By Dr. Charles Patterson, WCI ColumnistOn a frigid day in late fall, my wife came home after her shift at our local hospital and announced plainly that she intended to resign. She was clearly frustrated from the happenings of the workday, and she proceeded to unload the cornucopia of reasons why her next shifts would be her last.
As it was, she was working on an as-needed basis, typically between one and four shifts per month. We had small children at home, and her time with them was much more valuable to her than the weekends spent in patient care. While the income was nice, it didn’t “move the needle” meaningfully. The shifts kept her skills current but barely, and the time in between them eroded confidence in her medical decision-making. Importantly, when encounters didn't go well or a case had a bad outcome, she would experience terrible doubts for days afterward.
For my part, I work full time in clinical medicine as a pediatrician. I am privileged to do so, and the fact that our children are at home makes life a whole lot easier than it was when we were both working full time (her as a PA in the ED, and me in Residency). We are fortunate to have a strong partnership: any big life decisions (such as quitting medicine for the foreseeable future) are made together—and only after an extensive discernment process.
Despite persuasive arguments and legitimate reasons to hang up her white coat, however, I was still unnerved. Was there a less drastic alternative? How would this decision impact our financial goals? More ephemerally, is medicine a career or a vocation? If it's the latter, did that incur a moral obligation to serve society? And if so, what did society owe her? How did her role as a mother to young children factor into this decision? Would her opinion change in the future? What were the long-term career implications of being out of practice? Could she ever return to medicine? Each question, it seemed, created two more when answered in any particular way.
The questions were numerous and would be tediously considered, but the first step in their unpacking was recognizing my own biases. I am a male in a high-earning career field with a contract that does not allow part-time work. My family is my first priority, and at this early stage of my career, I have knowingly put hobbies, social pursuits, and extracurricular activities on hold. I enjoy my practice immensely, and I am working feverishly now so that I may securely claim more time with family in the near future. All of these factors played a role in my approach to this quandary. Placing my preconceived notions aside as much as possible, we continued the conversation with the shared goal of arriving at the most correct solution for our marriage, our family, and ourselves.
Financial Implications of Quitting Medicine
If the decision to taper back to resignation were to be made on a purely financial basis, then the question would be quite easy. Even after taxes, childcare costs, a jump in our income tax rate, and the ancillary expenses incurred in order to practice, there was still a generous net monetary gain by virtue of her employment. Full-time (and depending on the practice, even part-time) work opens the door to otherwise unavailable retirement savings accounts and more options in healthcare coverage.
Interestingly, the price of an extended sabbatical is not relegated to opportunity costs and significant licensure expenses. For instance, if a disability insurance policy does not stipulate current employment as a condition of coverage, then keeping it might be a sound (yet financially impactful) decision. Thus, taking time away would only result in lost income; keeping the door open to return would be a relatively expensive venture.
Choosing to step away from medicine raises a host of logistical challenges, particularly if there are plans to return to practice in the future. While state licensure requirements vary, this typically means currency with the governing board for the medical specialty, CME credit, life support certification (BLS, ACLS, PALS, etc.), and DEA and NPI registry at a minimum. For procedural specialties, extensive time away will corrode tactile and operative skills. Then, there are the institutional requirements: credentials policies of many hospitals and practices require a minimum number of patients seen in a given period to be in good standing (or hireable).
Difficult is not impossible. There are certainly ways by which a medical professional can return to practice after a period of time away. However, given the time and financial implications of such a recertification, it would behoove one to consider when, where, and how they could see themselves returning to the exam room. How much time was spent in other endeavors, what those endeavors were, and what, if anything, was done in the interim to maintain currency all affect future career trajectories.
Is There a Moral Imperative to Practice Medicine?
Unlike trades, crafts, contracted labor, or other forms of skilled expertise, to be in a profession is to be a part of a culture with strict standards of behavior, practice, and moral and ethical obligations. This professional structure is paramount to physicians, physician assistants, and nurse practitioners who routinely wield their highly-sought skills in caring for the ill, injured, and vulnerable. Of course, similar obligations exist for lawyers, dentists, veterinarians, pilots, military officers, and a myriad of other professionals whose rare gifts fill a unique societal role. Uniformly, these gifts are cultivated at a great personal and financial cost.
Society pays a price, too; not all who are otherwise capable and willing are selected to enter these professions, and the subsidies that incentivize schools and the training pipelines are invested with taxpayer dollars with an expectation of service in return.
