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
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."