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Women in Medicine Part 1
Can women "have it all?" That is, can they be good mothers, wives, daughters, friends, neighbors, and still be good doctors?
Are women as competent as men?
Are women achieving their potential?
What can women do to achieve more?
UPDATE: Some of what I wrote below years ago* rubs me the wrong way, in tone if not in fact. But hey, people evolve, and some of it is right on the mark. (*in the midst of severe sleep deprivation that plagued me for years)
UPDATE February 16, 2021: The authors of The Quiet Resignation:Why Do So Many Female Lawyers Abandon Their Careers? state that 30% of female lawyers and doctors abandon their careers. Coincidently, a local radio talk show superstar mentioned this morning that a Psychology Today article reported the unhappiest people in America are unmarried professional women (doctors and lawyers) without children. Just food for thought. If you're willing to risk heartburn, read on:
Q: Hi. I'm a mother of two and a premed student. Instead of studying Organic Chemistry as originally planned tonight, I stumbled upon your ERbook.net site and spent a good length of time reading it (that amount of time will remain undisclosed due to my chagrin).
I was particularly interested in your very thorough and lengthy rhetoric about why women don't maximize their potential. I found your list of personal accomplishments somewhat amusing. It's very apparent to me that you spend a lot of time alone and you do not have the demands of a wife or family. Your question was, "Well, what is the single woman's excuse?" Although I do see your point, I feel like you are missing the big picture. I don't have any statistics readily available, but I believe most women do have families.
I would like to give you an idea of my typical day: I get up at 5:00 AM to hop on the treadmill, study scriptures, meditate, and get to class by eight. I get home at 10:30 AM and my husband promptly hands me the baby, explaining he can no longer deal with him. I help my five-year-old daughter with reading or writing (right now we're working on vowels). Between feedings and diaper changes, I put in an hour of housework and a couple of continuously interrupted hours of studying. At 3:00 PM I commute a half hour to a college extension site to resume my work as a writing tutor. When I get home about 8:30, I put the baby to bed and read to my daughter, then I get one more hour of study time before I turn in at 10:00.
Now please explain to me just where in there I am supposed to be inventing perfect lawnmowers and beautiful sheds? I do dream of making robots. My real dream (and I am not being facetious here) is to program a robot to do housework. I think women are still in their evolution. I think the day will come when women will be repairing engines and discovering more than uranium. Twenty five years ago, men did not do housework and just look at them now. When I turn 65, (I am now 26) I'm willing to wager that these generalizations will no longer apply. I guess we'll see. As soon as my retirement begins, so does that robot.
As a side note, I loved your writing. I would like to ask you what you have done to lengthen your vocabulary. Very rarely do I run across someone with a more advanced mastery of the English language, but you were throwing some whopper words out there for me! :) I would also like to ask you if you have ever considered having a radio program? You are interested in talking about almost anything, and you most certainly have the abilities.
Thanks for the wonderful site.
Melanny
Answer by Kevin Pezzi, MD: Melanny sent the above question to me after reading what I wrote about the Can women "have it all?" topic on my www.ERbook.net site. To facilitate a comprehensive discussion of this subject, I will copy those postings, and then comment further. This is a long topic distributed over the next several pages. On the following page is a question from another person, and my response to it, that summarizes my position on this matter.
I will preface this discussion by emphasizing that my goal isn't to disparage the potential of women to innovate but to point out that they have various biological strikes against them, many of which can be mitigated if intelligently addressed but persist indefinitely when political correctness deems certain topics off-limits.
Thus when the PC police shield women from that reality, they limit the potential of women to improve. This helps explain why the past few decades of scientific and technological liberation for women haven't resulted in them matching male innovation even though the majority of college graduates are now women — and have been for years.
