Confessions of a burnt-out physician

I don’t harbor any illusions about how hard ob-gyn residency will be, let alone with a young child. But this physician’s story only reinforces my belief that I made the right choice — an intensely personal choice that was the right choice for me — to start our family while in medical school. I need to learn how to live with balance now, so that I can draw boundaries when necessary for my own health, and so that I can thrive in the face of career challenges as before.

Thanks Jenny for sharing. Reprinted below in its entirety.

I’ve wanted to be a physician for as long as I can remember. As a teen, the choice to become a doctor seemed to perfectly meld my affinity for science, academics, and helping others. Better yet, pediatrics offered the ability to work with families and children of all ages and developmental abilities.

For fifteen years, I lived, breathed, and worked toward my goal to become a pediatrician. In college, I studied the foundational cornerstones of science and humanities and focused on how health impacts the rest of our lives. In medical school, I learned about different aspects of each organ system and marveled at the miracles of the human body. During residency, I walked the halls of hospitals during the wee hours of the morning. I rubbed the sleep out of my eyes as I provided artificial breaths to a dying infant and smoothed the crinkles in my yellowing white coat as we brainstormed why another child was brought to us at death’s door.

When I finally achieved my goal to call myself a board-certified pediatrician, I beamed as I walked into my new office space that had my name posted on the wall outside exam room doors.

Despite my lofty dreams and expectations, practicing primary care pediatrics was nothing like I hoped it would be. My days were filled with opportunities to meet and grow with patients and families, but my tidbits of time were sliced into 15-minute increments. As my practice size increased, I was persistently pressured to add extra patients over my lunch hours, before the day started, and into time slots already booked with other patients. The need to move increasingly efficiently sparked anxiety within me — I was halfway through greeting one patient before I was also surreptitiously listening for the opening and closing of the next exam room door to signal that another patient was waiting.

The physical and emotional work of completing a visit every 15 minutes repeatedly refreshing my smile before I burst into the next room began to make me feel like a machine. As a robot in the factory of medicine, the demands of my job pulled at my greatest skills of empathy and compassion, two of the character traits that made me most suited for primary care. Try as I might, it was hard to feel compassionate for the mother of a child with a mild cold when I was already ignoring my raging headache, need to urinate, and fatigue. Despite my gut instinct to address the “one last thing” that patients often bring up at the end of a visit, the pressure of metrics that detailed my length of visit and wait time for patients coerced me to ignore their concerns, even if my actions translated into another office visit, another co-pay, another day.

When I did have time to sit down, I was crowded into the corner of a small office shared by two other physicians. When we all were present and trying to make phone calls, type office notes, and converse with staff, the cacophony rose. My brain and my inner self was desperate for peace, though I knew it would be only moments before the next patient was ready in a room to begin again.

By the time I got home each evening, I was a deflated emotional balloon, sucked of energy and ambition and left with little to share. When my own children rushed to greet me, I offered them a quick hug and kiss and then silently wished they would quiet down. After dinner and bedtime stories, I rested with them until it was time to open my laptop again and work through additional charts, emails, and work tasks. My husband personified my laptop as a bedfellow in our marriage. I struggled for the emotional energy to make my steadfast lifetime partner feel loved.

As a part of the middle management administration at my health care organization, I sat in meetings week after week where the physicians in the organization were referred to as “lazy, whiny, irresponsible, and unmotivated.” I gazed through the picturesque windows in the large administrative offices and chuckled at the irony that money is too tight to upgrade or expand space in clinics to improve the workplace environment. I seethed quietly as I listed to the mantra that we need to see more patients, more efficiently, and work longer hours as if I were listening to the drumbeat at a funeral march.

The articles on physician burnout cite the need for physicians to develop coping strategies to deal with the daily stressors incurred in the office. We are tasked to learn and practice mindfulness, meditation, and regular exercise. While I make exercise a priority, I simply can’t find the time to learn the other soul-saving techniques in my current work environment. I think it is not only a physician’s responsibility to take care of ourselves, but the scaffolding of the health care system needs allow for practices that will sustain those of us at its very core.

Last week, I submitted my resignation from medicine.

Many have asked me if I will ever come back, but I’m not sure. I am jaded by the push to provide efficient and effective health care for others while ignoring my own personal needs. I am saddened by the palpable wounds that I have left my children through lack of energy, lack of engagement, and inability to be there when they need me. I am discouraged that despite 15 years of focus and sacrifice, Dr. Google has become a smarter and more esteemed physician than I. I am worried that the advent and elevation of pseudoscience has led to increased vaccine resistance, re-emergence of previously eradicated diseases, and hours of time spent fruitlessly discussing why the opinions of thousand physician researchers should outweigh the thoughts of one or two dissenters.

I have heard that it costs up to $10,000 every time my organization hires and trains a new physician. It costs patients and insurance companies each time I ask a patient come back to discuss other concerns I didn’t have time to address. Every time I order a diagnostic test that is not medically warranted but desired by a patient that has Googled their symptoms, costs increase.

