Grappling and Grateful

I’m nesting.

No, I’m not pregnant, and I’m not sure when it started exactly, but with the start of residency looming and more free time on my hands right now than I’m used to, l have this strong desire to declutter and reorganize. Thanks in part to a nudge from Mommabee’s recent post on feeling stuck, I dove into Marie Kondo’s Netflix series.

I hoped that I would get some practical tips for decluttering, and I did, but I also found something much more enlightening. It clicked during the 4th episode, when a family of four was working to control the clutter after downsizing from a large house to a 2-bedroom apartment. The crux of the episode was when it became clear that the mother was responsible for essentially all of the “stuff”, both physically, cognitively and emotionally, to the point where her adolescent children and husband would call her throughout the day because they couldn’t find anything. She had taken on the role and implicitly assumed the responsibility while working a full-time job outside the home. I won’t dive into a full analysis of the show (although there’s a good one on the show’s gender dynamics here). The invisible labor of womanhood and motherhood becomes visible.

Suddenly, I saw my impulse to reorganize our home and life in stark clarity. While I’m grateful that my husband is committed to gender equality in our marriage, we’re still fighting generations of inequality and implicit assumptions about men and women’s roles at home and in managing family life. So while some things are straightforward, ie, if I make dinner, he cleans up, and vice versa, other forms of emotional labor are not. Looking back, we can both see the impacts of very unequal emotional labor on each of our mothers. And the “stuff” is just one example. We both moved at least 10 times throughout our childhoods, sometimes internationally, and usually lived in rented housing. While my father was the “packing expert”, my mother managed the bulk of the organizing and cleaning and knowing where everything was, on top of knowing who needed what doctor/dentist/chiropractor appointment or freshly laundered uniform and what we were going to eat for dinner. And I subconsciously still assume that’s my role too. I’ve been able to keep up (mostly) with this invisible work while keeping up in medical school, although it’s gotten a lot harder since my son was born. I’m actually pretty good at managing a lot of this in my head.

But here’s the thing - I know it’s taking energy away from other areas where I want to be excellent, like being really present with my son when I’m with him, and developing into an excellent physician, and building the career that I actually want, rather than just slogging along on a one-size-fits-all career treadmill. I know the other members of my medical-student-mom squad feel it too. We’re constantly exhausted and we’re not even in residency yet. And while decluttering is helpful, it’s not the answer. Delegating is definitely part of the answer, but first I have to list out all of the things that I’m trying to do and then figure out how to delegate them. So keep an eye out for my household organizing/delegating app once I actually figure out how to do all of this. (I'm kidding - this is way beyond the scope of any app.)

No, I put this out there not because I’m expecting someone has a magic answer, but because I’m grappling. And I’m also grateful. I’m grateful for my wonderful mother and mother-in-law, who managed two large, chaotic households with so much love and way more patience than we ever deserved. They fell into bed at the end of every day exhausted for reasons they couldn’t even name. I’m so grateful to them for managing all of our “stuff”, both physical and emotional. And I hope to honor them by finding a way to both love and care for my own little family while letting go of some of those expectations and responsibilities. I hope to honor them by sharing some of the empathy and intuitiveness that I learned from them with my patients and colleagues too. And I’m grateful for the #momsquad that lets me vent without judgement about how hard all of this is, and the husband and toddler who love me just as I am.

Learning how to self advocate for wellness and career advancement

I've recently been meditating on personal and professional development and in a lot of ways, maintenance. Part of it aligns with recently discussed concepts of wellness and work-life balance. Part of it also has to do with this intrinsic unsettled feeling I'm experiencing with work. I attended an academic conference recently which I believe was clarifying and is helping me to frame my approach.

Health

This all started with a dive into self care, specifically, trying to make sure that I was taking better care of this 41 year old body of mine. I had not been to a dentist in 15 years. Yes. You read that correctly. I had not seen a dentist since before medical school. Part of it was because I'm irrationally terrified of the dentist... part of this fear probably came from all those times my mother forced me to sit with her and hold her hand through many root canals and extractions while she squirmed, wiggled and held a vice grip on my hand. The other part of it was the silly thought, "If it ain't broke, don't fix it." The final factor was the disease of busy. I flossed. I brushed. I have a nice smile. I'm fine.

It wasn't until my little one bravely sat through the first couple of dental appointments during which we found out he had multiple cavities between all of the molars, necessitating 8 crowns, a failed attempt at in office nitrous and subsequent trip to same day oral surgery center with a pediatric anesthesiologist that I finally made an appointment. So I did it. I had a couple of cavities, needed scaling (which is a special kind or torture) and am now getting teed up for a root canal. I suppose it's not bad for 15 years. At least I'm keeping all of my teeth, for now.

Let's move on to fitness. I'd topped off the scale at 5 pounds over my full term pregnancy weight. I hated what I saw in the mirror. Inside I was happy. My outside didn't match my insides... maybe I wasn't happy. Regardless, I've spent the last year trying to make sure to make time to do tedious things like plan healthy and nutritious meals and get some exercise. I found a colleague and now friend who was an online health coach. I found a supportive environment of other busy, professional women who found time and prioritized this portion of self care and found that they ended up being happier, more patient and feeling more fulfilled all around. I found tools which were easy to implement (albeit requiring some behavior change), accountability partners and fun exercise options. I enjoyed it so much that I myself became a coach.

With everything we give to our patients, our learners and our hospitals, we absolutely must prioritize ourselves in there somewhere. Working out may not be your thing, but you have to identify what it is that recharges you and make time for it. Put it on your schedule or it will not happen. It will ebb and flow, but you've got to take care of you before you can take care of anyone else.

I still need to schedule that Pap and Mammo... I'm a work in progress.

Personal Development

Part of the company's philosophy is ensuring that you spend some time each day on your own personal development. This created an opportunity for me to read some personal development books (the former four letter "self-help" category). Below you will find the books I've gone through over the last 6 months (good grief, whoever created audiobooks is literally the best because I become narcoleptic while reading).

I've read (or listened to in audiobooks) "You are a Badass: How to Stop Doubting your Greatness and Start Living an Awesome Life" by Jen Sincero. She's not a physician, but she's been through some things and many of her struggles and insecurities resonated with me. She is also remarkably sarcastic and funny and I had many a laugh while listening to her book.

I followed that with "The Compound Effect: Jumpstart Your Income, Your Life, Your Success" written by Darren Hardy. This dude for all intents and purposes is a self made gazillionaire and did it all with hard work and discipline, specifically with small changes every day. He had an authoritarian for a father, so we have that in common. It focuses more on the business world, however if I ever consider entrepreneurship, I'll probably revisit it.

