Dr. Caroline Gérin-Lajoie:
Welcome to season two of sound mind, a podcast about physician wellness and medical culture. I'm your host Dr. Caroline Gérin-Lajoie. There's no doubt healthcare workers have suffered tremendous stress of the pandemic. In this podcast series, we've spoken to a range of physicians about the toll COVID 19 has taken on their mental health. But for one group of physicians, the impact has been particularly acute. According to a recent study, published in [Gemma 00:00:38] network open, physician mothers scored substantially higher on measures of anxiety and depression. Part of the reason, is that physician mothers take on a disproportionate share of childcare. Of the 215 early career physician parents surveyed, 25% of the women said they were primarily responsible for providing childcare or schooling. For the men, it was less than 1%. In households with two physician parents, that number dropped to 0% of men. It's a number that shocked Elena Frank, the study's author.
Elena Frank:
Incredibly startling. We have the sense, especially these days, oh that the gender roles are more egalitarian and particularly in these younger folks and relationships. And so, it is really striking. And I think, I mean, it speaks a lot, I think, to the culture of medicine and I mean, how deeply patriarchal it is. And how so much has not changed when it comes to policies, when it comes to culture that there's just a lot of room for growth here that needs to happen.
Dr. Caroline Gérin-Lajoie:
We have two physician mothers joining us to offer a reality check on being a physician mother. Dr. Rita Watterson is a psychiatrist and mother of two children. She's in Calgary. And, Dr. Shelley Zieroth is a busy mom and cardiologist in Winnipeg. She is also president intellect of the Federation of medical women of Canada. And full disclosure, I'm a psychiatrist based in Ottawa, married to an emergency room physician. Mother of three, and stepmother of two. Welcome to you both.
Dr. Shelley Zieroth:
Thanks for having us.
Dr. Rita Watterson:
Thanks for having us.
Dr. Caroline Gérin-Lajoie:
When the pandemic began, how did it impact you as a mother? And Shelley, let's start with you.
Dr. Shelley Zieroth:
So, I think we were all very much unsure of what was to come. And I think that the biggest impact was virtual school. Really, I have such great respect for what our teachers do. It was a completely different world for me. I remember the first attempt at online school in my mind, it did not go so well. We had to learn all these different apps and passwords. My daughter was in grade two at the time, so was not independent. Really had minimal screen time exposure in comparison to two years later. She's a pro and we're a pro at virtual online school as well throughout the waves. But wow, that was such a big change. And then at the same time, I'm clearing out my home office that really had functioned as a storage room for eight years and trying to turn it into a home office as well. It was incredibly challenging and stressful, I think for her and for me.
Dr. Caroline Gérin-Lajoie:
And Rita, how about you?
Dr. Rita Watterson:
At the start of the pandemic, I think was especially challenging for our family. Our second baby was born on the leap year in 2020, and then the pandemic hit just a couple weeks after that. And then, my other passed away just shortly after that. And then my husband as an internist, started on the COVID wards immediately at that point. And so, I think just the culmination of all those factors, which at that point was somewhat unique for an individual. But not unique during the pandemic, as we all experienced so much loss in grief. Was particularly difficult to wade through.
Dr. Caroline Gérin-Lajoie:
That stated, Shelley, I'm very lucky that my children are not school age. My children are four and two. And so in a lot of ways, they were sheltered from those exposures. And we were able to trudge through day by day, as having two little ones in our house.
Dr. Rita Watterson:
Yes.
Dr. Caroline Gérin-Lajoie:
And I'm sorry for your loss Rita, during that difficult time. One of the biggest findings from the Gemma study, was that physician moms reported greater symptoms of anxiety and depression during the pandemic than physician dads. Are you seeing a similar impact on your wellbeing or on that of your female colleagues?
Dr. Shelley Zieroth:
I think a large portion of the weight of this pandemic has been on women in healthcare in general. More women on the front lines, in both physician and nursing roles, are a lot more of the home, I guess, workload is their responsive as well as the study pointed out. And of course, this will translate into more depression and anxiety. And it really forces you to do what you can for your wellness and your wellbeing, and to reach out to your colleagues and your peer support. This, I keep saying it took a village to get through this. I remember the incredible amount of fear I had as we entered the pandemic. And, as a double-physician family, you're scared, like you are going to be exposed, not the people in your neighborhood.
