September
23rd 2008
“Family friendly,” my ass: and why M.D. women are large & in charge

Posted under: jobs

Yesterday Inside Higher Ed published an article on “New Questions on Women, Academe, and Careers.”  Go check it out–there’s something for everyone there.  I have two questions:  first of all, what’s with the hostile sub-literates commenting there?  Posts about gender equity always bring out the trolls at IHE, but some of those comments were especially stupid and pointless.  But on to my main question, which is:  Why are women academics so willing to chuck it all in after having even only one child (let alone more children) when they work in such a “family friendly” occupation?  Here’s a table summarizing the results of a study called “Harvard and Beyond Project” by Harvard economists Claudia Golden and Lawrence Katz, which “tracks what happens to three cohorts of graduates of the university — those who graduated around 1970, 1980 and 1990-15 years after they received their bachelor’s degrees.”  Lo, the results:

Percentage of ‘Harvard and Beyond’ Women Employed Full Time 15 Years After Graduation

Advanced Degree Earned   No Children   1 Child    2 or More Children
M.B.A.   84.4%   70.9%   40.0%
J.D.   82.5%   64.1%   48.5%
M.D., D.D.S., D.V.M   92.7%   80.5%   60.4%
Ph.D.   91.5%   64.9%   57.5%

This supports what I’ve noticed anecdotally with women M.D.s:  they have more kids by comparison to women with Ph.D.s, and they work.  Man do they work–they see patients four days a week, and then they’re on call usually one day a week plus one weekend a month, on average in private practice.  My women friends with M.D.s have three, and even four kids, and they have built successful and extremely busy private practices in pediatrics and OB/GYN.  How can this be, when academia is legendarily “more flexible” and “more family friendly”–you know, once we’re done with our second or third (or fourth!) class of the day, we can be home to meet the school bus, right?  (And have crackers and peanut butter with the kids while they watch Dragon Tales.  Right?)

Yeah, right.  Although our hours from day-to-day may be more flexible (I feel so flexible about setting my alarm for 4 a.m. so that I can finish the reading for my graduate seminar, really I do!), what’s not flexible is where we work, women and men alike.  Many of us end up at universities in small and rural towns we didn’t even know existed when we were in graduate school, and that’s only after years of searching for a permanent position.  We also have fewer job opportunities than other professionals, so unless you take that offer to move to Laramie, Wyoming to teach continental philosophy, well–I hope you’re happy adjuncting.

Physicians, especially primary care docs, on the other hand are different from most academics, and these differences, plus some advantages in their lines of work, make all the difference:

  1. They tend to be more traditional in their vision for their lives, in that most of them want marriage and children.  (There are very few really hippie-groovy physicians–whereas the academics I know, myself included, weren’t necessarily set on one particular vision of family or love relationship in our early 20s.)
  2. (Maybe what I mean here is that they have better planning and execution skills?)
  3. They have lots of job opportunities, especially if they’re in primary care and open to leaving the big cities where they trained.  (Some cities and metro areas are choked with primary care docs, but that just means that they may have to work for less money, not that they won’t be able to find work.)
  4. They make lots of money compared to academics, and so can pay for full-time nannies and other high-quality, in-home care.  The docs I know make between $200,000 and $400,000, which beats the hell out of what I make.  As Liz Phair sang in a song way back in the 90s:  “you have got to have $hitloads of money.”
  5. They are trained to work hard.  Medical school, and then a 3- to 6-year residency weeds out the weak like you wouldn’t believe.  The docs I know make good money, but they’re incredibly hard workers and they serve their patients well. 
  6. (Only point 5 applies for people in academic medicine, which from what I’ve heard anecdotally, is just as competitive and cutthroat as academia in general, if not moreso.  Academic medicine is all of the hassle, for much, much less of the money–on top of truly brutal student loan debt, compared to most humanities Ph.D.s I know.)

All of you parents out there, get your daughters into math camp and science enrichment programs.  Teach them to love something other than the humanities–which are great, but let’s face it:  they don’t exactly pay the bills.  Point out that physicians get to use much cooler equipment and tools than comparative lit profs.  Buy them anatomy textbooks and models of human skeletons to hang in their bedrooms.  Tell them that 4 years of college, 4 years of medical school, and 3-6 years of residency will go by really fast.  Trust me, they will.  And pretty soon one day, you’ll look at your little girl, and you’ll see the busiest pediatric nephrologist in the region, or the most popular pediatrician in her practice, or the go-to dermatologist in town.  And won’t that be a proud day?