So as someone who aspires to help women improve (something I've done for decades, helping many), I could ignore this topic and be politically correct by zipping my lip, or I could help women by exploring it. This is exactly what I've done in an upcoming book, now over 3000 pages and growing daily, devoted to improving health, happiness, and brainpower by addressing the ultimate roots of why we often — not occasionally — fail to achieve our full potential in everything from how we feel to how we look and perform.
Notably, those answers are very rarely found in prescription drugs or surgery, thus mainstream medicine is not the primary catalyst to better lives. That book includes a section devoted to identifying (and correcting whenever possible) roadblocks that prevent women from achieving more. I haven't totaled its length, but I wouldn't be surprised if it were 200 pages or more — all filled with countless scientific studies to corroborate my asseverations. If I never published those practical tips, I could be more politically correct, or I could be more scientifically correct by discussing them.
The irony: people who claim to be experts in health sacrifice theirs in exchange for somewhat larger paychecks. A deal?
Occupational Hazard? An Analysis of Birth Outcomes among Physician Mothers
Comment: Your career or your children?
Comment: Life gets in the way of almost everyone with ambitious career plans. Careers can consume 100% of what you've got to give; if you could give 10 times more, they could swallow that up, too. If you don't think so, you don't have ambitious career plans.
For example, I am now working on ways to quickly stop school and other shooters as well as rapists, muggers, home invaders, and other thugs. The usual approaches just aren't working well enough. Even if we could put a police officer in every classroom, they often don't shoot well in crisis situations, as the New York Times documented in A Hail of Bullets, a Heap of Uncertainty. When police fire at dogs (who never shoot back), only about “55 percent of shots hit home.” Who do they hit? Too often bystanders. Or nobody: San Francisco officers fired 65 shots at a homicide suspect but hit no one. A RAND Corporation report found that New York police had a hit rate of 18% during gunfights and 30% “when suspects did not return fire.”
Here’s a pop quiz: when so few bullets hit targets in crowded classrooms, who else might they hit? Students? Teachers?
Necessity is the mother of invention, so I do what I do best: invent. I've generated hundreds of ideas and prototyped several, which required learning CAD and buying 3-D printers to churn out prototypes — and they do, at their glacial pace, wasting oodles of time because even the supposedly best consumer 3-D printers are half-baked, riddled with problems that waste lots of time.
Did I mention that necessity is the mother of invention? I've consequently generated folders full of ideas focusing on better ways to rapidly produce more functional objects: stronger, with capabilities unmatched by current 3-D printers, and sometimes better looking, too.
Necessity is the mother of invention, so I've worked on thousands of other inventions, including some that have transformed my life and solved major problems. One example is how very early in the pandemic I conceived and prototyped a way to block almost all airborne germ transmission. What I documented in ProgressShack.com is just one of my hundreds of ideas for blocking pathogen transmission via air, contact, and sex.
Because necessity is the mother of invention, and because the path to optimal health isn't paved with pharmaceuticals and surgery, I proved that beyond any reasonable doubt in an upcoming book that is now 4223 pages and growing daily.
Because the current approaches to racism and discrimination aren't solving or adequately mitigating those problems, over the past few years I've generated a much better approach in a book that is now well over 700 pages and growing whatever I can squeeze in time.
If you knew the rest of what I've worked on, you would realize that even if there were 1000 of me, it wouldn't be nearly enough. If I had children, where would I find the time to be a great parent? How do I find the time to stop and smell the roses? While it is indeed possible to have a well-rounded life, that is a fantasy for anyone who is truly ambitious.
The New York Times: April 22, 2021: They Believe in Ambitious Women. But They Also See the Costs.
Comment: Unfortunately, the biggest costs are priceless.
April 19, 2021: Disrupted sleep is linked to increased risk of death, particularly in women
Comment: Disrupted sleep is very common in doctors (and those training to be) secondary to being on-call or working the night shift.
October 31, 2022: Good sleep can increase women's work ambitions
Comment: Conversely, poor sleep can erode ambition as well as drain the energy required to turn dreams into reality.
