Letters from Maine

Is it time for home economics in medical school?


It is no secret that across the entire job spectrum women are generally paid less than men for the same work. Pediatrics is not immune to this persistent blight (“Gender differences in earnings of early and midcareer pediatricians.” Pediatrics. 2019;144[4]: e20183955). However, Dr. Anita Raj, PhD, feels there is “cause for cautious optimism” for pediatricians in the most recent data as there is some evidence of a narrowing of the gap for younger professionals generally. And pediatrics “appears to be managing the gender wage gap better than most” (“The gender wage gap in pediatrics: Are things getting better or worse?” Pediatrics. 2019:144[4]:e20192437). Nonetheless, even when pediatrician earnings were adjusted for a comprehensive set of characteristics, women still were earning 94% of what men earned.

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But a paycheck is only money, and there is more to life than what is in your pocket. More troubling than the gender wage gap are the gender-related discrepancies related to work-life balance reported by Starmer et al. (“Gender discrepancies related to pediatrician work-life balance and household responsibilities,” Pediatrics. 2019;144[4]: e20182926). Reviewing the responses of nearly 1,300 pediatricians, the investigators learned that, “Women pediatricians were more likely than men to report having primary responsibility for six of the nine household responsibilities, including coordinating schedules, doing laundry, grocery shopping, cooking and cleaning, and caring for pets.” Not surprisingly, women reported less satisfaction with their share of the responsibilities. The authors also found that while half of the female pediatricians always felt rushed, only a third of male pediatricians reported feeling always pressed for time.

Are any of these data surprising? Getting to the point where the gender wage gap is closing has been a painful journey into uncharted territory for many women. Clearly, more money for female pediatricians is not going to provide a quick fix for the work-life balance gender discrepancies that the Starmer paper exposes. There may be some families for whom more money will make hiring day care and housecleaning more affordable. However, the perception and stereotype of who is responsible for the management of the household is going to take much longer to erode.

Dr. William G. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years.

Dr. William G. Wilkoff

In the 1950s when I was in high school and junior high, there was a mandatory course called “home ec” (home economics). The girls were taught cooking, sewing, and some basic child care. Meanwhile the guys took “shop” where we learned to make bird houses and spice shelves and spent the last 15 minutes of the class cleaning up the sawdust. Of course this was stereotyping at its finest. As my younger sister followed me in school there was a brief period of enlightenment during which the genders switched classes midway through the year before home ec and shop left the scholastic landscape. Over the ensuing decades there have been short bursts of enthusiasm for a variety of programs sometimes labeled Family and Consumer Studies but these courses often seem to be aimed at students who have been perceived as having less academic promise.

Maybe it’s time for medical schools to resurrect home ec and include it in their first year curriculum? A mandatory course in Family and Consumer Studies might go a long way to breaking down stereotypes and laying bare the challenges of managing a family before the painful wakeup calls begin. I can envision role-playing sessions and visits from physicians and spouses across the age spectrum to discuss how they have succeeded and/or failed to balance the household responsibilities across gender and time.

A balanced sharing of household responsibilities is one strategy for staving off burnout that can work. A family is a team. A little bit of preseason drilling and some professional coaching may pay some big dividends when the work-life balance game begins for real.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at pdnews@mdedge.com.

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