Do People Get Pregnant During Medical Schools Sdn
Give yourself a break–Don't have a baby during residency
Overheard in the OR—a surgery chief resident ruefully explaining to a senior surgeon why no intern or junior resident was available to scrub in on his case. "Everyone in our department is either pregnant or on maternity or paternity leave," he said.
The senior surgeon just shook his head.
From my vantage point as the anesthesiologist on the other side of the drapes, I thought to myself, "Really? What would give anyone the idea that residency is a good time to have a baby?" When I look back to what it was like to deal with pregnancy, give birth, and look after an infant, all I can say is that internship was easier. After all, as an intern—even in the bad old days—I had some nights off.
Yet having a baby during residency is increasingly common among male and female residents alike. For women especially, it sounds perfectly awful. We've all heard the stories—pregnant residents struggling with nausea and fatigue during long nights on call, or vomiting into a trash bag in the operating room; new mothers trying to breast-pump in the hospital locker room during a half-hour lunch break.
One possible response is to argue that senior physicians should be more sympathetic to pregnant and nursing residents, and give them longer lunch breaks. This would be in keeping with the kinder, gentler world of limited resident duty hours and mandated nap times.
But it's equally fair to consider that residency might be a suboptimal time to have a baby.
Even with today's work hour limits, residency in any field involves stressful days at work, limited control over your schedule, and frequent nights on call. It's hard to get nutritious meals on a regular basis, even if a pregnant resident could stomach the food in her hospital cafeteria. Nor can she get enough rest. Anyone who's been pregnant can recall moments of such profound fatigue that she would kill for an afternoon nap, and a resident can't simply lie down when she feels like it. Can this be a healthy way to go through pregnancy?
Time to study
Even if a pregnancy is easy, there are other issues. The purpose of residency, after all, is to train a new physician in the knowledge and practice of the specialty he or she has chosen. There is a great deal to learn. Textbooks must be read. Sometimes even Wikipedia can't bail you out in time; you actually have to remember things.
It's hard for anyone to come home after a full day of work and summon the energy to read a textbook or journal. For a pregnant resident, it's even more of a challenge. For a resident with a new baby in the house, it's tough to get any uninterrupted studying done whether you're the mother or the father. Sleep is inevitably in short supply for both parents, and this goes on for months unless you are lucky enough to have an angelic infant who sleeps through the night at an early age.
And though it isn't politically correct to say so, pregnancy is notorious for a combination of fatigue and mental fog that is sometimes referred to as "pregnancy brain" or worse, "momnesia". (I've heard physicians refer to it, not jokingly, as "dementia of pregnancy".) Though it isn't a legitimate diagnosis, it's hard to convince many women (and their partners) that "pregnancy brain" isn't real.
One residency director (who prefers anonymity) bluntly advises her female residents not to become pregnant at least during the first two years of residency. "You won't study enough," she says, "and your board scores will suffer." Certainly high scores don't always correlate with stellar performance as a physician at the bedside. But I think we can all agree that high board scores at least demonstrate facility with the subject matter. Given the choice, I'd just as soon have a doctor taking care of me whose scores were at the higher end of the scale.
Taking care of the patients
A residency director recalls the day when a resident came breathlessly into her office with the news that yet another resident was pregnant. "What are you going to do?" the resident asked, meaning how could all of the surgical cases and the night calls be covered. "No," said the program director. "The question is, what are all of you going to do?" The hospital isn't going to hire more doctors to cover for resident maternity leaves. The burden of coverage will fall on the remaining residents in the program.
In the majority of teaching hospitals, residents are critical for providing patient care—in the clinics, on the wards, and in the operating rooms. When the responsibility falls on fewer and fewer remaining residents, they may easily become resentful. The solidarity and morale of the group could suffer. Eventually a critical point may be reached where there aren't enough residents to cover the service.
