Ladies, we have been building our careers based off of a blueprint never meant for us. We were told we could have a fulfilling lifelong career in medicine, just like physicians have been doing for a millennium. This blueprint was designed for a different gender. I offer you the alternative “pink-print” for women in medicine; it may have more glitter, glam, and possibilities than was previously expected in this noble career.
Men and women lead very different biologic lives. A man can impregnate a woman at 14 years old and at 84 years old. A man’s testosterone drops approximately 1 percent per year from age 30 to 65. Women’s estrogen and progesterone fluctuate 220 percent and 1,400 percent, respectively, during our monthly cycles. Most of us do this crazy hormone dance for 35 years. These are the most productive years of our lives. A woman’s estrogen drops 90 percent overall from age 30 to 65, but it is not a gentle decline. It falls off the cliff between the ages of 40 and 51 (usually at the height of her career).
Eighty percent of women will conceive and give birth. The female hormones will plummet 90 percent within 24 hours of delivery. She’s not just exhausted from growing and pushing out a baby; her body has suddenly betrayed her. We all know that hormones impact our mood and emotions, and increasing evidence supports that hormone levels impact our cognition, body composition, cardiovascular disease, bone, and brain aging. Basically, these hormones are impacting every organ system in our body, not simply our reproductive organs.
Therefore, I propose that we were not designed to simply have one lifelong career that looks identical at age 30 as it does at 65. I propose that our bodies and brains are going through incredible wildly fluctuating internal swings; therefore, our careers can and should as well. As women physicians skillfully leverage these amazing shifts, we will plan and create beautiful new experiences, milestones, and goals in our careers never before seen and rarely modeled for us.
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Most of my mentors (99 percent were male, as this was the 1990s) would tell me early on that I needed to “establish expertise in one area” and find my niche. This was impossible for me. I loved liver disease and capsule endoscopy and nutrition and fecal microbial transplant; the list went on. So, I put together a study to screen for both hepatitis C and colon cancer by colonoscopy in a single encounter. It not only was published and had an accompanying editorial in a leading medical journal, but I also gave a podium presentation, and it became part of proposed legislation in Congress. As I look back, it’s no coincidence that this was after delivery of my third child. These amazing hormone fluctuations can lead to “crazy” ideas which can change the world.
My career during my 40s was fluctuating away from bread-and-butter gastroenterology, and I was building well-being programs for my patients and colleagues while leading as the fellowship program director and chief of hepatology. I continued down the trajectory of leadership, finding myself leading a large gastroenterology division, being the sole woman leader in local and national groups, and serving on boards of directors. I started to notice the strong politics taking over instead of high-quality leadership. I had had enough. I quit at the height of my career (against the advice of many) as I was starting to build my women in medicine groups.
I left my very busy hospital system and doubled down on my side gig, while I worked in a much slower-paced gastroenterology system where I could still practice and teach. My energy was now on fire as I gathered with other women and empowered them to reach their potential.
I coach women every day who are disenchanted by trying to follow the “proven” career and life path. They are frustrated that they have not “figured it out” and are constantly searching for “the perfect nanny,” “the ideal FTE,” or the job that appreciates and inspires them, because they watch confused male faces when we complain about our reality. For women, I see us having a different career trajectory. I propose that our career often follows our natural hormone cycles, which can intermix:
- Career phase 1: Often, we can conquer the world in our first fifteen years of our medical career, but we might get bored quickly. Therefore, we can do leadership at a much younger age than expected (many of us have been negotiating with a three-year-old to put on their shoes), and our emotional intelligence and complex problem solving are highly trained by being a woman in an unsafe world (knowing how to deal with a flat tire on a country road at midnight).
- Career phase 2: We have a natural inclination to nurture and build community. We are made to lead gatherings and collaborations. This is the chapter of entrepreneurship and development of those systems (possibly never before seen).
- Career phase 3: We are in no mood (oops, hormones literally left the building) to endure continuing to “watch our tone,” manage everyone else’s emotions, and pander to politics. We simply are ready to get things done with our limited time on this planet. We need to be in rooms where we can be authentic, where we don’t need to “prove it again,” and where our skills are seen and heard. We deeply desire collaborative work to create a better world for the next generation. Basically, we want to show up in the world and finish some very hard tasks. This is the only stage of our hormones that is somewhat predictable. Due to radical upheaval of sleep cycles and severely altered focus on the job, Spain has recently introduced focused legislation for menopause workplace accommodations similar to the Family and Medical Leave Act.
Should women continue to go into medicine? Absolutely. The three interesting phases of our life, career, and bodies are not necessarily linear and make women doctors a force for problem solving, system building, and creating a better world. If you are a woman, you now can throw away the “blueprint” and pick up the beautiful “pink-print” and join other amazing women who are doing radical and empowering things, such as simply showing up to do the “doctoring” work without focusing on everyone else’s comfort. Permission granted for you to be uniquely you. If you are a male, you might simply stop telling women physicians to “work harder” or “hire more help” and realize that your body, life, and career are very different than hers, and that is a beautiful reality for both of you.
Dawn Sears is a board-certified gastroenterologist and hepatologist, a clinical professor at UT Southwestern, and the founder of GutGirlMD Consulting. She currently serves in the gastroenterology division at the North Texas Veterans Administration, where she works as an instructor, gastroenterologist, and coach.
Much of her career and research has focused on the well-being of her colleagues, with a stated goal of stopping the loss of women physicians from health care. She spearheaded the Women Leaders in Medicine program, serving more than 300 women physicians and moving the needle on engagement, retention, and burnout, and she hosts the ACE and Emerge women physician empowerment conferences. As an ICF Certified Executive Coach, she works regularly with both private and institutionally based physicians. She has served as chief of well-being, program director, and chief of gastroenterology at multiple institutions, and has sat on boards of directors. Her work has been recognized with grants and awards from the American Medical Association, the American Medical Women’s Association, the Texas Medical Association, and the Physicians Foundation.
She has authored numerous peer-reviewed publications spanning physician burnout, women in medicine, hepatitis screening, and gastrointestinal disease, with work appearing in PLOS One, Clinical Gastroenterology and Hepatology, Gastroenterology, and The Lancet Gastroenterology and Hepatology. She shares updates on LinkedIn, Facebook, X, and YouTube.
