Happy Mother's Day, With Love From the ABPN

Just last week I received my diploma from the American Board of Psychiatry and Neurology (ABPN) announcing in elegant calligraphy that I am now a board-certified psychiatrist. The diploma was sent to my office by Federal Express, and it was hand delivered by a colleague who appeared more excited than I about its arrival. “This is a really big deal,” she assured me. But it was Friday evening, I was rushing to finish up before a vacation, and the unanticipated arrival of my diploma left me feeling more inconvenienced by the need to get it framed than proud of the accomplishment.

I was reminded of a similar Friday last August, near the end of my first month as a psychiatry consult attending at Dartmouth-Hitchcock Medical Center. I had worked late all week, supervised overnight call for a PGY-1 who knew as little about being a resident as I did about being an attending, and staffed an unprecedented nine consults in 1 day as medical teams called with questions that only became urgent after 3:00 p.m. on Friday. While I worked, my family visited friends on their Vermont farm, feeding chickens and eating organic vegetables. So I was sleep deprived and self-pitying when I got home and saw the envelope from the ABPN sitting at the bottom of a pile of neglected mail. The letter was thick, and its heft, coupled with a lifetime of hoping for acceptances and fearing rejections, prepared me for a good outcome before opening the envelope. Sure enough, I had passed part I of the boards. I have never been great at standardized tests, generally just squeaking by. This time I had done uncharacteristically well. I was relieved to have passed part I and excited about completing part II and leaving the last hurdle of training behind. Still, I could not help but reflect on my months of preparation, weekend mornings spent at the library, my son's naptime earmarked for memorizing DSM-IV criteria, and babysitters hired to entertain him while I completed hundreds more practice questions. With the security of that heavy envelope in my hand, I wished that I had studied less, missed fewer pancake breakfasts, and taken a few naps myself.

I went to my calendar to record the date I had been assigned to take part II of the boards: Sunday, May 9, 2010. Mother's Day. The intensity of my reaction shocked me: I was angry. Really angry. Initially my anger was puzzling, as I've never been overly invested in holidays. My husband and I joke about modeling holidays on Hanukkah: our gifts to each other trickle in over 8 days since neither of us is sufficiently organized to meet a deadline that lasts only 24 hours. Before I had a child, I considered Mother's Day a “Hallmark holiday,” another entry on my endless to-do list, a time to call my mom and corral my younger brothers into doing the same.

What upset me about my board exam being scheduled on Mother's Day went deeper than missing a chance to be served breakfast in bed; it encompassed my experience as a woman in a still largely male-dominated profession. I was angry at a system of medical training that actively recruits women without honestly preparing female medical students for the gender-related conflicts they may face while training to become doctors during their childbearing years. I was angry at a system of residency training that lacks an infrastructure to provide women flexibility in completing residency at their own pace, often forcing female residents to choose between devoting time to their careers and caring for their children. And most of all, I was angry at psychiatry, a discipline that should have insight into the emotional and practical challenges facing female physicians yet still seems to lack an appreciation for the conflict between being good-enough mothers and good-enough doctors.

I guess I expected more from our profession. We psychiatrists look for meaning in the symbolic. We appreciate the importance of maternal-child attachment; we see daily in the patients who fill our practices the downstream consequences of ruptured family relationships. Being scheduled to take my boards on Mother's Day symbolized to me that psychiatry has not yet found a way to support female psychiatrists as we navigate our two most important roles, mother and doctor. I wondered about the women involved in planning the boards: Were there any? Had anyone objected to scheduling the exam on Mother's Day weekend? What about the female oral examiners-were they reluctant to leave their families and travel across the country to ensure the competency of the next generation of psychiatrists? And finally, did anyone consider the female patients who participated in the interview process? I suspect many of them are similar to the patient I interviewed, a single mother struggling to care for her children while battling substance abuse and mood swings, women who lack many opportunities to have their maternal efforts supported, let alone acknowledged and celebrated.

I do not mean to sound ungrateful; after participating in the oral boards I have an increased understanding of the magnitude of the effort required to plan such an enormous undertaking, and I sincerely appreciate the contribution of everyone involved. I will even admit that I enjoyed myself: I live in rural New Hampshire, and 3 days alone in a plush hotel room in Philadelphia allowed me to shop at Macy's, order room service, and watch reality TV, which I have done little of since my son was born 3 years ago. It is just that this situation represents to me the difficult choices that women who are doctors and mothers constantly face: how to simultaneously care for their children, their patients, and themselves. I believe that as psychiatrists, physicians who search for meaning and value internal experience, we are in a unique position to lead the medical profession in increasing awareness of the experience of women in medicine. On the basis of my experience, I would like us to leave Mother's Day alone.