Obstetricians still wanted: mothers should read the fine print.

Harrumph! I am not the program director Dr.Plante cited in her essay on motherhood and medicine (1). However,I am a 63-year-old male obstetrician–gynecologist who spent manyyears as the residency director of an OB-GYN program at a majorteaching institution and who currently serves as the senior partner ofan 11-person OB-GYN group (5 men, 6 women). I have also livedthrough the “before” and “after” of the current revolution in medi-cine, during which women have become a major force. Given theseexperiences, I do have a few observations to make.The conundrum of the practicing female physician has in-trigued me throughout my career. The ones I have known have beenmostly brilliant, devoted, and natural caretakers, especially of otherwomen. Many have also been seriously torn by a signiﬁcant conﬂictof interest that men do not have in the same degree: the needs oftheir patients versus the needs of their children. For years, I wasuncomfortable even addressing this issue. It seemed somehow sexistto imply that women had a different family obligation than men. Mydaughter, an evolutionary biologist, helped me see the error of thatview: “Dad,” she explained patiently, “political equality is a right;everyone is entitled to that. But political equality is not gender equiv-alence.”Jared Diamond, a biology professor at the University of Cali-fornia, Los Angeles, has succinctly stated the nature of this “gendernonequivalence” in his nifty book, “Why Is Sex Fun?” (2). In it, afterciting data from across many species, he asks and answers the follow-ing question: “At the moment of birth, who has the most interest inthe offspring: the mother, who has one gamete per month to offerand who, during the nine months of pregnancy, is out of the repro-ductive business except for this one offspring, and whose reproduc-tive career is statistically over at age 40; or the male, who producesmillions of gametes per ejaculate, and is theoretically able to fertilizeanother woman every day during the pregnancy and well into hismid-sixties, or beyond?” No amount of socialization or training willever alter the self-evident answer to that question. It is politicallyunpopular, but it is reality.How does that translate into the professional lives of women? Itrequires compromise. The 6 women in my group have used 5 solu-tions. One woman long ago forswore both husband and children andworks a regular schedule. Two others, each with kids, work oppositeeach other in the ofﬁce, 2.5 days each, and take a full call schedule,and another woman has full-time help at home for her 2 childrenand works a regular schedule. One woman works a ﬂexible 3 days perweek and takes a full call schedule but reschedules often for runnynoses, soccer games, and the like. The youngest, not yet a mother,works a regular schedule; we will gladly support her creative solutionwhen the time comes. And, of course, as long as there is an availableprovider, there is also the option Dr. Plante’s 4 colleagues chose: toabandon the profession and dedicate oneself to the children.I do not agree with Dr. Plante that “if we gave more than lipservice to the importance of women’s choices,” the options wouldnot be so “unpalatable.” Medicine as a whole—and obstetrics espe-cially—has welcomed options. Dr. Plante’s problem is not that oth-ers fail to recognize the importance of female choices; it is her (un-derstandable) difﬁculty in making them. We should not deludeourselves that more choices make decisions easier or that it is possibleto “have it all.” It is not, and we do everyone a disservice to pretendotherwise for reasons of political correctness. We also therebycheapen the achievements of the many women who have successfullymade their choices and moved forward. Many choices are at leastpartially mutually exclusive. Some cannot be avoided. One—balanc-ing family and professional needs—happens to be biologically easierfor men.As the poet said, “Not all that tempts your wand’ring eyes andheedless hearts is lawful prize, nor all that glisters, gold.” Life is aboutchoices. All of us need to accept that reality.