldn't clone myself. I'm now in a group and I'm part-time (although I do full-time call). This is KEEPING me in medicine, instead of me dropping out for a non-clinical area. I am now able to deal with kids and an ill parent without exhausting myself.
BTW, my billing is about 3/4ths of what I was doing as a FT doc. Part of that is better efficiency of the new practice (more FTEs per doc, which helps me) and part of it is better billing (gone to coding courses & learned that I can bill for xxx).
I think Fizzy was highlighting these quotes as things she disagrees with. Ergo, you two actually agree.Delete
OMDG is right. I wasn't agreeing with the quotes I posted, I was disagreeing. (Grinding of gears is bad.)Delete
I think practitioners who work fewer hours are less likely to suffer burnout, so are ultimately more productive.
My bad then...trying to do too much at once!Delete
Kidlet got braces today...she is SOOOOOOOOOOO not happy with me right now!
I loved having braces. No, really.Delete
By this reasoning, then everyone that enters med school who is in their mid-40s is wasting resources because how long are they going to work...10 years, 15 years before they retire?ReplyDelete
So freakin' infuriating...seems like people want to move back into an elitist, sexist, ageism society where the women, elderly and disabled are shuttled off into a corner.
That is what those comments said to me.
Excellent point. How far do we want to go with this? Should we exclude people with any form of disability, because they MIGHT see one patient less per day than someone else? Should we screen people's genetics and family history, because some people are more likely to develop a condition that prevents them from working earlier than someone else?Delete
Since we're talking about resource management, some medical fields are over-saturated - should we start screening people for specialty choice before they're admitted to medical school? There are an awful lot of people who want to go into the high-paying, low-hour specialities, and the real shortage is in primary care. How about forcing people to commit to those areas before they even get accepted?
I think that as a whole, we (Americans) could do with being less work-obsessed across all fields. "Work to live, don't live to work," as the saying goes. It's healthier to take time to rest and "live life," and to spend time with your family. Medicine is more demanding of your life than most other jobs, but too many people seem to use that as an excuse to chastise anyone who doesn't want to be on-duty 24/7.
But the thing is that the way medical education is setup in the US, it is a zero-sum game. There are a fixed number of spots, so each underqualified student takes a spot away from a more qualified student. It's not like undergraduate or law school admissions where there are enough seats to go around no matter what. IMO, we should be giving each seat to persons who will practice medicine to the benefit of society, not those who will do it part-time for money.Delete
We already exclude some persons with disabilities by ensuring everyone can meet the technical requirements for becoming a physician (eg can you inject medicine). Depending on the school, some admissions officers frown upon older applicants. Personally, I believe that a maximum age of 30 should be instated for new medical students. That gives that person around 25 years of independent practice assuming that they become board-certified at age of 40 (4 years medical, 6 years post-graduate training) and retiring at 65.
Ideally, yes, we would either incentivize primary care better or restrict entry into specialty care. Again, this isn't an MBA or a cashier. Physicians are one of the glues that hold an entire society together and as such, society at large has a huge investment in each individual physician. Society suffers, as we have seen in the past 20 years, when primary care is de-emphasized and specialty care is emphasized. Not only does the US have fewer physicians than any other developed country, the physicians that we do have eschew primary care for specialty care. Like many other aspects of our society, we've incentivized the wrong things for too long.
Sometimes, we must make uncomfortable choices for the betterment of society. Yes, we should draw a line at disabled students. Yes we should draw a line at an age limit. Yes, we should prioritize male students over female. These are all uncomfortable, unpopular ideas, but they are also backed by data and by the needs of society. We should not be training 40 year olds for a career in medicine because that 40 year old just took a spot from a 22 year old who could practice for 10-15 years more. If a 40 year old wants to get involved in healthcare, there are many more opportunities, such as PA, nursing or nurse practitioner. Not everyone can be a doctor nor does everyone deserve to be a doctor. Again, we aren't training MBAs or electricians here. Each spot is highly valued and non-replaceable.
