By: Madison Jones
Editor’s Note: In 2023, Bakkensen et al published in JAMA Network Open the results of their survey [1] of more than a thousand women in medicine, including physicians, residents, and fellows. Their article, “Childbearing, Infertility, and Career Trajectories Among Women in Medicine,” adds to the growing literature exploring the impact of a medical career on women’s reproductive health choices and families. Madison Jones summarized the article while on the FACTS elective on fertility awareness. To learn more about infertility among female physicians with a focus on clinician wellbeing, plan to attend FACTS’ Virtual Conference this fall on October 10-11, 2025!
Introduction
It has been 176 years since Elizabeth Blackwell became the first woman in the United States to graduate from medical school and began to practice medicine. [2] Since then, the presence of women in medicine has increased substantially. Women comprise 37% of the physician workforce, according to a 2022 census. [3] Despite this advancement, considerable disparities remain between women and men. Women physicians are less likely to receive promotions to upper faculty ranks, publish in leading medical journals, hold positions on editorial review boards, or lead in academics. [1] Furthermore, many women physicians postpone starting their families until after medical training, and experience infertility later. The authors of the study [1] summarized below saw these disparities and sought to understand why they exist. The objective of their research was to examine delayed childbearing and infertility among women in medicine and how this alters their career paths.
Methodology
Bakkensen et al developed a cross-sectional survey to explore the incidence of delayed childbearing, infertility, use of assisted reproductive technologies (ART), and career alterations to accommodate parenthood among women physicians. [1] They also assessed demographic data, fertility knowledge, and factors associated with the timing of pregnancy and family building regret. The survey was distributed over social media and via medical society electronic mailing lists from March to August 2022.
Results
A total of 1,056 women completed the survey and were included in the analysis. These women represented both surgical and nonsurgical specialties, and included attendings, fellows, and residents. Of the 1,056 women physicians studied, 86.1% were married or had a partner, and 65.3% had children.
Of respondents, 29.9% reported working more than 60 hours per week while also bearing more household responsibilities compared to their spouses or partners. Regarding fertility knowledge, 78% of the women correctly identified the age of fertility decline at 35 years or older. [1] Most survey respondents (93.6%) reported concern regarding family planning given the length and intensity of medical training. Additionally, 75.6% of survey participants delayed starting their families, compared to 20.2% who did not. Interestingly, these results did not vary by specialty. Their stated reasons for a delay in starting a family included stress, financial strain, lack of schedule flexibility or time, and concern about burdening colleagues. [1]
“Most survey respondents (93.6%) reported concern regarding family planning given the length and intensity of medical training. Additionally, 75.6% of (them) delayed starting their families.”
While 42.4% of respondents considered the use of ART, such as oocyte or embryo cryopreservation, only 11.5% completed treatment. Out of all the women physicians surveyed, 36.8% experienced infertility, with higher rates of infertility among those who delayed childbearing more than 5 years. When asked about what they would do differently, 45.7% of physicians would have conceived earlier, 44.8% would have reduced work hours, 38.8% would have taken extended leave, and 28.4% would have pursued oocyte preservation. [1] These regrets were higher among the women who experienced infertility.
“When asked about what they would do differently, 45.7% of physicians would have conceived earlier, 44.8% would have reduced work hours, (and) 38.8% would have taken extended leave.”
Many of the physicians surveyed reported altering their careers for the sake of building a family: 28.8% took an extended leave, 24.8% chose a different specialty, 47.1% reduced work hours, and 24.8% changed practice settings. Overall, 47.2% of respondents reported passing up opportunities for career advancement for the sake of childbearing. Additionally, 4.3% left their medical careers entirely.
Discussion
Through this survey, Bakkensen et al sought to understand how women in medicine navigate balancing career and family, and the challenges and disparities that result. From their data, it is clear many women physicians alter their career paths significantly to build a family, and building a family may require further adjustments in their career trajectories. Per the authors, this is one of the largest studies to evaluate fertility and family building among women physicians, and the first to assess the association of parenthood and career. [1]
Several findings stand out in their results. Despite being aware of the decline of fertility with age, more than 75% of the physicians reported delaying childbearing due to the demands of medical training and career. [1] Based on data from the National Health Statistics Report, 6-19% of women in the general U.S. population had a history of infertility, [4] whereas 36.8% of women physicians surveyed by Bakkensen et al experienced infertility. [1] This concerning higher rate of infertility among women physicians is most likely due to postponing conception, but other factors such as stress and lifestyle factors could play a role as well.
“This concerning higher rate of infertility among women physicians (36.8%) is most likely due to postponing conception, but other factors such as stress and lifestyle factors could play a role as well.”
Nearly half of the women surveyed reported passing up career-advancement opportunities for the sake of their families. Compared to their male counterparts, they take longer parental leave and are more likely to return to work part time. According to the authors, the longstanding disparities between male and female physicians may be partially due to fertility and family planning concerns of women in medicine. [1]
The main limitation of the study was response bias. Overall, Bakkensen et al clearly demonstrated a need to support women physicians as they balance their career and families. More research is needed in this area, including comparisons between women and men in medicine. Furthermore, this study highlights the need for policies to make it easier for physicians to have children earlier in their careers, especially as growing numbers of women become physicians.
References
[1] Bakkensen JB, Smith KS, Cheung EO, et al. Childbearing, Infertility, and Career Trajectories Among Women in Medicine. JAMA Netw Open. 2023;6(7):e2326192. doi:10.1001/jamanetworkopen.2023.26192
[2] Biography – Dr. Elizabeth Blackwell. Nih.gov. Published 2025. https://www.nlm.nih.gov/exhibition/changing-the-face-of-medicine-V2/physicians/biography_elizabeth_blackwell.html
[3] FSMB Physician Census Identifies 1,044,734 Licensed Physicians in U.S. Fsmb.org. Published 2023. https://www.fsmb.org/advocacy/news-releases/fsmb-physician-census-identifies–1044734-licensed-physicians-in-u.s/
[4] Chandra A, Copen CE, Stephen EH. Infertility and impaired fecundity in the United States, 1982-2010: data from the National Survey of Family Growth. Natl Health Stat Report. 2013;(67):1-18,1,19.
ABOUT THE AUTHOR
Madison Jones, DO
Madison Jones, DO wrote this review as a fourth-year medical student at Midwestern University Chicago College of Osteopathic Medicine in Downers Grove, IL. Since then, she graduated from medical school and began internal medicine residency at Trinity Health Grand Rapids in Grand Rapids, MI. Dr. Jones is passionate about underserved medicine and health equity. She enrolled in the FACTS elective to learn more about alternatives to conventional birth control and the role of natural family planning methods in women’s reproductive health. She plans to use this knowledge to educate and empower her future patients.
