Alright, everybody, let's take 9 (months)

Docs have difficulties finding time to breed. Isn't it time to offer MDs the same benefits as other parents?

By Susan Usher

Like most working Canadians, physicians find it difficult to fit reproduction into their fertile years. Stats Can's latest report, from 2002, put Canada's birth rate at 10.5 live births per 1,000 people � representing a 25% drop in just 10 years.

These stats have prompted the government to take measures to make having babies more compatible with the demands of working today, especially with both parents working. One-year maternity leave was introduced in 2001 and Quebec, at least, has improved access to affordable quality day care. Unfortunately, these measures mean little or nothing to medical parents, most of whom are self-employed with erratic schedules.

CHANGING TIMES
The uneasy parenthood/medicine mix already influences everything from the number of hours physicians work in a week (women average 47.5 hours vs 55.6 hours for men) to the growing preference for salaried positions over fee-for-service arrangements. And it's a growing concern. The number of women physicians in their childbearing years is rising steadily: 52% of physicians in Quebec under 44 are women. What's more, 59% of medical students across Canada are now women.

There's been some progress. Now maternity leaves are available to residents and Ontario physicians can get 17 weeks paid maternity leave through the Ontario Medical Association (OMA). However, many younger MDs feel there's no 'good time' to be pregnant. In a Canadian Medical Association Journal article in March 2000, Dr Bibiana Cujec reported on attitudes among med students, residents and teaching physicians at the University of Saskatchewan. She found med students to be the most dissatisfied about the lack of time they had with their children and the least likely to recommend having children to their peers. Among older physicians she found the exact opposite attitudes.

Dr Cathy Younger-Lewis, President-elect of the Federation of Medical Women sees medical marriage and parenting trends following those of society at large. "Twenty-five years ago, women were getting into professions but also following the norm � married at 20, baby at 22, following your husband around. I was the first pregnant intern Ottawa U had ever had to deal with and my program director automatically assumed I would quit. That doesn't happen now."

Iqaluit family physician Dr Madeleine Cole, who's expecting her first baby on May 5, sees other hurdles to having children early on. "It's really hard to find the time to develop a good relationship during your training: you're in medical school in one place, residency somewhere else and maybe a fellowship. How do you even nurture a stable relationship that's going to make children an option?" 32% of women docs and 14% of men end up settling down with another physician.

IT HELPS TO BE NAIVE
Dr Younger-Lewis cobbled together three weeks' holiday and four weeks' sick leave to have her first child and get back on rotation, leaving the baby with a sitter. "It helped to be young and naive about child care," she says. Her second child was dubbed the million-dollar baby by Dr Younger-Lewis' accountant. "My due date fell in the summer and I couldn't get a locum, so I ended up begging and pleading for someone to fill in for me in my practice, and paying all the overhead during those three months."

Today, Dr Younger-Lewis sees efforts being made, by both mothers and fathers, to juggle schedules so that they can spend more time with their children. Dr Cole envisions some changes that would make things easier for new mothers. She'd like professional associations and colleges to offer 'inactive' status to parents on leave. She'd also like to see maternity benefit programs like the OMA's offered elsewhere. "What maternity benefits do," she says, "is buy people the comfort level to make the choice to actually parent their kids properly instead of working to the last minute and going back to work a month later."

In retrospect, Dr Younger-Lewis feels the flexibility of a career in medicine worked well for her family. Dr Cole agrees, despite expectations that everyone in medicine should work 80-hour weeks. "I always try and remember that's a personal choice we make," she says, "but it's hard to get over the professional and societal expectations, especially when you're a rural physician on call so much of the time and pulled in so many directions," she says. "However, financially we're in a better position than many other Canadians to say no."