Comments on: “Family friendly,” my ass: and why M.D. women are large & in charge History and sexual politics, 1492 to the present Sun, 21 Sep 2014 12:24:08 +0000 hourly 1 By: » Blog Archive » Women + advanced degrees + children = ??? Sun, 28 Sep 2008 19:17:14 +0000 [...] 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: [...]

By: Historiann Wed, 24 Sep 2008 23:32:34 +0000 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.”

By: pigeon Wed, 24 Sep 2008 23:09:30 +0000 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

By: Historiann Wed, 24 Sep 2008 18:18:26 +0000 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.

By: pigeon Wed, 24 Sep 2008 17:56:49 +0000 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… 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.

By: Historiann Wed, 24 Sep 2008 15:35:08 +0000 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…

By: Knitting Clio Wed, 24 Sep 2008 13:46:46 +0000 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.

By: Historiann Wed, 24 Sep 2008 12:19:54 +0000 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…

By: The Anti-Troll Wed, 24 Sep 2008 10:38:10 +0000 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.

By: Indyanna Wed, 24 Sep 2008 03:21:30 +0000 Historiann,

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