November 14, 2022: New study reveals that exposure to outdoor artificial light at night is associated with an increased risk of diabetes
March 28, 2022: Lack of sleep increases unhealthy abdominal fat, study finds
November 24, 2021: Researchers find new link between a disrupted body clock and inflammatory diseases
Excerpt: “When these cell rhythms are disrupted (due to things like erratic eating/sleeping patterns or shift work), the cells produce molecules which drive inflammation. This can lead to chronic inflammatory diseases such as heart disease, obesity, arthritis, diabetes and cancer, and also impact our ability to fight infection.”
Based on: The Circadian Clock Protein BMAL1 Acts as a Metabolic Sensor In Macrophages to Control the Production of Pro IL-1β
October 21, 2022: What happens if your circadian rhythms are out of whack?
Comment: ↑ cancer risk = ↓ chance of seeing your children and grandchildren grow up.
April 16, 2021: Heart health of shift workers linked to body clock
Comment: Heal the patient, harm yourself.
March 8, 2021: Research offers insights on how night shift work increases cancer risk
Excerpt: “Findings from the study suggest that night shifts disrupt natural 24-hour rhythms in the activity of certain cancer-related genes, making night shift workers more vulnerable to damage to their DNA while at the same time causing the body's DNA repair mechanisms to be mistimed to deal with that damage.”
Comment: DNA damage does more than increase the risk of cancer; it also contributes to many other diseases and conditions (such as neurodegeneration) as well as accelerated aging (1, 2, 3). In short, if you want to wreck your body and mind, work the night shift! In exchange for prematurely looking, feeling, and acting old, you might receive a night shift differential, but the measly two or three dollars per hour (if you are lucky) hardly compensates for reducing your lifespan by an average of a few years — or perhaps a few decades, as cancer can do.
May 23, 2021: New research suggests that night shift work is linked to menstrual irregularity and increased of developing endometriosis
July 28, 2021: Nearly half of surveyed female surgeons experienced major pregnancy complications
August 16, 2021: Night shift work is linked to increased risk of heart problems
February 3, 2022: Poor sleep and stress exacerbate each other among nurses who work night shift, study finds
Comment: And doctors.
March 14, 2023: Health care workers are frazzled – and poor sleep may turn stress into poor mental health
July 20, 2022: Shift workers 'can't all adjust to a night shift'
February 12, 2021: COVID forced Australian fathers to do more at home, but at the same cost mothers have long endured
March 15, 2021: Lockdowns tougher on women, and housework is big reason
December 22, 2022: Men may not 'perceive' domestic tasks as needing doing in the same way as women, philosophers argue
May 6, 2022: Men work out on time borrowed from women: study
June 14, 2022: New book examines the forfeit fathers pay for balancing family and full-time work
March 31, 2022: Married mothers who earn more than their husbands take on an even greater share of the housework
December 6, 2022: Why married mothers end up doing more housework when they start out-earning their husbands
August 8, 2022: Women are too tired and time-strapped for board games due to shrinking leisure time
Comment: But enough time to become and work as a doctor? Until you've done it, you likely cannot imagine how much time that is. Working two full-time jobs would have seemed like a walk in the park compared with what I endured in medical school and residency. Things are somewhat easier now, but the time commitment is still staggering.
Work that kills: The danger of nonstandard working schedules
Shift work, DNA methylation and epigenetic age
Why Working at Night Boosts the Risk of Early Death
Long work hours associated with increased risk of stroke
Rotating shifts shorten lives
Excerpt: “A study of 3,912-day workers and 4,623 shift workers … showed the former lived 3.94 years longer than their counterparts on shift duties …”
Here's why working nights could be killing you
Shift work and its effects on the cardiovascular system
Shift workers at risk for heart disease, stroke and type 2 diabetes
Sleep deprivation may affect our genes
Excerpt: “In the … study on 49 healthy full-time doctors …, on-call doctors who were required to work overnight on-site had lower DNA repair gene expression and more DNA breaks than participants who did not work overnight. … Damaged DNA increased after only one night of sleep deprivation.”