Dr. Shelley Zieroth:
They're at home hunkered down, you have to go in everyday and face COVID. And I still remember because of the fear and anxiety, we actually, we did our wills early on. It's just like, I don't know how to explain it, but that's the fear and anxiety that I had. We redid our wills and I'm sure most people on my street didn't even think about doing that. So I think I'm in a better place now, just came back from vacation first one in two years. And that really helped, I guess, recenter myself and our family.
Dr. Caroline Gérin-Lajoie:
And Rita, how about for you?
Dr. Rita Watterson:
Yeah, I mean, I think it's not surprising to hear that women are suffering more from depression and anxiety during the pandemic, especially within the field of medicine. We think in general that women are more prone to these conditions in this phase of their life. But certainly, when we hear the bulk of the childcare and bulk of these macro and micro decisions that we're making during the pandemic fall to women. It makes entire sense that women can only tolerate so much or window of tolerance is only so big. And certainly that will result in greater burden of anxiety and depression.
Dr. Rita Watterson:
And in my department, I work at one of the bigger hospitals in Calgary and do primarily inpatient psychiatry. And there has been a number of female psychiatrists leave hospital based psychiatry and move towards outpatient practice. Whether that be the burden of a call, the difficulties, especially that Alberta went through in early pandemic with our government. But, moving towards to protect the mental health of themselves and their families. So they can be afforded a more flexible work practice that better supports them. And I thought that was an interesting thing that happened for our department.
Dr. Caroline Gérin-Lajoie:
Rita, your husband is an internist. Shelley, yours is a nephrologist. And mine, is an emergency room physician. We mentioned at the beginning of the podcast that in households with two physician parents, 0% of physician fathers said they were primarily responsible for childcare and schooling. And this finding actually led the studies author to advise young women in medicine, not to marry another doctor, listen to this.
Elena Frank:
A couple months ago, I was meeting with a pre-med undergraduate student that I work with. And I found myself actually, saying to her, when you're in med school, just don't partner with another physician, if you can avoid it. And then it felt awful that I was giving that kind of advice, but that's what... I mean, this is something that I feel like if you told folks, "It'll be easier for you in your career, and your life, and your balance, if you don't partner with another physician." To give that advice to women. But in reality, that's the truth. It shouldn't have to be that way, but that's how it seems at the moment.
Dr. Caroline Gérin-Lajoie:
Have either of you received similar advice when you were dating your physician husbands to be. And, do you think that kind of advice is warranted? Rita.
Dr. Rita Watterson:
Ah, it makes me quite sad to hear her give that sort of advice. I mean, personally, I feel very lucky and my husband and partner, and the path that we've gone down. But I can hear a lot of what she's saying is, I think personally of some of the things that we have done. And, we have put Luke's career in the forefront at times. I think of his fellowships, his time on MTU, and it's hard to negate the service aspect of his career versus mine. That stated, I think there are ways that we can navigate that. And both personally and structurally, to start to shift that dynamic and reframe what we're trying to do there.
Dr. Caroline Gérin-Lajoie:
What about for you, Shelley?
Dr. Shelley Zieroth:
Yeah, I don't think I would make a statement like that on a single study in any way. I would agree that the online classroom aspect, my husband doesn't know how to log into Google classroom, or Seesaw, and all of these other apps. He's never done it the whole time in two years. And so, I'm the virtual school pro, but he does a lot of the childcare as well. Because, I think academically I am the busier one, and I have a lot of Zoom meetings and conferences that I'm on virtually, starting to travel again. And so, I think my career really has been supported well by my husband physician. He takes Taylor to all the hockey and all the extracurricular, and we really do share in the parenting. And we've done this really, in the absence of a lot of structural processes that encourage that shared parenting as well. As Rita mentioned, we have a lot of policies and changes that could be made at an academic level to help support dual-physician families. And, better parenting leave sick days would be great to have more consistent as physicians.
Dr. Shelley Zieroth:
And that has really just started as a point to the pandemic. But, there's so many changes that we can make to really help support double-physician families, I wouldn't discourage it at all. And especially in the pandemic, I think sitting across the table from someone who has an idea of what it's like, or day-to-day life is like, it's really important. I remember thinking that a physician husband would understand my passion and dedication for medicine. And I guess we're saying that like all couples, although there can be challenges, there can also be great benefits and great happiness.
Dr. Caroline Gérin-Lajoie:
The study also showed that as early as residency, women are already making decisions about their medical careers in anticipation of having to balance motherhood and medicine. Listen to this.
