I was pregnant in surgical training, and the program offered me a way out.
Not maternity leave. There was no policy for that. The last resident who took leave never came back, so the program acted like the option did not exist.
What it offered instead was a different specialty. Something more ‘family-friendly.’ A smaller version of the career I had already spent years training for.
I said I wanted to finish my training.
That’s when a senior surgeon told me it had never been done, and it would never be done.
The short answer: Women in medicine move ahead by treating the workplace as a system to read, not a test to pass. That means three moves: see the systems you are in, learn the unwritten rules, and replace coping with strategy. Effort alone does not work when effort is not judged the same way for everyone.
That’s the Defiant Career Strategy™. Here is what each step means in practice.
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Why does the ‘work twice as hard’ advice fail women in medicine?
The advice we get comes in two forms.
The first says: be a superwoman. Work twice as hard. Prove you deserve flexibility, and maybe it will be granted.
When that fails, the second version shows up more quietly: put your career first and delay family. That is why egg freezing became such a popular workplace benefit.
Both ideas sound practical. Both assume you are in a fair system where effort is weighed the same for everyone.
That assumption is the problem.
I spent 15 years becoming a double board-certified trauma surgeon while raising six children, and I nearly walked away from medicine in my first year as an attending. Not because I lacked discipline. Because the structure around me was never built for a woman who wanted a demanding career and a family at the same time.
After I became board-certified, I lost job opportunities the moment I asked about schedule flexibility and mentioned I had six kids.
That is not a personal failure. It is a system failure, and it leads to exactly what you would expect. Women exhaust themselves inside a structure that penalizes the choices they are told to make. They burn out. They pass on promotions. They stop speaking up. Some go part-time. Some leave clinical leadership entirely.
The shift that changes everything: stop asking how you survive this system and start examining the system itself.
What the data says about women leaving medicine
This is not anecdotal, and it is not new.
Roughly 40% of women physicians reduce their hours or leave practice within six years of finishing residency. Within that same window, 22.6% of women are no longer working full time, compared with 3.6% of men. (AAMC, drawing on the University of Michigan Intern Health Study)
The AMA’s national physician survey found 59.3% of women physicians intended to reduce their hours, against 34.4% of men. (AMA, 2024)
And in May 2026, AMA researchers published a national survey of 971 physicians who had left clinical practice. Among those who left, women had a median clinical career of 9 years. For men it was 12. The reasons split sharply along the same line: women were five times more likely to cite caring for young children (21.3% vs 4.2%) and more than twice as likely to say the work was too stressful (31.7% vs 12.9%). (The Permanente Journal, ‘Why Have All the Doctors Gone?’)
Sit with that middle number. Three years of career, gone. Not because of weak skill. Not because of low commitment. Because of a caregiving load the profession still treats as a private matter.
This is not a resilience problem that happens to show up in one gender. It is a predictable response to the conditions, and the usual fix does not change the conditions. So how do you advance your career as a woman in medicine without burning out?
Step one: Understand the system you are actually in
The first step is to stop assuming the playing field is level. It is not, and everyone in medicine knows it is not.
Some people have stronger networks, better sponsors, more flexible roles, and fewer penalties when they put family first. Others must prove themselves again and again just to be considered for the same thing.
That unequal access matters, because traditional career advice was built for a world that does not exist. ‘Work hard and good things will happen’ only works if hard work is seen fairly. If your work is hidden, discounted, or used against you, effort alone will not move your career.
And the system is not only the hospital. Your home, your community, your support structure, and the expectations around you all shape what is really possible.
You are expected to compete at work as if you do not have a family, and run a household as if you do not have a job. That is two full-time jobs, and no calendar app has ever fixed it. This is where the fixing starts. We work on ourselves, at speed, inside a structure nobody checked first.
The systems shaping the careers of women in medicine.
Once you can see the problem as structural rather than personal, the struggle stops looking like proof of failure.
