Saturday Morning Rounds July 25, 2020 - How medicine became the stealth family-friendly profession, and how to make it moreso by negotiating better parental leave; also, #MedBikini

Posted by BossB, MD on July 25, 2020
BossB, MD

Saturday Morning Rounds

A weekly round-up of career & negotiation content for women physicians

What got our attention

How Medicine Became the Stealth Family-Friendly Profession by Claire Cain Miller in the NYT Upshot.

This article captures the current-state of work-life integration for women physicians better than any other we've read - and we've read a lot.

The title, we'll admit, is deceptively cheery when compared with the reality that many women physicians face today. However, the author does a good job of balancing her celebration of the wins that have been tallied to-date with her coverage of the structural imbalances that still need to be addressed.

Overall, it's a pretty short read that's densely packed with good information - we highly recommend you scan it fully for yourself. Some of the main themes touched upon are:

  • The importance of flexible, predictable hours for shrinking gender pay gaps (this applies to all professions, not just medicine)
  • The transition from small private practice to large group practice or hospital employment as the driving force for this change, a "happy consequence" of which being more flexible arrangements for women physicians
    • There are a lot of downsides to this as well, which are not addressed in this article and which make many of the more lucrative work arrangements in medicine more punishing toward women than they are toward men even if their family planning decisions are the same. The biggest example of this is in how a lack of equitable parental leave policies financially punishes women physicians and hurts families by forcing male physicians to go back to work sooner than would usually be optimal after the birth of a child - we will cover this more thoroughly in our "Tip of the week"
  • Women & work hours
    • "Female doctors are paid 67 percent of what men are, but much of the gap is because they work less. After considering their hours, their specialty and the years they’ve been doctors, the gap shrinks to 82 percent"
    • "There’s a downside when women cluster in certain specialties: In general, when a field becomes female-dominated, its pay and prestige drops"
    • "One possibility — which could help alleviate this problem — is that more men will also choose less time-intensive specialties and ask for predictable hours. There’s evidence that’s happening. This year, 80 percent of male medical school graduates said work-life balance had a strong or moderate influence on their choice of specialty (up from 70 percent a decade ago, when the question was first asked)"

Who we're following 

Less of a who, and more of a what, this week - and that what is the trending #MedBikini controversy

Long story short, the Journal of Vascular Surgery published a "study" in which 3 male researchers created fake social media accounts, searched the Vascular Society's database to find member physicians on social media, and then shamed physicians they deemed to be "unprofessional" for wearing a bikini or holding a beer in their personal social media profiles.

Same bullshit, different day.

Med Twitter recently discovered the article, and the outpouring of rage + swimwear photos that has become #MedBikini has successfully gotten the journal to retract the article and publish a formal apology. Good on y'all for showing that being a doctor and being a human aren't mutually exclusive.

That being said, we have a responsibility as your de facto career consultants to point out that a lot of organizations do informal social media reviews like this without publishing them, and while we look forward to the day when such social media posts don't disproportionately punish women, that day has not yet come. We're not gonna preach to you about what's professional or unprofessional or make any specific recommendations, but we will encourage you to (a) intentionally draw that line for yourself and (b) generally err on the side of caution.

BBMD tip of the week

Parental leave, the gender gap, race and intersectionality, politics - all of these topics share a common theme: they're very charged.

What do we mean when we say a topic is charged?

  • Opinions about charged topics are often strong and entrenched
  • Emotions about charged topics often run high
  • Discourse on charged topics tends to quickly escalate or quickly shut down

But more importantly, what do we DO when a topic is charged?

The first question we should ask ourselves is whether it's worth the fight in the first place. If you (a) can't change the outcome and (b) aren't likely to change an opinion, yelling into an echo chamber or at an unreceptive counterpart is only likely to make things worse.

However, there are many topics - parental leave being one of the most important among them - that we can't afford to ignore.

So how do we wade into this dangerous territory in a way that's productive? The key is to:

  • Avoid defensiveness at all costs - in both yourself and your counterpart
  • Humanize, humanize, humanize - again, both yourself and your counterpart

Defensiveness is the single most counterproductive emotion in any exchange, and becoming sensitive to it in both yourself and others is a communication superpower.

Humanizing your counterpart and yourself is like putting guardrails on the conversation that keep it on the road and headed in a productive direction. It increases empathy and puts everyone's focus on solving the problem at hand rather than "winning" a fight against an opponent.

What can you tactically do to avoid defensiveness and increase humanization (I think we made that word up)? Ask yourself a simple question:

  • "How could a well-intended and intelligent person come to that conclusion?"

We talk a lot in our curriculum about how important it is to assume best intent - it provides the clearest path forward and maximizes the emotional resonance of your interactions.

In this case we also add the assumption of intelligence because it helps us to more effectively see things from our counterpart's perspective and to understand their priorities. Doing so greatly increases our chances of actually changing their position.

In the specific area of parental leave and career perceptions, one great way to do this would be to actually have an open conversation with the decision-maker(s) at your institution about the topic. Transparent conversations about charged topics can be incredibly effective if you follow this outline:

  • Start on the Right Foot - It's key to start the conversation with something like "I know that you are dedicated to creating an equitable workplace and that the studies I'm about to show you don't reflect the kind of institution you want to run." We call this tactic "preemptively saving face" for your counterpart - it avoids defensiveness and gives them an occasion to rise to; a positive vision of themselves to live up to.
  • Express Your Concern - Proceed to lay out your argument in clear terms, preferably with data to back it up. Share the article above, print out a study about the gender gap, tell an anecdote about what happened to a friend. Then make it personal by again reiterating that "I know this institution would never intentionally do something like that, but I'm still concerned about becoming one of those statistics."
  • Create Space for Them - After you drop a line like the one above, STOP TALKING. Let them squirm in silence for a few seconds. You'll be amazed at the kinds of commitments people will make to avoid a little interpersonal discomfort. And even if they don't commit to fixing the problem in that moment, you'll gain an informational advantage over your counterpart if you outline the problem in clear terms but then let them start to talk about solutions. There's usually very little to lose and a lot to gain by "not going first" in a negotiation.

The above method might not solve the gender gap overnight, but we've seen it change entire institutions' policies more quickly than any legislative action ever dreamed.

As an example, one of our clients works for a very large, well-known academic institution on the east coast. With our help, she negotiated an increase from 6wks of unpaid to 12wks of paid maternity leave. A year later she called to let us know that the mere existence of her contract had catalyzed an institution-wide policy change to match everyone's parental leave offer to hers - not just on the medical side of things but throughout the whole university!

Change comes most often from inside an organization itself, and you can be the most powerful force to make it happen for both yourself and others.

Quote we're contemplating
 "When you learn to see the world as it is, and not as you want it to be, everything changes." - Shane Parrish


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PPS - As always, please let us know your requests and suggestions by replying to this email (we read 'em all) or getting at us via Twitter. Which section above is your favorite? What do you want more or less of? Just send a tweet to @BossB_MD and put #SaturdayMorningRounds in there so we can find it.

Have a wonderful weekend, y'all!