The United States spent approximately $8,895 per person for health care in 2012, which is higher than any other developed country but is among the worst health outcomes. If we want to decrease the cost of American health care, it will be imperative to make efforts to retain primary care physicians, decrease administrative costs and overhead spending, and put back some autonomy in physician’s hands so that customer satisfaction does not override the importance of good patient care.”[sic] In addition, health care companies and patients need to recognize that those of us who chose to study medicine are not merely well trained machines but humans who strive to deliver care with compassion, empathy, and expertise.

I don’t know what my next career will be, but for now I will work on regaining what made me chose[sic] medicine in the first place. As I cultivate the human that has been suppressed by the robot that provided medical care, I look forward to regaining the health and happiness that we seek for all.

The author is an anonymous pediatrician.

Confessions of a burnt-out physician.

Creatavita: Tough Choices

Heidi Hayes is a fabulous voice teacher in the Philadelphia region. She is also a mentor to many artists here, and she recently wrote a piece on career-life balance. Although I am not a working artist, her words ring true. Worth a read for anyone thinking about work-life balance. Below is an excerpt.

I admire people who can hand their kid over to a caretaker and fly off to do a six-week stint in Europe. I really do. I admire people who can take on the role of a lifetime while their kids are under the age of 10. I couldn’t do it. I didn’t have enough psychological space. But what matters is that I know why, and that’s what you need to know for you and your life. I knew that being available for the Kid was the most important thing for me. I was lucky; I had had a pretty nice career before I had a child, so I knew that I’d be okay if I didn’t achieve more of my career goals in this lifetime. I also knew I could never forgive myself if I messed up a kid, particularly one that came from my gene pool.

I knew I was missing opportunities because there was a chance that they were coming at the wrong time in my relationship with the Kid and I was okay with that. Conversely, opportunities appeared that allowed me to be available for the Kid and fulfilled me as an artist. Maybe not as much as I wanted, but enough to keep me balanced.

I was also fully aware that I could mess my kid up even more by being around. My kid’s pretty self-contained, and he’s always been that way. So, I’ve done a lot of waiting, listening, and holding my tongue (and we all know how challenging that is for me) while calmly hanging in the parental holding pattern. He has always made it clear when I was really needed and every single time, I have been grateful. Grateful that I made the decision to be available and grateful that he could express himself.

I think the hardest part of this family and career intersection is figuring out what works for you. When it doesn’t line up with what you see others doing, you can really question your decisions. I know that’s hard for me. There’s a little part of me that’s very jealous of these people who can be parents and don’t have to be available all the time. I wish I could do that. But I can’t. So I haven’t. The reward is that I know I’m following my gut, and my kid is doing well. He’s a great human, he’s healthy, he’s vibrant, he’s his own person. I couldn’t ask for more.

via Creatavita: Tough Choices.

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“Get over yourself.”

Quote

Get over yourself.
This song is only doing
What it has always Continue reading

Why PepsiCo CEO Indra K. Nooyi Can’t Have It All

Reminders to myself for the tough days ahead. She makes me proud to be a Yalie.

I don’t think women can have it all. I just don’t think so. We pretend we have it all. We pretend we can have it all. My husband and I have been married for 34 years. And we have two daughters. And every day you have to make a decision about whether you are going to be a wife or a mother, in fact many times during the day you have to make those decisions. And you have to co-opt a lot of people to help you. We co-opted our families to help us. We plan our lives meticulously so we can be decent parents. But if you ask our daughters, I’m not sure they will say that I’ve been a good mom. I’m not sure. And I try all kinds of coping mechanisms.

I’ll tell you a story that happened when my daughter went to Catholic school. Every Wednesday morning they had class coffee with the mothers. Class coffee for a working woman—how is it going to work? How am I going to take off 9 o’clock on Wednesday mornings? So I missed most class coffees. My daughter would come home and she would list off all the mothers that were there and say, “You were not there, mom.”

The first few times I would die with guilt. But I developed coping mechanisms. I called the school and I said, “give me a list of mothers that are not there.” So when she came home in the evening she said, “You were not there, you were not there.”

And I said, “ah ha, Mrs. Redd wasn’t there, Mrs. So and So wasn’t there. So I’m not the only bad mother.”

You know, you have to cope, because you die with guilt. You just die with guilt. My observation, David, is that the biological clock and the career clock are in total conflict with each other. Total, complete conflict. When you have to have kids you have to build your career. Just as you’re rising to middle management your kids need you because they’re teenagers, they need you for the teenage years.

And that’s the time your husband becomes a teenager too, so he needs you (laughing). They need you too. What do you do? And as you grow even more, your parents need you because they’re aging. So we’re screwed. We have no… we cannot have it all. Do you know what? Coping mechanisms. Train people at work. Train your family to be your extended family. You know what? When I’m in PepsiCo I travel a lot, and when my kids were tiny, especially my second one, we had strict rules on playing Nintendo. She’d call the office, and she didn’t care if I was in China, Japan, India, wherever. She’d call the office, the receptionist would pick up the phone, “Can I speak to my mommy?” Everybody knows if somebody says, ‘Can I speak to mommy?’ It’s my daughter. So she’d say, “Yes, Tyra, what can I do for you?”

“I want to play Nintendo.”

