SheMD Journal Club: IMPACT survey- IMpaired fecundity in Physicians & Association with Clinical Time
Here at sheMD, we believe in the importance of practicing Evidence-Based Medicine. We believe the same principles apply to discussing Gender and Medical Education. Therefore, we are bringing you an entire Journal Club series! Our series will focus on foundational and new literature within the gender and medicine space.
Today, we will be discussing the article entitled, IMPACT survey: IMpaired fecundity in Physicians and Association with Clinical Time. I was the lead author for this study and wanted to share our findings to raise awareness about #physicianinfertility in honor of National Infertility Awareness Week.
Why is this article important?
There have been studies across different physician groups looking at rates of infertility in female physicians. In the general population, the infertility rate has been found to be approximately 12.1% in the United States. In US female physicians, the average appears to be approximately double, at 24%. Different groups of female physicians have been looked at ranging from thoracic surgeons, orthopedic surgeons, ENT and more. Emergency Medicine (EM) physicians work a shift-work schedule, which may have implications for fertility.
Additionally, infertility in female physicians is an issue for how we mentor women in their careers, for burnout and for recruiting more women into the field of EM. Studies have found that female doctors who face difficulty in reproduction/childbearing may have higher rates of burnout. Medical students may choose careers based on their concerns about the ability to bear children in the field. So awareness of this data is essential as we continue to bring more women into medicine.
What they looked at:
This study looked at the rate of impaired fecundity in a sample of female EM physicians. Impaired fecundity is defined as physical difficulty in either getting pregnant or carrying a pregnancy to live birth. The study also looked at EM work-related characteristics that may affect impaired fecundity.
How they measured things:
They performed a cross-sectional survey of women in emergency medicine to determine the rate of impaired fecundity and compared it to the national 2011–2015 CDC National Survey of Family Growth database. The survey was created based on questions from the National Survey of Family Growth sent by the CDC. 1705 female EM physicians responded, making it one of the largest surveys of practice women physicians related to reproductive health at the time of publication.
What were their outcomes:
Impaired fecundity was found in 24.9% of respondents compared to a national cohort sample (12.1%; P < 0.001).
Because age is a strong predictor of impaired fecundity, the study looked at impaired fecundity by age group cohorts. In the 30-34 year age group, EM physicians had 15.8% compared to 14% nationally, which was not significantly different. In contrast, impaired fecundity rates in the 35–39 and 40–44 year-old respondent age groups were 28.1% and 33.7%, respectively, compared to 15.2% and 16.2% nationally.
Also EM women with impaired fecundity worked 9.8 more overall clinical hours per month and 4.5 more night shift hours per month than those with normal fecundity.
Why do we care about this article?
What does this mean?
The study found NO DIFFERENCE in impaired fecundity when comparing 25–29 and 30–34 year-olds with similar cohorts in the general population. However, analysis of age groups 35–39 and 40–44 demonstrate SIGNIFICANT increases in impaired fecundity when compared with similar age cohorts in the NSFG general population. This suggests a risk of delaying childbirth for female emergency physicians that is above and beyond baseline risks associated with advanced age and reproductive capacity.
Additionally, the study proposed that the occupational factor(s) responsible for these findings are possibly (1) time-dependent, with risk correlating to increased exposure, or (2) variable, with effect dependent upon age.
How does this apply to us?
Educating female physicians regarding the challenges of childbearing and fertility issues early in their career may encourage family planning earlier in their training, rather than delaying childbearing for career goals. This is one of our goals at SheMD. We want to empower future generations of female physicians to make decisions that work for their personal lives. If women are going to be half of the physician workforce, the workforce needs to adjust for the needs of women, including the reproductive needs. We need to create policies to allow our learners to have parental leave during medical education. We need to SUPPORT women starting families during their training, whether that is in medical school, residency, fellowship or early career.
In the study, respondents noted that childbearing influenced career decisions and career decisions influenced childbearing. Thus, these issues are intertwined and it is important that we further understand how women incorporate information about reproductive health and career demands into their career and lifestyle decision-making.
Take Home Point
In this cross-sectional survey of 1705 female emergency physicians, impaired fecundity was found in 24.9% of respondents compared to a national cohort sample (12.1%; P < 0.001).
For further reading on the topic, check out these articles!
Re-evaluation of birth trends and pregnancy complications among female urologists: Have we made any progress? https://onlinelibrary.wiley.com/doi/10.1002/nau.24409
Does a Surgical Career Affect a Woman's Childbearing and Fertility? A Report on Pregnancy and Fertility Trends among Female Surgeons https://journals.lww.com/journalacs/Abstract/2014/11000/Does_a_Surgical_Career_Affect_a_Woman_s.11.aspx
Childbearing and Pregnancy Characteristics of Female Orthopaedic Surgeons https://journals.lww.com/jbjsjournal/Abstract/2012/06060/Childbearing_and_Pregnancy_Characteristics_of.16.aspx
Fertility and Childbearing Among American Female Physicians https://www.liebertpub.com/doi/10.1089/jwh.2015.5638