Elena Frank:
We found that in six years of finishing residency, that about 70% of women had already considered going part-time and almost no men had. And you just see these huge gaps emerge very early, all related to the work family balanced dynamic.
Dr. Caroline Gérin-Lajoie:
Shelley you're in cardiology, a very demanding specialty. How much did the prospect of being a parent factor into your choice of specialty?
Dr. Shelley Zieroth:
It really didn't for me. And as a result, I became a parent later in life. I was a 40-year-old mom giving birth, and I think they referred to me as a geriatric pregnancy, in fact, which shocked me at that time. But so I really chose my career first, and then in my late thirties appreciated that I also wanted to be a parent, and took a few tries, have to say. And, I do see more young women making career decisions in order to facilitate being a mother in or earlier stage in their career. And I think this really does factor into what we refer to as a leaky pipeline, particularly in subspecialties of medicine like cardiology. In medical school, over 50% of attendees are women.
Dr. Shelley Zieroth:
By the time you to cardiology, 22% of adult cardiologist are women. And, the perception is that some of these subspecialties are less attractive and appealing to women because of the intensity, the on call some of the procedural based as aspects of cardiology as well, and radiation exposure are less attractive. And I think there are some important campaigns, particularly on national levels with various cardiology societies in order to promote more women to enter certain specialties like cardiology. And, if you can see somebody like yourself in those higher levels of these specialties as well, it's harder to envision yourself and target a career in something that you might be passionate about. So, I agree that I think it's happening, and I perhaps maybe the pandemic is making people really reconsider what their priorities are, as well. I don't know if I would've made the same decisions coming if I was coming through residency during the pandemic to be honest.
Dr. Caroline Gérin-Lajoie:
And Rita, what about you with your choice to pursue psychiatry?
Dr. Shelley Zieroth:
Caroline, I feel very lucky that psychiatry's what I wanted to choose and I wanted to make a career in. And, I think both my husband and I were also very fortunate that was what I wanted to pursue. Psychiatry has given me slightly more flexibility than the other specialties, in terms of being able to think about the juggle of motherhood and career. But I think that's incredibly unfortunate, that I just by luck came into those circumstances and women who are going for something like cardiology or surgery are having to navigate that issue on such a more significant level.
Dr. Shelley Zieroth:
And, I think there's this idea of motherhood is a penalty and fatherhood potentially, is a benefit. And that women, as they go through maternity leaves, and time off, and providing childcare, that we aren't as a society seeing that as a benefit. But, also understanding the benefit for the women and being able to do and manage those multiple things. Whereas for father, it doesn't necessarily come into that same existence and thought form. And when it does come into play, it's sometimes seen more as a benefit rather than a penalty, which plays out when we see these statistics around our colleagues.
Dr. Caroline Gérin-Lajoie:
Elena Frank, says her study shows how medical culture is still deeply patriarchal. Where have you seen the inequality in your careers? Maybe we'll start with Rita.
Dr. Rita Watterson:
I think in psychiatry, there might be more of a move towards gender equity in a lot of ways. I think the things my colleagues describe in other specialties, and what I read about, I don't think is inherently what women feel as to the same degree of intensity. That's not to say that we don't feel those same as well. And I think about some of these micro decisions that my female colleagues and I are making on a daily basis. And, things like nurses day, Christmas presents, a colleague leaving.
Dr. Rita Watterson:
And the thoughts around making cards for people, or presents, or organizing, or emailing, or these sorts of things. Recently, it's come up that this is falling on women primarily. And this is a very small little thing, but it takes up our space and our time. And it takes away from us doing our job. And I think our group of female psychiatrists is becoming more mindful of when we start to see these gaps and these little pieces of what we're doing. Not on the smaller though, but also trying to stretch up to the structural level, to think about how we can have bigger conversations around them shifting dynamic.
Dr. Caroline Gérin-Lajoie:
And what about you, Shelley? Have you seen that inequality impact mothers in cardiology?
Dr. Shelley Zieroth:
Women in cardiology, mothers in cardiology, I think that there are definitely some major challenges. Women get paid less for the equal amounts of work. They get less academic opportunities in terms of being invited to be reviewers on editorial boards. The leadership both at the university level and at professional society level is not a representative of the percentage of women who maintain those memberships as well in terms of promotion as well. The number of women who make it to rank a professor in medicine is extremely low and not equitable. There are so many challenges everywhere, Caroline. I think that there are efforts to, I guess, initiate equity programs. I think we've got so much work to do. We're just starting to see some favorable changes that will help promote more women in medicine. And, get us to those decision making tables that can hopefully, influence policy and procedures to bring more women to the face of medical leadership.