So she has a set of questions. “Have you finished your homework?” Etc. I say this because that’s what it takes. She goes through the questions and she says, “Okay, you can play Nintendo half an hour.” Then she leaves me a message. “Tyra called at 5. This is the sequence of questions I went through. I’ve given her permission.” So it’s seamless parenting. But if you don’t do that, I’m serious, if you don’t develop mechanisms with your secretaries, with the extended office, with everybody around you, it cannot work. You know, stay at home mothering was a full time job. Being a CEO for a company is three full time jobs rolled into one. How can you do justice to all? You can’t. The person who hurts the most through this whole thing is your spouse. There’s no question about it. You know, Raj always said, you know what, your list is PepsioCo, PepsiCo, PepsiCo, our two kids, your mom, and then at the bottom of the list is me. There are two ways to look at it. (laughing) You should be happy you’re on the list. So don’t complain. (laughing) He is on the list. He is very much on the list.

via Why PepsiCo CEO Indra K. Nooyi Can’t Have It All – Conor Friedersdorf – The Atlantic.

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Mothers and Fathers | Brain, Child Magazine

Thanks to Anittah for passing along. Here’s a beautiful piece by Lauren Apfel of omnimom.net.

Sometimes I do get annoyed that I inevitably get more tied up in parenting than Chris does, and reminding myself that biology/evolution more or less programmed Madeline to cling to me doesn’t do much to quell my frustration. I’m also somewhat worried that I’m spoiling her when I get home because I feel bad that I don’t have much time with her anymore. But after reading this, I suppose I’m more content that things are as they should be, and I’ll go on kangaroo carrying her.

Gonna save this one for stormy days.

Mothers and Fathers | Brain, Child Magazine.

I’ll reprint it here, just in case:

When I think about what a mother is, I tend to think about what a father is not. My mother was day in and day out, my father was summers and some weekends. My mother was the endless overseeing of schoolwork and driving to lessons, my father was special occasions. My mother listened to my problems from the end of the bed, my father from the end of a phone line. This arrangement was, in part, a product of our individual situation: I am the child of divorce. But I am also a child of the seventies, an era when gender roles in the home were more clear cut than they are now. Even if my parents had stayed together, I’m not sure how different things would have been.

They both loved me. I would never argue that fathers don’t love their children as much as mothers do, I would only argue that their love often manifests itself differently. Because there is love and there is presence and they are not the same gift. Most mothers are present in a way that fathers are not. And I don’t just mean physically present. I mean emotionally present. I mean, to borrow Jennifer Senior’s perfect phrase, they are “more alive to the emotional undercurrents” of family life. A simple observation with a profound effect. It is at the heart of why, even in 2014, as fathers shoulder increasing amounts of childcare, mothers still perceive a palpable inequality in this arena, irrespective of whether they are employed outside the home or not. And their perception goes hand in hand with the facts: “women, on average, still devote nearly twice as much time to ‘family care’…as men,” according to Senior.

Growing up, I was blissfully unaware of these gender lines. My mom did everything because she was the one who was there, not because she was a woman (though if I had taken the next logical step, I would have realized she was there because she was the woman). Plus, she was raising her daughters in the twilight of feminism, with the genuine, entrenched belief that we could do anything we wanted to do. For my generation, gender equality was no longer a battle cry, it was the air we breathed. The year I enrolled at Yale was the first year more female applicants were accepted than male. But my presence at that university, along with the other young women who made up 51% of my class, didn’t feel like an achievement. It felt like our right.

* * *

When I found out I was pregnant with my first child, the sands under my long-held view of gender equality began to shift. From the moment those two pink lines appeared on the test, summoned there by the magical workings of my body, my husband and I were not the same anymore. Up until that point, our relationship had been thoroughly modern. We shared the housework, my aspirations were not subordinate to his. And now, together, we were expecting a baby, who would need to be cared for by some combination of our efforts, the details of which had yet to be determined. But that baby was nine long months away from existing separately from me, not him. I took that pregnancy test and, within minutes, I was staring down the barrel of the enormous responsibility that lay before me and me alone: the responsibility of growing a life. My husband stood next to me, but his part was over. For now.

He could forget about the baby, live out the other parts of his life in a way that I couldn’t. Not really. Not with the bouts of vomiting. Not with the swell of my belly making ordinary movement impossible. Not with the burning reflux that kept me sleeping upright for the last, lurching months before birth. And not with this creature constantly poking me, prodding me as if to say: “I’m here, Mom, I’m coming!” In a sense, the other parts of my life had already been consumed. “I hear you, baby,” I would whisper, pressing my hand against the tiny foot projecting under my rib, as if we were making a pact. “I hear you.”

I was a mother for 41 weeks and 1 day before my husband became a father. And then the baby was born and I put him to my breast, again and again and again, only me, every time, and in many ways I still felt like the sole parent. For six more months, the weight of responsibility that comes with sustaining human life from your own flesh fell on me. Six months after that, the baby continued to nurse, to seek me out because he was conditioned to do so, though Daddy could now give the odd meal when he wasn’t at work. And then at the end of the first year, after twenty-one months of being physically bound to this baby by one tether or another, I weaned him and, in doing so, mother and father were finally on a par. Except, with that kind of prelude, I would hardly describe the playing field as level.

