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Pediatrician and holistic wellness expert Noemi Adame discusses her article, “Having a female doctor is better for your health, but not for hers.” She highlights research indicating patients often experience better outcomes—including lower mortality, readmission, and post-surgical complication rates—when treated by female physicians, potentially linked to factors like longer visits and stronger adherence to guidelines. However, Noemi contrasts this with the significant personal toll on female doctors, who face higher burnout rates, a greater burden of uncompensated tasks like EMR messages (receiving 25 percent more requests), and a concerning lack of the longevity advantage seen in the general female population. She critiques the corporate medical system for failing to adequately support or compensate female physicians for the qualitative differences in their care delivery and the associated emotional labor. Noemi strongly advises female colleagues to protect their own well-being by considering alternatives to corporate employment, such as Direct Primary Care (DPC), independent contracting, or building a personal brand, while also acknowledging the unique challenges women face in setting boundaries within these models. Actionable takeaways emphasize the critical need for female physicians to prioritize self-care, implement sustainable practice systems, and advocate for themselves, whether inside or outside traditional employment structures.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Noemi Adame. She’s a pediatrician, and today’s KevinMD article is “Having a female doctor is better for your health, but not for hers.” Noemi, welcome to the show.

Noemi Adame: Oh, I’m so excited to be here, Kevin. Thank you.

Kevin Pho: Alright, so let’s start by briefly sharing your story and then talk about what led you to write your KevinMD article.

Noemi Adame: Sure. So, as you said, my name is Dr. Noemi Adame. I am also known as the Veggies Over Pills Doctor. I’m a board-certified pediatrician, Whole Foods plant-based at-home cook and baker. I’m a writer, I’m a speaker. I have over 20 years of experience in medicine. I am the founder of Culver Pediatric Center. It’s a concierge-style, direct primary care practice where we take a holistic approach to the care of the child and beyond the exam room. I’m passionate about advancing the direct primary care movement, but in a way that is sustainable and burnout-proof, especially for my female physician colleagues.

Kevin Pho: All right. So we talk a lot about, of course, burnout and burnout among female physicians. So tell us more about your KevinMD article titled “Having a female doctor is better for your health, but not for hers.”

Noemi Adame: Right. So I am going to start out by saying that I respect and appreciate all of my male physician colleagues. So just bear with me gents for a bit. If anyone listening has not read the article, please read it. Basically, in a nutshell, I go over how there’s good evidence that female doctors demonstrate better outcomes across multiple fields of medicine with patients, but they experience higher burnout rates than our male colleagues. I communicate best through writing, and this article has been percolating in my heart and my mind for years.

I remember as a young hospitalist noticing the different interactions that patients and staff had with female physicians compared to male. I remember working in clinic when I was still employed in corporate medicine, watching as my male colleagues left at five or five-thirty, and while I was still there, sometimes hours later. And of course, imposter syndrome takes over, right? And so I thought it was me: I am not good enough; I am less efficient, to the point where I actually asked for a time flow study from my employer at the time. The person who watched me and conducted the time flow study was an EHR super-user, and she found that I was actually very efficient with my time. I would come in early on my clinic days to prep, so by the time that I walked into the exam room, the visit was very streamlined. I huddled with my MA before clinic to make sure that we had everything prepared and we weren’t wasting any time, that there was no lag time. She commented on my typing, that I typed very fast, and that my notes were very thorough, that a scribe would actually be a downgrade and not helpful.

So fast forward to me leaving corporate medicine, starting my own DPC practice. I also realized very quickly that in that space also, there are issues and concerns that affect female DPC docs disproportionately. And it makes sense. As I mentioned in the article, portal data shows that both patients and staff make 25 percent more requests of female primary care doctors than male, which of course explains the longer work days and the EMR time, the added EMR time that is uncompensated and unrewarded time. So with this information and other issues like the second shift at home, it’s not surprising that the studies show that female doctors have higher burnout rates.

Noemi Adame: So, what made me write this article? I think the sentinel event for me really started two years ago when my mother died suddenly and unexpectedly. I did not feel I could disconnect from work. I owned the practice, I was the boss, and I showed no compassion to myself. I look back and realize that there’s so much I could have done to disconnect and be present in that very important moment, very important week. But I think this was me responding to years of socialization that women must put the needs of others first, which is exponentially magnified with women in medicine.

