Women Say Stopping Tenure Clock Isn't Enough

Having just recently met Dr. Shatz, I couldn't help but trying to figure out how she tried to balance work and life.

And result was...disheartening.

http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2004_12_17/nodoi.9322025004052172510

http://www.funjournal.org/downloads/PaulShatz.pdf

"What I expected to happened was not happened and what happened what not what I had expected. I fully expected while I was growing up, that I would have kids and a family. I was married but I put off the decision to have kids for too long and when it finally came time to have them, I found that I could not conceive. The subsequent infertility treatments were very time consuming, so what time was saved by not having kids got spent in the difficult struggle to conceive.

There is never a good time to have children, so my advice is not to postpone this decision. Find an environment where having children is an acceptable part of life and where there are supportive senior faculty. Senior women in the field are increasingly more understanding about the needs of a professional woman to balance kids and career. Now there are several senior women on the faculty here at Harvard."

This is an even more difficult problem for MD/PhDs. All of the popular discussion about family within academia focuses on helping junior faculty or PhD only types to balance work and family life. However, it is most common even without time off for us to finish fellowship and become junior faculty (not even close to tenure!) in our mid to late thirties when fertility is becoming impaired. Meanwhile, residency and fellowship are notoriously not family friendly, limiting the ability to start a family sooner, financially or otherwise.

At this point without serious changes to the system, I have no idea how to fix this problem for MD/PhDs. Until there is some serious discussion or resolution of the problem, it stands to reason that MD/PhD will continue to be a male dominated training pathway.

My program has almost 0.4 kids per MD/PhD student (w 25% of students having children) and has a slightly over 50% female composition. I bring these two issues (kids and gender #s) when we are recruiting, often resonating well among female applicants.

Fencer said:

My program has almost 0.4 kids per MD/PhD student (w 25% of students having children) and has a slightly over 50% female composition. I bring these two issues (kids and gender #s) when we are recruiting, often resonating well among female applicants.

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I'm not sure if I'm unique in this aspect, but this was also attractive to me when I interviewed at the program, since I've always been interested in having kids; knowing that women can have kids and successfully complete an MD/PhD and still be the (presumptive) primary caregiver is, I think, a great thing to showcase.

How common is on sight day care at institutions hosting MSTPs around the country. This is my app year so I am just starting my in depth investigations toward creating an app list. My mom was a working professional who frequently brought me to work with her. I had always assumed I would have access to a similar situation should I need it. I am currently single but a lot could happen over the next 8-10 years.

As for the quote from the article posted above about how there is "never a good time to have children", well, I was an only child and I plan to have several. My take is that, there will never be a bad time. There are things I plan to do in my life. These include being a productive physician/scientist and a mother. I don't plan to let anything stop me.

From the Science article:

Her own lighthearted attempt at addressing the issue, she says, has been "to insert my child's name and birth date in the chronological order of publications."

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😀 I am so going to do this.

plumazul said:

How common is on sight day care at institutions hosting MSTPs around the country.

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I haven't seen any, but maybe there is one. There is a day care next to my residency program; and it is for staff and faculty only. I have brought up to our administration how poor our benefits package is, and I've been told that we are temporary employees and our limited benefits reflect resident/temporary employee benefits nationally. 31 years old and a temporary employee... And I'd want to do fellowship and extend this another several years why? But that's another discussion.

My mom was a working professional who frequently brought me to work with her. I had always assumed I would have access to a similar situation should I need it.

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During patient care activities, no, you won't have access to these situations. A science lab is also often not an appropriate place for children as well.

I don't plan to let anything stop me.

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Reality is a significant problem. It's great that programs showcase their women who have children, but it's disingenuous not to bring up the harsh realities of trying to make this career work with a family. It's also disingenuous not to discuss how students make it work. For me, a lot of students were able to do things (buy houses, have children, etc) because they had significant family support. I have never had family support, so it always felt cruel to me as a student when we showed off to applicants my classmates who lived above their means.

Your options are:

1) Have a husband who will take care of your children while you work 60-80 hours a week for much of your career. It is tight living on only your salary during residency, but it can be done.

2) Have a husband who makes a lot more money than you do while training, who can pay for childcare expenses. Your income during an MSTP won't pay for childcare alone. Your income during residency/fellowship will be enough to pay for childcare, depending on locale and number of children, and not much else.

3) Have parents who will take care of your children for you much of the time or give you a lot of money to pay for childcare.

My dating life was a disaster as an MD/PhD student, but maybe you will fare better in finding a mate.

Just to add to discussion as a wife and a mother who is also pursuing an MD/PhD by giving an anecdote... When I told one of the directors of my program that I was pregnant (at the beginning of the 3rd year of my PhD) and was seeking his advice on how this might impact my training, his response was "Oh great! We've had many students in our program who were in a similar position." I was a bit surprised since I couldn't think of any other women I had met who had had kids so I asked him who. He went on to list multiple people... all men & most of whom had stay at home wives. While I completely do not want to minimize at all their situations (and particularly the difficulty of supporting an entire family of 3, 4, or 5 on a PhD stipend), I couldn't help but think that he was completely off base. Balancing family & career is so completely different for a man who has a stay at home wife vs. a woman whose husband is a resident even if they're both working on their PhD. I think part, though not all, of the problem is a general lack of recognition that women who have children on the road to becoming a physician-scientist face unique problems that men simply generally do not face. I also have to add that this particular director is someone that I personally like and respect a lot. He has 2 young kids (he had kids a bit later in his career but is probably in his late-40s) and his wife works... so I was a bit surprised when even he didn't really seem to get it.

Plumazul, in your post, you've vocalized a lot of thoughts that I had as I was applying to MD/PhD programs. I'm willing to share my experience with you (as someone who went into the MD/PhD & single, but aware that I'd want to start a family at some point). I do have to say though that from my experience (and from talking to other women who have been in similar situations) Neuronix is not far off. PM me if you want to chat 🙂

I will say though that I agree that there's no "good time" for kids (in terms of career). My husband and I are glad that we haven't put it off even though it's meant sacrifices (both financially and professionally).

Having a family generally requires one or more persons to manage the home and children while others work. Children are not plants that just grow with sunlight and water and dirt.

That's why this whole "you can have it all" nonsense spouted by the feminists is utter BS. Yes, you can be a professional woman and have a high powered career with children. However, you cannot have that career and mother those children. You will have to outsource the care of those children to your partner/husband/mother/father/siblings/nannies/professional daycare. You'll have to hire housekeepers to keep your home environment hygienic. You'll hire cooks to cook your dinners - or go and eat out at restaurants a lot - or eat TV dinners - or cook crappy food. Or your family members will have to handle these duties instead, which will thus require them to make sacrifices in their careers/retirement.

