Specialty selection: Men, too, seek work-life balance

Despite perceptions, it's not just women in medicine who are concerned about controllable lifestyles.

By Myrle Croasdale — Posted Oct. 3, 2005

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

With two children younger than 4 and his wife about to have their third child, emergency physician John Oester, MD, readily admits that time with his family was a factor when choosing his field of medicine.

"Definitely being able to control my life more entered into my thought process," said Dr. Oester, who practices in Augusta, Ga.

That thought process is typical of Dr. Oester's generation. Choosing a medical discipline with controllable hours was once considered a career trend confined to women, who now make up nearly half of new, U.S.-trained physicians. But new research shows that the trend is a generation-wide shift in attitude toward work, not a gender issue.

"The people going into medicine now ... don't see themselves solely as physicians," said E. Ray Dorsey, MD, lead author of "The Influence of Controllable Lifestyle and Sex on the Specialty Choices of Graduating U.S. Medical Students, 1996-2003," one of two studies looking at the topic in Academic Medicine's September issue.

The data show that although there is a belief that women are searching for a work-life balance, men, too, are pursuing this avenue. Dr. Dorsey found that the percentage of women choosing specialties with controllable lifestyles was 36% in 2003, but 45% of men made the same choice that year.

And there's been an uptick in interest in those careers among both genders. Between 1996 and 2003, the number of women pursuing controllable lifestyle careers such as anesthesiology, emergency medicine, ophthalmology, psychiatry and radiology increased by 18 percentage points. The number of men picking fields such as those increased by 17 percentage points during the same time period.

Another study in the same issue of Academic Medicine, "The Relationship between Specialty Choice and Gender of U.S. Medical Students, 1990-2003," found that men and women had a declining interest in specialties in which they did not have a work-life balance, such as family medicine. In 1995, 18.9% of women and 15.2% of men graduating from U.S. medical schools chose family medicine residencies. But in 2003, only 10% of women and 6.1% of men wanted to pursue family medicine careers.

Not just medicine

Physicians are part of a larger, nationwide trend in which younger adults are basing career choices on family and other factors. It's an attitude very different from earlier generations, said Carolyn Martin, PhD, who has written on the topic.

"Unlike the older generation, when life and work were one and the same, young people are saying there's more to life than work -- there's a richness outside this thing called work," she said. "The older generation identified itself by job and career. Young people have a broader definition of who they are."

Dr. Dorsey, an instructor in neurology and a fellow in movement disorders at the University of Rochester in New York, said the change had roots in the movement of women into the labor force. "Fathers are expected and want to play a greater role in child rearing. They fully expect to have children and be engaged in their development," he said.

Dr. Oester counts himself among the generation of involved fathers. He's chosen to work about 20 to 25 hours a week. "Because my kids are so young, I've made a conscious decision to step back and earn less so I can spend more time at home," he said.

Reversing the trend

Emily Lambert, MD, lead author of the second Academic Medicine study and an intern in the Dept. of Internal Medicine at the University of Rochester in New York, said she hoped the medical profession would respond by finding ways to build interest in the disciplines with longer hours to prevent shortages and sustain access to care.

"The specialties that are losing medical student interest need to look seriously at what is causing all medical students to not want to pursue these specialties," Dr. Lambert said. "We can't assume that women are the ones responsible for these trends. We need to look at men and women."

Dr. Dorsey also sees chances for action. For example, he would like to see training programs embrace more flexible arrangements. "The structure of medicine, especially medical training, has been largely unchanged for 50 years," he said. "Training needs to more closely match the current work realities."

With the number of U.S. medical school graduates entering family medicine declining, the American Academy of Family Physicians is especially aware of the generational divide and already is taking action to reverse waning interest among U.S. medical students. The academy launched the Future of Family Medicine campaign, which includes finding new, more efficient ways to practice medicine. Penny Tenzer, MD, president of the Assn. of Family Medicine Resident Directors, speaking for the AAFP and the AFMRD, said the AAFP was identifying new models of practices that ultimately will improve family physicians' lives, as well as improve patient satisfaction and quality of care.

For example, at the University of Miami, where Dr. Tenzer is vice chair of the Dept. of Family Medicine and community health and the family medicine residency director, the family practice clinic switched to open-access scheduling, where patients can make same-day appointments. The clinic also emphasizes team care that comes to the patient. Instead of sending the patient from the exam room to the lab, the technician goes to the patient's exam room. To speed referrals, the clinic is considering bringing in a dermatologist during the week.

Combined, these efforts are expected to make the practice of family medicine more efficient and more profitable and ultimately give physicians more control over their hours, she said.

Another reason doctors steer away from more time-consuming medical fields is that the profession itself has changed. There's less money, prestige and professional autonomy, Dr. Dorsey said, so those looking for rewards are opting for lifestyle balance.

"You cannot have your profession consume your entire life," he said. "By no means is lifestyle the most important factor in someone's specialty choice. Over time, the vast majority of people pick their specialty independent of lifestyle, but lifestyle is more important these days."

Back to top


A more predictable day

A 1990 study defined 16 specialties as controllable -- a field that allows more personal free time for family or pursuits outside the office -- or uncontrollable, a field where there is little free time. Experts today still use the definitions when discussing work-life issues in medicine.

Controllable: anesthesiology, dermatology, diagnostic radiology, emergency medicine, neurology, ophthalmology, otolaryngology, pathology, psychiatry

Uncontrollable: family medicine, internal medicine, general surgery, obstetrics and gynecology, orthopedic surgery, pediatrics, urology

Source: "The Controllable Lifestyle Factor and Students' Attitudes about Specialty Selection," Academic Medicine, 1990

Back to top

Medical debt seldom affects career choice

Rising debt load often has been cited as one reason U.S. medical graduates stay away from lower-paying disciplines, such as primary care. But Roger Rosenblatt, MD, MPH, lead author of a study evaluating debt's influence on primary care career choices in the September Academic Medicine, found that this wasn't necessarily true.

Looking at 2002 data from the Assn. of American Medical Colleges Graduation Questionnaire, he found that it was only students with debt topping $150,000 who were more likely to avoid choosing primary care because of their debt load. In 2002, 18% of U.S. medical graduates fell into that category.

Instead, race and gender were far more influential in specialty choices, Dr. Rosenblatt reported.

For example, black students as a group were much more likely to say they were planning to practice in underserved inner-city areas and extremely unlikely to want to practice in rural areas. They were as likely as others to choose primary care, but they were less inclined as a group to pick general pediatrics. Black students also tended to carry the heaviest debt load, with students in this group averaging $102,909 in total debt, compared with an overall average debt of $86,870 with a standard deviation of $63,010.

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn