Why women doctors get sick and blame themselves for it [PODCAST]

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Women doctors joke about being cursed with every complication, but what if the job itself is quietly damaging their health? Jessie Mahoney, a pediatrician and certified coach, returns to share her own story of pregnancy complications, an ICU stay, and a string of surgeries she spent years writing off as bad luck. This episode is based on her article “Women physicians’ health is paying the price of medicine,” published on KevinMD. You will hear why so many women physicians carry chronic illness, early cancers, and infertility at rates that feel too common to be coincidence, and why almost no one has studied the link. Jessie explains how the culture of medicine teaches women to blame themselves, hide what is wrong, and treat their own bodies as a liability when they fail. She makes the case for retiring the word curse, pushing for real data, and building a culture where taking time to heal is not seen as weakness. Jessie reframes a problem medicine has laughed off for generations and asks what it would take to finally take it seriously.

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Transcript

Kevin Pho: Welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Women physicians’ health is paying the price of medicine.” Jessie, welcome back to the show.

Jessie Mahoney: Thanks so much for having me again.

Kevin Pho: What is your latest article about?

Jessie Mahoney: This article is about the idea of the physician-patient being the challenging patient, the patient who always has the complications. We call it that curse of, if you are a woman physician having a baby, you will have complications, or if we go in for surgery, we are the ones who will fall apart.

I started noticing this trend, particularly over the last year, that so many women physicians have chronic illnesses and chronic health issues, and unusual stories of cancers at a young age, and real physical consequences potentially of the work. So I started digging into it, and I thought it was very worthwhile to share my own story, so I do not have to share theirs.

I used to think my story was unusual, and it is clearly not. So in my mind, I now wonder. We have clarity around the data of women living shorter lifespans than men if they work in medicine, but it also seems like there is a morbidity cost that I have never seen talked about.

I thought it was worth bringing up the conversation, and especially this idea that I think all of us believe it was something about us, that we failed personally, so we do not talk about it. There is this hiding of it and not having the conversations. And yet the more conversations I have with people, and I think much of it is that I do a lot of one-on-one work, and I do very small group work. So these are not the kinds of things that people talk about at a big conference with 500 people, or even 50 people, but when you are in a group of six or seven, these things come to light.

I am just blown away by the frequency. I think it is one of these things that once we begin to see it and once we begin to share it, maybe things will begin to change.

Kevin Pho: So you are saying that there may be a connection between the morbidity of being in clinical medicine and chronic illness.

Jessie Mahoney: Yes.

Kevin Pho: I was wondering, can you share your story, and maybe you could also share some of the stories of the other women physicians you coach, or see in your small group retreats?

Jessie Mahoney: I am happy to share my story, and I actually wondered for a bit. Many people go into medicine because they had an illness before, or they have had experience with the health care system. I was actually thinking that was not my story. I was a competitive athlete, and many, many women in medicine were competitive athletes, so they were really healthy people when they went into medicine.

I had complications with both my first two pregnancies as a young physician. I was in my mid-20s and late 20s when I had my first two kids, and with both of them I had very significant, and what I was told were unexpected, bad-luck complications. One as a med student and one as a resident, completely different and completely unrelated as well.

So I just thought, well, OK, bad luck. And then I had my third baby not in training, and I took extra time before and after, which is actually the law in California, you get to do that, and I had zero complications. Same body. Actually, I was now 35, so I should have had more complications, but I did not.

And then as a young 30-year-old, I ended up in the ICU with thoracic outlet obstruction. I ended up having literally every complication in the book. Again, I should have been this young mom with a four- and eight-year-old who was quite resilient, and I just kept being told, “Oh, it is because you are a doctor. Oh, it is because you are a doctor.” And I kept thinking to myself, they keep telling me this, what is this all about?

I think we have all heard that, and we all worry, as a physician, when we have a doctor patient, that they will have the bad luck. But I wonder if part of it is how we take care of ourselves. And really, part of my impetus in doing this is that I would love somebody to study it, because I think there is something there.

My story did not end with that ICU episode. I have had multiple random surgeries since then. And again I thought, wow, I just have bad luck. But I am beginning to wonder if that is true, given the frequency with which I hear this from other people, and we do not talk about it. There is a lot of shame around it, and a lot of “Well, it must be my fault,” or “I did not take care of myself.” So I really want to change the conversation and bring this out into the open.