On the subject of getting people in primary care: there are already programs in place to do just that. west virgina is an example with several scholarships including a state funded 20k to become a PCP. For that you sign a five year agreement to practice in a rural area of the state after residency.Delete
Anon: I think if we were a bunch of automatons, your system would be great. But can't we agree that more goes into being a quality physician that the number of hours they work? A student with a medical condition or disability may be able to empathize with patients in a way that others might not. An older student with more life experience and maturity might be able to use that experience to be a better doctor. And as for women, I've met so many patients who only want to see female doctors for a variety of reasons that I'm sure you can come up with yourself.Delete
I don't think turning out quality physicians is simply a matter of simply plugging someone's age, health, and gender into a machine, and calculating their productivity.
Anon: You know, I'm an MD-PhD, and I fully expect that I will NEVER see patients 100% of the time. In fact, if I am a successful researcher, most likely I will see patients no more than 20% of the time. Is it a waste of resources for me to go to med school? Perhaps you think so. Fortunately the NIH does not agree with you and is actually trying to recruit more people like me to go to med school. The argument is that I will contribute in ways other than direct patient care.Delete
Anon, I can't believe you just implied that women are under-qualified for medicine simply because of their gender. Unbelievable.Delete
By the same lack of reasoning used to state that women are under-qualified for medicine simply because of their gender, I could say that a lot of men are useless because they can't use the microwave or stove to cook/reheat food without burning it. In fact, they shouldn't even eat because they're under-qualified to make food.Delete
The economist covered a similar issue recently - why women are under represented at the top of businesses (http://www.economist.com/node/21560856 - if you are interested) - I liked the letter to the editor that appeared in response a few weeks later, I'll quote it here:ReplyDelete
"SIR – As a man who has interrupted his career to bring up two young children, maybe it is fathers that are limited in life options, and instead of setting quotas for women on boards, we should be setting quotas for stay-at-home fathers.
Personally, I think we should select doctors based on their ability to function on less than 5 hours of sleep per night. Perhaps a mandatory sleep study should be admissions requirement? Then we could require everyone to work full time, but it would be ok because they wouldn't need to sleep.ReplyDelete
Kidding, of course. For the life of me I cannot understand why anyone would want to work 60+ hours per week for the duration of their career. ANYONE (man or woman), at ANY career. There's just so much more to life.
Well, in the grand scheme of things, the 40 hour work week lasted only a scant few decades. It was a great experiment for the developed world, but outside of a few countries in Europe, the experiment has failed. 95% of the world never even knew what a 40 hour work week felt like and after the globalization movement of the mid '80s and '90s, companies realized that they could get more productivity for less money by making peasants work harder overseas than Americans onshore. Nowadays, it'd be tough to find a full-time job that was only 40 hours a week.Delete
If there had been a sleep study, I would have failed. Big time.Delete
I 100% agree with you, OMDG.
Anon: I think you're confused by my definition of full time. Full time in medicine is 60+ hours per week. I never said anything about a 40 hour work week.Delete
What a bunch of crap (not Fizzy's opinion -- the quotes she posted). I think it is important for EVERYONE to have a life outside of work, and if more women physicians have pushed the status quo, excellent for both the men and the women. Balance is so important....it will make you a better parent, person, doc, whatever.ReplyDelete
Yes. I think female physicians have improved the quality of life for ALL physicians, male and female.Delete
When there is a burn out drop out or parental duty drop out, these drop outs should be accounted for when planning med school and residency spots.ReplyDelete
The "grand scheme of things" proved working 40 hour balanced job is healthy and best for people. Multitasking every minute and putting in 10 hours plus a day leads to burn out. There have been very successful countries in the past century who practiced 40 hour work weeks.ReplyDelete
While this is a logical argument, logic can only go so far. Remove women who want the family also, and you lose a huge chunk of the physician population. Lose us, the remaining people are overworked beyond belief and then they drop out later due to burn out. Lose-lose situation. We need more doctors (with more spots in med school and residency) so we can have more normal lives while all our patients are covered.ReplyDelete
In the least, I am made a better medical student by the intelligent influence of my female classmates.ReplyDelete
All these Anonymouses (anonymice?) are confusing me! : )ReplyDelete
Srsly, as someone who plans to enter med school in her 40th year of life, I'm glad there are no arbitrary deadlines for entering school - I got an MPH, worked in hospital administration and community education and raised kids before deciding to become a physician. My life (personal & professional) experience will inform my career, which I don't expect to end when I'm 65. While I may not be interested in spending my golden years taking call after call, I am certain there will be teaching, clinic administrative and research good I will still be able to accomplish.