24 Comments »

24 Responses to ““Family friendly,” my ass: and why M.D. women are large & in charge”

  1. Feminist Law Professors » Blog Archive » “New Questions on Women, Academe and Careers” on 23 Sep 2008 at 7:17 am #

    [...] Via Historiann, who trenchantly notes: I have two main questions:  first of all, what’s with the hostile sub-literates commenting there?  Posts about gender equity always bring out the trolls at IHE, but some of those comments were especially stupid and pointless.  But on to my main question, which is:  Why are women academics so willing to chuck it all in after having even only one child (let alone more children) when they work in such a “family friendly” occupation? [...]

  2. Erica on 23 Sep 2008 at 9:13 am #

    My mom actually wanted me to become a neurologist, but I was all rebellious and like “hell no” and went into mechanical engineering instead. But engineering works as family friendly, too. While it’s not as lucrative as being a physician, you don’t have to go to school as long (an MS or even BS is plenty), you have very predictable hours (unless there’s a quality problem, but you’re not supposed to let those HAPPEN, are you!), and you can find a job anywhere there is manufacturing.

    In retrospect, the neurology thing is rather odd, because now that I have children I’m constantly nagged about working while putting the kids in daycare. I would have preferred consistency, to have been always told that I’d be stuck being a housewife — at least that’s something I could feel less silly about rebelling over.

    While I can speak only from the perspective of a spouse, and from only a few years along the tenure track, by far the worst problem we have had so far with him being in academia is not the hours, but the moving. We lived in Boston, then went to Bloomington Indiana, and now are in Columbia SC. Our family is all in the North, as are most of our friends; it’s also stressful to completely uproot every few years. (The kids aren’t old enough yet to really care. Yet.) While my professional life suffers somewhat from having to look for new positions after each move, I have a lot more personal repercussions (and disappointments) from this lifestyle.

    Daughter is TOTALLY going to be a lawyer (she argues SO well), but Son is just like his mommy :)

  3. Historiann on 23 Sep 2008 at 9:22 am #

    Erica–engineering is cool, too–my hat is off to you. I just think we should push more girls into the STEM fields, because they’re much more lucrative and portable than Ph.D.s in the humanities.

    Your comments about the moving around are exactly why I’ve always been skeptical of the “family friendly” propaganda of academia. It’s hard whether (like your husband) you already have a family, so everyone pays the price of moving around (spousal employment issues, kids’ friendships and changing schools, etc.–as you say, it’s difficult personally and emotionally, not just professionally), or whether you don’t yet have a family, because moving around and living in small/rural places make it hard to find a mate and create a family.

    Why anyone would ever marry or partner with a college professor in this day and age is beyond me. We must all be fabulous and super-sexy or something, because we’re a lot of trouble without the do-re-mi, as Hank Williams used to sing.

  4. e.j. on 23 Sep 2008 at 9:43 am #

    I do think it depends on the type of position you have and where you are at in your career. I’ve found that at my mid-level U, post tenure and post book, I’ve been able to devote a considerable amount of my time to childcare-she spends 12 hours a week at day care, and the rest of the time is home with my husband or me. While this does mean that I’m not exactly churning out the articles and my second book has been pretty much put on hold, it does offer the advantage of being home with her.

    I am also benefiting from a department that realizes I’ve cut back temporarily, and is fine with that.

  5. Penny on 23 Sep 2008 at 10:39 am #

    Hm, one caveat I’d add is that, especially for the pediatric specialties, it can be a heart-breaking job. The emotional toll of having a job where you’re seeing kids in pain, kids dying and parents grieving catastrophic news every day–or even every week or month–is not to be discounted. Yes, the training process “weeds out the weak,” but all the good peds specialists I’ve known are still upset by the bad days–and their bad days are REALLY bad compared to the worst faculty senate meeting or angry student at office hours.

    But on the other hand, my daughter spends a lot of time in hospitals while her brother’s having surgeries, and she’s still fascinated by them. What does she want to be for Halloween? Yeah, we’re getting her little “labcoat” embroidered right now, and digging out some toy stethoscopes and clipboards for props…

  6. Historiann on 23 Sep 2008 at 11:03 am #

    Hi, Penny–thanks for stopping by to comment. Yes, it is true: I rarely have–in fact, I’ve never–had a student or colleague die on me, no matter how tedious or unpleasant the interaction. And even if I did face death at work, no one would have expected *me* to save the life or bring someone back to life. That’s the other reason docs make the big bux. The primary care types I know go to their patient’s funerals. (My friend in PICU would sadly only go to funerals, if she went to them all.)

