MDs spend more time with children, less with patients
T H E M O M M Y T R A C K More than a decade after the phrase “mommy tracking” came into use, family-friendly initiatives are far more common. Today, in a look at the phenomenon among physicians, women work fewer hours, see fewer patients and take more ti
After four years of medical school and another seven of specialty training, Tracey Bridger could have made medicine her life, working the kind of long, unpredictable hours typical of some colleagues.
One fellow pediatrician told her he missed “a few years” of his child’s life staying late at the office or at the hospital.
But Newfoundland’s Dr. Bridger was not about to watch her son grow up from afar.
So she makes sure that she is home by about 5 p.m. every day, devoting herself to teaching and research duties only after the two-year-old goes to bed at 8 p.m.
Many of her female colleagues, both with and without children, have gone further, working partial weeks so they can devote more time to their personal lives. Others have cut their careers short after just a few years.
“I love what I do, and my career and work are a sort of extension of who I am,” said Dr. Bridger, 40, who works out of the Janeway Child Health and Rehabilitation Centre in St. John’s.
“But my family will always come first.”
Her lifestyle priorities are anything but unique these days in the profession.
Surveys suggest that, on average, female physicians work fewer hours, see a smaller number of patients and take more time off for personal reasons than do their male counterparts.
It is a pattern that could have a growing impact on Canada’s physician-starved health care system. Female doctors comprise an expanding percentage of the profession, accounting for 60% of the students who graduated from medical schools this year.
So just as more doctors are needed to treat an ageing population and many of those practising now get set to retire, today’s female medical graduates will stretch more thinly across the system than colleagues of the past.
It is a fact that causes some members of the profession to bristle, such as a family physician that Dr. Bridger knows.
“He was telling me how terrible it was that so many women are in medicine because it’s hard to find family doctors to take over the practice if he were ever to retire,” she recalls.
“I think the prejudices are there and it’s quite sad.”
Despite some grumbling, though, no one suggests that medical schools restrict the number of female students, especially after decades of women being under-represented in the profession.
But with half the country’s physicians expected to be female by 2020, experts say medical schools must produce many more doctors, already an imperative to meet burgeoning patient demand.
Meanwhile, female physicians and analysts say the feminization of medicine has brought numerous benefits, including a saner model for physician work-life balance and a more sensitive approach to patients.
But it is not necessarily easy for those female doctors. Research suggests they face higher than normal rates of suicide and divorce as they try to juggle the twin burdens of a demanding profession and raising a family, the latter task still falling disproportionately on women.
“Professionally they work fewer hours,” said Ruth CollinsNakai, president of the Canadian Medical Association, pediatric cardiologist and a mother of three herself. “But it turns out most women have at least double jobs and their hours of work are actually far greater than the men.”
Experts hasten to point out that men entering the profession in recent years have also had a different attitude toward their careers, making them generally unwilling to work the kind of punishing schedules followed by some older colleagues.
Still, studies like the recently completed national physician survey, the largest poll of doctors ever in Canada, found an even wider gap with women.
Female MDs worked about seven hours a week less on average than the males’ 53 hours, saw about 20% fewer patients and took off on average 56 days from work for personal reasons in the previous year, compared to 13 for men.
Lara Hazelton, a Halifax psychiatrist and university teacher, finished nine years of medical and specialty training in 1999, having her first child while she was finishing her residency. She has had two since then, taking parental leaves after each birth, and decided that working a fulltime schedule was just not in the cards.
She has a four-day work week at the office, although she does some teaching on Fridays.
“I wanted to have more time with my kids,” says Dr. Hazelton, 37.
Mary Doyle, 47, was originally an exception among her female colleagues. Even as she had four children, she endured a 100hour-a-week family practice in Sydney, N.S., pulling emergency room shifts and delivering, sometimes, more than 100 babies a year.
Meanwhile, a younger female partner in her practice quit medicine almost entirely to look after her own children.
At the same time, Dr. Doyle’s husband expected her to do the bulk of the domestic chores.
But after the couple separated in 2002 and her children moved into adolescence, with all the emotional needs that come with that, she realized things had to change. Dr. Doyle dropped her emergencyroom duties and obstetrical work and restricted her office practice as much as possible.
“I said: ‘I can’t leave home on Monday morning and come back Wednesday night when I have four teenagers,’ ” said Dr. Doyle, a former president of the Nova Scotia medical association. “ What does it do for my kids when I’m not available to them and I am available to 3,000 other people?”
Dr. Bridger, the Newfoundland pediatrician, stressed that she is anything but a slacker at work, adding both research and academic work on top of her clinical practice. But she says her devotion as a parent has only made her a better doctor.
“ You get the love parents feel for a child and you know how terrible they must feel to have a child who is not well.”
Still, the revolution in physician lifestyle is unfolding against the backdrop of a doctor shortage estimated in the thousands, which puts Canada in the lower half of industrialized countries in terms of number of physicians per capita.
The bottom line is that hundreds more medical-school graduates are needed, says Dr. Collins-Nakai of the CMA.
Enrolments across Canada were infamously cut 10% in 1992 in response to what provincial governments believed then was a glut of doctors. That blunder is being reversed but the current first- year class size of 2,200 is still far short of the 3,000 that the CMA feels is needed, said Dr. Collins-Nakai.
In the meantime, the lessworkaholic approach does appear to be affecting the kind of careers pursued by women doctors. They are more likely to enter jobs that pay a salary or some other alternative to fee-for-service and that offer 40-hour work weeks, such as with public-health departments or governments, said Dr. Beck.
Women also tend to gravitate to more “cognitive” specialties, like psychiatry and rheumatology, rather than technical and high-intensity areas like neurosurgery, said Tom Noseworthy, head of the University of Calgary’s Centre for Health and Policy Studies.
Research has also shown that women physicians tend to spend more time with each individual patient, while obviously offering female patients the choice to have a doctor of their own sex. Dr. Doyle said women unhappy with male physicians frequently ask her to take them on as patients.
“Many male physicians have taken on medical practice as an extraordinary calling, with lengthoftime commitments that actually have made them less good spouses and parents and role models,” Dr. Noseworthy said.
“ The impression one gets is that women are softening the hard edge of medicine, increasing the caring side of medicine.”
National Post
tblackwell@ nationalpost. com