What will keep women practicing dermatology?

In 2017, a landmark event occurred in medicine: The number of women in medical school exceeded the number of men (Association of American Medical Colleges, 2018). In 2017, women already had become 48.9% of the workforce in dermatology (Association of American Medical Colleges, 2017), and given the pipeline of women in medicine, this percentage will inevitably increase. This gender shift is of massive importance and yet, we in medicine have yet to adapt.

The great majority of young women in medicine are married, either in two-physician households or dual-career households, and most have children (Perlman et al., 2015). These unions have both strong advantages and profound disadvantages (Ferrante and Mody, 2019). Ferrante and Mody (2019) cite the obvious advantages, including the enhanced socioeconomic status, mission-driven companionship, and job security that these unions have. However, the disadvantages both professionally and personally are equally real. Why else are women physicians more likely than their working male partners to take time off during times of disruption to normal childcare arrangements (Jolly et al., 2014)?

Strategies for managing a dual career family are often assumed to be obvious. In a physician’s world, where multitasking is considered the normal pace, balancing the competing demands of career and personal life seems like it should have been long learned. The reality is that we do not prepare our young physicians, either women or men, with tools to handle these competing priorities. The significant time spent studying medicine often comes at the expense of time for personal reflection. Decisions on how to manage life’s many competing demands are almost never formally explored in the medical school curriculum. Fifty years ago, when almost all physicians were men, this mattered much less.

What should we be talking about? When broached, this discussion often is divided into two areas: professional development and family concerns. A more complete paradigm needs to be considered, where a dual-career couple’s time is divided into four areas: professional development, family time, personal exploration and development, and custodial needs. Understanding each of these components and their individual priorities is especially crucial for young women because they are often the central hub of their family unit. Many young couples attest to a belief in the sharing of responsibilities, but the reality is not often even. For example, Jolly et al. (2014) documented that female physicians spent on average 8.5 hours extra per week on domestic responsibilities compared with their partners. Achieving a balance that fits each individual is critically important to having a fulfilled life. Understanding that each of us will have different priorities and obligations, and therefore need a different allocation of effort, is critical. For some, part-time work may solve this dilemma, whereas for others hiring assistance many be more helpful.

One’s living arrangement may also be a factor in the equation. Family close by can be either helpful or create additional responsibilities, depending on the unique situation. Custodial tasks for some are solely a means to an end, but for others they offer relaxation and satisfaction. Although the balance will likely be different for each of us, regardless of our social situation, we each have needs in these areas that need to be met. Consideration of what is important to that person and prioritizing those needs is the first step toward wellness.

Why have we not acted on this problem? Why have we not, for example, opened daycare centers at our work sites or provided coverage for sick children? One reason is that only 26.1% of chairs of academic dermatology departments are women in the United States and Canada (Shah et al., 2018). The issue of gender disparity is not limited to academic dermatology; it is present in practice too. Efforts must extend beyond babyhood. Caring for a school-aged child presents a parent with different challenges. How about medical schools across the United States creating childcare facilities that offer care early in the morning, late in the afternoon, on weekends, and during school vacation times to fill in the gaps for most physician mothers.

Allowing for work hour flexibility is also critical. The occasional school play, concert, and sporting event needs to be accommodated too. Having to choose between being there for one’s child versus having a fulfilling career should never be necessary. When a choice must be made, too often dermatology loses. We must take steps to prevent burnout of these women, or our patients will suffer. These family-friendly steps are beneficial to all. Strategies that minimize the difficulties that women face must go beyond couples matching in medicine.

Women in dermatology are a welcome addition to our discipline. Ensuring that those admitted to this specialty thrive is critical. For that to occur, support of these women both personally and professionally is key. The days of “if I did it, you should do it” in medicine are fortunately ending. Every other night on call has happily gone the way of the wind. Let’s make this lack of support for women in dermatology also head to the pastures. Thirty years ago, being a female dermatologist and a mother was a novel thing but is now the norm, and we need to accommodate it. We cannot afford to lose more than half of the dermatology workforce because medicine is not compatible with being a fulfilled person.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Conflict of Interest

None.

Funding

None.

Study Approval

The authors confirm that any aspect of the work covered in this manuscript that has involved human patients has been conducted with the ethical approval of all relevant bodies.