I think we are talking about fertility issues in medicine quite a bit now, and the cost of delaying. But I also think there is a cost of the stress, there is a cost of the hours, there is a cost of all of these things. And I am a pediatrician, so then there is a cost potentially to our children as well.

I think we just have this idea that we should sacrifice our own bodies, or that they are a liability if they fail us. And if we are really about health, we should be modeling it and practicing it. Culturally, I do not think that I could have done anything different along the way. It really was not acceptable, and I do not think my women colleagues could do anything different in the current system. But if we bring this out into the open, maybe we will begin to change things. That is my hope.

Kevin Pho: You mentioned that you wish someone could study this. As far as you know, is there any data that supports that connection between chronic illness and practicing and training in medicine?

Jessie Mahoney: I could not find any. I have been working in wellness since 2002, and this has not really come up in my awareness until recently. And again, I think it is that I do this very small group work, and I do in-person retreats, so people often talk about it there, or it is relevant to things that they can do or not do.

There is a lot of new data out also about women leaving medicine earlier, and I am thinking, well, if it has this kind of cost on your health, it makes sense that you would make different choices when you begin to see it. But I have not seen any data about it. So yes, this is absolutely anecdotal. But once I started noticing, you cannot unsee what you keep seeing, and I thought, wow, maybe someone will listen to this or read the article and either do the study, or. I think, again, it is one of these things that until we start talking about it and try to figure out if there is a relation, nothing will change.

The other piece is that we talk jokingly and affectionately about this curse, and how all the complications happen, and that allows us to really ignore it, I think. We laugh about it, and we are just very accepting of it, and I wonder if we should be.

In law there is something called an eggshell plaintiff, where if something happens to someone who has these underlying things, you have this cascade of complications. And it strikes me that we are all eggshell patients. That is why the complications are happening. But why are we the eggshells? And if we are here to improve health, what about our own?

Kevin Pho: It goes without saying, of course, that training in medicine requires long hours and very little sleep. Some people are on call every two, three, or four nights. Now, you alluded to the culture of medicine, and we have talked many times before about how difficult it is to show vulnerability. Tell us how you think the culture of medicine may perpetuate some of these chronic illnesses that you see from the women in medicine.

Jessie Mahoney: Well, I will use my own story as an example. We cannot know what is in other people’s heads, but I know what was in my head when I came out of the ICU. I went back to work very quickly, in less than three months, with some long-term complications, some of which meant that I had to change some of the things that I practiced. I had a brachial plexus injury, so I could no longer do circumcisions, physically, and that is something a lot of pediatricians do not enjoy doing.

So there was a lot of tension around why I was getting out of it, when I actually could no longer physically do it, and a lot of pressure to come back quickly, how soon can you be back, and a lot of pressure to show up fully immediately. There is not this sense of, we see you have been through this really hard thing, let’s ease you in. That is just not how we approach it.

I do not think it is necessarily anyone’s fault, but it is the culture. And I think part of that desire to have us just jump right back in is that medicine, of course, does not backfill for us. This was many years ago. But everyone else has been covering your patients, so they are exhausted and depleted on top of their own. In a system where we do not have enough coverage at baseline, our absences impact other people, probably impacting their health as well. They are taking more call if you are taking less call. So this culture does perpetuate it.

There is also that culture of, if something is wrong with you, you have to overexplain and justify, and you should come to work. Before COVID, you should come to work no matter what, just wear a mask even if you had the flu. That was the original culture. That has shifted a little bit, but I think especially for people with hidden things, autoimmune things that maybe people cannot see. Most chronic illnesses are hidden to some degree.

There is not really an acceptance of working less or working part-time. It is seen as weak or a failure, especially early in your career. It is getting more accepted, but we really do judge one another. I do not think it is in a mean-spirited way. Our culture in medicine, of course, is that you should sacrifice yourself. But I think people are really sacrificing themselves, and we are making the consequences expected and almost laughing about it. This idea is just so commonly known, that there is the curse, or you are the doctor patient, so be careful because they are going to have every complication. But I do wonder why that is.

