Demystifying Medicine One Month at a Time

Thinking about Moms on Father’s Day

Archival poster.

Last week an anesthesiologist in Los Angeles named Karen Sibert stirred up a hornets’ nest of controversy in an op-ed piece that was published in the NY Times.

The piece, titled “Don’t Quit This Day Job,” addressed the hackneyed issue of physician shortage in the United States.

Citing federal subsidies for graduate medical education (i.e. residency training), Dr. Sibert suggested that in order to stem the tide of part-timers (mostly women) contributing to the physician shortage, “…we can only depend on doctors’ own commitment to the profession.”

All well and good; yet depending on the magnanimity of those in a profession to save it from itself is never a successful strategy without a robust marketplace of ideas and innovation.

Dr. Sibert’s solution to the problem, however, was anything but hackneyed:

Students who aspire to go to medical school should think about the consequences if they decide to work part time or leave clinical medicine. It’s fair to ask them — women especially — to consider the conflicting demands that medicine and parenthood make before they accept (and deny to others) sought-after positions in medical school and residency. They must understand that medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve.


We should ask women about their child-rearing plans before letting them go to medical school or take on a residency? Does that seem like a sensible way forward?

Dr. Sibert, citing her own full time commitment to the profession, declares:

You can’t have it all. I never took cupcakes to my children’s homerooms or drove carpool, but I read a lot of bedtime stories and made it to soccer games and school plays. I’ve ridden roller coasters with my son, danced at my oldest daughter’s wedding and rocked my first grandson to sleep. Along the way, I’ve worked full days and many nights, and brought a lot of very sick patients through long, difficult operations.

I’m glad for Dr. Sibert, but she comes across as self-righteous in the personal revelation in support of her larger claim. I certainly respect her right to have worked full time, but I’d never begrudge another professional the opportunity to work part time to help raise a family.

As you may imagine, there were some outraged letters sent in, including this one:

To the Editor:

While Dr. Karen S. Sibert’s point about the shortage of doctors entering primary care fields is valid, her proposal to address it by querying women on their future child-rearing plans smacks of patriarchy and sexism. Even if every medical school seat today were filled by a male student, at current rates of matriculation into primary care fields it would do little to mitigate the problem.

I chose to work as a part-time doctor early in my career to be supportive to my full-time physician wife. Being asked about my parenting intentions at any point in the process would have been chilling.

Chicago, June 13, 2011

I’d love to hear your thoughts.


  1. Emily B.

    Right on, Dr. John! I read the original article and was shocked to see such a rigid and antiquated view in the NYT. My social circle includes a number of medical students and residents — and I have been pleased to see both men *and* women considering work-life balance when ranking residency placements and considering specialties. As a young professional myself (lawyer), I believe one solution could be job-sharing between a mentor nearing retirement age and a younger mentee (the older professional gradually decreases hours while the younger professional works fewer hours to accommodate a family). Seems like a win-win solution for patients/clients, who receive the double benefit of accumulated wisdom from the older generation and cutting-edge techniques from the younger generation.

  2. glasshospital

    That sounds like a great job share solution. Great mentorship, too.

  3. Justine

    The benefits of professional scheduling flexibility while raising children seem boundless to me, for individuals, families, and society at large.

  4. Kristin

    I started looking seriously at med school about halfway through undergrad, and ended up doing a master’s in experimental psych instead because I figured it would give me a chance to mature a little bit and figure out what I wanted, whether research or medicine, before I committed to a field.

    Halfway through my master’s I decided: I didn’t want to live in a lab; I loved teaching; it would be medicine. Once I figured out that there was a blogosphere for doctors, medical students, nurses, and pretty much everyone with even a toe in medicine, I started reading like crazy. I’ve read through my post-grad year of O-Chem, and I’ve been absorbing like a sponge.

    A lot of what I read makes me wonder whether medicine is the right call, after all. I want to practice in family medicine, but the pay is so comparatively low (and prestige follows pay). I want to take good care of myself, but most residents sound exhausted and talk about how they aren’t eating right or exercising enough. I want to have children, but the mommy doctor bloggers post exclusively about being a mommy or a doctor (and how exhausting it is)–never anything else. And on top of that, it seems like anytime someone posts about work-life balance or resident hour restrictions or changing the abusive culture of residency, people pile on with accusations of a lack of commitment to medicine.

    It’s enough to make me not want to commit to medicine at all, despite my feelings about A&P, teaching, and the necessity of internally-driven policy advocacy. On the other hand, a lot of this posturing is familiar to me from my days in psych. People have invested their self-image in what they perceive as “medicine,” and it’s a threat to that self-image to see the face of medicine change. It’s particularly reminiscent of hazing: if we had to go through that, then surely it was for a reason; it must have been good for us; therefore it will be good for the next generation of doctors. Nobody likes to think that their suffering was unnecessary and preventable.

    On the third hand (the original hand?), the people who would be my teachers, mentors, and superiors are also likely to be deeply invested in the current system.

    It’s hard to see, from inside the labyrinth of 12- and 15-hour days of work and o-chem (and now studying for the MCAT), whether it would be worth it.

  5. Alita Dalby

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  6. Douwe Rienstra, MD

    Medical doctors disagree about our relationship to our profession, and perhaps we always have. Abraham Verghese in his “Cutting for Stone” has physician characters express the recognition that one can perfect one’s work or one’s personal life, but not both.

    Disagree with Karen Sibert if you will, yet every point she makes is true–limited educational resources, medical education as a privilege, and, compared to other professions, the time-critical nature of patient care.

    Disagree with my generalization, too, but my observation is that there are fewer socially-challenged doctors amongst our female physicians than amongst our male physicians. Women are and will continue to be giants in medicine especially because ours requires a nuturing yet realistic stance.

    But for both men and women, as Karen Sibert writes, we need to commit to medicine if we are to enter it. (And for what career does this not hold true?) Given our current situation of limited resources and great requirements for primary care, Sibert’s question has merit. Society does have a right to ask “Before we undertake to train you, do you intend to fulfill the responsibilities we’ll be trainng you for?”

    We have a right to expect things of each other. We have a right to ask male physicians to improve their sensitivity and communication skills, and we have a right to ask women who enter medicine to examine their priorities.

    Were you to require 3 am surgery, who would you rather the hospital call? Karen Sibert or one of her critics?

  7. Lilly Royston

    This post has been extremely helpful to me. Thank you.

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