Biology vs career

Several of my friends have had battles with biology over the past few years. It occurred to me that we doctors--who should know the most about biology--are often the ones who think we can outsmart it or that it doesn't apply to us. Among other things, I'm talking about fitness, sleep, mental illness, injuries, cancer risk reduction, and alcohol use. We should know better.
 

There is one biology battle that, as a female surgeon, I feel a bit more of a personal connection to: having babies. There is no good time in a medical career to have a baby--or at least no better time than any another. No matter what you do, how much time you plan to take off, or how tightly you schedule your dates, having a baby brings uncertainty and interferes with your ability to undertake your practice or training. It will affect your colleagues, your ability to keep up your usual pace of learning and practice, your life partner's ability to cope with your changed schedules, and your workplace commitments. And that's when everything goes well and according to plan.
 

So it worries me when I see that busy female residents perceive they should finish their training before having a baby. Most female specialists finish their training when they are nearing their mid-30s, some even a bit later. After age 35, the ability to conceive and carry a healthy pregnancy to term is significantly different from what it was before age 30. And unless you take advantage of the higher prevalence of multiples born to older moms--if you want more than one child after your training--your second and third babies will almost always arrive after your mid-30s. All of us who have hit certain age milestones know that one still feels very young and vital at 35. Unfortunately, one's reproductive biology will often fight back bitterly in this battle of age. One of the most heartbreaking scenarios I encounter is when one of my colleagues finally has her social, financial, academic, and career ducks in a row and feels she is ready to have a baby but can no longer easily conceive or carry one. It happens much earlier in life than we are so cavalierly led to believe. We choose to ignore the medical literature, and when we see celebrities having babies in their 40s we assume it must be reasonably easy--we can do it when we are good and ready. And we're doctors for goodness sake; we'll know the best ways to go about it! What those celebrities don't reveal is that many of them conceived thanks to expensive and somewhat invasive technology and often with donor eggs. Biology quietly plays the upper hand.
 

No one told me this when I was young and completing a surgical residency. For a woman to have children during or before surgical training was rare 20 years ago and would invite raised eyebrows, occasional expressions of doubt or awe, and varying degrees of support from colleagues and associates. As a resident, I remember reading an editorial in a major plastic surgical journal by an academic leader who wrote that his program was considering no longer hiring women as fellows because they so often used the year between residency and practice to get pregnant. It wreaked too much havoc on his school's training and call schedule and the workload planning for the fellowship. I can understand his perspective; however, for some women, even waiting 1 more year at that age might be too long.
 

I knew before I started residency that I wanted children; I just blithely assumed it would be easy to start having them in my mid-30s. The process didn't end up being that straightforward, and I had luck on my side. Some of my colleagues were not so fortunate. I now tell young women early in their training that, if they are sure they want to create families with their partners, they should plan to conceive when they are biologically best able regardless of how far along they are in their training. The process will throw a wrench into your life and the lives of your associates no matter when you do it--medical school, residency, early practice, or later practice. Planning children when it's easier to conceive at least decreases the chance of biology dictating whether you have children at all. I was heartened to see a baby born to a resident in my surgical program for the first time 3 years ago, and another two residents have become pregnant during training since then. It's my impression that surgery may be behind other more traditionally female-populated specialties, but I think we are getting there. Last year in our program, we drafted our first pregnancy/maternity policy for residents to officially clarify for women, their partners, and their co-residents the expectations and supports, training time requirements, and call considerations surrounding pregnancy within the surgical program.
 

We may live in an era of amazing advances in reproductive choices, but the biological clock still ticks. I'm not advocating that everyone should get pregnant tomorrow, or when they aren't otherwise ready, or at all, but we need to make it clear to our young female colleagues, especially those in longer training programs, that we support them in embracing their biological needs when the time is best for them.

--CV