Published in The New Physician, March 2005

Even Sethina Edwards was amazed when she attended the “Welcome to Medical School” gathering at the University of Bristol in England last fall. One would not expect Edwards, a mother of two and a former freelance publicist, to be surprised by the fact that a whopping 75 percent of her classmates were women. After all, for the past six years, aspiring women physicians around the world have been turning to her for support.

In 1999, when Edwards decided to seek a career in medicine, she was pregnant with her first daughter. Training to be a physician is difficult enough without the complications of motherhood. “People thought I’d gone mad,” Edwards says. “Lots of people told me it was impossible.”

And since little information existed on how to succeed at such a challenge, Edwards launched her own support network—MomMD.com —with the help of her husband and ran the site as she pursued medical school. MomMD features articles, forums, mentoring and other advice on what is a burgeoning demographic pocket. Around 70,000 people visit the Web site monthly, and Edwards draws from each of them as she tackles her long-awaited dream of physicianhood.

“I learned that there were a lot more women like me than people realize, and that being both a parent and a medical student is doable. The other thing I learned is that many of the issues I’m facing are issues that people who are not parents will face in a few years when they become parents,” she says.

In the United States, it’s no secret that the numbers of women in medical training and practice have been rising steadily since 1983—just more than half of applicants to U.S. medical schools were women in 2004, according to the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM). The AAMC reports that 45.9 percent of 2004 M.D. grads were women, and the AACOM estimates that 42.3 percent of its 2004 graduating class were women. Women also compose more than 25 percent of physicians practicing in the United States, according to American Medical Association figures.

And like the 20 percent of more than 6,000 MomMD members who don’t yet have children, many medical students and practicing physicians will become moms one day, if they aren’t already. So medicine has an important issue to address: How will it care for its mothering physicians?

A MomMD member survey last year found that almost 75 percent of respondents were “very concerned” about balancing their medical careers and families. But the same research also showed that an overwhelming number of women in medicine were not restricting the number of children they planned to have because of their demanding profession.

“I have struggles with the fact that going to medical school is such a big commitment and then having a child is a big commitment,” says Meredith Hancock, a 28-year-old aspiring medical student in California who’s taking premed courses at community colleges. “All of the things I’ve heard about it have scared me away a little. But I keep on thinking, what is the alternative? If I don’t go through with it, and I’m not a happy person, then my children won’t be getting the best out of me, anyway.”

MOM MED STUDENT

Imagine you’re Rivka Stein, beginning your medical school experience as you’re beginning your first pregnancy. And you’re in anatomy lab.

“I was nauseated, and I had to keep running out of lab because I was feeling sick,” says Stein, now a Brooklyn pediatrician who splits her time between her private practice and work as a hospitalist. “I certainly didn’t score as well on my tests as I would have liked to, and I wasn’t able to study as well as I wanted to. But I put in as many hours as I could.”

Morning sickness was just one hurdle. Stein, who attended the University of Maryland School of Medicine, ran into complications during her ninth month and had to take a week off before her son was born, causing her to miss a neurology section final. Then she missed a cardiology exam during the three weeks she was off after delivery.

Fortunately, Maryland allowed Stein to take the neurology test late and skip the cardiology exam, counting the cardiology section that appeared on her final twice to make up for it—two examples of how the school did its best to be accommodating to mothers.

Dr. Erin Harris’ challenges were even greater: She was pregnant throughout her grueling third-year clinical rotations. But her school, East Tennessee State University (ETSU) James H. Quillen College of Medicine, was just as supportive, allowing her to reframe her schedule.

“I was surprised everything went so smoothly,” says Harris, now a second-year family practice resident at ETSU. “They were very supportive about letting me pick out my schedule so that it would be physically easy for me during those clinical rotations. I didn’t expect them to be so supportive, because we did have older male administrators who didn’t have the same perspective.”

Although schools’ policies and procedures vary, many women report that administrators are far more accepting of their pregnancies and child-care issues than they might have guessed. Still, moms would like more leave time and to have on-site child care available.

The real resistance, it seems, is more likely to come from resentful classmates and colleagues.

“People would make little jokes during my pregnancy,” Harris says. “One person told me, ‘All you girls do is go and get pregnant and then expect special treatment.’ And some of my male colleagues got very angry because of my maternity leave. There’s just not an understanding of what it’s like to be a mother.”

Medical schools still need improvement, of course, but like new mothers, they, too, are learning as they go. One of the rough patches Stein and Harris navigated after giving birth was finding time and places to breastfeed between school responsibilities. With her second child born during her fourth year, Stein pumped in a bathroom until she discovered a pumping room in the hospital’s neonatal intensive care unit, noting that she would sometimes have to bow out of a surgery rotation to do so. The school has since established a breastfeeding room for its nursing medical students.

Scheduling the busy lives of mothers, fathers and their children can be difficult. Experienced mothers say that carefully structured timetables for child care and quality time with the kids are the keys to making it work.

