The critical first decade

I was at a conference a few weeks ago for rising chief residents. Hilariously, my husband (who had a few days off from work) decided to take advantage of the free hotel room and come with me, bringing out 20 month old. They had a lot of fun during the day, until he got a febrile URI and became a clingy mess. (Of course, then I felt guilty being wined and dined with the program leadership while he sat in the hotel room with a sick kid, but what else is new in Mom-land?)

But this isn't about that.

During the first day, the keynote speaker gave an address about carving a career path for yourself in academia -- life "after" chief year. He talked about the historic ideal of the "triple threat," where you succeed in teaching, research, and clinical time, essentially having a contract that allows you to spend 1/3 of your time in each area, adding up to a full time job. He reminded us, not so gently, that no one ever succeeds at all of these things, not as effectively as they could if they focused on one or two areas, and encouraged us to pick one or two when envisioning our future career.

And then he described the trajectory of a career in academic medicine: "The first decade is focused on establishing yourself, making a name for you and the research or clinical area you want to be known for. The second decade is to deepen that commitment to "your thing" -- publishing extensively, traveling, teaching, and speaking. By the third decade, you're known -- being asked to contribute chapters to books, leading courses with medical students, innovating as a clinic director. The fourth decade is a time to relax, to live in the space you've carved for yourself - and if you're lucky enough to have a 5th decade, you're an emeritus, enjoying the learning and not doing very much."

And as I sat in the audience, surrounded by future chief residents, I thought about how ~50% of us are women, and women who, most likely, will only be fertile during that first decade of our careers. What does that mean for the "most critical" decade of our work, to also recognize the very real demands that daycare and illness and doctor's appointments and soccer and pickups and dropoffs have?

Years ago, I once told a mentor that I thought that, realistically, this 10 years of my career would likely be my least productive, by publishing standards. I have a small child, I was planning on having multiple others. He was totally blown away, immediately shook his head, said there's no way that would be true, that he knew me and my work ethic, that lots of women "succeed despite kids." I left that meeting embarrassed, thinking that perhaps I shouldn't admit what I knew to be true - my partner works, too, and our lives have to adjust to the very real presence of our child.

This lecture was fresh on my mind when we returned from the conference and my husband went back to work. They've had some staffing turnover among the employees, and a new boss has been hired. Two leaders who currently work part-time (for various family reasons) were instructed that they would be welcome to sign a contract for next year in their current positions, but would not be able to work part-time - leadership requires a full time commitment. If they wanted part-time they could do a similar role, but without "a seat at the leadership table." This discussion among the staff at his job has been burning my brain ever since he told me - that two of the women (and, not-coincidentally, the only two mothers) on their leadership team were told that their commitment wasn't enough, that their desire to work part-time wasn't enough, that the hours they put in at night after their kids go to bed, and on the weekends, and in-between the other parts of their lives wasn't enough. I was in tears as he explained it to me, and I don't even know this women well - they work in another department.

I remember this keynote speaker, and I imagine the first decade of these women's careers. I suppose they didn't establish themselves, their credibility, their niche as clearly or as well as their male colleagues - that when it comes down to it, their skills are dispensable. The New York Times had a great article about this very topic yesterday - in short, that in heterosexual couples with children, employed mothers get the short end of the proverbial stick - faced with the demands of parenting and the ever-increasing demands of the work force, they end up forced to cut somewhere. For these women at my husband's workplace (and, realistically, for future me) - they cut back a bit at work. But working 25% less doesn't mean making 25% less, or being valued 25% less -- it means making 200% less, being valued 200% less.

I'd love to know reflections on your first decade at work, post-residency and fellowship and training. How did you carve out a niche for yourself? Or is that overrated in the first place? And what does it look like to parent when work is "greedy"?