Women’s careers and leadership opportunities look drastically different today than they did 20 or 30 years ago, a phenomenon that has been well captured in the media. However, a story less often told is how this is changing the face of motherhood. Becoming a parent is inseparable from the career choices women make. As more and more women physicians are pursuing leadership positions, it is important to discuss how this shift affects motherhood. The traditional motherhood role is not a reality for many working women today. Achieving gender equity in the workplace is currently at the centre of many political spheres, but Dr. Jones wanted to draw attention to the other gender issues women face that are often silenced.
We sat down with Dr. Victoria Jones to discuss her new novel, The Silence of Motherhood1 in which she addresses themes such as domestic violence, abortion, single parenting, and miscarriage, and how these issues influence how women physicians lead. Dr. Jones recalls being told that she would not be hired as a surgeon or become a leader if she chose to have kids. Professional women struggle with such experiences every day in silence, and rarely share them out loud. This book aims to change the silence of motherhood in the culture of medicine and bring these conversations to the forefront.
Silence is the central theme of Dr. Jones’ book. All of the characters experience silence in different ways and for different reasons.
“It is one word that everyone can look at and say that they have some understanding of what the meaning of silence is,” says Jones. “I think that everyone, both men and women, have experienced times in their lives when they love silence and times when they don’t love silence. There are many different emotional qualities the word brings up.”
Framing the book around the theme of silence allows everyone to relate. Depicting gender issues as women’s issues or victimizing men creates further divide and can make things worse. Framing gender issues in a way that everyone can relate to allows people to come together and drive change.
Powerful examples throughout Dr. Jones’ book allow readers to experience first-hand how women physicians are silenced. Reflecting back on her time as a resident, Dr. Jones remembers seeing a woman being silenced for the first time, “When I was a resident, our section head was female, and she was actually the person who said, ‘I would never hire you if you had children.’ I think that this is often what is touted about women, that women are harder on other women than they are on men. One time she said to me, ‘I have to be harder on you, because you have to learn how to survive in this profession.’”
Dr. Jones can only imagine the hardships her section head experienced to drive her to no longer have the vision and strength to make things better for the next generation of women. “When you talk about the silence of womanhood, I think that was really the first time I had experienced it in someone else where she could have really been standing up for things. Even I sometimes have trouble paying it forward. Sometimes I think about going back and telling her I see truly why she had become the person she was.” The culture of medicine becomes so engrained in us and we become socialized to accept things the way they are. This creates a fear of change and is one of the reasons gender imbalances still exist. Top
Some women feel they need to step away from leadership roles, not necessarily because they lack the qualifications, but because they cannot envision having the additional responsibility. Balancing motherhood with a busy career is already challenging enough. Women often feel the weight of having to choose between being a mother and pursing leadership positions.
“I have always been very goal oriented,” says Dr. Jones. “When I became a mother, my relationship with my goals changed. With children, they have to be more refined, be exactly what you want to do. Is this going to benefit you, your career and your home life? I still have goals, but they are fewer now, and they are very much more focused. In the past, I could put almost anything on that list, say okay this is feasible, but now it’s really what fits with who I am, because you change as a person when you go through these different experiences.”
The added work of a leadership role with minimal compensation or a reduction in clinical responsibilities can seem even less attractive to mothers in medicine, as they traditionally are the primary caregivers and responsible for organizing the household. However, women are often silent when it comes to asking for what it would take for them to take on leadership roles.
As Dr. Jones explains, “When I was section head I said ‘I am only doing 30% clinical and you are going to pay me for doing all of this other stuff. I am going to make at least the average salary of a general surgeon in doing this role, and this is what this is going to look like when I am the section head.’ I think women are often scared to ask for the things that would make it possible for them to take on leadership roles.” Top
One of the ways Dr. Jones manages single parenthood and a thriving surgical career in her book is by having a live-in nanny, but this choice comes with its challenges. Having children can result in the “mother bias,” a type of implicit bias where mothers are not perceived as fit for leadership roles, and when mothers do prioritize work, they are seen as an irresponsible parent. Facing these micro-aggressions is an additional reason mothers may choose not to seek leadership positions.
The characters in The Silence of Motherhood experience various challenges, such as domestic violence and abortion. These are powerful examples of what women face, often alone and in silence. These experiences are even more challenging during medical training and occur during critical moments of professional identity formation.
“Residents are already in a difficult position, because they have no power to do anything and it is impossible for them to think objectively about what they were going through. I think residency does that to you sometimes. It pushes you down so much that you have other personal things that you are trying to deal with, and it doesn’t even allow you to see that these things exist.”
In Dr. Jones’ book, she depicts a very strong resident with clear leadership potential, who experiences many of these different difficulties. Maintaining professionalism at work and putting her patients before herself, she is unable to think clearly about how these experiences are affecting her well-being, which predisposes her to burnout. Women in medical training often report higher rates of burnout symptoms than men.2 These early years of training often determine whether women can see themselves being supported as future leaders in the profession.
To sustain the increasing number of women in leadership positions, it is important to think critically about how these positions will adapt to the unique challenges some women face around motherhood. Dr. Jones’ book has a powerful impact on readers as it demonstrates, in an uncensored fashion, the intense struggles women face during their childbearing years, often at the peak of their careers. Supporting future generations of women in leadership needs to include strategies targeted at improving this. This includes re-examining our implicit biases around the role of motherhood and fatherhood. Just as motherhood has been silenced, fatherhood has equally had its challenges in establishing itself in the culture of medicine.
The Silence of Motherhood is the first book of what is intended to be a series detailing, from an insider’s perspective, the life of a woman who learns the delicate balance of being a physician, leader, and mother. Dr. Jones is currently working on the second book, with an expected release date of December 2018. Top
1.Jones V. The silence of motherhood. Victoria, BC: Friesen Press; 2018.
2.Dyrbye LN, West CP, Satele D, Boone S, Tan L, Sloan J, et al. Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med 2014;89(3):443-51. doi:10.1097/ACM.0000000000000134.
Achieng Tago is a medical student at the Max Rady College of Medicine, University of Manitoba.
Mellissa Ward, MD, and
Megan Delisle, MD, are residents in the section of general surgery, University of Manitoba.