By the time Ali Novitsky was in kindergarten, she knew she wanted to be a doctor. Inspired by her physician father who practiced medicine from their home in upstate Pennsylvania, Novitsky, along with her two brothers, stepped in as apprentices from the time they were old enough to hold a stethoscope — and all three children became doctors. But for Novitsky, who met her husband in medical school, disillusionment set in early.
“Right after my daughter was born, I started questioning my career,” says Novitsky, MD, who is dual board certified in pediatrics and neonatology. Within five years of completing her training, Novitsky left clinical medicine hoping for more time with her family. But between working full-time as a medical director, caring for two young children, and moonlighting to stay up to speed in her specialty, Novitsky was still depleted.
“I was burned out. I missed my kids and I never saw my husband,” Novitsky says. “Then a wild thing happened: I attended a retreat for women physicians and decided to become a certified life coach.”
Novitsky’s career path away from clinical medicine isn’t an anomaly among young women physicians. According to the University of Michigan’s Intern Health Study, almost 40% of women physicians scale back their medical practice, or leave the profession altogether, early in their careers. The primary reason? Family.
“When you invest more than a decade of your life to learn a skill and you’re willing to walk away from that early in your career, that’s more than a red flag. It’s a burning fire.”
Sasha Shillcutt, MD
University of Nebraska Medical Center
“When you invest more than a decade of your life to learn a skill and you’re willing to walk away from that early in your career, that’s more than a red flag. It’s a burning fire,” says Sasha Shillcutt, MD, professor in the department of anesthesiology at the University of Nebraska Medical Center and founder of Brave Enough, a master class on reducing burnout for women in medicine.
Much research has focused on the roles of gender harassment, salary inequity, and gender bias in limiting career opportunities for women in medicine. But work-family conflict early in a physician’s career also plays a significant role, says Elena Frank, PhD, director of the Intern Health Study and co-author of a June 2019 paper in JAMA Network Open that explored that conflict for the newest generation of physicians.
According to the research, within six years of completing training, 22.6% of women physicians were not working full-time compared to 3.6% of male physicians. The gap between men and women expands for those with and without children (30.6% versus 4.6%). That compares to 10% of physicians overall who were working part-time (30 hours or less) in 2018, according to a recent survey of nearly 700,000 physicians conducted by the research firm Merritt Hawkins.
“The emergence of this gap so early in physicians’ careers may contribute to later gender inequities in compensation and promotion and suggests the importance of expanding social and institutional support for work-family balance moving forward,” Frank says. “Until system-wide reforms are made within the institution of medicine to better support women in their roles as mothers and physicians, significant gender disparities in physician retention and advancement will persist.”
A family affair
Becoming a doctor requires extensive and expensive education followed by years of intense on-the-job training. The idea is that the time, hard work, and financial investment will pay off, not only in dollars and cents, but also in terms of job satisfaction. After all, doctors save lives, or at least improve them. Yet, after just a few years on the job, a growing number of women are walking away from full-time practice.
“People see the statistics and they think women are simply choosing family over their careers, but often there isn’t a choice,” Frank says. “When it comes to balancing a medical career and a family, our findings suggest that women physicians cut their work hours at substantially higher rates than men in an effort to reduce work-family conflict.”
At the same time, there’s evidence that household responsibilities are a greater burden for women physicians than men. Studies show that despite the increasing number of women entering the medical workforce, women still take on an average of 8.5 hours more work at home each week than men. Married men with children worked 7 hours longer and spent 12 hours less per week on parenting or domestic tasks than women, the research shows.
“The majority of child rearing and household responsibilities still fall on women, even if they are physicians,” says Kim Templeton, MD, a professor of orthopedic surgery at the University of Kansas Medical Center and past president for the American Medical Women’s Association.
“Until system-wide reforms are made within the institution of medicine to better support women in their roles as mothers and physicians, significant gender disparities in physician retention and advancement will persist.”
Elena Frank, PhD
University of Michigan Medical School
What’s more, nearly one in three physician moms have experienced discrimination because of pregnancy or breastfeeding. Leave policies, too, can be less than ideal. The American Academy of Pediatrics recommends 12 weeks of paid leave based on the proven benefits to both parents and children. Yet, according to a 2018 study published in the Journal of the American Medical Association, the average length of full-salary leave at 12 top U.S. medical schools was 8.6 weeks. Trainees often receive even less leave.
“When you have a 40% gap between men and women working full-time, it’s clearly not just an individual issue. It’s about women making personal decisions within a broader institutional context where both the policies and culture are systematically working against them,” Frank says.
