Physician moms continue to struggle in a male-dominated culture

June 20--As she prepared for the birth of her twins and the prospect of caring for three children under 18 months old, Dr. Hala Sabry felt anxious for the first time in her life. An emergency room physician, wife and mother in Southern California, Sabry lacked the option of taking years off to care for her growing family. Though she was accustomed to making split-second, life-or-death decisions in the emergency room, trying to figure out how to arrange and pay for child care for three small children while continuing to work was causing her chest pains and shortness of breath. "How am I going to do all this?" she wondered.

Many physician moms say it is challenging to be both a doctor and a mother. Dr. Uzma Yunus, a psychiatrist and mother of two from Glenview, knows firsthand the sacrifices physician moms make to succeed at work and care for their families. Sometimes, she says, it means skipping meals when a patient emergency causes the doctor to fall behind in her schedule. And often it means giving up downtime because, after working a full day (or night), she must also tend to children at home who need to be toilet trained, fed and cared for. "There are so many times when we are putting ourselves below other people's needs, whether it's our children, our families or our patients," Yunus says. "That becomes a very strong contributing issue to burnout."

Over the years, women have made great strides in the medical profession. In 2014 they represented nearly half (47.5 percent) of all medical school graduates -- up from less than 7 percent in 1966.

Today, women physicians represent about a third of all medical doctors and even form the majority in some specialties, such as pediatrics and obstetrics/gynecology.

But the profession doesn't always treat women fairly. According to two recent studies in the Journal of the American Medical Association, women physicians are paid less and promoted less often than their male counterparts.

Another challenge is that physician training takes place during a woman's prime reproductive years, but pregnancy is difficult in an environment that includes heavy workloads and long hours. Women who become pregnant may be "labeled selfish" and suffer the resentment of their peers, says Dr. Monique Tello, a primary care physician at the Massachusetts General Hospital (MGH), who deliberately sought out (and found) a woman-friendly practice after she completed her training.

Though improvements are being made, medical facilities are still struggling to meet the needs of those who are both medical doctors and mothers. Physician moms continue to struggle with a male-dominated culture and an institutional resistance to change that makes it hard for them to thrive.

A research letter published in the May issue of JAMA Internal Medicine reports, "Despite substantial increases in the number of female physicians -- the majority of whom are mothers -- our findings suggest that gender-based discrimination remains common in medicine, and that discrimination specifically based on motherhood is an important reason."

Researchers analyzed the responses to a survey of nearly 6,000 physician mothers who were members of the Physician Moms Group (PMG), an online community of over 60,000 from all medical specialties and every practice type. (Sabry founded the PMG in 2014.)

Nearly four out of five reported workplace discrimination of some kind, with two-thirds reporting gender discrimination and one-third reporting maternal discrimination. Maternal discrimination included inadequate pregnancy or maternity leave and lack of on-site accommodations for breastfeeding. Maternal discrimination was associated with higher rates of self-reported burnout.

One doctor who participated in the survey said she was told by her employer that she would have six weeks of maternity leave but "I had to take all of my six weeks of vacation and then had no vacation for the rest of the year, which was basically impossible with a new baby at home."

Providing physician moms with a breast-pumping area is another need that often goes unmet. Busy physicians cannot leave their clinic to search for a place to pump or to nurse their baby, says Tello. She says she has seen facilities that either lacked a dedicated area for pumping or had a room that was situated too far away from patients, forcing doctors to take time out to get there and back.

Considering the results of the survey, Dr. Eleni Linos, assistant professor at the University of California San Francisco School of Medicine and one of the study's authors, said, "What struck me is these women are playing so many roles. They are doctors to their patients, mothers to their children, caregivers to their sick relatives, teachers to their students." The study was intended to identify areas in which employers could make improvements.

Research shows that everyone benefits when the system accommodates women doctors. According to a February 2017 study published in JAMA Internal Medicine, hospital mortality and readmission rates were significantly lower for patients treated by female physicians than by their male counterparts.

Conditions are gradually improving as more women enter the profession and begin to change the culture. Dr. Rachel Salas, an associate professor of neurology at Johns Hopkins Medicine and the mother of two boys, says she was able to find a practice with family-friendly policies. The director of her division, the Johns Hopkins Center for Sleep, is also a physician mom, and the rest of her team (both men and women) all have young children and understand issues like snow days or illnesses that keep children out of school and require flexibility. "I definitely can empathize and know what a lot of (other physician moms) are experiencing," says Salas. "I have been really very fortunate."

Some medical facilities and hospitals have begun to develop more mom-friendly policies, and Linos says she'd like this trend to continue. "I'd love to see more workplaces, more hospitals and clinics provide paid maternity leave, places for new mothers to pump or nurse, and child care facilities on-site," she says. "I think these ... policies really make sense for everyone."

The first step in solving a problem, says Sabry is to acknowledge that it exists. She hopes that increased attention will encourage discussion and foster "a big change" that benefits not only today's physician moms, but also the next generation of female doctors.

"Everybody wants a happy doctor," says Sabry. "One who is optimized to the patient because her essential needs have been met is better able to help others."

Claire Altschuler is a freelancer.

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