I'm not apologizing for my part-time role in medicine

Over the course of pre-professional and professional education, my colleagues and I have had numerous moments of self-doubt. Would the next organic chemistry exam eliminate my 3.99 GPA? Would the MCAT decide what medical schools would immediately ignore me without ever meeting me? Would the sheer volume of material weed out the persons sitting next to me in medical school or would it weed me out instead? Would being yelled at by surgical residents, OB nurses, OR nurses, heck any nurse, do me in?

Would the presentations I made from medical school through residency to my attendings show that my fund of knowledge wasn’t encyclopedic enough? Or, despite all of that, would I find my place and offer sound care to the person before me?

Never did I think about this from the angle of being a woman in medicine (except, perhaps, the catty interaction I and other female colleagues encountered with female nursing staff or the chauvinistic overtones or undertones of a medical dinosaur). But, to read an article, from a female colleague apologizing for being part-time was too much. I know where she is coming from and why she did it. But I want her and the other mothers (and fathers and daughters and sons) in medicine to not apologize. There was no one we sold out to.

I was asked this specific question in my interview for a hematology-oncology fellowship in Chicago: “Aren’t fellowships wasting their time training female physicians if there are just going to go part-time? Shouldn’t we take people that will be full time and contribute the most to medicine?” After I closed my invisible jaw-drop, I answered.

“It depends on what you call waste. If we look over the history of generations and civilizations, educating women has been the single most important improvement in family and communal health. If you look at a society, having female contribution has enhanced social dialog and improved justice for countless disenfranchised groups. If you look at medicine, women in medicine, as daughters and mothers, often bear the weight of their family’s health as well. Be it going to an OB/GYN themselves, taking children or parents to medical visits, or urging spouses to seek attention. Women interface with medicine on both sides. As physicians and as receivers of health care, they toggle both worlds, empathetic to both. This has a profound impact on the care they deliver and the scholarly contributions they make.”

“In contrast, if you look at academic medicine, those at the pinnacle of success don’t even really see patients. But we don’t consider their education and training a waste. If I go part-time, I help my family. And if I help my family, then that means that I was around enough to give my children a moral compass to become contributing members of society. And maybe it also means that they won’t suck your money or my money for their self-loathing behaviors that require mental health services or substance abuse counselors. Finally, if I go part-time I still help my patients — the ones that you may have stopped seeing to do your research.”

“The problem here is not women, but the fact the every educational system has decided that the best time to be educated is in the 20s, squarely overlapping with maximum female fertility. So because society has refused to change, women are forced to constantly make a decision between career and family. In Italy, there is little support for childcare and most women never return back to the workforce. But in Finland, after well supported post-partum care and where childcare is a guarantee, the majority of women return to the workforce. Social studies have shown that while men may contribute most, and improve their earning potential most, in their 30s, women do so at just the same pace (if given support) in their 40s. And with women living longer than men, this can all even out. But most societies have refused to acknowledge this. And American medicine is no different. So to answer your question: No, it is not a waste to educate me. I will contribute as much as my male colleagues if you just know what metric to use.”

Oh, and I also said, “Just remember that you should, ask this question of your male applicants as well. They aren’t planning to work crazy hours anymore either. And you should ask them how they will also contribute to society and family outside of their career. The people with the most death bed regrets are ‘successful men.'”

A few final points. Physicians in medicine talk so much about what we need to do help our patients be healthy and do very little of it ourselves. I am supposed to breastfeed my children for at least one year. Damned if I could only get in 6 months because finding time for another “bodily function” in fellowship when no one else was taking a break was challenging.

We’re supposed to sleep. Yeah, right. Nocturnal work is associated with increased risk of prostate cancer and cardiac disease. The list goes on. So I’m not going to apologize for not killing myself, and taking the tortoise approach to making my career contribution to medicine.

Finally: Just remember I didn’t sell out. Lest we forget who truly sold out. I can list out a whole number of people who should apologize to medicine for killing its calling and its valued role in personal and societal health:

Dr. Mehmet Oz
Dr. Andrew Wakefield
anti-vaccine MDs and DOs, like Jack Wolfson
every MD (and PhD) who falsely reported on a clinical or non-clinical trial
every physician who took countless amounts of gifts from big pharma without full disclosure
every physician who lead to the creation of Stark and anti-kickback laws
every medical litigator that makes going “naked” without malpractice insurance the more attractive option
boutique medicine before managed care
every not-for-profit hospital that is in the black because of the way they cherry-pick outpatient follow-up patients (leaving some hospitals permanently in the red for being everyone’s safety net)
every cancer center that advertises procedures and treatments that are not cost-effective or clinically significant in prolonging overall survival but highly reimbursed
specialists who don’t take inpatient consults
psychiatrists that only take private pay
plastic surgeons that focus more on cosmesis than reconstruction
cardiologists who over-stents and gastroenterologist who over-scopes

20As of July this year, I will be going part-time as well I have looked for the part-time hematology-oncology track, but to no avail. So rather than leave medicine altogether, I’m going back to internal medicine.

Is that a waste of my education? I’m actually not asking. If I can save one patient from picking chemotherapy over hospice, I think my contribution will still be an excellent one.