The challenge of reentry
Taking a few years off to raise children through their early years and then returning to work when the children are in school full-time seems like a reasonable solution. Unfortunately, reentry to practice isn’t that easy.
“You can’t just go to your state licensing agency and ask to get your license reactivated,” Templeton says. Instead, if you want to take time away from medicine to raise children or care for an ailing loved one, you have to plan ahead, and in most cases, retain your license in the interim.
While laws vary by state, all reentering physicians are required to demonstrate their skills through a safety and competency evaluation after an average of just 24 months out of practice. Depending on the results of that exam, you’ll face one of three outcomes:
- Your knowledge base is solid and you can return to practice.
- You have the essential knowledge and skills, but you need a period of monitoring to ensure you’re delivering the highest quality care.
- You have to repeat at least a portion of your residency.
When Mina Lee, MD, a urologist in Denver, Colorado, decided to stay home with her young children, she didn’t expect to return to medicine. “I left because I was burned out,” she says. “I felt I wasn’t doing my best anywhere, not at work and not at home. I cried every day on the way to work and on the way home for months.”
Lee eventually decided to return to medicine part-time after 18 months, in part to avoid the extensive process involved in reentry. “Reentry into clinical medicine after an extended absence is difficult and expensive,” Lee says. “I wanted to avoid that if possible.”
According to an American Medical Association (AMA) survey, 49 state medical boards have policy or regulations that require physicians who leave medicine to undergo extensive assessment after one to 10 years of clinical inactivity. In nearly every case, the boards suggest or require an evaluation before granting a license.
Physicians who aren’t on solid footing may require monitoring by another practicing physician for a brief time period. In fact, the fees associated with reentry can range anywhere from $ 7,000 to $ 20,000. “This includes not only the fees of the for-profit assessment programs, but also the costs of … travel and any recommended educational programs,” Templeton explains.
In addition to the headaches involved with a proctor peering over your shoulder, depending on the state, returning doctors may also have a restricted license. “That limitation impacts your ability to get a job, and if you do get a job, to obtain hospital privileges and participate in insurance contracts,” Templeton says.
While there are no estimates of how many women physicians reenter the workforce after a period of absence, the AMA has estimated that 10,000 physicians are eligible to reenter practice each year.
Finding a way forward
Recognizing the need to retain women physicians, several academic medical centers have started to think creatively about how they can better support women with increased family leave, on-site childcare, or greater opportunities for advancement.
“When women leave medicine, it’s extremely expensive, not only to the institution, but also to the individuals and their families,” Shillcutt says. “Having a family may be perceived as the breaking point, which speaks to systematic issues that must be addressed.”
Just last year, the University of Michigan substantially expanded its parental leave policy, guaranteeing birth mothers 12 weeks paid leave and all new parents, including fathers, six weeks leave with full pay. Massachusetts General Hospital, a Harvard teaching hospital, also launched a parental leave program for professional staff in 2018 that allows eight weeks of paid leave for all new parents, regardless of their gender.
“In the model of change, the first step is recognizing the problem. I think that’s just starting to happen. Physicians are beginning to understand that in order to care for their patients, and stay in medicine, they have to learn how to take care of themselves.”
Ali Novitsky, MD
“Paternity leave is often overlooked, but studies show that offering fathers some flexibility in terms of leave and work schedules can positively impact mothers’ health,” Frank says. “Plus when men take parental leave it helps reduce the stigma on women taking leave.”
The University of California (UC), Davis, Medical Center and University of Texas Southwestern Medical Center have both implemented a “stop the clock” allowance to extend promotion and tenure for parents who take leave. And at UC Davis, leaders are even looking at opening an on-site childcare facility, in collaboration with Sacramento State University and Sacramento Municipal Utility District, to create a new child development center in Sacramento, California.
“When I arrived here a year ago, I quickly realized that better child care was a major need for our employees, trainees and doctors. It’s my hope this new partnership, sponsored by three major employers in this area, will help to alleviate some of that burden on our faculty, staff and students,” says David Lubarsky, MD, MBA, vice chancellor of human health services and chief executive officer of UC Davis Health. “We all look forward to the opening of this new child care center.”
Other academic medical centers, such as Harvard, offer monetary awards to eligible physicians, which provide for dependent care and childcare so women can focus on their research and attend conferences and professional society events.
“In the model of change, the first step is recognizing the problem. I think that’s just starting to happen,” says Novitsky. “Physicians are beginning to understand that in order to care for their patients, and stay in medicine, they have to learn how to take care of themselves.” Her mission now is to keep good women leaders in medicine. “That’s where I can have the greatest impact,” she says.