I followed that with bits and pieces of several books from Brene Brown... "Rising Strong" and "The Gifts of Imperfection," both of which hit chords with me. Let's figure out how to pick ourselves up after we fail at something because that is what bravery truly is. It takes no energy to stay down after you take a hit. Facing the day, reflecting on how you may have been responsible for whatever you've experienced is an important lesson. Reading her book is like sitting in a therapist's office, without the $200 price tag. She's a shame researcher and she hits the nail on the head when she discusses the mountains of self imposed guilt we shoulder unnecessarily. She's also witty and sarcastic from time to time.

Next was "The Subtle Art of Not Giving a F*ck" by Mark Manson. Now, if you can move past the fact that this guy is a bit like a frat boy in his use of language, there are some important lessons to be learned. Some things just don't deserve our energy. Seriously.

My latest read is "Feminist Fight Club: A Survival Manual for a Sexist Workplace" by Jessica Bennett. I came upon this book on my way to the aforementioned conference. I knew I was specifically attending a workshop designed to appeal to women interested in leadership in academic medicine. I was looking for something which would light my fire and help me think outside the box a bit. Jessica Bennett is a journalist who specifically writes about issues of gender, sexuality and culture. In her book, she highlights the research which discusses not only how institutions may unknowingly or overtly be preventing growth of their female professionals, but also behaviors we may be demonstrating which hinder our own progress.

I take each of these books with a respective grain of salt, but it's really kind of opened my eyes to some self reflection and highlighted some things I may want to work on within myself. When we spend so much of ourselves in tending to other's needs, our own needs and need for growth can get lost in the mix.

Professional development

So, I'm an academic. I teach medical students, PA students, residents, fellows, faculty. I have sought opportunities to develop my educational niche, my ability to provide feedback, teach a skill, develop a curriculum, pitch an idea to my department chair. I teach a lot of things... probably too many things, which is why I find myself feeling stale and unfulfilled here. I feel like I've spread myself so thin that I'm doing an ordinary job at all of the things for which I'd prefer to be doing an extraordinary job. I feel like an octopus juggling knives which are on fire. Is this imposter syndrome creeping in? Perhaps, but I know I could do better with my time and efforts if I peeled away from some things.

I officially mentor some and unofficially mentor others. I've not received any training per se in mentoring, save observation of folks I hope to emulate. I don't know what the steps are. I don't know what skills to hone. It's kind of like teaching, but also very different from teaching. There should be a program for mentoring the junior mentor. There probably is, but I've not yet had the bandwidth to seek out or discover it, but it is something I need. What I found most interesting in the sessions at this conference was the focus on not necessarily seeking out the most sage mentor. Sometimes peer mentors are actually better for you as you navigate different challenges in your career.

I've been at this academic gig for 6 years now. At the conference I attended, many of the female leaders commented on "cycles" and feeling unsettled after a certain amount of time doing each of the jobs they did. That hit home for me. I feel unsettled. I want to do what I'm doing differently and I need to advance my position from my current title to the next. As such, I've been meeting with my closest mentors, having heartfelt talks about what I thought I wanted when I started, what I've done and where I see it going. I see now that I've invested a tremendous amount of time and emotional capital in one path. It was my hope that by working hard and contributing, I'd be rewarded with position. Boom!!! Words from all of the books came to mind and highlighted for me that I in fact cannot do it all and I should be asking for compensation in some way for what I am doing. You will not get 100% of the things you DO NOT ask for. I must focus my efforts on those things which are most meaningful to me in my professional life. I need a new goal. I need a promotion. So, I'm going to spend the next couple of months working on my dossier, writing papers, reviewing and revising the curricula that I am responsible for and pouring the energy freed up by letting go of tasks held by one of my octopus tentacles.

It's exciting and anxiety provoking to have this new approach and challenging in that I've never before created a dossier or gone up for academic promotion. Why didn't someone tell me about all of the stuff that goes into this? Why didn't someone tell me to keep better track of all of the lectures I taught, programs I developed, mentees I invested in, meetings I attended, evaluations I received??? This wasn't part of orientation when I became faculty. It was discussed as an afterthought in my annual meetings "You should be ready for promotion in a couple of years." After reading my most recent book, I wonder if the experience is the same for my XY colleagues. Is the assumption that because I'm a single mother, I must not be interested in promotion or advancement, so I don't really need the guidance or personal investment? To adapt a quote from Jessica's book, "No one gets shit done like a mom."

I'm trying to figure out what my professional and personal mission statement is. What are my values? What do I hold dearest to me? Do my actions align with my values and my mission? How do I parlay these reflections into actions moving forward and be sure I'm looking out for my own professional interests, professional development and advancement?

Great article on STAT on female leadership and health care reform.

Genmedmom here. I simply to call attention to a wonderful article on STAT written by a kick-ass healthcare administrator/ CEO and mother of SIX children (yes, six, and TEN grandchildren, per her profile) Annette Walker. It's titled More female leadership: a different kind of health care reform and it's spot-on.

She points out that "women hold only 26 percent of hospital CEO positions and 21 percent of executive positions at Fortune 500 health care companies even though they make up 78 percent of the health care work force". This despite the fact that "Study after study has demonstrated that organizations with gender-balanced leadership are more successful than their homogenous counterparts."

The best part of this short piece is her emphasis on solutions. What she has accomplished in her own hospital system can surely be adopted in others. She lists:

• Flexible work arrangements
• Training opportunities for women to build leadership skills
• Increased visibility of female role models
• Connecting junior employees with female senior-level mentors
• Transparent advancement opportunities and clearly charted pathways to leadership
• Shining a light on the challenges of balancing family and work needs
• Support for community programs that promote opportunities for women in our service areas
• Emphasizing STEM and academic programs for women

I love what she's saying and admire what she's accomplished. I mean, all this and SIX kids, I just can't even imagine. Two kids has almost put me over the edge. Holy cow.

This blog is certainly helping to "shine a light on the challenges of balancing family and work needs" of doctor-moms, so let's acknowledge what MiM brings to the battle! We can also take a look at this list and think of what may be applicable in our own practices, hospitals, and medical schools.

Ladies, let's take some inspiration and motivation from Annette Walker, impressive mama and hospital CEO.

Don't forget they are someone's baby

Living in DC and taking the metro regularly provides me with ample fodder for social analysis and ample opportunities to be upset and amazed by humanity. For example, I get upset when able-bodied people see disabled, elderly, or pregnant people standing and sit in their seats anyway. Especially while pregnant, I spoke up very loudly (ex. As able-bodied men crowded on an elevator as I waddled to catch the door for a man in a wheelchair. I stared everyone down and said someone needs to get off so he can get on; we were obliged begrudgingly.). I am amazed when folks step in and help someone in need during an emergency.

An issue of growing contention in my neck of the woods is middle and high school students getting onto crowded trains. They are loud and there is often cursing involved. However, I have noticed that most of the adults regard them in a very unfriendly way or simply ignore them. The local listservs I am a member of are far worse; the disdain for these children is palpable and I have had to step in several times when the racism and classism became unbearable as well-to-do grown folks called children thugs, crooks, and goons. It literally hurts my heart!

