Female physicians are at increased risk of infertility, miscarriage, and pregnancy complications due to a multitude of factors. Physicians undertake long training and experience stressful work environments during optimal childbearing years. Female physicians commonly experience maternal discrimination,^1,2 and pregnancy complications and negative influences on family planning represent work-home conflicts that may increase the risk of burnout and career dissatisfaction.³

Prior reports indicating female physicians have children at an older age^4-6 and have fewer children^4,7 are limited by small sample sizes or are constrained to certain specialties. To identify contemporary pregnancy trends in a large sample of female physicians, an anonymous electronic survey querying pregnancy demographics and complications, infertility diagnosis and treatment, workplace environment, and prior education on these topics was distributed through private female physician social media groups. The results were compared to general population data^8-10 and between medical and surgical specialties.

Figure. Solutions for culture change across all levels of medical training/practice. APP indicates advanced practice provider; RVU, relative work unit.

A total of 4,533 female physicians completed the survey: 1,089 surgeons and 3,444 medical specialists. Compared with the general population, female physicians had children significantly later in life (31.8 vs 23.6 years; P < .0001), were more likely to have had a miscarriage (40.7% vs 19.7%; P < .0001), to have undergone infertility evaluation (35.2% vs 8.8%; P < .0001) or infertility treatment (28.1% vs 12.7%; P < .0001), or to have had a pre-term birth (20.4% vs 10.2%; P < .0001).

Forty-two percent of those surveyed were discouraged from starting a family during training or practice, 49% experienced negative workplace attitudes regarding pregnancy, and only 8% received education during medical training regarding the risks of delaying pregnancy. Those who received education were more likely to have pregnancies earlier in their career and were less likely to have had a miscarriage (33% vs 41%, P = .0017), infertility evaluation (27% vs 35%, P = .0012), or infertility treatment (23% vs 29%, P = .0179).

Compared with medical specialists, surgeons reported fewer children, older age at first pregnancy, longer working hours, and more pre-term births. Surgeons also reported less support for pregnancy and breastfeeding (58% vs 66%, P < .0001) and shorter maternity leave (8.6 vs 10.9 weeks, P < .0001) compared with non-surgeons. On multivariate analysis, with every hour more worked per week, there was a 1% higher chance of having a major pregnancy complication (P < .001).

These findings highlight that female physicians have a significantly greater incidence of miscarriage, infertility, and pregnancy complications than the general population. Compared with non-surgeons, surgeons are of even older maternal age and are more likely to experience discrimination in the workplace regarding pregnancy, breastfeeding, and family planning. Finally, and most importantly, education on the consequences of delaying pregnancy during training was found to mitigate many of these risks.

It is predictable that female physicians often find themselves delaying having children.^4-6 Physicians at all levels of training and practice often face pregnancy-related discrimination, stringent board training requirements, limited workforce redundancy, and brief parental leaves.^11,12 Guilt related to burdening colleagues who may be asked to cover leave and pressure to preserve professional reputation may also dissuade physicians from starting a family.

Over 40% of respondents were discouraged from starting a family and nearly 50% experienced negative workplace attitudes regarding pregnancy. These results reflect a pervasive culture throughout medicine that has changed very little over the past decade. Prior studies found only 16% of physicians reported their workplace to be supportive of pregnancy,¹³ 36% of residency program directors actively discouraged pregnancy during residency,¹¹ and among practicing physician mothers, 78% reported gender and/or maternal discrimination.¹

The culture of medicine and surgery must evolve to better support family planning and childbearing for physicians. Paid parental leave of adequate duration is a clear metric of parental support. Adequate paternal leave is associated with reduced post-partum depression, infant mortality, and maternal rehospitalization.¹⁴ In a survey of 243 female urologists, those who took 9 weeks or longer of maternity leave were 3.8 times more likely to report satisfaction.¹⁵ Despite these facts, over 70% of academic medical centers offer less than 6 weeks of paid parental leave.¹⁶

Lower rates of miscarriage and infertility were reported in those who received education while in training regarding the risks of delaying pregnancy. Such curricula should be provided during medical school and early residency to encourage trainees to make evidence-based decisions about timing of family planning and allow them to explore options for fertility preservation. Adequate and supported parental leave and early education of trainees are only 2 facets of culture change. Building on the work of recent studies,^4,17,18 key practical recommendations for system improvement are outlined in the Figure.

These changes would improve the health and well-being of childbearing female physicians and may reduce burnout seen in those suffering from infertility, pregnancy complications, and miscarriages.¹⁹ As physician burnout is increasingly recognized for its adverse impact on quality of patient care, professionalism, physicians’ own care and safety, and the viability of health care systems,²⁰ efforts to improve physician wellness must consider improved family benefits, education, and support for family planning for female physicians.