Abstract
Being a physician is hard. Physicians struggle through medical school and residencies only to be confronted with the grueling nature that the modern practice of medicine has developed. In addition to treating patients, meeting with families, and charting, physicians also must keep abreast of their field. This means completing a litany of continuing medical education credits throughout the year, but it also means passing board recertification examinations every 10 years.
In this issue of Journal of Women's Health, Dr. Eden et al. describe their study that explored what primary care physicians feel and experience as they prepare for the board recertification examinations and how that preparation impacts the rest of their lives. 1 Using thematic analysis of participant interviews, the authors identified seven areas of impact on physicians: administrative duties, missing out, parenting, spousal reliance, leisure time, positive impact, and stress. Going further, the data suggest a gender division: female physicians were more likely to report a negative impact on their parenting and domestic responsibilities and leisure time than male physicians. The strengths of this study are that it begins to shed light on a stressful component to practicing medicine and that it includes direct quotes from the participants. The qualitative data offer specific descriptions of the juggling that physicians must do when they are preparing to take their recertification examinations. Key limitations are that the researchers did not have sociodemographic data that might have impacted the study and that the interviewers were specialty board employees, which could have impacted physician forthrightness.
Dr. Eden's study presents an opportunity for future research. As more and more physicians struggle with burnout, 2 one of the areas that has yet to be addressed or studied thoroughly is the impact of the recertification examinations. A study that gathers sociodemographic data of respondents, that includes specialists (Dr. Eden's study only included primary care physicians), and that is conducted by nonboard employees would be valuable. Moreover, learning the coping mechanisms of physicians as they prepare for their examinations would be useful for developing workable solutions to ease stress.
Viewing Dr. Eden's study against the greater context of the American medical system, the study's results cast a warning for sustainability. We know women are now the majority of medical school matriculants, 3 women choose family medicine more often than men do, 4 and American medicine is prioritizing primary care. 5 Thus, what women physicians are doing is critical. However, we also know that women physicians experience higher rates of burnout than their male counterparts, 6 and that one aspect of stress is the board recertification examinations. Women physicians still bear the brunt of childrearing and domestic duties, 7 –9 and the time needed to study for and pass the examination would be coming from an already-filled schedule. Taken together, it is conceivable that the stress related to preparing for and taking the board recertification examinations might become overly onerous so that women leave the profession and a gap is created within the field of primary care.
Although women physicians are incredibly accomplished, there are limits on what they can or should do, for their own health and the health of those in their care. As a society, we cannot require that families restructure to more equitable distributions of the domestic or parenting duties. Each family is structured according to the needs and wants of those within it. However, as a society, we do have the power to change the culture of medicine to account for competing demands on a physician's time and allot time and support for studying for the board recertification examinations.
Changing the culture of medicine and accounting for personal needs will be difficult, but it is attainable. Eden's study suggests offering physicians protected time to study as they prepare for their examinations or offering incentives to study. A more tailored approach might have an organization survey its physicians to develop a panel of options and then meeting with the individual physicians preparing to study and seeing which options that physician prefers. An organization might also consider creating a designated study space with study materials and comfortable surroundings to promote concentration. Unconventional ideas that would more directly impact the home environment might include offering stipends for housecleaning, meals, or childcare during the physician's study period. Finally, there is the possibility of restructuring the recertification process so that it reflects and respects the many demands on a physician's time in today's culture. This restructuring might make the examinations more focused on or relevant to a particular physician's practice. Alternatively, it might incorporate continuing education requirements, or it might utilize data gathered by health care administrators as a physician practices.
In sum, the results of Dr. Eden's study are not surprising. Women professionals have struggled to balance work and personal lives for a long time. Proposed solutions have been for women to lean in, network, work harder, focus more, and the list goes on. Most recently, the juggling act has been described as women's “choice.” 10 Within the environment of medicine, there is little choice. Women physicians must work demanding schedules, and they must study and pass their recertification examinations. Physicians have duties to their patients and to their colleagues. Although there is no choice about needing to pass the recertification examinations, there is room to modify the recertification examinations and the expectations that medicine has of its physicians. Dr. Eden's study begins to describe the stress physicians face and invites discussions about solutions.