Not too long ago, my daughter, you asked me what you should be when you grow up. Over the years you’ve entertained the normal litany of ideas- artist, teacher, and even a doctor like your mom. I will answer your question the same way my mother did. You can do anything, and I will be proud. You are getting to an age when big life questions are starting to enter your awareness. Even as your limbs lengthen and your cheeks lose the pudgy contours of early childhood, your ability for self-reflection and discovery are developing. I hear in the recounting of your school days the initial thought processes of decisions that will affect your future. What kind of friend and sister and daughter am I and what kind would I like to be? What kind of work ethic will I have? What are my strengths, weaknesses, likes and dislikes? What should I be when I grow up?
You’ve watched our family transition through different households, states and job descriptions. You’ve seen your father go to work close to home and you’ve experienced his absence on deployment. You’ve seen me work long days and nights in a hospital, shorter and fewer days in a clinic, and even experienced having a mother whose energy is entirely focused on home and family. You’ve seen me work and parent in concert with your father, and you’ve seen me cobble together resources to work and parent alone. I wonder how all these influences will guide you. I see your aptitude for science and your natural propensity to leadership and I wonder if you will ever decide to be a physician like your mom.
As you will learn when approaching any decision, my daughter, you must weigh the good against the bad, or as many doctors will describe their daily choices; evaluate the risks and the benefits. Just as my mother riding the crest of women’s liberation in the 70’s didn’t know what the world would hold for me, I do not know how the world will receive you when you embark on your professional career. Additionally, I cannot know how the world will accept you as both female and mixed cultural background. Besides your female gender, you will have an additional “otherness” to contend with that will be unfamiliar to me. I can tell you that it has only been during my career that the prevalence of women in medicine has started to equal that of men. I can also tell you that despite the growing number of women in medicine, we are still undervalued, underpaid, and underestimated professionally. I hope in the years to come that gender wage gaps will close and that women of all backgrounds will be valued for their unique and relevant perspectives.
As a woman, you must take other factors into consideration when you weigh your professional goals. Will you be a wife? Will you be a mother? Will your spouse be flexible or demand traditional family roles in your household? These, sadly, are still questions that women from all walks of life must consider. Despite huge inroads into the professional world, women doctors are still expected to split their attention between home and work, patient and child, boss and spouse. There are increasingly more family-friendly scheduling choices for physicians with the advent of hour restrictions, nocturnists and hospitalists, and slowly increasing acceptance of part-time work schedules. You will likely have the income to outsource some of your domestic duties, but your heart will still lie heavy when you miss your child’s bedtime.
Becoming a doctor is a long road with many hours of study and work. It requires you to assimilate an astounding breadth of knowledge and experience. At one point in time the title of “doctor” itself commanded respect, but now the status of the “white coat” is yellowed and diminished. Mistrust of medical providers dilutes the respect that doctors once enjoyed. Now it is common to have your long hours of training questioned, and your integrity mocked. It will take additional fortitude to sidestep these attacks, and to avoid the doubt that will feed into imposter syndrome. Additionally, the practice of medicine itself is changing. Doctors must not only contend with the negative voices among their own patients, they are increasingly asked to defend themselves against the bureaucratic machines of insurance companies, proving repeatedly the validity of their knowledge and decision-making skills by completing Sisyphean mountains of paperwork. The precious time is spent with the patients they love is capitalized on and traded for dehumanizing clicks of computer keyboards.
My dear daughter, you must ask by now why do I practice medicine at all? What draws me to it? So far, I have painted a bleak picture, and based on this I would wholeheartedly steer you far away from a career in medicine. And yet, you’ve seen me walk away, and walk back again. The phases of my life as a woman and as your mother have pulled me through different phases in my career. But the power of this vocation has gravitas to it, much like the gravitational pull of the moon drawing the waves to the shore. It is a calling to practice medicine, my daughter. The love of healing and human connection provides a strength that fortifies you against the challenges that being a woman doctor presents. All the negatives are quickly eliminated by one small success; a cured infection, a healed wound, a comforted patient, a life saved. This is the WORK of being a doctor. It is the lasting effect you can put into the world- positive ripples that start with one patient and spread outward through a family and then a community.
