Physicians, trainees report multitude of barriers to family building in medical profession
Key takeaways:
- Pregnant individuals reported discrimination from their medical programs, including barriers to promotions.
- Survey respondents also reported difficulty in building families after residency.
Medical students and physicians reported experiencing cultural, organizational, interpersonal and individual barriers to family building, according to results of a qualitative analysis published in JAMA Network Open.
The findings indicate the critical need to create a more equitable family-building environment for all individuals in medicine, researchers concluded.
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Qualitative analysis
“One in four women in medicine suffer from infertility,” Qiang Zhang, BA, an MD student at UCLA, told Healio. “As medicine continues to grow more diverse, it’s important to raise awareness of this issue, because one should not have to choose between having a career and having a family.”
As Healio previously reported, researchers conducted a cross-sectional study that included 3,116 physicians and trainees recruited via social media in April and May 2021.
For the current qualitative analysis, they sought to examine the barriers and facilitators to family building among 2,025 medical students and physicians (92% women; 64% white; 85% heterosexual; 59% physicians).
Participants reported demographic, work-related and family-building journey characteristics, and they responded to at least one of three open-ended questions on family building experiences:
- What would you do differently, if anything, regarding family planning knowing what you know now?
- What advice do you have for current trainees who want to have a family?
- What else would you like to share about how your career has impacted your family planning?
Identified themes
Results showed the themes mapped to social-ecological model levels included:
- cultural — medical training being at odds with family building;
- organizational — lack of institutional support of family-building routes;
- interpersonal — impact of social support on family building; and
- individual — socioeconomic status and other individual factors that facilitate or inhibit family building.
Of note, pregnant individuals and those building families reported discrimination from their programs, including being less likely to be promoted. In addition, pregnant physicians shared similar experiences of discrimination, such as “[faculty] have made it painfully clear they would look down on and resent any female colleague who got pregnant.”
Respondents additionally reported difficulty in building families after residency and encouraged their peers to not give into pressure to delay family building.
“We hope that through sharing personal stories of these participants, readers can better understand how the structure of medicine is not conducive for family building, and also hear proposed solutions to this problem,” Zhang said. “We hope readers will see how there are many forces at play in the medical system, including lack of institutional support for artificial reproductive technology, a culture of strenuous work and rigid schedules, discrimination, lack of transparency, among others, that contribute.”
Limitations of the study included the inability to calculate a response rate due to the recruitment strategy, the potential for selection bias — due to convenience sampling using social media or to those desiring to have children or those with family-building challenges potentially being more likely to respond — as well as the need for future research to seek to better understand and quantify the desires of those who do not want or have children.
Recommendations for improvement
Researchers recommended implementing family-building curricula at medical schools, providing adequate parental leave for all physicians and medical students who become parents, and providing insurance coverage for all family-building routes as ways to improve family-building experiences in medicine.
“We can all play a role in stepping up and speaking up on this issue,” Zhang said. “Other proposed solutions we discussed in our paper include increasing protection for lactation and on-site child-care. Other steps include fighting against the discriminatory culture toward pregnant trainees.”
Researchers plan to continue work in this area to better understand how to implement the proposed solutions into the existing medical system.
For more information:
Qiang Zhang, BA, can be reached at qiangzhang@mednet.ucla.edu.
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