Friday, March 15, 2013


I had a recent post on KevinMD, explaining why I work parttime. It got a few comments (over 130, actually). It was written as a very delayed response to the op-ed piece by Karen Sibert from 2011. (I always jump on bandwagons about two years too late.)

To my surprise, I received a response from Dr. Sibert herself on the post, which kind of irritated me:

Good grief. So much emotion. I really don't recall saying that anyone who works part time is "ruining" medicine. What I said is that no one's medical degree is entirely his or her personal possession; society contributed a lot to that degree in terms of dollars and resources. Accepting the degree confers some obligation--how much, obviously, is a matter of debate.

When my children were small, I did indeed always work full time. I found the time to "blog" once the last one left for college.

The format of the commenting on there is such that it's difficult to have a discussion on there. So I've decided to write my angry reply here. And I'll make a funny post later, just to lighten the mood. I swear.

My piece-by-piece response:

Good grief. So much emotion.

You tell female physicians that work part time that they don't have an appropriate level of "commitment to the profession" and that they owe society to work harder.... and these women get emotional??? Imagine that!

I really don't recall saying that anyone who works part time is "ruining" medicine.

Right, only that our decision to work part time has "serious consequences for patients and the public." Enough so that you felt a need to write an op-ed piece in the NYT.

I said is that no one's medical degree is entirely his or her personal possession; society contributed a lot to that degree in terms of dollars and resources.

So if society didn't contribute so much, how much in loans would we have then? It's already like $300,000. If society didn't contribute, would we have a jillion dollars in loans? Because that's not even a real number.

I love it. We accrue massive loans, we work like a dog in training for at least a decade, yet somehow we are the ones who owe society.

When my children were small, I did indeed always work full time.

Classic physician attitude. "I did it, so you should be able to also." Well, if I worked 42 hours in a row with no sleep, I don't get why the interns can't do it anymore. Bell Commission? What? No, you don't get it. I did it. So everyone else should be able to also. Nay, they should have to. What? It causes burnout and unhappiness? No, but I did it. And I was fine. Everyone else is lazy.

I found the time to "blog" once the last one left for college.

Okay, she's convinced me. I'm shutting this blog down. I'll return in 16 years. And I'll also save everything else I enjoy doing for then too. I'm off to repay my debt to society!

Even if I disagree with Dr. Sibert, I genuinely respect her courage in voicing a somewhat controversial opinion under her own name in a public forum. But then she writes a passive-aggressive response like the above. I'd respect her far more if she stuck to her guns, even if I didn't like what she was saying.


  1. Fuck her and the horse she rode in on.

    I'm getting older and suffer fools even worse than I did while young.

  2. "If society didn't contribute, would we have a jillion dollars in loans? Because that's not even a real number."

    So very true! :)

  3. Agree completely! Her response was passive aggressive. Women are tough on each other. I stayed home with my kids, and my career took a hit, but I never regretted it. It's amazing some of the comments I received from working mothers. I didn't judge their decision, but some felt that they could judge mine. I think it all comes down to confidence in your choice.

    1. In all fairness, I think moms who work full time probably do also get judged for their choices. I agree about the confidence thing, but it still hurts to feel attacked.

    2. Agreed - there are extreme views on both sides. It hurts to feel attacked until you consider the source and her motivation. Plus, a kick ass response helps you feel better; too bad that the other person is unlikely to change her point of view.

  4. Since she's part of society, do you think she'd be up for contributing to my loan payback program?

  5. If you work part time because you do not have much back up and need a day so you can take your family and your self to doctors visits, I respect this choice. It is not easy for us MD's to drop everything at work and just leave. And part time physician still has full education debt,so it is more of a personal burden. I work with several part time women physicians now who are great. But I worked with one part-time woman in my old job who was shifting her work unto full time MD's in the office. What I am saying is do what works for you. As long as you do your job when you are working, you will be respected by patients and peers. It takes some guts to go out there and defend your position.

  6. Her argument is much along the lines of "You didn't build that."

    1. Riiiiiiggght.

      Sibert = Obama = pure evil. I totally get what you mean --- not.

  7. So anyone who is on the federal or state payroll should be my b**** and work when I say they do b/c my taxes pay for them?

    What a stupid logic to think that we as doctors owe something to society. This isn't the Soviet Union.

    I'm going to start telling the non-compliant diabetics that they owe it to me to stop being lazy.

    My 20's wasn't enough? What the hell else do you want from me?

    1. And how many women who were educated in public schools work part time or stay home with their kids? Why would the government spend all that money to educate you just so you can stay home????