What, then, is the obligation that the professional has to society—and society to the professional? I appreciate that this is a loaded question, particularly in an era when the average medical school indebtedness upon graduation is approaching a quarter-million dollars, the price of undergraduate education in the last 30 years has more than doubled (even with inflation-adjusted dollars), and reimbursement is growing ever tighter.
For practices to remain solvent, premiums are placed on volume and “value-based care”. Less time with patients, increased administrative burden, and the stresses of balancing sick patients and personal commitments all contribute to that insidious plague we call burnout. These competing factors impact the doctor-patient relationship and obfuscate the symbiotic dynamic that has existed between medical professionals and the communities that they serve.
The evolving state of play in our healthcare system has raised a plethora of other important questions. If there exists a moral obligation to serve as a physician (or PA, lawyer, dentist, etc.), how long does that obligation last? Or shall such servitude be measured in patients seen or outcomes achieved? Is this compulsion fulfilled as a researcher, volunteer, or humanitarian? Does raising a family supersede this vocational responsibility? Does the concept of physician FIRE represent a moral failing (and if so, for whom)? The answers are elusive, specific to each circumstance, and unlikely to be relevant given the rate of structural change in our healthcare system.
A World of Alternatives After Quitting Medicine
There are many palatable ways to break away from the typical medical career, and they all begin with understanding why a break is necessary. Options abound: one can cut back time (even to as-needed), increase volunteer or pro-bono work, take a sabbatical, try locum tenens, find a new employer, open one’s own practice, or even pursue administrative positions within a group, hospital, or insurer. Taking on new roles (chief of medicine, compliance officer, information technology, etc.), can reinvigorate the monotonous grind that is clinical medicine. Even monetizing a skillset or nurturing a side hustle outside of medicine can belay the untoward effects of a demanding medical career.
Of course, these options are all dependent on the person and life circumstance, and by no means would I mean to infer that they are a cure-all for burnout. But the take-home point is clear and salient: there are many options aside from hanging up the white coat completely.
Several months later, after many heartfelt conversations, my wife found her path away from medicine. Our world-view and lifestyle informed this decision. For us, having a parent at home consistently for our young children felt every bit as morally relevant and socially contributory as being in the hospital. From a financial perspective, my wife worked very hard in her first two years of practice to pay off student loans, and in subsequent years, we have lived comfortably off of a fraction of my income (an unforeseen but immeasurably important benefit of preventing lifestyle creep).
Not having her income while paying for continued licensure and insurance in the meantime didn’t change our financial goals, but it did highlight the importance of being content in my own career. Unfortunately, the work alternatives available to us in our neck of the woods did not lend themselves well to the balance that she sought. Our thoughtful consideration led us to a conclusion, one that was acceptable and even exciting.
Perhaps the most challenging aspect of this process was projecting what our goals and priorities might be in a decade or two or three. While we were confident that they will change, knowing how they will be different and how best to keep our options open was a formidable task. Frankly, much of this forecasting and planning boiled down to faith: faith in each other, in our work ethic, and in our intentions for our family. We don’t know what returning to medicine will look like in the future, but we are fully informed of the process for licensure and certification, and we are content with the challenges that such a return might pose.
There was never a moment of epiphany that made all of this clear. But in retrospect, our answer is as obvious to us now as it was difficult in the intervening months. In medicine as in life, I have found that the best decision is often the one that helps you sleep best at night. Curled up next to my wife, I doze soundly, comforted by the knowledge that we are doing what is best for her and for our family.
Have you or another family member seriously considered leaving medicine? Has burnout been a big factor for you? Do you think there's a moral obligation to stay in medicine even if your own personal goals have changed?
One area that is not well served in my opinion is quality improvement in the medical arena. It would take some training but perhaps this might be an alternative to consider as a part time or consulting business. It might be done remotely. Good post especially for those in management and policy makers.
Moral imperative? Hell no. If that were actually the case, then medical training should be free, which it is most certainly not.
Based on my own anecdotal experience, most of the people in medicine do not have a burning lifelong passion for it; it’s just a job. It’s an enjoyable job at times, but it’s still work. If society wants doctors to work longer, then provide incentive: either increase the pay or make the job more comfortable and less stressful and people will stick around longer.
There is nothing moral about half of the useless hoops we have to jump through in order to provide good care to our patients. If the government and insurance companies can waste my time like they do, I don’t think I owe them anything. Perhaps medicine used to be more of a moral obligation back when we weren’t treated like easily dispensable cogs in a wheel, but I don’t think society gets to have it both ways.
