The Hidden Cost of Being the Most Competent Woman Physician Leader in Every Room
There’s often a little stack of books (and other random things) that sits at the bottom of my stairs. I started this pile, honestly. It’s a system that works for me. Things that need to go up. Things that need to come down. It’s the kind of small, almost invisible system you don’t realize you’ve built until you leave for a few days.
I came home from a conference recently, and that little stack of books was still sitting there. In the same spot. Untouched. Because when I’m home, I don’t just build the pile — I remind everyone what to do with it.
Now multiply that by a hundred at home, and a hundred at work. And you start to see how something that should be a pebble in your shoe turns into a boulder you’re carrying around all day.
If you’re the competent one, the primary parent, the leader of the pack — you pay a hefty tax for it. More questions. More decisions. More of the ambiguous, in-between work that doesn’t sit cleanly on anyone’s job description. And today I want to talk about that tax, why it lands on us so consistently, and what to actually do about it.
The Competence Tax and Invisible Labor in Women Physicians
Here’s a truth I’ve come to: in any system, the most competent person becomes the default for ambiguous work. It’s not happening in bad faith. It’s just how systems behave when no one re-routes them.
Consider the line, “If you want something done, give it to the busiest person.”
And this tends to be even more accurate for women, and for women physicians, because we are incredibly capable at home and at work. Both systems — the hospital and the household — have been trained to know we’ll figure it out. And honestly, we keep proving it. Over and over again.
I am my dog’s person for the same reason. She knows I won’t forget her. Her walk, her water, her food, the dog sitter when we travel. None of it slips through.
But here’s where it gets exhausting, and this is the part I didn’t understand for a long time. The weight isn’t in the doing of the tasks. The weight is in being the person who notices all the tasks that need doing. That noticing is invisible work. And it never clocks out.
Real Story: How a Physician Mom’s After-School SOP Revealed the Unpaid COO Role
I’ll give you a concrete example. I recently hired a babysitter to help me with the after-school stretch a couple days a week. We’ve had many nannies and sitters in our lives, so this is not a new concept for us. But I realized that the busy activity days were killing me.
The idea was simple — let me actually work to the end of my day, and have a little more energy left for my kids when they came home after sports, instead of spending three hours in city traffic running carpool.
When I hired her, I sat down and combed through our family calendar in real detail. Every pickup time. Every location. Every carpool. Which day. Which kid. Where the Starbucks is that we usually hit on Wednesdays after school. The exact route — I actually drew out the maps! All these little rituals.
And somewhere in the middle of writing all of that out, it hit me. When you’re the one writing the standard operating procedures for every person who walks through the door of your home — you are effectively the COO of that house. It’s an enormous role. And it’s unpaid. And it’s invisible.
This is your competence tax. The babysitter does the execution. But I conceived the system. I planned the system. I’m the one holding the master document in my head — which is exactly why transitioning out of being home, even just to leave for work, a conference, or a locums shift, takes so much more out of us than it should.
And if you’re nodding right now, it’s because you know. You’re holding a thousand SOPs no one else can see.
Practical Tools for Women Physicians to Redistribute the Mental Load at Home and Work
So what do we actually do about this? Because telling women physicians to “just delegate more” hasn’t worked for any of us. The reason is we’re delegating the wrong part. Let me give you some ideas you can try this week.
First — hand off the whole file.
Not just the task. I want to give credit here to Dr. Eve Rodsky, who specializes in invisible labor and the mental load. She talks about the CPE framework — Conception, Planning, and Execution. And what I see in women physicians, including me, is that we delegate the execution while we hold tight to conception and planning.
The nanny does pickup, but you scheduled the dentist, the doctor, the music lessons. Your partner cooks dinner, but you decided what was for dinner, knew what was in the fridge, and registered that your kid didn’t eat lunch. That’s not delegation. That’s outsourcing one small piece and keeping the rest. We need to hand off the whole file.