Step two: Learn to read the hidden curriculum
When the rules are unfair, they are usually also unspoken. That is what makes the hidden curriculum so powerful.
Medicine has formal policies and written training paths. It also runs a second set of expectations about who is serious, who is committed, and who is allowed to ask for flexibility. Nobody hands you that set. But you are judged by it anyway.
The same action is read differently depending on who takes it. Ask about schedule flexibility as a mother, and you may be marked as less devoted. A male colleague asking the same question is negotiating. If you are a Black woman or from any other minority group, the read becomes even harsher.
Some of what that second set controls:
- Who gets called aggressive and who gets called confident for the same behavior
- Who is assumed to be free after hours
- Who gets cut off in meetings
- Who is expected to be grateful for basic flexibility
- Who is penalized for choosing caregiving
None of it is written down. All of it shapes promotions, collaborations, leadership chances, and how people speak to you.
This is not cynicism. It is a clear view of the rules. Once you can name the real rules, you stop spending energy trying to earn fairness from a culture that never promised it.
Step three: Stop coping and start strategizing
Coping is not strategizing. Coping gets you through the day. Strategy builds the career and life you actually want.
Women in medicine get coping tips when what we need are structural ones. Meditate more. Organize better. Wake up earlier. Lean in harder. Those habits may help your symptoms, but they do not change a system that penalizes caregiving.
A career strategy means making choices based on the environment you are actually in. In practice:
Negotiate your schedule on purpose. Do not wait until burnout forces the talk. Decide what your life needs to look like, then go in ready to say it clearly.
Name the silent rules before you walk into the room. If flexibility is being read as a lack of commitment in your department, say so. At minimum, say it to yourself. You cannot work around a rule you have not named.
Advocate with clarity instead of apology. When you understand the hidden curriculum, you can state what you need without overexplaining or bracing for the reaction.
Build the career around your life, not the reverse. The goal is not to absorb every demand and hope balance appears later.
I work half the month as a trauma surgeon. The other half I am driving to school, Quran lessons, basketball games, and speech and debate competitions. That was not handed to me for good behavior, and it was not luck. It happened once I started treating career design as something I could shape rather than something I had to endure.
The same is true for advancement. If you want leadership, visibility, or better pay, you need a plan built for the environment you are in, not the one you were promised. That is a career advancement strategy, not a coping plan.
Dr. Qaali Hussein with her children, in the operating room, and teaching.
What this means for your career right now
If you feel stuck, it probably is not because you are doing medicine wrong. You are following advice built for a system that was never made with your life in mind.
You have been using the wrong strategy in a system that was not built for your goals. That is part of why high-achieving women burn out faster than their male peers.
So stop measuring yourself against a model that was never built for you. Look closely at your workplace, your support system, and your goals. Do not wait for the culture to change before you make your next move.
The Defiant Career Strategy, in three steps:
- Understand the system you are actually in
- Learn to read the hidden curriculum
- Stop coping and start strategizing
That shift changes how you negotiate, where you set your limits, and how you define a win.
Start with clarity on what is actually holding you back. Take the Career Diagnostic. It is free, private, and takes about two minutes.
Because your workplace was not designed for you. Your career strategy should be.
Frequently asked questions
Why does the ‘do it all’ advice fail women in medicine?
Because it assumes a fair system. In real life, women physicians deal with bias, unequal expectations, and real penalties for family planning. Working harder inside those conditions is not a fix. It only shifts the cost of a structural problem onto the individual.
What is the hidden curriculum in medicine?
The hidden curriculum is the set of unwritten rules that shape how physicians are judged, promoted, and supported. It runs beside formal policy and is never handed to you. Those rules apply differently to women and to minority physicians, which is why the same behavior can lead to different results.
How do I start strategizing instead of coping?
Start by mapping the systems around you: workplace, home, and community. Then name the silent rules inside each one. From there, you can make deliberate choices about your schedule, your negotiations, and your path. That is how a physician career strategy starts.
Can women in medicine build successful careers and raise families?
