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On Being a Doctor |

Obstetricians Wanted: No Mothers Need Apply

Lauren Plante, MD
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From University of New Mexico, Albuquerque, NM 87107.

Ann Intern Med. 2004;140(10):840-841. doi:10.7326/0003-4819-140-10-200405180-00026
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I was an obstetrician, and then I was a mother, until I had to give up the one for the other.





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Obstetrical and Gynecological Care of Women-does anyone care?
Posted on June 10, 2004
Ralph R Chesson
Louisiana State University Health Sciences Center, New Orleans
Conflict of Interest: None Declared

I do not believe there was "outrage" in response to Dr. Plante's opinion piece in Obstetrics & Gynecology("Plante, LA "What's a smart women like you doing at home" Obstet Gynecol 2002 Dec;100(6):1359). Her suggestion that only a women can understand women("Perhaps it's shared experience, or, to borrow a phrase, the view from the other end of the speculum") might be viewed as a sexist remark just like the remark made by a department chairman stating there was no place for pregnant women in his specialty. I do not need to have a heart attack to be a cardiologist. Do I need to have cancer to be an oncologist?

Women need compassionate care by physicians who ensure they have a continuity of care. I too, have had home emergencies, but I do ensure my patients will have care. Being a physician does involve some sacrifice. If physicians are not ready to make some sacrifices for the care of their patients, maybe they need another less demanding profession.

Conflict of Interest:

Residency Program Director trying to provide Obstetrician and Gynecologists to provide care for the women of this country.

Yes, Dr. Cresson, We Do Care
Posted on June 22, 2004
Cynthia G Silber
Jefferson Medical College
Conflict of Interest: None Declared

To Dr. Cresson:

I am a board-certified obstetrician-gynecologist, who trained in the mid-1908's in New York State before the advent of the 80-hour work week rule. I was one of the residents alluded to by Dr. Plante who was berated by the chairman for being pregnant; except for the fact that I was NOT pregnant. I was called into the chairman's office and soundly verbally abused because he had heard that I was PLANNING a pregnancy (which was not true, as if it were any of his business). I vividly recall him yelling at the top of his lungs, with neck veins bulging; I thought he was going to have a stroke. "It's bad enough if a resident gets pregnant by ACCIDENT, but when it's actually PLANNED, it's the worst abuse of your fellow residents I can imagine. This is why we hate taking women into obstetrics programs." This was, understandably, a very embittering experience for an idealistic young woman.

After my training, I practiced obstetrics and gynecology in an academic medical center for 12 years, until I was asked to join the Dean's staff as Associate Dean for GME. During my time in practice, I had two children. I worked until I went into labor. I recall the cognitive dissonance I experienced on a daily basis when, as a physician, I would give my patients medical leave at 36 or 38 weeks for normal pregnancy, while I worked until the last moment. I would shake my head in bewilderment each time I signed short-term disability forms for companies that granted three months of maternity leave, while I was allowed 6 weeks. I distinctly recall a day in the OR when I was 38 weeks pregnant, doing three hysterectomies as the primary surgeon. I could barely reach the table.

Women love women gynecologists. There is no disputing this fact. Women love to share the narratives of their lives, such as childbirth, marriage, care of children and the elderly, and menopause, with their doctors who are experiencing the same passages. When I left practice, my patients wept. Four years later, they still weep when I meet them on the street. Although I miss them terribly, I do not miss practice. Obstetrics and gynecology is a stern taskmaster. When Dr. Cresson states that, "If physicians are not ready to make some sacrifices for the care of their patients, maybe they need another less demanding profession", I found myself wondering who was caring for his home and children while he was making these noble sacrifices; I suspect it was his wife. I know of no women physicians are not willing to make sacrifices; however, it is cruel and unreasonable to ask women to sacrifice the experience of motherhood that we protect for our patients.