Here’s what this looks like in real life for me. In our house, my husband cooks dinner. He genuinely likes to do it more than I do, and I really don’t enjoy it. So on paper, dinner is handed off. But for a long time, I was still the one doing the grocery shopping, which means I was still the one trying to hold what we needed in my head all week. How was I supposed to know what to buy if I wasn’t the one deciding what we were eating? The conception and planning were still on my plate. The execution was the only piece that had actually moved.
What changed it for us was the Alexa in our kitchen. Anyone in the house can just say, “Alexa, add olive oil to the grocery list.” Whoever notices it’s running low, adds it. Whoever’s making dinner that night and realizes we’re out of garlic, adds it. I’m still fine being the one who places the grocery order, but I am no longer the one carrying around the running list of what this family needs to eat for the week. The whole file finally moved.
Another way is to use an actual script when you do it. Because handing off the whole file feels uncomfortable, and most of us flinch and take it back the first time something doesn’t turn out as expected.
Try language like this: “I’m going to stop holding dinner. That means I’m not going to think about it, remind you about it, or check that it’s done. If I do any of that, I haven’t actually handed it over.”
Then name it out loud. Ask the other person if they’re ready to take on the whole process. It’s not punitive. It’s clarity.
Then — stop being the front desk. When you are the default communicator for your department or your home, every single question routes through you.
- The endless school emails.
- The texts from family planning the holidays.
- The page about a patient your colleague is covering today.
The system has just learned that you’re the reliable endpoint, because you are.
So gently, genuinely, start re-routing. When your kid asks where his cleats are and Dad is in the room, you say, “Ask your dad.” Or as I often say at this age, “I didn’t wear them last.”
When the school emails you about the field trip, you forward it with one sentence: “You’re the point of contact for school stuff now.” When a nurse pages you about someone else’s patient, you say, “That’s Dr. Smith’s patient today, please page them.” The discipline isn’t dramatic. It’s just refusing, gently, to be the answer fifty times a day.
One amazing example I have come across. I have a close friend whose son plays in two travel soccer leagues. If anyone has a kid in travel soccer, you know exactly what this means. The communication is late, the schedules overlap, the tournaments are far away, the planning is genuinely a part-time job.
And my friend told me, very matter-of-factly, that she does nothing with any of it. None of the email threads. None of the registration. None of the scheduling. None of the long drives. Her husband owns it, start to finish. To the point that when I asked her recently if her son was free to hang out one weekend, she said, “I have no idea, I’ll have to ask my husband — I don’t know the soccer schedule.”
That stopped me in my tracks. Because I realized she hadn’t just outsourced the driving. She had genuinely let go of even tracking the calendar. That’s what handing off the whole file actually looks like when you do it all the way.
And lastly — name the perfectionism trap when it shows up. Because part of why we hold all of this is the quiet belief that if we don’t decide, it won’t get decided well. Maybe someone picks a dinner you wouldn’t have picked. The result is a different dinner.
The cost of you being the sole decision-maker and the central switchboard for your family and your department for the next decade is a much bigger deal than that.
Next Steps for Women Physician Leaders Ready to Stop Carrying the Whole Load
If this episode landed for you, I’d love for you to do two things this week.
First — pick one file. Just one. One thing you’ve been holding the whole conception, planning, and execution of, that you’re going to hand off entirely. Not the task. The whole thing. Then have the conversation. Use the script.
Second — if you want a deeper roadmap on getting your time back, owning your value, and leading without carrying the whole invisible weight, I made a free guide just for you. It’s called the 4 Ways for Women Physician Leaders to Get Their Time Back, Own Their Value, and Command the Room. You can grab it at womenmdleaders.com.
And if you’re ready for something more — if you’re ready to stop stressing your way through every day, and start leading from a place that actually feels like yours — apply to work with me one-on-one at womenmdleaders.com/work-with-stephanie.
I take a small number of women physician leaders into my 12-session 1:1 coaching program, and this work — redistributing the load, holding the line, leading with clarity — is exactly what we do together.
Thanks so much for listening. If you enjoyed this, find me on LinkedIn @stephanieyamout and leave me a note. I’d love to hear which file you handed off this week.
I’m Dr. Stephanie Yamout — thank you for listening, and for leading with heart.