It takes a village

Paging Dr. Mom: DOs and students balance medicine and ‘mommyhood’

Dr. Moms manage their home and professional lives with excellent organizational skills, discipline and strong support systems.

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“If you wait for the perfect time to have kids, you’re never going to have kids,” Dr. Miranda Bailey observed on the hit ABC television show “Grey’s Anatomy.”

A student at the Michigan State University College of Osteopathic Medicine (MSUCOM) in East Lansing, Breanna L. Thiede, OMS III, is among the many women in the osteopathic medical profession who would likely agree with Seattle Grace Hospital’s fictional attending surgeon, as they strive to excel at both medicine and motherhood in the face of daunting challenges.

“There’s never an ideal time to have a baby—just make sure it’s right for you,” says Thiede, who gave birth last March to her daughter on a Wednesday and was back in the classroom taking a final examination the following Monday.

While a fourth-year student at the Edward Via Virginia College of Osteopathic Medicine in Blacksburg, Kristie Bailey, DO, was well into the third trimester of her pregnancy during her “audition” rotations, when she was trying to put her best foot forward for possible residency spots. “Being eight months pregnant, on your feet all day trying to impress, really is exhausting,” says Dr. Bailey, who would advise female osteopathic medical students to try to time childbirth before their residency interviews.

For family physician Kathie Horrace-Voigt, DO, the right time to have kids was before she started medical school. “I had many complications when pregnant with my second child, so I don’t know how I would have handled school, residency or a medical practice at that time,” says Dr. Horrace-Voigt, a graduate of the Lake Erie College of Osteopathic Medicine (LECOM) in Erie, Pa. But being the mother of two young children made the process of studying for the Medical College Admissions Test, applying to medical schools and traveling to interviews all the more difficult.

Given that approximately half of all osteopathic medical students and nearly a third of practicing DOs today are women, it’s no surprise that an increasing number of student DOs are feeling the pangs of morning sickness during lectures and that more and more practicing DOs are going on rounds by day and playing patty-cake by night. Though the difficulties to surmount can be numerous, many DOs and osteopathic medical students balance their family and professional aspirations with excellent organizational skills, discipline and strong support systems.

Taking leave

For osteopathic physicians and medical students, maternity leave often does not resemble that taken by women in other professions. “I was able to take two weeks off when I had my daughter,” says Brianna D. Jewell, OMS III, a student at the Des Moines (Iowa) University—College of Osteopathic Medicine (DMU-COM). “But I didn’t want to get behind, so I only took a week.”

Each osteopathic medical college handles maternity (and paternity) leave differently. Women who plan on becoming mothers during medical school would be wise to look at schools’ leave policies before applying or enrolling. For example, although LECOM does not offer maternity leave per se, a student may request a medical leave of absence for pregnancy or for the birth of a baby. New mothers may also switch to the school’s independent study pathway rather than taking a leave of absence. The Midwestern University/Arizona College of Osteopathic Medicine (MWU/AZCOM) in Glendale allows students in their first or second year to take time off for maternity leave and stretch their first two years into three. MWU/AZCOM students in their third or fourth years can take time off and make up their rotations, graduating later than usual.

As noted in the AOA’s “Postdoctoral Basic Documents,” interns and residents are considered employees of the hospitals for which they work. Per the Family and Medical Leave Act of 1993, employers with at least 50 employees must provide up to 12 weeks of leave per year to care for newborns and newly adopted children. Employers do not have to pay for this time off if employees exceed the time allotted for vacation and sick leave, typically 10 to 20 days, and maternity disability leave.

Hospitals typically give their employees six weeks of paid maternity leave or eight weeks if delivery was by cesarean section, but this varies by institution, says Diane N. Burkhart, PhD, the AOA’s director of education. “I have seen some creative scheduling that allows trainees to make up the time in the following year or two. But what new mother wants to give up her vacation for an entire year?” she observes. “It’s usually not possible to add time to trainees’ workweeks due to the 80-hour rule.” New mothers in graduate medical education programs who take off more than 20 days will likely need to extend their training.

Specialty choice

Pregnancy and childbirth or simply the expectation of starting a family can affect the specialty choices of women in osteopathic medicine. For example, becoming a mom while in med school can spur or reinforce interest in family medicine or pediatrics. And the desire for predictable practice hours can have a major impact on specialization.

The arrival of a daughter persuaded Dr. Bailey to reconsider her original plan to pursue an obstetrics and gynecology residency because the demands of delivering babies at all hours would take her away from her own family too often. “I didn’t think I’d miss my daughter so much,” she admits. Instead, Dr. Bailey decided to apply for family medicine residencies after taking a year off.

