After Earning MDs, Are Docs Obligated To Keep Practicing Med?

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In this week's parenting conversation, host Michel Martin looks at the debate over the growing number of doctors — mostly women — who work part-time or stop practicing medicine after earning their degrees. Martin speaks with Dr. Karen Sibert, an anesthesiologist and a mom, who recently wrote an op-ed arguing that doctors should prioritize medicine once they have their degrees; Dr. Michelle Au, author of This Won't Hurt a Bit (And Other White Lies): My Education in Medicine and Motherhood; Medical journalist Dr. Randi Hutter Epstein; and Dr. Laura Ment, Dean of Admissions at Yale School of Medicine.

MICHEL MARTIN, Host:

I'm Michel Martin, and this is TELL ME MORE, from NPR News.

Now it's time for our Moms conversation. Every week, we ask a diverse group of parents to take on the issues that parents care about most. Today, a special Moms conversation about work/life balance. This has become a hot topic in many workplaces. And the argument goes that people, especially younger workers, have come to expect a better work/life balance than their parents may have had. And if they don't find it or get it, they have a right - perhaps even the responsibility - to opt out, to put their families first.

But what if that job is at the doctor's office? Do doctors have a moral obligation to contribute as much as they can to their profession, even if they are parents? Recently, Dr. Karen Sibert caused a stir when she wrote an op-ed in the New York Times about the growing number of doctors, mostly women, who work part time or stop practicing medicine after they earn their degrees.

She cited a survey that four in 10 female doctors between the ages of 35 and 44 are working part-time. And she wrote that those decisions may seem personal, but have, quote, "serious consequences for patients and the public," unquote. She also questioned whether it's fair to taxpayers, since all medical education, not just in the military, is heavily subsidized.

As you might imagine, her article hit a nerve among doctors of both genders and moms of all professions and set off a firestorm of comments. We wanted to talk more about this. So we're joined now - and this is why this is special: we have four doctors with us who have different opinions, and they are also all mothers.

Dr. Karen Sibert wrote that opinion piece in the New York Times. As we mentioned, she's an anesthesiologist. She's also associate professor of anesthesiology at Cedars-Sinai Medical Center in Los Angeles. She's a mother of four. Also with us is Dr. Michelle Au. She is an anesthesiologist also, author of the book "This Won't Hurt a Bit (And Other White Lies): My Education in Medicine and Motherhood." She's a mother of two. She's also written a piece responding to Dr. Sibert.

A H: A History of Childbirth from the Garden of Eden to the Sperm Bank." She's also a mother of four. And last, but not least, Dr. Laura Ment. She is a professor of pediatrics and neurology and the dean of admissions at Yale University School of Medicine. She's been mentoring students for more than 30 years at Yale. And she's a former chair of the school's committee on the status of women and medicine. And she's also the mother of three.

So, doctors, moms, ladies, thank you all so much for joining us.

KAREN SIBERT: Thanks for inviting us.

MICHELLE AU: It's a pleasure.

RANDI HUTTER EPSTEIN: Thank you.

LAURA MENT: Thank you.

MARTIN: Dr. Sibert, I'm going to start with you, because you started this off. Your op-ed has prompted an enormous online response, especially - but not exclusively - for doctors. What prompted you to write the piece?

SIBERT: The initial conversation began with a college student that I happened to be speaking with. And she was telling me that she was interested in going into medicine and seemed to take it as a foregone conclusion that she could work part-time and that she would work part-time. And rather than really wanting to talk about what I love about anesthesiology and find fascinating about it, or how I've managed to combine my profession with motherhood, her only questions for me were whether I worked full time and what my hours are.

And I found that extremely discouraging. And it led me to wonder how many of today's high school and college students are looking at their choice of profession that way and what a sad thing that would be, because if you're not going to do what you love, you're not going to love doing it. And then you're really going to want to cut back more and more on how much you do of it.

And that, of course, has a cost for society. We don't have enough doctors, even today. And now the estimates are that for every doctor in their 60s who retires, it's going to take between one-and-a-half and two doctors to replace him or her because of the expectation that people just don't have to work as hard.

MARTIN: Well, obviously, as I mentioned, you sparked a lot of conversation. I'm going to go to Dr. Au first, because she wrote a piece specifically responding to you, where she says that she felt that your views are sexist, inflammatory and, frankly, discouraging. I want to ask about the sexist piece first, because I also saw a number of other online comments about that where people said, but you're not similarly critical of men who leave the profession because they want to make more money, and, say, open up Botox clinics or something like that. And what about that?

MARTIN: I don't think anybody should let their medical training go to waste. How you define going to waste is different for different people. A lot of the entrepreneurial spirit and the spirit that men have approached - sometimes leaving bedside medicine, but those people have gone on to invent pacemakers and a lot of the amazing technology that we have now that enables us do the work that we do. So going to work for a for-profit corporation does it mean that you've given up on medicine or on patient care at all. But obviously you can take your degree, you can do miracles with it or you can do not much.

