Doctor-Moms

By Mary Ellen Miller

With more and more women becoming physicians, academic medicine may need an attitude adjustment toward the kids issue.

Marion Couch, a head and neck surgeon, was married 15 years before she had time to have a baby. At almost 40, she produced twins.

Patricia Thomas was in the middle of packing up her family of five for a move from Bethesda to Memphis when her oldest daughter, then 4, got the chicken pox. It was a horrendous case, and Thomas held her breath—and washed her hands obsessively—hoping it wouldn't spread to her two other children. As any mother can tell you, of course, it did.

"The 3-year-old was up all night screaming, the baby was up, too, and I remember crawling out of bed the next morning-my husband had gone off to work, I knew I had to get off to work-and just sitting in the living room crying," says Thomas, whose "baby" is now 18. "I think every mother goes through those moments."

Not every mother, however, has to make the kind of wrenching sacrifices for a career that Thomas has. In 22 years, for example, she has never once been able to stay home with a sick child.

"You can't call in sick when you have a full clinic, with 10 patients expecting to see you that day," explains the 51-year-old internist, who is now deputy director for education in the Department of Medicine at Johns Hopkins. Plenty of women in other professions have eked out ways to keep on top of the laundry, the cooking, the car pool and runny noses while holding down a job. But the stakes are higher in the male-dominated field of medicine, where the period in which physicians are expected to be their most productive coincides with the years in which a woman is at her most reproductive.

Lately, though, Thomas and her other female colleagues at Hopkins have detected a slight shift in the culture since they were young mothers.

"When I came to Hopkins in 1988," says Thomas, "the internal medicine residency had a reputation of being a boot camp. But as women have come up through the ranks, they've changed things, changed how residents talk to each other. There's a less macho atmosphere—less taking-care-of-everything-yourself and not-letting-anybody-know-how-you're-feeling."

Sheer numbers are no doubt a factor. When Thomas was a medical student in the mid-1970s, it was still unusual for women to get into medical school; just 13 percent of medical school graduates were women. Today, reflecting broader changes in society as a whole, the number of women in medicine in the United States is approaching that of men. By 2040, it is projected that 50 percent of physicians will be women.

The steady growth is forcing academic medical centers to accommodate women, especially because the latest research shows that women are significantly more likely than men to pursue an academic career. John Flynn, clinical director of Hopkins' Division of General Internal Medicine, the field with the highest concentration of women, realized that if he wanted to recruit and retain new faculty, he'd have to be creative.

"You face the choice of finding [women] who are willing to work full-time while trying to raise a family—which they often don't want to do—or having them not work for you and losing an excellent physician," says Flynn. "We need to find an alternative, lest we want to make this a place where women with young families can't work or don't want to work."

Internists Suzanne Cotter and Kim Peairs are job sharing while they raise their young children.

One alternative is a small but symbolic experiment that's taking place on the seventh floor of the Outpatient Center. There, internists Kim Peairs and Suzanne Cotter are job sharing while they raise their young children.

  Job sharing is rare in academic medicine, and all the planets must be aligned to make it work. Peairs, 35, and Cotter, 31, share more than just a job. At home they have reliable nannies, supportive husbands (both of whom also are physicians), even daughters with the same name, Margaret. At work (both trained at Hopkins and knew one another from residency) they have indispensable secretaries, share the same holistic approach toward patients, and are fanatics about communicating with each other (which includes handwritten notes shoved under the door just in case the computer crashes).

And (this is key) they have a boss on their side: John Flynn, himself the father of seven.

"He told us, There is no way I could say we couldn't do this," says Peairs. "He has bent over backwards to make this work for us."

  Peairs, whose children are 4 and 2, and Cotter, whose daughter is 3-1/2, each work three days a week, and both of them come in on Mondays. They each have their own patients. Peairs' practice is made up mostly of young to middle-aged women; Cotter has carried over her patients from residency. But the young doctors often get to know both sets of patients.

Their patients do not seem fazed by the set-up. "They've been very flexible," says Cotter, "and very respectful that I'm a young mother. I think, on the whole, we're just like every other doctor at Hopkins. We're here, we're available for our patients."

Of course there are some downsides. "At an institution like this, where everyone's going 100 percent all the time, you can't keep pace, and there's a level of guilt about that," admits Peairs. "But the flip side is, I get to do the Mom thing."

Cotter, a super-achiever who was so jolted by the experience of motherhood that she almost left medicine, agrees that they've landed a dream job

"I believe there's a window in your life—maybe it's kids or a sick family member—that shifts your paradigm, and you want to donate your time to something. And if given the opportunity, and with the support network to do it, why not? I'm just stepping off the academic train for a while, but I'll be waiting for the next train. Meanwhile, I get to do academics—I get to teach courses to medical students, I get to precept in residency clinic—I get to see my own patients, maybe do a little research.

