The medical profession needs women. Women in medicine also need support—especially as they embark on parenting.
“Physician Fertility.”
This was the initial title slide of the conference presentation by one of the male fellows in training.
He continued, “One in four women physicians experience infertility. A recent survey showed that 42 percent of women surgeons had experienced pregnancy loss, a rate that is twice as high as the general public.”
Catching my breath because I wasn’t expecting this topic, I quickly looked around the room. Unlike other academic institutions, the division where I work as a pulmonary and critical care physician is unique in that half of our faculty are women.
This is in contrast to the Association of American Medical Colleges Physician Specialty Data Report reporting that the percentage of active female physicians for the subspecialties of critical care was 26.8 percent and pulmonary care 12.3 percent for 2019.
Yet I was the only female faculty member at this presentation. As the speaker finished and asked for comments, I pondered whether I should say something to the group. I decided to speak up because I realized that other women—specifically trainees—may be dealing with pregnancy loss and infertility. I needed to raise awareness about this topic as faculty do not discuss this issue openly.
Thinking back to my training and as a junior faculty member embarking on motherhood, I recalled working in the Intensive Care Unit while having a miscarriage because I felt guilty about having one of my colleagues cover my shift for the weekend.
In my obstetrician’s office a week later, I felt guilty that maybe the stress of my work is what caused this loss.
“Is this a good time for you to be trying anyway?” The nurse’s question seemed to answer my question.
I felt guilty that maybe the stress of my work is what caused this loss. “Is this a good time for you to be trying anyway?” The nurse’s question seemed to answer my question.
At 32 weeks pregnant, I treated 20 ICU patients, then headed to my OB that afternoon to find out I needed to immediately present to the hospital due to concern for preterm labor.
The nurse asked if I had done anything stressful that day.
“Not really. Nobody died,” I answered.
My OB then placed me on modified bed rest. Yet, if I could not return to work to see patients, I would have to start my maternity leave before the baby was born.
Fortunately, limiting my activities for the next few weeks helped and later my younger daughter was born closer to full term without complications. But the common theme during my experiences was I could have been better supported by my superiors, program leadership and administration.
In 2019, enrollment of women in medical school exceeded that of men for the first time according to the AAMC, and more than one-third (36.3 percent) of the active physician workforce in this country was female.
Despite more women entering the profession, the systems do not adequately address the challenges they face. This has been compounded by the COVID-19 pandemic, especially for those women physicians suffering infertility while functioning as a frontline healthcare worker.
Delay of care in receiving infertility treatments and increased risk of severe illness from COVID-19 during pregnancy are a just two of the many stressors that have impacted women in medicine during the last two years.
A recent study evaluated the experiences of physician parents during the COVID-19 pandemic. Among the physician parents surveyed, women were more likely to be responsible for household tasks (31.4 percent, compared to 7.2 percent); and schooling or childcare (24.6 percent versus 0.8 percent) compared to men during the pandemic. The women also experienced greater depressive and anxiety symptoms compared to men.
A publication earlier this year by Dr. Shikha Jain, creator of the Women in Medicine Summit, and colleagues assessed the burden of the COVID-19 pandemic on dual physician households. They identified that women physicians were more likely to worry about personal health, children’s health, partner’s health, job security and finances compared to men. This survey highlighted those women in dual physician households as they may have been disproportionately affected by the pandemic.
It is true that this medical profession is my choice. However, becoming a doctor and becoming a mother do not have to be mutually exclusive. Women trainees and young faculty need better support from their program directors, division leadership, colleagues and administration as they are becoming doctors and trying to become mothers.
Time is working against female physicians. Many wait until completing training before trying to have children.
When trainees ask me when they should think about starting their families, I say, “Yesterday.”
Many friends and colleagues who have faced infertility say they would have chosen to try having children earlier or chosen methods of preservation of fertility at a younger age.
Medical schools need to increase awareness of these issues for students, so women physicians can plan for the family they wish to have. Administration, colleagues and staff need to provide support to the partners of physicians as their involvement is crucial to sustaining a work-life balance. Support for parents going through the process of adoption or surrogacy is also critical.
Hospitals, healthcare providers, institutions and organizations need to offer insurance coverage of fertility treatments and time off to seek medical care for their medical staff. These considerations need to extend to the time after the child is born with adequate paid parental leave and support for breastfeeding as a woman returns to work.
The lack of parental support when returning to work is not unique to medicine—the U.S. is one of the few countries in the world without national paid leave.
Unfortunately, the lack of parental support when returning to work is not unique to medicine. The United States is one of the few countries in the world without national paid leave. Some congressional leaders recognize the need for policy change and are working to pass a proposal for national paid family and sick leave which would provide relief for many families across the country.
Many women physicians have dealt with much worse than I have during their motherhood journey without sharing their stories. It is time to speak up and raise awareness and support those who are starting their journeys to becoming doctors and mothers.
In a recent interview with Healio, Dr. Ariela Marshall, a hematologist, discussed a need for awareness of challenges physicians encounter with infertility and proposed strategies to address physician infertility. Those include increasing education about infertility starting at the undergraduate level and continuing through training, providing insurance coverage for fertility treatments and support for those undergoing fertility treatments.
Programs such as the American Medical Women Association’s AMWA IGNITE designed by women physicians specifically for women medical students, offer an avenue to address the unique challenges women medical students face. However, the education and awareness need to be embedded in standard medical education for all students, not just those who seek additional mentorship.
According to a 2017 Journal of the American Medical Association study, not only do women and men physicians have different practice patterns, but 30-day mortality in patients over 65 and hospital readmission rates decrease when women physicians care for them, compared to their male counterparts.
The medical profession needs women. Women in medicine also need support, especially as they embark on parenting.
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