Volume 75 Number 3

Achieving Fulfillment in Family and Professional Life as an Anesthesiologist Mom

Facing demands from family, friends, and patients, and without enough hours in a day, having children as a full-time physician anesthesiologist seems impossible. Can we really “have it all”? Can we juggle our professional and personal lives without dropping a ball somewhere? In the words of American writer and activist Betty Friedan, we argue that we “can have it all, just not all at the same time.”

From medical school to residency to fellowship and perhaps additional degrees in between, we have trained ourselves to believe that achieving less than perfection is a failure. A failure at what? Being a top doctor? A model parent? For some, this fear of “failure” begets delaying parenthood in favor of professional goals; for others it means neglecting professional goals in favor of starting a family. It is not a coincidence that most of our personal friends who are married with children are non-physicians; our physician friends are single, engaged, or newly married. Though challenges to starting families exist for anesthesiologists of all genders, it is hard to deny the additional obstacles faced by women. One of our grandmothers used to joke to her friends, “Your grandchildren have kids while mine have degrees!”

Friends and relatives never fail to remind us that our biological clocks have been ticking while we have been passing time chasing professional accolades. Unfortunately, they’re not wrong: Women in medicine have children later in life and have higher infertility rates than the general population (Stentz 2016), which is disconcerting for residents and young attending physicians who are finally considering starting a family. If a doctor mom is fortunate enough to surmount the hurdle of fertility at advanced maternal age, she is then faced with occupational stressors: exposure to radiation and volatile anesthetics, back pain (made worse by double lead aprons), difficult-to-schedule obstetric appointments, and finding time and means to breastfeed or pump.

Despite the challenges associated with pregnancy and childbirth, the number of women anesthesiologists increased from 2006 to 2016. However, a smaller percentage of female anesthesiologists than male anesthesiologists are full professors (7.4% versus 17.3%), based on a recent analysis by Bissing and colleagues of data from the Association of American Medical Colleges. Furthermore, the percentage of anesthesiology department chairs who are women has remained at just over one-tenth of chairs from 2006 to 2016 (12.7% versus 14.0%, P = .75) (Bissing 2019). Similarly, D’Souza et al. recently reported that out of 87 chronic pain fellowship programs, 17 were led by females and 70 by males, though equal proportions had attained senior academic rank status (D’Souza 2022). Although child rearing is but one factor contributing to this discrepancy, it is hard to deny that parenthood at least plays a role. How many part-time anesthesiologist parents can you personally name? How many of those are women with kids? How many of them have departmental leadership roles?

Viewing these trends from the perspective of the field of sociology, a 2007 study explored the repercussions of cultural assumptions surrounding motherhood. Correll et al. suggest that motherhood is a “status characteristic,” where qualities and expectations are attached to individuals by virtue of a stereotypical identity, which results in predictable behavioral interactions. The authors hypothesized that mothers would be perceived as less competent in the workplace, which would have consequences for their careers. The study focused on the tension that exists between the status characteristic of motherhood, including the idea that a good mother limitlessly devotes time and energy to her children, and the perception of an “ideal worker,” who is fully committed to and present for long hours at work. On the other hand, the understanding of what it means to be a good father, they describe, is not at odds with what it means to be a good worker. A simulated job application experiment held workplace performance constant and compared fictitious equally qualified male and female candidates who differed only in parental status. As hypothesized, mothers were evaluated unfavorably compared to women without children in terms of their competence and commitment, resulting in inferior hiring, salary and promotion decisions. In contrast, males were not penalized for being fathers. Females with children were perceived as less competent than males with children, and males with children sometimes actually benefited professionally from being a parent (Correll 2007).

Though it is impossible to discern correlation and causation from something as multifaceted as the interaction between growing a family and growing a career, we can at least start by making a difference in our own lives and those of our colleagues. We can be attentive to the experiences that our colleagues are having and offer advice, support, or an open ear. We can recognize that sometimes the most rewarding aspects of life are the most challenging, and that we don’t need to have or do everything at once. Balance requires realizing that “having it all” is better viewed as a longitudinal goal, necessitating adjustments in priorities over time and an acceptance that achieving less than perfection is part of being human and is perfectly all right. The real question then becomes, can we be OK with not having everything at the same time?

Lauren Lisann-Goldman, M.D., is an assistant professor in the Department of Anesthesiology at NYU Langone Hospital. Elvera L. Baron, M.D., Ph.D., FASA, FASE, is an associate professor in the Department of Anesthesiology and Perioperative Medicine, the Department of Bioethics, and the Center for Medical Education at Case Western Reserve University School of Medicine in Cleveland as well as director of the Simulation Center at the Louis Stokes Cleveland VA Medical Center. Barbara S. Orlando, M.D., Ph.D., FASA, is chief of obstetric anesthesiology, associate professor in the Department of Anesthesiology, and adjunct associate professor in the Department of Obstetrics and Gynecology at McGovern Medical School at the University of Texas Health Science Center. Poonam Pai, B.H, M.D., M.S., is an assistant professor and fellowship program director for the regional anesthesia and acute pain medicine fellowship in the Department of Anesthesiology and Perioperative Pain Medicine at Mount Sinai West-Morningside Hospitals.