Challenges to Navigating Pregnancy and Parenthood for Physician Parents: a Framework Analysis of Qualitative Data

Abstract

BACKGROUND: Some gender-based disparities in medicine may relate to pregnancy and parenthood. An understanding of the challenges faced by pregnant physicians and physician parents is needed to design policies and interventions to reduce these disparities. OBJECTIVE: Our objective was to characterize workrelated barriers related to pregnancy and parenthood described by physicians. DESIGN: We performed framework analysis of qualitative data collected through individual, semi-structured interviews between May and October 2018. Data related to pregnancy or parenthood were organized chronologically to understand barriers throughout the process of pregnancy, planning a parental leave, taking a parental leave, returning from parental leave, and parenting as a physician. PARTICIPANTS: Physician faculty members of all genders, including parents and non-parents, from a single department at a large academic medical school in Canada were invited to participate in a department-wide study broadly exploring gender equity. A P P R O A C H :T h e m a t i c a n a l y s i s g u i d e d b y constructivism. KEY RESULTS: Twenty-eight physicians were interviewed (7.2% of eligible physicians), including 22 women and 6 men, of which 18 were parents (15 mothers and 3 fathers). Common barriers included a lack of systems-level guidelines for pregnancy and parental leave, inconsistent workplace accommodations for pregnant physicians, a lack of guidance and support for planning parental leaves, and difficulties obtaining clinical coverage for parental leave. Without systems-level guidance, participants had to individually navigate challenges and resolve these difficulties, including negotiating with their leadership for benefits. This led to stress, wasted time and effort, and raised questions about fairness within the department. CONCLUSIONS: Physician parents face unique challenges navigating institutional policies as well as planning and taking parental leave. Systems-level interventions such as policies for pregnancy, parental leave, and return to work are needed to address barriers experienced by physician parents.

Experiences and Impacts of Harassment and Discrimination Among Women in Cardiac Medicine and Surgery: A Single-Center Qualitative Study

“…Maternal discrimination was an important subset of harassment and discrimination identified in this study and others. 20 , 21 , 22 Participants in our study selected their subspecialities and location of training to accommodate working as a parent, due to explicit warnings from other specialists and an implied understanding that some disciplines were more “family-friendly” than others. Participants also described derogatory comments about how pregnancy and parenthood impacted the workload of colleagues.…”

“…Medical leaders can advocate for systems-level changes to support pregnancy and parenthood in cardiology, including call-schedule flexibility, identifying lactation spaces, and advocating for onsite childcare. 20 , 23 In addition, medical leaders must act in the moment to address maternal discrimination, including casual remarks that denigrate the work ethic or potential of mothers, or refer to parenthood as an inconvenience.…”

“…However, the ubiquity of sex-and gender-based harassment and discrimination in other academic medicine departments and universities suggests that these results are applicable to many settings. 4,11,14,[16][17][18][19][20][21][22][23][24] Although the number of participants in this study may be small relative to the sample sizes typically seen in quantitative studies, qualitative data provide greater detail on experiences, impacts, and perceptions; for these reasons, sample-size considerations do not apply well to qualitative studies. 26 These qualitative data provide insight intto how experiences of harassment and discrimination were perceived by women in cardiac sciences, building upon numerical data and demonstrating the impacts, coping strategies, and contributors in ways that better link to potential interventions.…”

Moving Beyond Words: Leveraging Financial Resources to Improve Diversity, Equity, and Inclusion in Academic Medical Centers

“…Data obtained from the San Francisco Bay area from 2016 to 2017 revealed that, compared to white women, Asian, Hispanic, and non-Hispanic Black women received 0.9, 2, and 3.6 less weeks of paid maternity leave (Goodman et al, 2021 ). Paid parental leave within healthcare, especially among physicians, continues to also be extremely challenging (Freeman et al, 2021 ). This is especially important because paid parental leave can be protective against peripartum health complications, which are higher in minorities (Montoya-Williams et al, 2020 ; Van Niel et al, 2020 ).…”

Pregnancy, obstetrical and neonatal outcomes in women exposed to physician-related occupational hazards: a scoping review

“…Due to this lack of systems-level guidance, the experiences of women physicians are variable both between and within organisations. 7 Pregnant physicians may experience a greater prevalence of complications than other groups, 8 including more frequent preterm labour [9][10][11] and pregnancy loss, 12 though the literature is conflicting. 13 14 Further, the relationship between modifiable aspects of physician work that contribute to these worse outcomes is not well described.…”