If you asked me if I thought you should be a doctor, I would say no and smile in relief as you forged your own path. I would enjoy watching you grow, and I would share the joys and challenges of being a woman as you journey through life. If you told me you felt a calling to be a doctor, I would nod my head in understanding, hold your hand tightly, and walk alongside you on this rocky road. I would celebrate as you answer your calling, and as and you demonstrate the grit and resiliency of being a woman in medicine.
Dr. Alexandra Pinon, MD is a General Pediatrician, Navy wife, mother of four and a contributing author to the “Chronicles of Women in White Coats”. She lives in San Antonio, Texas with her family.
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Thank you for this. I’m a female junior in college on the Pre-Med track. I’m also a first generation American with a Middle Eastern background. Since as long ago as I can remember I’ve wanted to specialize in pediatric oncology. Instead of support, the majority of my friends and family advise me to do something more “suitable” for a woman, like dentistry or pharmacy. I don’t believe it’s them being sexist, these are their opinions based on their mindset. They want me to have an education and they’re perfectly cool with me working, but at the end of the day in their eyes, they think of the husband who may not approve of the hours and the kids that’ll need to be looked after. Usually, I’m able to just smile and laugh it off, confident in myself and my ambitions. But sometimes, I feel like I’ve been giving in to their comments and it’s been hanging over my head. Lately I’ve been second guessing myself, especially when I see all the girls around me that are my age getting married and MCAT studying around the corner. Your article gave me the punch I needed to get me back on track. Even though I know I’m not the only girl in school having these thoughts, to hear from someone that went through the same thing and know they succeed makes a difference. So I just wanted to say thank you. And if you have any other advice it would be much appreciated 💙
If time balance with respect to years of training and final professional commitment is critical, then consider becoming an NP or PA and subspecialize in pediatric oncology.
Otherwise, keep on your original path but recognize the path includes four years of medical school, three years of pediatric residency and I believe three years of pediatric oncology fellowship. Wishing you the very best.
In my opinion, she should pursue her goal, NP and PA will restrict her scope for the rest of her life.being M.D. can lead to many avenues just in case if pediatric oncology tires
her mentally and emotionally.
Bayan, Aim high and don’t give up on your goals. Things seem impossible from far away, but when you dive in, life will happen, you will face it, and you will carve out your path. Don’t let anyone stop you or dissuade you. If I had listened to people, I would not have had three kids and managed a busy career. PS Surround yourself with supporters and like thinkers.
Your letter is among the most comprehensive and honest view about the practice of medicine. Physician burnout is all time high because of many reasons you cited, even though these physicians recognize how medicine is such a noble career. Young physicians nowadays rather make less money, take less calls and have more balanced lives. OBGYNs like me walk away from call schedules at younger age than other fields.
It is time for those in administrative positions to read such letters like yours and reflect on why many specialties such as Pediatrics or OBGYN are desperate for physicians.
Thank you for taking the courage to write such honest letter.
Bayan, I have been a pediatrician for more than 50 years. I wanted to be a doctor since I was 10. I had a cousin who told me to be a nurse because as a doctor I would be too smart and no one would want to marry me. Needless to say I didn’t listen to her. I am married to a wonderful man who encouraged me to be whatever I wanted to be. I have two children and 4 grandchildren. The opportunities for women in medicine are so different than they were 50 years ago. I worked for other doctors and built my own practice which was very successful. Now I am thinking about retirement. Go for it. There are so many options now for building a successful career and family. The well meaning people in your life are reflecting the past. It will not be that way in the future. It will be easier.
I couldn’t have said it better meself!
This is so beautiful–and you hit so many of the points I considered as I moved thru med school (meeting and marrying my husband), residency and fellowship (as I had my kids). “Grit and resiliency” a perfect description of what we women physicians do.
Excellent article!!! So proud that several of my female physician colleagues have daughters that are becoming physicians!
There really is no pay gap for women in medicine, assuming they work the same hours as men. I have been a physician for 30 years, and males and females are paid the same.
That may be true of private practice where partners have full transparency of the financial records. Now that more than half of all physicians are employed, large corporations are less transparent. https://time.com/5566602/doctor-pay-gap/
Women need to demand to see the financials.