I personally make it a point to acknowledge these teenagers every chance I get with a smile or a hello; sometimes I’m ignored or begrudgingly acknowledged, but oftentimes you can tell these young people relish the positive attention and are surprised to have been seen. I remind myself regularly that they are someone’s baby no matter how “hard” they are appearing to be. No matter how many tattoos they may have on their young skin. No matter how many curse words they and their friends yell. And I try to remember that someday my little Zo will be one of these students taking the train and I hope that others will treat him well knowing that he too is someone’s baby. My husband and I are well-read in the studies that show that Black boys like my Zo are seen as being older than they are by the majority and less innocent than they are by police (see FURTHER READING below). We know the sickening statistics of disproportionate violence against boys that look like him. We pray that folks will remember these children are someone’s baby and that he is ours.

To bring it back home to the DC metro, the other day on the train a handsome young man with beautifully styled locs and sagging skinny-jeans and a uniform high school shirt  entered the train with a young woman I assume was his girlfriend. His new-aged rap music (the kind old hip-hop heads like me can’t understand and abhor due to the crazy amounts of auto-tune) was blasting. Adults bristled. Some sucked their teeth. He walked on the train and I smiled at him, he was visibly surprised, smiled back sweetly and sat directly behind me. Every other word of his song was f--- this and blast that. I turned and said as gently and respectfully as I could “Sweetheart, don’t you have headphones or something? My old ears just cannot take all of that cursing.” He said quickly “Ohhhhh my bad! My headphones broke and I don’t have another pair, My bad!!!” I pulled out a set of headphones from my bag and said “here, you can have these!” He smiled and said “For real?!? You serious?!? Thank you so much!” And just like that - connection. Respect. Compassion. His mama would be happy.

It could have ended differently. Someone else could have started cursing at him. He could have rebuffed my offer and cussed me out. But it ended wonderfully. And I modeled appropriate, compassionate behavior for children and adults alike.

I exited the train at my stop and wished him and his lady a good day and he did so too.

___________________

FURTHER READING:

http://www.npr.org/2014/03/19/291405871/consequences-when-african-american-boys-are-seen-as-older

http://www.apa.org/news/press/releases/2014/03/black-boys-older.aspx

http://www.theatlantic.com/national/archive/2014/03/cops-tend-to-see-black-kids-as-less-innocent-than-white-kids/383247/

Saying their names

I don’t have a television but your story flashes across my Facebook feed, my friends tell me about you, my husband the Anthropologist tells me about you, and I look you up online.

You were bullied for being a cheerleader and you took your life (Ronin Shimizu). You went out for a pack of Skittles, a stranger chased you, you were shot and killed (Trayvon Martin). You were selling cigarettes on the streets of New York and you were choked to death as you screamed “I can’t breathe” (Eric Garner). You were playing with your big brother and he accidentally shot and killed you with a gun you found (9 month old in Missouri whose name will not be released). You were born a girl but your birth body was that of a boy, you tried to be your true self but took your own life after not being accepted by your parents (Leelah Alcorn). You were misunderstood, you were playing with a toy gun in the park and you were killed (Tamir Rice). You were with your friends listening to music in your car at a convenience store when a stranger approached you and began arguing with you about your music, he shot you and you died and he went back to his hotel room, walked his dog, and had dinner and drinks (Jordan Davis).

I honor your legacy with my tears. I think about your family. I snuggle my little one more tightly knowing this world is both a beautiful and dangerous place. I honor you with this post; I apologize it has taken me months to find the courage to say your name in this space. This space that is sacred to me but after my last post about Trayvon Martin received some insensitive comments I was hesitant to share some of my deeper feelings since I don’t see much social commentary here at MiM. Why is that? We are mothers and we are providers and don’t we see how unique our vantage point is? We can talk about the intersection of life and policy, public health and personal life from a place most others cannot. I struggle to find the time to read anything besides mindless fashion blogs when I’m not balancing my own needs with full-time medical practice, my husband’s needs and those of my four year old let alone to allow myself the freedom to reflect on society’s transgressions and tragedies.

I thought of you today while looking at my ever growing to do list. And because your life matters to me I put away other thoughts and wrote your name, I am saying your name.

#BlackLivesMatter #ProudLGBTQAlly #MothersInMedicine #2016LivingMyTruth

Our foremothers

Foremothers? Maybe it's not even a word. I was trying to find a term like forefathers.

I often think about the women who have come before us. As I walk through the halls of our medical school, I see class photos from decades past with 1 or 2 women amongst a sea of male faces. I often wonder whether they had children during their training or afterward, or were they 'discouraged' from getting married or having children? How did they function as female doctors and perhaps mothers in a world that was probably less understanding than what we face today?

I would bet they faced great hardships--particularly sexism beyond what I can comprehend. They may have anguished over pregnancies they had to hide, grieved over the lack of child care options, and struggled to satisfy unrealistic expectations of their employers. And just maybe they dreamed about us--the women who would follow them--and hoped our lot would be easier.

It reminds me of a female doctor from my mom's era who didn't tell anyone she was pregnant in medical school then didn't show up for a test one day.  Yep, she had her baby and came back to school within a week!

I am forever grateful for the trails our foremothers blazed and admire their courage. They are true heroes to me.

Girls Don’t Cry

I have been following the response to Sir Tim Hunt’s incredibly sexist comments on women in science and thinking about how it relates to a working mother in medicine. If you haven’t heard of Tim Hunt, he is a Nobel prize winner who made headlines earlier this month for saying “…three things happen when [girls] are in the lab…You fall in love with then, they fall in love with you and when you criticize them, they cry” at a lunch for women journalists and scientists in Seoul.

Not surprisingly, the response has been overwhelming.  Some of my favorite tweets:

and…

and my all-time favorite…

But all joking aside, sexism still exists in science and medicine.  And as a working mom I’m very sensitive to issues of sexism, ambition, and differences between men and women.

This may be because I am constantly pulled in two directions (career versus family) and wonder if my ambition is ever questioned. On the one hand, I don’t want to draw attention to the fact that I am very much pulled in these two directions and must balance work and life.  But on the other hand, I do want to draw attention to this struggle to help support other women and help others understand decisions working moms need to make.

The fact is that I make very conscious decisions that incorporate both my work ambitions and my motherly ambitions. No, these decisions do not involve being distractingly sexy or crying in the lab but they do involve taking a slower and, sometimes, more convoluted paths.

I have rejected significantly higher leadership positions because they would squash my flexible schedule, I consciously avoid travel, and I am not willing to move my entire family for my career. To some of my male colleagues, these decisions may seem crazy, but, for me, these decisions are very calculated. 

I’m very conscious of burnout and hope to keep a level of balance that helps me work full time, find satisfaction in what I do, and keep me on an ongoing trajectory so that when I am no longer in the weeds of motherhood, I will still have interesting and meaningful career opportunities.

