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    Working Mom, MD: Always on Call


    When Katherine Chretien, MD, had her first child a dozen years ago, no other physician at work was walking in her shoes. All her hospital supervisors were men. Carving out maternity leave was one challenge. Finding time and privacy to express breast milk during the workday upon her return was another.

    “I had no colleagues who were young mothers,” recalled Chretien, assistant dean for student affairs at George Washington University School of Medicine and Health Sciences, as well as a hospitalist and mother of three young children. “I found it a very isolating time.... I felt guilty, almost, that I was missing important meetings, and I felt that I had pushback a little bit from my supervisors and people I worked with.”

    Katherine Chretien, MD
    Katherine Chretien, MD, founder of the Mothers in Medicine blog

    In 2008, the Annals of Internal Medicine published Chretien’s essay “Paying at the Pump,” about the “manic mothering” of her new-mom workdays. After receiving a tremendous response, she founded a group blog, Mothers in Medicine, to help medical-student and physician moms balance motherhood with a career. That physician mothers feel significant pressure in juggling careers and family is a reality reflected in the popularity of the blog, now totaling 5 million page views.

    Many institutions don’t have a culture that is ideal for physicians with personal caregiving and parenting responsibilities, said Diana Lautenberger, AAMC’s director of women in medicine and science. What seems like “a fairly innocuous issue” of taking a few months for maternity leave often happens at a critical time in a physician’s early career and can translate into lost opportunities later, she said.

    “When women take time off for maternity leave, which they absolutely should, ... because institutions don’t have sound policies about reentry, it could set their careers back” and hinder their rise into leadership, said Lautenberger, who heads AAMC’s Group on Women in Medicine and Science (GWIMS), a professional development group to promote gender equality and advance women in medicine and science.

    Chretien believes things are getting easier as more women gain leadership roles. Yet, a 2014 AAMC report noted that women remained underrepresented among full-time medical school faculties, at 38%, and that only 16% of medical school dean and 15% of department chair positions were held by women despite vastly higher ratios of women in medicine.

    “This emphasis on balance, on work-life integration, and on wellness is good for the profession.”

    Katherine Chretien, MD
    George Washington University School of Medicine and Health Sciences

    In her former role as a hospitalist section chief at the VA Medical Center in Washington, D.C., and in her current position, Chretien said she has tried to help pregnant students and physicians by making sure they weren’t stressed about taking ample maternity leave.

    She added that she is pleased to see a cultural shift away from the ideal of the doctor who stumbles into work when sick toward physician self-care. “This emphasis on balance, on work-life integration, and on wellness is good for the profession,” she said.

    Finding alternatives

    Last year, the Physician Moms Group (PMG), a global online network supporting female physicians with children, posted an online survey on Facebook asking members about perceived workplace discrimination and desired workplace changes. Published in The Journal of the American Medical Association, the survey found that of nearly 5,800 respondents, 2,070, or almost 36%, said they felt “maternal discrimination.” (When asked about discrimination of any type, almost 78% reported they had perceived it.)

    Of those reporting maternal discrimination, nearly 90% reported unfair treatment related to pregnancy or maternity leave, and more than 48% said they had experienced discrimination related to breastfeeding. These physicians favored changes such as longer paid maternity leave, backup childcare, and breastfeeding support.

    Monique Tello, MD, MPH, an internist and mother of two, is like most physician mothers who patch together childcare arrangements, marital teamwork strategies, workplace accommodations, and geographic locations that enable her to balance work and career. She has been working part-time since 2008 at Women’s Health Associates, a close-knit, female-run, woman-focused primary care practice affiliated with Massachusetts General Hospital in Boston.

    “We all work part-time and we all cover each other’s patients,” said Tello, also a clinical instructor at Harvard Medical School. Women’s Health Associates “was started about 30 years ago by an internist who really also wanted to be a mother and realized that the usual typical life of a doctor was not compatible” with raising a family.

    Tello, who blogs at Mothers in Medicine and her own website, called the practice “a big job-share program,” with about 12 MDs and two nurse practitioners. For her, part-time means working 40 to 50 hours a week—about 20 hours of clinic time and 30 hours for paperwork. Having career flexibility is a major concern, among many doctors with young children.  Full-time physicians may have to devote more than 80 hours a week to those tasks—a schedule that would require an army of babysitters, noted Tello, a mother of two children, one seven years old and the other five and a half.

    “A lot of academic institutions frown on women who step back” to focus on family, she said. “I work at a place that’s 100% in support.”

    Monique Tello, MD, MPH, with her husband and children
    Monique Tello, MD, MPH, with her husband and children

    In her seven years of training after medical school, Tello said she witnessed a lot of discrimination toward women, “but especially against women who were trying to have a family.” While things are improving, she said she saw fellows’ or residents’ pregnancies met with resentment. One resident had to forage for time to pump and “had breast milk running down the front of her shirt” on rounds, Tello recalled.

    Having both men and women advocate for issues facing physician parents is important, Lautenberger stressed. “The more we can make caregiving about caregivers and not only mothers, the more equity there will be.”

    “It may seem counterintuitive but when parental leave only talks about mothers, it continues to marginalize mothers and women and perpetuate this as a ‘women’s issue’ when it’s much larger than that,” she added. “We need great advocacy from all sides to promote sound policies.”