SIBERT: What I hate to see is the young person, and particularly the young woman, who gets straight out of residency, has a child, and then never goes back at all. There is just too much training at stake, too much tax money, too much Medicare money. I don't think the public realizes how much they pay for our training and I really do feel as though we have an obligation to give that back.

MARTIN: All right. Dr. Au, you are also an anesthesiologist. And you also have children and you also work full-time and you were very disturbed by the piece. Tell us why.

MARTIN: I was. I mean I agree with Dr. Sibert, that the key to the problems in the U.S. with our health care system is that we have more and more patients now, obviously we have an increasing aging population and the population of the U.S. is going up, whereas, the number of doctors are remaining stagnant. So she's right. There is a major doctor shortage.

I think she's correct that it's probably not going to be helped by more people going part-time. But I think that there are realities with respect to the fact that there is a sea change in the attitudes of people who are going into medicine. And you can say it's for good or for bad, but with modern medical training you have more and more people who are not willing to sacrifice everything in their lives for the practice of medicine as it was, you know, back let's say at the turn of the century, where work-life balance wasn't part of the conversation.

MARTIN: But what about her point, though? That number one, you're taking public resources and privatizing it and not utilizing it in the manner in which you said you would? And then secondly, it's just not fair to the society. What do you say to that?

MARTIN: Well, there are two points. One is I think that she's right that there's no figures as to how many people that she's talking about actually take their medical education and leave the field of medicine entirely. That's not something I see very commonly. I know that's somewhat anecdotal, I haven't done a study. But I see somewhat more of the people who sort of decide after training, which is, let's admit it, rigorous - the 80 to 100 hours a week of working - and decide to cut back. And let's be clear, a part-time job in medicine in primary care is usually more on the order of about 40 hours a week, which in any other industry is considered a full-time job.

So you could say that residents are subsidized by the government, that their training salaries are subsidized by the government. But what we forget also is that in exchange for this somewhat meager stipend for the three to seven years that a resident is in training, they get in exchange thousands of thousands of hours of highly skilled, extremely intense labor that I think would be difficult to substitute in any other circumstance.

MARTIN: Dr. Ment, you must've spoken with hundreds if not thousand of students over the years about what they want for themselves. What do you make of this?

MENT: I think that the issue that Dr. Sibert just brought up is not just a gender one but a generational one. Because watching students over the years, more and more of them, both men and women, are asking to work part-time because they have other important things they want to do. The AAMC is encouraging us to make more medical schools in this country and to try and encourage more people to go into primary care.

CME - continuing medical education credits - are all online so that the new generation who are so computer savvy can do it all online.

MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. In our weekly parenting conversation we're talking to four doctors, who are also mothers, about whether women are in some ways shortchanging the profession by cutting back or perhaps opting out entirely when they become mothers.

We're speaking with Dr. Karen Sibert, who made that argument in an Op-Ed in The New York Times. Dr. Michelle Au, Dr. Laura Ment, who's also the director of Admissions at Yale Medical School, and Dr. Randi Epstein, who is a medical journalist.

Dr. Epstein, what do you think about this? You, like so many commonalities here, also have four children, like Dr. Sibert, and you are - you don't practice.

HUTTER EPSTEIN: I don't practice. And I actually told them on my Yale Medical School interview that I wasn't planning on practicing and they accepted me anyhow. But I think I read Dr. Sibert's Op-Ed, and while she makes a lot of interesting points, I guess I was confused reading it because I felt it complicated different things. Yes, we do have an issue with a growing shortage of doctors. I'm not sure that part-time and full-time practice has anything to do with the shortage of doctors. Our shortage of doctors is in primary care.

There is one study, I'll just say, about 10 years ago that showed that there was a 40 percent jump in women going into primary care and a 16 percent decline in men. You might have some fantastic women that are working part-time as pediatricians when their kids are young and then will devote full-time later on. I think that might be a better asset to our society than someone who's a full-time cosmetic surgeon from day one.

MARTIN: Dr. Sibert, could you address that? Because one of the, I also wanted to pick up on something that Dr. Au talked about in her response to your article, which is why are you so convinced that this is a female issue as opposed to a perhaps a generational issue or an issue about the profession?

SIBERT: The current discussion really is, you take women in that 35 to 44-year-old age group who ought to really be shooting for the moon in terms of what they want to do with their lives as physicians and that's the highest group that are part-time. Men that are working part-time tend to do it as - again, a broad generalization - later in their careers, perhaps when they have health problems or are cutting back. But in those prime years, when you should be doing the work that you love to do and you want to do for the rest of your life, that's where we're seeing the predominance of women.

