7 Arguments In Defense Of Women Who Doctor Part-Time

A med school class takes the Hippocratic Oath

“Oh, ugh, a particularly noxious salvo in the mommy wars,” was my reaction yesterday when I read this op-ed titled “Don’t Quit This Day Job” in The New York Times.

Written by Dr. Karen S. Sibert, a Los Angeles anesthesiologist and mother of four who has always worked full-time, it argues that women physicians have an obligation to work full-time. If they work part-time or take time off, Dr. Sibert argues, they’re contributing to the national shortage of doctors, and the resources that went into training them have been partly wasted. “We can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine,” she writes.

Let me confess that I’m deeply biased in favor of part-time work for parents who want it, and my reaction was visceral: “Great. Instead of pushing for more of the workplace flexibility that so many families so desperately need, she wants less.” But I’m no expert, and I thought I should consult with those who are. So below are seven points on why the op-ed is off-base from some who know the data: Tracey Hyams, director of the Women’s Health Policy and Advocacy Program at Brigham and Women’s Hospital; Dr. Paula Johnson, executive director of the Connors Center for Women’s Health and Gender Biology at the Brigham; and Lotte Bailyn, professor of management at MIT’s Sloan School of Management.

Readers, what do you think? Please comment below; nytimes.com does not seem to have enabled comments on the op-ed piece, so here’s your chance!

Quality of care trumps productivity
Dr. Sibert makes the argument that women physicians don’t have the same productivity as men because they work fewer hours. In fact, women physicians spend more time with their patients than male physicians regardless of work schedule. And at least one study refutes her productivity argument, finding that part-time productivity among primary care providers is greater than that of full-time practitioners. Further, focusing on productivity neglects the essential metric of quality of care. Some research shows that part-time physicians are associated with higher quality performance than physicians working longer hours. (See references below.)

It’s not part-timers, its access
Dr. Sibert argues that the lack of access to physicians leads to more emergency room visits, more preventable hospitalizations and more patients dying of treatable conditions, particularly for low-income Americans. Lack of access can’t be blamed on women physicians in part-time practice, however. Low-income residents are less likely to have health insurance coverage, which affects access to care throughout the lifespan. In addition, physicians have few incentives to practice in medically underserved areas – reimbursement rates are low, and patients need intensive social support and intervention to live healthy lives. Even if women doctors all worked full-time, the problems of chronically underserved populations would not be solved. Medical schools need to do more to recruit students who are likely to work in underserved areas after graduation.

If women are not given the choice about how to structure their lives, they may reject medicine as a career choice altogether.

Doctors aren’t needed to provide all medical care
It is true that when critical medical decisions need to be made, patients want a “fully qualified doctor” leading the team. But much of medicine involves routine and preventive care and doesn’t require critical decision-making. Many aspects of care can be provided by nurses, physicians’ assistants and other ancillary providers – most of whom are likely to be women as well. Physicians and other clinicians should work at the top of their training in conjunction with a team that addresses all the social determinants of health. For example, nutrition counseling and chronic disease management may be recommended by a physician but can be provided by other members of the care team. In fact, our delivery system is already moving in this direction – away from solo practices and towards large, integrated provider organizations.

It’s also about policy
As the author notes, policy decisions have contributed to the shortage of physicians in this country. For example, Congress did not expand residency slots as part of the 2010 health reform law. From 1983-2004, medical schools voluntarily chose to keep enrollment flat after Congress voted to withdraw federal funding of medical education. Since then, medical school enrollment has increased, but not enough to keep pace with population growth and the overall needs of an aging and increasingly sicker population. These decisions are unrelated to what has been called the “feminization of medicine.”

What about the other part-timers, in research and administration?
In academic medical centers, most physicians are part-time clinicians regardless of gender; other activities include administration, research, and teaching. Should we hold them to a different standard as well? Dr. Sibert’s piece misunderstands the medical profession, where most people are “part-time” because they divide their time between clinical work and other essential roles in health care delivery.