According to the AOA, the most popular specialties among its female members are family medicine (39%), internal medicine (12%), emergency medicine (9%), obstetrics and gynecology (7%) and pediatrics (5%). Alyssa C. Rammer, OMS III, a single mom who studies at DMU-COM, is not surprised by these statistics. She acknowledges that family medicine would probably be more conducive to family life. Even so, she is still leaning toward other specialties.

“I’m interested in surgery and obstetrics and gynecology,” Rammer says. “I want to love my job and don’t want to end up unhappy because I chose a specialty that I wasn’t passionate about.”

Chicago obstetrician and gynecologist Teresa A. Hubka, DO, echoes that sentiment. “You’ve got to do what you love, or you won’t be doing it for long,” says Dr. Hubka, a mother of two. “I love taking care of women. I love growing families. I knew even as a student that obstetrics and gynecology would be the right field for me.”

Flexible arrangements

Beyond specialty selection, motherhood affects the practice arrangements female DOs are pursuing.

After the birth of her daughter, Amy S. Weiler, DO, read an article in Family Practice Management magazine about female physicians who had started their own practices, and she decided to do the same. “I’ve selected office space close to home and to the hospital with which I’m affiliated,” says Dr. Weiler, who opened her practice in October 2010. “I’m excited that I can spend more time with each patient and practice medicine with a more integrative approach. This includes attracting practitioners from other modalities to work with me in my practice. Most important, I can set my own hours so I can spend evenings and weekends with my daughter.”

Sarah H. Parrott, DO, who has two children, calls her work setup “the most parent-friendly position on the planet.” She made the decision to enter academia after spending time as a hospitalist. An assistant professor of family medicine at the Kansas City (Mo.) University of Medicine and Biosciences College of Osteopathic Medicine and a staff physician with a group practice associated with the school, Dr. Parrott is able to teach and care for patients and still be home by 6 p.m. to eat dinner with her family. “This job allows me to be the best physician I can be without sacrificing the other things I like to do,” she says.

Pediatrician Jennifer E. Supol, DO, has enjoyed a part-time practice arrangement since giving birth to her first child six years ago. Then a hospitalist in a neonatal intensive care unit, Dr. Supol practiced from 5 p.m. to 7 a.m. twice a week, catching up on sleep during the day when Grace was napping.

Three children later, Dr. Supol is still enjoying a part-time schedule. She practices three days a week in Southfield, Mich., for a small group pediatric practice in which four out of the five female physicians practice part time. “I feel bad for my boss, who has the hassle of putting the schedule together, but it is a very supportive environment for working moms,” Dr. Supol says.

A mother of five, Kyla D. Carney, DO, works four days a week as an assistant professor of family medicine for DMU-COM and as a family physician at the DMU clinic. To save time, she and her husband will eat their favorite breakfast of peanut butter toast as they drive to work together, discussing the family’s agenda and their kids’ activities for the week.

“For my husband and me, parenthood is very much a partnership, and we lean on each other,” Dr. Carney says. “I couldn’t do this without him.”

During her residency, Dr. Carney looked forward to nightly visits at the hospital from her husband and children. “Sometimes we’d go out to eat. Sometimes he’d bring dinner for all of us. Sometimes we ate hospital food, but we always ate together,” she recalls. As a resident, Dr. Carney also kept storybooks in her locker, so she could call home each evening and read her kids a bedtime story.

Nursing challenges

Between classes, rotations, demanding residency hours and waiting patients, making time to pump breast milk can be challenging for mom DOs and osteopathic medical students who want to breast-feed. Some creative thinking on the part of these mothers has enabled them to keep it up.

“As a family physician, I encourage my patients to breast-feed their babies,” says Dr. Parrott, “so I certainly wanted to do the same when, as a resident, I gave birth to my son. Unfortunately, he was born premature, and my milk never came in, so that wasn’t an option. But should it have been, I was fortunate that our program director was very understanding. She allowed other resident moms to use her office to pump.”

It wasn’t easy for Thiede, who was able to pump only during her 10-minute lecture breaks at MSUCOM last year. “By the time I would get to the study-turned-lactation room in the student lounge to set up my pump, I barely had enough time to complete the task,” she says.

