Weekend shifts on the teaching service at Beth Israel Deaconess Medical Center in Boston bring mixed emotions for hospitalist Grace C. Huang, MD. While she loves her work, she knows she may not see her children between putting them to bed on Friday night and sending them off to school on Monday morning.
“It means missing out on family time over the weekend and the chance to just hang out instead of doing the rat race on the weekdays,” said Dr. Huang, assistant professor of medicine at Harvard and mother of four children between the ages of two and nine. “But I love where I work, and working full time was a deliberate decision.”
Juggling the demands of a young family with a busy career isn't easy, no matter what your gender. But biology and cultural factors often make this particular balancing act more complicated for women.
A satisfying life doesn't have to mean sacrificing career for family, or vice-versa—but it does mean prioritizing goals, said ACP Member Colleen O’Connor, MD, director of the hospitalist program at Lankenau Medical Center in Wynnewood, Pa., and mother of five children between the ages of two and 12.
“You have to pick and choose what's important to you in both professional and personal domains, and be upfront about it,” Dr. O’Connor said. “It's important to prioritize those things that you see helping you accomplish your goals while at the same time delegating those that may not best fit.”
Excelling in a distinct role also proves your value to employers and may make it more likely they will embrace family-friendly policies, said Molly Carnes, MD, professor of medicine at the University of Wisconsin and director of the UW's Center for Women's Health Research.
Dr. Huang, for example, spends part of her time serving as director of assessment for BIDMC's Center for Education, which oversees medical educational activities at the academic medical center. The role feeds into her research interests such as the procedural training of residents and cognitive error, which has helped her publish scholarly papers and secure grant funding—key considerations in her case for promotion to associate professor, she noted.
“We have to frame this as an economic, competitive issue,” Dr. Carnes said. “Institutions can't afford to have these highly trained, knowledgeable workers disengage from the workforce.”
Full time vs. part time
Working part time is one way to balance career and family, but there are pros and cons to consider. A 2009 survey of part-time academic physicians published in Academic Medicine found that part-time schedules allowed physicians more time to focus on their research, family activities, and career and personal goals. But some women reported they were working more hours for less pay, were overlooked for promotions and challenging projects, and were viewed by their colleagues and supervisors as being less committed to their jobs.
“The challenge of part-time work is, ‘Will I be compensated proportionately?’” said Rachel Levine, MD, assistant professor at Johns Hopkins University School of Medicine in Baltimore, who has researched and written about part-time careers in academic medicine. “Will I get the same exciting work as my colleagues and get compensation, benefits and career development on a proportional basis?”
Dr. Levine opted for a part-time schedule after having her first child and beginning a faculty position at Johns Hopkins in 2004. The choice made sense because it gave her more flexibility and guaranteed two days off a week to spend with her family, she said—but she still worked about 40 hours a week, with reduced salary and benefits.
Part-time schedules can work if physicians feel like they are on a “fair playing field” with their full-time colleagues, Dr. Levine said. “I would be willing to accept being promoted at a slower rate as long as it was still a steady rate and consistent with the effort I was putting in.”
Alternatively, some women choose to work full time but adjust how those hours are spent while their children are young.
“The ratio of clinical to administrative [work] is important,” said Daisy Smith, MD, FACP, senior medical associate for content development at ACP. Dr. Smith served as the internal medicine residency program director and director of the hospitalist program at Lankenau Medical Center from 2003-2011, when her kids were young. “Even with three young kids I could go full time because my administrative work gave me flexibility. Patient care is a lot less flexible,” she said.
Other full-time hospitalists with children have made conscious decisions to cut back on things like travel or research.
“Without a family I would probably do more research activity, which is very strongly considered in terms of promotion here,” said Carrie Herzke, MD, assistant professor of medicine and director of clinical operations for the hospitalist program at Johns Hopkins University Medical Center. “I've made a decision that research is an area that I'm going to let lag a little bit even though my progress to associate professor will be delayed because of that.”