My fierce attachment to my son—and my subsequent decision to stay home with him—did not feel, at the time, like the mewl of circumstance. It felt like the roar of biology. Not every woman frames her experience of early motherhood in the context of nature: I am aware of the danger of drawing lines between males and females based on anatomy, and how unfashionable it is. But this was my reality. For close to two years, my body was awash with hormones that made it do things like let down milk at the sound of my baby’s cry. My son cried and my body knew he was hungry, without so much as a word uttered. It was astonishing to me: a physical reaction to a stimulus that had no such effect on that baby’s father. My darling husband who could sleep through the baby’s howls, who stood guard over the baby’s door, when we agreed on sleep training, because he could bear the siren-like sounds of distress and I, without somebody to hold me back, could not.

* * *

Mothers tend to be more involved with their young children partly because we have different standards than fathers, which we refuse to “compromise” and so we bear the brunt of potentially transferrable tasks. And partly because—and this is the key, I think—motherhood is more definitional than fatherhood. “Women, on average,” Senior writes, “assigned a significantly larger proportion of their self-image to their mother identity than…men did to their father identity. Even women who worked full-time considered themselves more mother than worker by about 50 percent.” “Father” might be one role among many, but “Mother” is a hat less easily taken off. Being continually awake to our children’s needs, embracing the responsibility for their emotional, as much as their physical, welfare, is how we measure the strength of the connection between us. It is, in turn, how we fuel that large portion of our identities.

There are, of course, fathers who are knee-deep in their children’s lives, a small percentage of whom are even primary caregivers or “pilot” parents, fathers who clip fingernails and fight the sickly pang of abandonment at nursery school drop-off. Likewise, some mothers are more detached, more typically “paternal” in their relationship with their kids. It’s not a matter of right or wrong. I’m not sure it’s something you can choose. It seems to be a brew of personality and cultural influence and, perhaps above all, the model of your own parents, whether you seek to emulate it or redress it.

I might be the one who is “more alive to the emotional undercurrents” of family life because of the biological pull I have felt since my kids were born. Or it might be because I have taken to heart my own mother’s example that parental love is a kind of ethereal presence. My mother wasn’t a hoverer or even home with us for the whole of our childhood, but she was our sun, the constant warmth under which we bloomed. My father was the moon. He was a part of our sky, but his presence waxed and waned with the tides. What is motherhood to me? It is a light so bright that sometimes it blots out everybody else.

Lauren Apfel is originally from New York, but now lives in Glasgow, Scotland (thanks to the Brit she married). A published classicist turned stay-at-home mom of four (including twins), Lauren thinks less about the Greeks these days and more about parenting, the tragedy and comedy alike. She writes regularly at www.omnimom.net. Follow her on Facebook and on Twitter.

Afterschool Activities and Prize Culture | TIME.com

Reminds me of those clubs where every member has a title because they all need to feel important and didn’t get into any other clubs.

How come it seems like every kid today is a champion for something, when we know every kid can’t be a star?…Trophies may keep kids coming back, and their parents paying, but psychological research finds that giving kids rewards for doing an activity (even something as simple as a paper certificate) means lower levels of intrinsic motivation. High levels of intrinsic motivation is precisely what we want to foster among kids to help them attain long-term success and take pride in a well-earned achievement. But the carving up of honor and the trophy culture that accompanies it has clearly gone too far: carving up honor probably doesn’t improve children’s performance or motivation — but it may mean a bigger payday for those who run childhood tournaments.

So parents need to be cautious when pursuing titles for their young kids, and make sure the honor created is for their kids, and not for reflected glory for anyone else in their children’s lives.

via Hilary Levey Friedman: Afterschool Activities and Prize Culture | TIME.com.

From a mama in academia: maintaining sanity and work-life balance

Although the experience of life in academia isn’t particularly generalizable, I think many of us can identify with and glean some comfort from this mama’s perspective on work-life balance:

I’ve enjoyed my seven years as junior faculty tremendously, quietly playing the game the only way I knew how to. But recently I’ve seen several of my very talented friends become miserable in this job, and many more talented friends opt out. I feel that one of the culprits is our reluctance to openly acknowledge how we find balance. Or openly confront how we create a system that admires and rewards extreme imbalance. I’ve decided that I do not want to participate in encouraging such a world. In fact, I have to openly oppose it.

So with some humor to balance my fear, here’s goes my confession:

Seven things I did during my first seven years at Harvard. Or, how I loved being a tenure-track faculty member, by deliberately trying not to be one.

  • I decided that this is a 7-year postdoc.
  • I stopped taking advice.
  • I created a “feelgood” email folder.
  • I work fixed hours and in fixed amounts.
  • I try to be the best “whole” person I can.
  • I found real friends.
  • I have fun “now”.

Read on to share in her experiences in The Awesomest 7-Year Postdoc or: How I Learned to Stop Worrying and Love the Tenure-Track Faculty Life | Guest Blog, Scientific American Blog Network.