That being said, there are times when keeping the reins on my career is hard. I wonder whether I am being left in the dust when I see male colleagues make different choices and move up the ranks faster than me. And as a working mom, I never want to compromise other women by having my ambition questioned. 

But even with these doubts, I am incredibly proud of the difficult career decisions that I and every working mother have to make.  I know I will only have a short time with my kids at home and I want to cherish that time.  I’m sure there will be time in the future to turbo charge my career if I want.

In terms of Tim Hunt, I’m not sure if #distractinglysexy and #crybaby necessarily come up as issues for my career but ambition, choices, and timing certainly do. I think if we keep open dialogues and try to respect for each person’s decisions then I think we can push the conversation.  What do you think?

Guest post: Gender equality?

I generally LOVE my job. I work part time as an anesthesiologist at an academic medical center in the Midwest. There are several other part-time faculty in my department, both male and female, which has created an atmosphere where the commitment of part-time workers to their careers is not typically questioned. My department recently scheduled an all day seminar on an upcoming Saturday, geared for and limited to our own department's clinical faculty, with educational topics ranging from reviews of clinical care, giving feedback to residents, and research resources. I decide not to go, as Saturdays that I'm not on call (I'm typically on call one weekend/month) are generally reserved for family time, my kids have some new activities starting this Saturday, the weather is (finally) getting nice, and with the exception of about a 2 hour period, I'm not that interested in the agenda. So I have a discussion with my husband (who is generally wonderful and supportive of my career) about our upcoming weekend plans and I mention that I may go to the 2 hr period of the seminar that I'm actually interested in, depending on what else he has planned/would like to do with the family. It turns out he is not at all in favor of me going to only the 2 hours of interest to me- he thinks I'm making a big mistake by not going to the entire seminar- commenting that I will likely miss out on networking opportunities, face time with higher leadership, etc. The discussion continues, and he comments, "3 out of the 4 women who directly report to me behave just as you're doing, not taking after work hours events seriously...and it is negatively impacting their opportunities for advancement." Side note: he works as an upper-level manager at a major business and typically spends at least 2 evenings/week out of the house attending either work related activities or board of director activities for local non-profits. At this point, I was pretty angry, reminding him that the 3 women in question all have young children (as do we), and I ended the conversation telling him, don't take it for granted that you are able to spend multiple nights/week away from home for various purposes- it's only because I am at home caring for the family that you get this opportunity- these women that you work with that don't make it to all the evening activities- who is caring for their families?- that's why they're not there.

As one may surmise, working at an academic center means that there are frequently lectures, town halls, discussions, seminars, etc to which faculty are invited to attend. Once in a while these sound interesting to me and actually don't conflict with my clinical responsibilities. However, I usually feel stressed when I decide to go as it means either arranging evening childcare or childcare on what would normally be my day off with our nanny (she is great and very flexible but out of respect for her I do my best to minimize requests for super early mornings, evenings, and significant schedule changes to what is truly necessary) or trying to explain the importance of it to my husband so that he will be home at a reasonable time (it is not uncommon that his evening activities come with only a day or two of warning). In the end, I usually just don't go- it's much easier that way. I am long past the "Mommy guilt" that I felt for working at all when my first child was born; I truly love what I do, am proud of my work, feel reasonably respected at work, and feel like I honestly do have a good work-life balance. I am able to make some time for myself without guilt- I go to the gym semi-regularly and spend time with girlfriends about once/month. However, I admit I continue to struggle with guilt in situations such as the one I mentioned.

So, I'm interested in the opinions of others- how much should our attendance be expected at after hours work activities? How much guilt do you feel about going (or not going) to these types of events? Do you even feel like you really have a choice to go given family responsibilities? If you regularly go to these types of events, how do you manage to get there?

A Teaching Moment

Genmedmom here. This was going to be a sweet little post about a teaching experience from my clinic yesterday. A patient presented with a classic clinical finding, and I knew that one of the other providers had a few students with them. So I asked the patient if I could bring in a student or two, and she cheerfully assented. It's been a very long time since I was involved in clinical instruction, and I enjoyed it.

I searched the web for a photo image or clip art to accompany this piece, something that illustrated a female doctor teaching medicine to students. I typed in all sorts of search phrases, but the vast majority of clipart or stock photos clearly depicting a doctor instructing medical students showed male doctors- and often with a lovely nurse standing by.

The best approximation of a female teaching physician that I could find was this (*and, this image is totally copyright of Disney Junior):

I mean, it's a good thing that Doc McStuffins exists, and that this image and the DVD it advertises exist. Not to imply a commercial plug; I must emphasize, I have no financial disclosures here! I just love the example she sets for little girls, all the pink and purple notwithstanding. She's a doctor, and her mom is too. They're African-american. The show is a hit. It's awesome.

So, why was this the only image I can find of a female doctor actively teaching medicine to students? This was mind-boggling to me. I needed to understand. I needed data to interpret; it's just my research fellowship training.

And I found data. According to the Kaiser Foundation, there are 893,851 practicing physicians in the United States, and 32% of those are women. The American Association of Medical Colleges (AAMC) has published a detailed breakdown of U.S. medical faculty, by rank, sex, race/ethnicity and specialty. Per their data for 2014 (which can be found at The AAMC website Reports page):


Of the 155,089 total U.S. medical faculty, 62% are male and 31% are female.

Of those that are at the higher ranks, as in professor or associate professor, 72% are male and 28% are female.

The breakdown by race/ ethnicity is frankly depressing, and I didn't even want to figure it out. For those of you that enjoy crunching numbers, have at it- there's tons of other good data in there as well.

It's clear that we need more women physician role models and teachers of medicine. So, what are the obstacles?

Well, in my case.... When I started by current position at a major academic medical center, I was involved in a medical school course geared towards fostering empathy and communication skills. I think every med school has these now, Patient/Doctor/Society type courses. But then I became pregnant with Babyboy, and realized I would be out on maternity leave for a chunk of the next session, so I never signed back up. Now, with two very young kids and enough to balance as it is, I'm not sure I want to take on the added responsibility of teaching...Not just right now.

I know my kids will get older, and I hope to get involved with teaching again someday. Likewise with medical volunteer work. I'm half Latina, I speak Spanish, and I've lived and worked in Latin America. At some point, I'd like to get re-involved in that work, as well as be a mentor for Latina students...Someday.

Meantime, I very much enjoyed interacting with our students over a case of erythema multiforme this week.

I'm curious what the doctor-moms out there think of these numbers. Do we need more female physicians teaching medicine? How about female minority physicians teaching medicine? And what do others think about Doc McStuffins?