As a veterinary medical professional 36 years into a career, leaving the profession due to burnout is more and more of an issue exacerbated and punctuated by the last 18+ mo. of practice during Covid.
I am not alone in this thought, DVMs barely breaking the surface of their careers are pushed to the brink right now, trapped between mountainous student loan debt and today’s challenging conditions. Distressingly, veterinary suicide rates are up.
For now, we push forward in the hope that stresses will ease and we can return to a once rewarding career and tolerable work conditions.
Am I looking ever more longingly at retirement? Absolutely! I currently feel a huge obligation to continue to play my role and participate in/lead our team because I know what it would do to them were I to exit vet med during this stressful time. The obligation I feel is to my team rather than society as a whole.
I don’t think there is any moral principle involved in deciding whether to prolong or terminate a medical career. I’m a licensed professional engineer and we have a similarly strict ethical code because the things we design can become weapons of mass destruction if designed poorly or carelessly. But nowhere in that code is even a hint of obligation to prolong a career. Nor is there any such notion in medical ethics as far as I know. All jobs are important. An Uber driver that gets a senior citizen to the pharmacy for their meds is performing a great service, perhaps a lifesaving one. But if they decide to switch to delivering pizzas or to become a stay at home parent there is no moral dilemma involved in that decision. The world will spin on and nobody will ever notice. The decision should only be based on what is best for your family.
Agreed!
Timely article. My wife (MD) will be retiring from clinical medicine on January 1,2022 after 9 years in private practice.
The author and his wife deserve to be commended on several factors:
1. Recognizing what will make their family truly happy.
2. Recognizing that financial well being is only part (often a small part) of their overall well being
3. To his wife- for her honest assessment of her career and what she wants from life
4. To the couple for their financial wellness. This decision could NOT have been made without a solid financial base. Once again proving that financial well being allows you to make honest decisions about your future.
5. Finally, to the author. For supporting his wife, participating in an honest assessment of their family needs (financial and otherwise), recognizing his own bias, not allowing finances to ‘rule the day’ and being a partner/sounding board for his wife’s ultimate decision.
The ‘moral/social obligation’ of a physician had always baffled me. Did I miss the ‘social contract’ that we all signed before medical school? Did my loans come with an employment agreement? What if my wife’s medical school was paid for by her father? Is she now released from that duty? How long does her duty to society last? 15 years? 25 years? 50 years? Can she retire at 50? 60? 70? Why shouldn’t we be forced to work until our dying breath if this is such an important social duty.? Does this moral obligation influence my 55 year old male physician partner when he decides to work 3 days a week to see his grandkids more? Furthermore, which of my patients will shoulder the moral obligation of child rearing, providing healthy meals, transporting kids to and from activities while we are both finishing charts at 6:30pm? So far none have offered….
Obviously a SMALL PART of the decision to step away involves the understanding that as a clinical provider you DO have skills that can help others. It is why many have such a hard time stepping away.
Having gone through this process, it is clear that many physicians who retire early to step away from medicine for a variety of issues. There are many factors to consider and the final decision may be different for each of us. As a spouse, I consistently tried to support my wife through her decision making process- regardless if that meant her working full time, part time, semi retirement, full retirement or even me stepping away from my practice.
Pertinent to the purpose of this blog- financial security allows you to make the best choice for yourself and your family.
It was easier for me since I was in my 50s already. I also had the alibi of a chronic illness which is known for causing chronic fatigue. However I acknowledge that I would have ignored that fatigue more if I were hungrier and needed my pay more, and I slogged through until I vested in my government pension. When I was running for office a contrarian student in a history class at the local Community College asked if I was wasting the community’s investment by switching from medicine to politics. I considered this, and that the state of Pennsylvania had subsidized my initial education in medicine without ever having my medical services in that state, and that the US Army had also subsidized that education and received in full the seven years repayment which I had agreed to in return. I also considered, if not in my own career certainly in that of the average doctor, my 20 some years in medicine at much more than 40 hours a week was as many hours as 30 or more at a 40 hour work week. Plus the many earlier hours at our studies! I also feel that the contract we made, when I entered medical school, involved a lot more time with each patient and a lot less paperwork than now expected and required. In other words, society and medicine broke its contract with us; we knew about the long hours but did not expect so many of them would be acting as secretaries and rushing our patients through.
I was terribly hesitant to give up medicine until the last few years, and maintained my licensure and volunteered to maintain my ability to stay qualified including going through medical training during four years in the United Kingdom to be able to work there during one of my husband’s tours. I had always wanted to work part time well into my 70s. However no one would pay me (no one with crown immunity anyway- already FI, I was unwilling to risk our retirement for what was basically a hobby for me) to work part time. COVID, the schedule, my fatigue, my husband’s retirement in his 40s!, and coming grandchildren as well as vesting in the civil service pension and able to add in my military years cemented my option to leave.