Nursing her daughter while serving fourth-year rotations forced Dr. Bailey to improvise. “During one rotation, a nurse practitioner on my service let me use her office to pump,” she says. “On another rotation, one of the physicians I worked with let me use his office. Other times, I used the bathroom. Thankfully I have a battery-operated pump since there was nowhere to plug in.”

Dr. Carney can speak to nursing at every stage of training, having given birth while in medical school, during her residency and in practice. “The hardest time for me was nursing during my rotations as a student,” she recalls. “You never know when you are going to have a break to pump or access to a bathroom with an electrical outlet.” If all else failed, Dr. Carney would pump in her car using a car adapter for power and covering up with a blanket.

Kyla D. Carney, DO, a mother of five, discusses how she manages her work-life balance. (Interview recorded by Flynn Wright)

“I had to leave a 10-hour surgery during my surgical rotation, and the surgeon gave me a hard time about it,” empathizes Thiede, who continues to nurse her daughter during her third year of med school.

While still nursing her newborn son, Dr. Hubka was periodically on “in-house call” in a hospital. Her husband would bring the baby to the hospital so she could nurse him. “When that wasn’t possible, I would pump in the call room and store the milk in the refrigerator with labels instructing people not to touch it,” she laughs.

Dr. Hubka encourages the residents with whom she works to continue breast-feeding even when nursing and pumping seem too overwhelming to fit into their busy day. “In our specialty, it can be impossible to pump every two hours,” says Dr. Hubka, who is the president-elect of the American College of Osteopathic Obstetricians and Gynecologists. “But I tell my residents that there are natural supplements like fenugreek and milk thistle they can take to keep up their milk production.”

Working mothers need to be aware that they now have the law on their side when it comes to breast-feeding their babies. The Patient Protection and Affordable Care Act of 2010 requires employers with 50 or more employees to provide a place other than a bathroom for female employees to express breast milk whenever they need to for their nursing children up to 1 year of age. This federal law does not preempt state laws that may provide greater protections to employees. Forty-four states, the District of Columbia and the Virgin Islands have laws that specifically allow women to breast-feed in any public location, and 24 states have laws related to breast-feeding in the workplace.

On-the-job hazards

Published in the Feb.4, 2004, issue of JAMA—The Journal of the American Medical Association, a retrospective study indicated that pregnant residents have elevated risks of pregnancy complications, including preeclampsia, low birth weight, placental abruption, premature births and still births.

Dr. Hubka frequently counsels her patients to cut back on stressful work hours while pregnant and likewise advises her residents to be smart about taking care of themselves while expecting. “Women in the health professions—or any profession that has them on their feet all day—are at risk for preterm birth, intrauterine growth restriction and other complications,” Dr. Hubka notes. “Expecting physicians must be extra cautious.”

For pregnant residents and practicing physicians, Dr. Hubka offers the following advice: “Don’t chart while standing. Get off your feet as much as you can. Sit down when you feel discomfort. Drink lots of fluids. Ask for help.” In addition, residents can ask to be reassigned rotations with more manageable hours and workloads.

Dr. Hubka cites the example of one expectant resident whom she was able to have reassigned from oncology to general obstetrics and gynecology floor work. “This worked out well because instead of her standing for 12 hours in an operating room where she wouldn’t be getting enough to eat or drink, she was on a rotation that was more manageable for her stage of pregnancy,” Dr. Hubka says.

Dr. Hubka helped this same resident get assigned to an elective that will ease her back into work upon returning from maternity leave. “She’ll be serving a urogynecology rotation, in which the volume of work is less,” Dr. Hubka explains. “It’s difficult to go from not working to jumping back into a frantic pace. This will help her as she nurses too. It takes more energy to nurse a baby than it does to grow one.”

During her pregnancy, Dr. Weiler had some concerns about exposure to certain viruses infecting her patients, especially H1N1. Though she avoided this influenza, she did get sick late in her pregnancy and ended up in labor and delivery before being put on antiviral medications.

As a consulting—and pregnant—physician, Dr. Hubka treated a patient who wasn’t aware of having tuberculosis. “I was handling bodily fluids, and there was no quarantine status for this patient,” Dr. Hubka recounts. “I later learned I was exposed, but fortunately nothing became of it. Still, it serves as a reminder to me when working with expectant residents to remind them to take universal preventive measures when dealing with all patients.”

Many hands

Acknowledging that “it takes a village,” DO and student moms are hardly making it work alone. Spouses, in-laws, parents, grandparents, friends, professors and colleagues all play a hand in enabling these women to wear their many hats.