"You're full of it"

I have read countless articles about how medical trainees have been berated and belittled, yelled at or pushed. I have never in my years of training felt that way or been treated that way. Yes, I’ve been questioned strongly. Yes, with lines of questioning sometimes called “pimping.” I have felt like I needed to study for 40 more hours and have gone into the bathroom afterward to cry, but I’ve never been berated. I’ve never been pushed. I never even thought of what I would say or do in those situations. I have heard my share of racist and sexist remarks and have found ways of addressing it directly and highlighting to the team why it’s unacceptable. But what would I do if someone directly belittled or disrespected me? Would I cry? Would my knees buckle? Would I yell?

Well, that all ended when a Pediatric Surgery Attending told me, “You’re full of it” in front of my staff while I was working in the Pediatric Intensive Care Unit. This particular Surgeon has a history of yelling at Resident Physicians that I learned of after the incident. That night, I was caring for a postoperative patient who had just left the operating room. During interdisciplinary sign out I asked for clarification of a medication dose as I was preparing to enter routine orders such as for PCA-administered pain medicine. The Surgeon turned and said, “No, we will enter the orders” meaning the Surgery Residents. I told him that in my experience PICU Residents enter the orders and manage the PICU patients. He said, “No, who trained you, this is my patient?”  I looked around and of course, everyone was staring at their feet. I was in my second month of PICU service and had heard countless times how our unit was a “closed unit” and that we managed our own patients, but this gruff, aggressively self-confident, tall male Attending with salt and pepper hair and a fresh tan was staring me down. I said, “You will need to speak with my Attending because this is not what I have been trained to do.” He turned, stomped away, and snuck in a low, yet completely audible, “You’re full of it.”

I stopped in my tracks and said more audibly, “Excuse me, but you just said ‘You’re full of it.’”I paused, collected myself and continued: “I feel very uncomfortable, and that was disrespectful. It is not appropriate to speak to trainees that way. I only want to provide excellent patient care.” He froze. When he turned around he had a look of utter contempt and disbelief; it was like no one had ever told him he cannot speak to people that way. His eyebrows furrowed and he spit out, “Well, I’m sorry,” and turned around. At that moment, my Attending arrived and my Fellow said, “Well, I’m glad you said it because I was about to.” I quickly excused myself as my hands began to shake and the pounding in my ears began to dull everything else out. I exited the unit, and sank onto the bathroom floor and cried. Big crocodile tears as my grandmother would say. I was anxious and nervous, but I was damned proud of sticking up for myself.

My PICU Attending found me later and asked me what had happened. I explained the facts and he shrugged and said, “I’ve heard worse,” and told me something about how that Peds Surgeon had cursed at him during his Residency. I told him that I hadn’t heard worse and had never experienced that type of behavior but that I thought it was unacceptable to speak to any member of the team that way. He shrugged and said he would address it with the Surgeon later. As I entered the Unit, the Nurses individually applauded me for speaking up the way that I had. I asked a trusted Nurse mentor if she thought I handled it well and she said I nailed it, and my Fellow echoed the sentiment. I didn’t get emotional, I said what I needed to say, and kept it focused on the patient. One of the Peds Surgery Chiefs came up to me later and had heard about it and gave me a quiet nod of support. She agreed that Surgery Residents who did not spend the night in the hospital should be consulted but they shouldn’t be the ones putting in orders since the PICU Residents are the ones who stay in house overnight. It’s a patient safety issue.

Many thanks to a different fabulous PICU Attending who a week earlier coached us on working in uncomfortable situations. She told us to use words such as “uncomfortable” and “unsafe” and keep things focused on the patient. Without her words, I probably would have shut down, my knees buckled and I wouldn’t have been able to say things in a way that would have gotten any response from that Peds Surgery Attending. I still believe, “You’re full of it” has no place when we are caring for patients.

I spoke on a panel earlier this year sponsored by the Student National Medical Association. They asked a group of underrepresented minority Attendings and Residents to discuss discrimination in medicine. I shuddered as I listened to the horror stories the Black and Latino Attending Physicians recounted. I think I would have quit if I had to endure the downright hostile environments they practiced in in their early careers. I don’t discount the real experiences highlighted by other trainees around the country and applaud them for their candor in sharing. I hope that we all are continuing to work so that abuse and disrespect are not allowed, and when they do occur can be apologized for and learned from.

Do Female Physicians Need Female Chaperones?

Genmedmom here.

Our department is considering a policy that would require female chaperones to monitor every pelvic exam. This would include pelvic exams performed by female providers.

As a primary care women's health doc who performs pelvic exams every day, I felt vaguely insulted by this.

But, as both a female physician as well as patient, I understand the reasoning behind this potential policy. In our department's case, it was apparently proposed in response to a complaint involving a female physician; we have no idea what the issue was. Of course, historically there have been cases where there was abuse of the doctor/ patient relationship in this context. Also, cases of perceived abuse. To have an official "observer" present can help to prevent any abuse, or false claims.

My own OB/GYN office uses chaperones. But it always strikes me as odd and impractical. My own OB/GYN is an excellent physician with superior bedside manner who has overseen both of my pregnancies; she even guided me safely through a VBAC. But even she has to leave the exam room and go fetch a medical assistant, who may have never met me and is not involved with my case, so that they can stand there and observe what is basic, routine office care. I've considered requesting that she NOT go fetch the superfluous eyeballs, as I think it's kind of weird, and it would save time, too. But I haven't wanted to rock the boat.

So, as I have myself experienced, having an additional person present for this exam can also in and of itself be uncomfortable, and can make routine medical care feel weird. It may not help many women to feel more comfortable at all.

Are there things we providers can incorporate into practice that can help minimize discomfort and prevent abuse, or perceived abuse?

I really try to help patients through what is generally considered, at the very least, an uncomfortable and awkward examination. For many women, a pelvic exam can even be a traumatic experience, either physically due to atrophy or inflammation, or psychologically due to past rape or sexual abuse.

I think there's some basic things that we can do to help women feel more comfortable and in control when a pelvic exam is necessary. These include explaining why we are doing the exam and what we are looking for before we even start. Does she need a Pap smear, or STD screening, or both? Is she complaining of pain during sex, abnormal discharge, abnormal bleeding? Is there a strong family history of GYN cancers? Is there a family or personal history of melanoma? Then we'll discuss whether the exam will include a speculum exam, or a bimanual exam, or just an external exam, and why. Not everyone always have to do have all of these.

It's important that the patient knows what's going on at all times. I think it's better if the back of the exam table is slightly elevated and the paper drape is pushed down, so that the patient can easily see the provider. I also try to explain everything I'm doing in real time. I don't even touch the patient in that area at all, without saying what I'm doing and why immediately beforehand. I'll hold the plastic speculum up, and explain that it's the same diameter as most regular tampons, that we use plenty of lubrication with this, and it's usually cold. I tend to talk through the entire procedure, Rachel Ray-esque. Often I'll suggest yoga breathing, letting the pelvic muscles and buttocks relax.

