Susan:
I am also very interested in this topic, and am preparing a presentation for
the summer.
In my own experience, pumping has never been an issue as I own my practice
and can structure it any way I choose.  In this day and age, however, that is
a relatively unusual circumstance for a female physician.  In order to have
the flexibility necessary for mothering, many physicians join multispecialty
groups.  Ironically this often is less flexible than independent practice,
but the income is guaranteed.
My friends in large groups (both male and female, but heavily weighted toward
the women) are regarded as "lazy, uncommitted, with poor priorities" when
they reconfigure their lives/practices in order to accomodate a family.  The
other physicians often feel that they are "carrying" a physician who chooses
to work part time (meaning 30-40 hrs a week).  (In my own call group, I am
the most productive (in terms of number of patients seen and accounts
receivable) despite the fact that I am in the office only 20 hours a week.
This is because putting my family first forces me to be extremely efficient
at the office.  I don't have time to come early or stay late--there is a
nursing baby waiting for me at home.)  The perception of the members of my
call group, however, is that I work part time--and therefore are not serious
about my practice.  In group practices, these feelings and perceptions are
magnified because the doctors' income depends on the productivity of the
practice as a whole.

In terms of what a large business (of any kind) can do to retain more new
mothers:

Allow flexibility with maternity leaves.  The ability to take unpaid leave
beyond whatever is standard is paramount.  Likewise, being able to alter
one's schedule and work part time, or modified hours while the children are
little is very attractive.  For example, until recently I worked M 1p-7p, Tu
10-4, W 1-7, Th off, F 1-5.  The physician with whom I share offices worked M
8-12, Tu off, W 8-12, Th 8-5, F 8-12.  It has worked beautifully for us and
our patients.  A quiet place to pump and refrigeration is also necessary.

The biggest hurdle, IMO, is the attitude of the other doctors.  There is a
brand of disdain (for those who "work to live" rather than "live to work") in
medical practice that is very difficult to overcome.  Honestly, the only
thing I've seen make a difference is for those individual physicians (men and
women) is to bear and nurse their own children.  I think that having own's
employer vocally and visibly support the new mothers in the workplace would
speak volumes.

Looking forward to the other responses!

Leigh Fredholm, MD, FAAFP
Austin, TX

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