Career factors impact childbearing decisions

Career factors impact childbearing decisions | Image Credit: © fizkes - © fizkes - stock.adobe.com.

According to a recent study published in JAMA Network Open, childbearing decisions in women physicians are often influenced by career-related pressures.

Significant gender disparities in health care have been reported despite the rise of representation of women in medicine. A 2000 study finding lower odds of being promoted to upper faculty positions among US medical school graduates received a follow-up in 2020. It was found that this gap had not narrowed since the initial study.

While the causes behind this disparity are unclear, it is likely fertility and family building are associated, as medical training often coincides with primary reproductive years. In a small survey, women reported lower rates of being willing to accept new projects or positions because of parenting worries.

To determine the association between family building patterns and career trajectory among women physicians, investigators conducted a cross-sectional survey study. Surveys were conducted as 1-on-1 interviews about fertility perceptions and experiences, parenthood, and career.

Participants included women physicians and trainees. Gay and lesbian women were included, but cisgender men and transgender men and women were excluded. The final analysis included participants who completed at least 50% of the survey.

Survey items were created using Dedoose version 9.0.107, with reproductive endocrinologists consulted for questions on fertility knowledge. Experts in qualitative and survey researchvalidated survey items.

Demographics, career, work hours, and household responsibilities were evaluated in the survey. There were 3 multiple choice items assessing fertility, the first of which asked during which age range cisgender women experience the most significant decline in conception ability.

The second fertility item was the odds of pregnancy per month per in vitro fertilization (IVF) cycle among age groups. Finally, women were asked about beliefs related to stress and infertility.

Other factors evaluated include IVF use, infertility, delayed family building, and oocyte cryopreservation (OC). OC was assessed through multiple choice questions about how beliefs influenced cryopreservation decisions. Questions about if participants would change past decisions related to family planning or career were used to assess family building and career regret.

Survey distribution occurred on social media from March to August 2022. Facebook physician groups were targeted, and study investigators conducted promotions on Twitter to help the survey reach more people.

There were 1056 cisgender women in the final analysis, with a mean age of 38.3 years. Of participants, 67.6% were attending physicians, 26.8% residents or fellows, 38.6% surgical, and 60.4% nonsurgical. Obstetrics and gynecology were the most represented specialties, followed by internal medicine and pediatrics. 

Marriage or partnership was seen in 86.1% of children, and 65.3% had children. Of those with children, 31.6% planned to have more children. Of those without children, 79.9% planned to have children eventually.

Sixty or more hours of work per week were reported by almost 30% of participants, with 14.3% of married or partnered women reporting their partner worked at least 60 hours of week. Married or partnered women were also likely to credit household maintenance roles to themselves at a rate of 49.2%. This rate increased to 58.4% among women with children. 

The correct age of fertility declines at 35 years or older was identified by 78% of women. A response of “a little” or more to an item asking if stress causes infertility was seen in 71.8% of physicians, with most obstetricians and gynecologists reporting an association. Fertility knowledge was greater among obstetricians and gynecologists than other specialties.

Concerns over the length of training and family planning were reported by 93.6% of participants, with 75.6% reporting delaying family building because of medical training. No differences were observed based on chosen specialty. 

A delay of 5 or more years was seen in 22.8% of respondents who delayed, with reasons including stress, financial strain, concern over burdening colleagues, and lack of schedule flexibility or time. Of participants who delayed, 13.1% were significantly worried about a lack of support from leadership.

Oocyte or embryo cryopreservation was reported by 42.2% of participants, with 11.5% completing treatment. Infertility was reported by 36.8% of participants, of which 51.5% report IVF use.

When discussing family building regret, 45.7% expressed a desire to have conceived earlier, 44.8% to have reduced work hours, 38.8% to have taken an extended leave, and 28.4% to have pursued OC. 

A prior extended leave was reported by 28.8% of participants, a change in specialty by 24.8%, and reduced work hours by 47.1%. Almost half of participants passed an opportunity for career advancement because of childbearing or parenthood, and 4.3% left medicine.

These results indicated career-related pressures may impact pregnancy timing and infertility. Investigators recommended disparities in medicine be addressed to reduce these stress factors.

Reference

Bakkensen JB, Smith KS, Cheung EO, et al. Childbearing, infertility, and career trajectories among women in medicine. JAMA Netw Open. 2023;6(7):e2326192. doi:10.1001/jamanetworkopen.2023.26192