It would be easy to suggest that residency programs should be expanded. With more residents on hand, maternity and paternity leaves wouldn't be an issue. However, the number of residency positions in the U.S. is capped. In 1997, Congress imposed a limit on how many residencies the government could subsidize as part of the Balanced Budget Act. The Senate failed to pass an amendment to the health care bill that would have created thousands of new residency positions. Future decreases in Medicare spending threaten the funding of the residency positions that exist now.
Hospitals could be forced to hire non-physician practitioners to make up for a lack of residents: nurse anesthetists to replace anesthesiology residents; physician assistants or nurse practitioners to replace residents in other fields. If that happens, we can't blame the public, the government, and hospital administrators if they reach the conclusion that people with far less training can do the work of doctors. We could face further downgrading of the physician's role in American health care.
What's the hurry?
If you go straight from college to medical school and residency, even if you complete a fellowship you are likely to finish your training in your early thirties. Nationally, later childbearing is the norm for many educated women—the Pew Research Center reports that births to women ages 35 and older grew 64% between 1990 and 2008. The likelihood of conceiving is still high for women in their early thirties, and the risk of chromosomal abnormalities is low. For the woman who begins medical training later in life, of course, the circumstances are different.
The pressure of having a baby during residency will strain even the strongest relationship. Residents of either gender may feel entitled to shift much child-care responsibility to their partners. Women residents face the impossible task of reconciling their desire to nurture the new baby and the need to return to work. The husbands and wives of today's residents are likely to have careers of their own and could resent the idea that the resident's career should take precedence.
If you postpone having children until you finish residency, you can decide with less financial pressure where you want to live and what kind of practice you want. Raising a child to the age of 18 costs well over $200,000 by current estimates, not including the cost of college. It's easy to slip into credit card debt on top of medical school debt if you have children before you can afford them. Heavy financial obligations can force you into career choices you wouldn't otherwise make.
Sermo readers opine
There's been an interesting chain of opinions recently on the physicians' website Sermo, responding to the post "Actual Resident Comment". This post concerned a resident who asked to switch a call night in the ICU when his wife needed induction of labor. Many readers were sympathetic; others took the side of the resident who wouldn't take the call in his place. A radiation oncologist offered a different take: "Residents should not be having babies, period."
Other writers disagreed vehemently. "Physicians who want to be parents make some of the best in the world by the examples of dedication, hard work, compassion, use of intellect, etc. that they set for their children," wrote a specialist in allergy and immunology. "This capacity for caring for others leads us to want children of our own."
But no one was saying that physicians should never procreate. The point was that childbirth during residency could be a problem. An emergency medicine physician noted that she conceived at the end of her intern year despite birth control pills, and went back to work five weeks later. "I had my second as an attending," she wrote. "MUCH easier." She advocates having children after residency as a first choice.
The achievement checklist
In a way, the determination and single-mindedness of physicians may help to explain why they have children during residency. Having a baby becomes part of the achievement checklist. Finish college—check. Finish medical school—check. Score residency position—check. Find life partner—check. A baby becomes the next item on the list, and residents often feel pressure from parents and in-laws who are anxious for grandchildren. For the young resident who's been a bridesmaid in her best friends' weddings, it can be hard to see them having babies without feeling the urge to have one of her own.
I certainly understand the desire to have children. I had my first at the age of 22, and started medical school when she was four years old. Not once did it cross my mind to have another until I was done with my fellowship—life was busy enough. My other children were born after I went into practice.
For today's residents, my message is simply this: Give yourself a break. Take advantage of all the teaching, and look at residency as the time to learn your life's work. Take care of your husband or wife or partner, and cherish that relationship. Go out for a drink with your fellow residents occasionally, and enjoy those friendships. Protect yourself from getting exhausted and burned out before you've really started life as a physician. The work is tough enough.
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Author's note: Comments on this opinion column are now closed. Thank you so much to those who have submitted comments, in agreement or disagreement. The essence of civilized discourse is to tolerate — even encourage — differences of opinion.
This column was featured on the Sermo Speakers Series on March 6, 2012
Do People Get Pregnant During Medical Schools Sdn
Source: https://apennedpoint.com/give-yourself-a-break-dont-have-a-baby-during-residency/