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September 15, 2021

Women are facing a 'reproductive toll' in medicine, research suggests

Daily Briefing

    Ariela Marshall, a hematologist at Mayo Clinic, says that demands inherent to the medical profession—such as long work hours, a stressful work environment, and lack of sleep—put her fertility at risk. And according to multiple surveys of female health professionals, she's far from alone, Jacqueline Mroz writes for the New York Times

    Your two-pronged approach to addressing—and preventing—physician burnout

    Marshall's story

    Like many physicians, Marshall worked diligently in her 20s and early 30s to complete her medical training, Mroz writes. As part of that effort, she chose to postpone pregnancy until she was established in her career. However, at the age of 34, Marshall found she was not able to get pregnant—even with the help of fertility drugs. 

    Ultimately, Marshall was able to carry and deliver a healthy baby via in vitro fertilization (IVF). However, according to Mroz, Marshall suspects that her struggle with infertility stemmed from working frequent night shifts, coupled with stress and sleep deprivation, which can affect reproductive cycles. 

    When Marshall shared her story with other female physicians, she soon discovered that many women in the medical field also struggled with infertility or carrying a baby to term, Mroz writes. In response, Marshall helped create an infertility task force with the American Medical Women's Association to raise awareness of the issue. 

    'We have to do a better job'

    After realizing that she was not alone in her struggles, Marshall connected with other female physicians on social media who were facing similar challenges. Along with two other women, Marshall wrote an article in Academic Medicine calling for better fertility education and awareness for aspiring physicians, beginning at the undergraduate level. 

    One of the women Marshall connected with was Arghavan Salles, a surgeon at Stanford University School of Medicine and the author of a 2019 Time essay detailing the infertility struggles faced by many female physicians. 

    While urging industry leaders and medical professionals to start having critical conversations about the demands that are placed on female physicians, Salles said, "We need to change the culture of med school and residencies. We have to do a better job of urging leaders in the field to say, 'Please, go and take care of what you need to do.'"

    A common, but silent, struggle

    According to Mroz, a survey of 692 female surgeons, published in JAMA Surgery in July, found that 42% had suffered a pregnancy loss—more than twice the rate of nonphysicians. Additionally, almost half of the respondents reported pregnancy complications.

    Part of the issue, Mroz writes, may stem from the challenging schedule health professionals must pursue for their careers.

    For instance, physicians traditionally have to navigate about "10 years of medical school, residencies, and fellowships" during their reproductive years, Mroz writes, an experience that typically involves irregular schedules working nights and weekends, as well as long shifts. As a result, women who get pregnant during that time in their careers often face dangerous challenges—such as the expectation that they work 28-hour shifts without sleep—that can lead to poor outcomes, including early labor and miscarriage.

    Accordingly, many women don’t begin trying to have children until after they have completed their medical training, Mroz writes. The average age women complete their medical training is 31—and according to a 2021 study, most female physicians first give birth at 32, on average, compared to 27 for nonphysicians.

    "For many physicians like me, everything is so planned," Marshall said. "Many of us decide to wait until we're done with our training and are financially independent to have kids, and that doesn't happen until we're in our mid to late 30s."

    "The thing that surprised me the most is that infertility is a silent struggle for many of these women," Vineet Arora, dean of medical education at University of Chicago Pritzker School of Medicine who underwent many IVF cycles in her 40s, added, "but when you see the data, you realize that it's not uncommon."

    Committed to change

    Currently, women make up more than 50% of all medical students—and many physicians are optimistically advocating for change, Mroz writes. 

    According to Mroz, Roberta Gebhard, governance chair and former president of the American Medical Women's Association, said the group is advocating for change and educating medical students and pre-med students about fertility issues so that they are aware of them. For instance, Gebhard said one such change might be permitting female physicians to complete their heavier workloads at the start of the residency, if they would like to become pregnant later in their training.

    While many people claim it is impossible to be a mom and a physician, Gebhard said, "[W]e're telling you that you can, but you need to keep your options open. A lot of it isn't just being able to get pregnant. Some of these women are so focused on their careers that they don't get into a relationship." (Mroz, New York Times, 9/13)

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