Again, it is a shame that those of us who trained to practice medicine decide it is no longer for us at ages earlier than our disability hopefully in our 70s or later, however medicine has not made it attractive enough for some of us to overcome the hardships of continuing once we are FI. In the UK they made an effort to keep doctors in the system, and it was much easier to work part time. They had subsidies for doctors returning to work and it was incredibly easy for me to have affordable reliable malpractice and to pick up locum shifts and after hours urgent care.
So here I am at 58 probably about to drop my license and give up medicine permanently. Perhaps I will schedule one more meeting with my local military clinic to see if the current Commander and Primary Care Chief can think of a fairly painless way for me to contribute. Their track record is poor: when I first started volunteering there the risk management fella thought I would pay for my own malpractice to work there for free! Also, coming in every few weeks, without the current home computer access they offer, I would find that my results had not been addressed as agreed, including a fella whose cancer work up only occurred each time I came in and reviewed my piled up results. Thankfully negative!
You should address the elephant in the room intimated by this post, which is women in medicine drop out at a vastly disproportionately higher rate than men. The implications for both the cost of medical education and the availability of doctors is huge, especially considering the majority-women graduating classes. It’s probably the single most important issue in the current and future lack of doctors, and yet people are scared to point it out.
You should address the elephant in the room intimated by this post, which is women in medicine drop out at a vastly disproportionately higher rate than men. The rate of part-time work is equally disproportionally female. The implications for both the cost of medical education and the availability of doctors is huge, especially considering the majority-women graduating classes. It’s probably the single most important issue in the current and future lack of doctors, and yet people are fearful to point it out because it’s not politically correct.
Definitely some serious work force implications there. I pointed that fact out on Twitter a week or two ago and was called “sexist.” I engaged the person and in the end I think she agreed pointing out the fact is not necessarily sexist, but a lot of the reasons women leave the career or go part-time might be sexist, both at work and at home.
This is malinvestment by society. Women are much happier being stay at home moms than they are being doctors. The women I work with are miserable. The only happy ones are married to other specialists and only work part time. 100% of my med school cohort women who did not marry doctors (or other ultra higa income professionals like attorney, private equity) all got divorced. 100%. One went catatonic while at work after her 3rd round of IVF failed. This is clownworld.
Is there any shame in forcing your wife to work while pregnant anymore? What about the risk to the baby?
If society wants to get serious about fixing this problem, medical schools need to:
1) stop discriminating against straight white men. (I was one of four gentile straight white men in my program. Out of 90. LOL)
2) allow more people in general to become doctors and reduce barriers to entry to medical school- we can replace NPs, PAs, and even some RNs with associate physicians.
3) stop encouraging women to apply, tell women: “this is going to negatively effect your ability to have a family”
4) end PSLF
5) cap tuition at the federal level, the med schools will learn to survive with less “administrators”
I sure I just touched a third rail noticing these things, but we’re just entrapping people in miserable situations if we can’t be honest about it.
My sister graduated with honors from an Ivy League in 3.5 years, and made it into the best medical school in the country. She is still practicing medicine after 25 years, putting in longer hours than most. Despite all of this, I can’t begin to tell you how many white men have said to her and her family that it must be nice that her gender paved the way for her getting to where she is in life. And the irony is, despite knowing all of this, these men could only surmise they were victims of “white male discrimination”. Talk about entitlement.
[Anonymous, inflammatory comment deleted and IP address set to moderate all comments prior to publication.
If you can’t say it nicely, don’t say it at all.]
Understood this comment got deleted but I’ll respond anyway…
I will admit there may be reverse discrimination in higher education student admittance practices, as soon as you admit that there are women who can make better doctors than you.
The effects of pregnancy are highly variable from woman to woman, with some saying they never felt healthier while others are vomiting all day. I don’t know what the studies say as far as stress and miscarriage, I don’t doubt there is a correlation. And I appreciate your concern for women’s health. However stress is not good for anyone regardless of your gender. Hence the multiple posts on physician burnout that are non-gender specific.
I think the fact that women are choosing to work part-time in medicine is a good thing. It’s a testament to the fact that there are more things in life than making alot of money. Especially if these women are still carrying the work of home life, they are still making that home life a priority. A stable home life is good for society in general. If more physicians are choosing to cut hours or retire sooner, all that means is there is more of an opportunity to produce more physicians. It seems that medical schools aren’t keeping up? Don’t know what the statistics are on that.
