I can hear my husband chuckling from the cavern of journal piles and stacks of free conference tote bags he refers to as his home office. “I am looking at a graph of your publications,” he calls out to me as I putter around the house. An inauspicious start.
As I look over his shoulder at the laptop screen, he shows the tiny dot representing my singular publication—work I did as an undergraduate—in the 30 years from 1993 to 2022. With gleeful pride, he points to the steeply upward-sloping line representing my 15 (narrative medicine) publications in 2023 and 2024. It makes for an unusual graph; I will give him that.
The proliferation of my academic work is rooted in the (not unrelated) events of the last few years: I turned 50, and my children grew up. Around my 50th birthday, I had the revelation that I was, with hope and health, halfway through my clinical career. Although I love the one-patient-at-a-time contribution of clinical medicine, I wanted something wider-reaching. With my children all in college, the time that once went into making dinner (and child-rearing tasks too numerous to count) now goes into writing. In addition to time and aspirations of grandeur, middle age’s confidence and stability have given me the space to take risks: try new things, risk rejection, and survive failures. I now have the time, flexibility, and resilience to attempt new roles instead of staying in the safety of my smaller community.
Those who estimated my potential contributions to medicine while I was also raising three children seemed shocked; they were not expecting this burst of productivity. When I look at my female peers, I am not alone. A company of gray-haired (or, as in my case, gray-haired, carefully concealed) female physicians are moving into the spotlight. Where family demands once prevented them from auditioning far and wide, many women in my training cohort are moving to center stage. They are interviewing nationally for chief executive officer jobs, chairing departments and committees, and establishing their dream start-up companies. Acknowledging this bloom of middle-aged women ready for new challenges should neither criticize nor diminish the contributions of those who were able, by circumstances or temperament, to take a starring role throughout their careers. However, many women of my generation, who were often the default primary parent, have more time and energy to devote to medicine in their 50s than they had in their 30s.
Should we rejoice that today’s world allows this mid-life productivity or resent the past (and present) environment that makes a starring role so challenging for primary parents (most of whom identify as female) in academic medicine? Neither action will move us forward.
We can seek to overcome barriers by naming them. Whether it is access to childcare or mentors, primary parent physicians need more support than has been given historically. Unforeseeable issues, such as an abstract submitted to a conference that now falls within weeks of a pregnancy due date, need better solutions than “resubmit elsewhere.” We can and should make it easier for primary parent physicians to raise families and grow careers.
We should also respect and facilitate up-ramping for those who eschewed the limelight when their families were young. Space can be created on academic committees for those whose time in community theatre has limited their academic curriculum vitae. Physicians who had to choose between clinical work and bench work may now have time to return to the one they left behind, with support. Some of these physicians have little formal administrative experience, yet they can combine a fresh approach with the absence of the burnout plaguing those with years in administration. A person who coordinates their own career, a traveling spouse’s schedule, children in three schools, and nine afterschool activities can certainly manage a clinic schedule or meeting.
There is a tremendous resource in these mid-career physicians who, though still devoted to their offspring, now can devote more to medicine. They are eager to expand their range and take on new roles. To tap into this, we must hold open auditions and be ready to consider those with less classical resumes. As a community, we should recognize that the arc of a primary parent physician’s career may look different from that of a physician who could travel, grant write, and publish without constraint or compromise. When these experienced but less renowned players appear on stage, rather than mutter to a seatmate about their credentials, we should listen to their performance and be ready to applaud.
Eleanor Menzin is a pediatrician.