MARTIN: Dr. Ment, what you think about this? As I said, you've probably had conversations with hundreds of people, if not thousands of people about these very issues.

(SOUNDBITE OF LAUGHTER)

MARTIN: So where do you come out on this? How do you talk to people about this - prospective students?

MENT: So I think that medical schools, clinics, private practices, whatever, are changing as the physicians are changing. For instance, this weekend, I've been invited to give a talk at the National Institute of Neurological Disorders and Stroke entitled "Physician-Scientist: Career and Family. Can You Have It All?" So my topic is to discuss with all of these young potential physician-scientists, who hopefully want to be neurologists, pediatric neurologists, how you can blend work, family, research, clinical, make it all work for you and how the institution will help you do that.

MARTIN: But what about Dr. Sibert's point? Her point is that while people are busy thinking about how they can make it work for them, they're not thinking as much about the patients to whom they owe their full attention, and the society that helped get them there. Do you think that that's true, that you just don't find, are there perhaps people who are really more about self and less about the service?

MENT: No, I disagree with Dr. Sibert about that. I think that people who go to medical school, who work at medical school, do the nine or 10 years of training, which everyone does now, are deeply committed. But it's not 1970 anymore and people are choosing to do many different things with their training. And how would she have us run admissions differently?

MARTIN: Dr. Sibert, do you have an answer to that? Is there something you would do different?

SIBERT: I would not have you run admissions any differently at all. But I do think, and this is the point, that we are about to run up against a perfect storm of simultaneous events. More and more people are taking that approach that I want to have it all, I want to work part-time, I want to have children at the exact time I want to, and yet we're in a time, a period of retrenchment.

MARTIN: how can we afford this? And I have yet to hear any answers.

MARTIN: Dr. Epstein, I want to give you a final thought.

HUTTER EPSTEIN: Sure. I mean I still go back to this issue of mixing up doctor shortages and work part-time. I think a lot of the overseas doctors that you are referring to, they agree to get stationed in rural areas, places that even full-time doctors don't want to be practicing. So I think yes, I agree with Dr. Sibert that we might be coming into some sort of storm of problems with where doctors are practicing, and we do need these doctors in rural areas and we do need people to practice primary care surgery and internal medicine. I'm just not sure that the message is telling women that they have to work full time.

There have been doctors working part-time in clinical care and doing clinical care and research and figuring out, or a part-time doctor in another moneymaking job on the side too. It's not always part-time childcare. So I think some of these issues are just getting blended together. And I also think we don't want to go back to two generations ago or even a generation ago when it was harder for women to get into medicine because the admissions committees worried that they would have children and it would be bad for medicine.

MARTIN: Dr. Au, do you want to go next?

MARTIN: In terms of where the money is coming from, you know, I'm not in health care policy, but the bill that Dr. Sibert was referring to was proposing in light of this physician shortfall, to add I think it was a total of like 15,000 additional residency spots over the next 10 years, which would cost - I think the estimate was about $10 billion. And this was pretty roundly voted down because of the expense. So I completely think she's right. We do have to see where the money is coming from.

However, even if you could compel every single doctor in America to work full-time, it's a drop in the bucket compared to the disparity in patients and doctors given the growing population, the increasing elderly population, the geographic disparity of where primary care doctors are, you know, given that an estimated seven percent of health care costs are devoted to administrative costs, it seems like with health care reform maybe some more money can be found to train more doctors to take care of their patients.

MARTIN: Dr. Ment, is there anything you would do differently if you were in charge of the world?

MENT: I think that as Dr. Epstein said, confusing women working part-time with how to provide adequate work force and funding is a mistake.

MARTIN: Dr. Sibert, final thought from you. And I'm also fascinated by your reaction to the reaction to your piece.

(SOUNDBITE OF LAUGHTER)

SIBERT: Well, anonymous blogging never brings out the best in people, I'll certainly say that. But here's my final thought. I really want the people that go into medicine to love it and want to do it. And to the degree that I think young women are feeling as though you can't work full-time and be a good mother. I don't agree with that at all. There are a lot of solutions. But giving up and even worse, going into a field that you don't love because you think the hours will be better, I think that's a tragedy both for the person, and I think it's a tragedy for our society because we need doctors to take care of everybody.

MARTIN: My Education in Medicine and Motherhood." She joined us from Georgia Public Broadcasting in Atlanta. And Dr. Randi Hutter Epstein is a medical journalist and author of "Get Me Out: A History of Childbirth from the Garden of Eden to the Sperm Bank." And she joined us once again from NPR/New York.

Ladies, doctors, moms, thank you all so much for joining us.

AU: Thanks so much.

MENT: Thank you.

HUTTER EPSTEIN: Thank you.

SIBERT: A pleasure, Michel. Thank you.

MARTIN: And that's our program for today. I'm Michel Martin and this is TELL ME MORE from NPR News. Let's talk more tomorrow.

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