It was once a rarity in this country to find women in medical schools seeking to become physicians, and it was even more unusual to find women who actually practiced medicine after their medical school training. Now the landscape appears to have changed dramatically. More than 50 percent of college students are female, as are almost 50 percent of the students entering medical school. While such changes have allowed the medical field to progress and become more inclusive in regards to gender, ethnicity, and culture, there are still inequities. Medical schools and workplaces are only now beginning to look at what is needed to address these inequities and bring about systematic changes to support the changing demographics of the doctors of the future.
Over the last few generations, medical trainees and practicing physicians learned early in training to expect that anything is possible to achieve; one only had only to dream of a goal. We learned that if we attacked our goals with tenacity, good intentions, and a dedicated effort, we’d get our rewards. In many ways, this was true for women who dreamed of a career in medicine, women who just a few generations ago did not have the right to vote and did not have a full career trajectory in medicine. But the same grit and determination that helped us break all kinds of barriers in medical research, surgery, clinical practice, and leadership is not necessarily what it takes now to maintain a well-rounded lifestyle, one that brings satisfaction and fulfillment. Many of the women in medicine in the first few generations have looked back on their amazing firsts and powerful careers and have wondered whether they could have done it differently. We want to have it all. We want great careers, family connections, leisure time, and beautiful and intelligent offspring who will change the world and live out our legacies. We want these things, and we want them now. Although patience and delayed gratification are synonymous with training to become a physician, many of us hold a sense of entitlement and the assumption that all of our hard work in medicine will lead to a fulfilling life soon after training ends.
Looking back on my college and medical-school training, I would have loved for someone to utter the word balance to me. Balance is an important concept to seriously consider for our lives as physicians. We frequently hear the phrase work/life balance in training and even in the workplace now, but our first reaction when we hear them is to say, “Yeah, yeah, I’ve got it all under control. No one is going to take advantage of my time, my personal life is in check, and everything is on track. Maybe a massage wouldn’t hurt every now and then, but work/life balance is really for the other guy’s benefit, not mine.” The question is, how in the world can we expect a well-balanced life when we just spent the last seven to ten years of our post-adolescent years focused on achievement in medical training? Each area of life requires focus and a good deal of energy and effort for success. Spending hour upon hour poring over books and getting ready to come across as brilliant on rounds the next day will do nothing for your relationship with your family and friends, just as spending the weekend bonding with your family won’t help you pass a qualifying exam the following Monday.
So what is real balance, and is it achievable? That may be the wrong question to ask. A better one would be: With a good understanding of your strengths and weaknesses and the world you want to live in, how do you set better goals? Having spent the last few years trying to stay at the top of the class in order to get into medical training, many of us take on the additional pressure of feeling like we have to be at the top of our game in every aspect of our life. If you understand that family life, career, and adventure do not all have to crescendo at the same time, it takes some of the pressure off.
The balance question comes in when you start thinking things like, “Well, I’ll focus solely on my career now, and I can put off having kids till I am much older and my career is established; there are so many good technologies these days, my clock will never stop ticking.” True, there are wonderful aids to help people conceive when they may not have been able to in years past, but that’s only part of the equation. Putting off having meaningful relationships with people and focusing only on career goals does not adequately prepare you to have the level of relationship maturity that can sustain having and raising a healthy family and child. I would say that if you find the right relationship or if the timing is right to conceive a child, go ahead and do it. Don’t assume that in ten or fifteen years you will be better at balancing everything than you are at that moment. There are many women in medicine who have taken time off from climbing the career ladder to raise their family. Some never set foot back on the ladder, but a significant number of women do and are very successful without compromising their family goals. The medical workplace is beginning to accommodate this choice, even in academic medicine. Guidelines for tenure and promotion are slowly beginning to make accommodations for people who want to slow down their career to raise a family and then resume it at a later date. There is also an increasing number of part-time positions in academics and in the private sector to accommodate the choices that both women and men want to have regarding their medical career and lifestyle.
Where do you start to design a plan that is structured enough to lead somewhere definitive on the career path, but accommodating enough to accept change as life unfolds? I recommend that women in medicine find mentors. Medicine is so multifaceted that guidance from someone you can relate to and someone you can trust to have your best interests at heart is essential throughout your career. This does not usually tend to be just one person. In my career in medicine, I’ve had key mentors every step of the way. Some of these were in the field of medicine and some weren’t. It’s nice to find someone who is not a medical professional to help you look at the overall balance in your goals. Their broader perspective can be illuminating. I am still in contact with my first undergraduate college mentor. Some of these relationships evolved into collaboration on projects and longtime friendships. Others were instrumental in my career advancement. Mentors have helped me unlock those unwritten rules that can help or hinder my career choices and advancement. None of my mentors came about through formal arrangements assigned by an institution or a program; they were people I found over time who seemed to relate to my take on life and were committed to helping me achieve to the best of my ability.
So, take a good look at your work and life choices, analyze and set your goals for the present and the future, and develop a strong mentor network to flesh out contradictions. This formula will help you achieve the full and rewarding life you expect to have at the end of all the hard work and training it takes to get to the beginning a medical career. During this very dynamic time in medicine, you and your generation have the opportunity to redefine what it means to live a successful life as a physician. Making wise choices now will preserve the profession we’ve all come to love, as well as preserve the work/life balance that we all need, regardless of who we are.
Leslie R. Walker, MD
Associate Professor, Department of Pediatrics
Chief, Adolescent Medicine Section
Children’s Hospital Regional Medical Center
University of Washington School of Medicine, Seattle