There are plenty of women, mothers and childless, that would prefer to stay at home and there’s nothing wrong with that. But I’m not sure ALL women are happier staying at home, especially if their spouses are at work all the time. Have a look at the blogs of some stay at home women…
As far as my sister, she had the benefit of family to help with the kids when they were young. But now her kids are teens with lots of after school activities that keep them busy. She manages stress by waking up a bit earlier than the rest of the house and exercising. She doesn’t drink alcohol. She’ll also be the first person to tell you she doesn’t regret it despite the difficulty of practicing medicine.
It isn’t a medical school problem, it’s a residency problem. Medical school enrollment has gone way up but residency size hasn’t changed much, thus the climbing unmatched rate.
“as soon as you admit that there are women who can make better doctors than you.“ You’re attacking a misrepresentation of my argument.
“But I’m not sure ALL women are happier staying at home.” This is the NAXALT fallacy. Not all “X” are like that.
@The White Coat Investor:
I understand my views are unpopular, but to call them “inflammatory” is dishonest. You can’t suppress the truth forever. I understand that the truth might be bad for your business, so I won’t post here anymore.
I’m amazed you want to comment here without moderation so badly that you have gone to a new device to do so after I set comments from your first device to be moderated prior to posting.
Your lack of insight into how rude and inflammatory your anonymous postings are is also amazing. You’re welcome to post your views. You are not welcome to do so in the manner in which you have in the past. As my wife often tells me, it’s not what you say, it’s how you say it. Calling me dishonest and greedy for maintaining an appropriate professional decorum says more about you than me.
Look man, I’m just telling the truth. If disagreeing with the groupthink or having an unorthodox opinion is rude or inflammatory- what does say about the current state of affairs? I never called you greedy- I just said I wouldn’t post here anymore. Is knocking down straw men the m.o. around here? If you want to pretend that “ [I’m] welcome to post your views,” don’t resort intellectually dishonest arguments when I do. All I meant to say was- I was surprised at the hostile reaction to my post. And out of respect for you and your business, I wasn’t going to post here anymore. I didn’t realize how controversial and “inflammatory” the truth was going to be!
Also- I’m posting under a pseudonym; not anonymously… for the same reasons Alexander Hamilton (who became the first U.S. Secretary of the Treasury), James Madison (who became the fourth U.S. President), and John Jay (who became the first Chief Justice of the U.S. Supreme Court) published the Federalist papers under the name Publius… I’ve attended 2 of your in-person conferences. We’ve shaken hands.
Also: I’m not using other devices- I just use my iPhone. You might want to get something stronger in place if you have to deal with a real troll.
Peace.
Yet a third IP address….
“I understand that the truth might be bad for your business, so I won’t post here anymore.”
# 1, you clearly didn’t mean it when you said you won’t post here anymore.
# 2 What exactly did you mean when you said the truth might bad for my business and that’s why I’m deleting your comments if it isn’t that I care more about money than truth? Just because you didn’t use the word “greedy”…
Your comments were rude. You owe someone an apology. I doubt it is something you would have said face to face and I think that’s pretty clear by the fact that you are hiding behind a pseudonym on the internet. You haven’t even left a real email address, meaning you don’t even want ME to know who you are, much less the rest of the world. Although I suppose it wouldn’t be very hard to figure out who you are at this point. There aren’t that many people who have attended two of our conferences who live near Walnut Creek.
Affirmative action is the reason people look at her this way. End AA and there will be not doubt of ones ability but as long as it exists the will exist doubt.
Really, you must be kidding. Why do you think affirmative action came about in the first place? And this whole thing about “ability”….when cronyism and inside connections seize to exist, we can talk about people’s abilities. Currently dealing with an inept, entitled young engineer at work who thinks he can pick and choose what work he does because daddy’s buddy got him his job. Remarkable you choose to pick on affirmative action as the problem when this sort of favoritism continues to exist.
