• Why do doctors want doctors to be so miserable?

    Austin sent me this story two days ago, and it’s still ticking me off:

    In 2007, Sophie Currier of Brookline, holder of M.D. and PhD degrees from Harvard, asked for extra time to take an all-day medical board exam. Her daughter was four months old at the time and exclusively breast-fed, and she needed more than the standard 45 minutes of total break time to pump her breast milk. The test’s overseers, the National Board of Medical Examiners, said no.

    The conflict has wended its way through the legal system since then, and late last week reached the Massachusetts Supreme Judicial Court. (Here’s my original front-page story back when I was at the Globe, the New York Times version and an update when Dr. Currier brought suit.)

    So a physician, who was also a new mother, needed some time to pump her breastmilk during the all-day board exams. She’s not asking for more time to study, or for an easier test. She’s asking for time to pump the milk out of her breasts. As physicians, you’d think this would be a no-brainer. You’d think we’d understand the physiology at work here. Evidently not.

    Look, I don’t even want to hear the slippery slope argument. She wanted some extra time to pump. Her need is obvious. I can’t even figure out what the benefit would be to her to claim the extra break time. We should be able to differentiate between actual medical need and frivolous requests. We’re doctors.

    If I’m being honest, I often think these tests are crap anyway. I don’t know of any link between test scores and performance as a physician. Some studies can show a correlation between scores on exams and performance in residency, but almost no data exist correlating scores and how you will function as a practicing clinician.

    So what does the profession gain here? We tell women as a group that that if they think about being pregnant or nursing while they need to take boards, they will be penalized, because this test is so holy and sacrosanct that we can’t possibly interfere with its process in any way to accommodate their needs. Once again, we confirm that it’s somehow important to medicine to teach physicians not to care, to martyr themselves, and to be miserable and unhappy. Evidently, showing motherhood any accommodation, any compassion, or any humanity might negatively impact the quality of the doctors we train.*


    *Yes, this is hyperbole. I’m annoyed.

    • Be hyperbolic. In this case it’s appropriate.

    • I think this is mostly a matter of the board maintaining power. Treating people like s**t because they can. However, I cannot discount some sexist behavior based upon my personal experience. I was deployed to Saudi Arabia for Desert Storm a week after it started. I got married at City Hall a few hours before getting on the plane. My wife was due to take her oral boards about a month later. She wrote and asked for a deferral, but was denied. She was upset, but she also wanted to be available if I needed help. She was actually instrumental in making sure that our ATH, Air Transportable Hospital, received a lot of the gear we needed. She went to our stateside hospital, and with the aid of my senior tech, “borrowed” a lot of stuff they sent to us.

      OTOH, my best friend asked for a deferment because his group call schedule was tight and they did not want to pay for a locum. His request was granted.

      I am still not sure if this was sexism. It may have just been callus disregard or screwing with people’s lives just because you can.


    • The American medical profession has worked quite assiduously to limit the number of practitioners (read: competitors). The profession’s success at this is one of the key reasons doctors are compensated so much more in the US than in other countries. The board exams are one of their most useful tools. I find this story disgusting, but sadly not at all surprising.

    • Isn’t this just like medical school, where the powers that be like to hold control over the students and just run you into the ground? I’ve said for years that the “medical boards” be it the MCAT, National Boards, and specialty boards, need to take the approach that many nursing boards have done–namely, the tester sits at a computer, starts answering questions, and once the computer has enough statistical analysis to determine that the tester has a high likelihood of passing the exam, then the test stops. It could take only 15 minutes or it may take 2 hours, but what’s the difference? There isn’t any, so why do we have to go through these day long tests in the computer age?

    • The absurdity that licensing. Do these test measure much that is important for the profession? I think not. PA’s, NP;s and midwives seem to do as well as doctors.

      The tests are not to test knowledge. I think that even the test supporters would admit that they are not to test knowledge but to test general competency. I think that more than that they are to restrict access to keep wages high. Consider all the Doctors that have practiced medicine in other countries now living here who cannot practice because they cannot pass the tests. There is probably a correlation between testing well and doctoring well but it is probably very, very weak.

    • Also all the MD residence and license test stuff reminds me of the “Sanford Prison Experiments” (or frat hazing ) (http://www.prisonexp.org/). The incumbents have too much power over the aspirants and our Government has support the incumbents for their own reasons.

    • Her experience is in stark contrast to my own. In July, I sat for an 8 hour qualifying exam for my PhD. At this point, I had a 2 month old who was eating every hour, so I had to pump 4 times during this period of time to make sure my supply stayed up. It was taking me 20 minutes to pump each time and time to clean the equipment, so my program permitted me 2 extra hours of break-time to pump. Perhaps the difference is that the PhD I am pursuing is in PUBLIC HEALTH. I’m glad that my program practices what it preaches, and I sincerely hope that the medical profession decides to do the same. And frankly, if my experience is representative, in taking such an exam under the circumstances that surround being a new mom, there is very little that anyone can do for you that puts you at any advantage over your fellow test-takers who have, no doubt, had many more hours to prepare and sleep in the months before the exam.