I know.. I wish people would just call themselves something.Delete
I think it's ridiculous to make a decision to allow an applicant just based on age. A healthy 35 year old may very well have more good years ahead of her than an obese 25 year old. And should we exclude people who have a strong family history of cancer or heart disease, who may be likely to get sick earlier?
"I can't get into medical school because too many women are applying for medical school!" - White people problems. More specifically, Anglo-Saxon Man problems. Seriously, this sort of faulty logic could be applied to any emerging minority competing for slots for med school.ReplyDelete
Fizzy, the lack of proper formatting threw me for a loop. I get which side of this argument you're on though, so don't worry about it ;-) I do take issue with this though:
"Yes, I know women are lazy bums because we only work 47 hours per week. On the other hand, women are more likely to pick specialties men don't want, like primary care, pediatrics, or ob/gyn."
Hey! I'm a man! Those are EXACTLY the fields I went into as a family medicine resident!
Right, but I wasn't arguing NO men go into those fields, only that women are more likely to.Delete
It's absolutely false that the number of med students is stable. In 2006 the AAMC called for a 30% increase in 1st year med student enrollment by 2015. Since then, many med schools have increased class size and several new schools have been established. Per AAMC data, first year med school enrollment increased from 16,488 in 2002 to 19,230 in 2011.ReplyDelete
As others have pointed out, the problem is finding $$$ and resources to create more residency training positions, as well as getting U.S. grads to pursue primary care in the face of increasing burnout rates. It's not just women working fewer hours or leaving medicine -- there are plenty of burned out men retiring early or transitioning to other careers b/c the U.S. medical system has a knack for burning out its most dedicated clinicians regardless of gender.
My clinically excellent UCSF professor dermatologist told me bluntly just before I started med school, "There are more women going into medicine these days b/c medicine is in the toilet -- men don't want to go into it anymore."
No, you guys still need more med school spots, residencies are filled by large number of FMG's. No other developed country takes in so many FMG's. They leave this competitive field for their own. I read that primary care is staffed by 30% FMG doctors. So, there is still a shortage of local graduates (in absolue numbers). I am an FMG though and thank God for this opportunity.Delete
We may still need more med school spots (we still have yet to reach the AAMC goal, but it seems we're on schedule), but some residency slots -- mainly primary care slots often in less desirable areas -- continue to go unfilled each year. Maybe even those spots get filled after the match by FMGs.Delete
I'm glad that many bright and well educated FMGs (some with prior training) are willing to fill U.S. primary care training slots, in part because I learned a great deal from my senior FMG residents during my Internal Medicine training year.
"47 hours per week on average, versus 53 for men" well it is only natural we're men, you girls go take a brake while we men handle the hard stuff... xD ftr just kiddingReplyDelete
What about doctors who engage in higher-risk activities? Should they be forbidden to skydive, ride motorcycles, binge drink, snowboard, etc? Where do we draw the line? Should we also dictate how many lifetime sexual partners they have - what if their productivity goes down from acquiring an STI? And will society provide drivers for doctors to take them home post-call? What if they get into a motor vehicle collision because their fatigue impairs their driving? What about the doctors who commit suicide b/c of burnout? The doctors who get heart attacks b/c of poor lifestyle choices or coping skills? Aren't all these doctors cheating society of their "certain societal obligation to better humanity"?ReplyDelete
- A Canadian GP
This just sounds like a bunch of butt-hurt men that didn't get into medical school. Just sayin'. --Girl who is in med school.ReplyDelete
An important point that this discussion brings out is the inevitable failure of central planning. The only reason we are having this discussion is because residencies are federally funded programs. If we paid each practicing physician whatever she was worth to society and charged each resident whatever she cost to educate we could have more residency slots and it wouldn't matter to anyone but themselves what those fully trained physicians did. There is of course the consideration that most of us would be a little leery of starting a career with $750,000+ of educational debt. Perhaps we need to find more efficient ways to train physicians.ReplyDelete
Considering I worked my ass off in residency, I have to believe that what I did had *some* monetary value. I mean, if residents just disappeared, a fully trained physician would need to be hired to replace us, which would cost even more money.Delete
Agreed 100% I HATE it when people bring up the guilt-trip: "You were paid with federal funds during residency - you are obligated to Uncle Sam to go into primary care/work a zillion hours a week!"Delete
Now I know that the lack of physicians in certain fields is a serious problem, but making everyone who decides to specialize feel guilty is just not fair. By this philosophy, then EVERYONE who has benefited from federal funds 'owes' the US - everyone who's ever gone to public school, or a public university, who's had access to clean drinking water, who's voted, etc. Basically, everyone.
