Parenting While in Hematology: Perceived Barriers

Background

Up to 50% of residents and fellows report planning to become parents during their training, carrying important implications regarding work-life balance, career development and professional satisfaction. Prior studies assessing medical career challenges in the US have demonstrated that teaching institutions often lack adequate support for trainees with children – as measured by childcare access, parental leave, lactation facilities, and the increased workload burden on peers. While more studies have focused on the examination of institutional support policies for trainees, fewer have included junior and mid-career attendings.

Methods

A survey method was employed to explore the perspectives on the US parenting experience of physicians within hematology and to determine potential barriers impeding parenting physicians from pursuing academic careers in Hematology. Participants were predominantly recruited from two main sources: the ASH and ASCO member directories. Respondents’ data were gathered through SurveyMonkey and transferred to SPSS for analysis. 5-Point Likert scale questions on behaviors, attributes or sentiments were dichotomized by combining strongly agree and agree vs else. Bivariate associations were assessed with Pearson Chi-Square or Fisher’s exact test as appropriate.

Results

Of 5,260 surveys emailed to member directories, 210 (4%) respondents constituted the study sample. Of these, 62.9% (127) identified as White, 13.4% (27) as Hispanic/Latinx (11) or Black (16), and 27.7% (56) as Asian. Participants were 63.3% female and 52.9% between ages 25-44 years. 14.5% self-reported as trainees, 20% junior attendings, 59.1% established attendings and 6.7% others.

Five major career barriers affecting parenting among Hematology providers were defined: institutional policies, institutional culture, economic issues, social support environment and career burden. 57.3% of female respondents reported being the primary childcare provider compared to 18.4% of male counterparts. 97.4% of the males were in a married/cohabiting relationship compared to 82.4% of females (p=0.001). Among females, not being in a married/cohabiting relationship was associated with reporting less support in family planning goals within their institution’s culture (p=0.04), greater feelings of being stereotyped as mothers due to their gender (p=0.02), and poorer work-life integration (p=0.03). Compared to males, female respondents reported higher levels of burnout (75.9% vs 55.9%, p=0.03), a greater need to decrease work hours (83.6% vs 61.8%, p=0.07), and feeling that parenting had impacted their career advancement opportunities (62.2% vs 44.1%, p=0.03). Many participants (60.6%) were unsure if their institution provided financial support methods to delaying childbearing (egg-freezing, adoption, surrogacy, and infertility treatments). Within the postpartum period, only 37% of women reported no pressure to limit breast pumping time (p<.001). 71.9% of respondents in the early childhood stages reported having no institutional support for daycare costs with 65.5% needing to decrease their work hours due to childcare needs. Midwestern respondents, compared to other regions, were generally more satisfied with their circumstances but also had fewer pregnancies during their hematology careers (p=0.05).

All respondents were asked: “If I had to do repeat this experience again, I would.” 74.8% of participants agreed that they would. The most common associations with not agreeing were insufficient social support network (p<.001), higher levels of burn-out (p=0.03), perceived limitations on career advancement opportunities (p=0.02), financial barriers (p<.001), and feeling unsupported in family planning goals (p=0.02). For the older and more established hematologists, finances were less likely deemed an obstacle (p= 0.045).

Conclusion

This study identifies targets for future interventions to best support physician parents pursuing hematology careers. The study yields insights into barriers that might impede parenting physicians from progressing into academic careers in hematology. Addressing these barriers could aid in the long-term recruitment and retention of candidates for the next generation of hematologists.