Dr. Horrace-Voigt, DO, relies on her husband, Rex, a stay-at-home dad who makes sure dinner is on the table each night so the family can eat together. He drops off their 14-year-old son and 11-year-old daughter at school each day, picks them up, and attends all of their sporting functions.

Dr. Parrott leans heavily on her mom, sister, best friend and in-laws, who are all on call to help her out, especially when her husband travels. “You need to surround yourself with people who love you and who can almost co-parent with you,” she explains.

Because Dr. Parrott’s son was born premature, she was uncomfortable leaving him in day care when he was so little. Thankfully, she had the support of her team. “My boss let me bring Robby in, and I kept him in a basket in the preceptor room,” she recounts. “People took turns holding him throughout the day. I did this for two or three weeks until he gained weight and I was comfortable taking him to day care.”

Because Rammer’s 6-year-old son, Porter, is in school right near DMU’s campus, she was able to eat lunch with him each day during her first and second years. Rammer was relieved to have been granted an exemption to stay in Des Moines for her third-year rotations, which means that she won’t be assigned to a rotation more than two hours outside of Des Moines.

“I need to be able to get Porter back and forth to school,” she notes. “Fortunately, my mom and dad come in frequently to help out, and I know I’ll be leaning on them quite a bit during my fourth year when I may be assigned to rotations out of state.”

For other women, the support of parents or other family members may not be readily available. In these cases, many women are turning to day-care centers or in-home day-care arrangements, which can be more affordable for trainees strapped for cash.

“I’ve thought about getting a nanny, and I actually tested someone last year during the school year, but it just didn’t seem right,” Rammer notes. “One of the biggest obstacles with a nanny is the price. Unfortunately, I already take out the maximum in student loans and do not have the extra funds to pay for a nanny whom I trust enough to care for Porter.”

DOs in practice may have the financial means to consider nannies or au pairs, options that can provide more flexibility for families with irregular hours.

Dr. Weiler is happy to have a full-time babysitter who comes over to watch her 14-month-old. “This works out well for us, and she came extremely highly recommended by a family we know,” Dr. Weiler says.

When her son was a newborn, Dr. Hubka often brought him into the office. Now, she has a live-in nanny who helps care for her two children. “This works for us because my hours change at a moment’s notice,” Dr. Hubka explains. “I also realized early on that I didn’t want my children in and out of various day-care centers or child-care arrangements. I like the stability a nanny provides.”

For many mom DOs and med students, their support system extends well beyond childcare providers. Rammer, for example, credits her professors for being understanding and willing to work with her. “The night before I was to take an anatomy final, there was a snowstorm,” she remembers. “All the public schools were closed, including my son’s. I was freaking out about who would watch him so I could take the exam. I called my professor, and he told me to do what I needed to do—that we’d work it out and I shouldn’t worry.”

Carving out quality time

With all of the balls they’re juggling, most mothers in the osteopathic medical profession may find free time to be a scarce commodity. But they do make a point to take a little “me time” when and where they can find it.

“For my sanity, I have to do some things for me,” says Rammer, who carves out an hour each week to take a kickboxing class. Dr. Bailey and her husband have a date night once a week and make a point to get together with another couple with a young child. When recently unpacking boxes after her family’s move to Colorado, Dr. Horrace-Voigt discovered her old stamp collection, which she hopes to revisit. She also plays the clarinet.

Like most working mothers, mom DOs and med students also feel their share of guilt. “My daughter called me at work the other day because she left her violin at home and wanted me to bring it to her at school,” Dr. Carney says. “I really wanted to, but I was seeing patients and couldn’t get away. Circumstances like this get to you. There are lunches and activities at school that you have to miss. You wouldn’t be human if you didn’t feel some guilt.

“But I’m a better mom because I work. When I’m home with my kids, I’m giving them my full attention. No television or video games are allowed on weekdays. This really makes us spend quality time together.”

Noting that she has been discouraged in the past, Rammer emphasizes that she is glad she persevered. “I love what I’m doing,” she says. “I want people to know that you can raise a child while you’re in medical school—even as a single mom.”

Just like the fictional Dr. Miranda Bailey on “Grey’s Anatomy,” many osteopathic medical students and DOs are proving that medicine and motherhood do mix.

