Time to stop treating family planning for doctors like a taboo topic, say U of T researchers

Medical students need better supports when it comes to family planning, and may be delaying having children over concerns about how it could impact their careers, suggests a study by U of T researchers. 

The findings of the study– published in JAMA Surgery – were based on interviews with 34 fourth-year medical students at the Temerty Faculty of Medicine.

Andrea Simpson, an assistant professor in Temerty Medicine’s department of obstetrics & gynaecology, and Shirin Dason, a fellow in Temerty Medicine’s department of obstetrics & gynaecology, collected insights from 11 male students and 23 female students for the study.

“I do think there needs to be more forward-thinking about how a lack of family planning discussions will affect the health and well-being of physicians. We need to come up with more creative solutions to how we can support physicians who want to have children at any career stage,” says Simpson, who is also an obstetrician gynecologist at Unity Health Toronto.

“If you delay, you’re putting yourself at more risk of age-related complications of pregnancy, or the possibility of infertility and never having a child. If we really do care about our fellow physicians, this is a part of personal fulfillment and longevity in your career, so that should be fostered and supported.”

Researchers said from interviews with participants, four themes emerged, including students saying they felt “family planning was a taboo topic” in medicine, and that “residents who have children are perceived to place a burden on their colleagues.”

“One of the findings that was really interesting was that a lot of medical students knew about age-related fertility declines from a clinical standpoint, but when they tried to apply that knowledge back to themselves, it was, ‘I’m existing in this culture where having a child is not possible, so I’m just going to have to delay, and I’m sure everything will work out for me,’” says Simpson.

Students also told researchers they perceived that “surgical specialities offer less for family building,” and that there was “no ideal time to family build in a medical career.”

“Findings . . . suggest there is a hidden curriculum in medicine that discourages medical students from family building during medical training and affects students’ family planning overall. Students begin their medical career with the concept that a medical career is not congruent with their ideal family plan,” says the research.

“They then develop an understanding through the hidden curriculum that there is little opportunity to balance family and a career in medicine. There is a substantial onus placed on the individual to set goals and be resilient to achieve parenthood in a medical career.”

Researchers say part of what could improve the problem are “open discussions about family planning” with learners, as well as integration of topics related to family planning into formal medical school learning.

“Family planning is not something that is well-discussed, it’s not institutionalized into the formal curriculum, and it’s not created as a lecture or workshop,” says Dason, who is doing a fellowship in gynaecologic reproductive endocrinology and infertility at the University of Toronto and Sinai Health.

“Family planning ends up being a hidden curriculum because of that. People are very interested in this topic – they’re interested in, ‘When am I going to be able to have children?’ The majority of people we spoke to were thinking about whether they would have children or not, and when they would have children within their career, but they didn’t really know where to go with this.”

Dason says much of what learners use to inform their approach to family planning are informal conversations with colleagues, like peers or mentors. Participants also expressed fear around having a child and its impact on their reputation.

“One conversation, positive or negative, could be very influential to a person’s decision as to whether they thought an entire specialty or entire program would be supportive of them having a family, or not supportive of them having a family,” says Dason. 

Researchers also say there could be better supports available to trainees who take parental leave, and more assistance to colleagues impacted by the leave, so people don’t feel like they are leaving their colleagues in the lurch.     

“I think this is also a reflection of a constrained health care system. The comments that we heard from medical students about feeling like they were placing a burden on colleagues by being off, it just reflects that we’re still operating at 110 per cent all the time,” says Simpson.

For Dason, the ultimate takeaway is that conversations around family planning should be done sooner, rather than later. She says there is continuing advocacy underway to ensure that family planning discussions are centred for learners and faculty. 

“Family planning and building is a conversation that should start early within anybody’s career, and there should be societal acceptance of parenting being a normal part of life and a valid choice, if that is the choice that somebody wants to make,” says Dason.

This research was funded by the 2021 Knox Richie Award from the Department of Obstetrics and Gynaecology at Sinai Health and the Physicians’ Services Incorporated Foundation’s New Investigator Award, as well as the Temerty Faculty of Medicine’s Comprehensive Research Experience for Medical Students Summer Research Program, and the Gordon C. Leitch Bursary for Student Research in Obstetrics & Gynaecology.