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“Women are much happier being stay at home moms than they are being doctors. The women I work with are miserable.” There is a reason for this that all the male posters are missing–often a female physician will have TWO full time jobs–one paid job as a doctor, one unpaid job as a mother and household manager. This is a recipe for burnout at work and divorce at home. I was able to spend two weekdays a week with my first child but that meant working every other weekend, two 12 hour weekdays and a 6 hour weekday every week for years. When the second child came along, I found a position with no nights, no weekends. Husband was busy with fellowship, then setting up and growing his practice. In spite of working as many hours weekly as he did, I cooked every meal our family ate, did the grocery shopping, cleaned the house, did all the laundry, drove the kids around, made doctor and dentist appointments, planned birthday parties, holidays and family events, etc. None of this was important enough for my spouse to do as well. I lost it one time when he said, “I help you with the children.” My response was, “The children are not my pets!” I used to go to sleep at 1 a.m. after doing chores all evening and finally taking a shower long after everyone else was asleep and then get up at 6 a.m. to start our day. I was taken advantage of for 16 years then finally kicked him to the curb. Wish I had done it a lot sooner. Now in a happy second marriage, we decided to retire my husband early (at age 57) so he is now a House Husband. I work full time, he takes care of cooking, cleaning, shopping, managing, organizing. I enjoy my job, provide excellent medical care, make good money and he likes having time freedom and making my/our life easier. Gives new meaning to the old adage “Every doctor needs a wife!” Creating more family friendly positions for both female and male docs (part time, job shares, etc) and supporting family needs (on site day care, plenty of vaca and flex time) as well as not burdening young docs with hundreds of thousands of dollars of student loans so they have more freedom to create their ideal medical career will serve everyone better, doctors and patients alike.
That’s funny, one of my partners often says she could really use a wife. I agree two careers are really hard to balance with raising a family. Katie and I are getting to experience that these days.
I have definitely had this thought despite the fact (as posted above) that both my husband and I contribute a lot to the management of our dual-physician household. There are some things that would be really nice if neither of us had to do! A nice option is obviously outsourcing which costs some money but really not that much in the grand scheme of things. I would personally rather continue to do the paid work that I enjoy and pay someone much less than I make to clean the house and take care of the yard. We both like to cook so we meal plan and cook >95% of meals at home, but our nanny helps w grocery shopping. I like being there for my daughters doctor appointments and have enough flexibility in my schedule that this isn’t a problem. We are fortunate in that our jobs allow us both to be home by 5:30 almost every day with no nights and minimal weekends. I am sure this makes a huge difference, but lifestyle played a factor into our career choices so it was intentional.
I feel like a hear a lot of these stories.
I watched a netflix series on about pandemics (the flu, specifically) and there was one tough woman who was committed to “doing it all” in her small town. She worked crazy hours and in tough conditions because there were not enough doctors in that area. In one of the scenes she is describing her husband coming to have dinner with her at the hospital because otherwise she would never see him. I was shocked to see SHE was cooking dinner in the breakroom while he was watching TV. This was not even the point of the scene and was never mentioned; it was just background.
That’s wild. Sad. Wildly sad. But it’s interesting to see what was considered progressive just a generation ago.
Not sure what the deleted post said but this should have been deleted as well. “Tell women not to apply” are you kidding me? As a female physician mom I can promise you I would be much more miserable as a SAHM…have you ever spent 12 hours straight with a 3 year old? I love my daughter and spend copious amounts of time with her and am expecting more children and to grow my family while continuing to practice. But I do not need to spend 168 hours of my week with my children. My husband who is a GI physician (and makes more $$ and publishes more articles than me) also spends lots of time with her, cooks dinner regularly, does his own laundry, and is an equal partner in managing our very well run household. I think this is key to my happiness at work and home. If all of the home stuff was on me yes it would be miserable and stressful.
I feel the same way. As much as I love my kids, I don’t know that I’d be happy as a full-time SAHD. So I’m not surprised that lots of women feel that way.
As far as deleting comments on the site, I don’t delete them just because I disagree with them. They mostly just get deleted for ad hominem attacks and profanity and even then if it’s possible I try to save the gist of the comment.
Yeah, the elephant in the room is illegal to take direct “ok no women in med school” action on. Addressing the sexist causes for it, in society or at an organization, are long-term and local only fixes respectively which don’t address personal family sexist issues. Locally, having outstanding subsidized 24/7 and illness back up daycare keeps nurses etc showing up for work and not deciding it just isn’t worth the hassle on the family to keep working. High(er) pay keeps the decision weighted toward staying in a job. Not legal to hire only sterilized or permanently single or postmenopausal or lesbian or married to a low earner females (and all of them might gain a child some other way or due to family decisions- some entrenched in the sexism of their partner or even the female herself- be the one to quit working to do elder care).
As a committed feminist (want equally/ equity and equal opportunity for the genders) I want all docs, not just female, with healthier, family friendlier schedules and support for our patient care work. I hope rising docs all spend more time, AWAKE, with their family and hobbies than did the docs I knew as the friend’s dad asleep in the living room or plain absent when I was growing up.
