Fans of the New York Times editorial section were treated this month to an unusual bit of controversy over Dr. Mom and the medical work place. Back on June 11th, a mom and anesthesiologist out of Los Angeles, Dr. Karen Sibert, criticized her fellow female physicians for taking too much time off work in the pursuit of child rearing. Invoking an odd mix of feminism and patriotism, Sibert casts herself as a kind of medical “Rosie the Riveter” in comparison to the new generation of female docs whom she chastises. Today’s female part-time physician/mothers, she charges, are contributing to the looming national doctor shortage, defaulting on their responsibility to the American tax-payer who subsidizes public medical schools and residents’ salaries, and are failing to live up to the ideals of their forebears by not working as hard as men. Work-life balance, and being there for most of your kids’ upbringing, is just self-indulgence. “You can’t have it all,” she says.
Tough stuff, and you can imagine the response has been equally hard on Dr. Sibert. Various commentators have responded, going after Sibert’s sexist, inflammatory remarks. One critic of hers is Dr. Michelle Au, another mother/anesthesiologist, and she does a good job of articulating why Sibert is wrong to single out women, and how the pernicious system of gender bias in medicine is only abetted by these sentiments. In short, the argument has gotten very well publicized because it seems to be about gender equality and motherhood, hot topics no matter in which arena they fall.
Dr. Sibert has stayed entrenched in the fray, however, and even ventured into the talk-show circuit to defend her views. As to the charge of sexism, Sibert counters that the NYT editorial staff actually significantly cut back her much longer, original manuscript, excluding the parts in which she did try to fairly apportion blame for the doctor shortage between men and women. I can’t find her original essay, but let’s give her the benefit of the doubt and talk no more about charges of sexism. Nonetheless, I submit that Dr. Sibert misses the point entirely.
So, the debate is about whether or not part-time physicians, regardless of gender, are appreciably worsening the national physician shortage, and whether individual doctors can or should be held accountable. Dr. Sibert certainly thinks that she, as a full-time doctor and mother of four, is part of the solution and an example to be followed. But when answering interview questions about her own work-life balance, Sibert extols the value of working in a flexible practice like hers. Dr. Sibert is part of a large group of anesthesiologists which staffs the operating rooms of a very advanced and highly regarded West Hollywood hospital. When Dr. Sibert needs time off to read a bedtime story, go to her kids’ soccer games, or appear on talk shows, one of her colleagues covers for her. Simple.
But, with all due respect to Dr. Sibert, I must point out that there is not now, and never will be, a shortage of shift-working, highly paid, specialist physicians in L.A. Never.
For that matter, there will never be a dearth of such practitioners in New York, Chicago, Dallas, Miami, Boston, etc. Part-time or otherwise, specialist doctors in America’s premier neighborhoods will always be in adequate supply. The physician shortage is about rural and urban poor settings, and getting young doctors to choose to practice there at all.
As a part of their rural health curriculum, medical students from Oklahoma State University spend half of their 3rd and 4th year clinical rotations in very isolated settings in some of the most underserved parts of the state/country. During a two-month stint in Poteau, Oklahoma, I worked closely with one of the two general surgeons then at Eastern Oklahoma Medical Center, Dr. Steven Medeiros. When Dr. Medeiros wasn’t operating six days per week, he was moonlighting in the hospital’s E.R. On the rare moments when neither he nor his colleague were available to operate, surgical patients had to go to Fort Smith, AR for the next nearest surgical center. Transfers could take several hours to arrange, either by life-flight or ambulance.
Like Dr. Sibert, Dr. Medeiros prides himself on his work ethic. But when he retires gracefully or otherwise moves on to the great O.R. in the sky, his community will struggle to replace him either on a full or part-time basis. Even rural health care focused schools like OSU have a hard time sending enough physicians to these impoverished, small towns and regional medical centers, far removed from the most desirable amenities of even modestly-sized, affluent cities and their state-of-the-art hospitals.
The answer to the impending physician shortage has nothing to do with part-timers and everything to do with incentivizing docs to work in these underserved areas. Indeed, the PPACA attempts to address this, by allocating $1.5 billion in supplemental funding to the National Health Service Corps, for example. (The NHSC, which provides for debt relief for newly graduated health professionals who agree to work in underserved areas, not incidentally allows their work force to keep part-time hours in exchange for longer periods of service). The PPACA also increases Medicare/Medicaid reimbursement to less well-paid primary care providers in hopes that more med school graduates will resist the allure of specialists’ superior compensation. As opposed to the normal shrill cries of socialism and over-reach, critics of the PPACA here more often say these provisions don't go far enough. Agreed. And truth be told, the long term fix to this (and basically all of our problems as a country) relies on prioritization of resources and a fair tax policy that provides all the income needed for the public good…Granted, that last part is much easier said than done.
But let us not delude ourselves into self-righteous thinking that it all comes down to doctors' own commitment to their profession. Unless one recommends a draft for physicians that would enforce strict minimum work-hour regulations and dictate where we are to practice, we must recognize that work/life balance will be part of the solution, not the problem.
Whether or not to have a family is not about trying to have it all. It is a deeply personal and existential question everyone must face, and it is not as if part-time doctors are seeking some kind of elite privilege by having a job while watching their children grow up, particularly when full-time work for us often means double the hours that normal 9-5ers put in. If you really want to exacerbate the physician shortage just try to tell the next generation of would-be docs that being a real physician means always putting patient care ahead of one's own family for a lifetime. Even our most patriotic professionals in the armed forces get a reprieve every few years as their enlistments run out, and no one else in secular society is required to subjugate their personal lives entirely to their work. Asking doctors of either gender to do so is neither realistic nor relevant to the problem at hand.