Family Planning, Fertility, and Career Decisions Among Female Oncologists

Abstract

ImportanceFemale oncologists often spend their childbearing years in training and establishing careers, with many later experiencing fertility issues when starting a family. Physician fertility and family planning are rarely discussed during training. Attitudes among female oncologists regarding family planning are unknown.ObjectivesTo understand barriers to family planning as well as the association of fertility treatment with career decisions and to assess experiences of pregnancy-based discrimination among female oncologists.Design, Setting, and ParticipantsIn this survey study, a novel 39-item questionnaire was distributed to US female oncologists from May 7 to June 30, 2020, via email and social media channels. Questions regarding factors associated with family planning, maternity leave, and discrimination were included.Main Outcomes and MeasuresThe distribution of survey responses was compared by oncology subspecialty. Multivariable logistic regression was performed to determine independent variables for discrimination experienced during maternity leave.ResultsResponses were collected from 1004 female oncologists. Most respondents (847 [84.4%]) were married, and 713 (71.0%) were currently working full-time. A total of 351 oncologists (35.0%) worked in radiation oncology, 344 (34.3%) in medical oncology, 186 (18.4%) in surgical oncology, and 91 (9.1%) in pediatric oncology. A total of 768 respondents (76.5%) had children, and of these, 415 (41.3%) first gave birth during postgraduate training, and 275 (27.4%) gave birth in years 1 to 5 as an attending physician. Almost all respondents (951 [94.7%]) stated that their career plans were at least somewhat associated with the timing of when to start a family. Having a supportive partner was the most commonly cited positive association with family planning (802 [79.9%]), while long work hours and heavy workload (669 [66.6%]) were the most common negative factors. One-third (318 [31.7%]) had miscarried, and 315 (31.4%) reported difficulty with infertility that required fertility counseling and/or treatment; 660 (65.7%) thought fertility preservation should be discussed with women during medical school and/or residency. One-third (312 [31.1%]) reported experiencing discrimination during pregnancy, and 332 (33.1%) stated they experienced discrimination for taking maternity leave. On multivariable logistic regression, having more than 1 child was associated with increased likelihood of experiencing discrimination during maternity leave (2 children: odds ratio, 1.62 [95% CI, 1.10-2.39]; P = .02; ≥3 children: odds ratio, 1.84 [95% CI, 1.14-2.95; P = .01).Conclusions and RelevanceIn this survey study of female oncologists, 1 in 3 reported experiencing infertility and 1 in 3 stated they experienced discrimination during pregnancy and/or for taking maternity leave. Systemic changes are necessary to ensure women are supported and able to advance equitably in the field.

Considering the Effects of the Dobbs Decision on Clinical Training and Practice and on the Lives of Medical Professionals

“…34 An underappreciated dimension of the Dobbs decision is the direct repercussions on health professionals themselves. Women in medicine commonly experience fertility problems and miscarriage [43][44][45][46] and are at greater risk compared with the general population. 46 A significant number of women physicians have had an abortion; according to a recent study of 3,104 U.S. physicians and physicians-in-training, 11.5% of those who have been pregnant have had an abortion.…”

Female Oncologists' Perceptions on Family and Career—Does It Have to Be a Choice?

“…Female physicians who want, will soon have, or do have children do not have it easy. Lee et al 1 advocate for early education on ART 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. These cultural values are so deeply pervasive (one could also say invasive) that they affect even these most educated and wealthy professional women, such as those who participated in this survey.…”

“…This study by Lee et al 1 surveys female (assigned female at birth and those identifying as female) oncologists about the barriers they faced in pursuing their childbearing aspirations and most notably found that 1 in 3 of those surveyed experienced infertility, and 1 in 3 experienced discrimination during pregnancy and/or maternity leave. Lee et al 1 recommend more education in, as well as access to, assisted reproductive technologies (ART) and paid pregnancy leave policies in medical school and residency. While both of these items would certainly be steps in the right direction, challenges to childbearing constitute a national problem that transcends women in medicine or any other profession.…”

“…In a Society of Gynecologic Oncology (SGO) evidence-based review, Temkin et al report that parenting affects academic advancement opportunities more for women than it does for men and that perceived workplace pressures (such as those related to institutional productivity goals) as well as concern about retaliation lead to truncation of maternity leave. This segues into the study by Lee et al, in which one-third of survey respondents reported discrimination due to pregnancy or maternity leave.…”

“…Medical students are already taught that as women age, their fertility decreases. Encouraging formal and directed education regarding the infertility risks specifically toward female physicians (which Lee et al recommend) could be perceived as a blanket recommendation that it is best for women in medicine to delay childbearing and pursue ART. Medical schools and residency and fellowship training programs should instead focus their energy on 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 ART and delay fertility until after training.…”