My hope for the upcoming generation of physicians

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.

But from my vantage point, the young physicians I see in their 30s who are newly married, buying their first homes, and starting families, tend to have spouses who don’t work outside the home or who earn less money than they do. These young physicians work very hard indeed, and take their professions very seriously. And very many of them–not all, but many–are men.

Some people take offense at hearing the simple truth that younger women physicians as a group tend to work considerably less outside the home than male physicians. That data is well documented by the AMA, Medscape, and other sources. Anyone who chooses financial dependence on a higher-earning spouse must be an optimist with great faith in marriage and in the stability of the spouse’s job and health. Perhaps I’ve seen enough marriages fail and lived through enough recessions to be skeptical. It may be harder to return to practice than you think, if you haven’t devoted the time to gaining expertise and building your career early on.

I have friends who practice medicine in Silicon Valley, and if you get a few drinks into them they’ll regale you with stories of young, attractive female residents who marry wealthy dot-com husbands and are never seen in the hospital again. It will be interesting to see what Mark Zuckerberg’s wife, Priscilla Chan, does with her pediatric training. She has a tremendous opportunity to do good, and I hope she follows Melinda Gates’ example. I get tired of hearing from women physicians who use the excuse “I married a surgeon” (or any other busy, ambitious breadwinner) to justify backing away from their professions.

It’s fascinating to read the flurry of publications and blog posts in reaction to the opinions of Anne-Marie Slaughter, Sheryl Sandberg, and Marissa Mayer. I agree with Princeton’s Professor Slaughter that you can’t have it all, though her solution–to make your schedule as flexible as possible, and work at home as much as you can–is woefully inapplicable to medicine. I certainly agree with Facebook COO Sheryl Sandberg that if you don’t “lean in” to your career early, you may not have a career to lean into later on. And I’m not reflexively critical of Yahoo CEO Marissa Mayer’s decision to stop letting Yahoo employees work from home at will. Not everyone has the self-discipline to work from home, and it should be viewed as a privilege, not a divine right.

But enough about women. Let the record show that I don’t think much of the current trend among young men or women to get joint degrees along with an MD in order to give themselves an escape route from the tiresome business of taking care of patients. I’m not sure the world needs more MD/MBAs, and I’m quite certain it doesn’t need more self-designated “thought leaders” to tell the rest of us what to do. To those who just want an MD as an entry ticket to a lucrative career in biomedical industry, to starting their own dot-coms, to a hospital corner office, or to a comfortable job with the Joint Commission–could you please stop and give your spot in medical school to someone who genuinely wants to practice medicine?

As far as work-life balance is concerned, I would be the last person to say that I handled it flawlessly. Doing full-time work in high-risk inpatient anesthesiology in a tertiary care medical center means that you get to work very early and never know with certainty what time the workday will end. I wish I liked outpatient anesthesiology better, but to me it’s boring, so night and weekend calls have always been a factor in our lives. I can think of a dozen motherhood challenges that I wish I had managed better, and I’m sure my children could think of many more.

My oldest child loves to tell the story of how she developed an earache at age 12 or 13 and I, distracted, kept telling her it would get better on its own. When we finally made it to the pediatrician, he turned to me with some disapproval and asked, “How long has this been going on? Her eardrum is perforated.” My daughter said, “See? I TOLD you so,” and gleefully has never let me live it down.

There were bigger crises too. Our second child died when she was five months old, and I’m certain that going to work every day thereafter helped me carry on through that terrible time. My oldest daughter had to weather the family’s grief at the same time she faced the onset of adolescence, and the younger two eventually had to deal with the consequences as well. As they entered their teenage years, I told them without sugar-coating that there is only one rule: Nobody else in the family gets to die before me. When you think about it, that’s the perfect rule. It covers reckless driving, drug abuse, unsafe sex, hang-gliding–you name it. If anything you’re thinking of doing could possibly lead to your death before mine, I explained, you’re not allowed to do it. This saves a lot of argument and negotiation. My son told me years later that as his car spun out of control in the rain late one night, his first thought was, “If I die, Mom’s going to kill me.”

My son survived that and other adventures. Now, the occasion of his admission to medical school is time to celebrate, and allow myself a moment to think that I must not have done everything wrong. Certainly I didn’t take care of the children alone; you need the right husband, and it really helps if he can cook. All three of the children grew up with the knowledge that “OK” isn’t good enough when it comes to work that matters, and you can’t quit until the job is done right. All three took responsibility for their own successes and failures. All three wrote their own college admissions essays. My older daughter has a master’s degree in health care administration, a full-time job, a wonderful husband, and two little boys of her own. Her younger sister graduated in 2012 with a degree in art history and faced the worst job market in decades. Through her own initiative she landed a full-time job–with benefits–in a design and advertising firm.

Here’s what I hope for the upcoming generation of physicians, men and women. I hope you love and value your work as much as we did coming up through the system in the 1980′s, and that the Affordable Care Act doesn’t completely ruin American healthcare. I hope you spend enough time with your children to make your family happy, and not so much that your children feel smothered or start to believe that they can’t handle their own challenges without your constant intervention. And most of all, I hope that when you celebrate your 30th anniversary of graduating from medical school, as I did last year, you have no regrets over how you have chosen to spend your life. Best of luck.