Physician survey breeds discontent

Since when is balancing work and family a bad thing?

By Shannon Devine

Dr Wendy Graham, lead physician in the Blue Sky Family Health Network clinic in North Bay, ON, calls the alarm over women doctors' work habits "most unfortunate and inaccurate." Another physician, currently on maternity leave, says the coverage was "ridiculous and totally missing the point." But she insists on anonymity because commenting "could reflect badly on me because I'm just starting my career." When her maternity leave finishes, she plans to work a full schedule.

TIME FOR A RETHINK?
Published on October 27, the survey of over 21,000 doctors has confirmed what everyone suspected: we're on the verge of a major physician shortage. The survey also found that 3,800 doctors plan to retire in the next two years, and that 16% of doctors have reduced their hours and a further 25% plan to reduce their hours in the next couple of years. Women, who currently make up 31% of Canadian physicians, average about 45 hours per week, compared to 51 hours for male doctors. Another finding of the report was that all younger physicians � men and women � are working fewer hours than their older peers. Dr Albert Schumacher, president of the Canadian Medical Association (CMA), said that the "70-year-old rural GP who did anesthesia, delivered babies, took care of the nursing home, made house calls and worked 80 hours" is a fairy tale that no longer exists.

UPHILL STRUGGLE
Dr Schumacher's CMA replacement for 2005, Alberta pediatric cardiologist Dr Ruth Collins-Nakai, knows all about the balancing act women doctors with children are expected to perform. Speaking from her Edmonton office, she recalls one Saturday afternoon early in her career. She was at the hospital finishing some abstracts to submit to a conference. On her way out she ran into a male colleague, also working on abstracts. "He asked where I was going, and why wasn't I writing up an abstract on another topic. I told him that I had a three-year-old at home, had to see her, get groceries, etc. His response was 'My wife does that!'"

Many female physicians have similar stories. As a mother of four, Dr Graham says the unique challenges of having to balance childcare with a career still plague far more women than men. She describes one instance shortly after the birth of her third child, when she was unable to find someone to replace her for a shift at the clinic. In her small northern Ontario community, over 5,000 people are without a general practitioner, so any absence is severely felt. "I had a patient who was HIV positive who I knew needed me, but I also knew my baby needed me," she says. In the end, she had to bring the baby to work, and breastfed between patients. "It was the most stressful experience of my life," she recalls. "There was a torrent of tears that day � from the patient, myself and from the baby."

The survey itself contains some impassioned comments from respondents. One doctor, who was having an extremely hard time finding someone to cover her maternity leave, wrote: "I fervently believe this is an issue that needs to be addressed � we are literally discouraging young female family physicians from committing to the job they were trained to do."

Dr Graham says older women doctors have always been there to help in that regard. With her children now in university, she's able to pick up the slack of her other colleagues � men who are burnt out from over-working early in their careers and young doctors who want time for families. Research by the CMA has shown that while child-rearing women may work less early in their career, they tend to work longer hours in mid-life.

REGRETS, I'VE HAD A FEW
And of course, this problem doesn't only affect women. Men also want to spend more time with their families, and don't want to end up like some older male doctors now regretting those long hours. One about to retire, Dr David Knox, told CTV News, "I think I'll have more interaction with my grandchildren than I had with my own children."

The fact that women now make up about 58% of med students should herald a change in the way the profession is organized � for the benefit of male and female doctors and their families. But it's uncertain if that change will come quickly enough to stave off a crisis. Inflexible schedules and an absence of practical support systems continue to prevent women from entering fields like cardiology, general surgery, research-driven fields and administrative roles. Dr Collins-Nakai points out that only 5% of cardiologists are women, a figure that she says has barely budged since she graduated from medical school in 1972.

The sponsors of the survey � the CMA, the College of Family Physicians of Canada, and the Royal College of Physicians and Surgeons of Canada � have all responded with proposals to improve the situation, including fast-tracking foreign-trained doctors, increasing med school spaces, and offering childcare help and better maternity/ paternity leave provisions for doctors.

See also "Alright, everybody, let's take 9 (months)" (NRM Vol 1 No 10, May 15) for more on physicians' parental leave.