I have long recognized that I might be working a lot more, a lot longer, were I paid much less. Society seems to be implementing that strategy to get more time in service from docs/ doc substitutes.
In our family BTW please note that the man retired 10 years younger than me, but certainly I did plenty of part time.
Is it sexist to point out that I have multiple female partners that put in 12-20 hours per week less of face time at the office (as Full Time Equivalents) and that the male doctors have that much more work to do to “balance the scales”. It’s not just childcare either as I have multiple children of my own and that much less time to see them. A lot of our work these days are phone messages, staff responses, patient emails, etc…, none of which impacts our RVU’s and all of which require responses.
Your practice lets some docs work 20 hours less and still remain full-time? Sounds like a management issue. Unless you’re being paid on productivity that sounds discriminatory, no matter what the genders.
Pardon Dr. Dahle, but I thought physician burnout was a real thing that you’ve covered repeatedly on your blog, podcast, etc.? I’m pretty sure the spinoff medical finance bloggers that frequent your site are more commonly male and some no longer practice medicine either. How can you say that the rate at which women physicians go part-time is a concern with respect to work force implications when you yourself are practicing part-time too? Why is it that you don’t bring up this same concern about male physicians-turned-entrepreneurs robbing the field of medicine of their expertise?
I’m not trying to be a jerk here. Everyone is free to choose the life that works for themselves, their families, and their communities. I’m trying to point out that these assumptions and concerns are not well-founded.
I’m a big fan of part-time practice, no doubt about it. The first thing I tell burnt out docs to do is cut back to full-time.
At any rate, the work force implication is a simple multiplication problem of the two trends we see: Higher ratio of women to men in medical school classes and more women going part-time or leaving medicine all together within a few years of completing training. When you look at the broad numbers, you realize there are implications. That should not be reduced to anecdote that some doc is doing something wrong by doing what is right for them. I don’t see anyone going part-time as “robbing the field of medicine.” But when you look at all the docs going part-time, you realize there are fewer doctor hours happening.
There is a third trend you mention that we should talk about though that will also have an impact–more docs of all genders are going part-time. It went up among docs in large groups from 13% to 25% just from 2005 to 2011. I’m sure it has continued to climb since then.
https://www.acponline.org/system/files/documents/running_practice/practice_management/human_resources/part_time.pdf
What to do about these workforce implications, if anything, is an open question. But pointing them out is no more a jerk move than it is sexist.
As far as “male physicians turned entrepreneurs” I’ve never seen a study showing it was a big problem. I can only think of a few handfuls of them honestly and I know just as many female physicians turned entrepreneurs. I’m not sure that’s really an issue.
Furthermore, I don’t doubt the stress of the pandemic on healthcare workers will only further exacerbate the downward trend.
I’m a software engineer, so my experiences are different, but I can totally relate to being burned out. In fact, I’m so burned out right now that I’m in therapy. After fixing the 100th bug and watching the organization make the same mistakes over and over and dealing with escalations from frustrated customers, you just want out. I could leave, but I’m not sure other places (in silicon valley) are any better.
Covid maybe over (or winding down one way or the other) but I can’t shake the feeling that people are on edge and everyone could do with a nice long sabbatical.
FYI- covid ain’t over.
I did add a caveat in brackets – it’s winding down, one way or the other.
Yes, that caveat is doing a lot of carrying. The people who are going to get vaccinated are going to get vaccinated, and the others are not. There is still going to be loss of life and hard work for you docs before it’s all over, but I’m not going to dwell on stuff I cannot control.
Does anyone have resources or information on how one would go back to medicine if one was so inclined? If I FIRE and haven’t seen patients for five years is there an avenue back?
You may be able to practice supervised for 6-12 months and get back in. I know a surgeon who did that after 3 years off to do a non-medical mission.
You could make sure to maintain your licenses, board certification and contacts…. I self managed my own reentry to medicine after 3.5 years off clinical practice… (I am not in a procedural specialty.) Google physician reentry – it can be very expensive… so be careful.. you could maintain some type of clinical work even just 1-2 days a month or volunteer work to keep your skills or do telemed per diem (not sure if you’re in a procedural speciality)
Thanks! That was helpful
I volunteered a few days a month when I was getting too many months into my sabbaticals. Main issue is reassuring employers you weren’t institutionalized (jail or mental hospital), but I am/ was FP and no procedures.
