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Financial Limitations of Fertility and Family Planning In Cardiothoracic Surgery
*Laura Scrimgeour4, Madigan E. Stanley3, Naima Alver5, *Ramin E. Beygui2, Tom C. Nguyen1
1Cardiothoracic Surgery, Miami Cardiac & Vascular Institute, Miami, Florida, United States, 2Cardiothoracic Surgery, University of California San Francisco, San Francisco, California, United States, 3Cardiothoracic Surgery, Brown University Health, Providence, Rhode Island, United States, 4Cardiothoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States, 5Cardiothoracic Surgery, University of Washington, Seattle, Washington, United States
Objective
Over 70% of residents delay family planning during training. While all surgical trainees are faced with many years of post-graduate training, cardiothoracic surgical trainees spend a minimum of six years and often up to twelve years in training if they choose to subspecialize. As a result, many trainees have both limited time and limited wages during prime childbearing years. Furthermore, infertility and pregnancy complications are prevalent in surgeons more so than the general population placing even greater pressure on trainees during this time. Given these limitations, the option of fertility preservation is becoming a more and more attractive option for women in cardiothoracic surgery.
Methods
We sought to evaluate the current climate of cardiothoracic surgeons' opinions on fertility preservation and limitations of usage. We surveyed cardiothoracic surgeons and surgical trainees via an emailed survey and collected responses in RedCap. The survey was created to evaluate demographic information, as well as elucidate training patterns and attitudes of training programs towards fertility treatment. A reminder email to complete the survey was sent six months later.
Results
Of the 70 respondents to the survey, 38 were female (54%). The median age group was 35-40 years old. 74% of respondents identified as married, with another 7% partnered. 60% of respondents have children, and of those, 74% had children during training. When choosing a career, 40% noted that they considered family planning. Of those, 61% were female. More than half of respondents noted that they delayed having children for training (n=39, 56%). The median length of training was 9 years (n=17), ranging from ?6 (n=7) to >10 years (n=11). Nine respondents noted that they would have considered pursuing additional training if fertility treatment or preservation had been a more attainable option for them.
Parental leave policies in the U.S. have been evolving rapidly in recent years. In our study, the median time for maternity and paternity leave was 4-8 weeks. During these leaves, 94% noted that the work was covered by other residents and fellows. Most respondents were unsure of whether residents were allowed to take time off for fertility treatment (70%), however, 13% reported that a time of more than one week was allowed and only two responded that no time off was allowed.
When looking specifically at financial coverage policies, while most were not familiar with the coverage policies (59%), 19% did note that some or all of infertility treatment was covered by insurance. For fertility preservation such as egg freezing, 13% reported some or all was covered, whereas 31% reported no coverage.
Forty-six percent reported that they or their partner considered in-vitro fertilization or egg freezing either during or after their training. Of those, the median age at time of fertility preservation was 33-35 years of age. The out-of-pocket cost (not covered by insurance or other sources) ranged from <$5,000 to more than $15,000. 38% noted that they paid more than $15,000. When looking at the total costs (including insurance coverage), eleven respondents noted that the cost was >$15,000 (46%).
Conclusions
In conclusion, many challenges to family planning still exist in cardiothoracic surgery. Both the substantial cost of fertility preservation compared to a resident salary and the limited leave time available during training years can be prohibitive. Funding options for fertility preservation either through insurance or hospital-based support could attract more women to the specialty and allow further freedom to pursue both their careers and family options at the timing of their choice.
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