In some cases, urinary incontinence is a problem. If Kegel exercises may help, I ask women if they know how to do these. Then, I either test their Kegel, or ask if they want to learn this. What I've seen is that many women who think they're doing a good Kegel squeeze will actually be tightening their buttocks, or simply tilting the pelvis. So I add pelvic floor physical therapy here: a lesson in isolating the pelvic floor muscles, and a test to see if the patient is able to do a decent Kegel. I think if someone walked in as I'm saying "Squeeze!" they'd wonder what was going on. But since Kegel exercises are effective for preventing and treating urinary incontinence, we'd better make sure patients can do them before we recommend them.

Sometimes, a patient is extremely uncomfortable with some part of the pelvic exam. Then, the exam must be halted. I usually pull the drape back down and discuss, ask if they would like to try again, or hold off. I really don't think a provider can proceed in those cases without a time-out and discussion. It's okay, and sometimes absolutely necessary, to just skip the exam. It can be rescheduled; special arrangements can be made as well, as in cases of extreme physical or psychological discomfort, such as exam under anesthesia.

I've had patients tell me that the pelvic exam "really wasn't that bad", or even that they learned something useful. I take this as positive feedback! I'm sure I can do better; we all can. I'd be interested to know what techniques other providers have found to be useful.

If we are required to institute this female-chaperone-for-pelvic-exams policy, it would mean significant logistical hassle. In our office, we work one-on-one with the medical assistants, and several are male. Would the guys need to be let go, transferred to other practices? In addition, our medical assistants perform the phlebotomies on the patients they've checked in. Were this policy to be put in place, we would need to reorganize our whole system, and likely need to adjust the operating budget to include additional staff. And, of course, if we're required to go fetch a chaperone before every pelvic exam, that will add time to all of those patient visits. Either we'll all run even more behind, or we'll have to restructure our scheduling, and likely need to institute longer days for us and our staff, to accommodate. Again, this could mean a budget problem.

In summary, I don't think that requiring a chaperone to stand there and observe every single pelvic exam is a good idea.
But, I'm very curious what women physicians think about this, both as providers and as patients.

What better place to ask, then the physician-mom blog? What's the vote: Yay or nay?

For those docs that perform pelvic exams, what have you incorporated into your practice to help women feel more comfortable and in control?

-Genmedmom

Journal Club: Women in academic medicine

In March, the Annals of Internal Medicine published a study by Jolly and colleagues  demonstrating that women in academic medicine -- those holding K grants, or career development awards -- do more domestic work than do their male counterparts. There are a lot of reasons: more women had working spouses than did men in the same position, but that didn't explain the whole difference. The article itself is quite interesting, but the editorial that went with it (accessible by same link) -- written by two women in senior academic roles -- was what really got my attention. They suggest that the differences are really a matter of choice, and that disparities are not as disturbing as the study authors suggest.

They ask: "...is the fact that talented women may choose to shift a few hours from research to their family roles until the youngest child is in high school a threat to academic medicine? We certainly do not think so."

I think the perspective of these very successful editorialists is one of hindsight rather than foresight: we made it work, in traditional or non-traditional ways, and so why are you so worried about a few hours here and there? The answer is that we won't have the jobs we love if we can't make it by the standard criteria -- these being acquisition of grant funding, publishing papers, and providing patient care. I certainly appreciate, and have taken advantage of, the flexibilities of my research time -- but flexibility is an illusory concept. The hour I spend (or that my husband spends -- I think this equally applicable to both genders in many ways) taking the kids to school or getting home earlier is at some price, either in late nights or in projects unfulfilled.

You can see my response, written with two colleagues in similar positions (we are all women with K grants, patient care responsibilities, and families, trying to make it in academia) with the original article.

What is fascinating to me about the dialogue that goes on in these letters is the span of decades of women's perspectives that are included among the letter writers. This is a pesky problem and it won't go away soon.

Dena

Question: Maternity leave

Lately every night I'm on call I seem to be the magnet for pregnant patients - trauma, acute abdomens, appys, choleys - you name it.  During my last call as we talked about my pregnancy magnet, it lead to a discussion about having babies during residency.  We happened to be a diverse group of providers with a diverse and international training background. The take away from the discussion was basically that in the US we don't value new moms, dads or babies.  Those who had trained elsewhere (in surgery) seemed to feel that it was just natural to expect residents to take 4 months, 6 months, or 1 year off (mom or dad).  Meanwhile we all told stories of post c-section residents NSAIDing their way through full operative days 4 weeks after giving birth.  We talked about how broken your body can feel so soon after giving birth, both mentally and physically.  We talked about those itty bitty 6-week old babies in daycare.

So, for those of you who have trained elsewhere in the world:

What is the attitude towards new moms and dads in other countries with more flexible and lengthy maternity leave policies? 

Are residents looked down upon for taking leave (like they often are in the US)?  

Does a culture of more family centric leave create a more equitable distribution of gender roles in the home and the workplace? 

I'm just wondering...

Reverse Sexism in OB/GYN

From the moment I was accepted to medical school, I began to get unsolicited advice about which specialty I should choose. The most common recommendation was OB/GYN. “Female OB’s are in such demand!” I was told on a regular basis. However,I had ZERO interest in becoming one of THOSE women. As I began my rotations, I realized that there was more to the specialty than pap smears and stereotypes. In time I embraced it as my calling.

The year I graduated (2005), 75% of OB/GYN residents nationwide were women. I don’t know today’s numbers, but some recent journal editorials have brought attention to the fact that there are fewer and men going into OB. As more and more practices are marketing themselves as “women only,” some male OB’s are beginning to cry, “Foul!” To some extent they are right.

When I made my appointment for my very first pap smear, I called every female doctor in our town, only to find them all on a 6 month waiting list for new patients. I begrudgingly went to see my male FP, and he was fantastic… well as fantastic as the person giving you a pap smear can be (not THAT fantastic). Some of the kindest and most compassionate OB/GYNs I know are male. Many of my mentors in residency were older male physicians, who would really take the time to teach, while the female attendings often hurried home to their families.

At the end of the day, when starting with a new physician, a lot of women just feel more comfortable with a female OB/GYN. I am part of an all female practice, and honestly that is beneficial to getting new patients in the door. A significant majority of our obstetrics patients will ask to confirm that there is no possibility of a male physician delivering them. I answer in the affirmative, but the answer makes me a little uncomfortable. "I prefer to see a woman because you KNOW what I'm going through" they will often tell me. As women, the ‘been there, done that factor’ can cut both ways. Yes, I do get pap smears and understand the discomfort of putting my junk in the literal spot light every year. I also worked 12 hours the days I delivered my baby, and find it hard to muster up compassion for the multiple complaints of my term pregnant patient who work a part time desk job.

Being a MIM is not easy, but honestly in my field it is an advantage. Is it in yours? These men are saying the current situation in OB is rife with discrimination. What do you think?

