Female Physicians More Likely Than Other Women To Delay Childbearing

Compared to women in the general public, female physicians in Canada are less likely to have children overall, less likely to have babies when they are in their twenties, and far more likely to delay childbearing until they are in their late thirties, a new study finds.

An analysis of data from 5,328 female doctors and 26,640 non-physician women revealed that the physicians were 38% less likely to bear children, 85% less likely to have a baby in their 20s, 35% more likely to bear children between the ages of 29 and 36, and more than twice as likely to have babies after age 37, researchers report in JAMA Internal Medicine.

"Women physicians delay childbearing to later ages compared to non-physicians, with specialists delaying pregnancy longer than family physicians," said study coauthor Dr. Andrea Simpson, an obstetrician gynecologist specializing in minimally invasive gynecologic surgery at St. Michael's Hospital/Unity Health Toronto, assistant professor in the department of obstetrics and gynecology at the University of Toronto, and an adjunct scientist at ICES.

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There are numerous downsides of delayed childbirth, Dr. Simpson said in an email.

"The downsides include an increased risk of age-related infertility and pregnancy complications associated with having children at older ages (increased risk of miscarriage and hypertension, for example)," she added. "Many female doctors may delay pregnancy until after training to focus solely on their career development. They often experience challenges if they choose to have children during their training, including challenges with childcare during long/unpredictable working hours. They may also experience discrimination, with fewer career opportunities and assumptions by others around how having children will impact their work as a physician."

The fact that few women choose to have children while in medical school is revealing, Dr. Simpson said. "This suggests that the culture of delaying pregnancy begins very early in training," she added. "As a profession, we need to identify our own biases and support physicians and physicians-in-training who wish to have children at any career stage."

To explore whether female physicians were more likely to delay childbearing than other women, Dr. Simpson and her colleagues performed a population-based retrospective cohort study of reproductive- age women in Ontario, Canada, where 14.6 million citizens reside and 40% of Canadian childbirths occur.

Women were classified as physicians if they had a record of being licensed to practice medicine with the College of Physicians and Surgeons of Ontario, either as a postgraduate trainee or an independent practitioner. For their analysis, the researchers included only the 5,328 female physicians who resided in Ontario from at least the age of 15 and who could be observed over their reproductive lifespan. The female physicians were compared to 26,640 non-physician women, a 1:5 ratio.

The physician sample included 2,442 (45.8%) women who were in training or practicing in family medicine, 1,878 (35.2%) who were training or practicing in other specialties, and 900 (16.9%) who had not completed training during follow-up and were categorized as specialty not yet determined.

Over the reproductive life span, physicians on average had a decreased rate of childbirth compared with non-physicians (hazard ratio 0.62). Physicians had a markedly decreased rate of childbirth from age 15 to 28 years (HR 0.15), a slightly increased rate of childbirth from age 29 to 36 years (HR 1.35), and markedly increased rate of childbirth after age 37 years (HR: 2.62), compared with non-physicians.

Ultimately, female physicians achieved a similar cumulative probability of childbirth as nonphysicians overall, the authors note.

"This study is very interesting and really nicely complimentary to largely survey-based studies, including one of my own," said Dr. Reshma Jagsi, Newman Family Professor and director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan, in Ann Arbor. "We're seeing here evidence of the current system of medical training that is premised on the faulty assumption that physicians are all men with nonworking wives at home who can bear and raise children so their husbands can work many hours with no leave to care for the family."

There are signs that the leaders in the profession are starting to pay attention, Dr. Jagsi said. "In February there was a special meeting to address this," she added. "More specifically how to ensure adequate leaves of absence."

Right now, there's a sense that doctors are supposed to take care of patients, while "we stigmatize extra-professional caregiving," Dr. Jagsi said. "That is aberrational and wrong. Do you really want a doctor to be someone who doesn't care for their family?"

Continuing as things are is something "we do at our peril," Dr. Jagsi said. "There is accumulating evidence that those organizations and fields that have been more nimble and adaptable attract the best talent and end up with the best output and the most diverse workforce."

—Linda Carroll

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