And I get to be home. Because for me, there is no joy at work, or in some interesting differential diagnosis, that could ever outweigh the joy of watching my daughter discover the world."

For Marion Couch, it took years to realize that particular joy. Couch married her childhood sweetheart at 24, but between getting her M.D., her Ph.D. and becoming a head and neck surgeon, she didn't have time to have children until she was nearly 40. The pregnancy was difficult-she was on bed rest from the 19th week on—and her twins, a boy and a girl (now 4), were born premature. When she came back to work two months later, she was not sleeping at night, "literally, period." She likens the experience to being a surgical intern again. "You just really focus down,"says the otolaryngologist.

Nothing seemed to be going right. She hired one nanny, then another, and neither worked out. Meanwhile, she was feeling the pressures of getting her practice up and running again. "I was having to cancel surgery. It was grim." It forced her "to reassess everything, from the fundamentals on up," she says. Was her job worth it?

Fortunately, the third nanny was the trick, and Couch didn't have to give up the academic career she loves. Still, she admits "it takes every bit of energy to keep this train on the track," and she is very conscious of "being a good Hopkins citizen" and paying her dues back since the department was so supportive during her pregnancy.

And she worries about getting promoted. She has watched five female assistant professors, people she considered superstars, "spin off into private practice" upon not getting promoted. "Not only does it get lonely for the remaining women faculty members, but I worry about the message that the medical students might be getting. It's very sad to me."

Ironically, says gynecologist Julie VanRooyen, the field of medicine that deals only with women, Ob/Gyn, is one of the least tolerant of working mothers within its own ranks. She had her first baby during her residency in Chicago, despite "serious pressure not to," but found the environment at Hopkins more positive when her second child was born three years ago. Still, she took a mere six weeks off after the birth of each child.

Recently she has felt the need to be at home more. "I catch it from my 5-year-old about why I can't ever pick her up from school," says VanRooyen, 35, who relies on her nanny as well as her husband, Michael, whose schedule as director of the Center for International Emergency Studies in the Department of Emergency Medicine is more forgiving than hers.

"He is very, very involved with them," she says. "To do this, you have to have a husband who is an equal partner."

Still VanRooyen, who has always worked full-time, is looking for a way to cut back without joining the legions of female gynecologists who have left Hopkins in search of a saner lifestyle.

"There's been a history of going through women very quickly in this department, and it frustrates patients when they've just established a relationship with somebody and then they move on. At least once a week a patient asks me, Are you gonna stick around? Are you planning to leave? And then they tick off this litany of names."

VanRooyen recently reported that her chairman, Harold Fox, had been "wonderfully supportive" of a new work schedule she's been dreaming about: to work 75 percent-time, not by knocking off a few hours every week, but by paralleling the school calendar and being "absolutely away in the summer for three months.

"It's really up to us to be creative about proposing new solutions," Van Rooyen says.

Adrian Dobs is that rarest of creatures: a female full professor. There are only 34 of her kind at The Johns Hopkins School of Medicine, compared with 304 men, a proportion that has hardly budged in the past 20 years.

She also is the mother of four children, ages 20 to 13, but she quite deliberately never mixes those two worlds. "I'm very concerned with being very professional at work—much more so than a man—because otherwise it goes against you," says Dobs, deputy director of clinical research in the Department of Medicine and director of Hopkins' Clinical Trials Unit.

Dobs has never spent more than six weeks (four times, for maternity leave) away from work. Such constancy was ingrained in her by her parents who ran a small clothing store in New York to support their three daughters. Also, Dobs feared that dropping out of research for too long would leave her hopelessly behind.

"You're planning research projects a year or two in advance," she explains, "and if you get out of sync, you don't know what's hot. Once you're out of the research realm, it's hard to go back."

Medicine is "a much more accepting career" for younger women today, Dobs thinks. "It's no longer the old-fashioned way of seven years [to get promoted], and if not, it's up or out. Women are taking longer, working part-time, and pregnancy is accepted," says Dobs, who was the first pregnant woman to go through her residency program.

Still, she thinks, women have miles to go. "The assumption's always been that once you got a big group of women coming up from the lower ranks, they'd move up and take the top positions. But that's not been the case. Women are leaving academic medicine in greater numbers than men, and we have to ask what can be done to keep good women in place. For one thing, women don't get the right mentorship."

Dobs also believes that a woman's career needs to be evaluated differently. "Being on search committees, the question of age and women continually comes up. It'll be said, This woman is too old. Well, a woman might have taken a long time to get where she is, and since women live longer, she could have more productive years later on. Our mind-set about age and productivity should probably change."