This is the first of a series of articles on balancing parenthood with a rheumatology career.
Giving birth to triplets is daunting for any parent—even more so when you have to balance parenthood with a medical career that includes teaching and research responsibilities. This was the situation for Sujata Sarkar, MD, a clinical lecturer and research fellow at the University of Michigan (UM) in Ann Arbor, who was unable to work for nine months when she gave birth to her triplets three years ago. She says that her colleagues and coworkers were extremely supportive during this time. They pitched in and took over her on-call responsibilities, and her clinic patients were temporarily reassigned to other clinicians.
Because of this support and understanding, she cites only one major challenge upon returning to work: “I returned to work full time when my triplets were only three months old. The biggest challenge at that time was staying awake!”
With a growing number of women choosing rheumatology as their specialty and younger physicians seeking balanced professional and personal lives, the field will have to be nimble to meet the needs of today’s young physicians. The medical profession faces a unique set of challenges in this endeavor. It is not usually feasible to close up shop for several months to give birth—or even to take the day off because a child is ill or to attend his or her school play. Some specialties are more amenable to flexibility in scheduling than others, and with the proper planning and support, rheumatology can provide the adaptability necessary to enjoy a fulfilling career and a rewarding family life.
Proactive Policies
Some rheumatology departments are ahead of the curve and already have policies that help physicians succeed both at work and at home. All of the universities discussed herein—UM, Yale, and Temple—have policies allowing their faculty to exclude up to one year from the countable years of service that constitute the tenure probationary period for childbearing or dependent care.
The staff and faculty at the UM Medical School Division of Rheumatology are very familiar with accommodating the needs of expectant and new parents. According to Janet Stevens, administrator for Fellowship Program and Faculty Affair Issues, since 2002, the university has had 10 fellows and faculty members take time off when they became new parents (seven maternity leaves, two paternity leaves, and one leave for adoption)—with two more maternity leaves already expected this year. The division has made it a priority to provide as much support to its team members as possible.
Carol Cottrell, division administrator at UM, says the university is constantly reviewing and updating its policies as necessary to make them as family-friendly as possible. There is a standard practice guideline currently in effect that allows new parents modified duties. This flexible policy allows the faculty member to work with the relevant dean to modify their duties.
Audrey Uknis, MD, is associate dean of the office of admissions at Temple University in Philadelphia. Temple’s residency policy regarding how coverage is handled in the absence of a member of the house staff was updated based on Dr. Uknis’ experience when, as a second-year resident, she was unexpectedly confined to bed with preterm labor 20 weeks into her pregnancy. Now, residents are fully aware that they may be expected to fill in for someone for a short or extended period of time. The university has “reserve residents” who may be pulled from their electives to provide this coverage as needed.
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Rheumatology: A Family-Friendly Choice
Rheumatology lends itself quite nicely to a healthy work–life balance, says Lisa Suter, MD, instructor of medicine at Yale School of Medicine. She cites three primary reasons:
- A large proportion of rheumatology physicians are women;
- Many rheumatic diseases are more common in women; and
- The vast majority of clinical work is not emergent and allows for greater scheduling flexibility.
Dr. Suter feels these things contribute to a parallel understanding among colleagues and patients alike, creating a very supportive environment.
“Rheumatology offers a career opportunity that is fulfilling and extremely interesting but allows everyone—not just women—to have a life,” says Audrey Uknis, MD, associate dean of admissions at Temple University School of Medicine. “This makes rheumatology an increasingly popular option for a lot of people.”
Make Policies Work
Without the support of the entire team—from clerical staff to clinical staff to faculty to administrators—policies are just words on paper. Communication is extremely important. All personnel should know the policies and what benefits are available to them, as well as what may be expected of them regarding coverage for other team members. Also, any individual who expects to take advantage of such benefits must communicate that impending need appropriately and promptly. If handled properly by all those involved, a short-term inconvenience can have the long-term effect of fostering an atmosphere of caring and support among team members.
Seetha Monrad, MD, clinical lecturer at UM, found the division very accommodating. She received assistance with all of her necessary paperwork and rescheduled her clinics “with very little fuss.” This understanding and support were especially helpful when she felt overwhelmed with her son’s health issues.
Individuals need to take a certain amount of responsibility for making the balance between career and family work for them.