So yes, Dr. Cresson, we do care. And yes, we are willing to make sacrifices. But almost every woman I know has given up obstetrics or has given up practice altogether, because we exhausted ourselves trying to provide the kind of support for our patients and their children that we were denied by our own profession. If we do not figure out how to provide our own doctors with the kind of compassion and respect for family that we provide our patients, this exodus will continue. And we will all be the poorer for it.

Conflict of Interest:

None declared

Doctor wanted-mothers should apply
Posted on July 13, 2004
Roxanne M Tyroch
Texas Tech University Health Sciences Center
Conflict of Interest: None Declared

Dear Editor,

We wish to respond to the insightful and candid piece by Lauren Plante titled "Obstetricians Wanted: No Mothers Need Apply" published May 18, 2004. Dr. Plante brought to light the importance of developing creative solutions to balancing family and profession.

Equal representation of women in U.S. and Canadian medical school classes has come to pass. As a result within the next 10-20 years a great number of older male physicians will leave practice and in their wake, a large cohort of female physicians will emerge. A lot of "duty trading/sharing" within family structures has enabled women physicians to practice quality medicine and raise families.

It saddens us that Dr. Plante's suggestions of promoting change were met with outrage by her profession. The full-bodied presence of women in medicine is an issue deserving of institutional, regional and national action. Obstetrics and Gynecology is not the only medical specialty having undergone a very abrupt gender proportion transition. Our challenge is to develop and foster a medical community in which the needs of the physician membership are foreseen, respected and a palpable willingness to try a new approach exists.

Just as men have a gender associated human duty to defend their country in times of war or natural disaster, women still bear the gender associated human duty of ensuring the welfare of children is intact. Historically, when men went to war, communities underwent dramatic change to support them and their families. Let us embrace the concept that, to borrow a phrase, we are all bound to one another by our humanity.

The mommy tenure track is a wonderful concept for any person (male or female) who needs to abandon themself briefly to care for another. At a national level, we promote the AAMC to increase the number of medical students nationally in order to adjust for the need for flexible physician lifestyles and the aging of America.


Roxanne Marie Tyroch, M.D. Tamis Bright, M.D. Carmela Morales, M.D.

Conflict of Interest:

None declared

Dr. Plante's 'On Being a Doctor'
Posted on August 23, 2004
Philip E Young
Conflict of Interest: None Declared

August 3, 2004

The Editor Annals of Internal Medicine

Re: Reply to "Obstetricians Wanted: No Mothers Need Apply"


I most certainly was not the department chairman cited by Dr. Plante in her letter in the May 10 edition of the Annals. However, as a 63-year- old male obstetrician-gynecologist who, when I was younger, served for many years as residency director of a major university Ob/Gyn training program; and who is currently serving as the CEO of a ten-person private practice Ob/Gyn group which consists of five male partners, five female partners, and one female physician employee; and as one who has lived through both the "before" and the "after" of the revolutionary changes that have occurred in obstetrics, and indeed in medicine, as a result of the wholesale entrance of women into the profession; and as the father of a brilliant (pardon my paternal pride) female evolutionary biologist who graduated Princeton and Yale; I have a few observations on the poignant problem presented by Dr. Plante, and the angst she apparently feels about it.

I have struggled for most of my professional life with the conundrum of the female obstetrician-gynecologist: knowledgeable, skillful, competent, the ideal caretaker for other women, except for the unfortunate fact that there is a conflict of interest between the doctor-mother's interest in her family and her interest in her patients.

For years I was uncomfortable even stating this conundrum, as it somehow implies a sexist view of the world in which men have less family obligations and are therefore more readily available in a professional world. My biologist daughter helped me a great deal in understanding the underlying difficulty with this interpretation when she explained to me patiently in the midst of one of our discussions, "Dad, political equality is a right; everyone is entitled to that; but political equality is not gender equivalence, and biological laws cannot be repealed."

