R. E. Scully1, N. Melnitchouk1, J. Davids2 1Brigham And Women’s Hospital,Boston, MA, USA 2University Of Massachusetts Medical Center,Worcester, MA, USA
Introduction: Procedural specialization requires prolonged training times and demanding schedules that have the potential to negatively affect pregnancy and maternity outcomes. The impact of these factors has not been well described.
Methods: Data from 739 U.S. female resident and fellow level physicians was gathered via an anonymous, IRB-approved online survey. Univariate analysis was performed using Chi-squared and Student’s T-test. A multivariable model was constructed to determine whether procedural status predicted increased rates of assisted reproduction use, pregnancy complications, or early breast feeding cessation.
Results: Of the 729 individuals, 221 (30.0%) were in procedural fields. In univariate analysis, a higher proportion of trainees in procedural fields were older at the time of first pregnancy (age>30 at time of first pregnancy 52.9% vs 43.1%, p=0.01). The proportion of trainees reporting prolonged time to conceive (>1year for those under the age of 35, >6 months for age 35+ ) was higher in those in a procedural training program (15.4% vs 9.9%, p=0.03). Controlling for age at pregnancy, procedural trainees were significantly more likely to require assisted reproduction (clomid, IUI, IVF) than nonprocedural trainees (OR 1.28, 95%CI 1.01–1.61, p=0.04). In univariate analysis, there was no difference between the proportion of pregnant trainees reporting absence from work (27.0% vs 25.4%, p=0.64); however, procedural residents were more likely to rely on their co-residents to arrange coverage (39.7% vs 34.0%) compared to their chief resident (19.8% vs 29.9%) or department chair(7.4% vs 14.3%, p=0.03). Following delivery, a higher proportion of procedural trainees had short maternity leaves (< 6 weeks of leave following vaginal delivery, < 8 weeks of leave following C-section, 30.5% vs 22.1%, p=0.017). Procedural trainees were also more likely to report that they would have breastfed for longer if their schedules were more accommodating (58.4% vs 50.1%, p=0.04) and were less likely to report that their schedule had been adjusted to allow for pumping (21.6% vs 29.8%, p=0.03). Controlling for age, individuals who became pregnant during procedural training were significantly less likely to report that their decision of specialty was influenced by pregnancy or children (OR 0.24, 95%CI 0.17–0.34, p<0.001), yet they were more likely to report a desire to have chosen a different specialty (OR 1.95, 95%CI 1.40–2.72, p<0.001).
Conclusion: Compared to non-procedural trainees, residents and fellows in procedural training programs have higher rates of infertility, shorter maternity leaves, face challenges with breastfeeding, and are ultimately more likely to express a desire to have chosen a different specialty. Given these findings, the importance of adequate support for female trainees around pregnancy and maternity cannot be understated, particularly for those in procedural specialties.