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Average parental leave for full-time employees:

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A reminder, in case you thought American parenting was doing well:

From a 2008 study by The Center for Economic and Policy Research. Sorry, Americans, it’s not the norm to get paid leave for taking care of a newborn.

Average parental leave for full-time employees

via Working In America Vs. Working In Other Industrialized Countries.

Home Economics: The Link Between Work-Life Balance and Income Equality – Stephen Marche

This essay rings home so well. Read it entirely. My favorite paragraphs:

The solution to the work-life conundrum is not “enlisting men” (as Slaughter puts it) in the domestic sphere. The solution is establishing social supports that allow families to function. The fact is, men can’t have it all, for the same reason women can’t: whether or not the load is being shared 50-50 doesn’t matter if the load is still unbearable. It will not become bearable once women lean in, or once the consciousness is raised, or once men are full partners, always, in domestic life. It will become bearable when decidedly more quotidian things become commonplace—like paid parental leave and affordable, quality day care (which Sandberg and Slaughter both advocate).

As long as family issues are miscast as women’s issues, they will be dismissed as the pleadings of one interest group among many. And truly, it’s hard to see, at least in terms of political theatrics, why the complaints of the richest and most successful women in the world should bother anybody too much. Fighting for the American family is another matter. When gay-rights activists shifted their focus from the struggle for their rights as an oppressed minority to the struggle to create and support families, their movement experienced nearly unprecedented political triumph. It is easy to have a career as an anti-feminist. Force the opponents of day-care support and family leave to come out instead against working families. Let them try to sell that.

Home Economics: The Link Between Work-Life Balance and Income Equality – Stephen Marche – The Atlantic.

In case of the implausible event that the essay is no longer available at that link, I reproduce it here:

Ross MacDonald

My wife leans in. A year ago, after nine hours of labor, she received an epidural and immediately asked me to pass the iPad so she could send a note to work. I suggested that this time should be for us and for the little girl who was making her way into the world, but it’s hard to argue with a woman who’s eight centimeters dilated. Besides, why not send the note? Soon enough the baby, our second, would be out. The pause for an epidural was the most calm we would see for months. We are all in the thick of it, in the mash-up of work and family, in the confounding blur of everything, instantly, at once, the way life happens now. Why waste a moment?

A year after The Atlantic published Anne-Marie Slaughter’s “Why Women Still Can’t Have It All,” the plutocratic wave of feminism continues to roll in. Sheryl Sandberg’s Lean In looks to dominate the best-seller lists for months to come. Both accounts are full of stories like the iPad in the delivery room, stories of women furiously multitasking, worrying about family over champagne at a United Nations event, or diagnosing children with head lice while aboard a corporate jet. Men are mostly offstage. Slaughter, to her great credit, talks repeatedly about her husband, noting that he has done everything possible to support both her career and their two sons, including taking on the lion’s share of parenting duties while she commuted for two years from Princeton to Washington, D.C. Sandberg, too, talks about her husband’s role at home (in her book’s dedication, she credits him with “making everything possible”). But in the ensuing discussion of gender politics, which has been conducted almost entirely by women, for women, men are far more anonymous—implacable opponents of progress in the upper echelons, helpless losers elsewhere. Meanwhile, the good husbands—the selection of whom is “the most important career choice” young women can make, according to Sandberg—are as silent as the good wives once were.

Men’s absence from the conversation about work and life is strange, because decisions about who works and who takes care of the children, and who makes the money and how the money is spent, are not decided by women alone or by some vague and impersonal force called society. Decisions in heterosexual relationships are made by women and men together. When men aren’t part of the discussion about balancing work and life, outdated assumptions about fatherhood are allowed to go unchallenged and, far more important, key realities about the relationship between work and family are elided. The central conflict of domestic life right now is not men versus women, mothers versus fathers. It is family versus money. Domestic life today is like one of those behind-the-scenes TV series about show business. The main narrative tension is: “How the hell are we going to make this happen?” There are tears and laughs and little intrigues, but in the end, it’s just a miracle that the show goes on, that everyone is fed and clothed and out the door each day.

“What would you do if you weren’t afraid?,” Sandberg asks women in the opening chapter of Lean In. She obviously does not work in journalism (as my wife does) or academia (as I used to), let alone manufacturing. The question for most American women, and for most families, is much simpler: “How do I survive?” Sandberg’s book has been compared with feminist classics like The Feminine Mystique, but it really belongs in the category of capitalist fantasy, a tradition that originated with Samuel Smiles’s Self-Help and was popularized by the novels of Horatio Alger. The success of Lean In can be attributed, at least in part, to its comforting espousal of an obviously false hope: that hard work and talent alone can now take you to the top. This is pure balderdash, for women and men. Class structures have seized to the point where Denmark has more social mobility than the United States. The last myth to die in America will be the myth of pluck; Lean In is the most recent testament to its power.

Slaughter’s essay, too, reflects the blind spots of the technocratic elite. It is a superachiever’s guide to having a family. Here is how she describes taking a break from her usually harried work existence to concentrate on her family life during a sabbatical: “I think of these plateaus as ‘investment intervals.’ ” Louise Richardson, the vice chancellor of the University of St. Andrews, in Scotland, is so “ruthlessly” organized, in Slaughter’s telling, that when microwaving, she keys in 1:11, 2:22, or 3:33—instead of 1:00, 2:00, or 3:00—as a way of saving time. This is not so much a ruthless use of time as a fetishization of time—the cult of the billable hour run amok.

