One thing most people will agree that medical education and parenthood have in common is that they are both challenging and incredibly demanding in regards to time and energy. And yet for many students, the majority of their medical education will take place during their 20’s and 30’s, a time of life also considered to be prime for becoming parents. The phenomenon of medical students entering parenthood has become so widespread that a plethora of studies have actually looked at various aspects of this issue – and revealed that while some progress has been made to help support these new parents, there is still a long way to go.
Rising Number of Women in Healthcare
According to Dr. Glese Verlander, doctor and mother of four, in her article in Academic Psychiatry, while parenthood affects both male and female students, the burden of pregnancy and infant care falls hardest on women. And the challenges and issues that female students in particular face will only become more of an issue as the number of women in healthcare continues to rise:
-In 1997, 43% of all medical students and 22% of working doctors were women
-In 2001, 45.8% of medical students and 28% of medical faculty were women
-In 2010, women comprised 30% of doctors and that number is expected to rise to 50% by 2050.
However, though the demographics of the medical profession have changed, many hospitals and other medical facilities lag behind in their support for the decisions that medical students – especially women – must make in regard to their careers and parenthood.
The Challenges of Parenthood and Medical Education
Verlander also notes that the challenges of becoming a parent during one’s medical education are complex and can include the following:
Timing of the Pregnancy
For women, timing a pregnancy during the course of their medical education can be critical – and there are times which studies have shown to be better or worse for starting a family. Verlander notes that studies have shown that the internship and the 3rd year of medical school are considered to be the worst time to be pregnant, while the most common time to begin a family is during the residency portion of a woman’s medical education. And some studies have shown that some women recommend pregnancy be postponed until all training is over. However, there are risks involved here as well: women who put off pregnancy until later in life can face more problems with issues like infertility or congenital anomalies.
Some women can find themselves in a hostile environment when it comes to getting pregnant during their medical education. In a 2017 study of women being trained in plastic surgery, researchers found that 2 decades ago, 36% of program directors actively discouraged pregnancy. Adverse effects for women residents included the fact that 33% suffered from infertility problems and another 26% chose elective abortions during their residency. Even today, only around 1/3 of plastic surgery residency programs have formal, written policies on issues like maternity leave, which can cause stress for pregnant residents.
Taking Maternity Leave
The issue of maternity leave is another significant challenge for medical students who are about to become parents. Ideally, according to the American Medical Association itself, maternity leave should begin around 2 weeks before the expected due date and that one parent should act as the primary caregiver for 4 months after birth. The reality is nothing like this, however, and although federal law like the Family Medical Leave Act guarantees up to 12 weeks of unpaid leave, many medical students who give birth do not take full advantage of this time off to care for their new baby.
Verlander’s article was written in 2004, but maternity and paternity leave issues remain a challenge for those undergoing medical education:
-In a 2016 study of surgical residency programs, researchers found a “lack of national uniformity in surgical residency policies regarding maternity and paternity leave and length of leave as well as inconsistency in access to childcare and available of spaces to express and store breastmilk”. The researchers recommend increasing support for the training and well-being of female residents, who were more adversely affected than male residents.
-In another 2016 study which looked at provisions made in orthopedic programs across the country, researchers again found a lack of uniformity in program policies. While some programs have written, formal policies for maternity leave, others were informal and unwritten. Less than half of the programs had similar policies for paternity leave and even fewer had adoption leave policies. Researchers recommended a discussion among orthopedic programs in order to generate “a more transparent and uniform policy” from one institution to another.
Some areas are better for supporting parents to maintain a work-life balance and, perhaps not surprisingly, obstetrics and gynecology is one of the areas that is more accommodating for these issues. In a survey of obstetrics and gynecology residency programs, researchers found that:
-80% of residency programs had written, formal maternity policies
-69% of programs had similar policies for paternity leave
-77% of the programs are designed to have other residents help to cover for a colleague on maternity leave.
However, researchers noted that even ob-gyn residencies fell short when it came to generating work schedules that were sufficiently flexible for new parents and suggested that “a more flexible curriculum may help accommodate the residents on leave without overburdening the residents who are left to cover.”
Transition Back to Work
Challenges continue as new parents transition back to work when maternity leave is over. One of the most important issues facing these new parents is the challenge of finding childcare that Verlander calls “consistent and competent”: while there are several options for childcare, from a live-in nanny to daycare to having extended family take care of the child, all of these options have distinct disadvantages, not the least of which is expense. Breastfeeding, too, can present another challenge to women who want to nurse, though with the advent of mechanical breast pumps and the ability to freeze breast milk for future use, new moms have more options than in the past.
In the study of surgical residency programs mentioned above, 38% of the general surgery programs had on-site daycare facilities and 58% provided lactation facilities for new mothers.
What Can Mitigate these Challenges
The good news is that there are things that can be done to help mitigate the challenges that medical students face when they enter into parenthood.
Careful Planning and Notification
Resentment on the part of colleagues is an often reported problem for medical students who take family leave following their pregnancy. However, this resentment and the perception that parenthood is going to diminish a student’s dedication to medicine and their work can be minimized by both planning the pregnancy carefully and by notifying colleagues as soon as possible about what is being planned in regards to taking leave.
On-Site Childcare
Another factor which could help medical students transition more easily to parenthood is the provision of on-site childcare by hospitals and other medical centers. This could help overcome the challenges of finding high quality, accessible daycare and also help with the issue of breastfeeding since it would be easier for women to actually breastfeed their children while at work.
A study of residents’ experience with pregnancy during their medical education shows a number of different stressful factors but “pregnancy during residency is common and growing more common” and programs need to find ways to support the new parents. Researchers in this study suggest a combination of flexibility in the scheduling of rotations, giving residents privacy and facilities to maintain breastfeeding, and allowing residents to participate in some clinical and academic work during maternity leave to keep clinical skills fresh and to reduce resentment on the part of fellow residents.
The American Medical Association (AMA) itself has weighed in on these issues; in their article, Making a Medical Resident’s Life More Family Friendly, the association discusses the phenomenon of increased numbers of medical students becoming parents during their medical education and reiterates the need for programs to make it easier for these new parents to balance their home and work lives. Specifically, they mention maternity and paternity leave, the need for childcare and breastfeeding facilities, and increased flexibility of hours to make childcare easier even in the face of demanding career education.
In short, mixing parenthood and medical education is not easy and the burden, not surprisingly, falls particularly hard on female medical students. However, more and more medical students are becoming parents at some point in their medical education, and while some specialty areas have made strides to help accommodate the work-life balance of these students, other areas appear to be woefully behind. This is unfortunate because as more women are opting to become doctors, this issue is destined to become more of a problem not only for the students themselves but for their peers, instructors, patients, and the healthcare system as a whole.
Brian Wu, MD, Ph.D., MNM, graduated from the University of Maryland with a Bachelor’s of Science in Physiology and Neurobiology, and graduated from the Keck School of Medicine (University of Southern California) with an MD with a focus on holistic care and treatment. He currently holds a Ph.D. in integrative biology and disease for his research in exercise physiology and rehabilitation.