September 12, 2022: Daytime eating may benefit mental health: A study on meal timing found that eating at night increased depression and anxiety-related mood levels among participants
How Night Shifts Perpetuate Health Inequality
Five Years of Night Shift Work Elevate a Person's Risk of Death
Irregular schedules raise risk of injury for miners working long hours
Working the Night Shift May Affect Your Lifespan
Total and Cause-Specific Mortality of U.S. Nurses Working Rotating Night Shifts
Night shift work at specific age ranges and chronic disease risk factors
Rotating night shift work can be hazardous to your health
Women's long work hours linked to alarming increases in cancer, heart disease
Night shift work linked to an increased risk of obesity
Maximising alertness and productivity on the nightshift
A gene linked to job-related exhaustion in shift workers increases the risk of Alzheimer's
Kids' sleep may suffer from moms' tight work schedules
Superwoman: A Hard Act to Follow
PepsiCo CEO Indra Nooyi: No, Women Can't Have It All
Article by Anne-Marie Slaughter in the July/August 2012The Atlantic: Why Women Still Can't Have It All (subtitled: “It's time to stop fooling ourselves, says a woman who left a position of power: the women who have managed to be both mothers and top professionals are superhuman, rich, or self-employed. If we truly believe in equal opportunity for all women, here's what has to change.”
A retired female surgeon wrote, “As for women in surgery? You can't have it all and be good at any of it. If you want to be a good mom, then stay at home or pick a 9-to-5 career.” (source: in a comment to that article)
Katya Andresen: Moving Above and Beyond 'Doing It All'
Burnout: Sleepless firefighters at risk of exhaustion and mental health conditions
[Female] Physician Dies After Patient Attack in Dallas Hospital
Worked to death? Study says lack of control over high-stress jobs can lead to early grave
Book: Opting Out?: Why Women Really Quit Careers and Head Home
If Norwegian Women Can't Have It All, Can Anyone? Subtitle: Even in a country with forward-thinking child-care policies, women still can't get ahead.
Former CFO Erin Callan Regrets Not Having Children, Reignites Work-Life Balance Debate In a New York Times article (Is There Life After Work?), she reflects “on the decisions I made in balancing (or failing to balance) my job with the rest of my life. … I didn't start out with the goal of devoting all of myself to my job. It crept in over time. … I don't think I could have "had it all" … I can't make up for lost time.”
“Forget work/life balance. You can sleep when you die. At least that's how Snapchat's Emily White and Coca Cola's Wendy Clark said they approach time management …” (source)
Challenges around childbearing owe to dissatisfaction among surgical residents: Refined mentorship programs, further education and understanding are cited as necessary to improve work-life balance
Comment: Or find a way to stretch each day into 36 hours. Realistically, early motherhood is often exhausting. Add in a career working two to three times as many hours per week as average folks, and something is bound to get the short end of the stick: children or current and future patients. As impressed as I am about the ability of women to do a lot, I see no way for them or anyone to escape this reality.
Billionaire investor says babies are like divorce: they both 'kill' focus
Facebook COO Sheryl Sandberg Isn't Kidding About People Hating Successful Women
Excerpt: Sheryl Sandberg “published a new book called Lean In. The book offers career advice for women in a world that is still dominated by men.”
Comment: A seemingly mundane experience (a stray dog in my yard) unfolded in a way that taught me how true that is, as I discussed in Sexism isn't dead yet.