The plutocratic wave of feminism has positioned itself as the heir to a long-standing feminist revolution undertaken in the name of all women. And yet when I first read “Why Women Still Can’t Have It All,” I immediately thought of the men I know who might be said to “have it all.” The wife of one of my editors had a premature baby at 28 weeks; after they brought the baby home, he did not miss a day of work. Soldiers, I suppose, “have it all.” They have meaningful work and then come home (eventually) to their waiting families. Does anyone imagine that they consider themselves the victors of society’s current arrangement?

Although you might not know it from the discussion Sandberg and Slaughter have touched off, American fatherhood has evolved almost beyond recognition in recent decades. The Pew Research Center released a study called “Modern Parenthood” in March, well after either Sandberg or Slaughter could refer to it, which is unfortunate. When it comes to work-life conflict, the study found, about half of all working parents say it is difficult to balance career and family responsibilities, with “no significant gap in attitudes between mothers and fathers.” Perhaps this is not surprising, given that mothers’ and fathers’ roles have converged dramatically in the past half century. Since 1965, Pew reports, fathers have tripled the time they spend with their children. Fathers’ attitudes about mothers’ roles are changing quickly, too: In 2009, 54 percent of men with kids younger than 17 believed that young children should have a mother who didn’t work. Just four years later, that number has dropped to 37 percent. Finally, although stay-at-home dads are still very much in the minority, their numbers have doubled in just a decade’s time.

Meanwhile, women’s rise to economic dominance within the middle class continues. Since 1996, women have earned more bachelor’s degrees than men, and last year they started earning a greater number of master’s and doctoral degrees. It is an outrage that the male-female wage gap persists, and yet, over the past 10 years, in almost every country in the developed world, it has shrunk. In developed countries, by most economic indicators, women’s lives have improved relative to men’s. Of the 15 fastest-growing job categories in the United States, 13 are dominated by women.

What isn’t changing is that top leadership positions remain overwhelmingly filled by men. “As the 99 percent has become steadily pinker, the 1 percent has remained an all-boys club,” Chrystia Freeland pointed out last year, in her book Plutocrats. According to the World Economic Forum’s “Global Gender Gap” report, women around the world hold a mere 20 percent of powerful political positions. In the United States, the female board-membership rate is 12 percent—a disgrace.

We live in a hollow patriarchy: the edifice is patriarchal, while the majority of its occupants approach egalitarianism. This generates strange paradoxes. Even women with servants and powerful jobs and hundreds of millions of dollars feel that they have an institutional disadvantage. And they’re right. Women in the upper reaches of power are limited in ways that men simply are not. Various men’s movements have emerged, purportedly to provide a counterweight to feminism, but this proposition is inherently absurd. The greatest power still resides in the hands of a few men, even as the majority of men are being outpaced in the knowledge economy. Masculinity grows less and less powerful while remaining iconic of power. And therefore men are silent. After all, there is nothing less manly than talking about waning manliness.

The good husbands—the selection of whom Sheryl Sandberg calls “the most important career choice” young women can make—are as silent as the good wives once were.

In the 1950s, the patriarchy at work and at home were of a piece. The father was the head of the household because he provided for the family, and the boss was head of the company because he provided the work that provided for the family. At home, for the overwhelming majority of families, the old order has disappeared. The days of Dad working all week and then, having fulfilled his duties, going to play two or three rounds of golf on the weekend are long gone. So are the days of Dad as the head of the household, the decider in chief. A 2008 Pew study asked cohabiting male-female couples, “Who makes the decisions at home?” In 26 percent of households, the man did; while in 43 percent of households, the woman did. The family has changed and is further changing, while at work, patriarchy survives as a kind of anachronistic holdover, like daylight savings or summer vacation.

The hollow patriarchy keeps women from power and confounds male identity. (The average working-class guy has the strange experience of belonging to a gender that is railed against for having a lock on power, even as he has none of it.) The current arrangement serves almost nobody’s interests. And yet it may be harder to break than older modes of sexism. The struggles articulated by The Second Sex and The Feminine Mystique and The Female Eunuch were broadly oppositional—women against men, young against old, feminists against the existing structures of power. Today, men and women are not facing off on a battleground so much as stuck together in a maze of contradictions.

In 2007, my life was right where I wanted it to be. After the lean misery of graduate school at the University of Toronto, I had, at 31, landed a job on the tenure track at City College in Harlem, as a professor of Shakespeare. My second novel was in the windows of appealing independent bookstores in Brooklyn, it had a good review in The New York Times, and the lead singer of the Decemberists was recommending it in interviews. This was basically all I had ever hoped for. Then I gave it up. My wife was offered her dream job as the editor in chief of Toronto Life magazine (roughly speaking, the New York of Canada), and we returned home.

