Navigating a career as an ear, nose, and throat surgeon while starting a family can be a major challenge, and institutions often don’t offer enough support, panelists said in a session here at the Combined Otolaryngology Spring Meetings.
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August 2024Being fully informed about the logistics of family-planning efforts—whether it’s fertility preservation, in vitro fertilization, or surrogate parenting—and being your own advocate can help physicians through this challenging terrain, the panelists said.
A statement published by the American College of Surgeons in 2021 addressed pregnancy, parental leave, and workplace accommodations for surgical fellows and residents. It said a successful surgical career should not preclude the choice to be a parent, allowed parental leave without requiring additional training if it is less than six weeks, and noted that parental leave shouldn’t factor into evaluations and access to leadership programs.
“Maybe you’re thinking, ‘Gimme a break, this is obvious,’” said panel moderator Julie Wei, MD, professor of otolaryngology at the University of Cincinnati College of Medicine in Ohio. “That is still not our reality today.”
A study involving 10 Accreditation Council for Graduate Medical Education programs and 283 ophthalmology residents who graduated between 2015 and 2019 found no differences in performance, including exam pass rate, research activity, and surgical case volume, except for one type of procedure.
Another, in which researchers interviewed about 1,000 female physicians, revealed a high degree of professional sacrifice among those with children, with 30% having to take extended leave just to accommodate childbearing or parenthood and nearly 50% passing up opportunities for career advancement.
“I think it adds some factual data to concepts that were well known for a while, and it solidifies the experience that many people have when they’re trying to have a family and the disproportionate impact it has on one person than another,” said James Schroeder, MD, professor of otolaryngology at Northwestern University in Evanston, Ill., who navigated the surrogacy process with his now-husband at a time before they could be married. Not being married legally—it was not permitted at the time—complicated insurance matters and other aspects of the process, he said. Becoming familiar with the legal aspects and potential pitfalls of legislation perceived as anti-LGBTQIA+ is important as you start a family, he said.
Christine Settoon, MD, MS, a pediatric otolaryngology fellow at the Children’s Hospital of Philadelphia in Penn., underwent fertility preservation—about a two-month process that involved appointments every other day during certain cycles—as a resident.
“Overall, I think this is something that’s definitely feasible in training, whether it’s residency, fellowship, or after fellowship,” she said, acknowledging that “it’s a very personal decision.”
Jennifer Lavin, MD, MS, attending physician in otorhinolaryngology–head and neck surgery at Lurie Children’s Hospital in Chicago, described the lonely experience of having had two miscarriages, the second of which occurred in the operating room.
“(I) changed my scrubs and went out and talked to the family and told them that everything went well with their child’s surgery,” she said. “This is the reality of what miscarriage is.” Through in vitro fertilization, which involves a process similar to fertility preservation, Dr. Lavin, who already had a daughter, eventually had a son, and now has two sons.
Stephanie Pearson, MD, an obstetrician by training who now runs an insurance advocacy firm, recalled her pregnancy when she was a first-year attending physician. On a self-scan in the early morning hours one day, she found she had no fluid, but was persuaded by colleagues to keep seeing patients through the morning and just wait to get fluids at lunchtime, and her baby was not delivered until 10 p.m. A patient in her condition would have had delivery performed immediately, she said. She regretted not standing up for herself.
“I let myself get bamboozled,” she said. “There is this tyranny of perfection that exists in medicine that we’re supposed to be tougher and stronger and more resilient, and we don’t treat each other with compassion…. That has to change. We have to stand up for ourselves.”
Thomas R. Collins is a freelance medical writer based in Florida.