Medicine has long valorized the early riser – the physician who arrives before sunrise, who joins 7:30 a.m. meetings and stays for evening journal clubs, case conferences, and post-dinner networking events. These scheduling patterns have come to symbolize dedication, productivity, and professionalism. However, for many physicians, particularly those with caregiving responsibilities, these norms reflect more than tradition; they represent structural exclusion.
The architecture of medical professionalism was built on an outdated model of the “ideal worker,” unencumbered by domestic responsibilities and available at all hours. While the demographics of medicine have changed, the expectations have not. Physician-mothers are often expected to work as if they have no children, and parent as if they have no job. In this context, early morning meetings and after-hours events become more than calendar entries. They become signals of who belongs, and who is silently penalized for absence.
Recent data reveal stark gender differences in time allocation. In a national survey of high-achieving physician-researchers, women spent 8.5 more hours per week on parenting and domestic tasks than their male counterparts, despite similar professional roles.¹ That invisible labor constrains availability and forces difficult trade-offs. When meetings and events are held outside core working hours, women—especially those with young children—may need to opt out. These absences can lead to fewer networking opportunities, slower career progression, and exclusion from leadership pathways.
This time inequity is not simply a matter of convenience. It reflects a deeper cultural bias within academic medicine. A qualitative study examining women faculty experiences identified early morning and late evening scheduling as barriers to mentorship, collaboration, and inclusion.² These are not minor inconveniences; they are embedded signals about who is expected to adapt, and who the system is designed for.
After-hours events further entrench this disparity. Professional development opportunities, including social receptions, informal networking dinners, and evening leadership summits, often occur during times when caregivers must be physically and emotionally present at home. Participation in these spaces is not always optional. It can affect perceptions of visibility, commitment, and ambition. And yet, the necessity of these events is rarely questioned.
The professional cost of missed opportunities is cumulative. Women physicians remain underrepresented in academic leadership, in part because they are systematically excluded from the decision-making tables, sometimes literally. A bibliometric review found that women are less likely to be senior or last authors on academic papers, a gap linked to lack of mentorship, protected time, and access to informal professional networks.³ When key conversations happen in the early morning or after hours, they often happen without women caregivers.
While parental leave policies and flexible work options are important, they are not sufficient. Equity requires more than isolated accommodations. It demands structural redesign. Time-based exclusion is a form of gatekeeping that disproportionately affects women, and especially mothers. It persists in part because it is so normalized: Rarely challenged, and often rewarded.
To address this, institutions must critically evaluate scheduling norms and intentionally design inclusive practices. Specific recommendations include:
- Limiting nonessential meetings to core hours (e.g., 9:00 a.m. to 4:00 p.m.), recognizing that time outside this window is not equitably accessible.
- Offering asynchronous or hybrid options for professional development and decision-making forums, reducing reliance on physical presence as a proxy for engagement.
- Normalizing non-attendance at after-hours events and eliminating informal penalties for declining invitations.
- Collecting and analyzing data on meeting times, participation rates, and perceived inclusion to inform policy.
Importantly, these changes benefit not only women or caregivers, but all physicians who seek balance in their professional and personal lives. The future of medicine depends on sustainable, inclusive work environments. Flexibility, fairness, and equity are not just luxuries, but important retention strategies and wellness imperatives.
The idea that professionalism must be demonstrated through early arrivals and late stays is a holdover from a bygone era. Institutions serious about inclusion must stop asking physician-mothers to contort their lives to fit a rigid mold. Instead, they must reshape the mold itself. When time is used to reward some and penalize others, it becomes a tool of inequity. Recognizing this is the first step. Redesigning around it is the necessary next one.
Samira Jeimy is an allergy and immunology physician. Menaka Pai is a hematologist.