Or you will have to make sacrifices in your career, whether that means pursuing a different residency, giving up a research career at a major university, working part time, working shifts that do not overlap with when your kids are at home, etc.

sluox said:

Having just recently met Dr. Shatz, I couldn't help but trying to figure out how she tried to balance work and life.

And result was...disheartening.

http://sciencecareers.sciencemag.org/career_magazine/previous_issues/articles/2004_12_17/nodoi.9322025004052172510

http://www.funjournal.org/downloads/PaulShatz.pdf

"What I expected to happened was not happened and what happened what not what I had expected. I fully expected while I was growing up, that I would have kids and a family. I was married but I put off the decision to have kids for too long and when it finally came time to have them, I found that I could not conceive. The subsequent infertility treatments were very time consuming, so what time was saved by not having kids got spent in the difficult struggle to conceive.

There is never a good time to have children, so my advice is not to postpone this decision. Find an environment where having children is an acceptable part of life and where there are supportive senior faculty. Senior women in the field are increasingly more understanding about the needs of a professional woman to balance kids and career. Now there are several senior women on the faculty here at Harvard."

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I read Carla Shatz's interview a number of years ago. Very wry, very ironic. And sad. But she did connect the dots, as one might expect of a person of her intelligence. And I think her input is invaluable for aspiring professional women AND men.

mercaptovizadeh said:

Having a family generally requires one or more persons to manage the home and children while others work. Children are not plants that just grow with sunlight and water and dirt.

That's why this whole "you can have it all" nonsense spouted by the feminists is utter BS. Yes, you can be a professional woman and have a high powered career with children. However, you cannot have that career and mother those children. You will have to outsource the care of those children to your partner/husband/mother/father/siblings/nannies/professional daycare. You'll have to hire housekeepers to keep your home environment hygienic. You'll hire cooks to cook your dinners - or go and eat out at restaurants a lot - or eat TV dinners - or cook crappy food. Or your family members will have to handle these duties instead, which will thus require them to make sacrifices in their careers/retirement.

Or you will have to make sacrifices in your career, whether that means pursuing a different residency, giving up a research career at a major university, working part time, working shifts that do not overlap with when your kids are at home, etc.

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Agree. I have never understood what is the point in having children if neither parent raises them? There is no dishonor in abstaining from having them, if neither of you are interested in making sacrifices to nurture them. You and I are about to get flamed.

solitude said:

Agree. I have never understood what is the point in having children if neither parent raises them? There is no dishonor in abstaining from having them, if neither of you are interested in making sacrifices to nurture them. You and I are about to get flamed.

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Don't I know it!

solitude said:

Agree. I have never understood what is the point in having children if neither parent raises them? There is no dishonor in abstaining from having them, if neither of you are interested in making sacrifices to nurture them. You and I are about to get flamed.

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I think this opinion depends very heavily on personal experience, which is why traditional values die hard. I grew up with two working parents and I don't think their parenting had "no point", so to speak. Based again on my personal experience I disagree that parents need to constantly be there in order to provide necessary parenting. There is a big difference between seeing your child a few hours after dinner per day than not having a child at all. Also, this opinion differentially penalizes women, which is exactly why feminists are against it, because most male doctors can easily find women who want to stay home--and are okay with this kind of arrangement, but most female doctors can't find men to do that, and even if they do have it, they don't like it.

Unless you can provide solid evidence that dual income couples who send their kids to daycare somehow provide inferior parenting, I'm gonna have to reject this opinion. In fact, if you look at the evidence, it's exactly the single income parents who are getting hit the hardest in this economy, because if the husband loses his job, it's a complete mess. Children need their parents to be happy, and daycare (or grandparents, for that matter) cannot possibly be that bad.

mercaptovizadeh said:

That's why this whole "you can have it all" nonsense spouted by the feminists is utter BS. Yes, you can be a professional woman and have a high powered career with children. However, you cannot have that career and mother those children. You will have to outsource the care of those children to your partner/husband/mother/father/siblings/nannies/professional daycare. You'll have to hire housekeepers to keep your home environment hygienic. You'll hire cooks to cook your dinners - or go and eat out at restaurants a lot - or eat TV dinners - or cook crappy food. Or your family members will have to handle these duties instead, which will thus require them to make sacrifices in their careers/retirement.

Or you will have to make sacrifices in your career, whether that means pursuing a different residency, giving up a research career at a major university, working part time, working shifts that do not overlap with when your kids are at home, etc.

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Or you can change the model in your head of your ideal mothering, since actually this model of women stay at home and mother full time has been extraordinarily rare in history except during the post-war era in America, and mostly White middle class America, because most of the time in human history women needed to work in some shape or form outside of the family.

Again, your assessment that academic career in incompatible with a research career is exactly the kind of antiquated misinformation that needs to be dispelled. I don't see any reason to scare talented women away for things that aren't even true anymore. Only poor and uneducated people have stay at home mom these days anyways.

sluox said:

Only poor and uneducated people have stay at home mom these days anyways.

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Are you just being sarcastic here, or are you interested in making inflammatory statements of little value?

uniqenam said:

Are you just being sarcastic here, or are you interested in making inflammatory statements of little value?

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While there is an element of sarcasm and hyperbole in this statement, there is very clear statistical evidence that families with one rather than two incomes have significantly lower education level and overall income.

sluox said:

While there is an element of sarcasm and hyperbole in this statement, there is very clear statistical evidence that families with one rather than two incomes have significantly lower education level and overall income.

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But what does that have to do with whether the parents are better parents, or whether the kids are better adjusted/cared for? One shouldn't make life decisions about something as momentous as child-rearing based on the sage advice of "everyone does it, so it must be OK".

Besides, I take issue with your claim that women have been working in one form or another for most of human existence. If one considers clothes-making, food preparation, etc as work, then yes, but the fact of the matter is that these women still were the primary caretaker of children; it's possible to have two children on one's hip and an eye on four others while one grinds grain into meal. If, as you say, women were doing work outside of the home for most of human existence, wouldn't there be evidence of mass child care services throughout human history? I don't think that this is the case.

All of this is not to say that having two working parents can't work out for everyone involved, I just think you're basing some of your logic on faulty assumptions.

uniqenam said:

But what does that have to do with whether the parents are better parents, or whether the kids are better adjusted/cared for? One shouldn't make life decisions about something as momentous as child-rearing based on the sage advice of "everyone does it, so it must be OK".

All of this is not to say that having two working parents can't work out for everyone involved, I just think you're basing some of your logic on faulty assumptions.

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Not at all. I'm simply saying, everyone does it, and there appears to be no clear evidence of ill effect, and therefore it must be OK. In fact, statistical evidence points to the OPPOSITE correlation: women working is probably better for the household. The more important point here is that there is a particularly egregious, and I would argue factually invalid strand of thought that somehow if you don't stay at home full time you are not a good parent, which is neither substantiated by evidence nor consistent with either historical cultural norms or practical convenience.

