Faculty voice:

Julie Phillips: Maintain balance

May 18, 2016

Julie Phillips in an associate professor in the College of Human Medicine and the assistant dean for student career and professional development. In addition to her teaching and administrative duties, she practices family medicine in the Sparrow Family Medicine Residency Program in Lansing.

My medical students ask lots of questions, but this was one I couldn’t answer.

“What is it like to be a rural doctor and raise children?” Sarah Bjorkman asked.

It’s a challenge for women generally but it’s especially challenging for women who practice medicine in a rural setting. Thus, I, Bjorkman and three other students, as well as other medical school faculty, undertook a study of how women physicians in rural areas balance the demands of work and family.

Our findings, based on interviews with 25 women family physicians in rural areas all over the country, are published in the May/June issue of the Annals of Family Medicine, a prestigious medical journal.

Those who were able to achieve that balance often had employers who allowed them to work reduced or flexible hours, a supportive network of spouses, partners, parents or other community members, and the ability to maintain clear boundaries between their professional and private lives.

The issue is important because of the chronic shortage of primary care physicians, particularly in rural areas. Meeting the demands of work and family can be difficult for any physician – male or female – but it is especially so for women, because the social expectations are different for women when it comes to parenting.

That can be even more challenging in rural communities, where doctors often have more patients, broader practices, work longer hours and have fewer community resources, such as reliable childcare. Primary care physicians in rural areas, particularly women, are more likely to deliver babies than their urban counterparts. That can mean calls anytime, day or night.

I think for me the most interesting finding was learning about this network of support around these women and how important that was. When you deliver babies, you really have to be available, so that network of support is very important.

Some of the women said they usually were able to maintain a balance, but often experienced periods of stress. A third of the participants said they worked reduced or flexible hours, even though that still required maintaining a very full schedule. Some credited supportive spouses, other family members or friends with helping them maintain balance.

Setting clear boundaries around work also was important in allowing the physicians adequate time for vacations, recreation and parenting. Some of them really struggled with that, how to set boundaries. These women, they’re very committed to their patients and their families.

Although I have never practiced in a rural area, as the mother of a 9-year-old daughter, I know how difficult it can be to achieve that balance, particularly since my husband also has a demanding job. It’s a constant negotiation. You’re always trying to figure it out.

Sarah, whose question sparked the study, has since graduated from the College of Human Medicine and is in an obstetrics-gynecology residency program at the Yale University School of Medicine, where her husband, Kurt Bjorkman, who also helped with the study, is in a pediatric residency. Both graduated from the College of Human Medicine’s Rural Physician Program in the Upper Peninsula, where Kurt Bjorkman was raised.

This study could provide those physicians serving rural communities with specific ideas of how to meet the competing demands of their patients and their families. These physicians make real differences in the health of their communities. If some decide that a rural practice is too demanding, that would be a serious loss for those communities.