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At What Age Do Doctors Make a Family, According To Specialty? Surgeons Are At The Bottom of The List

Discussion in 'Doctors Cafe' started by Nada El Garhy, Jul 26, 2019.

  1. Nada El Garhy

    Nada El Garhy Golden Member

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    Doctors' age at domestic partnership and parenthood: cohort studies

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    Introduction

    Key stages of doctors’ training, in their 20s and early 30s, coincide with times when people typically make decisions about family formation and first having children. It is important for employers, workforce planners and senior doctors to know about typical patterns of family formation by doctors at different ages and career stages. Living with a spouse or partner is likely to reduce doctors’ scope for easy geographical mobility and for ease of working unsocial hours. For workforce planning, it is important to know the ages and stages at which women doctors may take maternity leave. It is also of interest to know how doctors compare with the general population in respect of family formation and parenthood; and whether there is any evidence to suggest that some doctors sacrifice parenthood in the pursuit of their medical careers. We report on the ages at which UK-trained doctors marry or live with a partner; and the ages at which they have their first child. We compare men and women, and doctors practising in different clinical specialties.

    Results
    The response to surveys including questions about domestic circumstances was 89.8% (20,717/23,077 doctors). The main outcomes – living with spouse or partner, and parenthood – varied according to age at qualification. Using the modal ages of 23–24 years at qualification, by the age of 24–25 (i.e. in their first year of medical work) a much smaller percentage of doctors than the general population was living with spouse or partner. By the age of 33, 75% of both women and men doctors were living with spouse or partner, compared with 68% of women and 61% of men aged 33 in the general population.

    By the age of 24–25, 2% of women doctors and 41% of women in the general population had a child; but women doctors caught up with the general population, in this respect, in their 30s. The specialty with the highest percentage of women doctors who, aged 35, had children was general practice (74%); the lowest was surgery (41%).

    TABLE

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    Table 1
    Percentages of respondents aged 23 or 24 on qualification who were living with spouse or partner at certain ages after qualification, compared with the general population in England and Wales who were from the same birth cohorts, by year of qualification and sex

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    At ages 24–25 years the partnership rates for doctors were far lower than those in the general population: 21% of women doctors were living with a spouse or partner compared with 46% of women in the general population (Table 1). The corresponding figures for men doctors, and for men in the general population, were 19% and 31%. By the ages of 30–31, partnership rates for doctors, both for women and men, had overtaken those in the general population by a substantial amount (Table 1). At the age of 34–36, 83% of the women doctors were married or living as if married compared with 71% of women in the general population; and 89% of the men doctors were living with a spouse or partner compared with 68% of men in the general population.

    It is useful to consider family formation by years since qualification as well as by age. As noted above, approximately a quarter of all respondents in the combined cohorts were living with a spouse or partner in their first year after qualification. Three years after qualification, 48% of women and 49.6% of men respondents were living with a spouse or partner. Five years after, the percentages for women and men doctors living with a spouse or partner were both 64% (Table 1).

    Table
    Percentages* of women and men doctors who had their first child by each age, up to age 35, within mainstream specialties; 1988 to 2002 cohorts combined (censored Kaplan–Meier survival analysis)

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    Discussion
    Comparing doctors with the general population, doctors have lower rates of partnership formation in their 20s and higher rates than the general population by their mid-30s. Thus, a medical career does not adversely impact on the likelihood of eventual domestic partnership.

    Women doctors had much lower rates of parenthood in their 20s than women in the general population but caught up with the general population in this respect in their 30s. We found that, just as the trend in the UK generally is towards later childbirth, UK women doctors are postponing having children until older ages.

    Percentages of men doctors who became parents were generally a little higher than those of women doctors. However, the percentages of both women and men doctors who became parents varied across specialties. For example, the percentages of women and men in general practice who were parents by the age of 35 years were very similar (74% and 75%, respectively). The percentage of women surgeons who were parents by the age of 35 (41%) was substantially lower than that of men surgeons (69%), as was that of women who were hospital physicians (50% of women, 62% of men).

    A major strength of this study is its size and national coverage. The longitudinal data on marriage or living with a partner, and age at first childbirth, of doctors in different specialties are unique in the UK and, where available, we show equivalent data on the general population for comparison.

    A potential weakness is that, though our response rates are high, we cannot take account of any non-responder bias. It is possible that doctors who are in partnerships, or who have children, are more likely, or maybe less likely, to reply to us. A weakness is that we do not have data on population rates of partnership and parenthood by social class. It is entirely possible that the low rates of domestic partnership in young doctors, and the low rates of early parenthood, reflect the generality of professionals in postponing partnership and parenthood. Perhaps surprisingly, though we tried, we could not obtain data on these factors by social or professional groups in the general UK population. We have no data on separation or divorce.

    Further work is needed, in more detailed study designs than ours, to determine whether doctors in some specialties, particularly women doctors, decide not to have children as part of decision-making to put career before family. Specifically, we cannot account fully for differences between specialties in the percentage of doctors who become parents. It is possible and indeed likely that expectations about family life, and about having children, influence specialty choice for some doctors. The fact that parenthood rates are high in general practice for both women and men confirms that doctors view general practice as family friendly not only for women but also for men. It is possible that doctors’ personalities and temperaments incline them both to want children and to want to work in particular branches of medicine. For example, a relatively high percentage of both women and men in paediatrics have children of their own. It is also possible that doctors who intend to have children make different specialty choices than doctors who do not. It is possible, for example, that doctors who do not intend to have children, anyway, are more likely than others to commit themselves to a working life in surgery or the hospital medical specialties. However, the large gap between women and men in the percentage who choose a career in surgery,3 and the gap between women and men in surgery in the percentage who have children, suggests that decision–making in women and men is different in these respects. The gap suggests that a percentage of women in some specialties have taken the view that their specialty career is not compatible with having children. Further work is needed into whether some doctors decide not to have children because of their career when they would otherwise wish to do so.

    Conclusions
    Doctors are more likely than other people to live with a spouse or partner, and to have children, albeit typically at later ages. Differences between specialties in rates of motherhood may indicate sacrifice by some women of family in favour of career.

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