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Original Investigation
Physician Work Environment and Well-Being
May 3, 2021

Delay of Pregnancy Among Physicians vs Nonphysicians

Author Affiliations
  • 1Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
  • 2Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
  • 3Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  • 4ICES (formerly the Institute for Clinical Evaluative Sciences), Ontario, Canada
  • 5Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  • 6Department of Medicine, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
  • 7Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
  • 8Department of Psychiatry, Women’s College Hospital, Toronto, Ontario, Canada
  • 9Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
  • 10Department of Obstetrics and Gynecology, St Michael’s Hospital/Unity Health Toronto, Toronto, Ontario, Canada
JAMA Intern Med. Published online May 3, 2021. doi:10.1001/jamainternmed.2021.1635
Key Points

Question  Are women physicians more likely to delay childbearing or less likely to have children compared with nonphysicians?

Findings  In this population-based retrospective cohort study of 5238 reproductive-aged physicians matched 1:5 to nonphysician counterparts, physicians significantly postponed the initiation of childbearing. Despite this delay, physicians ultimately achieved a similar probability of childbirth as nonphysicians, owing to higher rates of pregnancy at advanced maternal ages; this phenomenon was most pronounced for specialists.

Meaning  Physicians appear to delay childbearing and may be at increased risk of age-related adverse pregnancy outcomes.

Abstract

Importance  Women physicians may delay childbearing and experience childlessness more often than nonphysicians, but existing knowledge is based largely on self-reported survey data.

Objective  To compare patterns of childbirth between physicians and nonphysicians.

Design, Setting, and Participants  Population-based retrospective cohort study of reproductive-aged women (15-50 years) in Ontario, Canada, accrued from January 1, 1995, to November 28, 2018, and observed to March 31, 2019. Outcomes of 5238 licensed physicians of the College of Physicians and Surgeons of Ontario were compared with those of 26 640 nonphysicians (sampled in a 1:5 ratio). Physicians and nonphysicians were observed from age 15 years onward.

Exposures  Physicians vs nonphysicians.

Main Outcomes and Measures  The primary outcome was childbirth at gestational age of 20 weeks or greater. Cox proportional hazards models were used to examine the association between physician status and childbirth, overall and across career stage (postgraduate training vs independent practice) and specialty (family physicians vs specialists).

Results  All physicians (n = 5238) and nonphysicians (n = 26 640) were aged 15 years at baseline, and 28 486 (89.1%) were Canadian-born. Median follow-up was 15.2 (interquartile range, 12.2-18.2) years after age 15 years. Physicians were less likely to experience childbirth at younger ages (hazard ratio [HR] for childbirth at 15-28 years, 0.15; 95% CI, 0.14-0.18; P < .001) and initiated childbearing significantly later than nonphysicians; the cumulative incidence of childbirth was 5% at 28.6 years in physicians and 19.4 years in nonphysicians. However, physicians were more likely to experience childbirth at older ages (HR for 29-36 years, 1.35; 95% CI, 1.28-1.43; P < .001; HR for ≥37 years, 2.62; 95% CI, 2.00-3.43; P < .001), and ultimately achieved a similar cumulative probability of childbirth as nonphysicians overall. Median age at first childbirth was 32 years in physicians and 27 years in nonphysicians (P < .001). After stratifying by specialty, the cumulative incidence of childbirth was higher in family physicians than in both surgical and nonsurgical specialists at all observed ages.

Conclusions and Relevance  The findings of this cohort study suggest that women physicians appear to delay childbearing compared with nonphysicians, and this phenomenon is most pronounced among specialists. Physicians ultimately appear to catch up to nonphysicians by initiating reproduction at older ages and may be at increased risk of resulting adverse reproductive outcomes. System-level interventions should be considered to support women physicians who wish to have children at all career stages.

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