Taking Collegiality Further: Part-Time Practice
Although the Palo Alto Medical Clinic may no longer be "family" for its physicians, it has made major efforts to let doctors spend more time with their own families while still providing the best possible patient care. Several partners today take advantage of Clinic policies permitting part-time practice, through which two doctors generally share responsibility for a single group of patients. Even doctors who practice full-time say that, in the spirit of collegiality, partners willingly help each other meet outside obligations, such as attending a child's soccer game.
The Clinic's "family-friendly" focus is one of the biggest draws for newly graduated doctors, for whom flexibility to meet outside commitments is often as important as salary and benefits. As with so much else in its history, the Clinic is unusual among medical organizations in how strongly it embraces the concept of part-time practice. From the leaders' perspective, however, a family-friendly culture not only allows it to continue attracting the best doctors at a time when work-life balance is increasingly important, but also pays off in preventing those doctors from suffering burnout and frustration down the road.
‘Gentlemen…and Ladies': The Growing Influence of Female Physicians
While both men and women benefit from family-focused policies, it was the growing number of female physicians that prompted the Clinic to implement more flexible practice options in the 1980s. As in other American professions, the physician population for most of the 20th century was predominantly male. Dr. Esther Clark was one of the first female doctors in the country when she joined Dr. Russel Lee's practice in 1927. In later life, she recalled becoming interested in medicine through a Palo Alto High School science class. When the teacher one day asked what each student planned to study, Esther dared to say she wanted to be a doctor. The other students burst out laughing, but the teacher said, "What are you all laughing at? Of course she can be a doctor, and she will be a good one, too!" The teacher was right. Dr. Clark went on to become the first pediatrician between San Mateo and San Jose, and her tenure at the Clinic lasted 45 years, long enough to care for three generations of children.
If the Clinic was unusual for having brought a woman on board so early, her colleagues apparently found her presence unremarkable. Dr. Clark was tough and no-nonsense, committed to improving children's health and loved by her patients. She took an active role in Clinic life, serving as head of the Department of Pediatrics and a member of the inaugural Executive Board. The fact that she was a woman was "never a thing," said Dr. R. Hewlett Lee. Parents trusted her with their children because "she didn't give you an opportunity not to trust her," he added.
Dr. Clark's role as a founder may have made the Clinic open to the idea of female physicians, but that acceptance did not necessarily translate into volume. For decades, the number of women in the physician partnership at any given time could be counted on one hand. Female physicians came and went, staying for a few years as employed or temporary doctors before moving on. There were a few exceptions; for example, Dr. Anna Barnett, wife of Dr. Tom Williams' original partner, Dr. George Barnett, joined the Clinic to fill in for doctors during World War II and stayed the rest of her career. But by and large, women physicians were a rare occurrence at the Clinic and in medicine as a whole.
One reason for the dearth of women with M.D. degrees was the demand placed on a doctor's schedule. How could the need to make house calls at any hour of the night be rectified with a woman's responsibilities to husband, home and family? Many early female physicians, Dr. Clark included, were unmarried or had no children. At some medical groups, women physicians who did become pregnant were told they would have to leave. By contrast, male physicians had wives at home who were expected to care for the children and household, freeing the doctor to see patients whenever and wherever he wished. The 1962 Palo Alto Medical Clinic physicians' manual even included a special section on Clinic wives: "Partners should always keep in mind the vital part their wives can play in promoting their professional success," it read. "They should do their best to provide the opportunity for their wives to have a congenial social life and to take part in the many civic and professional activities which are available. With the pitter-patter of little feet in the household, this may be a counsel of perfection, but it is wise to realize that time off for your wives may bring large dividends through the contacts and friendships they make."
At the Palo Alto Medical Clinic, "I didn't sense prejudice [against female doctors], but the pool of women educated in the various specialties we were searching for was very limited," said retired physician William Clark. "The percentage of women in medical school when I first came here in 1947 couldn't have been more than 10 percent."
Actually, it might well have been substantially less. Dr. Lenore Sheridan, a Clinic pulmonologist from 1967 to 1987, was one of only four female students out of 120 in her medical school class at North-western University. There were eight women among the 365 members of her residency class at the Mayo Clinic. When she left Mayo after a few years on staff, she and her husband chose to relocate on the West Coast. Looking for new practice opportunities, she interviewed with a physician in Helena, Montana. "After we got through the interview, he said, ‘Well, I wasn't really looking for anyone, but I just wanted to see what you looked like,'" she recalled. Later, she interviewed at a clinic in Spokane, Washington. She did not get the job, and was later told that though the hiring physicians had been impressed with her, "they didn't figure Spokane was ready for a woman yet."
Palo Alto was ready, but just because the Clinic was willing to hire her did not mean Dr. Sheridan was treated like one of the guys, she said. She went through nine interviews before receiving an offer, including one with a psychiatrist. "I knew it was more interviews than other people were going through. And the things they asked, you couldn't ask now – are you going to have children? Are you planning to practice full time?" Where William Clark may have seen no prejudice against women, Dr. Sheridan felt some resistance throughout her time at the Clinic. However, she did not feel there were different expectations placed on her as a doctor because of her gender.
The few female physicians "were friendly, although we did not see much of each other," Dr. Sheridan said. "I used to sit next to Esther sometimes at partnership meetings, and Jamp [Dr. Robert Jamplis] always addressed the partnership as ‘gentlemen.' One time I said to Esther, ‘Aren't you tired of being addressed as a gentleman?' And she thought about it and she said, ‘Yes, you're right.' And so she wrote Bob a letter and then it was ‘gentlemen and ladies,' but never ‘ladies and gentlemen.'"
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A Demographic Shift
By the 1980s, a change was taking place in medicine. As in other professions, an increasing number of female doctors were graduating from medical school. It became clear that in order to continue recruiting the best and brightest, the Clinic would have to make itself more attractive to women.
Dr. Sheridan said she predicted the demographic trend early and pushed her partners for years to realize they would need to institute "female-friendly" programs such as maternity leave to remain competitive. But what the Clinic ultimately did was make itself more family-friendly by shifting to a culture in which working part-time became feasible for both women and men. Indeed, it may have been a male anesthesiologist who forced the change in the late 1980s, when he left the Clinic after being denied permission to decrease his hours to 70 percent of full-time practice. "The leaders decided that if that was what it took to keep good people, they would allow it to happen," said Dr. Francis A. Marzoni.
Today, most part-time doctors share their practice with another physician, allowing the two to manage one group of patients as a team. The doctors communicate regularly to ensure that care is consistent and that one of them is always available to patients, most of whom do not seem to mind having two primary physicians rather than one. "I work hard to make sure the fact that I'm part-time does not affect patient care," said internist Susan Elgee. "I'll call patients back from home if I need to. It's not about, ‘Here are my hours and if it's not within those hours, I'm not available in any way.'"
Maternity leave, once nonexistent, is encouraged. "I remember consulting [primary care division head] Susan Smith when I was pregnant about how long a maternity leave I should take. And she answered me as a mother. She said, ‘Six weeks is not enough. You really should take three months. You're not going to feel comfortable coming back after six weeks,'" said internist Patti Yanklowitz. "I appreciated that."
Beyond formal Clinic efforts to help doctors balance work and life, individual physicians cover for one another under the expectation that their partners will return the favor. "If somebody says, ‘I've got to fly to Chicago because my mother got sick,' there are probably five or six people who jump in and say, ‘I'll take call for you,'" said family practitioner Jay Schlumpberger. "This is a place where the people I work with I consider my friends."
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