You could see our departure as the triumph of egalitarianism, and in a way it was. I don’t think my father would have given up a tenure-track job for my mother. But in my marriage, the decision came down to brute economics: My wife was going to make double what I made. Good schools and good hospitals are free in Toronto. These are the reasons we moved. And if I were offered a job where I would make double what she does, we would move again. Gender politics has nothing to do with it.

Not that politics didn’t intrude. We were moving back to downtown Toronto, where people self-identify as socialists, so I expected open-mindedness. Yet the reaction to my reduced professional status and stepped-up involvement in child-rearing was sharply divided along generational lines. Among Baby Boomers, classic gender stereotypes prevailed. To them, I had become “the woman” and my wife had become “the man.” Boomer men could not wrap their heads around what I had done, while the women would smile an amazed smile, their eyes glinting with a touch of self-satisfaction. A younger generation was completing what they had begun.

I don’t think my father would have given up a tenure-track job for my mother. But in my marriage, the decision came down to brute economics.

Among people my own age, the reaction was more complicated. Our story possessed a sort of circumscribed romance: to academic friends, the idea that I had given up a tenure-track appointment was like the Charge of the Light Brigade—glorious professional suicide. At any rate, most friends and acquaintances in roughly my age group at least understood the nature of the decision. They appreciated that chasing jobs was part of 21st-century life, and that marriage sometimes requires sacrifice. Well over half my male friends have wives who make more money than they do. Nonetheless, in social life, I found myself more and more of an addendum: “This is Stephen. He’s Sarah’s wife.”

But let us get down to the details—specifically the financial details. The key fact of our story, the overwhelmingly most important factor in our personal gender politics, is that in Canada, we have access to high-quality, modestly state-supported (though far from free) day care. Of all the privileges my wife and I gained, our boy being in a safe place we could afford between nine and five was by far the greatest. It’s why this story has a happy ending; it is the thing that enabled me to build a new career for myself. Day care is not theoretical liberation. It is the real deal, for women and men alike.

Our new domestic arrangement, like the move that precipitated it, was shaped more by circumstance than by ideology. I was a freelancer. My wife was running a magazine. So I picked up the boy from day care each afternoon and pushed him in his stroller though the unbearable Toronto February. When she was out at various events, the boy and I had “guys’ night,” the two of us watching hockey and eating take-out Portuguese chicken, often in our pajamas. Think of it as our answer to Slaughter’s “investment intervals.”

The days of Dad working all week and then, having fulfilled his duties, going to play two or three rounds of golf on the weekend are long gone.

For the Boomers and members of older generations, a married couple’s decisions about work were ultimately questions of power. For younger generations, marital decisions boil down mostly to money. And yet the debates about gender, particularly the debate that has emerged in a thousand blog posts surrounding “Why Women Still Can’t Have It All” and Lean In, retain the earlier framework. These discussions tend to recognize the residual patriarchy, but they do not see its hollowness, or the processes hollowing it out.

The plutocratic feminists almost always end up, out of habit, calling for an attitude adjustment, a switch in thinking—they hope to re-create, and perhaps cash in on, the transformational optimism of ’60s-era consciousness-raising. But the consciousness has been raised. Gender attitudes do not affect economic reality, but rather the other way around. The rise of women is not the result of any ideology or political movement; it is a result of the widespread realization, sometime after the Second World War, that families in which women work are families that prosper. And countries in which women work are countries that prosper. In 2006, a database created by the Organization for Economic Cooperation and Development demonstrated what common sense tells us: with few exceptions, countries in which women have more economic and political power are richer than countries where women are relatively powerless. Patriarchy is damn expensive. That’s why it’s doomed.

Sheryl Sandberg’s “Lean In Circles”—her national network of book clubs cum professional self-help groups for women—are not supposed to be mere marketing exercises; they are intended to be psych-up sessions for elite women who want to learn to be more demanding. Good for them, I suppose. But do we want women emulating the egomania of the corporate male? Do we really want that particular brand of insanity to spread? Wasn’t it exactly that arrogance that led to the 2008 financial collapse? I suppose a world in which female bankers spend as much on blow and hookers as their male counterparts would be a fairer world; is it a world worth fighting for?

Both Sandberg and Slaughter imagine benefits to women flowing from the top to the bottom. Slaughter wants

to close the leadership gap: to elect a woman president and 50 women senators; to ensure that women are equally represented in the ranks of corporate executives and judicial leaders. Only when women wield power in sufficient numbers will we create a society that genuinely works for all women. That will be a society that works for everyone.

She may well be right—but in the meantime, having a few women in positions of power has hardly proved to be a panacea. Britain had a female head of state and leader of government for nearly 12 years without becoming a feminist paradise. Sandberg makes a big deal out of how “one pregnant woman at the top” can make a difference for other women. But the specific example she cites—her campaign for designated pregnant-woman parking spots at Google—hardly seems revolutionary.

I remember, as a boy, waking up on a mattress in the back of a station wagon in a hospital parking lot in Edmonton, Alberta. My father was not in town—he commuted to another city by plane every day for two years. And so, on a few occasions, my mother, who is a physician, left my brother and me in the car while she delivered a baby in the middle of the night. At the time, I loved the adventure. Later, I came to realize that my parents had worked their way into the middle class through many such superhuman maneuvers. My mother-in-law, for her part, used to return home from her job as a broadcaster, feed two children, put them to bed, and then return to the office for a couple more hours of work. If it was like this for doctors and broadcasters, what must it have been like for factory workers?

