Arian Nachat, MD As a later in life mother of 2 young children, the experiences of physicians bearing children is of great personal significance to me. More specifically, over the past few years I have been wondering about the data on women physicians and issues surrounding in pregnancy.
A recent article in the Journal of the American College of Cardiology: “Cardiovascular Medicine and Society – The Pregnant Cardiologist” attempts to analyze the issues influencing women cardiologists in their career trajectory and family planning. Many of the findings in this article are relevant to the women of emergency medicine. I decided to highlight major points in the article and add in an emergency medicine point of view.
Most female cardiologists become pregnant during their career, often early in career development.
Being an EM physician mom has a whole set of challenges, that frankly, I had no awareness of during my training. I was raised with the feminist belief that I can and should be able to do anything I put my mind to. The fallacy is that I was raised to believe I could do it all. While I can do it all – it typically means that not all things are done as well as I would like.
A high proportion of children born to cardiologists are conceived using assisted reproductive technology (ART).
I chose to complete my training prior to starting my family. Then I wanted to wait until I was in the right relationship and waited some more. At 38, I realized I needed to make a conscious decision to create my family. Now it required medical intervention – Intrauterine insemination (IUI) for my first at 38 and In Vitro Fertilization (IVF) at 41 for my second. While not formally studied – many of my friends from the Physician Mom Group and FemInEM have similarly used ART.
Pregnancy related complications are common.
Pregnancies are unpredictable. Both of mine wound up being high risk pregnancies necessitating giving up shifts unexpectedly. or going out earlier than expected. Even after delivery, post-partum pre-eclampsia x 2 landed me back as a patient in CHF. Prolonged recovery and postpartum complications happen all the time.
These unexpected issues impact an emergency department team. A physician’s pregnancy may require covering shifts, swapping shifts, or reassigning cases (let’s face it intubating a patient emergently with an 8 month gravid abdomen can be tricky). Emergency department work is a team sport and when one is on the “disabled list”, the rest of the bench needs to help out more. Most EDs are pretty tightly staffed and so anything that challenges that balance is stressful for all members of the team. No one likes to upset their colleagues or ask them to work harder.
Women feel pressured to take shorter maternity leaves than available to them.
ED coverage is a team sport. Is it surprising that we feel guilty for staying home with our new babies, knowing our partners are covering for our shifts. As doctors, we also have significant expenses, and with few employers in EM offering paid parental leave, many of us are forced back to work earlier than our time off allows.
Cardiologists are increasingly concerned about radiation exposure during pregnancy but are underusing radiation reduction and monitoring strategies.
While we have some radiation exposure – our bigger exposure in the ED is the unknown. Walking into a room with a rule out meningitis or TB while gestating a little human is not ideal. Many times we walk in o a room not knowing what the diagnosis is and therefore take unknown risks.
Female cardiologists do not meet their breastfeeding goals and experience significant barriers to breastfeeding.
For some breastfeeding comes easily. For others, like myself, it took domperidone, excessive pumping and was a struggle. One needs to stay well hydrated. I am guessing you all have gone a whole shift without urinating or eating. Doing that while trying to breastfeed risks one’s milk supply. Withholding ED patient assignments so we can go pump if often not a realistic request in an ED setting unless you staff up intentionally. Where to pump has not been particularly convenient either in many hospitals. My favorite experience was using a patient room that has a sink and a do not disturb sign on the door. Another was nursing my daughter during an admin meeting that was important enough I needed to go and bring her along.
A career in cardiology influences the family planning decisions of most female cardiologists.
I felt like my residency training prepared me the best for those cluster feeding sleepless nights with a newborn. But, throw into it the impact of using ART medications, physiologic changes from the pregnancy to peri-partum period and ensuing complications and a colicky baby – not so much. Pursuing additional exciting career opportunities were not on the docket for about five years. This did impact my career trajectory and in fact encouraged my expansion into hospice and palliative medicine which had a more reasonable and predictable schedule. Being an EM doc with no call is great when you are single and childless, but a variable schedule when you are trying to get pregnant of have very young children at home is much more difficult.
The workforce group believes cardiologists deserve recognition of the importance of issues surrounding pregnancy, parental leave and breastfeeding.
The ED is not a predictable place. The volume, the staffing and the acuity are all moving targets. On our best days – fully rested and without any other stressors – it’s a challenging environment. The ED has little room for error. Hospital systems and ED administrators need to explore ways to allow flexibility in work schedules that account for the unique needs of women physicians.
Physicians in general, compared to most other professions, have the lowest satisfaction in work-life-balance. Having access to mentorship, and flexibility in schedules, are substantially helpful to women physicians in achieving satisfaction in their work-life-balance.
The issue of burnout has been discussed extensively and we all know what it looks like without an EBM article to prove it. Physicians need to regain control over medicine and administration needs to allow physicians more autonomy in devising solutions for real world challenges we encounter. Physicians who cannot be afforded the ability to self care are not going to be able to care for patients effectively and enjoy a balanced and rewarding career.
In summary, women going into medicine should be having early career discussions (from the preclinical years of medical school through residency) about fertility and family planning. As a large portion of the ED workforce, we need to create work environments and schedules that support women wishing to become pregnant, to having safer pregnancies, to successfully breastfeed and encourage post-partum leave. Women need women mentors who actively create opportunities for new moms to pursue administrative and leadership roles. Addressing the complex workplace and life planning issues are vitally important to longevity and diversity for women in emergency medicine.