The fact of the matter is this white picket fence life of father working and mother staying at home and caring for children is a peculiar form of existence specific to a particular era in history, and to claim that it has any kind of normative value, to me, has no legit basis, and is very much subject to critical examination, especially considering certain flavors of racism, sexism and homophobia involved. There's a really good NYTimes article, which I can't find right now, that showed that African American women throughout the 50s and 60s worked outside of the home, and the "new feminist" idea that there was some profound change in the women at work trend is really much more specific for a particular ethnic/cultural melieu, and not at all new for others. Given that there are a lot of smart, talented women out there who want to both be successful as physician scientists and have families, the right solution is to find and build institutional ecosystems that encourage and promote more gender balanced family arrangement, as opposed to articulate and defend an intellectually inert position.

This also has to do with the local environment. In certain parts of the country, it's extremely common in the past few decades now to have women who have families and sustain high powered careers. It's possible that people who maintain a particular set of opinion, i.e. that it's not possible, just don't see it around them because they live in a different environment. To a certain extent, Dr. Shatz is saying exactly the same thing to today's women in science--don't be like me and assume it's not possible; go into this assuming that it's possible, and figure out how to make it work.

sluox said:

Or you can change the model in your head of your ideal mothering, since actually this model of women stay at home and mother full time has been extraordinarily rare in history except during the post-war era in America, and mostly White middle class America, because most of the time in human history women needed to work in some shape or form outside of the family.

Again, your assessment that academic career in incompatible with a research career is exactly the kind of antiquated misinformation that needs to be dispelled. I don't see any reason to scare talented women away for things that aren't even true anymore. Only poor and uneducated people have stay at home mom these days anyways.

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What you've said here is sheer nonsense, as anyone who knows a bit of history could tell you. Nobody said that women didn't work at the home, they just didn't work outside of it. By "outside" I mean that you do not have flexibility over your time, that you can't leave the laundry to breastfeed the baby, that you can't take a break from tending the garden while you cook dinner, etc. You can do very little of that with a high powered career. You have bosses, clients, patients, pressures, papers to be written and revised, night shifts, meetings to attend, grant applications that need to get funded, etc., etc., and none of those things are flexible and none of them have understanding for a crying baby, a kid who's come home sick from school, a kid who just needs to talk to his mom or dad about a rough day for an hour or two or three, etc. You will always put a priority over your career over your kid, because your career pressures have the power to get you disciplined, demoted, lose your job, funding, etc. Your kid will just hope you spend a little more time with them, act out a bit, cry, distance himself, turn to peers for advice, etc. No big repercussions to you, of course. Until you have a ****ty relationship when they're 30, and they dump you in a nursing home when your 80 because you're nothing but a sack of money to them. Just that.

That's why I said, you can have kids, but you have to outsource their care to others. As a woman, you have to give up on breastfeeding or you have to take long bathroom breaks at work to pump your own milk. So you're feeding your kid formula, which is a less healthy option than what you could be giving them.

You have to get them a nanny or pay for expensive daycare, where people who are paid for their services take care of your kid - not because they actually care and love that kid, but just because it's their income.

Instead of being at home to teach your kid how to have a head start on numbers, reading, playing piano, etc., you have to trust that a rapidly faltering education system will be there to do that for them. Or you have to pay big bucks for private school or a governess. And the list goes on.

As solitude put it so well, I don't see why people who don't want to make the professional sacrifices to raise their kids, want to have kids at all. It sort of defeats the point of having kids, really.

Oh, and I am neither poor nor uneducated and my mom was a SAHM. So there are some exceptions to your general rule. 🙂

I'm just going to leave this here, post by a female surgery resident on the surgery forum:

http://forums.studentdoctor.net/showpost.php?p=13656947&postcount=11

Hey all, I've been largely absent from this forum for the last two years, but just so happened to come back today to find this thread front-n-center.

I'm female. I'm married. And, towards the end of my PGY-2 year, I had a son.

Most women will spout meaningless BS, frankly, on the work-life balance. They'll say "you can make it work, you just have to be really organized" or "it's easy to have a baby in residency, you just have to prioritize" without really getting not the nitty-gritty. Well, here's the nitty-gritty: having a baby in residency, as a woman, is really really f*****g hard and you shouldn't do it.

I had a dream pregnancy. Was on call on my due date. Worked all the way up to 41weeks. The only accommodations I requested were not being assigned to endovascular cases due to the fluoro, which was fine. I had my son, had a 28-day maternity leave (sacrificing all vacation and flex time for the whole year in order to meet the RRC's 48 wks of active clinical duty requirement. Remember, trainees in other fields can actually take their FMLA for longer leaves, or arrange 'research electives,' but we can't, not if you want full credit for the year). Then I came back to transplant, with its erratic q2 40- hr calls and long procedures. When you're holding a liver retractor for 8 hours, how amenable do you think the attending is to you scrubbing out to go pump for 30 minutes at a time, q3 hours? I had a month-old baby whom I wasn't seeing, or nursing, for 2 days at a time. I was contributing absolutely nothing to his care, nothing. It is impossible for female trainees in other fields to understand how much more radically different the demands of surgery residency are on motherhood.

The other thing to keep in mind is once a child enters the picture, you examine your own working life in a new light. You have to find someone else to provide competent, reliable care for that child literally every single minute you're out of the house. What nanny-- or nannies, because you'll need at least two-- will arrive at 4:30AM when you leave, be content to stay till nine when you said you'll be home at seven because a patient had a complication, work overnights, weekends, holidays, covering 30+ hours at a time? At least 95% of the burden will fall on other people, be it your partner, family members, or commercial help. To make up for this, you also, out of inclination and biology, will be "on" from the moment you step foot in the door at night till you leave in the AM. Words really cannot express how completely exhausted you'll feel, being q1 for months on end, with absolutely no post call day to make it up. The worst, hardest month you ever experienced in residency is absolutely no comparison.

Finally, as prosaic at it sounds, you suddently do have competing demands which genuinely compromise your ability to be a good resident. I will say that unabashedly, if no one else does: being a woman and having a baby makes you a worse resident. The exhaustion honestly compromises your ability to think, speak, read and analyze clinical situations. I felt I was functioning completely on autopilot. I do not think any patient was harmed, but I cannot be sure. Then there are the time constraints: you are nursing your baby at 4 AM, since you need to be out the door at 445. The time comes and he hasn't finished. You can't make him drink faster. Do you leave him unsatisfied, or show up to work 10 min late? Or, you're signing out in the evening and you get a page that a patient is near to coding. Any decent resident would go look in on their own patient and manage the situation. But your daycare is closing-- staff is going home-- in 30 min. Your first duty is to your own child, isn't it? You have to go get him, no questions asked, else-- seriously-- he goes into protective custody via CPS overnight, as do all unclaimed children. Again prosaic concerns, nothing exciting, but you must make a million such small choices which will result in suboptimal residency performance and suboptimal mothering.

