WORK as a doctor involves long hours, night shifts, prolonged standing and other physical demands. Doctors are notorious for delaying pregnancy to older ages because the formation often takes place during their prime reproductive years.
Our group assessed the timing of pregnancy in physicians and found that female doctors had their first child later than non-doctors (on average, 32 years v 27 years old). Physicians seemed to “catch up” to non-physicians in having children at older ages, and family physicians were more likely to have children than other specialists at all observed ages. Very few medical students (2%) had children before beginning their postgraduate training, suggesting that the culture of postponing motherhood in the medical profession starts early.
The risks of the medical profession on the outcome of pregnancy are not known; there are studies that have shown a increased risk of negative pregnancy outcomes for doctors, such as premature deliverywhile other studies have shown no increased risk. Our aim was to assess pregnancy outcomes among physicians versus non-physicians using population-based data, to determine whether the profession of physician is associated with adverse pregnancy outcomes.
In Ontario, Canada, doctors are licensed by a regulatory body, the College of Physicians and Surgeons of Ontario (CPSO). We were therefore able to identify all practicing physicians in Ontario and link this information to their health outcomes through Ontario’s public health system records. Because lower socioeconomic status is associated with many adverse pregnancy outcomes, such as prematuritywe compared physicians to high-income non-physicians to create a fair comparison.
In our latest study, Posted in Open JAMA Network, we compared 10,489 pregnancies in 6,161 female physicians with 298,638 pregnancies in 221,191 non-physicians. Physicians were older than non-physicians (34 years v 32 years old) when they gave birth and more likely to experience their first birth (48.1% of physicians v 43.2% non-physicians).
We assessed the risk of severe complications for the mother, such as intensive care admission or severe pre-eclampsia, using a validated score. Before adjusting for factors that could influence these results (such as medical comorbidities including high blood pressure, cesarean delivery v vaginal delivery, etc.), we found that physicians were more likely to experience serious outcomes than non-physicians (odds ratio, 1.21; 95% CI, 1.04-1.41), with 2.1% of physicians and 1.7% of non-physicians experiencing a severe outcome. However, when we controlled for age and other important factors that could influence the results, this difference was no longer observed.
Similarly, physicians had an increased risk of giving birth preterm compared to non-physicians, but this difference was not observed after adjusting for age and other important factors. This suggests that doctors’ risk of serious pregnancy outcomes is linked to their tendency to delay childbearing until later in life than any effect of their particular work.
We also compared early outcomes (first month of life) of babies born to doctors and non-doctors and found that babies born to doctors were less likely to have a serious outcome (such as neonatal death, injury cerebral and other adverse outcomes). ).
Finally, we compared family physicians with surgeons and other specialists to see if there was an increased risk of adverse pregnancy outcome depending on the type of work performed by the physician; no significant difference was found based on medical specialty.
Our findings are important for several reasons.
First, they suggest that the tendency of physicians to delay pregnancy to complete their training is associated with poor pregnancy outcome. Egg freezing has often been offered as a “workaround” for female doctors so they can avoid pregnancy during training. Although egg freezing may reduce the risk of infertility among doctors (which is reported in a survey study to be as high as one in four female doctors), it will not prevent age-related pregnancy complications.
It is important to recognize that although we found a 21% higher chance of having a poor physician outcome, the absolute increase in risk was small (2.1% v 1.7%).
Second, working as a doctor alone does not appear to increase the risk of poor pregnancy outcome, and children of doctors actually had better outcomes than non-doctors. A limitation of our study is that we were unable to examine specific work-related information, such as how much night work a doctor was doing until the end of her pregnancy, and how this might impact on pregnancy outcome.
In summary, our study showed that female physicians are at increased risk of pregnancy complications compared to high-income nonphysicians, but this association appears to be mediated by physicians’ tendency to delay childbearing until they are older.
Medicine as a profession has historically excluded women; now that more than half of medical students are women, the culture of the profession must evolve to support female doctors who wish to have children at any stage of their career. Supporting the health and well-being of female physicians will also benefit patients, as job satisfaction is critical to physician retention and career longevity.
Acknowledgements: This body of work was supported by the New Investigator Grant from Physicians’ Services Incorporated (PSI).
Dr. Andrea Simpson is an obstetrician and gynecological surgeon at St Michael’s Hospital in Toronto. She is an Assistant Professor at the University of Toronto and completed a Masters in Health Services Research at the Institute for Health Policy, Management and Evaluation.
Professor Nancy Baxter is Director of the Melbourne School of Population and Global Health and was previously Professor in the Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health and Professor of Surgery in the School of Medicine at the University. of Toronto. She is a clinical epidemiologist, general surgeon and health services researcher.
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