    2. You did the right thing.
      I did the same (worked in Big Pharma).
      I hated working full time, but loved working part-time.
      Our children (now 28 and 30) are very appreciative.

  8. I think it would be reasonable to compare the expense incurred by society in training a doctor (in residency and fellowship, not med school, which is where the loans came in) to the expense incurred by society in training a fighter jet pilot in the military. It costs at least a million dollars. No one is going to have that saved up for training, and very, very few would be able to pay that back. But ... the pilot and the resident serve. The pilot is risking his/her life when a war breaks out, and a resident is risking his/her sanity with long shifts and studying on top of that for boards (and to know what to do with the very sick patients on those long shifts).

    The repayment is going on as the debt is incurred. It's not monetary. And we need a certain number of fighter pilots and a certain number of residents.

  9. My favorite was this one:
    "Okay, she's convinced me. I'm shutting this blog down. I'll return in 16 years. And I'll also save everything else I enjoy doing for then too. I'm off to repay my debt to society!"
    No, wait! This was my favorite:
    "Classic physician attitude. 'I did it, so you should be able to also.'"
    No, wait...Rats, I liked it all!

  10. I love your responses and blog posts, Fizzy. Thanks for standing up for reasonable people.

  11. Love this blog. Makes my decision to apply to med a little less scary knowing there are physicians like you exist. However I am scared of those "Dr. Sibert" individuals. Time to build some thick skin I guess...

    1. Wow-major typo. I meant to say "knowing physicians like you exist". Going a little cross eyed from MCAT studying :P

    2. I really feel bad about how at the end of her article, she mocks that college student who dares to ask about work-life balance. How dare that girl be concerned about having time to spend with her children?? Glad we shot down her desire to be a physician.

  12. Doctors lives aren't balanced if we go by the standard, but our stressors have increased dramatically. So, a doctor who worked full time 30 years ago is not doing the same job expected today. They aren't on constant cell phone page with a ton more chronically ill people. Doctors are leaving practices all the time. Why not encourage doctors to find that balance and keep them in the specialties that we need them in. The answer is not to tell them to shu$ up and work, the answer is to keep them happy. I can not tell you how many OBGYN or ER docs with YEARS of experience are leaving their specialty because of burn out.

    When it comes to Moms - your kids don't care that you are a doctor. They don't care that you invented or cured anything. They care that you played with them, loved them and spent time with them. Moms and Dads owe more to their children than to just pay the bills. Society isn't going to raise them or make them good people. And society certainly isn't going to pay me back if I have an ulcer, chronic illness or cancer because of immune dysfunction from exhaustion.

    Whew....sorry, guess I have some feelings about this :)

  13. As a physician just out of residency, I find that older female physicians are the worst in terms of expecting long work hours. I respect them for trailblazing in a field where women weren't treated as equals for a very long time- but I'm sorry, things have changed since the days of 100-hour work weeks and multiple overnights in a row. There's still a pervasive attitude of "well, I had to give up MY family experience for my professional career, so you ought to do the same."

  14. I'm currently a medical student at state school, and my tuition is highly subsidized. Last time I checked, my school is one of the cheapest in the country. I will most likely work full time (I am male FWIW) but even the thought that I may move out of state to practice gives me pause. If this state subsidized my education so heavily, with the hopes of providing its residents with more physicians, don't I have some obligation to the state?
    This probably won't keep me from moving to where I would like to settle down, but it does make me feel a little guilty.

    While I am not militant about it, I do feel that society gets the short end of the stick when doctors work part time. My mother is a physician and worked 4 days/week throughout my childhood. My SO (also in med school) will most likely work less than me. It's not that I think we "owe" society our time, I just feel guilty that those who work part time are taking advantage of the system.

    The government subsidizes medical school and pays for GME (via medicare). We (doctors) constrain the supply of physicians, and many Americans have difficulty getting appointments.

    One of the posters above referenced a phrase from the election: "we built it." I think what Sibert is really getting at is the same thing that Obama was trying to convey when he spawned the creation of that phrase. Regardless of how hard we work, we did not become doctors without various means of support along the way. These supports are a cost borne to society, and may be something we should consider when making career decisions.

    1. "This probably won't keep me from moving to where I would like to settle down, but it does make me feel a little guilty."

      Exactly. You feel guilty that you're ripping off your state, yet you're still willing to do it. And this is enough of a problem that some state school makes you sign a contract promising to work within the state for a certain number of years. In some ways, your breach is worse, because at least doctors who work part time are contributing *something* whereas you would be returning nothing to your state.