Ours is a system that runs on a permanent skeleton crew, with absolutely no slack or redundancy built-in. It is impossible to overstate the differences between having a baby as a surgical resident versus being in pediatrics, medicine, psychiatry, pathology, FM, EM, etc.

Marriage is completely different. Marriage involves almost no time or personal sacrifice when it comes to residency. Butif anyone is contemplating a planned pregnancy in Surgical residency, I would advise them not to do it. At least as an attending you have some control over your own day, schedule and normal workplace protections like FMLA. Otherwise, simply understand that you will be entirely dependent on other people to raise the baby.

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sluox, I understand your perspective. And I have no data to indicate that kids somehow turn out "better" in one parenting arrangement vs. another. Most kids end up f----- up no matter what 🙂.

Mine is not a normative argument that people should do it one way vs. the other. I would never constrain individual choice. All I am saying is that I just don't understand why people try to "have it all". Nobody can, men included. Every man I know, even those with a SAH wife, have real conflict about working so much instead of being with their wife/kids. They do not "have it all". Hell, I don't even have kids yet and I'm conflicted about time away from my family. Everybody needs to realize there are major opportunity costs (as explicated by mercaptovitzadeh) and go into this career and parenting with open eyes. There will be sacrifices galore. This is true for men and women considering MSTP.

Also, as others have noted, it is absolutely not true that only the poor and uneducated have SAHMs. Actually, the poorest and least educated are forced to be two-parent households because they need the income. I know many, many very well-educated families with SAHMs (and dads). I know MD-PhD graduates with fellowship training who stay home with kids. There was a study at Yale a few years back where 50% of women desired to be a SAHM mom. The Atlantic article "why women can't have it all" was a blockbuster, and the Atlantic demographic is not exactly uneducated. This isn't to say there isn't a huge population of well-educated, well-off couples where both members work, because there is.

And more power to them. This is America, people can do whatever they want and we need not fulminate about which choice is backward. Your condemnation is precisely why people who still hold on to "traditional" parenting arrangements, for whatever their reasons, are so turned off by feminists and the media in general. We're not trying to condemn your choices--why condemn ours?

mercaptovizadeh said:

As solitude put it so well, I don't see why people who don't want to make the professional sacrifices to raise their kids, want to have kids at all. It sort of defeats the point of having kids, really.

Oh, and I am neither poor nor uneducated and my mom was a SAHM. So there are some exceptions to your general rule. 🙂

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Your perspective is predicated on experience. So is mine.

Your n=1 experience is of a SAHM. And she did a great job - you're in an MSTP.

My n=1 experience is different. My mom was and is a high powered, successful physician who graduated when med school classes were 10% female (ie no role models to speak of), worked crazy hours and I turned out great - I'm in an MSTP. She was/is very involved in my life and moreso than some SAHM I knew growing up. To me while growing up, your mom working wasn't correlated with how "good" or how involved your mom was. She and I are great friends at this point in life.

Yes - some things were outsourced like housekeeping, laundry, or carpools for school/sports - but if you live in a rich enough neighborhood, even those SAHM or the trophy wives don't sully their hands with that type of work. Not at all sure how doing laundry relates to being a good mom.

I never knew there was an issue with being a woman and having both a career and a family until I went to college. Those women with SAHM's had no idea how they could do both. I had no idea how you could NOT do both because I grew up with a great role model.

It's all about your n=1 perspective. I know a lot of MSTPs didn't have that experience growing up. But it can be done, especially if you outsource the non-parenting components of running a household, and yes means you live frugally for quite awhile.

solitude said:

All I am saying is that I just don't understand why people try to "have it all". Nobody can, men included. Every man I know, even those with a SAH wife, have real conflict about working so much instead of being with their wife/kids... We're not trying to condemn your choices--why condemn ours?

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First of all, the idea that "nobody can have it all" is false. Clearly some people have it all--i.e. have satisfying and meaningful careers and family life. The idea that "having it all" means that I need to breastfeed my baby 24/7 while winning the Nobel prize is a straw man. No reasonable woman in science is actually looking for that. Secondly, the reason I (and ? the media) condemn your choices is that the idea of these choice are "choices" at all, as opposed to compromises due to institutional prejudice, is untenable. It's not just a "choice" that you make. Your choice has implications for people around you and your institutional ecosystem. It's like saying, as a slave you can choose to either be okay with it or flee your owner. It's a choice. Don't condemn us and encouraging our slaves to flee when they "choose" to stay. It's an evil logic. Again, as I said, this idea that women can't just "have it all" is very problematic to me because to a certain extent it smells exactly the same sort of intrinsic sexism and racism. You can CHOOSE to not fight for change, but I don't think it's moral or ethical.

I just wanted to chime in as a mother of 4 who is pursuing a PhD, even though I know full well that the program I am applying for is nowhere near as grueling in terms of time demands as an MD.

As controversial as it is, in many respects I do agree with those who say that having children during your program is not a good idea, if you have a choice in the matter. I don't agree that you can't be a good mom AND a good professional... just that babies are incredibly time-intensive and doctoral work is incredibly time-intensive, and I think it would be very hard to give your best to either if you are trying to do both at the same time.

I am not saying that it cannot be done. People do it. One of my friends is an excellent, highly respected physician, who had her baby during her residency and went on to become chief resident, and she and her child are very well-adjusted and extremely attached. However, I cannot understate how significant it is that her partner is a work-from-home programmer, and they were able to afford an in-home nanny.

I am saying that having a baby DURING your program is not ideal. Having a baby afterwards may also not be ideal, for that matter, and unfortunately it isn't always very practical for women to have babies beforehand, either.

So we still, in this day and age, have a tough row to hoe when it comes to having a fulfilling career and a family. However, if you have babies before starting a graduate program, you will be able to give them ample time while they're little. Waiting isn't always ideal from a biological standpoint, but I would really suggest that if you DO have the option, either have the kiddos before you start grad school or wait until after you finish.

Gliabelle said:

...I am saying that having a baby DURING your program is not ideal. Having a baby afterwards may also not be ideal, for that matter, and unfortunately it isn't always very practical for women to have babies beforehand, either...

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I will argue exactly the opposite for MD/PhDs as compared to PhDs (The time to "having a baby [is] DURING your program). The Clinician Scientists career is very demanding. The fact is we only attract 38% women despite MD classes of 53%. The time when you have the most flexibility of your time and schedule is during your PhD years. In residency, you have to wait for the latter years to have that flexibility in your time. Once you take on an assistant professor position, the time is ticking (with or without time stops)... During the MD/PhD program, time is ticking but a 9 year MD/PhD will not impact significantly your career as it would later in your career.