9 comments

  1. Pingback: Tweets that mention The DO | Paging Dr. Mom: DOs and students balance medicine and ‘mommyhood’ -- Topsy.com

  2. Lori Arney

    I am a 4th year medical student at Oklahoma State University College of Osteopathic Medicine with 3 children, ages 14, 8 and 8 (yes, twins!). I have survived school with my family intact, and will graduate in 3 months. Thank you for writing this article to remind us that there are other moms out there who are also doing this, and doing it successfully. It definitely has been a balancing act, and sacrifices have been made at school, as well as at home. In the end, I am so thankful for having made the decision to go back to school and pursue this dream. To those of you moms out there wondering if you can do it: You CAN!

  3. Sheila Dunlop

    I am a family practice physician with 25 years experience and three children. I’ve had the full FP experience with admitting privileges at three hospitals for OB, peds, IM (including ICU) and surgery assist.

    Yes, you CAN have it all, but you do best when you focus on what you love most. Treasure your kids and spouse, cut the things that annoy you most, and perfect the things you do best.

  4. Jennifer Olson

    I started medical school with a 4 month old. During my rotating internship year, I had my son. I do not recommend a pregnancy during that first year of residency but I found a way to balance it. My children now have no recollection of the many nights I saw them for only enough time to tuck them in or the many breakfasts I missed in the morning. I would not trade it at all. Now they are 20 and 15. We have an excellent relationship and they only remember how I was at all their school activities and how they are number one in my life. Not to mention I am still happily married after 22 years. Hang in there! Remember what matters most in the long run.

  5. Charlotte J. Worpel, D.O.

    I’ve been in the profession for greater than 30 years and there was no great way to decide when to begin family and try to balance both. I was in private practice for 25 years and now have joined a group. I raised my 3 children in my practice as I had a room for them to play and sleep, come after school. It worked out for me. Patients accepted that I was a pediatrician and that sometimes I had to be interrupted by my children, but I tried to make time for my children throughout the day and arranged this in my schedule. I was very blessed with an outstanding staff that helped as well through those years.

  6. Lisa E. Hart, DO

    I am 5 1/2 years past residency and now have a 6 year old, 3 year old, and 8 month old. Initially, I shared a private pediatric practice for 4 years working part time 4 days a week and supporting my family, while my husband went back to school. I learned so much about the practical business side of medicine. When it came time for my husband to find a job, we were fortunate to move closer to our supportive family. I am now employed in a private pediatric office and work 2 days a week. I get to enjoy my 3 kids more while they are young, and I plan to increase my workload as they get older. My father was a surgeon, so I have experienced the professional absent parent. My own childhood has given me confidence in this compromise between work and family; and in understanding how to be content in this season of being a working physician in my mid 30’s with young kids.

  7. Bernadette McKell, DO

    I went back to medical school when my youngest son (out of six boys) was ten years old. Because I went away to medical school at University of New England College of Osteopathic Medicine, in Biddeford, Maine, while my children remained with my husband in Springfield, MA, I was essentially an absent mom. Although I saw the boys on most weekends, the day to day family issues were dealt with solely by my husband. I cannot say this was an ideal situation as I missed my children terribly and often felt disconnected and estranged from them. Even though we had discussed my going to medical school as a family prior to my application process, I know the boys resented my absence especially when I was unable to attend many of their school and sports functions because of my own school obligations. Transitioning back to home during my fourth year and then through residency was also difficult as they boys had grown used to Mom (me) being away and were not at all accepting of what they viewed as mom’s interference. They also were not understanding of my crazy hours and my continued need to study and try to catch up on sleep when I could no matter what time of the day. I was home so I should resume all the “mom” duties I had done prior to medical school. However, when I had to take time off during residence because of several family issues that interfered with training, and questioned whether or not to continue training at all, my youngest son reminded me that I had come too far and worked too hard to get to this point and in no way should I give up. Despite the sacrifices and compromises made by all members of my family, I am glad that I didn’t give up because I am now doing what I had always dreamed of and I no longer have the nagging “what if…” in the back of my mind. Bottom line is, if you want it bad enough, you will find a way to make it work and attain your goal, no matter what age or stage of life you are in!

  8. Sharla Clark

    Thank you so much for this article! It makes me feel like I really can have it all even though there are so many out there saying that I can’t. I am currently a 3rd year medical student and have no children. I don’t have any great insight on the subject, but I am looking for advice. I was thinking that I would try to have a baby during my second or third year of residency. I know there is never a “good” time to have a baby, but what is the BEST time? Any advice would be so appreciated!!

  9. Stephanie Letney

    I started med school with a 3 month old and a husband who works full time. It definitely has it’s challenges, but we’re hitting second year strong!!! Thanks for those of you who are past the training sharing that you have a good relationship with your kids AND your spouse! Definitely an encouragement.

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