This is a wise, heartfelt, and thorough letter. I would add only 2 observations after 40 years of practice. One is that I have never put medicine ahead of my love for my husband and son. The other is that my identity is so vested in medicine and the sense of accomplishment in helping patients that I am finding it impossible to retire. Jill Karatinos MD
My daughter was always certain that she would never do anything medical. Growing up, she went on rounds with her doctor mom and said: I don’t even want to be a nurse. So when in her mid 20’s, my daughter announced that she wanted to follow in my footsteps, my jaw hit the pavement.
She moved home for two years to do the prerequisite coursework. In that time she and I thought and reassessed. In the end she applied to a nurse practitioner program. It will basically let her do everything that I can do as a family physician. I did harbor the hope that the training would be kinder and gentler than medical school was for me, but no. At least I can hold her hand long distance as she goes through some of the deja view abuse that I guess is any kind of medical training in this country. I’ll probably be doing more of that as she enters the world where your value as a healer is measured more by your “productivity” (how many patients you can see how fast), rather than in the quality of the care you provide.
I have had many of the same discussions with my son. Even though he does not have the female factor to contend with, the same issues of the changing face of medicine will affect him as well. The last paragraph you wrote states it best; it is a calling to practice medicine – that is why we do it despite the obstacles. Well written!
Very nice and optimistic .Every individual pursues their passion for medicine given their circumstances and resilience is key to success.
Beautiful piece. I have tears in my eyes.
Great letter. As challenging as being a doctor can be, i would not chabge a thing. The difference I make in my patients lives on a daily basis is extremely rewarding. My daughter is currently in her 1st year of med school. She knows what she is getting into, she knows there were times i missed out on things for her, yet she still has chosen this noble profession. I would say, in medicine, now easier than ever before, you can make specialty choices that will work with your chosen life choices. There is flexibility to chose work schedules and be a wife and mother and business owner or whatever you choose. Just chose a career (medicine or otherwise) you love and that brings joy to make up for the sacrifices and bad days that happen with EVERY job.
As a mother of an 18 y/o female who is a Freshman at High profile University in a Pre Med track and doing a double major, I felt identified with your letter and with those same sentiments I had manifested to my daughter when she entered college. Do Medicine, if you will enjoy taking care of human beings, not for the status or making a high salary because that is far gone through the years. Thanks for your personal story.
You spoke to me. 30 years in- two residencies and doing it exactly the way I choose. Still, I cry as much as I laugh. I love medicine but hate the business of medicine. I am of the generation where the respect died and suspicion grew. My daughter will not be a doctor. She sees my tears. She hears me fight with insurance companies. Even though I do not accept insurance for my care, I must battle for testing, medication, and hospitalization for my patients. I am fortunate. I can retire anytime I like, but I stay. I know if I am in tears, my patients are trembling. I am still moved by any chance I have to guide, heal, and love. It is a scary place out there, especially when unwell. Keep writing and we will keep reading.
Thank you for your heartfelt discussion about advice to our daughters as a female physician. I have had the privilege of having had a private practice in Ob-Gyn starting in 1982. Yes, it was challenging as far as the hours and when my youngest daughter was about 4, I made the decision to quit Ob because I was missing so much with my girls. I turned to gynecologic surgery and did miss my Ob patients but loved the time I gained with both girls.
I was fortunate in my practice to not accept the issues as a female physician and refused to allow being a woman to determine what I did.
Fast track to 2019 and I am now retired due to degenerative arthritis but still enjoying involvement in medicine with consultations in various arenas.
My daughters are both professionals, one an attorney and one a DNP. The younger one who elected to follow the DNP path entertained the MD and DDS paths. I will say, as medicine has changed, I recommended she look at the DNP path rather than the MD path since she was not interested in surgery. She is amazing and has the gift to care for patients with the knowledge needed in her specialty. Since I teach medical students, in addition to my consulting to the Medical Board, I see what they go through. The cost of time and dollars is huge and considering our current medical practice environment, I think being a “mid-level provider” is something I would continue to support, especially since I had NPs in my practice almost the entire time.
