No Good Time? Medical Students Fret Over Family Planning

Derick Alison
Derick Alison
7 Min Read

Medical students perceive their medical education to be at odds with planning for a family, which in turn may affect their choice of specialty, a qualitative study from Canada suggested.

Four themes that emerged from interviews with 34 fourth-year medical students were that there is no ideal time to family build in a medical career; family planning is a taboo topic; surgical specialties offer less support for building a family; and residents with children are a perceived burden on colleagues, reported Andrea Simpson, MD, MSc, of St. Michael’s Hospital in Toronto, and co-authors.

These perceptions may affect specialty choice and family planning goals among medical students, they noted in JAMA Surgery.

“We don’t get a lecture on how you create your family plan, we can’t ask these questions in interviews, so people feel like it’s become this topic of conversation that is very taboo. We don’t really talk about it,” co-author Shirin Dason, MD, of Mount Sinai Hospital at the University of Toronto, told MedPage Today.

“The message of this study is that there’s a general culture of discouragement,” she added.

Students described concerns about the time constraints of medical training and having children, and hearing from female physicians who described their own difficulties in balancing these responsibilities. Many said they had a sense that family planning was something not to ask about, or heard from faculty and residents that parental leave can delay or prevent trainees from finishing residencies.

Some perceived that having children would be unfair to others; for example, if a childcare emergency meant someone else would have to take on more work. They had the impression there were uneven expectations of men and women in parenting, and that surgery in particular demanded more from trainees and staff than other medical specialties.

One student said she saw two pregnant women operating for 6-7 hours one day without eating, “so I was very worried and with a nurse, we had to get juice for them in the middle, because they did not look well, but they pushed through,” she recounted. “So it’s doable for those who are very determined, but I don’t think, for me, I would want to do that.”

Dason noted, however, that because of the taboo nature of the topic, it’s unlikely that the medical student would have discussed the situation with these surgeons. In fact, the pregnant women might have planned their day effectively — eating a big breakfast, wearing a support belt, taking a break for water — and been satisfied with their work and home life, Dason said.

“But the students feel as though they only get one side of the story and they make their own interpretation,” she added. “So it’s almost like ‘Don’t Ask, Don’t Tell,’ but then people create this very negative experience, in some ways, about what their interpretation of the situation is, and … may not have gone into surgery for that reason.”

Past studies have found that many physicians delay childbearing until they complete training, which can put them at higher risk for infertility and pregnancy complications. Research has also found that pregnancy, lactation, and childcare are subject to workplace stigma, and a lack of support from peers and directors.

Canada has a medical training timeline similar to the U.S., but provides more social protections, including paid pregnancy, maternity, and parental leave. Still, a common sentiment in training, according to the study and an invited commentary, remains, “Don’t go into surgery if you want to have a family.”

Liane Feldman, MD, of Montreal General Hospital, and colleagues wrote in the commentary that “the attitudes and perspectives of medical students in this study mirror the prevailing culture: as a profession, we value work and productivity above all else.”

For this study, Simpson and colleagues recruited fourth-year medical students from the University of Toronto Temerty Faculty of Medicine who had already matched through an email to all students and social media. Students could recommend additional participants.

Interviews of the 34 participants were conducted via Zoom from May to August 2021, and were 30-60 minutes long. Most participants were women (67.6%), median age was 26, 29.4% each were white and East Asian, and most were heterosexual (88.2%). All participants received a $25 gift certificate.

Of the participants, 23.5% were specializing in family medicine, 17.6% in obstetrics/gynecology, and 11.8% each in internal medicine and surgery.

Questions assessed participants’ knowledge of family planning support in residency, family planning education, attitudes around family planning, personal family planning goals, and factors considered in selecting their specialty and residency program. The researchers used descriptive thematic analysis to determine themes.

Simpson and colleagues acknowledged limitations to their study, including the possibility that certain viewpoints, along with aspects of family building in other career stages or in medical training outside Canada, were not reflected.

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    Sophie Putka is an enterprise and investigative writer for MedPage Today. Her work has appeared in the Wall Street Journal, Discover, Business Insider, Inverse, Cannabis Wire, and more. She joined MedPage Today in August of 2021. Follow

Disclosures

Funding for the study came from the 2021 Knox Richie Award from the Department of Obstetrics and Gynaecology at Sinai Health, Toronto; the Physicians’ Services Incorporated Foundation’s New Investigator Award; and the Comprehensive Research Experience for Medical Students Summer Research Program and Gordon C. Leitch Bursary for Student Research in Obstetrics & Gynaecology, both at the University of Toronto Temerty School of Medicine.

The study authors and commentators reported no conflicts of interest.

Primary Source

JAMA Surgery

Source Reference: Dason ES, et al “Medical students’ perspectives on family planning and impact on specialty choice” JAMA Surg 2023; DOI: 10.1001/jamasurg.2023.6392.

Secondary Source

JAMA Surgery

Source Reference: Tang JE, et al “Fertility, family, and a career in surgery — time to change the narrative” JAMA Surg 2023; DOI: 10.1001/jamasurg.2023.6397.

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