I think the issue of work/life balance is much larger than women and childbirth. We recently had a lecture from a marriage therapist and psychologist who has lots of clients who are physicians, scientists, etc. He said that the biggest trap that they fall into is the myth of deferred happiness. We all know the drill:

I can have a baby once I am in the PhD years, then I will have the time. Oh wait, I'm so busy trying to graduate that I can't afford to take the time.

I can have it during fourth year, that will be OK. Well, that won't work because how am I going to take care of the baby during internship? I'll do it after residency and that first year of fellowship once I'm in lab.

Wait, I need to be a productive scientist and can't afford to take time off during my research year. I only have so many years of funding before I have to submit my K-award.

So, I'll wait until junior faculty. But wait, the tenure clock is ticking.

Now I'm 40 and my ovaries no longer work. I don't make any money and can't afford in vitro fertilization (talk to the reproductive endocrinologists at your institution... they will tell you that a large proportion of their clients are MDs). How is it possible that adoption costs that much?

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The reality is that our career path pushes us towards that thinking, that maybe if we wait, we can have what we want. This occurs not only with having children, but getting married, moving to the location we want to, starting up that rockabilly band we always wanted to do, hiking the Appalachian trail, etc. It's a frenetic rush from high school -> college -> med school -> residency -> fellowship -> assistant professor -> full professor -> department chair -> death. The advising we get from those established in academia is "Things will be better during the next step, do it then." When we applied to the MD/PhD program, we were all bright eyed and naive; unfortunately, many of us don't realize the reality until we find ourselves 8 - 20 years in, lacking fulfillment. Then those same academics write angry articles pontificating why people don't stay in academia.

Deferring 8 years of your life may well be 10% of your life. It is not trivial. At some point, you just have to do it, career be damned. Otherwise, you end up unhappy, never getting your dreams, and complaining to a therapist. The therapist's wife graduated MD/PhD, realized she was not content with the career madness and became a hospitalist. She is much happier. There is no shame in choosing life over career or altering career because of life. It's not just about being a successful clinician or scientist, it's about having a fulfilling life.

The advice you get from people in academia is very skewed towards the values of the academic institution. Back when they trained, they worked 120 hours a week, their wives sat at home and took care of the kids and meals, and the majority of them finished their training divorced and bitter. Why am I listening to their advice on a personal life again? Always seek advise from people outside of academia.

People drink the "being a tenured professor is the be all and end all" Kool-Aid. Going into private practice/industry/pharmaceuticals is trivialized as "selling out." Dropping out of the game to take care of your children is "wasting your potential." They say you can have it all in academia, but they are all rationalizing. They chose career and sacrificed their life; to them, that is "having it all" because they highly value their career and don't value many aspects of child rearing that you may. I don't think that's wrong, just a different value system, which is a value system that I don't think resonates particularly well with the current generation. Maybe you value things differently, so live your life, not theirs. Do it TODAY.

sluox said:

First of all, the idea that "nobody can have it all" is false. Clearly some people have it all--i.e. have satisfying and meaningful careers and family life. The idea that "having it all" means that I need to breastfeed my baby 24/7 while winning the Nobel prize is a straw man. No reasonable woman in science is actually looking for that. Secondly, the reason I (and ? the media) condemn your choices is that the idea of these choice are "choices" at all, as opposed to compromises due to institutional prejudice, is untenable. It's not just a "choice" that you make. Your choice has implications for people around you and your institutional ecosystem. It's like saying, as a slave you can choose to either be okay with it or flee your owner. It's a choice. Don't condemn us and encouraging our slaves to flee when they "choose" to stay. It's an evil logic. Again, as I said, this idea that women can't just "have it all" is very problematic to me because to a certain extent it smells exactly the same sort of intrinsic sexism and racism. You can CHOOSE to not fight for change, but I don't think it's moral or ethical.

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Well we may have to agree to disagree. It seems you dispute the concept of opportunity cost. No matter how fancy the legal and institutional accomodations to child rearing, there will always be opportunity costs. I am all for setting up a system in which people can make those choices the way they see fit. The crux of the matter is that I perceive in the current system that there is the ability to make that choice, and you do not. Sorry, but I'm not sure how you would change the system? We already have family medical leave, maternity/paternity leave, flexible tenure clocks, campus child care, work from home, etc. What exactly do you want? Until MD/PhD training and life is a 40hr/wk job, it will always be a tough balance.

Furthermore, I find your logic tenuous. We have already allocated resources towards making the institutions more amenable to people who make those choices. You know where a lot of that money comes from? People who make the alternative choices. At some point, the burden falls on the individual, who is making the choice to have children, to bear the costs and consequences of that choice. It is not everybody else in the world's reponsibility to pay for institutional programs that support your spawn.

Also, another 👍 to debateg. Sluox, nobody truly "has it all". You are out of your mind if you think that, I am sorry. You can have a lot of things, but there will always be trade offs. Not enough time for job, or kids, or hobbies, or visiting your parents, etc. I look around at many of the "very successful" academic researchers at my institution, and they are miserable human beings. Do they have a family life? They have a family, but that's not the same as having a family life. Some manage to have a successful career and family life, but very few, and even fewer women.

solitude said:

We already have family medical leave, maternity/paternity leave, flexible tenure clocks, campus child care, work from home, etc. What exactly do you want?

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It has already been pointed out that MD/PhDs do not have campus child care or work from home. They often have serious restrictions on leave, particularly in residency. These things are often flexible on the PhD side, but not on the MD side. I disagree that enough is being done for MD/PhDs.

debateg said:

so live your life, not theirs. Do it TODAY.

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Sweet! I'm quitting residency TODAY! I agree with a lot of what you say dg, but once you've invested 10 years into the MD/PhD pathway, you really can't leave.

Neuronix said:

Sweet! I'm quitting residency TODAY! I agree with a lot of what you say dg, but once you've invested 10 years into the MD/PhD pathway, you really can't leave.

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You actually can leave, at any time. At one point, I got very frustrated with my medical school, asked around, and found a mentor who did not know me and had no vested interest in my well-being. He told me that I was on the "conveyor belt" that shoves people from medical school to residency, and he's seen so many people just stay on it because it's the next step, and they end up unhappy. He told me to consider not going to residency and get a job in a field I enjoyed. It was a huge slap in the face for me, but I needed it. I seriously thought about it, but some great experiences in the rest of my medical school led me to believe that's not the right choice for me.

There is this sense of sunk cost, that if you're truly, deeply unhappy, put up with it until things get better. That's probably reasonable advice for surviving the brutal intern year or a rough year in grad school, but it's not good advice long term. It's sadly the advice I've been told again and again. Go train at XYZ school that is the top program in the country! So what if you you hate the institutional culture and the city? It's only three years!

