There is a wonderful editorial in this week’s JAMA by Laura M Prager, MD a child psychiatrist who worked part-time during her children’s early years. Years in which she completed her fellowship on an extended schedule, then worked only four hours a week – just enough to keep her skills honed and her foot in the door – until she re-entered the full time work force some years later when her children did not need her at home.
This work schedule gave Prader the time to be the mom she wanted to be – in her case, the mom who was able to sit outside her anxious preschooler’s classroom every day for the three weeks it took her child to adjust to the world away from her –
Drawing from my years of training in child psychiatry, I offered to be a transitional object for her or, in her vernacular, a “cubby toy.” …Each morning I walked her into the class and then retreated to the hallway outside the room, where I sat in a wooden cubby with a magazine and waited. The first week she came out to check on me quite regularly. By the second week, she waved to me when she came out to get her jacket on the way to the playground. By the third week, she was done with me. I asked her if she wanted to bring anything else with her to take my place, and she shook her head no: her shiny pink backpack full of the precious toys of the moment that we’d packed with care the night before was enough.
In addition to having what sounds like an amazingly supportive boss, Dr Prader also had a role model for her unique career path – her mom, a doc who had a successful part-time child psychiatry practice for many years. A woman who showed her that achieving work-family balance is possible with some inginuity (and some creative financing).
I have to be honest and say that I rarely ever considered working part time, and working just four hours a week would have been completely impossible financially. I was lucky enough, though, to have the world’s most amazing baby sitter, who in fact handled my youngest daughter’s preschool transition in much the same way Prader did. (I said she was amazing, didn’t I?)
And while I was not able to do the cubby sitting for my kids myself, what I did do was to carve out my own little area of medicine that made it work for me and my family – office gynecology. I first gave up OB and then surgery, giving me regular hours and some semblance of a managable home life.
At the time I chose to limit my practice to the office, no one else in my field that I knew was doing it. A few women were giving up OB, but usually at the end of their careers, when children were usually grown and out of the house. It took a lot of persuasion to convince my boss that an office-based practice was financially viable (it is), and a little more time than that to convince myself that I wasn’t less of a doc than my colleagues still putting in the grueling hours in the OR and on the labor floor (I’m not).
Now, a decade later, I regularly have residents and students asking me “How do I get to do what you do?” I’ve now become the role model for a new generation of doctors, showing them a path they might not have considered when they first became attracted to this field of medicine.
The carrying costs for a doc (malpractice, licensing, support staff, call coverage) may be too high for many practices specialties to allow them to retain an employee who only works 4 hours a week, as Prader did. And it’s hard to envision a workplace that can support more than an occasional employee working part time. Or a fellowship program that can sustain that kind of flexibility for more than one fellow at a time.
But the opportunities are expanding. They have to, with 50% or more of medical student graduates being female. At our institution alone we have one obstetrician who works regular hours as a hospitalist (we call them “laborists”) and another doing what I do, only half time. And several other women working regular hours on the teaching service, with limited on call duties and predictable hours (for the most part).
I don’t know that any of us will be doing much cubby sitting any time soon, but it’s a start.
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Tempeh, over at Mothers in Medicine, tells you how to get a part-time job in medicine.
It’s nice when it works, but as you point out the malpractice costs make it tough for many. Probably more so in the surgical practices. Still it’s nice when it works.
Wow, there must have been a pretty sturdy second income there, too, eh?
And here’s my deep snarkiness coming out: is her kid going to come to college and have Mom come to advising meetings?
RL – agree, it’s not something most of us docs could do. And agree, it’s nice when it can be done.
Bardiac-
Agree. Staying home with one’s kids is a luxury that some cannot afford. Still, there are many families out there that have made the decision to get by one one income, whatever size that is, to keep a partnet at home. Assuming of course that one income pays for the basics and comes with good medical insurance.
Re the snarky comment, I supect this kid won’t be needing Mom in college since Mom took care of both their separation anxieties so nicely at an early age. 🙂
I had a gyn (before she quit to go home full time) who only had an office practice. My friend has one as well – and they seem to thrive. It’s impossible to get an appointment in your lifetime. I think it’s very viable especially in more upscale areas where childbirth is long delayed.
Interesting how none of your OBG colleagues deride you for being “less than complete” for “not providing the full range of services that you’ve been trained to do,” an accusation flung at me by many an FP because I no longer do hospital care.
Mal practice insurance for part-timers is cheaper than full-timers, so I don’t see how that’s such a huge added cost. I know this because I work part time and had to price out the insurance myself.