—Primal Kaur, MD
Wendy Marder, MD, clinical instructor in internal medicine/rheumatology at UM, has also utilized some of the university’s programs and policies. Dr. Marder also received assistance filing paperwork and ensuring that her funding source was appropriately managed during her absence when she gave birth to her first child. She especially appreciates the periodic e-mails sent about university childcare opportunities, including reminders to register for emergency childcare services provided by the university (which requires an annual renewal). (See “Support Services for Busy Parents,” below, for more examples.) She decided to reduce her effort to an 85% appointment and feels that she has been supported completely in this decision. “Our division has a very supportive atmosphere from the support staff through the division chief,” she says.
That division chief is David Fox, MD, and his colleagues are not at all surprised at his vision and support in the area of work–life balance. “David Fox is a very progressive, liberal-thinking individual,” says Dr. Uknis. “It takes a forward-thinking person who understands the realities of today and takes time to actually implement some important policies.”
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Big Ideas for Small Practices
The policies and programs at large institutions can be adapted to fit even small-town rheumatology practices. Here are some tips to bringing balance to your practice.
- Make work–life balance a priority: There are many creative ways to make this work. A good starting point is your local hospital. Upon investigation, you may discover that many support programs already exist in your area. If they don’t, you will likely discover that other physicians in your area have a mutual interest in creating such programs. Working together, you can duplicate some of the support systems available at much larger practices and institutions.
- Share the load: Consider job-sharing for clerical and nursing staff. For example, hire two part-time people to fill one full-time position. It may be feasible to cross-train staff between offices of different specialties to providing emergency coverage when necessary. With an open mind and some pre-planning and creativity, you can find mutually beneficial staffing solutions.
- Be flexible: Arranging for physician coverage, especially long-term, can be more challenging than staff coverage. It may involve covering a little more geographic distance or a more flexible patient schedule. The keys: Be prepared, communicate, and plan for absences—both expected and unexpected—before they occur.
- Reap the rewards: Time and effort invested in ensuring a work environment that respects and supports the family will be rewarded with a less stressed and more productive staff. Staff members are then free to spend their time at work focused on their work—and on the common goal of quality patient care.
Dr. Suter feels these things contribute to a parallel understanding among colleagues and patients alike, creating a very supportive environment.
“Rheumatology offers a career opportunity that is fulfilling and extremely interesting but allows everyone—not just women—to have a life,” says Audrey Uknis, MD, associate dean of admissions at Temple University School of Medicine. “This makes rheumatology an increasingly popular option for a lot of people.”
Personal Responsibility
Primal Kaur, MD, assistant professor of medicine at Temple, says individuals need to take responsibility for making the balance between career and family work for them. “You have to show a certain efficiency when you’re married and have children,” she advises. “I make a list in my mind of what I have to do for today and make sure I’m on time for finishing it. I do what I’m expected to do and pursue my career interests and make sure I finish everything in time to go home and be with my family.”
Dr. Kaur chose rheumatology because of the freedom it allows her to meet those goals. Early on in her medical education she felt that her husband, a non-physician, was “left behind” in her life, and that they didn’t really have time for each other. “I wanted to do something where I could balance my lifestyle with his lifestyle, and that’s when rheumatology came into the picture,” she says. “I felt it would give me the time I need to spend with my family.”
Sheri Polley is a freelance writer based in Pennsylvania.
Support Services for Busy Parents
As any parent can attest, the actual birth or adoption of a child is only the beginning. Parenthood opens up a whole new world of concerns and issues that must be incorporated into minds and schedules. Many organizations provide resources and contacts to assist parents in dealing with some of the common parenting issues.
UM’s Web of Resources
UM developed a Work/Life Resource Center Web site to support a healthy work–life balance for its faculty and employees. The site offers confidential assistance and support with:
- Locating child care;
- Locating elder/dependent care;
- Locating emergency, back-up child care;
- Balancing work and personal responsibilities;
- Creating flexible work schedules;
- Using the Expectant Parents’ Resource Program; and
- Planning maternity leaves.
Yale’s WorkLife Program
Yale School of Medicine in New Haven, Conn., has the WorkLife Program, which originates from the Office for Women in Medicine, directed by Merle Waxman. According to Waxman, this program addresses issues such as:
- Day care (offered on-site);
- Leaves of absence;
- Stopping or slowing of the promotion cycle;
- Emergency back-up childcare; and
- Lactation rooms on campus for nursing mothers.
The program also offers a variety of classes, including:
- Kindergarten readiness;
- Shopping for daycare;
- Interviewing nannies; and
- Being part of the “sandwich generation,” which must deal with young children and aging parents at the same time.
Waxman has no doubts regarding the long-term effects of such support services. “Women make wonderful physicians, but they may need a little more support at certain times in their career development,” she says. “A little support early on reaps wonderful results later on.”
