Changing Trends in Medicine: Lifestyle Options

A NextGen Article
By Karen Maule

When asked what the greatest change in medicine was in the past twenty years, a senior faculty member at my medical school answered, "When I was applying for medical school and residency, programs warned me not to marry. They told me that I was already married-to medicine. Now, there are so many options."

He was right. The 100+ hour work weeks with 36-hour shifts every other day are transitioning to the 80-hour work week limit instituted by the Accreditation Council for Graduate Medical Education in 2003 [1]. Two decades ago, four-fifths of residency training programs had no maternity-leave policy. Unsurprisingly, before 1950, only 24% of the physician-mothers surveyed had had their children during training. By 1989, the ratio had reached 42% [2].

While in medical school, I listened to these stories with gratitude and impatience. I appreciate not being overly sleep-deprived in the coming residency years and not having the House of God as my autobiography. An open discussion of lifestyle options was simply unheard of a few decades ago. On the other hand, I am acutely aware of continuing problems - residents struggling to find child caretakers, fellows saddled with school loans, and attendings dictating patient cases at home. I worry about the implications of balancing work and life. Would I be compromising the health of my patients? What if I had a family emergency? What if I became seriously ill? Would I be able to return to medicine, or would my time off leave me outdated and unwanted?

Growing Trends

I am not alone. There is much discussion among medical students about the "ADORE" specialties-anesthesiology, dermatology, ophthalmology, radiology, and otolaryngology (ENT)-being the only lifestyle-friendly professions. With fewer emergencies, shift work, and procedure-based reimbursements, these specialties provide more flexibility, autonomy, and financial compensation. The increasing competition for these residency programs is evidence of the growing desire to practice medicine on these terms. In a profile of two Harvard medical students applying for dermatology, the New York Times wrote, "The vogue for such specialties is part of a migration of a top tier of American medical students from branches of health care that manage major diseases toward specialties that improve the life of patients - and the lives of physicians" [3]. A growing number of medical students and residents are prioritizing lifestyle options above prestige from status or further specialization [4].

Following this trend, female physicians are more commonly taking leave after childbirth and working part-time thereafter, most often to care for their children [5,6]. Dr. Jean Holland, a part-time dermatologist, argues that ignoring one's personal life leads to a disgruntled and poor physician, unable to relate to one's patients [7]. Dr. Holland notes that her specialty's annual conference was moved from December to March out of consideration for the winter holiday season. This change had no detriment to her learning, increased her time and satisfaction with family life, and would not have occurred had it not been for the growing number of vocal advocates.

Dr. Kristen Walsh is now practicing as a part-time general pediatrician in New Jersey. After her twin sons were born prematurely, she took a 2-year leave of absence to be with them during their prolonged stay in the neonatal intensive care unit. While on leave, Dr. Walsh continued reading journals and moonlighting to maintain her professional contacts and to preserve her license and society memberships. Updating herself on her field eased the transition into part-time work [8].

Her leave of absence also benefited her career. She agrees with Dr. Holland, writing, "Even as I continue to strive to keep up with my field, I know that my twins have done more to make me a better pediatrician than all the journals and lectures combined." Her time with her children provided an easy way of relating to patients, many of whom are young mothers or children born preterm.

There is growing support for physicians who take leaves of absence or work part-time. The increasing female presence in medicine - half of all medical students and even greater proportions in pediatrics, psychiatry, and OB/GYN- gives them a stronger voice for change [2,6]. Specialty organizations are beginning to study the effects of career interruptions and are learning to accommodate physician re-entries. Three physicians in an OB/GYN program in Oregon were returned to practice after a few months of re-entry training without detriment to the residency or medical school training programs already in place [9].

Evaluating the Options

Seeking part-time work or leaves of absence clearly has its disadvantages. Physicians choosing part-time work have greater difficulty finding a job, lose a portion of their income and job benefits, and are more concerned about loan repayment [6,10]. There may also be repercussions on the organization of medical fields. Some researchers speculate that an increase in part-time positions may attract more to primary care, which may offer a more controllable lifestyle. More part-time options may also decrease the number of total working hours provided, exacerbating the physician shortage [6,11]. One displeased physician commented, "It is all going wrong if a third of the openings in medical school have been awarded to part-time professionals or misplaced housewives" [11].

However, a study suggests that part-time physicians perform as well as full-time physicians in interpersonal aspects of patient care [11]. While full-time physicians provided greater continuity of care, the study attributed this to the organizational structure of the practice, not to more time in the clinic. These long hours were also detrimental to physician satisfaction with their careers and personal lives.

Conclusion

Medicine has become more forgiving of the personal lives of physicians, but certain specialties - transplant surgery, cardiology, or rural family practice - still present obstacles to working part-time. In any case, Dr. Walsh and Dr. Holland recommend pursuing one's passions. Dr. Walsh states, "There is no reason to blindly accept external limitations, and there are more open doors than you think there are. We all need to be doing what we love… I think we have to advocate for ourselves a little bit more aggressively in order for these things to happen." In other words, have the courage to be the change that you seek.

References
  1. Program director guide to the common program requirements. Resident duty hours in the learning and working environment. www.acgme.org. 20 May 2008.
  2. Jagsi R, Tarbell NJ, and Weinstein DF. Becoming a doctor, starting a family - leaves of absence from graduate medical education. N Engl J Med. 2007;357(19):1889-1891.
  3. Singer N. The price of beauty: for top medical students, an attractive field. www.nytimes.com. 19 Mar 2008: 1-2.
  4. Dorsey ER, Jarjoura D, and Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical students. JAMA. 2003;290:1173-1178.
  5. Walsh, K. On being Dr. Mom: a pediatric career interrupted by life. Young Physicians newsletter. Fall 2006: 4-5.
  6. Cull WL, Caspary GL, and Olson LM. Many pediatric residents seek and obtain part-time positions. Pediatrics. 2008;121:276-281.
  7. Interview. Dr. Jean Holland, dermatologist. 20 Apr 2008.
  8. Interview. Dr. Kristen Walsh, general pediatrician. 27 Jan 2008.
  9. Adams KE, Allen R, and Cain JM. Physician reentry: a concept whose time has come. Obstet Gynecol. 2008;111:1195-1198.
  10. Cull, WL, et al. Pediatricians working part-time: past, present, and future. Pediatrics. 2002;109:1015-1020.
  11. Murray A, et al. Part-time physicians: physician workload and patient-based assessments of primary care performance. Arch Fam Med. 2000;9:327-332.

 
Karen Maule is a writer for the Next Generation and a member of the U. Michigan Ann Arbor Medical School Class of 2009.

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