Yes, though it rarely works by following traditional advice alone. It takes clearer limits, direct advocacy, and a career strategy that fits the realities of caregiving and workplace culture instead of assuming support will just appear.
Why do so many women physicians leave or reduce their hours?
Roughly 40% reduce hours or leave practice within six years of residency. Among physicians who leave clinical practice entirely, women’s median career length is 9 years compared with 12 for men. Research points to structural conditions: unequal caregiving load, bias, and career penalties, not weak resilience.
Is burnout in women physicians a personal problem or a system problem?
Burnout is a signal, not a flaw. When women burn out at higher rates than men in the same specialties and settings, the issue is the conditions. Treating it as a personal failure is why wellness programs keep lagging.
Episode transcript
The Defiant Career, Season 3. Listen on Apple Podcasts or Spotify.
Read the full transcript
How do you balance advancing your career in medicine with starting or raising a family and all the responsibilities that come with it?
Welcome to The Defiant Career, the career strategy for women in medicine podcast. I’m your host, Dr. Qaali Hussein. After 15 years of becoming a trauma surgeon, raising six children, and following every career rule I was given, I nearly walked away from medicine in my first year as an attending. On this show, we talk about how women physicians can advance their careers and navigate hostile workplace cultures without burning themselves out in the process.
The question I open with is the most frequent question I get, whether it’s at speaking events, workshops, through DMs, or in my community.
The traditional career advice we get as women physicians is to be superwomen. To do it all. To have the career and to have the family. At work, we’re told to work twice as hard so we can be recognized and get the flexibility we need, and to multitask. And if we don’t want to do both, or if we can’t do both, the subtle advice is to put your career first and delay starting a family. This is why egg freezing has become such a popular workplace incentive.
So why does being a superwoman who can do it all fail women in medicine, and why does being career-focused hurt women in medicine in the long run? Because these two pieces of advice completely ignore the underlying cause of the problem.
Why is it that women are entering medicine at higher rates but not advancing at the same rate? Why are women burning out more frequently than their male colleagues? The reality is that the culture of medicine is not designed for women. Even in a field that knows the importance of the biological clock and the consequences of advanced maternal age, medicine remains behind in allowing women to prioritize their families.
I was the first intern to get pregnant in my residency. The last person to attempt it before me was a third-year resident, and she never came back from maternity leave. When I announced my pregnancy to my boss, I was told: “It’s never been done, and it will never be done.”
There was no maternity leave policy because they never needed one. Nobody had ever gotten pregnant and actually returned to finish their surgical training.
And when I returned, I was told to quit on an almost weekly basis. I was told it was because I was wasting my time and I wouldn’t be a productive surgeon. I was told I was taking up the spot of someone who could be a more productive surgeon.
When I finished my training and became a board-certified surgeon, I had my resume thrown across the table in an interview just because I asked about schedule flexibility. I lost job offers the moment recruiters and interviewers found out I had six kids. And on top of all of this, I was carrying so much mom guilt that I almost walked away from a career I’d spent 15 years building.
When I look back on all of this, I realized that nothing had prepared me for this reality. I was told it would be difficult. Nothing ever prepared me for this level of hostility.
So the advice to just be a superwoman, multitask, and manage your time better completely ignores this reality. It assumes you’re on a level playing field. It ignores the hostility you’ll face when you choose to prioritize your family, and the consequences that come with it.
So what happens when women pursue medicine unaware of the hostility toward their family planning goals, and they’re told to just do it all and be a superwoman? They’re chronically exhausted and burned out. Their careers take a hit because they’re too drained to go for a promotion, submit proposals, speak at conferences, or ask for a raise. They go part-time. Some even consider leaving altogether.
That’s exactly where I was about 10 years ago. After doing everything I was told and still hitting a wall, I contemplated walking away.
And for a long time, I had this nagging feeling that made me feel uneasy. I honestly felt that everyone was right. I bit off more than I could chew. Of course it was impossible to balance a demanding career like trauma with raising not one but six children. Who did I think I was?
