Female Docs and a Work-Life Balance in Rural Medicine

Within the overall shortage of physicians across the country, there is an even greater need in rural healthcare settings. According to the National Rural Health Association, only 10 percent of physicians practice in rural areas despite the fact that one-fourth of the country lives there.

Julie Phillips, a family physician and the associate professor of family medicine at Michigan State University (MSU) College of Human Medicine, said this is one of the primary reasons her newest research effort was worth exploration. "There is a shortage of primary-care physicians in rural medicine. It's valuable for us to know how we can support those physicians and how they can have long careers in rural communities," she says.

The research team, led by Phillips, studied how female family physicians could balance work and professional responsibilities in a rural setting. Phillips, who is also the assistant dean for student career and professional development at MSU's College of Human Medicine, said the idea came about when one of her students asked her what she could expect about maintaining a work-life balance in a rural setting.

"I didn't find much in the literature [that answered this question]," says Phillips. "There were descriptions of barriers to rural practice for women, but not a lot about how they'd be able to have solutions around those barriers. Not a lot of in-depth research."

Phillips recently spoke with Physicians Practice on what she and fellow researchers found on how female family physicians could maintain a work-life balance in a rural setting. Below are excerpts from this conversation.

What were the findings of your study and how did you reach them?

Our methods were interviews. We reached out to women who were in rural practice around the country using [list services] and word of mouth as a way of finding our sample. We interviewed 25 women. We recorded and analyzed the text. We asked them questions on their … work hours, scope of practice, how they chose this career, and what their work-life balance and family relationships were like and how those intersected with their careers. We analyzed the text of the data using a team of people, reading the interviews and thinking about the content.

They really valued flexibility and practices that supported that flexibility. They also approach their work with flexibility and accepted that the demand of their patients would vary from day to day. They also had a lot of support. They also had very supportive partners and spouses, and many of them described that as being very important for them to be successful ... Having someone around them who could take care of their children if they had to attend to patients [during an unscheduled time] was essential. They had these networks of support that made their careers as physicians possible. The third thing was they all tried to find ways to take care of themselves. They made sure they had time that was personalized and allowed them to maintain their sanity. They talked about boundaries around their work and that their patients understood they weren't available all of the time.

How are female physicians' challenges unique as rural providers? How is that different than providers in urban practices or suburban practices?

It's a little bit different than urban practices in that physicians in rural settings tend to work more hours, they don't have as many community resources, and they're more likely to have a broad scope of practice. So family physicians in rural settings are more likely to do inpatient care, emergency care, or obstetrics. They tend to be more [on] call and they need be available for more nights and more time overall for work.

The community is different in rural practices too. It can be harder to find reliable childcare. There are fewer physicians around, so the burden of work is shared among a smaller group of people. There is more time devoted to the job. Patients don't have as many resources, so it has a more direct impact on patient care. It's not as large of a community to absorb the need for patient care. So, for all those reasons, it's demanding in a different way than an urban practice.

And it's different for women … there isn't a lot written on women because it's a male dominated society. If you look back, most participants [of previous studies] are men and it's built around that model of men being the main people who are physicians. My generation of women is defining our work lives in a new way and it's something many women struggle with … in all different fields. I wanted to understand that unique perspective of women's lives. The social expectations for women are different, society still anticipates women will be primary care givers. It was actually interesting because we found in the study that the male was actually the primary care giver with the kids. The way they planned their lives the women's career would be the priority, the male partner would work his career around her career. It's different. You don't see that very often.

What were some interesting findings that surprised you?

That was biggest surprise with men taking over on childcare. I was surprised how much unseen work went into building the support networks. [Physicians] talked about how when they first came to the community, the work they had to do … to make their job possible. And it didn’t always work. Some of them said they haven't been able to solve [a particular] issue and they don’t know if [they] can stay. I can't help but think, a community is going to lose a physician because they can't find someone to babysit overnight occasionally. It's astonishing to me. There is this whole network of support needed and it's a little bit tragic when they can't get it to work. We have a shortage of physicians, we especially have a shortage in primary care, and especially in rural areas, it seems like we should be doing more to support these women who want to serve these communities. It's tragic we can't do better.

What advice would you have for a female medical student looking to go into this kind of community practice?

One thing I'll say, the women we talked to really loved their work and loved taking care of their patients. They found it rewarding. I'd never want to discourage someone from going to a rural practice, it can be an incredibly rich and fulfilling career. I would tell [the student] to go to the rural practice, but as she develops in her career to look for ways to make sure she is supported and taking care of herself. Make sure the community she goes to, look for a practice that's supportive and allows for her to have flexibility. She should look to build support in the community and ask for help. It is a team project to raise a family and be a physician, to both, you need to have a team around you. Whatever the team looks like … and make sure to take care of yourself too.