Women oncologists face difficult career choices, biased practices when planning a family
Women oncologists reported encountering difficult career choices and discriminatory practices when planning for a family, according to survey results published in JAMA Network Open.
Systemic changes are needed to support women oncologists in advancing equitably within the field, researchers concluded.
Source: Healio Interviews. Photo courtesy of MD Anderson.
Background and methods
“The idea for this study occurred organically through discussions with women in our field about their experiences with oocyte preservation,” Anna Lee, MD, MPH, assistant professor in the department of radiation oncology at The University of Texas MD Anderson Cancer Center, told Healio. “There was limited understanding of women’s attitudes on this subject and how family planning may have been affected by our careers.”
Lee and colleagues distributed a 39-item survey — including questions about factors associated with family planning, maternity leave and discrimination — to 1,004 U.S.-based women oncologists (35% radiation oncologists; 34.3% medical oncologists; 18.4% surgical oncologists; and 9.1% pediatric oncologists) via email and social media between May and June 2020.
Researchers compared survey responses according to oncology subspecialty and performed multivariable logistic regression analyses to determine independent variables for discrimination experienced during maternity leave.
Findings
Researchers found that most women (84.4%; n = 847) were married and current full-time employees (71%; n = 713). In addition, 76.5% (n= 768) reported having children, of which 41.3% (n = 415) gave birth during their postgraduate training and 27.4% (n = 275) gave birth during the first 5 years as an attending physician.
Results showed the majority (94.7%; n = 951) of women reported their career plans were at least somewhat associated with family planning. Of note, women most commonly cited having a supportive partner as a positive reason for family planning (79.9%; n = 802), with long work hours and heavy workloads most commonly cited as negative reasons (66.6%; n = 669).
Moreover, one-third (31.7%; n = 318) of women reported having a miscarriage, 31.4% (n = 315) reported difficulty with infertility that required fertility counseling and/or treatment, and 65.7% (n = 660) thought fertility preservation should be discussed with women during medical school and/or residency.
Researchers additionally found about a third of respondents reported experiencing discrimination during pregnancy (31.1%; n = 312) and discrimination for taking maternity leave (33.1%; n = 332).
Results of multivariable logistic regression also showed an increased likelihood for experiencing discrimination during maternity leave among women who had two (OR = 1.62; 95% CI, 1.1-2.39) or three or more children (OR = 1.84; 95% CI, 1.14-2.95).
Implications
“The findings are concerning in that women may be having to make hard decisions about balancing their career and desire to have a family. Our findings show that they may be facing either biological consequences from infertility, discrimination in the workplace or, sadly, both,” Lee told Healio.
“The data support what we have been hearing anecdotally and underscore the challenges women face with trying to excel in their careers while starting a family. The data point to the work that still needs to be done to improve gender equity within medicine,” she continued. “Gender discrimination is systemic and exists at all levels. As our community becomes more aware of gender discrimination, we realize there are opportunities to intervene early starting in medical school through larger organizations to set standards and policies that will ensure women are supported and able to advance equitably in the field.”
Lee and colleagues now plan to conduct a qualitative analysis to categorize comments they received during the survey process about the lived experiences of women in the oncology field and find recurring themes to better understand their challenges and needs.
“Female physicians who want, will soon have, or do have children do not have it easy,” according to an accompanying editorial by Mona Saleh, MD, gynecologic oncology fellow, and Stephanie V. Blank, MD, professor in the department of obstetrics, gynecology and reproductive science, both at Icahn School of Medicine at Mount Sinai.
“Lee and colleagues advocate for early education on assisted reproductive technologies risks, benefits and success rates, but this is not getting at the underlying issue: pregnancy discrimination and unfair distribution of childbearing responsibilities are a reflection of a larger problematic culture rather than an issue specific to women in medicine,” they wrote. “These cultural values are so deeply pervasive (one could also say invasive) that they affect even the most educated and wealthy professional women, such as those who participated in this survey. Increased access to assisted reproductive technologies only delays the lack of support and discrimination women will face if and when they do ultimately bear children.”
Instead, the editorial authors suggest “creating a framework and culture that normalizes conception during these points in training while also subsidizing and supporting trainees and physicians who prefer to use assisted reproductive technologies and delay fertility until after training.
“Women medical students become women residents and fellows who become women attending physicians,” they wrote. “Whether they are becoming pregnant at the beginning or end of this spectrum, or not at all, there will be a workplace that must support them.”
References:
- Lee A, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.37558.
- Saleh M, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.42367.
For more information:
Anna Lee, MD, MPH, can be reached at alee13@mdanderson.org.
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Lee A, et al. JAMA Netw Open. 2022;doi:10.1001/jamanetworkopen.2022.37558.
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