A brilliant colleague of mine at UCLA, Jared Diamond, has written a number of interesting books and has won awards for his well-known text, "Guns, Germs and Steel," but one of his more interesting works is entitled, "Why Is Sex Fun?" In it, after much presentation of biological facts and material from across the animal world, he asks and answers the obvious question: at the moment the child is born, who has the most vested interest in the baby -- the mother, who produces one egg a month, and who, when

pregnant, nurtured it for nine months, during which time she was out of the reproductive business entirely, except for this one child; or the male, who produces millions of sperm per ejaculate and in theory can inseminate hundreds of women per year, and who, once pregnancy ensues, is perfectly free to continue to reproduce with as many other females as he can persuade? No amount of socialization and training will ever seriously alter the self-evident answer to this question, or the unalterable facts that it implies: when the chips are down, taking the population as a whole, women have more vested in their children, and therefore more obligations at home, than do men. This is a terribly unpopular thing to say, but it is reality.

How does this translate into the world of women being obstetricians and gynecologists? Obstetrics and gynecology is a demanding field, even for males. In my personal practice group, we have several models of how women solve this conflict which men do not appear to have. In one model, we have two women working opposite each other with the intention of functioning as "one doctor," providing the equivalent of full-time office, telephone, and in-house care. So long as the patient and the primary physician are comfortable with this relationship, this is fine. For these two doctors and their patients, this model works.

We have another model in which one young woman works extraordinarily hard, but finds it necessary to constantly rearrange and rebook her schedule to deal with such things as sick children, plays, baseball games, etc. She has a similar relationship with her patients: those who are willing to tolerate the uncertainties for their own reasons are happy with it; those who are not, are not. This doctor seems to be happy with this arrangement.

In our third model, the female doctor has extensive home child care help and works the traditional Ob/Gyn office schedule and call schedule.

We also have one female partner who long ago made the choice to have neither children nor husband. She also works a traditional schedule and is content with the choices she has made.

And, of course, there is still one other option - the one that Dr. Plante's "other four" Ob/Gyn associates chose when they "could not reconcile the competing demands, nor add more hours to the day:" consciously choose the biological imperative.

Life is about choices. Medicine is about choices. How many more options does Dr. Plante feel we need to develop so that the "choices we leave ourselves" are not so "unpalatable."? In recognizing the autonomy of patients and physicians to make their own decisions, and our responsibility to give them all the possible help that we can in making those decisions, we should not delude ourselves into believing that enough information or more choices will make the decisions no-brainers or make them go away.

Women biologically have more choices, by one, than do men: they can bear a child. In most other situations, we regard more choices as better than fewer choices. I am not sure why that concept has been lost in the shuffle in the case of women professionals. Men, in fact, make the same choices as women do when men choose to be full-time professionals and let their wives or other persons care for their children. It just happens to be biologically easier for them to do that.

I think it is clearly true that women have much to offer to obstetrics and gynecology and to medicine as a whole, and I agree that we should work to make as many options available as possible, but really, we, as a profession, have explored and do offer many of these options. Let us not kid ourselves that we can remove the biological difference in the complexity of the choices that face women, as opposed to men, in choosing lifestyles and careers. I do not believe that it is true, as Dr. Plante says, that if we "gave more than lip services to the importance of women's choices" we could find a "system that enables women to have both children and satisfying professional life, whether those women are patients, our colleagues or ourselves." Satisfaction only comes from within, and from recognizing - and making - the choices which are required of us by the realities. No external structuring can take away the responsibility for accepting, making, and living with choices, and being happy with one's decisions. It is not possible to "have it all;" and it is not fruitful to be forever distressed about that fact. It is also not useful to suggest that those who remain in the profession, in one form of reconciliation or another, should feel guilty for those who cannot find a satisfactory compromise. As the poet says, "Not all that tempts your longing eyes or heedless hearts is lawful prize, nor all that glistens, gold." All of us need to accept that reality.

Sincerely yours,

Philip E. Young, M.D.


Conflict of Interest:

None declared

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