I just finished the just profoundly awesome article “Why Women Still Can’t Have It All” by Anne-Marie Slaughter, in this the Atlantic. This is the article that has all the buzz going about professional women and work/life balance.

It has taken me a full week to finish this article, reading in bits and snatches before work, between patients and after work. I finally got through all 6 pages. Totally worth it. She says what I have been feeling and trying to voice to the women coming up the ranks of training in medicine.

Though I disagree with one fundamental point. She feels that most women can’t Have It All, and by All seems she means breaking into the higher echelons of their professions, making the highest possible achievements. I agree with her on this.

My feeling is that All can mean something else. All, to me, means achieving total personal and professional fulfillment. And this does not have to mean being the CEO/Secretary of State/Department Chair/Nobel Prizewinner.

When I am asked advice by pre-meds or medical students considering a career path, I hedge my response based on their answer to my questions: “Do you have or want to have a family? And do you want to spend time with them?”

There are few professions that require as much schooling as medicine. It took a long time for women to get into those schools, to break into the profession. Women now comprise 50% or more of the students entering medical schools. However, we still don’t see many women in positions of power in medicine or in certain subspecialties. While women in medicine has been a long time coming, women in power positions in medicine, and women  in certain subspecialties, may be a long time coming yet. The basic reason? The paths to those positions mean too great a sacrifice at the expense of a family.

I wish I could say to any of these incredibly bright, hardworking, determined women that “Hey, with enough brains and hard work and determination you go anywhere in medicine!” But that’s bull, and Anne-Marie Slaughter says so in the pages of the Atlantic.

But they can have it All.

If All means achieving personal and professional fulfillment, of finding that elusive work-home balance, then I’d say, it’s entirely possible, but think it through very carefully. Look to the future.  Look to the women who are working and practicing doing what you want to do. What kinds of positions are available? Is anyone working part-time? Are family values promoted and respected? Would you be expected to be at work and working endless hours? Is there a lot of call? Would you need to go into the hospital unexpectedly?

If women have or envision having a family someday, I ask them to think really hard about the kind of life they imagine. What kind of a partner do they or will they have — is this someone who can stay home when the baby is sick, it’s a snow day, there’s an unexpected holiday, or they are sick? What kind of partner and mother do they want to be — do they want to be present, participating, reassuring, enjoying family dinner, tucking in? If so, can that vision fit with the lifestyle of the specialty they’re considering?

When I was interviewing for jobs four years ago, I had just come out of a research fellowship, and I knew that life wasn’t for me. Very competitive, getting those grants. I also saw women MDs who aspired to be Heads of Something, or Experts in Something Else, and I knew I didn’t want to do that either. I knew I wanted to focus on family as my priority, and to work part-time at a clinical practice with a good “vibe”: supportive, flexible, Mom- friendly.

I had to really search. I hired a professional job headhunter guy. He kept sending me listings. Some places wanted me to work 10 clinical sessions a week! Others had 1 week of call a month. Ugh.

Now, I’m a part-time internist, with two little kids. I was lucky to have found work in a small, progressive practice, 5 sessions a week, with 1 week of call every 3 months. The vibe? Well, just this morning, I met with my practice head and explained our situation:

Our two-year-old isn’t talking. He’s been diagnosed with severe delays in receptive and expressive communication, as well as some cognitive delay. He’s eligible for all kinds of services. We’ll be taking him to speech therapy and group therapy at least … and before that, he needs hearing testing, a developmental evaluation, etc. We’d also like to get him into some other activities to help him start communicating. This will all take some time, and time involves rearranging my work schedule. Like, dropping my Friday afternoon clinic.

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My boss was great. There was no issue here. The support was 100% there.

All, to me, is where I am. Yes, I had to search this place out. Yes, there is tweaking here and there. I’ll be glad for a promotion and a raise when it comes. I’ll be glad for some adjustments to my schedule; a decrease in clinical time and an increase in admin time. Work sometimes edges into home, and home into work; I think that is natural and inevitable. But I consider all of that to be fine-tuning of an otherwise really excellent arrangement.

Can All be as easily achieved in all the areas of medicine? I don’t think so, not yet. So my advice to those making their way up the ranks is to think about what will bring you personal and professional fulfillment, and to work towards a healthy work/ home life balance.

It may be that practice arrangements like mine in medicine are few and far between, but I see them popping up here and there in primary care. Where they are not, then shift work, as in emergency or hospitalist work, may be far more inviting to the aspiring physician-mother.

But maybe someone is driven to be the Head of a Department or the Expert in Something, and they feel they will not be happy or fulfilled until they have made the achievement; AND they want to have a family. In that case, I think the choice of a partner, living close to extended family, and a very organized schedule could help. Personally, I don’t believe that these external professional achievements give one true life satisfaction. I think many of us start off thinking they do, and hope they do, but then realize, they don’t. Family does.

My way of seeing this: I was trained to do a hard job that I loved. I also wanted to have a strong, healthy family. So for me, I chose carefully. Now, I am doing the job I trained to do and that I love, I do it well, in a great hospital and positive environment. I also spend a lot of quality time with my two little kids and my husband and my extended family. “A lot” to me is what I need. I get the time I need with my family.

So I feel very lucky. I have it All. I think we all can, even in medicine, but it takes looking to the future, thinking hard, being honest, and choosing carefully.

“Genmedmom” is an internal medicine physician who blogs at Mothers in Medicine.