Qualitative interviews with a group of female physicians identified several concerns about fertility and family planning and how those concerns affected their career choices.
Among the findings in a new study were that all 16 women interviewed said medical school education surrounding fertility was inadequate. Many said students should get comprehensive information about fertility’s decline with age and fertility preservation options and that information should be presented early in medical training so students can make choices. Yet, such issues are rarely discussed as part of medical training.
“[I]t would also be helpful for medical students and trainees to know what their options are, what insurance covers ... It wasn’t even touched at my orientation,” said one participant.
The findings from the hour-long interviews were used to build a survey. In a pilot test of the survey on 24 female physicians, researchers found that 71% had delayed childbearing and 67% had altered their careers to build families.
Kathryn S. Smith of Northwestern University, Chicago, led the research. Results were published online in JAMA Network Open.
In addition, 29% of survey respondents turned down career advancement opportunities; 21% chose a different specialty; and 17% changed from an academic to private practice setting to accommodate having children.
Women in the survey cited as factors in their decisions lack of support from physician peers and leadership, particularly around time off for pregnancy, maternity leave, infertility treatments, or parental responsibilities.
Results ‘alarming’
“These results are alarming, particularly in light of known gender disparities that exist within academic medicine in time to promotion, achievement of academic rank, and appointment to leadership positions,” the authors wrote.
As of 2020, women made up 43% of medical school faculty but only 21% of department chairs and 19% of medical school deans, according to Association of American Medical Colleges data.
Navigating motherhood as a physician also can take a physical and mental toll. Recent data presented at the American College of Obstetricians and Gynecologists (ACOG) 2022 annual meeting found that one in four physicians who are new mothers report struggling with postpartum depression, a rate twice that of the general population.
And one in four women in a recent survey of 600 female physicians who had attempted conception were diagnosed with infertility.
Lack of support ‘pronounced in medicine’
In an invited commentary, Ariela L. Marshall, MD, of the division of hematology-oncology at University of Pennsylvania, Philadelphia, and Arghavan Salles, MD, PhD, of the department of medicine at Stanford (Calif.) University, noted that career-family struggle is not unique to medicine but “the lack of support for pregnancy is particularly pronounced in medicine.”
The editorialists wrote that they have battled infertility and faced family-building challenges and have intimate familiarity with the struggles.
“Although other workplaces, such as Microsoft, Google, and Facebook, long ago adopted policies to support employees’ family building, including via cryopreservation, those in medicine all too frequently must pay back their parental leave, make up missed call, or even pay back money to their practice,” they wrote. “It is embarrassing that employees of tech companies have better support for reproductive health than do physicians.”
They advocate for change on the entire continuum from fertility awareness and infertility management, bringing children into a family by any method, and child care and career development support for physicians who become parents.
They urge establishing adequate paid parental leave, not just for parents who give birth but for all parents involved in rearing children. They say providing leave to only one parent sets up a discriminatory divide between the partner who continues to work and the person providing care.
Dr. Marshall and Dr. Salles wrote that lack of support is likely part of the reason that 40% of women in medicine switch to part-time positions within their first 6 years in practice.
They also note that too often fertility and family-building discussions focus on cisgendered women who are in heterosexual relationships.
They cite some “nonsensical“ policies around insurance. They give an example of coverage for fertility treatments that often requires trying to conceive before benefits are provided.
“How do two women, two men, or a single person try to conceive?” they ask.
Helen Kang Morgan, MD, clinical professor of obstetrics and gynecology at the University of Michigan, Ann Arbor, said that she, too, has made the trade-off the researchers describe.
Dr. Helen Kang Morgan
She was in her first year as a faculty physician at the University of Michigan when she became a mom and decided to go part time.
Unlike some of the women interviewed in the Smith et al. study, she said she felt lucky to have peer support and the support of leaders in her department who made sure she wasn’t derailed from her career path because she chose part-time work for nearly 5 years.
“For some women, part-time is the right choice and for me, at the time, it was the right choice, but it should not be the only choice. It makes it so much harder for women to advance their careers if part-time is the only option,” she said.
Dr. Morgan said this work highlights that conversations about work and parenting needs in medicine have to go from informal conversations to formal conversations.
Department leaders should be asking what female physicians need and what flexibility is needed, she said.
The COVID-19 pandemic showed how bad things could get, she said.
In Ann Arbor, Dr. Morgan noted, schools were virtual until the spring of 2021, putting demands disproportionately on female physicians who absorbed much of the at-home child care responsibilities.
“That created gender inequities I think it is going to take women many, many years to catch up from,” she said.
COVID-19 also, however, forced medicine to incorporate more virtual options, something that should stay in finding solutions to ease the burden on physicians who are mothers, she said.
Reshma Jagsi, MD, deputy chair in the department of radiation oncology at the University of Michigan, said both policies and cultural norms need to change in medicine.
Courtesy Michigan Medicine
Dr. Reshma Jagsi
Hospitals must find alternative approaches to the historical reliance on residents to provide clinical service needs, she said in an interview.
“It’s not just about educating women or ensuring access to fertility services – it’s also about making it more possible and acceptable for women to combine their pursuit of a medical career and beginning a family during the peak years of fertility.”
She said the medical profession – dedicated to human well-being – seems to carve out an exception when it comes to optimizing the well-being of its future members.
“It breaks my heart to read about how hard we have made it for women to succeed in our profession,” she said.
This study was funded by the American Society for Reproductive Medicine. The authors report no relevant financial relationships. Dr. Marshall, Dr. Salles, Dr. Jagsi, and Dr. Morgan report no relevant financial relationships.