Dr. Caroline Gérin-Lajoie:
And Shelley as a follow-up. Do you believe that the pandemic has made all this even worse, even harder?
Dr. Shelley Zieroth:
I see pros and cons to how the pandemic has influenced maybe not just women in medicine, but the medical workplace. I think that there is a much greater ability for a flexible work schedule now. So I'm considered to be working from home still. I'm not staying at home with the kids, I'm working from home. And so, I think that the flexibility in this virtual environment is in favour of women. I think another positive aspect of the pandemic is the reduction in travel for conferences. At one point I was travelling at least once, if not twice a month, internationally, nationally as well. And it was really interesting, recently the European society of cardiology made a policy change towards supporting more virtual meetings. Significant reduction in face to face. And, they showed an impressive graph of the reduction in their carbon footprint during the pandemic, because of less flights for all of these meetings. So, I couldn't even possibly keep up with my conference and travel schedule that I have currently. So, I think that has been a favourable aspect of the pandemic.
Dr. Caroline Gérin-Lajoie:
And Rita for you. Do you think that the pandemic is making it even harder on physician mothers?
Dr. Rita Watterson:
My quick answer there, Caroline, is yes. I think when we look at the data out of that study, that it suggests that women are taking the burden of the work and that the pandemic has highlighted that in a number of ways. That when push comes to shove, that women often will step into that role more quickly in childcare and home care to ensure things continue on in that front. I agree with Shelley, I think that it has created some flexibility within our home space around working from home, which I hope will continue into the future. But, I think it's also highlighted these conversations around these discrepancies. And how we potentially, once we come out of this and as we come out of this, need to be shifting this.
Dr. Caroline Gérin-Lajoie:
You both seem to have a mindful approach to balancing work and parenting. What advice would you give to young women or even to your own daughters who wonder if it's really possible to be a physician and mother without burning out? Rita, will start with you?
Dr. Rita Watterson:
Well, I think my husband and I would both support our daughters in pursuing whatever career they want to, medicine or not, and any specialty or not. And I think about the personal strategies that we do that is to teach our children about how to have these assertive conversations. And, difficult conversations about topics that we value and care about in our house personally, in the workplace, I think about this phrase, name it, to tame it. And that comes from naming the emotion that's coming up and thinking about what we do with that emotion. And when I feel when a patient, my child feels anger, or sadness, or something coming up, it's important that as females, we address those things. Because if we don't address what's happening internally and start to externalize it with meaningful change, then we aren't going to be able to get at many of these issues, which we are trying to move.
Dr. Caroline Gérin-Lajoie:
And Shelley, what would be your advice?
Dr. Shelley Zieroth:
I think we come from a work hard, play hard family. I mentioned, we just came back from our first vacation in two years and I didn't do any presentation, no recordings, no reviews. We laughed. We had so much fun. We played games and we've really tried to find a healthy balance during the pandemic. I think my daughter does want to be a physician despite having watched two parents go through the pandemic. Hasn't dissuaded her in any way. And I have to say, I'm just so impressed with her generation's awareness of mental health and just being comfortable about speaking about their mental health. And I think, frankly, I took some cues from her as well. And you know, about to talking about your feelings, and your emotions, and your fears. And so, we do that on a regular basis and in part it's also because of her cues to us.
Dr. Caroline Gérin-Lajoie:
Yes, we do learn a lot from our children. Rita and Shelley, thank you both so much for joining us today.
Dr. Rita Watterson:
Thanks for having us.
Dr. Shelley Zieroth:
Thanks for having us.
Dr. Caroline Gérin-Lajoie:
Dr. Rita Watterson, is a psychiatrist in Calgary and mother of two young children. And Dr. Shelley Zieroth, is a mom and cardiologist based in Winnipeg. She's president-elect of the Federation of medical women of Canada. Sound Mind is produced by Podcraft Productions. If you're looking for resources, tools, and research on the topics covered today, please visit the CMA physician wellness hub, cma.ca. And we'd love to hear what you think of Sound Mind. Please consider giving us a rating or review through your favorite listening platform. I'm Dr. Caroline Gérin-Lajoie. Thank you for listening.