    I’m sorry to hear that you have a sick child now, but I’m pleased that your daughter looks up to her brother’s physicians and is excited about dressing up like one for Halloween. Kids have pretty good B.S. detectors, so my guess is that you’ve got a decent team working on your boy.

  7. Erica on 23 Sep 2008 at 11:39 am #

    Penny’s Halloween costume triggered a funny memory — Once I was playing with a friend whose mother was a doctor. We got to play with a real stethoscope, (empty) prescription bottles, the bonk-your-knee hammer thing, and an otoscope. It took me a good decade to figure out why my mother had looked shocked when I cheerfully announced I’d been “playing doctor” all afternoon.

  8. Historiann on 23 Sep 2008 at 11:40 am #

    And p.s. to ej: yes, it depends on the institution you’re at, and on your department. I’m already feeling sweated, because my first post-tenure review is next spring! Yikes.

  9. Mercie on 23 Sep 2008 at 1:43 pm #

    Well, I’m just starting out in a surgical residency, and I think you’ve pretty much hit it on the head! This job definitely makes you one tough cookie. Working 100+ hours a week is no picnic, but the trust patients give you, the admiration people have for you, and the pride you can take in your job (and in being able to say you’re a tough cookie) are not comparable to anything else. What I really want to do, though, is give credit where it is deserved…to the husbands/wives/significant others of these female docs. Without them, it would be nearly impossible to have those children, nevermind raise them. I mean, I can barely cook myself dinner most nights! Thank goodness I have a supporting and infinitely patient husband to help me through this fabulous career.

  10. Mercie on 23 Sep 2008 at 1:47 pm #

    Oh, and I think it was my academia-minded mother who really taught me how to be a tough lady in the first place!

  11. Historiann on 23 Sep 2008 at 2:03 pm #

    Hi Mercie–thanks for stopping by and commenting. Good luck with your residency–surgery is brutal, especially for women. You’re right that physicians (most of whom are still men) rely on a huge amount of goodwill and uncompensated domestic labor from their spouses/partners. You’re gracious to acknowledge it. Your husband’s infinite patience will certainly come in handy over the next 6 years…

  12. Susan on 23 Sep 2008 at 4:14 pm #

    Another difference between medicine and the academic world is that backup is fairly straightforward if you have to deal with something. We may not have someone in our departments who can substitute on short notice.
    The other thing that is interesting about this survey is that for academics (as opposed to MBAs, lawyers & doctors) adding a second kid does not make that much difference.

    I agree, too, that it’s a relief not being responsible for someone’s life, but we do have students die. When a student of mine was murdered by her husband (along with her two children) I realized that we’re not responsible for life and death, but we do, like parents, invest in students’ potential. . . It was heartbreaking.

  13. Historiann on 23 Sep 2008 at 4:23 pm #

    Oh my goodness, Susan–what an awful story! Students have died on campuses I’ve been affililated with, but no students of mine have died (so far as I know.) It’s sad even when they’re not your students, but I can’t imagine what it was like to have a student murdered with her children.

    On your other point: I think it’s because the big dropoff for academics is if they have one child. (From 91% to 64%–almost a 1 in 3 dropoff.) That’s related to the moving-around and isolated/small-town problems that Erica and I talked about above. If you’re a woman with a Ph.D. in a position to have a child, that means that it’s already much more likely that you’ve compromised or given up on full-time employment in order to have a partner and a family. Whereas for professional women who have more job opportunities, fewer of them drop out of full-time employment when they have one child, but it becomes more difficult with two or more.

    And, you’re right: doctors are more “replaceable,” at least in primary care.

  14. New Kid on the Hallway on 23 Sep 2008 at 8:29 pm #

    I don’t know how this tallies with big universities, but I found it interesting that the pre-med students at the SLACs I taught at were overwhelmingly super-organized super-smart women. Granted, NLLDH and I always worried a little about when some of them were going to snap – they were wound pretty tight – but they were crazy impressive.

  15. Indyanna on 23 Sep 2008 at 9:21 pm #

    Historiann,

    Post-tenure review is pretty pro-forma. You’re the pro,
    and they’re the forma.

  16. The Anti-Troll on 24 Sep 2008 at 4:38 am #

    Though the eventual pay-off for an MD may be high, the residency schedule is brutal. For example, you can expect one day off every 10 days, 80-100 hour weeks (in the hospital), and around 2 weeks of “vacation,” during which you’ll likely spend your time studying for board exams. For two to five years you’ll have few to no friends and the relationships you do have will be strained to the breaking point. Oh, and your patients will treat you like a pill-dispensing moron intent on making their lives more difficult. Ph.D. work in the humanities may be low paying and with low job security, but it is not inhumane (mostly). I’m the spouse of doctor, and I wouldn’t subject my worst enemy to a medical residency. Medical training is not just tough, it is irresponsibly and organized and executed. We need to hold all programs, Ph.D. and M.D., to a higher standard in looking out for their students.