I literally sat in the ICU watching her die while I responded to texts and sent refills to the pharmacy. In the aftermath of processing all that trauma, I reevaluated my entire life. I restructured a lot of my workflow and my processes. I hired staff to help me. I outsourced social media to my daughter, so she’s our favorite nepo baby here, you know? And it took me a long time after that experience not only to articulate those thoughts and feelings into words, but I also wanted to embed a lighthearted twist on a very heavy topic. And I hope that came across in the article.

Noemi Adame: Sure. I also wanted to have a solution and an action plan to go along with it. I wanted to not just put these thoughts on paper, but I didn’t want to just bum everybody out with this disconcerting data. I wanted to offer a solution. You know, I’m the firstborn daughter of immigrants, right? So problem-solving laced with external validation, that’s my drug of choice.

So the final push that I needed to write this was two things. First was an article published in JAMA less than two months ago that essentially showed that while generally women outlive men, that’s not the case amongst physicians. We don’t have that longevity benefit, and there’s a lot of reasons that are explored in the article, but the added stress specifically of being a female doctor may contribute to that lack of longevity benefit. And the other was I attended the pediatric DPC Mastermind around the time that the study was published. I mentioned to one of my colleagues, Dr. Deanna Berry, who coordinates a mastermind, that I did some retreats for some parents that were very helpful, and she sidebarred me and said, “You need to do retreats for us.” So with that, I felt like I could put pen to paper, not just with the data about what’s going on with the burnout rates amongst female physicians and my own thoughts about it, but with a solution in the form of a physician women’s retreat, which is scheduled for September fourth through seventh.

Kevin Pho: All right. So before we talk about some of these solutions, you mentioned, of course, you work in a corporate setting. Can you envision any type of corporate setting acknowledging the data that female physicians spend more time in the inboxes and spend longer times interacting with patients and making any type of amends to compensate for that? Do you see any of that happening?

Noemi Adame: You know, and of course, I’m going to answer that, and I’m going to preface it with a bias, right? I’m a DPC doctor, and DPC doctors, we are DPC evangelists. And a lot of us, certainly in my case, have been quite morally injured by the corporate medicine world. So, for me, it is very difficult to envision a situation, to envision the corporate medical system basically saying, “Oh yes, female doctors, we’re going to give you more time with patients. We’re going to use other metrics besides volume to determine quality and to compensate you.” I have a really hard time seeing that happen, which is why I mentioned in my article, my recommendation is to leave. But if someone can prove me wrong about that, I will take it, and I would be very happy about it. But I just, with the current system the way it is, I just don’t see it happening.

Kevin Pho: So tell us about moving to Direct Primary Care, and you said even in Direct Primary Care, female physicians in Direct Primary Care are still burned out and undergo some of that same gender-specific stress. So tell us the path forward. What do you think?

Noemi Adame: Right. So, I think a few years after opening up my practice, I realized that I had jumped out of the corporate medicine frying pan into the DPC fire, and it was completely self-inflicted. I set very unrealistic expectations for my patients, like responding to texts within minutes when I first started out and didn’t have a big panel. And these expectations were just not sustainable as my practice grew. So now, five years in, I’m retraining my patients, and thank goodness 99 percent of them are so understanding and so grateful, and they want me to be healthy physically and mentally so I can take care of their kids for a long time.

You know, but I do wish that someone had told me at the start, “Hey, don’t respond to texts within five minutes. Set a timer. Wait a few hours.” So that when you do get busy down the road and you do take a few hours to respond, your patients are OK with that. They expect that that’s the standard operating procedure. So those are the kind of pearls that this September retreat will address.

Kevin Pho: So are there any systemic changes beyond what female physicians can do individually that you think can help solve this issue?

Noemi Adame: Well, it boils down to money. It really does. When the one metric that the system uses to compensate physicians, to assign value to a physician, is not the quality of care that they deliver, but the volume, like how many patients you can see in one day, it’s going to be difficult, right? It’s going to be difficult if we were to move to a system where things like, you know, what are your outcomes? You know, what is your relationship with your patients? The low-hanging fruit, of course, is patient experience surveys, and there are pitfalls that we can talk about for an hour about that.