Wow. I did not know that John Gruden was a med school graduate. Hoping that post was an attempt at humor.
I would not stop practicing with a thought of coming back years later. Medicine moves fast and becoming competent after a layoff can be difficult, if you can do it at all. Once you fall behind it can be hard to catch up. For the spouse who is leaving medicine, working part time apparently lead her to lose her touch. Now change from practicing a day a week to sitting on the medical sidelines for a year or longer. Not just technical skills would fade.
I would hesitate to hire someone who had been out for more than a few months. Time off for a new baby is one thing. The mom docs I have known remained fully engaged while on leave and got right back in the groove when they returned. Being off for a year? I would worry a lot. Even more if the person had done nothing clinical at all during that time.
A better solution would be to pay for more child care and keep practicing enough to remain sharp.
One puts a huge amount of time and effort into becoming a physician. I would be reluctant to throw that away.
Well…I thought the article was good, but was curious as to why there were 30 comments as it didn’t seem like one that would generate a lot of comments. Now I know. That was fun.
I commend the post’s author for a thoughtful, nuanced discussion.
RE: finances and factors leading to women leaving medicine.
I am an attorney. From reading this website, my view is that the median doctor works much harder than the median attorney. Even so, one attorney coach/law firm development consultant, has a module on the importance of hiring a household manager. The lessons talk about how to interview for the position, who to hire, what kinds of tasks to delegate, and how to be efficient about management.
I don’t recall seeing any similar posts here. I don’t think it’s crazy–particularly for dual physician covers with children–to hire a nanny/household manager/cook/whatever.
After being exposed to the idea, we’ve hired someone to handle dinner meal prep a couple of times a week, and stopped second guessing whether the housecleaner should come every two weeks or every three weeks.
Some of these intermediate steps, earlier in the author’s journey, may have resulted less strain on the family, even if the couple ultimately would make the same decision.
Also, and unrelated, your wife, should she be interested in working from home, could make decent money explaining medical records to attorneys on a part time 1099 basis. We all have that need and are happy to pay for it. It would be as simple as calling the top 10 law firms on google in your market.
Sounds like a great guest post! Want to write it?
https://www.whitecoatinvestor.com/contact/guest-post-policy/
The post author stated that his wife worked as a “PA in the ED”–curious if attorneys/law firms consult with PAs as often as physicians for explanation of the content of medical records?
Never heard of one doing so.
I am a female physician. I practiced as a PCP for 11 years before I burnt out. Being a PCP is one of the hardest and most poorly compensated fields of medicine. I was tired of the constant documentation, bickering about call coverage , endless long forms and at the end did not want to be a Percocet vending machine. I think at the end of the day it’s the hospitals, ambulatory centers, outpatient radiology centers who overcharge. Most people think doctors are responsible for these charges. We are NOT and we are all employees. Private practices are rare these days. Ladies please think of alternate careers. It’s just not worth the stress. We have a shortage of PCP’s in this country. The day our work environment and compensation models improve, we will be back.
I’ve hired nurses and PAs to help explain records to me. Often there is a component of organizing and condensing records too. So shrink 1500 pages of records into a 30 page narrative with the key records highlighted. Answer my dumb questions to help me prepare for a deposition. That kind of thing. $75/hour on a 1099.
Some nurses estimate medical costs or testify as to whether expenses are reasonable. Usually those nurses have access to a database and some credential. I haven’t done that as much.
As far as opining on what medical care was necessary, or what the future care is, that is something only a doctor is able to do. The nurse/PA is more of a background consultant to help me figure out what I don’t know.
The wrong question is being asked here. Unless you assume as some here seem to that women as less capable to be physicians than men are.
The right question is what is occurring in the system of medicine (or society) that is leading to the higher rate of women leaving medicine (if this is actually true, and not just anecdotes).
Realize how we practice medicine was developed in a society that excluded most citizens (whether by gender, class, race…). Though the access has improved, it can still be that the structures and expectations are still set to meet the needs of the past.
So in effect it was set it up as system without women, that is inherently more difficult for women, and then blame the women for having more difficulty.
And yes, ultimately you are at risk for having your explanation being labeled as sexist if you blame the gender, not the structure that is creating the outcome.
Thank you! This is why we recognize that when there are no or much fewer women’s restrooms in Congress, or none permitted for colored women in their building at NASA, that was a system barrier for women working there rather than a problem with women/ Black women.
Beyond that though the old structure counted on men with maids, at home wives, children used to rarely seeing them, and higher pay which made all that easier. Even male docs nowadays are much less likely to have or want every aspect of that.