Caregiving inequality
The reality is that in our society, women are burdened disproportionately with caregiving responsibilities across the lifespan, from childcare to eldercare. Unless there’s gender equity at home and in society, we can’t expect that women will not want and need to work part-time at some point during their lives.

You think you have a shortage now…
Women are much more likely than men to populate the lower-paying ranks of primary care, family medicine, pediatrics, and internal medicine. Regardless of whether women physicians choose to spend part of their careers working part-time, they are filling essential medical roles that U.S.-trained male medical graduates are less likely to assume. If women are not given the choice about how to structure their lives, they may reject medicine as a career choice altogether.

Special thanks to Katie Sullivan and Laura Cohen for research assistance. References:
i Fairchild DG, McLoughin KS, Gharib S, et al. Productivity, quality, and patients satisfaction. JGIM 2001 16:663-667.
ii Parkerton PH, Wagner EH, Smith DG et al, Effect of Part-time Practice on Patient Outcomes, J Gen Intern Med. 2003 Sep;18(9):717-24

Please follow our community rules when engaging in comment discussion on this site.
  • Lfusky

    My concern is that so many are coming straight out of training into part time positions.  As a practicing physician I think that there could be a delayed or perhaps absent transition to what it means to be an independent (no longer under the umbrella of a training program) physician with such decisions.  You learn a ton in medical school, and even more in residency.  But you might learn the most in your first few years of work post-training and without a full time commitment to this part of the medical education experience, I fear that doctors will be less apt to be competent and successful long term.

  • glevin1

    And there are plenty of male physicians who chose to work part-time, such as urgent care doctors, emergency room doctors, private practice limited hours, older physicians who cannot work full time anymore.  Surgeons who no longer operate. And those who quit early. Dr. Sibert is probably an outlier regarding her opinion. However she is certainly entitled to her opinion. In the past many medical school admission committees were biased against women for this very reason, as Dr. Sibert stated.  Fortunately this is not the case anymore.

  • Richardl

    There is a shortage of doctors. There are only a few more medical schools in the US than when I graduated college 30 years ago, and the population is nearly 50% larger. We need more doctors period.
    Here in Massachusetts the problem is huge. If I were seeing a primary care doctor who decided to leave practice, I wouldn’t have a doctor for months, possibly a year. I understand the desire to be home with the kids. But saying that it necessarily means an improvement in outcomes is delusional.

  • Kmeisinger MD

    Dr. Sibert’s reactionary piece and this well intentioned follow up article both entirely miss the point – raising children is a time consuming and challenging enterprise that US society undervalues, regardless who is taking the time to do it. Feminism is a dead end prospect until we allow men, not just women, to change their role in society and in relation to their families. More and more men are staying home to care for children because their physician wives out earn them – it is a simple financial equation. Fewer graduating physicians go into Primary Care because the “privilege” of becoming a physician costs hundreds of thousands of dollars in this country – another financial equation.
    Overwhelmingly, female physicians make the same choices other human beings do – those that best reflect the balance of their self-interest. Let’s move on from pointing fingers to subsidizing medical education for those who want to embrace the primary care shortage – both in medical school and as practicing physicians. Loan reduction or elimination programs work, they should be expanded. Community health centers have long endorsed alternative schedules for physicians, regardless of gender, who find balance in their lives by working hours that increase access for other working families – evenings, weekends and the like. Creative solutions with financial incentives are already out there, but apparently, as long as specialists like Dr. Sibert are given the dominant voice, these will take a back seat to inflammatory and counter-productive articles.
    Kirsten Meisinger, MD
    Medical Director, Union Square Family Health Center
    Family doc

  • http://twitter.com/Renegotiating HealthCareNegotiate

    Professional health care providers are subject to the same demands, demographic trends, and desires as other workers. Roles and responsibilities are being renegotiated throughout health care are we are likely to see more part-time doctors, nurses, technicians, and administrators — and we’ll be happy to have them. Clinging to notions like a requirement for doctors to work full-time is out-of-date and not particularly useful.

