In February, the U.S. Bureau of Labor Statistics' shared grim numbers: left the workforce in 2020. Not surprisingly, as schools and childcare facilities closed, and work shifted from in-person to remote, women had even more to do at home, from homeschooling to other domestic responsibilities.
The wasn't much better for women working in the healthcare industry: In early 2021, women left or lost 480,000 jobs, compared to 28,000 for men. Making matters worse, it has been widely reported that women are publishing less now than prior to the pandemic. These statistics bring additional urgency to address other known barriers to career advancement and success for women physicians, including pay inequality, long-standing imbalances in leadership positions, and the challenges of finding affordable, reliable quality child care.
These compounding circumstances all belie one fact: Medicine is a great career choice for women.
The appeal of becoming a physician may not be entirely clear to young women because the gratification is delayed. What's more, the cost and timing of training, as well as the years in which a physician's schedule is most intense, coincide with the period during which many women also want to have children. There is an undeniable crush of effort to both develop a career and start a family -- all in the same small window of time.
Less obvious is that on the other side of this bottleneck lies a career with enormous flexibility. For example, a female physician has the choice of whether to enter private practice, academic medicine, join an established medical group, or start her own business. She can work with patients every day or barely see patients at all. She can work in shifts or on other schedules. She can choose to do research or be an administrator. And she can do all of these things at once -- or in sequence. Other healthcare roles afford some of these same features, but the flexibility as a physician is often even greater.
Perhaps most importantly, there is the opportunity, one that is not available in the same way in many other professional careers, to temporarily reduce work effort to concentrate on other things, such as raising children or pursuing another passion. As long as the physician keeps up some of her practice and licensing, she will find a fulfilling and rich career on the other side of this "break." She can retire at 65, or keep working into her 80s, with the guarantee of greeting new and interesting problems, challenges, and advancements in medicine. And because our skills are and will likely always be in demand, as physicians we can always support ourselves and our families. Given that it was only 50 years ago that women were often denied access to credit cards, I find that to be an enormously important reality.
In medicine we've also had a work culture in which a colleague could take on the role of covering for you. This was acceptable, appropriate, and expected -- and it meant that physicians could take time off and be away. This is a concept worth protecting that isn't found in many other professions.
As technology advances with the ability to see patients virtually, we see telehealth opening new doors that could make our careers in medicine even more flexible. Want to see patients from 2 p.m. to 10 p.m.? You can. Need to see patients from your home office so that your commute doesn't interfere with time needed to work on a research paper or drive your children to school? Telehealth makes that possible, too. However, as with all technology, it is essential to set boundaries to prevent a "flexible schedule" from turning into a schedule that requires us to be "on" 24/7.
Lastly, there is the enormous satisfaction of having meaningful work, knowing that you have contributed and helped enormous numbers of people along the way.
With all of this in mind, how do we proceed to further the careers of women in medicine?
We must start by meeting them where they are now -- for many women that is a different place than they would have been before the pandemic began. As we reflect carefully on the lessons we have learned, we must not shy away from the reality for most women: we still do more family care and work at home.
This is very difficult, but not an insurmountable challenge. If we make smart decisions for ourselves and for our team members about delegation, valuing our time properly, building in buffers for time stresses (like the inevitability of forgotten class projects or the add-on patient), we can make small changes and choices about our time that allow us to focus on what matters most. It's not so much about balance, it's about decisions. But we must give women the confidence to make these choices.
For organizations, having an institutional agenda to propel women means to pay, sponsor, promote, nominate, elect, invite, cite, credential, and recognize them. Do not wait to give a woman an opportunity -- her sequence may be different than her predecessors, or the later part of her career might be her most powerful one, so getting her set up for success is critically important.
We must take steps at every beginning, which means actively soliciting new nominations of women for every job search, and making sure women are part of job search committees. It also means reducing the need to demonstrate impact via congresses that require travel. Eliminating meetings that occur before 8 a.m. or after 6 p.m., when it's particularly hard to manage child care; these are obvious and easy things to do.
We, as practicing physicians and administrators, and those who run healthcare businesses and practices, will gain much by encouraging flexibility and providing for the needs of female physicians. And as an industry, as patients and providers, we all have a stake in encouraging women to continue to enter -- and to return to -- the medical profession.
Alexa B. Kimball, MD, MPH is the president of , CEO of at Beth Israel Deaconess Medical Center, and a professor of dermatology at Harvard Medical School.