Similarly, Dr. Huang has cut back on travel in order not to be away from her four children for long periods of time.
“That's one big tradeoff,” she said. “I'm not out there on the talking circuit and the work that I do to disseminate my ideas has to be through publications.” The decision hasn't stalled her career, she said, but led her down a different promotional track that focuses more on scholarly work and less on national presentations.
When successful women are asked how they “do it all,” most cite a strong support system, including an understanding spouse, a family-friendly workplace, and help with child care.
Johns Hopkins, for example, offers onsite day care and access to an emergency child care service, said Dr. Herzke. In addition, the director of Dr. Herzke's division is “very conscious” about not scheduling meetings before 8 a.m. or after 5 p.m., when parents are likely to be dropping off or picking up children from day care, she said.
Before- or after-hours meetings are difficult for parents who rely on paid child care arrangements that follow traditional hours, but they are still common in many hospital divisions, including at Hopkins, noted Dr. Levine.
In an internal survey of Hopkins' physicians, 10%-15% of respondents said they felt early and late meetings interfered with their ability to advance professionally because they coulnd’t attend and so were perceived as less committed.
Employers can help by allowing flexibility during work hours, said ACP Member Anna Liza M. Rodriguez, MD, president of the hospitalist group at Chesapeake Regional Medical Center in Chesapeake, Va., and mother to three children ages nine through 14. “I can talk to my partners and say I need to be away for a couple of hours. We cross-cover for each other.”
At BIDMC, Dr. Huang job shares with another female academic hospitalist who also has young children. Both work full time but split the patient load of one physician, so they can spend the rest of the day attending to their significant nonclinical responsibilities, which can't be placed on hold while they see patients. Dr. Huang said she spends about 12-16 weeks a year on clinical service, and splits the rest of her time between research, administration, teaching and consulting.
The result is more flexibility, reasonable daytime hours, and the ability to cover for one another when child care issues arise, she said.
“My hospital medicine boss sets the tone for allowing me as well as other working parents to have flexible job descriptions that work for our lives,” said Dr. Huang. “He is one of our greatest advocates for flexible schedules.”
Dr. O’Connor noted the importance of having a supportive spouse who shares equally in family responsibilities. She relies on her husband, who is a full-time nephrologist at Lankenau, to stay home with their children during the weekends that she is on call at the hospital. The two carefully coordinate their schedules months in advance so that their weekends on call do not conflict and one parent is always available at home.
Securing a mentor
Many women cite the value of having a female mentor who has successfully combined work and family, to provide advice and support. There's no way to take the stress out of being a full-time working physician and parent, but a supportive mentor and workplace can help motivate women to push through and succeed, said Dr. Levine.
“If you're pushed to your limit, it makes sense that you might burn out,” she said. “But if you love your work and get great support and mentoring and feel a sense of personal accomplishment, it is more likely that you will stay in your job.”
While women are still greatly outnumbered in leadership roles, it's usually possible to find a female mentor with some effort, said Dr. Carnes.
“When I entered medical school, women were a small minority and I had to call the dean of the school of nursing for advice,” said Dr. Carnes. “But now there are thousands of women with children who can be role models. If there are no women in your hospitalist group, reach out to internal medicine or another department. Network across disciplines.”
Even in a supportive workplace, women with children can be perceived as less willing or able than men to assume leadership roles, experts said. The best way to combat these assumptions is to show people what you can do and speak up about your career goals, Dr. Rodriguez advised.
“If women really want to move up, they have to be proactive,” she said. “Sometimes men will assume that women aren't ambitious enough to go after certain administrative roles and assume they don't want the extra work while raising kids. If you want to advance your career, you should let people know and show them that you are capable.”
And don't succumb to guilt just because you don't conform to society's expectations of the traditional or ideal mother, said Dr. O’Connor. The desire for an engaging and challenging career does not mean you are any less committed or devoted to your family.
“I love being a mother but I also like that my kids see me going off to do this other important job,” she said. “And when I'm not working, I'm with them. I don't go out a lot or travel. My family is my priority.”