  17. Historiann on 24 Sep 2008 at 6:19 am #

    New Kid–that’s been my impression recently, too–and not just with Med school aspirants, but law school, too. (And Indyanna–thanks for the vote of confidence!)

    Anti-Troll: thanks for stopping by to comment. You are absolutely right–and I certainly didn’t mean to trivialize the brutality of the experience of residency. Back in the 1990s when my friends and family members were going through their residencies, there was a lot of talk of reform: limiting the hours one could work consecutively, etc., in the interests both of patient safety and physician sanity, but I don’t hear about that so much any more. It’s like the medical profession just gave up. And while it was a rough experience, many of my friends and relatives came out of it thinking that it may be a necessary evil to work people that hard if you want to get it all done in 3-4 years–otherwise, the training even for primary care subspecialties could extend to 5-6 years on very low wages–and you well remember that those student loans come due early on and they just won’t wait…

    But, I guess what I was suggesting that the table above reflects is that when people work that hard for their professional credentials, they keep working hard and they don’t give up as easily as we humanities Ph.D.s! Dealing with a squalling infant in the middle of the night or screaming kids in the house is just like more call, and not such a life-altering, heart-stopping ordeal like it is to people who are more accustomed to working in quiet offices and sleeping peacefully through the night…

  18. Knitting Clio on 24 Sep 2008 at 7:46 am #

    Regarding women in medicine — it could be that certain specialties have become more female/family friendly because of a shortage of qualified applicants for residencies. I’ve heard that pediatrics is the least desirable specialty, and OB/GYN has trouble attracting residents as well due to an enormous increase in litigation. So, perhaps certain residency programs are allowing women (and perhaps men as well) more flexibility in hours, but that’s just a guess. Also, maybe private practice is more compatible with family because you can (sort of) set your own hours and be your own boss, although that means also dealing with insurance providers, drug reps, etc.

  19. Historiann on 24 Sep 2008 at 9:35 am #

    Private practice only has reasonable hours if people are seeing patients 3 days a week instead of 4, and only if the call is at least 1 in 6 nights and weekends. But, most practices are still set up and run by men with wives who aren’t necessarily in the paid workforce. A friend of mine set up a practice with other women, and that has been a little better than when she joined a more established practice & couldn’t necessarily set her own hours. (I think she can now–but she’s such a worker that she’s probably seeing patients 4 days a week anyway.)

    OB/GYN is attractive to many because it’s a surgical sub-speciality, and so you can bill like a surgeon. (Much to your chagrin, I know, all of those obstetric surgeries anyway!) But, the call is rough, and most docs try to go in and attend their patients’ deliveries even if they’re not on-call, so it’s a very, very demanding sub-specialty. So is peds–they don’t make as much money, but the call is rough, and you have the whole dealing with the parents who aren’t your patients but you need to work through them because the children aren’t calling the shots issue…

  20. pigeon on 24 Sep 2008 at 11:56 am #

    Historiann -

    As a “recovering historian” and now back-to-grad-school future nurse practitioner, I have been pondering the “academia vs medicine as a woman” topic for several years.

    While the Harvard and Beyond stats show that women MDs have an easier time having larger families while continuing to work, I think that you might want to reframe some of your comments, at least on the salary differences between physicians and academics, in light of another topic you have discussed at length in the past – the political economy of health care or the lack of health care in this country. There’s no question that the physicians are making more money, but…..as an example…

    At the hospital where I work, a significant (though variable) percentage of clinical (ie, non-academic) physicians’ base salaries is dependent on their number of “billable hours.”

    That means that if you are an emergency room physician, where the vast majority of the patients have no health insurance and no money, it does not matter how many patients you treat during your ten-hour shift, if none of them can pay, you won’t necessarily make your full salary.

    And it also means that if you have one fully-insured patient who is very sick and requires several hours of a physician’s full attention in order to survive an acute condition, unless every single one of those hours can be accounted for in a way that an insurance company will reward with compensation, you won’t necessarily make your full salary.

    Even for a physician in private practice, the structure of our nation’s health care system dictates how they can see patients. Insurance standards affect who physicians see in private practice since, even if they take an occasional patient who has no insurance or sub-standard insurance, the physician then needs to compensate for that patient with one who can afford to pay in full.