The solution to the work-life conundrum is not “enlisting men” (as Slaughter puts it) in the domestic sphere. The solution is establishing social supports that allow families to function. The fact is, men can’t have it all, for the same reason women can’t: whether or not the load is being shared 50-50 doesn’t matter if the load is still unbearable. It will not become bearable once women lean in, or once the consciousness is raised, or once men are full partners, always, in domestic life. It will become bearable when decidedly more quotidian things become commonplace—like paid parental leave and affordable, quality day care (which Sandberg and Slaughter both advocate).

As was recently noted in a New Republic cover story titled “The Hell of American Day Care,” the National Institutes of Health has rated only 10 percent of child-care facilities nationwide as providing “high-quality care” (most are instead rated “fair” or “poor”). And in every state, the average annual cost of day care for two children exceeds the average annual rent. Not surprisingly, low-income mothers are far more likely to stay at home today than are upper-income mothers. Such women are forgoing paid work not because they refuse to lean in but because they can’t earn enough money at their jobs to cover child care.

If men’s voices are absent from the conversation about family, we have, I’m afraid, only ourselves to blame. Yes, there are the occasional pieces in newspapers and magazines by new fathers—a genre that at times seems more oriented toward establishing one’s literary machismo than toward engaging in substantive dialogue—but men have generally failed to make themselves heard. Those who speak loudest tend to be either members of the aforementioned men’s-rights groups, or explicit anti-feminists, who long for a traditional family that bears little resemblance to the current reality. Men are not victims in this story, nor helpless witnesses to their wives’ struggles. And yet: A chorus of women demands maternity leave. Where is the chorus of men asking for paternity leave?

A conversation about work-life balance conducted by and for a small sliver of the female population only perpetuates the perception that these are women’s problems, not family ones. If you doubt that such thinking is still pervasive, see the recent op-ed in The New York Times about tax policy’s effect on working families, which contained this sentence: “Most working mothers who pay for child care do so out of their after-tax income.” That’s right: child care is a not a father’s expense, or a family’s expense, but a mother’s. As Sandberg points out, when the U.S. Census Bureau studies child care, it “considers mothers the ‘designated parent,’ even when both parents are present in the home. When mothers care for their children, it’s ‘parenting,’ but when fathers care for their children, the government deems it a ‘child care arrangement.’ ”

As long as family issues are miscast as women’s issues, they will be dismissed as the pleadings of one interest group among many. And truly, it’s hard to see, at least in terms of political theatrics, why the complaints of the richest and most successful women in the world should bother anybody too much. Fighting for the American family is another matter. When gay-rights activists shifted their focus from the struggle for their rights as an oppressed minority to the struggle to create and support families, their movement experienced nearly unprecedented political triumph. It is easy to have a career as an anti-feminist. Force the opponents of day-care support and family leave to come out instead against working families. Let them try to sell that.

Gloria Steinem’s famous declaration that “women’s liberation will be men’s liberation, too” is true. The opposite is also true. Real liberation will not be one against the other, but both together.

Americans have problems with working motherhood, but not with working mothers?

All the recent banter about whether moms “should” work is nuts. Obviously, approval depends on whether kids are better off one way or the other, and if America wants to install the necessary supports for working moms, it can. But it needs to get politics out of the way.

A large proportion of Americans, then, appear to have problems with working motherhood, but not with … working mothers. What does this mean? What message are respondents trying to convey to pollsters?

People’s answers vary substantially according to a mother’s life circumstances, ranging from truly overwhelming support for her work when she has good child care, likes her job and needs to earn money, to extremely meager support if her child care is bad, she doesn’t need money and/or doesn’t like her job.

The fact that most Americans do not have access to high-quality child care, Jacobs told me this week, undoubtedly plays a very large role in driving survey results that find that people in our country, despite their positive feelings toward contemporary women’s changed lives, remain highly ambivalent about two-income families.

Rather than fighting about what mothers should (or should not) do, we’re now deeply divided about what society – and our government in particular — should (or should not) do to support them.

The fact that American attitudes have evolved in this way – that we’re thinking clearly now about the problematic conditions in which working families muddle through their lives, and not continuing to obsessively focus on the good or bad “choices” that mothers make – means that we’ve conceivably reached a true turning point in our country. It means that – despite the seeming hopelessness of our fatally divided Congress — this could potentially be a very promising time to at least start a meaningful conversation about solutions and change. Universal public education for children under age five is on the table, with White House backing, for the first time since the very early 1970s. Two states – California and New Jersey — have paid family leave programs in operation; in the state of Washington, such a program is awaiting implementation, and a handful of other states are now exploring how they might provide paid leave as well. And there are a number of high-profile female members of the U.S. House and Senate eager to push forward a legislative agenda centered around improving the lives of American families.

Working parenthood does not have to be a painful, anxiety-and-guilt-inducing, seemingly intractable problem in our country. It’s only politics that makes it so.

via What People Really Think About Working Moms | TIME.com.

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