I know people who dropped out of the PhD portion and went back to medical school. They all matched into residency. I know someone who quit graduate school and moved to Hawaii just because she could, and she's now married to a guy she met in Hawaii and happy with a kid. I know two people who failed to match, one scrambled into an unrelated specialty that he now loves, and another said "screw it" and took a job in California that she also loves. I know people who dropped out of one residency to go to another one with better lifestyle. I even know a guy who was kicked out of psychiatry residency and is now somehow working as a psychiatrist. I know a girl who got kicked out of residency where she was miserable and now works for an MCAT review course, but she's now living in a city she loves and getting paid the same hourly wage as a resident. I know a guy who dropped out of residency for a few years, sorted out his life, went back, and now runs an insanely successful pediatrics practice. I know people who after residency went full time hospitalist, or full time industry, or full time mom. I know people who went full clinical scientist during fellowship, or went private practice. All of them are quite happy now.

The idea that you're somehow trapped is something the academic institution perpetuates, mainly because they're extracting value from you now. No one loves you but us! It's a lie. The conveyor belt is there to make it easy for them to continue extracting value from you. Some people stay on because they truly love what they do. A lot of people should probably get off. The statistics bear out that most MD/PhDs usually do.

If you want something out of your life, and your career path reasonably does not provide that, you should choose a new path rather than wait around for things to change. They likely will not change. I think a lot of the unhappiness people feel is because they delay their gratification until it is too late.

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Neuronix said:

It has already been pointed out that MD/PhDs do not have campus child care or work from home. They often have serious restrictions on leave, particularly in residency. These things are often flexible on the PhD side, but not on the MD side. I disagree that enough is being done for MD/PhDs.

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Actually at my university we do have campus child care for students and residents. The main hurdle is, of course, financial. Touche on work from home and leave (although that surgery link has examples of flexible leave policies, even for surgery residents). My larger point, that MSTP will never be a 40hr/wk job, so there will always be sacrifices between work and family, as expounded by ctenj, stands.

ctenj said:

The reality is that every situation is different. Clearly, there are some situations that don't allow women to really be moms at all (the surgical resident), but there are also ways to make career choices which allow you to work and also parent to varying extents. That may mean being much less ambitious in your career than you otherwise would be. Ultimately, each family has to make their own (very personal) decision on what's best for their family.

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I largely agree with you, except to say that there exists a large institutional bias still to make it very difficult to establish reasonable careers as a woman (and a man) in becoming a reasonably productive physician scientist and having a more balanced family life, and while current measures are improving, they are not enough. I simply think that it's disingenuous to claim that it IS enough. To a certain extent, this is the area we can fix a lot more readily than other areas in the entire pipeline. For instance, we CAN probably with some advocacy realistically create a law that guarantees childcare for all medical residents and fellows in training.

solitude said:

At some point, the burden falls on the individual, who is making the choice to have children, to bear the costs and consequences of that choice. It is not everybody else in the world's reponsibility to pay for institutional programs that support your spawn.

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This is not right. Perhaps you don't see it as such but many people believe that childcare and support for family constitute a collective good for the community deserves consideration at an institutional level. Much of childcare and education in our society IS subsidized by taxation. Obama just proposed universal pre-K. Many European countries have more generous maternity/paternity policies. Maybe you don't have kids and don't want to, and somehow think you are better for it, but you opinions are not universal or even the majority.

debateg said:

If you want something out of your life, and your career path reasonably does not provide that, you should choose a new path rather than wait around for things to change. They likely will not change. I think a lot of the unhappiness people feel is because they delay their gratification until it is too late.

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While you can always find rare examples otherwise, after 10 years of training I am, and most of us are, virtually unemployable outside of a residency or post-doc. Believe me, I feel no obligation to stay within academics. But, I have no desire to go back to a post-doc with questionable future research prospects, nor do I want to start out essentially from scratch in another field. In competitive specialties like mine, if you leave you're not going to get a new spot. It's extremely rare and looks bad on you to transfer (except for special reasons), even if I wanted to. I do love the clinical practice within my specialty, and that's not something I want to give up.

So yes, for me it is a matter of waiting it out a few years until I finish residency and am employable clinically. MDs are shackled into staying in a clinical path by debt. It's true we don't have debt. But, we do have all that sunk cost. For me personally, even though I'm unhappy with how the match turned out, it's still just another 3.5 years until I regain some control of my life and am virtually guaranteed a strong salary. I just hope there's a job waiting for me in the part of the country in which I used to live and wanted to live, but somehow managed to get no interviews in.

I'm going to be one of those man-eating feminists who mostly delegates child care to the other people in my life. I might even feed them formula. When my children are putting me in my nursing home I will rue my decision and weep, I'm sure

but seriously, there are lots of problems, the system should pay for child care so that it doesn't become disproportionately burdensome on people who can't afford it, and just because I don't want to stay at home doesn't mean I look down my nose at other people who choose to do so. possibly someday I'll be in a position to make changes to the system.
#tiredofthistopic

Neuronix said:

I haven't seen any, but maybe there is one. There is a day care next to my residency program; and it is for staff and faculty only. I have brought up to our administration how poor our benefits package is, and I've been told that we are temporary employees and our limited benefits reflect resident/temporary employee benefits nationally. 31 years old and a temporary employee... And I'd want to do fellowship and extend this another several years why? But that's another discussion.

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I don't understand this. If the infrastructure is in place and a need identified, shouldn't all employees be included? This appears to be a good target for legislation. If you work over a certain number of hours/week for a certain sustained time period then you are not a temporary employee. We could call it the "Sanity in Benefits Act"

My dating life was a disaster as an MD/PhD student, but maybe you will fare better in finding a mate.

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"Disaster" is ok, that would be an improvement.

plumazul said:

I don't understand this. If the infrastructure is in place and a need identified, shouldn't all employees be included? This appears to be a good target for legislation. If you work over a certain number of hours/week for a certain sustained time period then you are not a temporary employee. We could call it the "Sanity in Benefits Act"

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Residents exist in a quasi-state, somewhere between student, intern, and employee. Essentially, many institutions attempt to use all of those statuses. Whichever one is cheapest or most convenient for them is the one they will use in interpretation. Given the match, we are forced into this system, and we have no recourse. Could I leave my program? Sure, and the odds are I would never find another position in my specialty again.

I brought up to my program that our non-existent retirement plan actually does not comply with the law as written, as the law actually does state that working a certain number of hours/week for a certain sustained period classifies you as NOT temporary. They don't care. And am I going to sue them for that? Do I have any recourse whatsoever? No way.

Frankly, residents, like grad students and post-docs, provide a source of cheap labor to keep the academic enterprise afloat. Residents further provide important medical services to populations that typically cannot afford medical care. We don't generate much revenue for the health system, and thus our value is limited. As long as there is no shortage of attending physicians, they really don't care if we stay at their institution as attendings or not as we're generally easily replaceable widgets.