Too wordy, but I would state that I had the best time having come into medicine when women were still not a standard and I feel I refused to accept the standard. That said, the practice of medicine has changed and I am so happy that my youngest is practicing medicine without the burdens of the time and cost required in these times.
What a beautiful description of life as a woman physician. I followed the calling in the 1970’s and loved my life as a physician, trying to balance family/patients, home/office. The joy of retirement with completed to-do lists, enough sleep and no-more-EMR, is tempered by the loss of my relationships with patients, colleagues and the satisfaction of a well-reasoned accurate diagnosis.
I am a third Generation woman physician. My Grandmother was an ob/gyn , my mother an ophthalmologist and ophthalmic plastic surgeon and I am a Family Physician in private practice . The lineage stops here. My daughters have seen the how hard I work, the hours that I am not at home or with them at multiple school functions.It has impacted all of us negatively. Family first, it’s increasingly just not worth it.
Women are underappreciated, underpaid and underestimated in all fields, although hopefully less so than in the past. Our daughters (and sons) must do whatever they are most interested in and do best…that someone else will pay them to do.
Beautifully written. Thank you.
I was an academic hospitalist so the job was daunting and I worked very long hours.
Having said that I really loved the detective work or sorting out the patients’ illnesses and treatments. I really enjoyed working with veterans who I found to be kind and appreciative, and I enjoyed spending time with them at the bedside listening to their stories.
I had also always assumed that I would have children, but that wasn’t in the cards for me. I was already so busy and I easily accepted that I, for one, could not do both.
Having said that there were a number of young women around me who were successfully doing both. Some of the women job-shared until their kids were in school. Another had a stay at home husband. I am retired now for 7 years with no regrets. Best wishes to all of you as you find your path.
Wonderful. My daughter is a first year in med school right now.Your piece eloquently distills the trials and tribulations each day and yet the transcendence of that calling, the vocation. I will definitely share this with her. Thank you!
Thank you for articulating so beautifully some of the challenges women physicians face.
I practiced Hematology / Oncology and Hospice care and inspite of the challenges of being in Solo practice for many years , knew that this was my calling.
I feel that the practice of medicine should be a vocation if one is to practice and derive the satisfaction of knowing this is what you were meant to do.
A friend reminded me once “ you are so fortunate , you get to help people every single day “ and I realized this was true.
As Oncologists we don’t get to cure people too often , but to hold their hands , support their families and love them through the challenges they face everyday is an amazing way to spend ones life
Yes , one has to sacrifice being a perfect wife and mother , and the family too does suffer. One is quite often conflicted about spending time on the phone , answering a family members questions and comforting them as opposed to going home in time for dinner.
I was fortunate as a first generation immigrant my children were a little older when I got into the full swing of private practice.
Our 2 sons did not want to pursue medicine after living with 2 Doctor parents !
One of my friends ( a physician( )daughters told her she would not do medicine as she wanted time for her family , and chose a career in finance ! The demands of that field though, she found were even greater with less than half the
Satisfaction one receives in being a healer and impacting people’s lives.
My one regret though was that I did not have enough time to visit my parents in another continent as they got older . As it was impossible to be away for long . I did decide to retire at 68 yrs so I could spend more time with my family both in the US and different parts of the world and am so enjoying this time to travel andxsee beautiful places as well
Yes I do miss my patients. I do an occasional locum at my old office and love it, but do not miss the stresses of the business part of medicine and running a practice. I was blessed to be able to sell my practice to my partner who is an excellent physician who cares about his patients.
Hardly a day goes by that I do not get unofficial “ consultations “ from family and friends far and near to help them navigate an illness. It keeps me on my toes and up with the latest research.
Feel very thankful and would not have changed my life , ( Though I did stop working for 6 yrs when my children were little ) .
I am the daughter if physician parents who tried to deterr me from becoming a physician when I was in highschool.
I had wanted to become a physician since I was 10 and would not let anything interfere with my dream. The best decision I evwr made, the best hib I could have chosen; it is not for everybody but in spite of all difficulties it is the most beautiful noble rewarding job for me and I love going to work after almost 30 years.
Well written, and BRAVO!