The hunt for oxytocin

Why do single, middle-aged, female EPs have the smallest enrollment rates of ACEP membership? This question has been buzzing around ACEP circles. As I have spent a great deal or time ruminating about subtle EM gender differences I have come to some of my own idiosyncratic conclusions. I think the answer comes down to “isolation”, not in the whiny left-out-of-the-boys-club sense but something much more complex. In EM we spend most of our internship year being fed to the wolves of outside rotations. But during these long months, relationships are established that sustain us during the rest of our training. Sharing cold french fries and geriatric abdomens takes the bite out of that bitchy surgery resident. It is residency boot camp and we are all in it together.

Then we graduate, get a job and jump some tax brackets. But now, for the very first time, many of us don’t have any built in playmates. This is especially true for women. Few groups have a preponderance of women so we (women) often find ourselves practicing alone or surrounded by men. Anything beyond a cursory friendship with the younger guys often requires spousal/partner approval. And as for the older guys, they may be great bosses and academic mentors, but they are not usually the ones you want to chat with over an espresso about consultant cat fights or family planning.

So in our search for some cheap oxytocin we look to other professional women in the hospital. But these relationships may now be more difficult. There are no longer intense off service exposures and most of our new relationships start over patient care in the ED. As these interactions are often loaded with chaos and conflict, friendships may be slow to develop. This is only compounded by the time crunch that most female physicians with outside families experience.

OK, I know that some of you are shouting at this point: “Just go hang out with the female nurses for Christ sake!” That’s easier said than done. Although they certainly share a lot of our life issues and get the unique stressors of the ED, our relationships with them are usually different than their relationships with each other. Ultimately our patient care and job responsibilities vary and nurses tend to run in their own shift-related packs with different professional agendas.

So we turn to the world beyond the hospital to find our posse, but even this has its obstacles. We often accept wonderful jobs in cities far away from family, unknowingly sacrificing our own “surge capacity”. Your mother-in-law may be controlling but she sure would be handy during those unexpected school snow days. And although our odd hours let us mingle with both the stay-home and 9-5 working mums, many of these relationships are quickly strained when we are unable to predictably barter in either of their currencies. It is hard to commit to Tuesday and Thursday soccer pick ups or a monthly book club without some serious schedule manipulation.

At the end of the day we are left with this incredible paradigm. As female EPs we have more opportunity, responsibility and income potential than most women in history, and yet the truly meaningful connections in our life can be dangerously fragmented. Yes, of course we can have them, but we may need to consciously create them. And since so many of us seem to be wandering up this same steep mountain without maps or guides, I’d like to offer a few trail markers.

For female EPs. Choose your job location carefully. Either move to a place where you already have a good support system or understand that you will need to commit time and energy to create a new one. Seek out other women professionals. Join the American Association of Women Emergency Physicians (AAWEP). This is an invaluable underutilized resource as the members have a collective wealth of life experiences and all have truly “been there.”

Check to see if your hospital or community has a formal association of women professionals. We developed one at our hospital a few years ago to encourage networking and programming and it has been very successful. It has particularly benefited me by extending my professional relationships beyond the ED and helping me better understand the systems within my organization.

Consciously consider and develop your own career and life goals. If a traditional mentor relationship is not feasible, consider seeking out several individuals with mentoring “traits”. Understand that busy men don’t take subtle hints. Be clear about what you want and what resources you will need to achieve it. Practice negotiation and depersonalizing “no”. Finally, when you do find your niche remember to be generous to those behind you.

Outside the hospital, invest time in yourself. Yeah, duh… but many of us feel tremendously guilty about spending any more time away from our families than we already have to for work. Give yourself permission to join that book club or cooking class. This will give you an oxytocin hit and buffer your own breaking point.

For male colleagues. For starters, just recognize some of these gender differences. Keep an eye out for your new hires, make them feel welcome, and take the time to introduce them to acquaintances both in and outside the hospital. Support policies that allow flexible scheduling and which will keep good colleagues loyal and happy.

For directors and chairs. Know your staff. Understand that some EPs simply want to be clinical worker bees while others need a greater departmental/hospital identity and that the same person may seek different roles in different periods of their career. For those who are interested, consciously create opportunities to include them on hospital committees or projects and help them find mentors.

When planning informal departmental activities make sure they are inclusive such as a journal club which rotates to different physicians’ homes. Develop fair and transparent personal leave, maternity and part-time policies and most importantly, set a tone of departmental acceptance and support if your physicians actually choose to use them. Make sure that salary lines are gender neutral.

National EM organizations. Affirm that there are some unique needs of female EPs that have long gone unrecognized. AAWEP is not enough. Most academic advancement studies of women show a “cone” effect–where lots of women start out as junior faculty only to see the numbers of women further advancing funnel down with time. If we want more women to be involved with our national organizations we need to recognize subconscious bias and to offer specific programming on leadership, negotiation and development to get women out of this cone and into a pipeline.

To reach out to the broader clinical female EP work force we need to provide lectures to them at regional and national meetings which address the concerns of their immediate lives such as balance, career sequencing, advancement and child care.

Currently, a good many of us female EPs spend a great deal of time figuring out the logistics of our own individual circumstances, as a specialty it is time that we bring these issues to a bigger platform–this will improve participation and support.