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How to Advocate for Yourself in Medicine

My first year as a mother was a blur of little sleep, incessant washing of breast pump supplies, breaking speed limits to and from work to make it to my son’s bedtime, and struggling to find normalcy and remember who I was in the midst of it all. There’s no guidebook on how to be a good mom and doctor; most of the time, female physicians learn how to juggle in real time but don’t specifically discuss how they do it. After breastfeeding for a year as a surgeon, and having received both good and bad advice on how to advocate for yourself, these are the lessons I’ve learned this year: 

1) Find allies.

Allies aren’t just friends. They are individuals who have dealt with what you’re dealing with: being a physician and mother. The more specific you can get, the better. A mother of two who is a surgeon can help you figure out how to prioritize surgical tasks in the context of motherhood; the same can be said for any specialty (anesthesia — how to sneak pump supplies into the OR; primary care — what’s the best way to chart efficiently and finish notes and orders before going home; etc.). The key to finding allies is ensuring they are true allies. When I asked a fellow surgeon mom how to advocate for blocked time in my clinic to pump, her reply was, “You’ll just have to figure out how to do it all — sorry, I know that’s not the answer you were looking for.” This woman was someone who clearly hadn’t committed to her own wellbeing, nor was she invested in mine. After this conversation, I sought out other mentors via Facebook and found an entire community of women (see Dr. Milk) who had forged their own paths for ensuring their nursing success. Reading stories of how courageous and committed these women were to making it work inspired me to advocate for myself. 

Ideally, you want to have allies in your workplace, but if you can’t find them there, then find them through other avenues (search “Doctor Moms groups” on Facebook, go online dating for mom friends through apps like Peanut, Momco, etc.). When I had just moved to a new city and had zero mom friends, I joined a local doctor’s wives book club and found these women to be some of my best allies, as they understood medicine because of their spouses, but also sympathized with the difficulty of being a mother.

2) Seek out sponsors.

Sponsors and allies are not the same thing. An ally will listen to your story and support you, and give you words of wisdom (and potentially, wine and chocolate, if that’s what you prefer). A sponsor is someone who can implement change on your behalf for your benefit. These are typically individuals who are higher up the chain of command than you are, and choose to support you. For me, most of my sponsors have been male surgeons. I had a surgical case that ran particularly late and I knew I was about to miss yet another of my son’s swim classes. My attending asked why I seemed distracted, and I explained. Not only did he release me early, but he also rebooked his cases to start 30 minutes earlier on my son’s swim days, so that we could get out earlier on a regular basis. It hadn’t even occurred to me to ask for this. Sponsors don’t necessarily need to be experts in motherhood to understand with your needs, but you need to find people who can impact change on your behalf and are motivated to do so. 

3) Don’t be afraid to ask for what you need, but have a back-up plan.

Once you’ve located sponsors and allies, be forthright with your requests (this means that you need to think about what your requests are before making them). When I first returned to work from maternity leave, I contacted my practice manager and kindly asked for pump breaks. I detailed how long I would need breaks to last and how often I’d need them. I was fortunate that my manager’s response was positive, and that my breaks were instituted immediately. However, I know that not all women receive such a positive response, and you have to be prepared for a negative one. I thought critically before asking for what I wanted and considered how far I was willing to go to get what I needed. Would I go to Human Resources (HR) if the practice manager refused? Would I be willing to risk my job? Would I seek out legal representation? These are all uncomfortable questions, and, as physicians, we’re afraid that asking for more time at home with family will make us seem needy or lazy. I knew in advance that my plan was to escalate the situation to HR if I received negative feedback. If HR wasn’t helpful, I’d likely try to find additional, non-official methods of improving my schedule. If that failed, I’d go try to find a sponsor (back to step No. 2) who could improve the situation through stronger advocacy. I also knew that I wasn’t willing to leave or pursue legal representation for this specific issue.

4) Be persistent, yet willing to change.

If you feel that the negative response you’re receiving is repetitive and unyielding, ask yourself if this is where you truly want to work. If your situation is temporary, perhaps surviving the storm is necessary. But if not, consider what you’re willing to change to make things better. However, being willing to change does not mean willing to accept circumstances that make you miserable. The key is to develop a better technique for treading water — not to drown under a mountain of rocks because the system won’t help move the rocks from above you. If you’ve tried to request changes and been met with resistance, ask yourself if there are any other avenues open to you. The practice manager and HR said no — what about developing a plan with your managing attending and front desk coordinator? What about reaching out to leadership in a different department? Be creative! Advocacy doesn’t always mean going to the most obvious, immediate person. 

I realized early on in motherhood that I was spending far too long in the office and hospital charting. There was just no way to make charting less onerous. It’s one of the top things that physicians consistently rank as the worst part of the job. I tried bringing my charts home, only to find myself distracted by my family and wanting to spend time with them. I knew I needed to change something, so I committed to developing improved note templates on the weekend and then forced myself to write brief concise notes in-clinic, between patients. I simply couldn’t remain a prolific writer and see my son for an hour before bed. Something had to give. Similarly, when I was pumping between surgical cases, I realized that I was missing out on some of the things that were expected of me: my operative notes were slightly briefer, my introductions to patients less drawn out. It gnawed at me until I realized I simply couldn’t do everything. I needed to prioritize my family and my goals at home as much as I did my career goals. 

5) Reevaluate your needs often.

Sometimes it is difficult to recognize what specifically is causing you to struggle as a mother. One day, I asked my partner why I seemed so unhappy and he replied that I wasn’t spending any time on myself. I was working hard, I was investing in being present when I was at home with my son, but I didn’t do my makeup anymore (something I used to enjoy), didn’t exercise, didn’t read books independently. In short, I had abandoned myself. At this point, I had made the “asks” that I wanted. I was more efficient in the OR, in the clinic, and had created a more efficient workflow at home (hiring out cleaning, subsidizing cooking through apps such as Emeals and Plated) — but I wasn’t using the time I freed up for my own personal benefit. Instead, I’d spend time watching television or on my phone. So, I set a strict bedtime for myself at 9 p.m., and an alarm so that I could wake up and go for a run every morning. I let nothing deter me (if I was on call, I argued that a 15-minute run wouldn’t derail a consult; nor would it ruin my workflow in clinic to be several minutes late). I was exceedingly happier once I started treating my morning run as an appointment that nothing could stand in the way of. 

6) Give yourself grace.

This advice is the hardest for me to accept and to give. We miss bedtime and we feel like we failed them. We miss a soccer game or a gymnastics meet and again, we wonder what kind of psychological damage we’ve done. Try your best to advocate for the changes you need in order to systematically produce change, but some things are out of control, even for the most regimented person. After a seminal event, try to deconstruct it and ask yourself if there’s anything that can be done to avoid it happening again in the future. If so, advocate for a change; if not, let it go. You are not alone in your feelings — there’s a very large community of female physicians who also have difficulty balancing it all. We are each other’s allies and each other’s sponsors, and the equity we deserve in medicine will come to fruition if we keep uplifting one another, advocating for our female counterparts, and ultimately giving each other grace. 

Dr. Muldoon is a minimally invasive gynecologic surgery fellow, a mother to the world’s tallest one year old and a 7-year-old Labrador, a wife to a kind Canadian, and an avid reader and fridge magnet collector. Dr. Muldoon is a 2020–2021 Doximity Op-Med Fellow.

Illustration by Jennifer Bogartz

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