Work-Life Balance: Is it possible to have it all?

 

            As I begin the dreaded process of applying for residency, I have been deeply thinking about what my priorities are in life. In addition to applications, I am also in the midst of planning my wedding for the spring. Of course I want to have a great learning experience in residency and a successful medical career, but I would also like to be able to start a family. Is it possible for female physicians to have an amazing career and family – can we have it all?

            This is a common problem faced by many women in the healthcare field. As the number of female physicians continues to rise, the challenges that women physicians face in trying to maintain this balance has come to light. The work-life balance is a significant factor in which specialty a woman chooses. There are many specialties where women are underrepresented, especially in the surgical fields and in the academic setting, likely related to difficulty to find balance in these demanding careers.¹ The timing of pregnancy is also a major decision for women. Many factors contribute to this decision, including the program’s policies on maternity leave, the availability of childcare, and even whether the new mom would have a private place to pump breast milk at work in order to continue breastfeeding. One issue with pregnancy during residency is that there is a potential for resentment among co-residents, as physician-mothers may be seen as having special treatment.¹ However, this also needs to be balanced against the a physician-mother’s guilt of leaving her infant at home or daycare as she returns to work. Unfortunately, female physicians who desire starting a family continue to face these (and many other) challenges when entering residency in the medical field.

            In order to make this balance more feasible for women, it would be beneficial for more programs to establish accommodating practices that allow female physicians to tackle the aforementioned challenges. Flexible hours and part-time work are good options to allow women to have more time to manage childcare. Also, there needs to be a decrease in stigmatization of women who decide to take time off for parenting reasons, especially in the surgical fields. It would also be helpful to many mothers if more hospitals provided childcare during working hours. This would allow physicians (and all other healthcare workers) to continue to work and still be nearby to their young children.

            As for me, I hope to find a happy balance between my roles as a physician, wife, and mother in the future. I know it will take a lot of sacrifice to juggle a clinical and academic career with motherhood, but with some flexibility, a lot of hard work, and establishing priorities, you can accomplish everything that is important to you.

 

Reference:

1. Verlander, G. 2004. “Female physicians: Balancing career and family.” Acad Psychiatry 28(4):331-6.

https://www.med.upenn.edu/gastro/documents/BalancingCareerandFamily.pdf

Shelby McLaughlin, MS4
WHEP Pathway Student

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While looking at the most recent news stories concerning women's health by searching “women's health” in google news on August 11, 2016, a vast majority of the articles were concerning sex, having babies, weight, and relationships with men. They were mainly about sex positions and zika virus, which may be important, but aren't very representative of all the issues that are important in women's health today. There were a couple particular stories that were more complex though looking at the intersectionality of women's health with other social identities, such as race and transgender issues. One particular article was about the impact of racism on mental health in the magazine website, Women's Health.

 

This Women's Health article appeared to be inspired by the Black Lives Matter movement and the mental trauma of police violence and brutality. A majority of their website article was trying to explain a scientific article in the American Journal of Public Health concerning the mental health risks of daily racial discrimination, and they actually did a fair job of explaining the health, science, and research components. The study actually took place in the UK, but there were a lot of findings and lessons that could be transferable to America. It was a short internet article, but at the end of their discussion of the research, they gave a call to action and steps to address discrimination and racism in America. These included contacting elected officials to keep them accountable concerning race and law enforcement, becoming an educated voter about were candidates stand on these issues, and volunteering for or donating to specific community organizations that have a history of working towards racial equality.

 

It was a good example of explaining scientific evidence to a broad audience including both those that may or may not be experiencing racism themselves as well as connecting it to action. This is something academia often lacks. Publishing articles in scientific journals doesn't mean the American people or the world will learn or benefit from hard scientific work or that social action and policy change will occur. The media plays an important role, but these days they are more interested in entertaining than educating or seeking truth. Explaining science isn't always the most entertaining news, and if they do report scientific findings, they often report on poorly done studies with one sentence headline conclusions unsupported by the findings. Academia has a greater responsibility (actually it should be their main responsibility) to educate the public with quality scientific evidence in a way that different education levels can interpret and appreciate across social identities as well as political and cultural views. Academia must also ensure that their research leads to actual social and policy change as well. These issues concerning the media, academia, and the education system are a part of the problem resulting in our current political climate and presidential election situation.

 

Obviously, there is a long way for academia and the media to go as only a few articles out of a hundred under “women's health” on google news were about complex social, health, and scientific issues. It would be interesting though to see if the magazine website and the researchers collaborated on this article to ensure the conclusions were appropriate and that it was presented in a way to be interpreted across the spectrum of society as well as to explore how often this occurs.

 

http://www.womenshealthmag.com/health/racism-mental-health

Alexander Sloboda, MS 4

Women's Health Pathway

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Still Blaming the Victim

No matter which political party you belong to, I think we can all agree that this election season has been like no other in recent history, plagued by an abundance of controversies, accusations, theatrics and faux pas – including some that concern women and women’s health issues.  Part of this past week’s drama involved sexual harassment in the workplace.  Following the resignation of Roger Ailes, former Fox News chief who is accused of sexually harassing many of his female employees, Donald Trump responded to a question about how he would feel if his own daughter were being harassed in this way: “I would like to think [Ivanka] would find another career or find another company if that was the case."                                                                So, just leave and find another job?  Another career?  

