Female physicians often delay starting a family, in part due to career-related pressures and the hours required for medical training and residency programs. The competing priorities of parenthood and career may account for higher rates of infertility among female physicians than women in the general population, according to a study in JAMA Network Open.
Researchers with Northwestern University Feinberg School of Medicine surveyed 1,056 cisgender women from March to August 2022, with 98% of respondents living and working in the U.S.
According to the study, 86% of respondents were married or partnered, and 690 65% had children. In addition, even though most women physicians (78%) correctly identified the age when fertility declines precipitously (35 years old or older), three-fourths of these physicians (75.6%) delayed starting a family anyway.
On average, female physicians were 32 years old when they gave birth to their first child; the average for non-physicians was 27.
“More than three-quarters of female physicians in our survey reported delaying childbearing due to medical training or career,” the study states. “This figure is striking in light of the well-documented decline in female fertility with age.”
Respondents tended to underestimate the number of years that they would remain fertile, but that knowledge did not prevent them from delaying childbirth, nor did it factor into the duration of the delay. The issues cited as having the most influence on decisions to delay childbirth included financial strain, lack of a flexible schedule and stress.
“Alarmingly, 36.8% of respondents endorsed a personal history of infertility, among whom more than half required [in vitro fertilization (IVF)] to conceive,” the study states. “In contrast, 6% to 19% of women in the U.S. general population have infertility and 12.2% have used fertility services.”
The findings also illustrate how often and to what degree women in medicine interrupted their careers because of childbirth and parenthood. One-quarter of those surveyed took an extended leave of 12 weeks or greater. In addition, almost half of the respondents passed up opportunities for career advancement and wound up reducing their hours because of parenthood.
While women are increasingly represented within medicine, pervasive gender disparities exist. A landmark 2000 study found that female U.S. medical school graduates were less likely to be promoted to upper faculty ranks, with a 2020 follow-up study finding no narrowing of this gap over time. Women are less likely than men to publish in leading medical journals or hold positions on editorial review boards and are less likely to hold academic leadership positions.
"Although reasons for attrition are unclear and likely complex, fertility and family building may be contributing given the duration and intensity of medical training, which coincides with women’s peak reproductive years," th study authors wrote.
Not only does public policy need to change to address this wage gap and infertility problem but also policy in private institutions, the study authors noted.
The study states that “paid parental leave is not federally mandated in the U.S., and nearly half of top-ranked medical schools do not provide paid parental leave for birth (42%) or nonbirth (44%) faculty.”
Shifts in policy must be accompanied by cultural change, as well, the researchers argue. The notion that taking leaves of absence can damage someone’s professional reputation or can disqualify someone from career advancement should be countered. In addition, fathers should also get leaves of absence so that mothers don’t have to carry the entire infant care burden.
The study states that “in addition to offering insurance benefits and clinical flexibility to the nearly 20% of women physicians who use IVF to conceive, awareness of and access to fertility preservation services should be offered to those desiring greater flexibility in family planning," the researchers wrote.
For instance, 11.5% of respondents underwent oocyte or embryo cryopreservation, but less than 10% had insurance that covered the procedures.
The study notes that although the American Medical Association “has supported resident physician access to oocyte and embryo cryopreservation, buy-in at the institutional level is needed to implement these benefits and expand coverage to medical students and faculty. Until that happens, access to fertility preservation may be unattainable for medical trainees and junior faculty during the years it is most likely to be effective.”