WORKING as a doctor involves long hours, night shifts, prolonged standing, and other physical stresses. Doctors are known to delay pregnancy at later ages because training often occurs during their peak years of reproduction.
Our group evaluated the time of pregnancy among doctors and found that women doctors had their first child later than non-doctors (on average, 32 years old and 27 years old). Doctors appeared to “catch up” with non-physicians having children at later ages, and GPs were more likely to have children than other specialists at all ages observed. Very few medical students (2%) had children before starting their postgraduate training, suggesting that the culture of delayed motherhood in the medical profession begins soon.
The risks of the doctor’s employment on the outcome of the pregnancy are unknown; There are studies that have shown an increased risk of negative pregnancy outcomes for doctors, such as preterm birth, while other studies have not shown an increased risk. Our goal was to evaluate pregnancy outcomes among physicians compared to non-physicians using population-based data, to determine whether physician employment is associated with adverse pregnancy outcomes.
In Ontario, Canada, physicians are licensed through a regulatory body, the Ontario College of Physicians and Surgeons (CPSO). Therefore, we were able to identify all practicing physicians in Ontario and link this information to their health outcomes through the records of the Ontario Public Health System. Because a lower socioeconomic status is associated with many adverse pregnancy outcomes, such as prematurity, we compared high-income physicians who are not physicians to create a fair comparison.
In our latest study, published in JAMA Network Open, we compared 10,489 pregnancies among 6,161 female doctors with 298,638 pregnancies among 221,191 non-physicians. Doctors were older than non-doctors (34 years vs 32 years) when they gave birth and were more likely to have their first birth (48.1% of doctors compared to 43.2% of non-doctors).
The risk of serious complications for the mother, such as admission to the intensive care unit or severe preeclampsia, was assessed using a validated score. Before we looked at the factors that could influence these outcomes (such as medical comorbidities, such as high blood pressure, cesarean delivery, or vaginal delivery, etc.), we found that physicians were more likely to ‘experience serious outcomes compared to 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 monitored age and other important factors that may influence outcomes, this difference was no longer observed.
Similarly, physicians had a higher risk of preterm birth compared to non-physicians, but this difference was not seen after adjusting for age and other important factors. This suggests that doctors ’risk of having a serious pregnancy is related to their tendency to delay motherhood until later ages compared to any effect of their work specifically.
We also compared the first outcomes (first month of life) of babies born to doctors and non-doctors and found that babies born to doctors were less likely to suffer a serious outcome (such as neonatal death, brain injury, and other poor outcomes). ). ).
Finally, we compared family physicians with surgeons and other specialists to see if there was any increase in the risk of adverse pregnancy outcomes based on the type of work the doctor does; no significant difference was found according to the 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 an adverse pregnancy outcome. Freezing eggs has often been proposed as a “solution” for women doctors so that they can avoid pregnancy during training. While freezing eggs can reduce the risk of infertility among doctors (which according to a survey study is as high as one in four women doctors), it will not prevent pregnancy-related complications. age.
It is important to recognize that, although we found a 21% higher probability of a poor outcome among physicians, the absolute increase in risk was small (2.1% vs. 1.7%).
Second, working as a doctor alone does not seem to increase the risk of poor pregnancy outcomes, and the children of doctors actually had better outcomes compared to non-doctors. One limitation of our study is that we could not examine specific work-related information, such as the amount of night work a doctor was doing until the end of her pregnancy and how this could affect the outcome of the pregnancy.
In summary, our study showed that women doctors have a higher risk of pregnancy complications compared to high-income non-doctors, but this association seemed to be mediated by the tendency of doctors to delay motherhood until they were big.
Medicine as a profession has historically excluded women; now that more than half of medical students are women, the culture of the profession needs to change to support women doctors who want to have children at any professional stage. Supporting the health and well-being of women doctors will also benefit patients, as professional satisfaction is essential for physician retention and career longevity.
Acknowledgments: This body of work was supported by the Physicians’ Services Incorporated (PSI) New Researcher Grant.
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 master’s degree in health service research at the Institute for Health Policy, Management and Assessment.
Professor Nancy Baxter is the director of the Melbourne School of Population and Global Health, and was previously a professor at the Institute for Health Policy, Management and Evaluation at the Dalla Lana School of Public Health and a professor of surgery at the Faculty of Health. University Medicine. of Toronto. She is a clinical epidemiologist, general surgeon and health services researcher.
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