Family planning decisions for both male and female physicians are often affected by medical training. Challenges arise when the common reproductive age is the same age individuals are doing their medical training, building their careers and deciding their future career plans. Concerns often arise regarding parental leave, training interruptions, radiation exposures, fear of infertility, childcare, self-care and breastfeeding accommodations. These concerns among many others can unfortunately lead to postponing family planning.

Despite a rise in female cardiology fellows, challenges still exist. For example, female cardiologists are less likely to have children, have less support at home, and are more likely to experience an interruption in training compared to their male counterparts¹. A survey conducted by the Mayo School of Graduate Medical Education (GME) across 3 academic sites assessed the experience of cardiology fellows who become parents during training². Most fellows reported a stigma related to parental leave, along with lack of support and inflexibility to accommodate pregnancy related health issues. In this survey, compared to male cardiology fellows, female fellows were less likely to have children during fellowship and were less likely to plan to have children. All female cardiology fellows who had children during fellowship made alterations to their training compared to only 20% of male cardiology fellows who reported changes to their schedule. This may be due to the significantly lower number of female trainees in the field (8% interventional and about 22% general). This, in turn, may translate to less experience in dealing with maternal needs from a program. It also may be due to the increased responsibilities on females at home in child rearing which then leads to burnout; discouraging females from childbearing during fellowship.

One of the biggest challenges is the lack of clarity, implementation and variation in parental leave. Although the Accreditation Council for Graduate Medical Education (ACGME) policy³ providing protected parental leave during training is a step in the right direction, it can only be used for limited time and leaves the details of leave utilized to each individual program. Another challenge is seeking out information on radiation and nuclear safety in pregnancy which are not always easily available or understood⁴. These institutional hurdles may discourage childbearing and can be addressed by ACGME by standardizing leave across GME programs as well as mandatory training on radiation and nuclear safety for pregnancy.

Another major challenge to childbearing during training is the lack of sufficient childcare support. Providing adequate and affordable childcare to fathers and mothers in training is essential to encourage childbearing. An additional stipend for childcare should be considered as well. Asking for help from family members, arranging nanny services or a close by daycare are also very helpful.

To accommodate childbearing during training, the schedule should be set to where it can be adjusted should a fellow or their spouse become pregnant. This will ensure fellows do not miss core training requirements to graduate to prevent extension of training. Early communication with program leadership is key to this.

Other accommodations are necessary to look at in terms of the training environment for pregnant trainees. A few examples include sitting during rounds, providing coverage for all obstetrics appointments, avoiding difficult rotations with physical exertion in the third trimester, avoiding long and radiation provoking procedures, and allowing for early dismissal if needed. Finally, once back from leave, further accommodations are necessary for breastfeeding including a clean private workroom and allocating time during the day for lactation.

Becoming pregnant during fellowship is challenging and many measures can and should be taken to not only protect the rights of childbearing trainees but also accommodate them in order to encourage childbearing, reduce infertility rates and attract more females to the field of cardiology if they wish to have children during training. Cardiology programs that strive to get rid of the stigma surrounding parenthood in training and minimize the real and perceived barriers of childbearing set an example of how the future of cardiology should be.

Planning is the key for a successful childbearing experience. It is important for cardiology trainees who decide to get pregnant to consider doing early discussions with their program leadership for better schedule utilization, leave planning and accommodation of a dedicated time for important postnatal care such as breastfeeding and doctor appointments. Make your requests clear especially regarding meeting training requirements without interruptions and getting information on nuclear and radiation safety.

Parenthood can be very rewarding and the people around you can be supportive. As parents in training, we should lead the example for others who are afraid to take this step. Prioritize your life and work to live, do not live to work.

References

1. Lewis SJ, Mehta L, Douglas P, et al. The professional life of cardiologists: insights from the third American College of Cardiology professional life survey J Am Coll Cardiol. 2016;67:1928 doi:10.1016/S0735-1097(16)31929-5
2. Mwakyanjala EJ, Cowart JB, Hayes SN, et al. Pregnancy and Parenting During Cardiology Fellowship. J Am Heart Assoc. 2019;8(14):e012137. Doi:10.1161/JAHA.119.012137
3. ACGME Program Requirements. Accreditation Council for Graduate Medical Education. Available at: https://www.acgme.org/programs-and-institutions/programs/common-program-requirements
4. Radiation Safety in the Practice of Cardiology With an Emphasis on Special Considerations in Women. American College of Cardiology. Available at: https://www.acc.org/latest-in-cardiology/articles/2021/01/05/21/26/radiation-safety-in-the-practice-of-cardiology-with-an-emphasis-on-special-considerations-in-women