It’s no secret that it’s incredibly challenging to balance a career in medicine with having a family, particularly for women. As two medical students and a researcher studying family building in physicians and medical students, we are acutely aware of these challenges.
Medicine does not make building a family easy. Although no one should ever have to choose between having a career in medicine or having a family, many physicians and medical students continue to struggle. In our recent survey, published in JAMA Network Open, our team examined responses from more than 2,000 physicians and medical students to understand the barriers faced by those building families. We uncovered shocking stories that demonstrated a lack of institutional support for the costs of assisted reproductive technology (ART) and surrogacy, a toxic culture of discrimination, and complex interpersonal conflicts surrounding pregnancy. Our findings underscored how profoundly broken the system is.
Due to the implicit and explicit messages encouraging trainees to delay childbearing until after training, many who want to have children would benefit from access to ART, including cryopreservation. Unfortunately, the high cost of cryopreservation and lack of insurance support during residency hinder many from pursuing it as a viable option. The cost of egg freezing for one cycle can range from $8,000 to $20,000.
Those who are not able to have children or pursue cryopreservation during training may need IVF later on, which is also costly and time-consuming. One cycle of IVF can involve many steps, including fertility assessment, monitoring appointments, bloodwork, egg retrieval, embryo creation, storage fees, and expensive medications and injections. Doing all of this within a short period is often unrealistic with a demanding medical work schedule.
Alternative family-building routes, such as surrogacy, which LGBTQIA+ physicians often pursue, are even more expensive. One physician in our study wrote, “At the start of our journey, we were told to expect up to $200,000 worth of costs for a single pregnancy. Now that we have gone through two miscarriages, we’ve already spent $100,000 and have to start the process of finding a new surrogate, labs, travel, genetic counseling, lawyers, surrogate insurance, and IVF costs all over again.” Unfortunately, many residency programs do not provide coverage for fertility care, specifically for elective egg freezing.
Beyond financial hurdles, the culture of medicine is not friendly toward those trying to have children. Respondents in our study described how supervisors and peers would discourage individuals from having children, and they felt pressure not to discuss their pregnancies or pregnancy losses. Multiple individuals shared situations where they continued to work after having a miscarriage due to fear of stigmatization: “I had a miscarriage during rounds as a fellow in a hospital bathroom. There was so much stigma around being pregnant that I went back to round. I only told my mom.”
The extreme physical pressures of medicine — such as making residents endure exhausting 24-hour shifts and adhere to rigid schedules — can also create barriers to building a family. The statistics are grim: 1 in 4 women in medicine struggle with infertility. And personal stories abound: Ariela Marshall, MD, a hematologist at Mayo Clinic and an author on our study, delayed having children until she was 34. She found that, even with fertility drugs, it was challenging to conceive — likely due to frequent night shifts, lack of sleep, and stress.
For those who are successful in becoming pregnant, there is little to no accommodation. Parental leave policies are sometimes as short as 4 weeks and often nonexistent for non-birthing parents. One woman wrote, “I wish it was more expected for residents and physicians to take a more reasonable length of maternity leave, rather than having to return to work while your body is still in the acute phase of recovery.” This grueling culture in medicine should no longer be embraced as the standard, given the toll it takes on the lives of physicians and medical students.
Interpersonal conflicts may also arise related to pregnancy. The existing system disproportionately burdens our colleagues without children when someone chooses to start a family. As one woman wrote, “As the only resident in my program that didn’t have kids, I took more call than everyone in my class combined and at the end of my senior year, nearly committed suicide because of the stress and sleep deprivation.” The workload should still be bearable even if someone is on parental leave, but too often that is not the case. Paradoxically, while society often perceives women choosing not to have children as selfish, in medicine, the opposite is true because of these dynamics.
People in medicine already make substantial sacrifices for their career, undergoing years of rigorous training in emotionally taxing environments. Hospital, departmental, and residency program leaders need to take steps to fight against the discriminatory culture toward pregnant workers in medicine. Institutions should provide support to cover the high cost of cryopreservation and ART, create a more humane work schedule, and improve parental leave policies. Additional staff should be brought in to protect co-workers from heavier work burdens when a colleague goes out on leave. Institutions such as the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education need to speak out and take a stance on this issue to protect all medical students, especially residents. It’s time to put in the work to change this unjust system and promote a future of medicine that supports everyone.
Qiang Zhang is a medical student at the UCLA David Geffen School of Medicine in Los Angeles. Morgan S. Levy is a medical student in the MD and Master’s in Public Health program at the University of Miami Miller School of Medicine. Zoe King is an incoming PhD student in Public Health and Community Medicine at the University of New South Wales Sydney in Australia.
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