But then this thought didn’t sit well with me either. I did do the two together throughout my training. As hard as it was, I did complete a grueling surgical training while being pregnant five times. But I had to fight for it instead of focusing on my training and my family. I had all these fights I had to have just to be able to do my job.
And that’s when it actually occurred to me that all the advice we’re given is aimed at us improving how we navigate a broken system. We’re told to bend over backwards and fit into these systems if we want to make it. Nothing and no one ever addresses the flaws in the system itself. We’re given all kinds of coping mechanisms to deal with a system that actively ignores our biological clocks and punishes us when we choose to prioritize it.
So that’s what we’re going to do here. We’re going to stop coping with a broken system and we’re going to start strategizing.
And the first step is for you to let yourself off the hook. You’re not struggling to balance your family and your career because you’re incapable or bad at managing your time. The culture of medicine was not designed for you, and its hostility toward your family planning is why it’s so difficult.
You’ve been taught to work twice as hard and prove yourself so the powers that be can recognize you and grant you flexibility. What you need to do instead is stop waiting for the culture to change and equip yourself with strategies to advance your career without sacrificing your family and without burning yourself out in the process.
And here’s where you can start. This is the exact framework I use to advance my career as a double board-certified trauma surgeon, work half the month, and spend the other half at my kids’ basketball games and their speech and debate competitions. It’s the Defiant Career Strategy, and it’s also what I use to help my clients advance their careers without sacrificing their health, their family, or their values.
This is not about endurance or perseverance, and it’s not about coping better. This is a strategy.
Step number one is to understand how the system actually works. The idea that you’re on a level playing field is a pure myth. There’s unequal access and unequal opportunity, and we all know it. But the overwhelming advice to work hard and prove yourself is based on the assumption that you are on a level playing field. It assumes your hard work is weighed the same as someone who knows the system and who has connections and a network. That’s why it fails, and that’s why we’re burning out at higher rates.
And when I say learn how the system actually works, I’m not just talking about the workplace. The system also includes your home environment, your community, your support structure, and society. The fact that you’re expected to compete at work as if you don’t have a family, and take care of your household as if you don’t work, is a system problem.
So when you understand how the different systems you’re navigating are impacting you, then the next step is to learn how to read the hidden curriculum.
Unequal paths mean different rules. The same things you do as a woman in medicine are seen and treated differently than your male colleagues. If you’re a Black woman or from any other minoritized group, your words and actions will be seen and interpreted completely differently. There are multiple rules that most of us follow but are completely unaware of. That’s why it’s called the hidden curriculum.
Once you learn to look below the surface and see the real rules that govern the workplace, your home, your community, and society as a whole, you’ll have a much better understanding of why workplace culture and society make it impossible to balance family and career as a woman in medicine.
Once you learn to read this hidden curriculum, you’ll be ready for the next and final step, which is to stop coping and start strategizing.
Instead of being upset at the inequality and the unfairness, you’ll see why you’re being held to a completely different standard. You’ll be able to verbalize the silent rules that are sabotaging you, and you’ll be able to advocate for yourself more effectively. When you do that, you can negotiate everything, including your schedule and how you structure your career around your life and your family, and not the other way around.
So to go back to our opening question. How do you balance advancing your career in medicine with starting or raising a family and all the responsibilities that come with that?
One, you stop following traditional career advice that assumes you’re navigating a fair workplace that respects your family planning. And two, you stop waiting for the culture of medicine to change, and you equip yourself with the tools to achieve the life and career goals you want.
If you’re stuck in your career and don’t know where to start, take the Career Diagnostic so you can begin with clarity on what’s holding you back. If you’re a woman in medicine and you already know you want to take the next step in strategizing for your career advancement, you can book a strategy call with me.
I hope this episode resonated with you. I’d love to hear your feedback and any questions you’d like covered in future episodes. And please share this episode with other women in medicine who need to hear this message.