June 20, 2011
Moms v. Moms: Are Part-Time Doctors (and Attorneys) Cheating the Public?
Posted by Christine Hurt

In last Sunday's NYT (June 12, 2011), I read two articles that seemed to beg to be blogged together.  The first article, Words of Wisdom, excerpted various commencement speeches, including one given by Facebook COO Sheryl Sandberg:

Women almost never make one decision to leave the work force. It doesn't happen that way. They make small little decisions along the way that eventually lead them there. Maybe it's the last year of med school when they say, ''I'll take a slightly less interesting specialty because I'm going to want more balance one day.'' Maybe it's the fifth year in a law firm when they say, ''I'm not even sure I should go for partner, because I know I'm going to want kids eventually.'' These women don't even have relationships, and already they're finding balance, balance for responsibilities they don't yet have. And from that moment, they start quietly leaning back. So, my heartfelt message to all of you is, and start thinking about this now, do not leave before you leave. Do not lean back; lean in. Put your foot on that gas pedal and keep it there until the day you have to make a decision, and then make a decision. That's the only way, when that day comes, you'll even have a decision to make.

I totally agree with this. This is the same advice that I give my students. Negotiating a great reduced load is a lot easier after several years when you have become indispensable. I have a great friend who worked full-tilt for the first ten years we practiced. Now, she is one of a handful of attorneys in the country who does what she does, so she only does it about 20 hours a week. For loads of money. But that deal wasn't offered to her when she entered the law profession. I was a "lifer" until I wasn't an employee any more. However, I don't think I agree with this piece by Dr. Karen Sibert, entitled Don't Quit This Day Job, in the same issue:

Today, however, increasing numbers of doctors — mostly women — decide to work part time or leave the profession. Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time. This may seem like a personal decision, but it has serious consequences for patients and the public.  Medical education is supported by federal and state tax money both at the university level — student tuition doesn’t come close to covering the schools’ costs — and at the teaching hospitals where residents are trained. So if doctors aren’t making full use of their training, taxpayers are losing their investment. With a growing shortage of doctors in America, we can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine. It isn’t fashionable (and certainly isn’t politically correct) to criticize “work-life balance” or part-time employment options. How can anyone deny people the right to change their minds about a career path and choose to spend more time with their families? I have great respect for stay-at-home parents, and I think it’s fine if journalists or chefs or lawyers choose to work part time or quit their jobs altogether. But it’s different for doctors. Someone needs to take care of the patients.

Wow. Those are tough words. Should they be dismissed as "pulling up the ladder" talk from a woman of an earlier generation who made very tough choices and hates to see others have a wider array of choices than she had?  (Dr. Sibert begins her piece by telling us she had four chidlren and always worked full-time, and ends by saying that she never made cupcakes for homeroom.)  There is definitely a phenomenon that's not hard to spot among both working moms and stay-at-home moms of convincing oneself over the years that one's choice not only was best for that mom, but is the best for all moms. If not, then one may experience regret over one's choice, which is particularly unsavory.  Dr. Sibert has contributed a chapter in a book exploring these choices, Torn:  True Stories of Kids, Career & the Conflict of Modern Motherhood.  Dr. Sibert, however, packages her annoyance with "kids these days" by alleging that doctors who go part-time cheat the taxpayers.

I would probably want a little more information before deciding if part-time doctoring cheats taxpayers.  Dr. Sibert never follows up her allegation that state tax dollars subsidize medical education.  I suppose she means state-run universities, in which case we will just note that states are subsidizing less and less these days, and move on.  However, she does specify that Madicare pays for $9 billion of resident salaries and teaching.  I've always thought that the resident program was a win-win for everyone.  Teaching hospitals get really cheap labor, and residents get really great training.  Dr. Sibert seems to think that residents get more out of these programs than the hospitals and the public.  I have no other information.

However, even if the new doctor owes something to the public, how much?  Forty years of 50 hour weeks?  Thirty years?  Dr. Sibert doesn't seem to have the same ire for her male counterparts who retire early or step down from the more unpredictable parts of practice (delivering babies, surgeries, etc.).  Dr. Sibert is even upset with full-time female doctors who practice a few hours less a week than male counterparts or see a few less patients a week. 

I also have a hard time linking owing something to the U.S. taxpayer with being a private physician.  Am I giving back to the public at large merely by being a physician that private individuals have access to for a fee?  I went to law school at a time in which my degree was heavily subsidized by the people of the great state of Texas.  I'm not sure if they felt paid back by my years of service at the private law firm, at the prevailing billing rate.

Dr. Silbert seems to be saying that if you take up a spot in a U.S. medical school class and a residency program, then you have to practice as hard and as long as the person who did not get that spot.  And I think she means as hard and as long as the person who did not get that spot in 1983.

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