In my third year of residency, there was a baby boom. I remember getting an invitation to a triple baby shower: an internist, an OBGYN, and an ER doc, all friends from med school, were due within weeks of each other. Everyone, it seemed, had gotten the memo. Meet your spouse first year of med school. (Or before, ideally.) Get married fourth year. IUD out during second year of residency. Baby right as you’re winding down training.
It was a disorienting time for me. I was not on that trajectory; I was in the midst of a painful breakup and all the weddings and baby news made me feel like I had done something terribly wrong. My doctor friends were experts at time management and career planning, and it felt like everyone except me was able to apply the same drive and determination to their personal lives, too.
Doctors are used to the illusion of control. When I got that triple baby shower invitation, I thought my friends had just done a better job planning their lives and executing those plans. My doctor friends ran marathons, aced exams, won awards. It seemed like becoming a parent was just another milestone in the competition of life.
Looking back on it, it’s clear that was not the case, it just felt that way from my vantage point. I realize I have physician friends who embody almost every family configuration possible: friends who remain child-free by choice, friends undergoing fertility treatments, LGBTQ families who have used surrogates, friends who’ve gotten divorced or choose to be single, friends who had unintended pregnancies and needed abortions, friends who are step-parents and foster parents. Life is messy and complicated for all of us.
That’s why I was interested to read this recent article in JAMA Network Open about how medical students, residents, and faculty view “family building” in the context of their careers. As a resident, I thought everyone else had magically figured out how to work long hours, take great care of patients, be a loving parent, have a spouse who does all the childcare but also somehow makes a lot of money — phew.
Complete and utter magical thinking. Turns out that I wasn’t the only one who was mystified – and overwhelmed – about how to think about parenthood in the context of my career, or my career in the context of parenthood.
The authors surveyed over 2000 doctors about their experiences with family planning. The results were pretty damning.
Across different levels of medical training and practice, the stories from more than 2000 respondents in this study depict a harsh reality in which the medical profession creates and sustains barriers to family building.
Oof. Through a series of open-ended questions, the researchers explored several domains where our field makes it hard to be a parent:
Cultural: Long shifts, a competitive work environment, facing penalties and missing out on promotions.
Organizational: nonexistent parental leave policies or painfully short parental leaves (4 weeks!), lack of gender equity in leave policies, lack of parity for LGBTQ+ families, no insurance coverage for fertility treatments or surrogacy.
Interpersonal: Difficult dynamics between colleagues, training programs forcing residents to move away from support networks. “My work burden increased to accommodate my coresidents’ maternity leave, and while I fully support their decision to have kids during residency, there’s still a penalty that others pay.”
All this reminds me of a moment on my OBGYN rotation on medical school, when I stepped on to a crowded elevator with an attending and a senior resident. Patients and staff were both crowded on, and a pregnant person in a wheelchair was struggling to squeeze in. The doors closed on her wheelchair, and there was a brief murmur of concern from folks on the elevator about moving to let her on. Our team of three — resident, attending, and me, the student — stepped off to avert another door closing.
“Jeez, no rest for pregnant people around here, even in a hospital,” the attending said. The resident laughed, a little bitter. “I mean, I was working in the OR right up until I went into labor. We don’t let ourselves rest when we’re pregnant. What makes us think we’d do a good job advocating for our patients?”
The authors of the JAMA article nicely summarize some suggestions for improvement. A few seem a bit pie-in-the-sky — covering clinicians for physicians on leave?! hahaha — but many are within reach.
Credit: King Z, Zhang Q, Liang JW, et al. Barriers to Family Building Among Physicians and Medical Students. JAMA Netw Open. 2023;6(12):e2349937. doi:10.1001/jamanetworkopen.2023.49937
What do you think? Are these barriers unique to medicine, or are they symptoms of workplace culture at large? How can we navigate them?