Pressures, challenges of pregnancy while working as a physician
Fact checked by Kristen Dowd
In the first two trimesters of pregnancy, women physicians had heightened workloads vs. before pregnancy and a lower workload in the final trimester, according to results published in JAMA Network Open.
“Our findings suggest physicians may increase their workload in early pregnancy in anticipation of working less later on,” lead study author Andrea N. Simpson, MD, MSc, obstetrician and gynecologic surgeon at St. Michael’s Hospital, said in a press release.
Members of Healio’s Women in Allergy Peer Perspective Board agree that maternity leave is challenging for practicing clinicians and offer advice for managing their time while prioritizing their own health and family.
Study findings
In a population-based retrospective cohort study using physician billing claims, Simpson and colleagues assessed 5,948 deliveries (40% first deliveries; 40% second; 20% third or higher) among 3,932 practicing physicians (median age, 35 years) registered with the College of Physicians and Surgeons of Ontario between April 1, 2002, and Nov. 18, 2018, to determine what a physician’s workload looks like during pregnancy and how the time from delivery to work return differs between specialty groups.
The deliveries in this population came from eight specialty groups: family medicine (58.9%), medical specialties (13.2%), pediatrics (6.4%), surgery (5.3%), anesthesia/emergency medicine (4.4%), OB/GYN (4.3%), psychiatry (4.2%) and diagnostic imaging (3.3%).
Workload was higher during vs. before pregnancy (rate ratio [RR] = 1.06; 95% CI, 1.06-1.07), according to the study. When divided based on trimester of pregnancy, physicians had elevated workloads in the first two trimesters vs. before pregnancy (first, RR = 1.12; 95% CI, 1.11-1.12; second, RR = 1.12; 95% CI, 1.11-1.13) but a reduced workload in the third trimester (RR = 0.95; 95% CI, 0.94-0.97) vs. before pregnancy.
In terms of overnight work, researchers found a smaller rate of nights worked per 100 person-days during vs. before pregnancy (RR = 0.92; 95% CI, 0.89-0.95). By trimester, there were higher overnight work rate ratios in the first two trimesters (first, RR = 1.09; 95% CI, 1.06-1.12; second, RR = 1.05; 95% CI, 1.01-1.08) and a lower rate ratio in the third trimester (RR = 0.62; 95% CI, 0.58-0.65).
“In group practices, physicians may need to take an equal share of call or overnight work, and some may schedule more of those shifts to the first and second trimesters,” Simpson, who also is a scientist for the Institute for Clinical Evaluative Sciences, said in the release.
“Overall, the pattern suggests some physicians may be ‘paying the price’ early — taking on more work up front — to make it possible to step back later in pregnancy.”
In the evaluated specialty groups, the study reported a high cumulative probability of return to work. The earliest median time from delivery to work return was 133 days (19 weeks) among surgeons, followed by 156 days among OB/GYN physicians, 161 days among diagnostic imaging physicians, 187 days among medical specialties, 199 days among family medicine physicians, 214 days among anesthesia/emergency medicine physicians, 245 days among pediatric physicians and 270 days (39 weeks) among psychiatry physicians.
“Parental leave practices were highly variable among physicians in Ontario and significantly shorter than leaves for the average Canadian receiving parental leave pay; this is likely a reflection of the culture of medicine and the constrained medical system,” Simpson and colleagues wrote.
“These issues are likely even more prevalent in other jurisdictions, such as the U.S., where adequate paid parental leave options for physicians are even more limited,” they continued.
Additionally, researchers observed that physicians who delivered in 2010 or later had a smaller cumulative probability of return to work by 180 days postpartum vs. those who delivered between 2002 and 2009 (39.6% vs. 47.2%).
Pregnancy workloads in allergy/immunology
To learn if these study findings are applicable in the field of allergy/immunology, Healio spoke with Vivian Hernandez-Trujillo, MD, FAAAAI, FACAAI, FAAP, Jennifer Namazy, MD, FAAAAI, and Melinda M. Rathkopf, MD, MBA, FACAAI, FAAAAI, all members of Healio’s Women in Allergy Peer Perspective Board.
As an attending physician, Hernandez-Trujillo, now allergy/immunology division director at Nicklaus Children’s Hospital and owner of Allergy and Immunology Care Center of South Florida, had two pregnancies, and the first one was with twins.
Similar to Hernandez-Trujillo, Namazy, professor of clinical medicine at Scripps Clinical Medical Group, had twins for her first pregnancy. She was 2 years out of fellowship and matched the median age of the study’s population.
Rathkopf, medical director of allergy/immunology at Children’s Healthcare of Atlanta and associate professor of pediatrics in the division of allergy and immunology at Emory University School of Medicine, had her first pregnancy during residency and her second when she was a general pediatrician. During both, she was in the military.
While pregnant, both Hernandez-Trujillo and Rathkopf said they had a consistent workload, with no differences between trimesters. However, Rathkopf wished she raised her workload before delivery.
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