24/7

Mamapop had a great discussion Thursday about feminism, and how it applies to politics, specifically Sarah Palin. Feminist is not one of the labels I apply to myself (like juliaink). Just don’t consider myself a pioneer in moving the cause of women forward. I also don’t tag myself as a political animal. However, this election has me fired up because I feel that the items the media has picked up and discussed are issues in my back yard.

As women in medicine and specifically mothers in medicine, we have a unique perspective. My occupation is 24/7. I share call with other physicians, now, although I was once a solo practitioner. The ownership part of my practice is still there seven days a week and requires maintenance whether it is employee reviews I need to write, maintenance of the facilities or just a late night security call. Being a physician is a 24/7 job whether I’m on call or not – and I suspect it may be that way for my fellow MIM writers. Have you fielded a phone call from a worried neighbor or family member because you have MD or DO (or RN, PA, NP) after you name?

Mothering, Fathering and Parenting are also 24/7 jobs. Even with my two healthy children, the balance is precarious and dynamic. I can only imagine what adding intense media coverage, decision making for 300+ million citizens, and overlapping passport stamps would do to my stress level. It’s not that the VP (or presidency, for that matter) job isn’t compatible with parenthood. It is. I’m not sure the job that will require 110% focus seven days a week (or at least this is what I expect out of elected leaders ) is balanceable with children that need their parents as much as 2 of the 5 Palin kids will need their parents in the coming months.

Childbearing in Surgical Residency

My intent was not to make such a serious posting, but I did not succeed.

After 8 years of surgical residency and fellowship, I am happy to report that our lives are returning to some sort of “relative normalcy.” Stress the word “relative” as most would not describe it anything close to “normal.” Life as a junior staff surgeon involves frequent call, occasional emergencies, and the ability to pick up slack for my senior partners. But my life now carries with it innumerably greater amounts of flexibility than life as a resident or fellow.

I now have a small teaching group of 2 female medical students in their first year of medical school. They “shadow” me in clinic or the operating room once a week. Although both are interested in what I do as a surgeon, inevitably they are most curious about my decisions and experiences with childbearing and family life. I tell them about training. I tell them that it is hard but that family life and motherhood are great and well worth it.

It was harder than what I tell them, especially as most of my training was before 80-hours and “80-hours” is often still theoretical in surgical training. All medical training is difficult, but surgical training is perhaps the hardest. Finding the balance between family life and work duties is hard for all surgeons, particularly for women surgeons in training.

The “ethos” of surgery remains principally masculine and rigid. Surgeons are supposed to be particularly strong, not to complain, and to go along with the “status quo”. While this may sound backward and negative, paradoxically in many circumstances I find the first two of these qualities admirable, and I still believe surgery to be one of the most exciting and rewarding career paths that anyone could choose.

As most parents will testify, childbearing is one of the less challenging aspects of parenting. But decisions around childbearing and the time with your newborn are important shaping experiences.

The concept or image of a pregnant surgeon, whether or not in training, is still a foreign one to quite a number of surgeons, some of whom feel free to share their opinions. The decision and process of pregnancy for women residents (I suspect in a number of medical fields) produces anxiety and (both subtle and overt) comments. I have seen female residents leave surgical residency either for another medical specialty or leave medicine entirely as a result of issues surrounding childbearing. Two of my female resident colleagues “decided” to return to work only a few weeks after giving birth because one had been placed on bedrest before giving birth and the other was told two weeks was all the residency program could bear. Female residents that take full time for maternity leave often “owe” additional months (as it might be in other training programs) but also often suffer palpable resentment from fellow residents.

This is, in part, because typically the decision for a female surgical resident to have a child directly impacts the entire training system. And surgery, worse than most other medical sub-specialties, has not found solutions to address these issues. Most surgical training programs suffer from more limited people-power. When one person is not performing optimally or is absent for any reason, the entire team feels it. The call schedule might change from every 3rd night to every 2nd (of course, illegal under current regulations). This issue is perhaps the worst in some of the sub-specialties where the entire training program is composed of a handful of individuals. Interestingly, several of my female friends who have entered small private practices after training also experience similar pressures as childbearing would impact their partners' lives significantly.

Issues of maternity leave, parental leave, and time for other parenting duties in most residency training programs have not been traditionally prioritized. Not surprisingly, fields like surgery which have been slowest to find solutions and to transform their ethos feel much-needed pressure to start making changes -- as women now make up over half of graduating medical school students nationwide.

Personally, I “timed it” well, having my daughter during my years in research during residency. My 4-year-old daughter is beautiful, well-adjusted, and a great kid. And my husband and I have found a satisfactory parenting balance that works. I am extremely lucky, but I would like for my experience to be less of the exception.

Guest Post: Vigilance 101

Several decades ago I began medical school as one of five women in my class. Medical school was followed by internship/residency at a tough city hospital in the days before 80 hour work week restrictions. So I considered myself a non-pampered full-fledged member of the medical profession. But after fellowship finished I was elated with the offer of a half-time job at a university clinic. The hours would prove perfect for raising young children. Of course, half time in medicine means 50% pay for at least 75% time. I worked 5 days per week, 6 hours each day, straight through lunch, so I could finish the workload and get home at a reasonable time. Outside of the regular clinic hours I was also responsible for any of my patients that were hospitalized and for every other week 24/7 on-call. But it was all tolerable because of the flexibility. I essentially job-shared with a near retirement age physician who had raised a large family and he was welcoming of my bringing children to work on the occasional school holiday or child care emergency day.

My rude awakening was the chance spotting of a young male physician at the shopping mall one mid-week afternoon.

“Hi – are you on vacation this week?”

“No – Wednesdays are my discretionary time”

“Discretionary time???????”

“Yes – the day I don’t see patients. It’s the time I write my book, review residency training curriculum, do phone conferences…”

OK, I calculate. He’s my age, same amount of training, hired by the same university division. I work 5 days x 6 hours = 30 hours in clinic for 50% pay. He works 4 days x 8 hours = 32 hours in clinic for 100% pay. I did register a complaint which did nothing but label me troublemaker, but I was attached enough to my work hours that I didn’t pursue legal action. (That’s another story for when children were older).

Fast forward to August 3, 2008, The Outlook Section of The Washington Post. There’s an op-ed article by a physician bemoaning the current state of patient care in primary care medicine. No argument, primary care medicine is dying for a variety of economic reasons. But wait – our author has an answer. He claims there’s a “silver lining” in that many more women are entering medicine. Women tend to migrate to primary care fields, and they are documented to spend more time with patients even if they don’t get paid more. So there we go – cheap, undervalued labor is still with us!


Dr. Nana is a private practice internist in a suburb of a large east coast city. She has a physician son, a medical student son, and a physician daughter-in-law. Besides her clinical work, she is active in political action/legislative lobbying/educational efforts to preserve the practice of medicine, which is currently under assault on multiple fronts.

