Why Do Women Leave Medicine? My Look at Pregnancy During Residency
Surviving years of medical training requires a certain personality type—one with a willingness to skip the party, stay home and study, work on both Saturday and Sunday, and switch from night shifts to day shifts and then back to nights without a break in between. Yet, this commitment and lifestyle might be incompatible with starting a family, and it may be why many women physicians go part-time or leave medicine altogether.
A recently published article by the Association of American Medical Colleges titled “Why women leave medicine” reports that according to the University of Michigan’s Intern Health Study, “Almost 40% of women physicians go part-time or leave medicine altogether within six years of completing their residencies.” Reasons for this astounding statistic include the roles of gender harassment, salary inequity, gender bias, work-family conflict, evidence that household responsibilities are a greater burden for women physicians than men, and discrimination related to pregnancy and breastfeeding. A national survey of 347 general surgeons who had one or more pregnancies during residency found that the challenges associated with the experience had “39% of participants seriously considering leaving residency and 30% reporting they would advise a female medical student against pursuing a career in surgery.”
Nonetheless, these studies are not stopping women from entering the medical profession. In fact, in 2018, women were the majority of matriculants to medical school for the second year in a row (51.6% versus 50.7% in 2017). Perhaps these women, young and naive, are unaware of what lies ahead of them. I certainly was. No one had ever shared with me the trials and tribulations of being a woman, or a pregnant woman, in medicine. Being a woman in medicine is one thing, but being a pregnant woman in medicine is another.
I am currently in my third trimester of pregnancy and am a family medicine resident. My schedule was front-loaded to knock out the most challenging rotations before having the baby, which meant working 6 days a week for an average of 12 hours a day throughout the first 7 months of pregnancy. When asked how the pregnancy was going, I couldn’t help but laugh that the “inconveniences” of pregnancy (nausea, back pain, insatiable hunger, exhaustion, reflux, sleepless nights, and weight gain) pale in comparison to the physical, mental, and emotional challenges of residency.
The story of the “boiling frog” explains that if a frog is placed into a pot of boiling water, it will immediately jump out, but if the frog is placed into a pot of warm water that is slowly brought to a boil, it will never perceive danger and can be cooked to death. Residents across the country, particularly women, are the frog, and the pot is slowly starting to simmer.
In 2003, the popular “80-hour workweek restriction” was established prohibiting residents from working more than 80 hours per week, greater than 24 hours per shift, and having 1 day off in every 7 and at least 8 hours between shifts. Yet, for many residents these rules are disregarded, as the hazing to prove oneself worthy of a career in medicine can require an all-or-nothing attitude. So where does that leave women in medicine, like myself, who are pregnant or have young families? Sadly, my anecdotal evidence demonstrates that there is not much room for us.
There are countless moments when being a woman has made me feel “less than” in medicine…the number of times patients have called me “nurse” or asked to speak with the doctor despite my long white coat and hospital badge with bold block letters that state PHYSICIAN. I found that I am far from alone. As I started speaking to doctors who are currently pregnant or who had been pregnant during residency, I noticed a theme: they all had discouraging stories about how pregnant women in medicine are treated. Per request, I’ve kept their stories anonymous.
When I was 37 weeks pregnant, I had to block off two appointment slots on my OB/GYN outpatient rotation for my own prenatal appointment. This was apparently unacceptable and unprofessional because as I walked into the clinic for my rotation, the OB/GYN attending told me she was concerned that my time off would impact my educational experience. To add insult to injury, my last patient, who was also 37 weeks pregnant, was requesting a doctor’s note saying she was unable to work for the past month due to the discomforts of pregnancy. The attending had just shamed me for taking an hour away from residency to seek my own prenatal care but empathetically told the patient that “we are on your team” and will do “whatever we can to support you.” As we walked out of the patient’s room, the attending proudly said, “It’s so important to protect women’s rights in the workplace” and told me to write a letter to the patient’s employer.
I was in my third trimester of pregnancy while on call for a patient delivery. I asked another resident if the program had any restrictions regarding working night shifts during the third trimester. “No,” she said, “the last two pregnant residents who worked nights went into preterm labor during their shifts.”
My program only offers 5 weeks of short-term disability pay at 60% of my salary for parental leave. (Author’s note: the American Academy of Pediatrics recommends that residents should receive 12 weeks of paid leave—there are proven benefits to both parents and children). I can take an optional unpaid 12 weeks due to protection from the Family Medical Leave Act. The best part? Every day missed must be made up. Not a single day, including the day of delivery, is excused. Some programs get creative and use research months or “mother-baby” bonding electives to prevent women from having to make up time from maternity leave, so I asked my program director (who has children) if those were options. She responded “We don’t do that here.”
Late in my third trimester, a patient was yelling that I was the “worst doctor ever” because I wouldn’t renew her opioid prescription. Her urine drug screen didn’t confirm that she had been taking the opioids that I had prescribed for her the prior week. Walking out of the room, I starting having contractions from the stress of the situation and asked an attending for help managing the patient. The attending, who had just returned from maternity leave, said, “You can’t use your baby as an excuse, you have to be the doctor now.”
In a policy statement titled “Parental Leave for Residents and Pediatric Training Programs,” the American Academy of Pediatrics cites three different studies that found “increases in pregnancy complications, such as preterm labor, pre-eclampsia, and fetal growth restriction, have been associated with strenuous working conditions during residency training.” Yet somehow these findings don’t translate into any protective policies. How many more preterm labors or adverse outcomes will it take? Are we waiting for a newborn to end up in the NICU or a critical maternal postpartum condition? The line needs to be drawn now.
I share these stories with a fundamental belief in change. By reflecting on the challenges of those who have come before us, we can envision how the road could be less bumpy for those to come. Rather than discouraging young women from entering our careers and specialties, how can we create policies that protect and support them? What opportunities do we have to be creative and flexible that empowers residents, both men and women, to pursue both their career and personal aspirations? Let’s all imagine that world and go create it.