Gender inequities and being a physician-mom [PODCAST]

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“As the COVID-19 pandemic unfolds day by day at an exponential rate, we as doctors have been called to duty in unprecedented ways. Speak with any physician in the last few weeks, and you will be hard-pressed to find one who didn’t feel an intrinsic obligation- indeed, wish- to rise to the occasion with an all-hands-on-deck attitude, despite the taxing and indefinite toll this will take. Speak with any physician mother, and you will quickly see that our intense drive to lead on the frontlines is matched with an equally intense anxiety about protecting and preserving the wellbeing of our families. Indeed, for most of us, the conflict between being a physician and mother has never felt greater.”

Tamara Goldberg is an internal medicine physician.

She shares her story and discusses her KevinMD article, “The duality of being a physician-mom in the age of COVID-19.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Tamara Goldberg. She is an internal medicine physician, and she wrote the KevinMD article “The duality of being a physician-mom in the age of COVID-19.” Tamara, welcome to the show.

Tamara Goldberg: Thank you, Kevin. Great to be here.

Kevin Pho: So we’ll get to the article in a bit, but first off, if you could share your story and your journey to where you are today, that’d be great.

Tamara Goldberg: Sure. So I am currently the director of the primary care track at Mount Sinai Morningside West internal medicine residency here in New York City. I grew up in Connecticut, did my undergraduate training there, spent a few years traveling abroad, and came back to Connecticut for medical school, Philadelphia for internal medicine residency training, and I’ve been in New York now 10-plus years as a clinician educator.

Kevin Pho: Wonderful. And how is the pandemic affecting you and your practice?

Tamara Goldberg: Yeah, so, you know, in many ways, like all of us, the pandemic has really shifted how we are practicing our roles within medicine. As I mentioned, I’m a clinician educator. So, much of the work in New York City, many of us were redeployed. We’re now back in our outpatient practices, and it’s seemingly a new normal, but I would say there’s still an air of uncertainty about what’s coming next for us in New York City.

Kevin Pho: So let’s get into your KevinMD article, “The duality of being a physician-mom in the age of COVID-19.” Now, can you walk my audience through that article, for those who haven’t read it, and share the story of why you decided to write it?

Tamara Goldberg: Sure. This article really stems from my own personal experience as a physician mother, and it was really in response to the very early stages of COVID in New York City. Mid-March is when I wrote the article, and at that time we were in survival mode. There was a great deal of uncertainty, and I remember within a matter of days, those of us in the outpatient world were redeployed, schools were closed, and so it felt very overwhelming. As a physician mother, as someone who takes my work very seriously, I wondered, “How am I going to do this? How am I going to balance work and child care? Will my husband be able to work from home? What about the safety of my children? How will I support my residents during this time?”

So I would say this article really stemmed from my personal experience of uncertainty and overwhelm at that time. Then, having talked with my colleagues, you begin to realize, “Oh, not just you.” And I think one of the best parts about the article was the feedback I received from folks across the country saying, “Thank you for giving me a voice.” It was really quite rewarding to be able to do that.

Kevin Pho: So let’s get into more details. What are some of the non-clinical obstacles that you were facing during that time, or you may be facing now?

Tamara Goldberg: Yeah, you know, I think I’ll speak on behalf of many women physicians who are parents as well when I say this, but studies have shown female physicians take on a huge amount of the caregiving burden and domestic responsibilities compared to their male peers. And, you know, there was a study that came out in JAMA last year that looked at a physician cohort from multiple different specialties, and they were interested in the work hours of physicians early in their career. What they found was that 30 percent of physician mothers, within the first six years of being an attending, reduced their work hours, compared to 5 percent of their male colleagues who are parents.

And this has significant implications, as you can imagine. You know, this will affect your compensation, your potential for leadership positions within an institution, promotion. And so we’re really looking at potentially an even wider gender disparity for physician parents as we move through the course of this pandemic.

Kevin Pho: I have a lot of administrators and policy experts who listen to this podcast. Now, what are some of the things that they can do to address this issue?

Tamara Goldberg: That’s a great question. And, you know, I’ll start by saying I think so much of the gender equity in medicine movement over the last few years has been focused on sort of the “lean in” era type mentality: To fix part of the gender equity issue, fix the individual themselves. Learn how to become a better negotiator, learn how to become more of an effective leader. These are really important skills, but we found they’re insufficient. What we really need to be doing is asking, “How can our systems better support female physician parents and retain us?” And again, I think it’s sad that we’re losing women physicians in much greater numbers than their male peers, and at such early stages in their career.

So some of the solutions I think we’re looking at: obviously, the child care crisis. We did not know in the beginning of this pandemic the duration, and we’re now looking at a school year in which some schools may be closed part-time. How are we going to better support female physician parents during this time? And many institutions set up sort of temporary child care options for staff and physicians during peak pandemic periods. Well, how can we convert those to more long-standing, employer-sponsored child care options? That’s a big one.

I think in terms of promotion and tenure committees, we need to rethink what metrics we’re using to evaluate physicians during this time period. Can we really rely on the same productivity measures that we relied on historically? What are the sacrifices physicians have had to make in terms of research, teaching, service during this time? So those are two of the ways I think we can really address the structural inequities.

Kevin Pho: Excellent. That’s all well said. Over the course of the pandemic, and during the course of my podcast, I’ve talked to so many physician mothers and physician parents. I’m a physician parent myself. I have two daughters; one is just entering as a sophomore in high school. Now, can you share any advice from the last few months during the pandemic that you could share with other physician parents?

Tamara Goldberg: Yeah, I’ve learned over the years, you know: Be cautious with your advice. Everyone’s going through different things at different times. But one thing that has really helped me during this period is to reach out and nurture the relationships with other women colleagues in similar positions. And I know, you know, there’s a lot of talk about mentorship and sponsorship for women in medicine. I would say really reach out to those same-level relationships. They matter a great deal in terms of support. Whether it’s just to sort of vent and commiserate, or whether it’s to really think more proactively about how we can improve our system, I think it’s been a huge source of support, because the reality is, you know, it’s going to be tough times ahead.

Kevin Pho: We’re talking to Tamara Goldberg. She’s an internal medicine physician, and she wrote the KevinMD article “The duality of being a physician-mom in the age of COVID-19.” Tamara, what’s something that you know now that you wish you knew back before the pandemic started?

Tamara Goldberg: I think the duration. When it started, again, I think we were in survival mode, and it was almost like adrenaline was keeping us going. And I think there’s a real fatigue now, and obviously not just among physicians, among folks everywhere. How do we sustain this, and how do we continue to function in all parts of our life, despite these unprecedented circumstances?

Kevin Pho: And my final question, do you have a take-home message that you want to share with the KevinMD audience?

Tamara Goldberg: That’s a great question. I would say get involved in your institution. I think one thing the Black Lives Matter movement has done very effectively is to cause us to examine the structures in which we operate day to day that continue to perpetuate inequities. And so I would say look at your own institution. What are ways that you can voice solutions to these long-standing problems, and how can you get involved? And I know it’s a crazy time for everyone, but working together is, I think, what’s going to get us through this and ultimately make change for the better.

Kevin Pho: Well, thank you so much for sharing your story and your insight, and thank you for being on the show.

Tamara Goldberg: It was so much fun. Thanks, Kevin.

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