Trump’s son, Eric, added that as a strong woman “Ivanka wouldn't allow herself to be subjected to that.”  In other words, women are able to control being subject to sexual harassment.

                               Sexual harassment is a choice?

According to the National Women’s Law Center, one in four women experience workplace harassment but most do not report it for fear of retaliation.   It’s time we stopped placing the blame on women rather than those who harass them and say “you’re fired” to the perpetrator.  And it’s time we elect a president and members of Congress who understand this and do something about it.

                                                                                                                                                    Judith Wolf, MD    Associate Director, WHEP 

 

 

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Sex/gender disparities in atrial fibrillation-related stroke risk

  

At a recent European cardiology meeting, a retrospective cohort study¹ was presented which looked at differences in hospitalization rates for acute ischemic stroke among male and female patients with atrial fibrillation over a 15 year period (1998 – 2012).  The study, which included 1.1 million patients admitted to 1000 hospitals in 46 states, revealed that women had a 23% higher risk of being hospitalized for stroke than men after adjusting for such risk factors as age, diabetes, hypertension, previous stroke and heart failure.  In addition, women had a higher risk of stroke compared to men regardless of race, socioeconomic status, or geographic location.  According to the study authors, “women have second-rate outcomes across the board due to inadequate stroke prevention care rather than biological differences”.   Why should this be so?

A previously published, related study² that evaluated over 500,000 Medicare patients (87% white, 41% male) after newly diagnosed atrial fibrillation found statistically significant differences in the receipt of appropriate medical services (e.g. evaluation by a cardiologist, catheter ablation, anticoagulation, use of beta blockers and antiarrhythmic drugs) - especially catheter ablation (female vs male: AHR 0.65; 95% CI 0.63-0.68; P < .001) and receipt of oral anticoagulants (female vs male: AHR 0.93; 95% CI 0.93-0.94; P < .001). 

It is all too obvious that women with atrial fibrillation receive less state-of-the-art therapy for atrial fibrillation and stroke prevention compared to men.  Although the reasons behind this disparity remain uncertain, they likely include differences in presenting symptoms (see illustration) including the absence of symptoms in ~30% of women, delays in seeking medical attention (women are notorious for putting everyone else’s needs above their own), and provider bias (attributing symptoms to panic attacks or stress).  As medical professionals we need to be aware of and eliminate disparities so that we deliver appropriate, personalized care to all of our patients.

                                                                                                    

             Judith Wolf, MD             Associate Director, WHEP

 

1. Ghanshyam Palamaner Subash Shantha; Hardik Doshi; Anita Kumar; Gopi Dandamudi; Prashant Bhave; Alexander Mazur; Denice Hodgson-Zingman; Michael Giudici ‘Gender differences in the rates of hospitalizations for acute ischemic stroke among patients with atrial fibrillation in the United States: A 15 year experience involving 1.1 million patients’ CARDIOSTIM – EHRA EUROPACE 2016.  June 8-11. Nice, France  http://www.cardiostim.com/
2. Bhave PD, Lu X, Girotra S, Kamel H, Vaughan Sarrazin MS. Race- and sex-related differences in care for patients newly diagnosed with atrial fibrillation. Heart Rhythm 2015;12(7):1406–1412.
   http://www.sciencedirect.com/science/article/pii/S1547527115003306
    

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One battle over, but not the war

The US Supreme Court this week ruled unconstitutional a 2013 Texas law requiring hospital-grade facilities in abortion clinics and hospital admitting privileges for their physicians within 30 miles of the clinic citing “an undue burden on women abortion access” guaranteed under the constitution.  In his comment, Justice Stephen Breyer noted that the law did not offer evidence that it protected women’s health or led to better treatment.  Justice Ruth Bader Ginsburg opined that it was “beyond rational belief“ that these provisions were designed to protect women’s health, let alone withstand careful judicial scrutiny under Roe v. Wade.  The Court also rejected appeals from Wisconsin and Mississippi that sought to overturn lower court rulings blocking restrictions on doctors who perform abortions.   

In an attempt to restrict abortions, a number of states have instituted measures such as banning certain types of procedures, prohibiting abortions after a certain number of weeks of gestation, requiring parental consent or notification for minors seeking abortions, and enforcing waiting periods, mandatory counseling, transvaginal ultrasounds, and listening to the fetus's heartbeat.  Whether the Court’s most recent ruling will encourage pro-choice activists to challenge these and other restrictive state laws or motivate the pro-life community to develop new strategies to limit abortions remains to be seen.  But, if history is any guide, both sides in this controversial issue will likely continue to battle it out.

                                                                                                                 Photo credit:    KEVIN LAMARQUE / Reuters

         Judith Wolf, MD

         Associate Director, WHEP          

                                                                                               

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