June 23, 2011
By Ishani Ganguli, MD, Outgoing Progress Notes Editor
With great power (and taxpayer investment) comes great responsibility. Absolutely. But as a recently inducted physician whose education has been federally subsidized, should I feel guilty that I may want to practice medicine part time?
In a recent piece in The New York Times, anesthesiologist Karen S. Sibert argued that “With a growing shortage of doctors in America, we can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine.” Female doctors, she adds, bear the brunt of the blame.
As a recent medical school graduate, starting a residency in internal medicine and primary care, I found Sibert’s piece to be shortsighted. I agree with her that medical education is a privilege and that its pursuit should not be taken lightly. But her view of what it means to honor that education is far too rigid. What about doctors who also spend their time studying disease, teaching trainees, and educating the public? These are the women and (more often, men) that all medical students learn from and are influenced by as they begin to make their own career decisions.
Most of my medical school professors saw patients a few days a week at most. These doctors might not have spent 100 percent of their time directly caring for patients, but it was still valuably spent and certainly worth taxpayer dollars. They have taught me, both explicitly and otherwise, that having the room to explore other interests makes you more complete and able to give back to your patients. Those interests don’t have to be medical to count.
On Monday, I began orientation for my residency program at Massachusetts General Hospital. Our director (notably, male) reminded us of the busy schedules we’ll have in medicine and reflected that he has often made the choice to schedule his clinic around his son’s soccer games in the suburbs. “The best doctor is someone who is a good child, brother, sister, or father,” he said, encouraging us to “sustain the beings that you are and the relationships that you have.”
As of now, I plan to work full-time but split those hours between clinical practice, writing, and teaching. The majority of my medical school classmates and residency colleagues will have similar paths. The flexibility of this plan appeals to me, in part because I like multitasking but also, yes, because my fiancé and I hope to start a family in the coming years. I’ve heard that practicing part-time can make it harder to keep up with the latest medical knowledge; it’s on me to do so for my patients.
And then there’s the gender issue.
As Michelle Au nicely argued, the notion that women doctors shoulder the responsibility for our physician shortage is frankly sexist. Sibert’s piece also struck me in its simplistic view of our workforce crisis. Even if female doctors are more likely to work part-time (let’s say, to raise families), there is an undeniable value to gender diversity in clinical medicine. Patients want to see doctors who are like them, and may deliver better care in certain ways. For example, a 2002 study found that female primary care doctors engage in more patient-centered communication and have longer visits with their patients than their male counterparts.
The question we should be asking is not how to strong-arm more doctors into practicing full-time, but how to keep women and men energized and able to take care of our growing insured population. The onus is on the system (including the hospitals that benefit from cheap, subsidized resident physician labor) to ensure that female and male doctors can be more productive. This means practice innovations that make better use of doctors’ time through efficient, team-based care.
For those considering a career in medicine, I’ll say: Don’t go into medicine unless you’re sure you want to do it. Besides the taxpayer investment, it is an enormous personal investment of time and money. But if you’re sure, don’t be scared off by the idea that clinical medicine is an all or nothing deal. With our health care system in crisis, we need more than more man-hours—we need fresh perspectives.
Ishani Ganguli is a journalist and an intern in the Internal Medicine/Primary Care Program at Massachusetts General Hospital. She is the outgoing Editor of Progress Notes.
This piece originally appeared in Short White Coat, part of The Boston Globe’s White Coat Notes.