Book Review

Women in Medicine: Career and Life Management

N Engl J Med 2002; 347:1459October 31, 2002

Article

Women in Medicine: Career and Life Management
Third edition. By Marjorie A. Bowman, Erica Frank, and Deborah I. Allen. 187 pp. New York, Springer, 2002. $29.95. ISBN: 0-387-95309-4

This is the third edition of a book that was previously titled Stress and Women Physicians. A new author, Erica Frank, has been added, as have data from the Women Physicians' Health Study, of which Frank is the principal investigator. With these additions, many chapters take on a scholarly tone, and the book can be read as a scientific monograph designed to communicate data regarding women in medicine. However, other chapters appear to be intended to advise and coach individual women physicians throughout their busy lives. These chapters directly address the reader, with language and content along the lines of a sophisticated self-help book. This hybrid approach has its advantages; as scientists, most physicians are information-driven. However, it also leaves me uncertain as to the book's goals and intended audience and puzzled as to how to review what appears to be two books in one. To try to sort out this identity crisis, I turned to the preface, which states that “the major purpose of this book is to help women physicians cope with stresses.” Even so, there is tension between the goal of trying to help each individual reader cope with her own situation and the goals of reporting on the current state of affairs and of trying to influence the way in which medicine as a profession treats women physicians.

The order of the chapters indicates that stress, though not mentioned in the title, is still the primary emphasis of the book. The first chapter, “Historical Context,” is a mere three pages long and could easily and appropriately have been expanded. The second and third chapters are entitled “The Stress of Our Profession” and “Stress Prevention and Management.” I found this sequence puzzling. As a woman physician, I certainly agree that our lives are stressful, but it seems that more general topics might start off a general book on career and life management, thereby providing context for the stress-related chapters and clarifying their relevance.

After the initial two chapters, the book has some trouble finding its voice. The fourth chapter is called “Enjoying a Marriage or Partnership,” and the fifth and sixth focus on household work and child rearing. It is not until nearly the final chapter in the book that the subject of women physicians as healers is addressed. I could not help but think that the order of the chapters implies that women physicians are first stressed, second reproducing, and finally healing, only as an afterthought. Although I sincerely doubt that this is what the authors had in mind when creating their book, to the extent that reading any book is a conversation with the authors, the priorities appear to be rather skewed.

That said, many of the chapters are superb and offer a great deal of insight that may be particularly helpful to younger women physicians. For example, chapter 6 includes a nice discussion of the pros and cons of choices in the timing of childbearing as well as different types of day care. In discussing the “second shift,” the authors make note of a few important ways in which the woman physician's experience is made difficult. Time-sensitive chores, such as preparing dinner, are often performed by women, as compared with time-insensitive chores, such as yardwork, which are often performed by men. The authors also consider the greater emotional and mental impact of nonprofessional duties that involve multitasking and frequent interruptions — again characteristic of women's work in the division of labor in two-career couples.

Other chapters are less informative. In particular, I found the chapter on sexual harassment to be unenlightening. It would have benefited greatly from a similar pros-and-cons dissection of various personal strategies for dealing with harassment. A presentation of successful strategies for personal or institutional change as well as a list of resources would have been most welcome. The chapters on ethnicity, the older physician, and physical and mental health seem largely designed to convey the results of the Women Physicians' Health Study. Although these chapters are admirable and enhance the scholarly quality of the book, they contribute to the identity problem noted above. Furthermore, issues pertaining to work–life balance remain relevant to all women physicians but are addressed only in the context of child rearing.

The chapter on academia is extensive but also would have benefited from a presentation of personal strategies, a list of resources, and a discussion of positive examples of institutional change from the peer-reviewed literature. The chapter on practice is limited to productivity, income, and professional satisfaction and avoids many practical issues such as the effect of part-time work on partnership status, women in decision-making or managing-partner roles, practice equity held by women physicians, and relationships between women physicians and office staff, to name just a few. There is little coverage of career management, despite the book's subtitle.

There is much for women in medicine, and for men for that matter, to learn about career and life management. If the reader begins this book from the end, some of the bothersome issues in the prioritizing of topics may be alleviated. The chapters that are done well provide information not readily available elsewhere and make this a valuable book for younger women physicians struggling to make a life for themselves.

Pamela S. Douglas, M.D.
University of Wisconsin, Madison, WI 53792