Full-time professional to full-time mother: A choice laden with cost
Researchers with children: A disadvantage in academia
Women driven by status, wealth rather than wanting babies, study suggests
Working Moms Spend Less Time Daily On Kids' Diet, Exercise based on Maternal employment and childhood obesity: A search for mechanisms in time use data
Just 20 Minutes Of Weekly Housework Boosts Mental Health (no wonder I'm so happy! :-)
Dads who do chores bolster daughters' aspirations
Living with children may mean less sleep for women, but not for men
Men's Involvement at Home: Sports 1, Housework, 0
January 10, 2023: Women work harder than men: An anthropological study reveals why
Exactly How Much Housework Does A Husband Create?
Married Men Really Do Do Less Housework Than Live-In Boyfriends
A Man's Occupation Linked to Time Spent On Housework, Study Finds
In Dual-Career Couples, Mothers Still Do the Most Child Care
Dads are often having fun while moms work around the house
When the baby comes, working couples no longer share housework equally
June 10, 2021: 'Disagreeable' married men who shirk domestic responsibilities earn more at work
Mothers, but not fathers, with multiple children report more fragmented sleep
Dads, not just moms, battle balancing work, family, exercise
Housework gender differences may affect health in elderly men and women
Women have less time for hobbies because they spend more time on chores than men
Why the institution of fatherhood is taking so long to change
Comment regarding the several above articles suggesting women do more housework: This isn't always true, of course. Of all but one of the women I've dated, I recall only one who once baked something for me: cinnamon rolls using store-bought dough sheets after I made her cinnamon rolls from scratch that were the tastiest ones I've ever had, easily surpassing Cinnabon's rolls. That resulted from me following a recipe, guesstimating how to modify it to amplify taste, but some of my other culinary successes stemmed from what initially seemed major mistakes: one resulting in the yummiest bread crust I've found, and the other blueberry muffins to die for—both outclassing their counterparts from all bakeries I've sampled.
I could fill a book listing other things I've done for women, from installing crown molding to fixing their mowers to free plastic surgery—yes, really, and they were pleased while one was thrilled with the results! And shoveling snow, painting, laundry, general cleaning, and on and on. But except for that single outlier, women I've known resisted housework and cooking as if they were allergic to it, such as when I was rushing to prepare breakfast and asked one to put bread in the toaster: she flat-out refused, excusing it by saying her cooking skills were so exiguous she would burn water if she boiled it.
I am not fond of housework or cooking (one reason I later invented a robotic chef), but someone must do it. I understand that women are perhaps revolting from how most of that burden once was shouldered by their homemaker predecessors, but the pendulum may have swung too far in the opposite direction—in my experience. Your mileage may vary.
Forget Marcus Welby: Today's docs want a real life
Working Odd Shifts Can Hurt Parent-Child Relationships (Ya think?)
Does Becoming a Doctor Pay Off for Women? * Excerpt: “Women who go to medical school just for the financial rewards of being a doctor could be making a mistake … The research found that after factoring in the high upfront costs of becoming a doctor, most women primary-care doctors would have made more money over their careers becoming physician assistants instead.” (*based on Are Women Overinvesting in Education? Evidence from the Medical Profession)
Average 25% Pay Gap Between Men and Women Doctors Largely 'Inexplicable' based on Is there equal pay in healthcare? Not if you are a doctor
Genetic cause for shift work fatigue discovered
Excerpt: “Some people adapt easily to shift work, but not everyone can handle constant disruptions to their daily rhythm. Researchers have now found that a melatonin receptor gene influences tolerance to shift work.”
Don't shoot the messenger department: An article asks, “Are There Too Many Women Doctors? As an MD shortage looms, female physicians and their flexible hours are taking some of the blame.”
When Mom Is CEO at Home, Workplace Ambitions Take a Back Seat
One of many studies documenting the risk of shift work (which is almost inevitable in emergency medicine): Female Shift Workers May Be at Higher Risk of Heart Disease
Increased risk of coronary heart disease seen among women who work rotating night shifts
Untimely immune cell clocks may contribute to obesity and diabetes in shift workers
Time of day influences our susceptibility to infection, study finds
Excerpt: “We are more susceptible to infection at certain times of the day as our body clock affects the ability of viruses to replicate and spread between cells, suggests new research. The findings may help explain why shift workers, whose body clocks are routinely disrupted, are more prone to health problems, including infections and chronic disease.”
