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I’m giving a talk about fertility and physicians. Many of you have read about my personal struggle (link below). This talk is more about systemic challenges. Given that it’s Women in Medicine month, I thought I’d summarize some of the key findings.
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https://time.com/5484506/fertility-egg-freezing/
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https://time.com/5484506/fertility-egg-freezing/
Of course, we all learn in medical school that fertility wanes with age. But what I and many others don’t realize is that if we wait until after we complete our medical training, we may be at the tail end of our fertility.
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These two graphs show the fertility rate by maternal age. On the left is the distribution over time, and on the right is what was left after training (for me).
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As I and others (including @amarshallMD and @FutureDocs) have written in the last couple of years, this isn’t just about statistics. This is about our lives—and as the cliché goes, we only have one life to live. Some of us believed what we were told—that we could have it all.
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And maybe you can, but not without some very careful planning. It won’t just happen serendipitously. Although there are not a ton of data, it seems that one in four womxn physicians face challenges with fertility.
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A study by @reshmajagsi et al showed that of those who had terminated a pregnancy, the most common reason for doing so was concern about their career. That our careers could dictate our lives to that degree is powerful.
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In a study of fertility and surgeons, Phillips et all found that womxn surgeons had higher rates of requiring fertility treatments, being diagnosed with infertility, and needing assistive reproductive technologies than did other womxn.
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They argued that, while there may be reasons to delay childbearing, concern about a residency program shouldn’t be one of them.
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Yet difficulty navigating parental leave is a significant obstacle. In our study (with @altierim1, @aurorapryor, and others), lack of support from faculty and peers were among the top obstacles for residents wanting to take parental leave.
Read more here: https://twitter.com/arghavan_salles/status/1159867955963805696?s=21
Read more here: https://twitter.com/arghavan_salles/status/1159867955963805696?s=21
And, as @PendlKM and I pointed out, this problem doesn’t go away when training is done. It’s a challenge for faculty as well.
10/ https://journals.lww.com/academicmedicine/fulltext/2020/04000/maternity_leave__not_just_a_challenge_for_trainees.4.aspx
10/ https://journals.lww.com/academicmedicine/fulltext/2020/04000/maternity_leave__not_just_a_challenge_for_trainees.4.aspx
Maternal discrimination is another reason people may put off childbearing. A study by @choo_ek, @linos_eleni, @reshmajagsi, and others outlined the numerous ways this affects the careers of women. Read more about it here:
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https://twitter.com/arghavan_salles/status/1083068233572339712?s=21
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https://twitter.com/arghavan_salles/status/1083068233572339712?s=21
So putting this all together, we get a picture of the numerous obstacles to womxn in medicine building our families when our fertility is at its peak. And these obstacles, for many, lead to heartaches and significant financial expenses chasing the dream of the family we want.
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What can we do? As we outlined in our call to action, we need to 1. raise awareness of these challenges, not just among womxn, but among all leaders in medicine. 2. We need to provide insurance coverage as well as...
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3. emotional support and time off for people who are seeking fertility treatments. 4. We need to update our policies at the level of divisions, departments, institutions to support physicians building their families, regardless of level of training.
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While being a physician is an important part of our identity, I think most of us agree that our families mean even more. It’s beyond time to make sure our policies and procedures are in line with that perspective.
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