      The government subsidizes medical training, but also a wide variety of other training. Nobody is writing a NYT op-ed piece about women who go to government-subsidized colleges or public schools and then stay at home with the kids, yet far more money is spent on colleges and public schools than subsidizing medical training.

      Above all, there's value in children having the benefit of time with their parents and not being raised by daycare or a nanny. I don't think we can quantify what it's worth, but I think it's worth a lot.

    2. Its worth as much as producing next generation of doctors. My peer physicians all admit they were either raised by part time or home staying mothers, or otherwise heavily involved parents. Both of my kids expressed interest in medicine and I am already preparing them for that possibility (they are 10 years away from med school).And I am glad to be a full time working physician with good schedule. I dont' even want to remember my years of 60 hour work weeks and nanny-care. Maybe I was contributing to my employer financially, not so much doing justice to society. Burnt out physicians equals medical errors, poor quality of care. Dr Sibert's views are outdated. I admire you for your bravery to post your response to Dr Sibert. I personally think she just got lucky with childcare, and judges everybody who did not get lucky. If she was the one changing nannies twice a year like my friend she possibly would not have written her article.

    3. I just finished one hell of a week where I took call without a fellow because the fellows all got to take vacation at the same time. When I was a fellow, we weren't allowed to do that. But I don't have duty hours or sleep rules to protect me as a faculty, so I just suck it up.

      Maybe your generation of trainees does OWE something back to medicine. Because, guess what...even thoguh your duty hours as a resident are restricted, there isn't any less work to be done. While you go home b/c you turn into a pumpkin after 24 hours and need your adequate rest/time for relaxation, so you don't kill my patients, I'm still in house working my butt off. I'm still finishing your crappy notes that tell me what Suzy ate for breakfast but tell me jack crap about how many days she's been on antibiotics or that she had a fever again last night, trying to make discharge summaries legible so my colleagues on the outside actually know what happened to their patient, and trying to understand just what the hell is actually ordered in the CPOE system b/c I am scared to death that there was such a rush to go home that it wasn't done right. I'm tired too, damn it, and you just waltzed out of the hospital because "it's the rules." And guess what, I have to follow the rules too. If I don't, I get in trouble for 'over working' you. You just go one to become a doctor who can't communicate very well, refers everything b/c you don't really know how to take care of constipation or hematuria, and never really learned patient ownership because that doesn't nicely fit into resident shiftwork.

      So there, I just supported you right through your duty hours and we got 'rounds' done in 2 hours instead of 4, where you might have actually learned something. So, yes, maybe you do OWE something once your done. Maybe your conscience should feel guilty that you won't have put in all the hours we did, or learned everything you needed too. Just don't sptread your guilt around if I want to work part time to be able to spend more time with my family someday...I given everything I have back for years and now the system just wants more.

    4. Pedispecialist, you sound burned out. The solution to your problem isn't to go back to an unsafe system so that you get a break. Be a part of finding the solution rather than laying a guilt trip on those who want balance in their lives.

    5. I agree with DreamingTree. You sound angry at a system that's set up so the residents don't, as you noted, "kill your patients." Just because you put scare quotes, it doesn't mean resident exhaustion isn't dangerous. I'm not even sure what point you're trying to make in your last sentence. That only people who trained before the Bell Commission are worthy to work part time?

  15. I wonder how many hours you work being "part-time." As a med student, the doctors I've come into contact with who are part-time are still working around 40 hours a week, which in most careers would still be considered full-time.

  16. Sure. Let me know how many hours I have to work to "pay back" my debt. I have a debt-- the govt gave my program oodles of money to train me. And I finished my training and spend a significant amount of time (wait for it) training other residents. Does that count? Does it count that I make less money than I would if I was in private practice? Does it count that I am a sub specialist in a field that is in demand? Does it count that I decided to go part-time BEFORE I had kids? Or what if I got injured and had to work part-time-- would that be OK?
    If it is such a problem for doctors to accept training and (god forbid) chose to practice part time, then perhaps we do need some kind of rule. But it should cover people who get training and (for example) chose a specialty that is overrepresented. I mean, that's a waste of their training too! Or chose to practice in a location that already has a lot of doctors-- again, total waste of training and redundancy of effort. Or maybe a doctor who goes through training and doesn't do any research-- TOTAL waste of training.
    Would she be OK if someone told her she couldn't be an anesthesiologist, because that specialty is overrepresented in that area, and she should be a primary care physician otherwise it would be a waste of the taxpayer's money?
    But there are no such rules at this moment. So Dr. Sanctimommy can just stick it in her pipe and smoke it.
    For the record, I tend to work about 40 hours a week, between my clinical and nonclinical duties. Will someone let me know how many years that will take for it to be "enough"?