    Furthermore, insurance companies limit the amount of time a physician can spend with a given patient, even in private practice. You could choose to spend longer but you won’t be getting paid for it. If your 4 kids are waiting at home with the nanny who’s had it and is ready to quit…. just how many times can you afford (financially or otherwise) to see pro bono patients or spend as much time with needy patients as you and they might want?

    The only way for a physician in private practice to ensure her $200k – $400 k salary is to refuse to take any health insurance of any kind. And, especially in large cities and in OB/GYN, that’s what many do.

    But that comes at a cost of a different kind – you will only be “healing” the people who can afford to pay to be healed.

    For everything that I did not enjoy about lecturing to undergrads, I didn’t trade the pleasures of academic research and writing so that I could only serve the health needs of the rich in order to make five times my professor-friends’ salaries and still be the mama of a dozen kids. It’s not necessarily what all physicians are facing in terms of _how_ the money is getting made, but before we go encouraging our daughters to go to med school, perhaps we need to encourage them first and foremost to demand more of their political system.

    That’s just my opinion and my very jaded view; but, it’s also why I’ve switched from med school to nursing school. Nurse practitioners’ time is far less restricted by health care institutions and insurance companies (at least for now). And, though the word “nursing” may have a sour flavor from any view that considers the implications of gender, it is a profession that is in dire need of a feminist re-appropriation. It’s hard work, hard science and best done by people with fully-functional critical thinking skills – the kind that might get nicely honed by many years in a history PhD program. But I digress.

  21. Historiann on 24 Sep 2008 at 12:18 pm #

    Pigeon–I agree with everything you say, except the part about salaries. There are some pediatricians who make more than $200K and take insurance–even including medicaid and tricare. I can’t say how, but I have direct knowlege of people who make this kind of dough while seeing a good proportion of working-class and needy families.

    I absolutely share your concerns about equity and social justice when it comes to health care, and I truly admire your commitment to training as a nurse in order to put your values into practice. (I like your point about a “feminist reappropriation” of nursing–bring it ON!) IMHO, it’s not the doctors who are making money they haven’t earned–it’s the private, for-profit insurance companies who are unethical in making money off of denying people coverage (besides the fact that they add little value and much hassle and waste to the whole system). I know that there are some physicians (inc. some primary care docs) who have gone to a cash-only model of care, and I have real ethical problems with that.

    In the end–this post was mostly about how I would want any daughters of mine to seek out a higher-paying profession (with more job opportunities) than I did. I lucked out, but others haven’t. Nursing pays more than academia, and there are more jobs in the field, so it too would qualify as a preferred profession. Economic independence is something I think we still need to emphasize for ourselves and our daughters.

  22. pigeon on 24 Sep 2008 at 5:09 pm #

    Historiann -

    I agree, it’s not the doctors who are making money they don’t deserve – not at all. It’s just that many of them (luckily not the ones you know) are forced into (what I consider) ethical gray areas when it comes to how they can make their salaries.

    I don’t blame the physicians with whom I work when they make the effort to see some insured patients each shift; it doesn’t keep them from caring equally for everyone who comes through those ER doors. But, I also know that they would be far happier if the salaries in their contracts were based on the quality of the care they give instead on the insurance status of the patient to whom they give it. The plague of the billable hour can be a soul-draining experience for many in hospital-based or community-clinic-based medical practices.

    Ultimately I guess my real point is that choosing a profession (or helping a child or student to do so) is a process that needs to look below the surface of the salary to be sure that the financial compensation is made on terms with which the aspirant will be happy – regardless of whether she’ll be a doctor, lawyer, anthropologist or plumber.

    (Plumbing, by the way, is a very well-paying job with great transferability and many opportunities. We might well encourage our daughters to take up toilet repair.)

    With admiration, pigeon

  23. Historiann on 24 Sep 2008 at 5:32 pm #

    Thanks, Pigeon–you’re right, plumbing and H-VAC skills offer good jobs. (In fact, one of my regular commenters here is an H-VAC guy…)

    I agree that there is a much better way to do medicine than the one we have today. As one of my physician friends says on a regular basis, “This was just one more day of trying to cope with a hopelessly broken system.”

  24. fxto.cn » Blog Archive » Women + advanced degrees + children = ??? on 28 Sep 2008 at 1:17 pm #

    [...] Historiann provides some context fr.f her own observations, and then offers some adv.: Physicians, especially primary care docs, on the other hand are different fr.f most academics, and these differences, plus some advantages in their lines of work, make all the difference: [...]