My son has been accepted into medical school, we learned last week, and I must say I’m about as happy a mother and a physician as you could find anywhere.  For everything that’s wrong with the American healthcare system today, medicine is a wonderful profession and it’s still the greatest honor in the world for a patient to have faith in your skills and care.

It will be interesting to see how my son navigates the still controversial issue of how to manage family and “work-life balance”. How do you do justice to the trust that was placed in you when that invitation to medical school was extended?  That trust came from the college faculty members who recommended you, the medical school faculty who evaluated your application, the public whose tax dollars help support your medical training, and the patients–now and in the future–who will need you to take care of them.  No, that doesn’t imply that you’ve accepted a life sentence to work 80 or 100 hours a week until the day you retire.  But it does imply that all those people believed that you accepted the calling to make the practice of medicine one of the highest priorities in your life.

You’ll hear the argument that the desire for “work-life balance” is a generational thing, not a gender issue–that young men in their 20s and 30s today don’t want to work as hard as their fathers did at their age.  That may be true.

Read the Full Article

When you walked into the voting booth on Tuesday, November 6, did you do so with a feeling of calm certainty that the man who would get your vote for President was unquestionably the best choice, or even the only possible choice?  Did you feel confident that your candidate’s political party fully supports your political views as well as your personal values?

For many physicians, I suspect that the answer to those questions was not a resounding “yes”.  Perhaps more so than in any previous election that I can recall, there were elements in each party’s platform that many thoughtful physicians might have a hard time accepting.  The extreme left and right wing contingents within the Democratic and Republican parties argue for wildly different policies, but does either of them truly represent the best interests of our profession or our patients?

Read the Full Article

I gained a certain notoriety last summer by suggesting in a New York Times op-ed that it isn’t a good thing for growing numbers of physicians to work part time.  American-trained physicians have an obligation, it seems to me, to make full use of our professional skills because there is a shortage of doctors and because American taxpayers provide so much of the funds for our training.  Now, in a new article in the Atlantic magazine–“Is Medical School a Worthwhile Investment for Women?”–two Yale professors suggest that physicians might as well work full time or more because, if we don’t, medical school is an investment of time and money that doesn’t make financial sense.

This article didn’t surprise me at all.  It specifically points to the example of American primary care doctors who are less well compensated than specialists. Using a tool called net present value (NPV) calculation, Professors Keith Chen and Judith Chevalier compared the costs of earning a degree against the income earned over the likely course of a career.  They compared the NPV of training as a physician assistant (PA) compared to a primary care physician, and also looked at gender differences in anticipated earnings.

Their conclusion?  “We found that, for over half of woman doctors in our data, the NPV of becoming a primary-care physician was less than the NPV of becoming a physician assistant,” the authors wrote.

Was this true for men as well?  No, said the authors.  Most men are better off financially if they become physicians.  But women physicians tend to earn less than their male counterparts, and they also tend to work less.  A male physician “earns more per hour relative to the male PA than the female doctor earns relative to the female PA,” the authors noted.  “However, a big part of the difference comes from an hours gap. The vast majority of male doctors under the age of 55 work substantially more than the standard 40 hour work week. In contrast, most female doctors work between 2 to 10 hours fewer than this per week.”

The professors concluded, “Even though both male and female doctors earn higher wages than their PA counterparts, most female doctors don’t work enough hours at those wages to financially justify the costs of becoming a doctor.”

After reading the Atlantic article, I don’t doubt the reasoning behind it but have other questions to raise.

Read the Full Article

This column was featured on KevinMD on August 13, 2012, and on the California Society of Anesthesiology website as an “Online First” selection on July 16, 2012.

Unless you’ve lately returned from a retreat at a remote Cistercian abbey, if you’re interested at all in women’s issues you’ve probably read Anne-Marie Slaughter’s recent article in the Atlantic, “Why Women Still Can’t Have It All”.  The author eloquently tells how she left her dream job in the State Department as the first woman director of policy planning in order to return to her husband, her two adolescent sons, and her tenured professorship at Princeton University.  The weekly commute to Washington proved impossible, and her family needed her.

Professor Slaughter’s article is well worth reading for its meditations on how difficult it can be to combine motherhood and a challenging career.  Her conclusion is that work practices and work culture need to change.  Unfortunately, her take-home points have little application to the life of a physician.  She quotes from Republican political strategist Mary Matalin, who wrote, “Having control over your schedule is the only way that women who want to have a career and a family can make it work.”

That certainly leaves me out.  If there’s one thing I don’t have as an anesthesiologist, it’s control over my schedule.

Read the Full Article

Naturally, I remember the night I met my husband.  We were walking along the seawall on a lovely evening in San Diego, having met over dinner at a nearby hotel, and were exchanging all the usual get-acquainted questions. Eventually, he asked where I went to college.

“Back east,” I said.

“Where?” he persisted.

“In New Jersey.”

“Oh, come on,” he said kindly.  “It can’t be any worse than where I went to school.”

He was right on that score.  Before he went to medical school, my husband attended Cal State Los Angeles, which is a fine state college but not in the same echelon as—well—Princeton.  Which is where I went, and didn’t want to admit to him.  Not in the first hour of our acquaintance, at least.

A long time has passed since that meeting, but apparently nothing has changed—young women still hesitate before admitting to potential suitors that they went to an Ivy League college.  Nikki Muller, who graduated with Princeton’s Class of ’05, just posted a YouTube video on this very subject that’s gone viral, with over 100,000 hits so far.

Read the Full Article