“Find a way to get extra help,” says Dr. Julie Wonderling, an emergency medicine intern at Drexel University College of Medicine and a mother of two, “whether it’s help cleaning the house or setting up child care. Do it in as far advance as possible, with a plan B if that doesn’t work, and a plan C and D if B doesn’t work. Planning ahead for every possible contingency makes it so much easier when those things happen—and they will.”

LETTING GO OF PERFECTION

But no matter how prepared mothers are, they may still feel inadequate, and that’s normal. “Pretty much no mother thinks she is handling her situation correctly,” MomMD’s Edwards says, “because you set such high standards for yourself that you probably never live up to them.”

That’s true, says Wonderling, whose heart breaks each time she calls home from work to say good night to her kids. “It’s always, ‘Am I going to see you today, Mommy? I miss you.’ Guilt is a constant companion. If you’re spending time with kids, you feel like you should be doing more reading to keep up with things for the residency. And the hours you spend at work, you feel like you should be spending with the kids.”

“The emotional aspects, by far, are the hardest part,” Harris agrees. “With organization and diligence, getting down the time management isn’t a problem. It’s the emotional management that wears on you, the long, bad call nights, feeling guilty because she’s in day care, and you’re not there with her more and yet still trying to give the best patient care. It was hard. In my eyes, I did not do well for that first month or two.”

Academically, Harris’ mindset also changed. Her accelerated program called for her to begin her fourth year of medical school and her internship the same term she returned to training after having her daughter. Always a perfectionist, Harris still managed to finish medical school first in her class, but in that last year, “it was a total shift in priorities. I had always been focused on good grades, but you find yourself torn. You want to be the best at everything—academically, medically—but you know you have other priorities at home that need your attention more.”

Mothers in medical school sing the same refrain: If you’re going to have a baby, you have to lose the Type A academic determination. “As long as you pass,” Stein says. “You can be a wonderful doctor and not do as well on your exams. Clinical is what counts. I never minded getting those C’s on exams if I knew it was because I was up late taking care of my sick son. You have to prioritize.”

PARTNERS IN CRIME

Judith McElhiney, a 38-year-old mother of an 11-year-old son and a 15-year-old daughter, is no stranger to stress. A combat veteran of the first Gulf War, McElhiney had her first child when she was in the army. Her husband, also in the military, lost his right arm—and nearly his life—fighting in Afghanistan in 2001. But she says the stress levels of being a first-year medical student at the Mayo Clinic College of Medicine are entirely new to her.

Luckily, McElhiney’s husband is making life easier. “He does all the housework. He does all the grocery shopping, the cooking, takes care of the kids. It’s like I’m just living in a hotel.”

McElhiney, who is at home only for dinner Monday through Saturday because of Mayo’s full-time class load, says she couldn’t do it without his help and that of her son, who often reviews her reading assignments with her.

“You question putting your family through this sometimes, but then you realize how much it’s worth it,” she says. “My kids are proud of me. They brag about me a lot to their friends. And I think it’s a positive that after so many years of deployment, my husband can now be the caregiver for our children the way I was. He’s getting to know them better.”

Spouses and families, say physician– mothers, are essential elements to survival and success. Although Wonderling’s husband often jokes that he might not have been in favor of her training if he’d known how difficult it was going to be, he’s supported her throughout her studies. “I’ve found that my husband really is willing to do a lot of the things that I feel are my responsibility,” she says. “It’s just because I’m the mom that I always feel like it’s my responsibility to arrange doctor appointments for our kids or take them to dance. And my husband is perfectly capable. It’s really just a matter of me letting go of some of the control.”

Don’t underestimate what your spouse or your partner is capable of doing, mothers say. Stein’s husband took a job with more flexibility during her schooling so he could pick up their children each day from the babysitter. Harris’ spouse left a job with too many overtime hours for one that allowed him to be with his family more, alleviating some of her stress.

And even in situations like Edwards’—her husband was unable to find work in the same city as her school; they see each other only on weekends—there is great comfort in having children at home. “My two kids gave me an apple to take to my teacher,” she says, laughing. “And the three of us sit down to dinner each night and tell each other what we learned in school that day.”

In fact, most mothers in medical training feel their situations should be the envy of other medical students and residents. The very challenges that make their pursuit of medicine so difficult are also the greatest rewards of their lives. “Having children gives me perspective,” Stein says, “because I see them from a patient’s side. It helps knowing what it’s like to be a family member, to be a parent. When I first started my residency, I’d freak out at all the mothers who’d come into the ER for stupid things. Well, now I understand why a fever in the middle of the night is really scary.”

And if being a mother benefits your medical practice, being a physician certainly makes you a better parent, Wonderling says. “I’m setting an example for my daughters that they can do anything with their lives,” she says. “It keeps me a whole person. I have balance. Even when you have the worst day, you come home and you give your kids a kiss good night, and they snuggle up to you and say, ‘I love you, Mommy.’ And even though it was a bad day, things are still good with the world.”

Copyright 2005 American Medical Student Association