The closer equivalent to replacing a resident is a PA, not a fully trained physician. According to a health policy brief from August 31 of this year Federal subsidy of residency programs is $100,000 per resident per year in addition to a smaller state expenditure( http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=73 ). In addition, insurance companies pay higher rates to teaching hospitals. I am forced to conclude from this that non-teaching hospitals which are not bankrupt are in fact able to provide patient care using a combination of MDs and PAs which is more efficient than the combination of attending MDs and resident MDs in teaching hospitals. There is some argument that hospitals are overpaid for training residents, and this may be true, I am not privy to enough of the details to form an opinion. We could find out by reducing the subsidy and waiting to see how many teaching hospitals go bankrupt, and I believe this has been proposed . I think the final statement of my first post stands: we need to find a more efficient way to train physicians.Delete
I completely agree with an earlier comment you made, Fizzy, about how being a good doctor isn't all about the absolute number of hours you work. Women bring a completely different 'flavour' to medicine than men do, and the two genders complement each other. Men in primary care may be able to get through more patients in a day by working through each patient more quickly, while women may spend more time with each patient and give additional emotional support or pick up additional problems. Each has their advantages.ReplyDelete
Also, where do these people think the next generation of professionals is going to come from if no-one in the medical profession is allowed to have children? I'd say at least half of my medical school class are the children of nurses and/or doctors (not me)...
I would rather be seen by a woman then a man. Caitlin is correct that women spend more time with their patients. When I have seen a man I always feel like I'm just another patient but when I am seen by a woman I feel like they really listen and take the time to understand why I am there. As for the quotes, being a woman myself (although not in the field of medicine) I found the whole thing to be insultingDelete
Anyone who works hard enough to get into medical school, and sacrifices years of their lives and hundreds of thousands of doars in order to help others can do whatever they want with their degree or after their residency. Looking at women as a liability due to their exclusive ability to bear children is the dumbest thing I ever heard. It is an assett, we need inteligent people who support their own familys to procreate.ReplyDelete
So long as your going on maternity leave, or part time work, as a man or as a woman, doesn't make more work for me, do what ever makes you happy. I could really care less how many hours you work, so long as we are all compensated fairly for the work we do. For me as a resident, when my female colleagues go out on maternity, we get pulled off our vacations, electives and otherwise down time to cover for them, and this infuriates me. Doesn't seem fair that I should have to suffer. Pregnancy is a choice, so just plan wisely and think about those your decisions might effect.ReplyDelete
I disagree. Sex is a choice (except in cases of rape), pregnancy is something that may or may not result from that choice.Delete
Good point, Phillip. It's like saying breaking your leg is a choice because you made the decision to go skiing.Delete
"Pregnancy is a choice, so just plan wisely and think about those your decisions might effect."Delete
Oh, I did't realize that biology works so perfectly in a way such that one can plan EXACTLY when she can get pregnant. Life stressors bear no impact on this whatsoever...duuuude, what medical school did you go to where you were taught such an asanine concepts?
So here's a question: the idiots- sorry I meant people- that think women don't belong in medicine: are they really old and about to retire? That would help me to understand where their views are coming from- an outdated model of life that has been disproved at every level. I feel like this is along the same vein as the orthopod who thinks medicine is not what it used to be because the nurses don't stand up every time he enters the room anymore. I think the time that they used to give good care is past and it's time to step down. Mostly because if these are the feelings they have then the chances of getting an objective differential are essentially nil. You can't think negatively of an entire class of people if you want to be a good healer, which is what medicine is supposed to be about. Just my opinion and I'm not even done with med school, so take it for what it's worth.ReplyDelete
A pregnancy is most often a decision made by a woman AND a man... still only women are to blame apparently. We have to carry the baby around for months, go through delivery and take care of the helpless little one after. I want a kid with my man one day, but I tell you -if I could get my man pregnant instead of me being pregnant, I would. I'd rather go to work than stay at home and change diapers.ReplyDelete
Yes, I know having kids is a choice, but it's still a choice most people make and we should make room for that.