Study Highlights Challenges of Family Building Among Physicians and Medical Students

A national study led by an M.D./M.P.H. student at the University of Miami Miller School of Medicine highlights the challenges that physicians, trainees and medical students face in building families.

“Physicians often delay starting their families because medical education, training and starting a practice takes many years,” said Morgan Levy, a fourth-year M.D./M.P.H. student planning a career in obstetrics/gynecology, noting that the median age of first birth for physicians is 32 years, compared with 27 years for non-physicians. “For physicians who desire children, the family-building journey is often complicated by infertility issues, relationship stresses and regrets over delaying childbearing,” she added.

Levy was the first author in a research letter, “Psychosocial Burdens Associated with Family Building in Physicians and Medical Students,” published July 24 in JAMA Internal Medicine, a journal of the American Medical Association. Her mentor Alberto J. Caban-Martinez, D.O., Ph.D., M.P.H., associate provost for research integrity, regulatory affairs and assessment, M.D.-M.P.H. program deputy director and vice chair for research and associate professor of public health sciences, was a co-author, along with medical students and professionals from New York University, Stanford University, Northwestern University and the University of Chicago.

“It is important to address reproductive and family-building issues in the physician workforce, since the training is a long process,” said Dr. Caban-Martinez. “We need to think about developing more supportive policies and strategies, so professionals don’t feel they need to choose between work and family. For instance, the Miller School’s student services group can accommodate women students who become pregnant and give birth, such as providing time off before stepping back into the program.”

A National Study of Physicians and Children

A native of New Jersey, Levy credits her mother, Lisette, with providing the impetus for her interest in women’s health. “She is a corporate career woman who delayed childbearing, and a great example of someone who is both an amazing mother and a successful professional.”

As a Miller School student, Levy became interested in studying family building in spring 2020 when she helped launched the American Medical Women’s Association’s Physician Fertility Initiative. She currently serve as the group’s medical student executive chair. One year later, Levy and her collaborators launched the “Study of Physicians and Children: Expectations and Experiences (SPACE)” in April 2021 during National Infertility Week, reaching out to medical students and physicians via email and social media.

“Because family building affects everyone, we wanted to include women, men and members of the LGBTQ community as well,” Levy said. “We know that it’s not just women who can benefit from discussing the psychological issues associated with childbearing.”

About 90% of the 3,310 respondents who completed the survey were women, and most expressed a desire for biological children, Levy said. Almost two-thirds delayed childbearing due to training, and many regretted doing so. The most common reason cited for delaying having children was “residency requires too many hours at work, which makes parenting difficult.”

Other findings point to the psychosocial burdens related to family bearing, especially when assisted reproductive technology was involved. About 28% of respondents reported that fertility issues affected their well-being, and 14% cited negative impacts on their relationships with spouses and partners.

“We found high rates of regret among physicians who delayed childbearing due to training, indicating the importance of family-friendly policies for the well-being of physicians and trainees,” added Levy. “We need to have more conversations about having children at the time that seems right for each medical professional and advancing policies that promote reproductive autonomy.”

Reflecting on the family-building study, Levy said, “It’s exciting to see the culmination of three years of collaborative effort for this project. I feel lucky to have worked with a great team of mentors and colleagues from design to completion. It’s truly been a labor of love.”

Tags: Dr. Alberto Caban-Martinez, family building, JAMA Internal Medicine, medical education