    Instead, we should ensure that the renegotiation is done in a way that enables health care providers to best serve their patients while also spending time with their families. The system will need to become more, not less, flexible if it wants to retain the quality and quantity of talent it requires.

  • Ben O.

    I can see how you might interpret this as gender bias, but in most of the medical world (for profit, non-academic), what she says is true. There are far male FTEs than there are women. You could argue that this is a cultural thing — women often desire to or are expected to do a lot more work at home than men are — but it doesn’t change the fact that male doctors see more patients and do more work. 

    Of course, this says nothing of the quality of their work (Dr. Sibert doesn’t claim men do better, just more). Nor does it discount the likelihood that a physician with a healthy work-life balance is perhaps more effective when they are seeing their patients.

    But what Dr. Sibert gets at is a serious and important issue. She say’s it best herself: becoming a physician is a privilege, not an entitlement. When a student decides to pursue his or her MD, she signs an oath of service. There is a movement afoot in the practicing world that emphasizes the individuality of a doctor and their right to happy life. This is fair. But, Sibert is right … you cannot have it all. Patient access to doctors is a complex issue to be sure, but fewer FTEs is a major contributing factor.

    Per your specific remarks:
    - Yes, quality of care does trump productivity, but the two are not mutually exclusive. For example, surgeons need a certain case-load to maintain their skill level.
    - Yes, access is about more than just FTEs, but FTEs are a contributing factor. There are lots of contributing factors, ranging from socioeconomic status to number of providers, that are linked to limited access in the US healthcare system.
    - True, doctors are not always needed. But, understand that nurses and advanced practice providers (like physician assistants, for example) require lots of a training and support from the physicians themselves. These individuals do not have residencies like physicians do. Their “field training”, as it were, is largely provided and subsidized after graduation and on the job.
    - Certainly there is a need for MD administrators and researchers. But, their knowledge and expertise is indispensable in improving and sustaining healthcare systems.
    - You’re right that women frequently bear the burden of caring for their families. I was raised by two full-time doctors, and they were still excellent parents. One can be a quality parent and a FTE.
    - That is true. We need to find ways to make primary care more attractive to all medical school graduates, regardless of gender.

  • Dianna

    As a healthcare consumer, I would rather have rested, balanced, happy physician. And I believe that woman or man would be teaching his children how to value relationships, while sharing their skills in medicine. No one wants their choice taken away. Karen Sibert needs to own hers, without diminishing the choices of others. 

  • http://www.playthisway.com Dr. Jen
    • Careyg

      Great post, Dr. Jen!!

  • Dr. A.M.

    I worked part time when my first child was born and found it to be incredibly unrewarding.  I worked a lot of extra unpaid hours and yet when I was introduced (by a man) to the new head of the hospital, he said, “This is Dr. M., she has the cutest one year old you’ll ever see.” which really wasn’t how I defined my role in the hospital!  There was no chance of career advancement and it just felt like a huge compromise.  When my second child proved to be difficult to care for I happily quit that job and somehow never found a position that didn’t feel like another treading water situation.  If one more person tells me to review cases for insurance companies, I’ll scream–I went to Med School to be able to help people solve problems in a therapeutic relationship, not to do scut work for the rest of my career!

  • Sara

    Oops sorry about typo in my comment
    Of course I meant commonwealth

  • Sara

    This is typical Carey Goldberg/commonwealth thoughtful, enterprise reporting. Hope you send this to the Nyt op Ed editor so they can link to it. Thank you, Carey,

  • Dr. M

    As a part-time Emergency Medicine physician I find the NYTimes  piece to be simply a case of gender bias- worse it is propagated by a woman. In my field both women and men work part time – to be with their families, pursue other areas of interest and to have social lives outside of work. This makes us BETTER doctors – we are able to be more focused at work, more compassionate, and better patient advocates because we are happy and energized when we come to work. Not only that but I find practicing medicine before I had children and now after – I am a better doctor for my experience’s as a parent.  It is a shame Dr. Sibert can not appreciate the benefits of being both mother and doctor – maybe she needs to take some time off to get a life.