Perspective
A Conversation about Change
By Caitlin Conboy
A first-year medical student talks with her mother, a family physician with 30 years’ experience, about women and family in medicine.
At age 26, after eight years of living on the East Coast and abroad, I moved back to my hometown, Minneapolis, to start medical school. Coming home and embarking on a new venture has given me the chance to be mentored and inspired by some familiar sources. On a recent Sunday evening, over mugs of tea in our kitchen, my mother, family physician Pat Fontaine Conboy, and I chatted about balancing a career in medicine with raising a family and how that challenge has evolved from her time to mine.
Caitlin Conboy: Mom, when you were thinking about going to medical school in the 1970s, were you concerned about being able to have both a career and a family?
Pat Fontaine Conboy: It actually was a key issue for me. At that time, fewer than 20 percent of medical students were women. We were only a decade beyond the time when medical school admission committees had set an informal quota of having 15 percent women per class. I had few role models and no mentors. Short on guidance, I remember doing something a little out of the ordinary: I cast the I Ching, asking, “Will I be able to become a doctor and still have a family of my own?” The ancient Chinese oracle, in its wisdom, told me it would be “like riding the back of a tiger.”
CC: I imagine it seemed daunting—that some people discouraged you from pursuing medicine. I remember a story you told me about being asked during a medical school interview, “Why should we let you into our medical school when we know that women physicians are just going to work part time?”
PFC: Yes. I told him society wasn’t going to get much use from my talents if I stayed home and did my husband’s laundry.
CC: Really?
PFC: Well, perhaps I said it more diplomatically.
CC: It’s interesting, actually, to recall that story. When I was interviewing at medical schools last year, the most jarring question I was asked came from a male ER physician in his mid 40s, who said to me, “When I interview the children of physicians, I always ask, When you were growing up, did you resent your mother?”
PFC: I wonder what he meant by that?
CC: Well, the implication was that a physician might work excessively at the expense of her children. I’ll give him the benefit of the doubt and assume he wasn’t trying to be offensive. I think he was trying to ask a better question, to see if I would be reflective about the potential costs or compromises involved in the life of a physician. Thinking about it now, I see that question as the next-generation equivalent of the question you were asked 30 years ago. The context of medical education has changed dramatically: It’s not assumed that I’ll work part time now, impressive female mentors exist in medicine and science, and my medical school class is fully half women. But it’s still assumed to be almost overwhelmingly difficult to balance a demanding career with raising children. And it’s true. It’s something I think about as I’m beginning my career. I know what I want to do, but I wonder how I’ll navigate.
PFC: A flexible and supportive spouse or partner is probably the biggest asset. Beyond that, it takes focus, time management, and outside help. Some young physicians are fortunate to have their families nearby to help with child care, and some do choose to work part time. I chose to work full time, and we had the help of wonderful people. Your first “daycare mom” worked as an R.N. before she had seven children of her own. She lived three blocks from the clinic where I worked, so I was able to come at lunchtime and nurse you. She even fixed me a sandwich and iced tea! Later, with two kids, we had nannies. Some were like grandmas who kept the house clean and fed us Brussels sprouts; others were younger women who took you to wave pools in the summer and made pizza. We’re fortunate in medicine that we have the resources to hire help when needed.
CC: Did you ever feel like you were missing out on any of the family stuff while we were in daycare? Or that you were too drained by the end of the day to be present with us?
PFC: Everyone has examples where they missed out on something. But overall, love for your children and the intense motivation to make a good life for them gives you the almost superhuman energy needed to tackle two full-time jobs at once—doctor and mother. I used to come to your preschool to teach songs on my afternoon off.
CC: I remember that. You also came to my Girl Scout troop and taught us how to do first aid. I thought that was so cool. You brought a bunch of gauze and bandages, and I was proud of the fact that you were there and could teach us neat tricks. Of course, I also have memories of you being worn out and taking naps after being on call, so no one’s superhuman. Looking back, do you think you got it right? Did you find the right balance, or do you have any regrets about compromising too much in either sphere?
PFC: No regrets. There is always a pull between work and family life, yet they complement one another in fulfilling ways. I had been in private family medicine practice for only a year when you were born, and the expectation was that I would return to work after a four-week maternity leave. I’d be seeing patients at clinic, and if the history turned into a long litany, I’d mentally check out for a moment and think of my sweet baby at home. I’m sure the patients thought I was a wonderful listener with that blissful smile on my face.
Seriously, though, it would be better if society did more to help ease the transition back to work after childbirth. I fully expected that by the time the next generation of female physicians entered the workforce, there would be greater acceptance of options like job sharing and part-time work, and that maternity leaves would be better integrated into practices. From the standpoint of a small practice or a residency program, it can be quite a hardship for the remaining partners to cover responsibilities for the woman on leave, and that’s a problem we’re still trying to solve.
We were ahead of the curve, I think, at the Smiley’s Family Medicine Residency when we created a parental elective during the early 1990s. It was designed as a two- to six-week block of time to supplement the standard six-week maternity leave after the birth or adoption of a child. The resident who took the elective did a minimum number of shifts in the clinic and was also required to do a research or quality-improvement project related to parenting or a perinatal medicine topic. The goal was to allow residents to start a family without unduly interrupting their training. The experience was open to both men and women, although the guys took some heat from their peers if they elected it.
CC: I like to think there’s hope for making those changes and humanizing the institution of medicine. Of course, I’m a first-year medical student. We’re nothing if not naively idealistic.
PFC: On the very broadest scale, this is about making the practice of medicine more healthy. In order to be healers, doctors need to find meaning and balance in their own lives. With the women in my generation now in leadership positions and the influx of women from your generation into the field, we have an opportunity and an obligation to work toward that. MM