Unequal Time: A new book looks at work-life balance for health care workers.

A New Book Confirms That Male Doctors Have It Really, Really Good

A New Book Confirms That Male Doctors Have It Really, Really Good

The XX Factor
What Women Really Think
Oct. 15 2014 3:56 PM

A New Book Confirms That Male Doctors Have It Really, Really Good

It's cool, my wife has the kids.

Photo by Stokkete/Shutterstock

A few months ago, New York Times reporter Jodi Kantor wrote about the havoc that on-call scheduling wreaks on low-income employees with children. She profiled a Starbucks worker who had to rely on a patchy network of relatives and friends to care for her young son because her work hours were so unpredictable. The story resonated, not just because of its frustrating particulars, but also because it was just one more example of how the modern working world is dysfunctional for many working parents: From Debra Harrell, the McDonald’s worker who was jailed for letting her 9-year-old go to the park alone while she worked, to Rhiannon Broschat, the Whole Foods employee who was fired because she missed work to care for her special-needs son when school was cancelled, it has become abundantly clear that our systems of work and care do not fit together.

Jessica Grose Jessica Grose

Jessica Grose is a frequent Slate contributor and the author of the novel Sad Desk Salad. Follow her on Twitter.

The new book Unequal Time: Gender, Class, and Family in Employment Schedules explores the clash of childcare and work scheduling. What makes the book—by UMass Amherst sociologists Dan Clawson and Naomi Gerstel—a particularly necessary addition to the topic is that it explores how odd hours affect men and women up and down the socioeconomic ladder.


Clawson and Gerstel look at four different kinds of health care workers: Doctors, nurses, EMTs, and certified nursing assistants. They chose health care because it’s one of the few fields where both white collar and working class jobs need to be filled 24-hours a day, seven days a week. The way these workers dealt with their job scheduling was impacted not just by their class, but also by their gender, in surprising ways.

In their sample—which was taken from Massachusetts hospitals, nursing homes, and emergency medical services—the majority of doctors were men. And doctors had by far the most traditional work and family arrangements. They worked long hours and had a lot of control over their schedules (they basically hashed out their hours in group meetings with other physicians). The male physicians, almost to a man, depended on stay-at-home wives, or a combination of working wives and nannies, to pick up all the household responsibilities. If a kid was sick or there was another unexpected emergency, someone else took care of it. Most of the working wives of these doctors had flexible schedules. Even the male physicians who were married to fellow doctors worked more hours than their wives.

By contrast, of the 11 women doctors that Clawson and Gerstel interviewed at length, “four worked part-time, four worked full-time and had primary responsibility for their children and household, and three had a stay-at-home partner.” Interestingly, two out of the three female doctors who had stay-at-home partners were lesbians. So in the entire sample of doctors and their partners, there was a single man taking primary responsibility for his household.

The EMTs Clawson and Gerstel talked to were also mostly men. EMTs had less control over their schedules than the doctors did, but many of them were unionized, and so had ample vacation, and reported that much of the time their bosses accommodated their family needs. But the EMTs’ relationships with their wives were much, much more egalitarian than the doctors’ relationships with their wives. Ninety percent of the married EMTs had wives who also worked full-time. As Clawson and Gerstel note, “The EMTs talked of picking children up from school, feeding them dinner, or staying home with them when they got sick. The EMTs saw this work as their responsibility—shared with their wives.”

Nurses—a predominately female occupation—had good control over their weekly schedules, because they are in such high demand. They were all well aware of their rights: They took ample unpaid Family and Medical Leave, because they knew they were allowed it. But they had little control over when they took vacation. Because so many of nurses have families, vacation days that coincide with school vacations are highly restricted. At one hospital, nurses were not allowed to take more than a day or two off around Christmas and Thanksgiving. They still do the majority of care giving and housework even if they are the primary breadwinners, and many of them said things like, “My husband’s hands would disintegrate if they hit dishwater!” Some of the nurses arranged their schedules so that they could care for their young children themselves during the day (they only worked nights and weekends); others paid for childcare.

At the bottom of the totem pole in every respect are the Certified Nursing Assistants. They make the least—their mean income is $21,000—and they have the least control over their schedules. They are most likely to be minorities, and many of them are single mothers. Unlike doctors, nurses, and EMTs, their workplace (in this study, nursing homes) is entirely family unfriendly. CNAs rely on their extended family for childcare, and they often get into situations that sound like Debra Harrell’s. “One CNA explained that she had a 13-year-old who could get herself and her younger siblings home from school and could cook for them (that is, she could use the microwave).” The CNAs were not happy about these arrangements, but they felt they had no choice.

Clawson and Gerstel suggest the usual policy fixes for the issues that CNAs in particular face: paid sick leave, paid family leave, and paid vacation among them. But they also suggest that low-income workers get “a range of shifts, weekend-only jobs, and the ability to take their legally guaranteed FMLA leaves,” the way the better-educated nurses do. Still, the heart of the problem for all of these workers—even the doctors—is that hospitals and nursing homes are trying to run with extremely lean staffs. Hospitals aren’t doing so well themselves, so I don’t want to lump them in with, say, Walmart, which cuts health benefits to its workers while the Walton family is worth a collective $140 billion. But something like giving CNAs ample paid sick leave isn’t exactly going to break the whole system—or break it that much further, since its problems run deep. After all, sick leave is a matter of public health, which in the long run is a cost (and life) saving measure.