Women physicians get 25 percent more patient portal messages than men in the exact same practice, and 26 percent more from their own support staff. That is Dawn Sears's figure, and it is one of the quieter reasons she thinks women leave medicine. Sears, a gastroenterologist for 25 years, has seen it from both sides. She trained with no duty hours and no maternity leave, raised three kids, and served as program director and chief while working 0.8. Her starting point: "the system was designed for someone who is a male, who is married to a female, who is at home taking care of everything." Seventy to 85 percent of women physicians are moms, and many carry the elder care too. An article she read in May put the average age at which women physicians leave at 45. She takes on the obvious objection, that someone who plans to leave early should not apply at all. She had classmates who never practiced, and it bothered her. But "we thought we could do it all, and we were sold a pile of lies." She points to April 2020, when visits went from almost all in person to 80 percent virtual within four weeks. Health care can move fast when it has to. What she says works: Staff the inbox. If women get 25 percent more messages, give them 25 percent more MAs to sort the real medical questions from the venting. Ease the return. Three colleagues of hers asked in the past month for 50 percent of call and 50 percent of weekends for the first six months after a baby, and they got it. Add five days. Women need more screenings, and their children need well visits. Do the math. Losing her costs half a million to a million dollars, far more than the time she is asking for. And when a partner says it isn't fair, she asks whether they like their call schedule as it is, because if she quits in two months, their call is going to double. Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts What is one change your practice made that kept a physician from leaving? #ThePodcastbyKevinMD #WomenInMedicine