Physician Mothers Face 'Insidious, Persistent' Discrimination

Kerry Dooley Young

December 12, 2018

A survey of physicians who are mothers turned up reports of diminished pay and chances for advancement, along with accounts of hardships faced with breast-feeding and other aspects of child care.

"Our findings suggest insidious, persistent, and sometimes blatant discrimination experienced by physicians, based on their status as mothers," write Eleni Linos, MD, DrPH, of the University of California, San Francisco and colleagues in a paper published online today in The BMJ.

With 5782 physician mothers completing a full survey, this research is the largest qualitative study to date of physicians' varied experiences of maternal discrimination, Linos and colleagues say, adding that it's also one of the largest studies on this phenomenon in any profession.

The article includes comments from survey participants about obstacles faced in their daily practice of medicine, as well as in their attempts to advance their careers.

"When my husband and I were applying to residency at the same time he was lauded for having a family, [and] I was always asked if I thought I could handle residency and being a wife and mother," one participant said.

"Several times in the [operating room] I have been told in one way or another I will not amount to much because I was a female and having a family," another participant said.

Survey participants also told of being pressured to "make up" for time spent on maternity leave, even when this is unpaid leave.

Women reported being expected to perform tasks while pregnant that presented risks to the fetus, including exposure to communicable diseases known to cause fetal defects. They also said they had been expected to continue working while in preterm labor or while having a miscarriage.

Many respondents reported prematurely curtailing breast-feeding or pumping due to lack of time, space, and support, the authors note. One participant wrote about the lack of dedicated space for lactation.

"We usually sneak off to a call room but it's infested with cockroaches. For years. Complained but nobody cares," a participant wrote.

Another participant wrote of being criticized for taking off days due to her son's asthma flares. She said she was told that her "child had better be hospitalized (not just in the [emergency room])" to justify an absence.

Linos and colleagues note that previous research has shown persistent sex discrimination against female physicians, even as the proportion of medical school graduates who are women has increased from 7% in 1965 to 53% in 2017. For example, in a study published in 2016, researchers found that an estimated 80% of physicians who are or will become mothers reported experiencing maternal discrimination.

In the current study, Linos and colleagues sought to characterize the ways in which physician mothers experience maternal discrimination. Participants in their survey reported being excluded from administrative decision making because of their pregnancies or after returning from maternity leave. They also said they had been passed over for leadership roles in favor of colleagues perceived as less qualified. There also were reports of employment contracts being modified or terminated in response to announcing a pregnancy or when returning from maternity leave.

One participant said she was told the practice where she worked would lose money due to her pregnancy and maternity leave, especially if her child spent time in the neonatal intensive care unit (NICU).

"I was told my ankles would swell, my baby would end up in the NICU, and then I would want to be there with her so the practice would lose even MORE money and because of all this I need to accept a new contract with lower pay, no partner track, and no right of first refusal if the practice was ever sold," the participant said.

Other participants told of facing higher expectations than colleagues due to their status as mothers.

"Despite meeting my [relative value units] goals (even with 10 weeks of maternity leave), I was told I did not qualify for a raise because I hadn't been productive enough," one participant said.

Linos and her colleagues called for steps to address the "cyclical nature of maternal discrimination in medicine." Left unchecked, the current attitudes and practices may reinforce and perpetuate the challenges faced by physician mothers.

"It is noteworthy that some of the downstream effects of maternal discrimination might be mitigated by policies and procedures: flexible schedules including shift work, on-site high-quality child care, longer paid parental leave," they write.

Linos and colleagues note the limits of their survey, saying it should be considered a preliminary exploratory analysis. They recruited participants through a Facebook group for physicians who are mothers, thus they didn't study female physicians who were not mothers. As a result, "disentangling the effects of gender versus motherhood on discrimination was not possible with these data," Linos and colleagues write.

They also note that the voluntary nature of the survey may have skewed results. Physicians who had experienced maternal discrimination may have been more motivated to respond to the survey. Conversely, many physicians who may have experienced severe consequences due to the maternal discrimination might have left the profession entirely, and thus not have been included in the survey.

At the time of the survey in June 2016, there were about 60,000 members of the Physicians Moms Group on Facebook, with 34,956 of them considered active participants who visited the page at least once a month, Linos and colleagues say. The median age for survey respondents was 39 years (range 24-62 years), and median number of children was 2.

To participate in the survey, participants clicked on a link via the Facebook group to a cover page with a consent form that explained the goals of the study. The survey was posted three times, with the data collected through the end of August 2016.

Further research is needed to address the challenges of physicians raising families, writes Kate Lovett, MBChB, FRCPsych, dean at the Royal College of Psychiatrists in London, England, in an accompanying editorial. Research should look at employers' and coworkers' attitudes to parenthood in healthcare, including the attitudes of both male and female supervisors and more emphasis on the role of fathers.

"Lengthy training, long hours, and high societal expectations mean that doctors —  parents or not — lead challenging lives," Lovett said. "However, as long as parenthood is seen as a women's issue rather than an issue for us all, maternal discrimination will remain unresolved."

The authors and editorialist have disclosed no relevant financial relationships.

The BMJ. Published online December 12, 2018. Full textEditorial

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