Too many female doctors are part-time or stop working!?

When I applied to medical school in 1969, I was asked during my interview whether I wanted to get married. This was followed with a query regarding whether I hoped to have children. I responded by asking the middle-aged white male physician interviewing me if he was married, if he had children, and why he expected that my personal aspirations would be different from his. Likely because I displayed more guts than brains, I was accepted and attended that very same medical school. The concern in the 1960s and early 1970s, before medical schools opened their doors to more women, was that women would “take the place of a man” in the classroom and residencies and then drop out to have children.

A recent article by Meera Jagannathan in Market Watch (2019) suggests that this concern has in fact been realized. The article cites a recent publication in JAMA Network Open that documents that female physicians are more likely than male physicians to work part-time or discontinue working completely because of family (Frank et al., 2019). The survey study included women and men who had completed their training approximately three years ago. The results showed that 87% of the 344 women who completed the survey (of the 486 who were asked to participate) reported working full time, 11% part time, and 2% not at all. The authors noted that female physicians were significantly more likely than male physicians to not work full time: 23% of women without children and 31% of women with children versus 4% of men without children and 5% of men with children. In addition, 77.5% of female doctors who reported working part-time or not at all cited family (and specifically childcare) as the primary factor causing a change in their employment status.

The authors of the JAMA Network study concluded that physicians who are parents need better support systems and work flexibility, paid parental leave, and on-site daycare. They also supported men having access to and taking advantage of family leave to emotionally and physically support the family. Although legally available in many work environments, men taking this leave will require a culture shift.

My take from this article is not that women have behaved as badly as men predicted but that society has not provided the support system we need to care for our families without guilt while we are at work. The mobility of our society has caused many of us to move far away from our support system of parents and other extended family who could help us. Additionally, many of today’s child-bearing generation have working parents (like me) who have their own jobs to contend with.

Women not working full time is not brand-new information. For example, Heidi Moawad, a neurologist and medical writer, reported in 2016 that 30% of female doctors work part time (Moawad, 2016). She stated that many women view this decision as part of their freedom to make career choices based on their personal needs and desires. She also enumerated the potential negative implications of part-time employment, which included financial issues (usually less pay per hour than full-time physicians; ineligibility for conferences, administrative or education time, benefits, and/or paid vacations), professional ramifications (e.g., less access to networking and collaborations, possibility of being viewed as less dedicated or a dropout by peers or chairpersons), and personal concerns (e.g., how best to juggle taking on more home responsibilities while enjoying more time for hands-on care of children; Moawad, 2016).

Additionally, is this issue of female part-time employment unique to the United States or is it different in other countries, where child care and medical leave are more readily available? Although limited data are available, in the United Kingdom, 42% of women and 7% of men were reported in 2016 to work less than full time. For women, having children significantly increased the likelihood of working part time, with greater effects observed for those women with a greater number of children. In contrast, the presence of children had no effect on male working patterns (Lachish et al., 2016). Therefore, this is a universal and international issue that is not unique to the United States.

The bottom line is that this is a very complex and nuanced issue, and there is no easy solution that can be prescribed for all women. How a particular woman responds to becoming a mother is variable and cannot be predicted in advance. Additionally, depending on cultural background, historical role expectations may put more pressure on some women to perform these responsibilities rather than share them with their partner or hired personnel. Furthermore, not all partners are willing to take on some of these obligations. Finally, financial resources may be limited or helpful and dependable family members or friends may not be available due to geographic distances.

No matter the complexity of this issue, university medical centers, large medical groups, and towns everywhere need better childcare facilities near our places of work, where we can drop in at lunch and feel confident that our children are well cared for. We need flexibility in our work hours so that we can feel secure in the fact that we are being good mothers and wives as well as good physicians. And we need to share our guilt with our partners, who need to be responsible for an equal amount of childcare.

My husband of more than 45 years lived by the philosophy that each of us needed to think we were doing 60% of the heavy lifting at home and with the children. The reality would be that we were likely only each doing 40%. Although that would mean 20% would be falling between the cracks, hopefully that 20% would not involve the children but rather the vacuuming and dusting. If we each felt that way, 80% of the family and childcare responsibilities would be done, and each of us would be pulling our weight and feeling good about our role as parents. I was and am a lucky woman to be married to a “liberated” man, but it would have helped to have available daycare that was accessible and affordable at my workplace and more flexibility in my hours. Now that women represent more than 60% of the dermatology work force, we need to stop complaining and implement the kind of changes that allow us to “have it all” and continue working if that is our desire.

Consider this missive a call to action. We can, individually and even more so collectively, make a difference. These changes will enhance our own lives and have a tremendous positive impact for our daughters and the next generation of women. Petition the organization where you work to start a daycare center. Petition the Scientific Assembly Committee that organizes our American Academy of Dermatology (AAD) semi-annual meetings to reinstate daycare so that you can have your children accompany you to the meetings and actually attend courses. Run for the AAD board and seek leadership positions in the AAD and at your place of employment so that you can have an impact and change the culture. We have the power if only we are willing to take up the gauntlet.

Conflicts 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.