Now normally I don't bring these things up. I don't have a family and I don't really care that much about my lousy benefits. But, we're talking about family issues, and most residencies are NOT family friendly. That affects MD/PhDs uniquely.

PhDs and post-docs typically have some level of flexibility for family. The MD-only often pushes childbearing past residency/fellowship until being an attending. Tenure clocks and family benefits are only a hot issue for junior faculty. Nobody is talking about improving the family friendliness of residency and fellowship. Because frankly, as a resident of internal medicine or pediatrics or neurology or a fellow in a subspecialty of those, who else is going to be in the hospital 24+ hours including in the middle of the night admitting patients and taking care of emergencies? The attendings sure aren't (except maybe ED/crit care/hospitalist/some types of surgeons/anesthesia, which all have more schedule flexibility and salary regardless).

But unlike most MDs, MD/PhDs are performing those residencies and fellowships until the mid to late 30s. So what do you with your kids when you're on duty 24+ hours at a time? It comes back to my earlier post. You either need an available spouse, a lot of money, or parents.

There is another out. My residency for the most part is 8 AM - 6 PM Monday - Friday. So it's not so bad for me. This is unusual, even in my relatively light clinical duty specialty, so I wouldn't expect it. I'm in radiation oncology, and you could consider this sort of schedule during residency in a lot of dermatology programs as well. But, apparently according to some other threads picking such a lifestyle friendly residency is selling out or some nonsense, so you'll get some flack for choosing it.

But that's just clinical duty. I don't see where you can do research on top of that unless you are taking extended protected time for research or can do experiments from home. Paying for childcare during the day is a separate issue. But it is more feasible to have children in some specialties as opposed to others.

miz said:

I'm going to be one of those man-eating feminists who mostly delegates child care to the other people in my life. I might even feed them formula. When my children are putting me in my nursing home I will rue my decision and weep, I'm sure

but seriously, there are lots of problems, the system should pay for child care so that it doesn't become disproportionately burdensome on people who can't afford it, and just because I don't want to stay at home doesn't mean I look down my nose at other people who choose to do so. possibly someday I'll be in a position to make changes to the system.
#tiredofthistopic

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I'm with you here.

It's great if you want to be a SAHM, or want your wife to be so, full time/when the kids are young/etc. It's annoying to be told one *can't* be a good mom if one works full time and you'll be making sacrifices to the detriment of your kids. It's the underlying tone/frank statements in a lot of these comments. It's one thing to have a friend in their 30s who's overwhelmed with all the things, trying to make it work and you see that as "nope, just can't do it." It's another thing to see their kids when they hit 30 and see how successful or not they've become. There are not a lot of current 30ish folks who were raised in a mom worked full-time scenario particularly in the medical field, but it can and has been done and we still love our moms and are not resentful monsters of human beings.

And yes, the system should accommodate - particularly with childcare costs and benefits afforded others at the same institution. The two takeaways I've gotten from many of these work-life balance panels are 1) get staff - laundry, housecleaning, daycare, etc [note: I grew up with this and consider my mom to be a great friend - just a sack of $ she is not] and 2) women - don't wait to have kids, bc the ovaries stop working so well. Most talks I've heard are women not wishing they didn't have kids; they lament waiting too long and not having more kids. Each step of this crazy md/phd has it's own demands and it's never going to feel like a good time.

As a side note, this current issue of Nature is entirely dedicated to the issues that women face in science. May be worth a read: http://www.nature.com/nature/current_issue.html

sluox said:

I largely agree with you, except to say that there exists a large institutional bias still to make it very difficult to establish reasonable careers as a woman (and a man) in becoming a reasonably productive physician scientist and having a more balanced family life, and while current measures are improving, they are not enough. I simply think that it's disingenuous to claim that it IS enough. To a certain extent, this is the area we can fix a lot more readily than other areas in the entire pipeline. For instance, we CAN probably with some advocacy realistically create a law that guarantees childcare for all medical residents and fellows in training.

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I think I agree to some extent on this. I agree that it's difficult to be a productive physician scientist and have a balanced family life at home as things currently stand. I agree that certain measures could be taken to help with this, but although neither of us has provided a lot of specifics, I think we probably disagree with how far those measures should go. Look, I love my husband and my kids more than anything else in this world, but my husband and I have chosen to have those kids when we chose to have them. I'm not expectingsubsidized childcare to be handed to me just because we have to work long hours and don't get paid much although I will happily take it if it's offered. Do I hate writing out the daycare check every month. Heck yes. But they're my responsibility and I knew that when I decided to have them. Do I wish that I could get more time for maternity leave or easily stop the clock at any point of my career, spend some time with my kids, then come back when I'm ready without penalty? Yes, and I think that option should be offered although in contrast to many other countries' policies, I wouldn't expect to be paid.

That said, I do think that it's in the hospitals' and universities' best interests to provide some measure of work-life balance. Quite honestly, programs that have some benefits like available back-up care, etc... will help me focus on being the best doctor I can and being productive at work instead of worrying about how I'm going to find someone to take my kid when they're sick enough that they can't go into daycare/preschool, but not sick enough to actually need a parent to stay home with them. I completely agree that med students and residents should be allowed to put their kids in the on-site daycare where they exist. Unfortunately, I bet like many daycares everywhere, there are more people who want to enroll their kids there than they have spots. So they give priority to their permanent employees. The logical solution, of course, would be to expand the daycare since clearly the demand exceeds the current capacity... Expanding is not always so easy (especially finding the space within the hospital to house extra daycare facilities), which is probably why it's not being done, but I think it makes sense. Some private employers are catching on that the better you treat your employees, the harder and more efficiently they tend to work for you (and the more likely you'll be able to retain talent within).

I think at the top of my wish list would be a daycare on-site (as others have mentioned) with hours that actually jive with medical professionals' hours. When I'm an MS-3 and MS-4, we're fortunate enough that one of our kids will probably be able to go to a preschool which isn't in the hospital, but is affiliated with the hospital/university and is located in a university building just a couple blocks from the hospital. Our other kid will probably be in a daycare completely unaffiliated, but still very close-by. However, the preschool's hours are 8-5:30. The daycare's hours are a little better... But still, we'll have to pay someone to drop off for sure and will probably need someone to pick up (even though some and possibly most days depending on my husband's job, one of us could get off in time to pick up before 5:30... but we'd still need someone... just in case because you never know in medicine...). Looking forward at various residency programs, even those hospitals that do have daycare affiliated have hours that just don't correspond with residents' and even attendings' work hours.