Long Term Night Shifts Linked to Doubling of Breast Cancer Risk
Shift Work Linked to Increased Risk of Heart Attack and Stroke based on Shift work and vascular events: systematic review and meta-analysis
Higher Job Strain Associated With Increased Cardiovascular Risk for Women based on Job Strain, Job Insecurity, and Incident Cardiovascular Disease in the Women’s Health Study: Results from a 10-Year Prospective Study
Work-Related Stress Linked to Increased Blood Fat Levels, Cardiovascular Health Risks based on The relationship between job stress and dyslipidemia
Rotating Night Shift Work Linked to Increased Risk of Type 2 Diabetes in Women, Study Finds
Night Work May Put Women's Health at Risk (Higher risk of heart disease, diabetes … and cancer, too? Yikes!)
Women Working Shifts Are at Greater Risk of Miscarriage, Menstrual Disruption and Subfertility
Molecular Link Between Circadian Clock Disturbances and Inflammatory Diseases Discovered based on Circadian clock protein cryptochrome regulates the expression of proinflammatory cytokines
Rotating Shift Workers Have Lower Levels Of Serotonin
Night Work May Impair Glucose Tolerance
Shift work linked to heightened risk of type 2 diabetes
How Long Hours at Work Hurt Your Health
Physicians Lead MomDocFamily Support Group
Study finds Working Moms Feel Better Than Stay-At-Home Moms
Working Moms Multitask More and Have Worse Time Doing So Than Dads
'All Work' Won't Help 'No Play:' Professor Scrutinizes Link Between Job and Life Satisfaction
Motherhood 'Detrimental' to Women's Scientific Careers, Study Concludes
Thirty-Five-Hour Work-Week Recommended for Parents
Most Women Would Choose Surgical Profession Again based on Women Surgeons in the New Millennium
Surgeon-Physician Marriages Can Place Stress On Careers, Emotional Health
NOTE: In mentioning these and other drawbacks pertaining to emergency medicine, my goal is not to deter students from choosing that profession, but to educate them so they can make informed choices.
Women Speak Less When They're Outnumbered based on Gender Inequality in Deliberative Participation
Women's Scientific Achievements Often Overlooked and Undervalued based on The Matilda Effect in science: Awards and prizes in the US, 1990s and 2000s
Gender Gap: Selection Bias Snubs Scholarly Achievements of Female Scientists, Study Suggests based on Scholars' awards go mainly to men
Why Are There Too Few Women Consultants in Surgery?
Why Do So Many Women Leave Biology?
Is Shyness Holding You Back at Work?
Fathers' long commute to work is linked to children's social, emotional problems
Weight Discrimination Could Contribute To The Glass Ceiling Effect For Women, Study Finds
Excerpt: “Weight discrimination appears to add to the glass ceiling effect for women, finds a new study co-authored by a Michigan State University scholar.”
Comment: Years ago, I noted that the shape of a woman's body affected the shape of her wallet; specifically, thinner body, thicker wallet. I loathe discrimination, so I am not fond of this correlation, but that's just the way the world is, and the last time I checked, few people want to change themselves, only others.
Women Sell Themselves Short On Team Projects, Study Suggests based on It Had to Be You (Not Me)!: Women’s Attributional Rationalization of Their Contribution to Successful Joint Work Outcomes
Operating room reproductive hazards for female surgeons
Excerpt: “Researchers in this review article discuss occupational reproductive hazards for female surgeons in the operating room, including radiation exposure, surgical smoke, working conditions and physical demands, sharps injuries, anesthetic gases and the use of toxic agents. ”
Based on: Occupational Reproductive Hazards for Female Surgeons in the Operating Room: A Review
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