As an early career physician, I struggled for years to build my family. Hormone treatments delayed by board certification exams. Short-notice vacation requests. A decrease to part-time status. And a miscarriage thrown in. There’s no time to fail, and no good time to bleed.
Imagine needing to undergo a surgical procedure with an indefinite date. Leading up to said procedure, you must appear in the clinic for preoperative blood draws and ultrasounds. The date of your impending procedure is a moving target hinging on the daily results of these labs. Does this sound compatible with a physician’s schedule in any practice setting?
It is currently estimated that infertility affects 24% of women physicians. With a rate this high, infertility is surely infiltrating our already tenuous workplace wellness landscape. Yet many are not talking about it openly. Both fascinated and frustrated by this phenomenon, I devised an anonymous survey for women physicians with infertility about their experiences balancing work and treatments. In the fall of 2021, over 150 women responded.
What became clear from their responses is that being an infertility patient while working as a doctor comes with a unique set of costs for both physicians and their practices. Infertility gets in the way of a medical career, but the pursuit of a medical career often gets in the way of having a family.
The total amount of money spent out of pocket to date by this cohort of women physicians surveyed exceeds $8 million. The average amount spent was approximately $63,000. As this adds to the already high debt burden of early career physicians, how do these women cope?
The most common way respondents have financed their infertility treatments is by dipping into savings, highlighting the importance of having an emergency fund as part of a sound financial plan. Some also seek additional loans, either through a bank (home equity lines of credit are common), or through friends and family. Many respondents mentioned their need to defer investments, retirement savings, and loan repayment.
Some women choose to work more hours or moonlight to fund their treatments. Some utilize credit card rewards to offset some of the costs. Only nine women mentioned insurance coverage. It’s clear that they have all had to rebalance their finances to prioritize treatments over other expenses. Unfortunately, infertility journeys have an unclear length and therefore an uncertain price tag. One woman noted, “One mistake in a cycle can mean thousands of dollars wasted and one-two months of more waiting and anxiety.”
Think about it: Most physician women have children during one of two critical phases in their medical career: training or early career practice. During this critical time, physicians typically have decreased control over their work schedules. They must work long hours and establish themselves as team players in their practice. They may have an increased call burden based on seniority in their respective groups. Sixty-eight percent of respondents said that they had trouble scheduling their infertility treatments around their work schedule.
Several women also told stories of being reprimanded for not giving the proper amount of notice for time off requests, which is often impossible due to the uncertain timing of the cycles and procedures. One respondent shared, “I’m expected to give 90 days’ notice for more than two consecutive days off and 30 days’ notice for one day off. This is impossible to do and resulted in a write-up in my annual review for ‘unplanned absences.’” In addition, 30% of respondents said they had to change jobs or decrease their clinical workload because of their infertility.
We already have a retention problem in medicine. How many of these women might miss opportunities for advancement or leadership due to their infertility? When asked what could be done by organizations to support them, respondents overwhelmingly used the word flexibility. Flexibility in scheduling, flexibility in coverage — of the sort one would expect for cancer treatments or death in the family. As one respondent put it, “This is a medical diagnosis like any other. Treat it as such with time off for grieving and insurance coverage.”
Infertility also brings a cost to physicians’ mental health in an atmosphere already charged with burnout. A diagnosis of infertility has been associated with levels of depression on par with a diagnosis of cancer. Because of the age-related decline in egg quality, treatments can also become an anxiety-provoking race against time. When asked what they wish they had known, many women said they would have begun trying for children much earlier. Many would advise others to seek cryopreservation, or advocate for education on cryopreservation during medical training.
On the bright side, women surveyed often said, “Know that you are not alone.” Counseling and talking with trusted third parties were common methods used to cope with the psychological game of infertility. A change of mindset is often in order. One woman said she settled on telling the truth about why she needed the time off: “I decided to be open with my coworkers about my treatments. It was a struggle, of course, but that made it easier to switch shifts.”
I was eventually successful in my quest for a baby while simultaneously finding my own path in medicine. Unfortunately, not all who travel on this journey end up with a child. The costs of infertility are immeasurable beyond money, but we can help mitigate them through awareness and a disregard for the typical narrative of invulnerability in physician culture.
Have you experienced the tension between infertility treatments and professional growth? Share your experience and advice in the comments below.
Dr. Dawn Baker is an anesthesiologist, writer, speaker, and coach for physicians in the areas of work-life balance, mindful achievement, and infertility. She actively writes at https://www.practicebalance.com and can also be found on Instagram at https://www.instagram.com/practicebalance.
Illustration by Jennifer Bogartz