I've kidded with my husband before that "on the side" with all of our free time (hah! 😛) we should start a daycare that opens early enough that doctors can actually drop off their kids and that stays open late enough that they can also pick up! Of course in this "dream world" the daycare would be right in the hospital and there'd be an area for breastfeeding (because just feeding your kid is generally a lot faster than setting up, pumping, and cleaning especially as they get older and more efficient with their eating) and doctors could store their lunch in the daycare fridge then come by on their lunch breaks (or between cases, or whatever...) to say hi and to scarf down their food with their kids. For that, I would be willing to pay more per hour out of our measly stipend/salary for childcare (and just to be clear that this is no small thing... childcare for our two kids in a high cost-of-living city costs basically 1.5x my MD/PhD stipend so we live very frugal lives and basically are going to use savings from pre-children days to get us through these years). One can always dream 🙂

Quite honestly, until the culture in medicine changes I'm not too sure that any amount of advocacy and legislation is going to have a huge effect. Right now, my sense is that showing that you value your family or even quality of life in general is considered a negative during your medical training because it means that your unwavering devotion isn't solely directed at putting in hours at their hospital. I can understand how it would look for the hospital comparing myself against an almost identical (but single) candidate and why you'd want the workhorse, not the mom who might need to take maternity leave or pump or even just not be willing to stay late when she doesn't have to. So even if you "win" benefits for work/life balance, many of these benefits will not be used by people because people are afraid of coming off "weak" (which I think is basically the attitude today for people who slow down their career for family). For programs that offer part-time residencies, how many interviewees do you have kept their mouths shut even if they wanted to ask about it for fear of ruining their chances? They've shown that despite the offer of "stopping the clock" on tenure, that if you have to "opt-in" that many women didn't take them up on it (making it an opt-out made it much more popular). Simply having these options available doesn't mean that they'll be used because until people feel sure that they're not going to be penalized for using them, many people will decide that they don't want to jeopardize their career or be looked at as "that woman" who got off easy.

I don't think that as trainees, we have much say in the prevailing culture at any institution much less the medical community as a whole. One day we might and when that day comes, maybe some of us will work to change it. I do think that slowly things are going to change because people in our generation and following are expecting more work/life balance than those who came before us... A large part of this probably has to do with the number of working professional women now in the workplace. But unfortunately, from what I can see, the people at the top trained in a different time and are largely middle-aged men who just don't really understand the problems that many women and even men currently in training today are facing as I mentioned before.

Just curious... other than the daycare issue, what other things would you hope to change through advocacy?

So for a woman MD-PhD, she will be better off in lifestyle specialties...when we got into the program young and fresh, we weren't thinking of family. Towards the end of my training, all I care about is ending up in the same city as my husband, so we can finally start a family. I no longer want to be a surgeon. My priorities are different. Men just don't have the same problem...

sluox said:

For instance, we CAN probably with some advocacy realistically create a law that guarantees childcare for all medical residents and fellows in training.

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Yes, the government is going to devote more funding to residents/fellows so that childcare can be "guaranteed" to people who are sure to make the top 3% of incomes, when in fact we dont guarantee it to anyone else in the country.

I have a better idea -- we'll add an additional tax at 25% of your income at the attending level so that you can have "guaranteed" childcare during your residency/fellowship years. Deal?

greenteapudding said:

So for a woman MD-PhD, she will be better off in lifestyle specialties...when we got into the program young and fresh, we weren't thinking of family. Towards the end of my training, all I care about is ending up in the same city as my husband, so we can finally start a family. I no longer want to be a surgeon. My priorities are different. Men just don't have the same problem...

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WTF? Men dont have the same problem? Wrong. How many male MD/PhDs or CEOs, or top lawyers are the PRIMARY caregiver of their children?

This is what really pisses me off about this "women have an unfair deal" crap. Neither men nor women get the opportunity to be PRIMARY caregivers in "elite" careers.

The difference between men and women is that males in "elite" careers generally dont give a damn about being the primary caregivers of their children, whereas it bothers many women that they cant be both the primary caregiver AND an "elite" professional.

.

ctenj said:

I think you're off-base here in implying that this is all a load of crap. Here are several reasons:

3. Women feel a unique burden to be their children's primary caregiver. I completely agree that generally speaking women feel a desire to be their child's primary caregiver in a way that men don't.

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Two points

1) I will agree that in our society it is far easier to find a wife to stay at home or work part-time and raise children than it is to find a husband to do so. So even for women who want to have a full-time, high-powered career, a main support system in a spouse is more difficult to find. This comes down to traditional societal roles.

2) I'm of the belief that traditional societal roles should change. However, I think women who advocate for family rights do themselves a disservice by taking the above viewpoint.

Women feel a unique burden to be their children's primary caregiver.

I think that women who state this opinion make it sound as if the needs of the family are uniquely born by the women. Usually, this manifests itself as women only discussions. "Women in MD/PhD" type groups, for example. Occasionally, these beliefs manifest themselves as the more extreme viewpoint that the man does not matter in this discussion. But this is damaging to the whole discussion.

By not bringing men into this discussion, or by separating men from the responsibility of childrearing by saying things like "women feel a desire to be their child's primary caregiver in a way that men don't", it perpetuates the issue as a woman's only issue. When in reality this is a children's or family's issue. If we are to change society in a way to make academia and society as a whole more friendly to the needs of the family, men need to be intimately involved in the discussion. I always argue, why isn't there equal maternity and paternity leave? Shouldn't men also have time off when a child is born? Shouldn't men also have access to all the same resources and accommodations that women have when it comes to children?

Separating a woman's role and a man's role in the family just damages the ability for women to advance to equal status in academia. By making the woman the primary caregiver, it still means that the burden of child rearing remains on the woman. It still means that the woman needs special treatment that makes her less valuable. It still means that the man can work harder and achieve more. I think that's the wrong way to approach this. The right way to move forward is to say: why aren't both sides contributing equally, and here are ways to make that happen.

Socrates25 said:

Yes, the government is going to devote more funding to residents/fellows so that childcare can be "guaranteed" to people who are sure to make the top 3% of incomes, when in fact we dont guarantee it to anyone else in the country.

I have a better idea -- we'll add an additional tax at 25% of your income at the attending level so that you can have "guaranteed" childcare during your residency/fellowship years. Deal?

Click to expand...

You have no idea how D.C. works. What's fair isn't necessarily realistic, and what's realistic isn't necessarily fair. What's realistic is simply what may be politically viable. Wealthy people get exceptions lobbied to them all the time. You have no idea what sounds good on paper and what doesn't. Furthermore, residents don't make top 3% of incomes. Do I think that everyone should day care? Maybe. Do I think it's more realistic to start with a specific population that sounds good on paper (i.e. selfless female primary care doctors)? HELL YAH.

Secondly, the second option you are giving is equivalent to a guaranteed loan or tax credit for child care expenses for physicians, which actually equivalent to what I'm advocating. Maybe that's more palatable to you? It sounds like you are as gullible as the rest of America in thinking that giving you a tax break is not the same as just giving you a check.

The system should be set up in a way that's somewhat gender blind, but clearly there's asymmetry that's evident in the existing pipeline.