But I think finding some sort of objective way to measure adherence—adherence to guidelines, for example—or relationship with colleagues in a 360-type evaluation. If we were to move from this RVU, volume, how-many-patients-are-you-seeing type of system and more into quality metrics that actually assess quality and not quantity, I think that we can start moving the needle towards change.

Kevin Pho: So what other tips do you have for other female physicians who may be listening to you, who may be working in a corporate setting and experiencing what you did however many years back? What other tips do you have for them?

Noemi Adame: I want my female-identifying physician colleagues to continue to deliver amazing care. We need to keep doing that, but I want them to do it without harmful self-sacrifice. So I advise: protect yourselves, set boundaries, and remember, no is a complete sentence.

Kevin Pho: A lot of people, both male and female, find that difficult because as physicians, right, we jump through a series of hoops. We are by nature people-pleasers, so how does one go about setting those boundaries? Give us an example of some tips, because I hear that a lot, and I agree with you. I think that physicians in general, we need to set more boundaries, but is there a process or a mindset that you advise clinicians to go about doing that?

Noemi Adame: Right. So one thing that really helped me is using the acronym FAST. I heard about it in a DPC women’s Facebook group, and it has been so helpful for the mindset change. Whenever I feel a boundary is being pushed, you know? Then I ask myself, “Is this fair?” (F). Is it fair for me to provide you with free medical care that you’re asking for just because we have a relationship outside of medicine? Is it fair for me to see your child for a sports physical at 6:00 PM on a Wednesday, the only night that I have dinner with my son and husband together, because that’s the only time that you won’t miss work or your child won’t miss sports practice? You know, so like, who’s going to give more in this relationship? So that’s the first thing. A physician that’s feeling that pressure with a boundary is: Ask yourself, is this fair to both parties involved?

The other is, don’t apologize. That’s what the A stands for. Don’t apologize. I have worked really hard not to do that. For example, if I am running late for a patient appointment, instead of saying, “I’m sorry,” I say, “Thank you for waiting. Thank you for your patience. I really appreciate it.” And that creates just a huge mindset change, and it really makes me feel better. And what I hope will also tell the patient: I wasn’t running late because I was out having drinks or I was out eating bonbons. You know, there were systemic issues, right? There were issues why I was helping somebody else. So that has also helped, not apologizing.

And the other is sticking to your values. That’s the S. Don’t make exceptions; don’t bend the rules because the moment you do that, then that person is going to keep pushing the boundaries and is going to keep testing them, and it is really going to cause tension in the relationship. So that’s S.

And then the T is tell the truth and don’t exaggerate. You know, explain the consequences. For example, in my case, if I have someone who wants me to see them at a time where it’s infringing on my personal time, I’m very upfront about it. I say, “OK, if I see you at that time, that’s a time that I have dinner with my husband and with my son. I can see you at this other time. I won’t have to infringe onto personal time. Is there any way you can make that work?” And there are times, yes, I will tell my family, “I can’t have dinner with you because I’m going to see a patient.” You know, that’s the life of a doctor. Our families know that, right? Our families are completely used to us missing birthday parties and missing dinners and missing events because of patient care. But I do at least want to negotiate with the patient, and I do want them to know, “Hey, this is what I’m giving up. I’m giving up a dinner with my family.” So that’s where, just, I’m not going to exaggerate, you know, but just be very truthful about what the consequences are when we push that boundary.

Kevin Pho: We’re talking with Noemi Adame. She is a pediatrician. Today’s KevinMD article is, “Having a female doctor is better for your health, but not for hers.” Noemi, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Noemi Adame: So I want to end by saying that most patients appreciate you. Most patients understand that you’re human. Most patients understand that you have a family, that you eat, that you go on vacation. But sometimes it’s us that need to accept that about ourselves: that we are human, that we do have physical needs that we also need to address. And it’s just so important as physicians that we stop glamorizing overwork and stress and being super, super busy that we don’t have time for our families. I think that is just so important because if we are healthy, then we are going to be able to be much better healers for our patients.

So I do encourage, if you’re a female-identifying physician, to join us for this retreat in September. Just check out our website, www.culverpediatrics.com, and check out the page under DPC Women’s Retreat. I look forward for you to join us for a weekend of learning, recharging, and connecting.

Kevin Pho: Noemi, thank you so much for sharing your story, time, and insight, and thanks again for coming on the show.

Noemi Adame: All right. No, thank you.