It’s grey skies for women inspired by the docs on Grey’s Anatomy: Keith Chen and Judith Chevalier, both PhDs at the Yale School of Management, write in The Atlantic about their new study under the gulp-inducing headline “Is Medical School a Worthwhile Investment for Women?” and make the case  that, financially speaking, women are better off becoming physician assistants than doctors. If there was ever a finding that more clearly demonstrated the myriad ways in which our system isn’t working, I’d love to see it. (And by “love,” I mean hate.)

Now, the authors (thankfully) come right out and say that their intention is not to dissuade young women from becoming doctors, just that this is information they should consider when plotting their future career paths. Which is certainly true. After all, med school is expensive, as are most advanced degrees. (In fact, they cite studies that show that more women MBAs and JDs drop out than do doctors.) And, you know, ROI is important. BUT.

First, the obvious: the inequities. According to the study, women doctors start off making less money than their male counterparts, and, as anyone who’s ever filled out the salary history portion of a job application knows, that kind of disadvantage right out of the gate is only going to be compounded. But the study’s authors quickly move on from this issue and focus instead on another: a difference in hours. From the piece:

This captures the insight that in order for an investment in the high up-front cost medical degree to overcome the lower up-front cost of a PA degree, not only do a doctor’s wages have to significantly exceed those of the PA, but the doctor needs to be willing to work enough hours to make those wages pay off.

“Willing.” Interesting choice of words, no?

More than likely, what that means is this: male doctors are far more likely to have the benefit of a spouse who can and will take on the bulk of the Life Administration tasks than are women. (Score another one in the “The Biggest Career Decision You’ll Ever Make Is Who You Marry” column.) Of course, that’s pretty reductionist: undoubtedly there are many women–even the high achieving sort who become MDs–who wind up ramping down their careers, at least for a little while, because they want to. They want time with their children while they’re young. And that makes perfect sense. But again, what it amounts to, for women, is a choice. To make a high-powered career pay off, do we have to sacrifice motherhood? To have a family, must our career take a hit? It’s a choice that most men don’t have to entertain.

From our book:

But absent structural and societal changes, the conflict between work and family often involves retooling the dream. In 2010, Harvard Magazine ran a feature on a study showing that women who’d gotten their MBAs from Harvard were far less likely to both have kids and a full-time job at the time of their fifteenth reunion than were MDs. And in both cases, working mothers chose less-demanding areas: The story pointed out that women make up 41% of new doctors nationwide, but only 30 percent of ER doctors or general surgeons.

The story was somewhat unremarkable (sorry, Harvard), except for the dialogue it provoked. One comment from a twenty-nine-year old med student named Erin was right on point. About to choose her specialty, she confessed that she thinks she was made to be a surgeon but knows that she’ll never go into that field. She writes that she can’t figure out how to be a good mother someday and factor in the hours–and the lack of flexibility–required to be a good surgeon. ‘I hate that this conflict exists,’ Erin writes. ‘I hate that I keep running into a roadblock. And I also hate that my male counterparts don’t have this same internal dialogue.’

Career or family? One hates even to ask the question — especially in the face of a study like this, rife with cold, hard numbers — lest it might lead some smart, ambitious, valuable, talented, potential-filled women to, as Sheryl Sandberg might say, “lean out.” To take themselves out of the game before they need to, anticipating the work-life conflicts a certain career path might present, and ramping down their ambitions accordingly.

And yet. To pretend they don’t exist is to bury our collective head in the sand. But women represent over half of the labor force in this country, and to leave so much untapped potential on the table is a momentous waste, for our society as a whole, and for each one of us individually. To do nothing is not an option–we’ve outgrown the status quo. So it seems to me that the question is not career or family, but: isn’t there some way to structure the world of work so that it works for everyone?