Mothering a med student

Pathmom has been off the air for many weeks, primarily due to the addition of a full time med student last month. I have a healthy amount of respect for med students (we were all students once), and this one was particularly bright and appeared to have the requisite "good eye" that any successful pathologist must have. So in the title of this blog, I don't want to sound pandering or condescending in any way, but there was an incident that I found particularly memorable, and worthy of sharing.

This young woman had a 4 month old baby girl at home. She came back from maternity leave and went straight into her general surgery rotations. Her medical school was in the habit of "farming out" students to community groups across the metro area (and even the country) for their clinical rotations. The two surgeons she rotated with were geographically close, but had a reputation for inappropriate behavior.

"K", as I will refer to her, had an initial interest in surgery, but she was fully cured of that in the process of her rotation. Apart from being bad-tempered and complaining vocally about having to have med students at all, these surgeons were apparently openly misogynistic. They reduced one female med student to tears by verbal abuse, got cited for making "inappropriate remarks" to another, and told "K" directly that the only way they would ever hire a woman was if she had a hysterectomy.

The last incident really burned me, but I was more appalled by the way "K" told me about it, almost like she was waiting for me to chuckle or at least smile.

"Are you serious? They said that to you?"

"Well, these guys are pretty old school."

"Old school, nothing! That's an extremely offensive remark!"

I had that bewildered sense of reacting very strongly to something that appeared to have no effect on someone that I would consider more or less a peer, based on age and being the mother of a small child. I explained that you can't change individuals, but that she should not take that comment as something either acceptable or amusing. I also thoroughly derided her medical school for allowing students to be with these physicians (apparently, options are rather on the slim side). Despite having quite strong opinions about many and varied things, I actually do not "soap box" very often. This, however, did ignite a spark. The term "flipped out" sums it up nicely.

I couldn't help but wonder if it was her upbringing or just a lack of social aptitude that made her fail to realize the abhorrent nature of that comment (and, yes, I am intentionally leaving out the option that I was just plain over-reacting).

I also couldn't help waxing philosophical about the whole incident. Obviously, this blog is built around the notion that mothers in medicine are worthy and capable members of the medical field. We are also, frankly, necessary to the system. If every "mother in medicine" were to disappear from the profession, and if only those women who were indeed sans uterus were allowed to practice, what then? Not so great for aging baby boomers, that's for darn sure.

This student was convinced that surgery was not an option for her - and maybe it wasn't her path for other reasons - but these horrid surgeons certainly made it clear that she wasn't a candidate based on who she was. "Of course you can be a surgeon!" I explained to her that my sister-in-law is a practicing general surgeon, and has had two girls and plans to have more. I also pointed out that 3 of the 6 general surgeons at my hospital were women, all of whom had small kids. That being the case, I had already melded her mind towards the utterly cool and completely irresistible field of pathology, so I believe it's unlikely she will do anything else (path props).

Frankly, mothers in medicine typifies a scenario that all professional women of this era face: creating the reality of how working moms fit into the American workforce in the 21st century. We're living at a time when there is no "norm" for working mothers, and the expectations and experiences are supremely varied. Some moms get months of maternity leave with full pay; others get paltry weeks (or even days) and pro-rated salaries. Some moms have to take leaves of absence; others invoke FMLA. But we are an increasingly powerful and valuable voice in the professional community, and I believe the situation for working moms reflects that more with every passing year (a generation ago, my mother in law and her female residency colleagues had to sign contracts with their programs explicitly stating they would not get pregnant - they did anyway). We are more involved in making our own reality today than ever before, and I believe that what we want to be and how we want to practice are out there waiting for us, be we single, married, pregnant, or toting around that mysterious black bag with the plastic suction devices on it. And if there are still the remnant neanderthals who feel that the possession of fully function female parts excludes someone from consideration, they are, of course, free to limit themselves thusly while the rest of the world spins ahead with diverse, talented, and dedicated mothers in tow.

Guest Post: Medical School Now and Then

I graduated from medical school in the 1970s. My daughter started medical school two weeks ago. Many things I thought were crazy in the '70s are still crazy today (like the schools requiring Calculus and Organic Chemistry for no reason I can fathom even after thirty years of working in hospitals and clinics). And why did I have to memorize the Krebs Cycle? But some things are vastly changed.

1. The Interview Process.
I remember the male interviewer asking me, "Are you engaged.........or anything?" I thought it was a fair question at the time. After all, letting a girl into medical school was risky. She might fall in love with a surgeon and drop out to get married. So I was quick to let the interviewer know that I was completely uninterested in ANYTHING like that. Little did I know that I would fall in love with a graduate student and get married at the end of my second year, right before National Boards.

I hear questions like that are illegal nowadays.

2. The male:female ratio.
My class was around 5:1. A group of us girls would sit in the back of the lecture hall dressed in jeans and men's shirts and hiss at the sexist remarks from the podium. We had a teacher who projected gigantic photos of scantily-clad models in front of the class between the pathology slides. I hear they don't allow that anymore. But looking back, that hissing and booing was a lot of fun; it was a great bonding experience for the women students.

Now there are more women than men in medical school, which is why the pay for primary care doctors is dropping compared to the rate of inflation.

3. The money!
The tuition that medical students pay nowadays is insane. I was upset when my tuition rose to $2000 my 4th year. With all the blood drawing, xray fetching, middle of the night foley catheters and EKGs, I thought the school should be paying us. I wonder if students today still provide all those services for the hospital even though they are paying $40,000 for the privilege.


"Fiddler" practices Internal Medicine in the Pacific Northwest. She has two daughters, ages 18 and 23.

Cinderella isn't pre-med

The vast majority of our TV viewings these days are dedicated to the Disney Princess Sing-along videos. The songs in these videos feature only the princesses of the Disney movies, such as Sleeping Beauty, Snow White, Cinderella, Princess Jasmine, etc. Melly loves them so we've been subjected to each of these videos roughly five thousand times in the couple of weeks since we've discovered them. It's gotten to the point where I'm subconsciously humming "A Whole New World" while examining patients and they look at me like I'm nuts.

Between each of the songs, there's a narrative that I find rather disturbing. For example, after the Cinderella song, the narrator states: "Cinderella finally lived out her dream of going to a ball in a beautiful dress. Is that your dream too?" And so on.

It sort of emphasizes the point that Disney movies have two kinds of female characters:

1) Princesses who have developed a deep malaise, which can only be cured by an exciting new man.

2) Poor girls (usually also abused by their stepmothers) who are eventually saved by a handsome prince, often met while wandering through a forest and singing.

Between the popular Disney movies and dolls that pronounce "Math class is tough!" it seems like a miracle that so many women have high powered careers these days. My husband and I get nervous that if we don't turn off the Disney videos, Melly is going to end up doomed to a life of dancing in forests with strange princes. (My dream for her is to be a mathematician, which is about as far as you can get from going to a ball in a beautiful dress.)