Women in Medicine and the Ticking Clock

To the editor:

Thank you for this timely and moving essay ("Women in Medicine and the Ticking Clock.") As a family medicine residency faculty member, I recruit, teach, and try to support female residents struggling with competing priorities of motherhood and medical training. As a mother, I know that no other experience compares to that of bearing and rearing children. In our area (northern Utah) women are still under-represented in medicine. While we are highly sought after by employers and patients we still sometimes face pressure from colleagues, patients, and ourselves to fit our careers into patterns that have traditionally worked well for our male colleagues but may not be the best arrangements for ourselves. How can we better encourage women to pursue careers in medicine while more openly acknowledging the peril of delayed child-bearing?

Pregnancy as a perceived or actual threat to one's career has been well-studied in physicians (1, 2). Better support of the pregnant or postpartum physician may help mitigate this. In a study of pregnancy and residency, we found that newly- delivered residents' perceptions that their newborns' needs are met influenced their satisfaction and self-ranked performance (3). Structuring training programs to allow more flexible scheduling, including extension of residency if needed (4); communicating clearly with trainees about maternity leave options (5); and encouraging experienced mother-physicians to interact with younger docs as role models may help. Beginning this support as early as medical school, or even pre-medical training, might provide the most impact. In our area with low numbers of female physicians, our residency program has partnered with the local university's pre-medical program to offer an annual "Girls Exploring Medicine (GEMs)" conference which has raised awareness and enthusiasm of female physicians in our community and also increased the percentage of female applicants to medical school from our city. If we could actively promote open discussion about not only the option to have children during medical training, but the potential biological peril of waiting too long to start a family, perhaps we could minimize the difficult circumstances described in this essay. More research about attitudes and outcomes of pregnancy and medical training are needed.

1. Willett LL, Wellons MF, Hartig JR, et al. Do women residents delay childbearing due to perceived career threats? Acad Med 2010;85(4):640-6.

2. Young-Shumate L, Kramer T, Beresin E. Pregnancy during graduate medical training. Acad med 1993;68(10):792-9.

3. Hutchinson A, Anderson N, Gochnour G. Pregnancy and Childbirth During Family Medicine Residency Training. Fam Med 2011;45(3):160-5.

4. Rose SH, Burkle CM, et al. The impact of parental leave on extending training and entering the board certification examination process: a specialty-based comparison. Mayo Clin Proc 2006;81:1449-53.

5. Gjerdingen D, Challenger K, et al. family practice residents' maternity leave experiences and benefits. Fam Med 1995;27(8):512-8.

Competing interests:   None declared

I was moved by this piece and greatly appreciate the authors for their thoughtful exploration of a very important topic.

I have a different experience because I had children young, before medical school. During medical school and family medicine residency, I was the only mother in training. I was disheartened by the prejudice I experienced as a mother who was aspiring to be a doctor. The message I got, repeatedly from a multitude of people from school of medicine professors to classmates, was that somehow it was wrong of me to be a medical student/resident and mother of young children at the same time.

We should rewind the clock and reframe how we view motherhood in our profession. We should encourage systems change that supports women medical students and residents to not delay childbearing. There is never a "right time" for a mother-doctor to have a baby. Better younger than later for most of us.

I hope to support my young woman doctor colleagues to feel that is good and safe professionally to have children younger. And I think as family doctors we should carefully address how motherhood is supported in our profession. Child care centers associated with our workplaces for example.

Competing interests:   None declared

I think all of these stories underscore the complexity of being a female physician and a mother. The key is that we should all have choices -- do we have children in medical school or residency, or do we wait until we are "done" with our training. Either way, we face hardships and potential barriers.

To me, as a mother and a part time physician, I feel lucky to be able to try and do both. I too look on my profession as a marathon, not a sprint, and hope that I am able to enjoy the time I am spending now with my children and continue to be a physician for many years to come.

I think our profession makes it unnecessarily difficult to do both. We frown on working part time, taking time off in medical school, or shared residency spots. It seems to me that there is no right way to pursue medical training and motherhood, but that we all need to make our own decisions. I hope our discipline of family medicine can really think about how to be family friendly in the future in order to attract new physicians.

Thanks for sharing your stories. Sarina Schrager

Competing interests:   None declared

Dear Dr. Lesko, We greatly appreciate you opening the discussion to our article, "Women in Medicine and the Ticking Clock." We admire your courage to share your meaningful story and to have kept such a positive attitude despite a less than supportive environment during your childbearing years. We agree that we as a medical profession should consider changing our approach to the career-life balance issue. It is our hope that more people will step forward in sharing their experiences and stories. Thank you for sharing yours with us.

Sincerely, Lisa Miura, MD and Rebecca Boxer, MD, MS

Competing interests: None declared