Kevin Pho: Now, I know that most of your clients are women. Are you seeing, just from talking to your other physician coaches, the same effect stress has on male physicians?

Jessie Mahoney: I do not know. I would say that most of my clients are women physicians, and I also wonder, my guess is probably yes. Although there is this whole newer conversation about the second shift at home for women physicians. And men physicians are not having babies, which is just the physical task of that. Along with that, many, many women now are having babies in training, so the physical piece of that, I think, is a whole other level, or the breastfeeding piece of that.

And then the psychological piece of the infertility, which is also four times the national average. There is a study about that. So I think, or maybe it is one in four who has infertility. It is much more than the national average.

So I have not heard anything about men, and I just do not have enough knowledge to know. I do also wonder if, as women, we are really quiet about it, but I am guessing the men are even more quiet about it. So I do not know if there is a way to collect data in a more private way. But I am certain that there is some impact there. Whether it is different between the sexes, I would assume that if it affects one sex, it is also affecting the other.

Kevin Pho: Now, you mentioned infertility a few times. If we were to redesign medical training and medical culture to take into account biology and potential association with chronic illnesses, what would you do? How would you reconstruct our health care system to take those factors into account?

Jessie Mahoney: Well, we would have to change training, I think especially for people who want to go into fields that have longer training, because you are literally spending the entire time of training during your reproductive years. I heard a conversation at a women’s conference recently about the idea of covering egg storage and fertility, so that you can save them for later. Part of me wonders if that is reasonable, I guess, but it is better than nothing.

But could we make it acceptable to take longer, and stagger things, and have it be less intense, and be really thoughtful about what is actually needed? I think a lot of our training is a relic of what we used to do. Medicine has changed so much.

I happen to know the law path, because I am married to a lawyer, and their training happens on the job afterwards, where they are actually making adequate money and they can work less time, and there is more flexibility built into it. It is still very challenging, but the way that we pull out residency and have it be a really financially challenging time means that most people cannot or do not want to extend it. But is there a way to extend it? Shared residency spots might be a way to do it. There would obviously have to be a change in the way that we pay for medical school and pay our residents.

But I do think the other change is if we, as physicians, can make it acceptable for our colleagues to take time for themselves, and stop having the mentality that the more you can tax your body, the more committed you are. We actually want the physicians to be the healthiest of everyone, modeling that for our patients. We are telling them not to be stressed, and to have time to exercise, and to have time to eat, and to have time to sleep, and yet we do not do any of that. So I think it also lands somewhat hollowly.

Changing the culture of medicine, which I would advocate, I think is going to be really hard, because we have this big business in here, and it is a business, and they are counting on us to sacrifice ourselves. But if collectively we are not willing to do that anymore, and we are also not willing to expect our colleagues to do that, I think that is really the first step. Because you can expect yourself not to do it, but then you are in a culture where that is the expectation, and it is nearly impossible.

I do not think it is that I did not stand up for myself, or that other women are not standing up for themselves. It is really that the system is not set up to allow for it. So until we really look at some of those pieces, I do not think things will change. And I think if we do not have any data to say there is any problem, to me, this would be very compelling.

Kevin Pho: We are talking to Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Women physicians’ health is paying the price of medicine.” Jessie, as always, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: I think the biggest take-home message is that we should probably stop calling it a curse and start looking at what the reality is, because a curse is just something that is out of our control. But if we can find some linkages and consequences, that is where I think we would have the compelling data to make change happen.

And I think when we think about one another, and caring for one another, and supporting one another, that is something in the culture of medicine we can change. We can advocate for it. In an ideal world, those of us who are leaders in this space can also advocate for backfilling if someone is out, and making sure people have enough time, and really letting some of those old practices no longer be acceptable.

Because I do think a lot of what I see now is people who are in the later half of their career who have the consequences. But they are the consequences of things that happened years ago, because it does not happen right away. So how can we begin to advocate for the next generation? We do have this culture in medicine of, well, I took it, so they can take it too. But instead, the pediatrician mindset is, let’s figure out how we can change things for the next generation.

Kevin Pho: Jessie, as always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Jessie Mahoney: My pleasure. Thank you.

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