Recently, reports surfaced that two Silicon-valley giants, Apple and Facebook, are covering elective ooycte cryopreservation, a.k.a. egg freezing, for its female employees.  Silicon Valley, like medicine, has a shortage of women at the top and it is presumed that this move will attract more women to enter — and stay — in the field of technology.

As both a recent graduate of medical residency and a new mother, who is dually fostering the lives of a young career and a young human, I find myself disturbed by much of the media conversation surrounding egg freezing.

A Time article heralded company-paid egg freezing as “the great equalizer” and this Business Insider piece declared that this coverage “isn’t about changing the system. It’s about making it easier for ambitious women to exist in the world we have.”

It’s about making it easier for ambitious women to exist in the world we have.

Since when has society given up on changing the world to make it more accessible for women to achieve both personal and professional success, and not the other way around?  How swiftly we have forgotten the rah-rah message of Sheryl Sandberg’s Lean In, in which women were to negotiate a world in which everyone from employers to partners were to make motherhood compatible with career.

The coverage of egg freezing is not inherently a bad thing, but I worry that using this technology for non-medical reasons has the potential to further cement the responsibility on the female employee to make her reproductive timeline most convenient for her employer.   Instead of attempting to change the system by creating solutions like affordable childcare and flexible hours, employers now have a temporary stopgap to delay dealing with the ambitious woman’s womb.

I fear that this would be a very easy attitude for medicine to adopt.

The issue of work-life balance for the female physician is as old as the entry of women into the profession of medicine.   In 1894, Dr. Gertrude Baillie published an essay in the Woman’s Medical Journal discussing marriage and why many female physicians chose to remain single, writing: “Either her work or her family will feel the neglect.”  More than one hundred years later, female physicians are still trying to find the professional and personal sweet spot.  Although females now make up nearly half of graduating medical school classes, women comprise only 37 percent of full-time academic physicians.  The divide only grows more pronounced further up the academic ladder; while 43 percent of assistant professors are female, women only represent 32 percent of associate and 13 percent of full professorship positions.  Gender roles and responsibilities — namely, birthing and raising a family — have often been blamed for this discrepancy.

Navigating the traditional fraternity-like environment of medicine has often been women’s biggest obstacle.  In the mid-1980s, Dr. Lee Roy Hendricks, the chairman of the obstetrics department at Stanford University, was forced to resign after publicly chiding a chief resident who got pregnant, declaring that having a baby in training was “presumptuous and a disservice to oneself and to one’s colleagues.”

While one might hope that this attitude was left in the last century, sadly, many still believe motherhood and medical training to be incompatible.  If you do an Internet search for “Getting pregnant in residency,” you’ll find forums and essays dedicated to the topic, but one of the top hits is an essay written by Karen Sullivan Sibert, MD in 2012 titled “Give yourself a break – Don’t have a baby during residency.”  Dr. Sibert makes the case that not only will having a baby in training be miserable for the resident, it will be even more miserable — and even dangerous — for both her patients and her colleagues.

The essay sparked an active debate in the comments — one in which Dr. Sibert actively engaged and formerly responded, writing:

Your fellow residents will cover for pregnant residents because they must, not necessarily because they’re glad to do it. Faculty members may seem supportive because they’ll run afoul of the thought police on the Residency Review Committee if they say what they really think. But behind closed doors, they may be telling a different story. Don’t be surprised if their letters of recommendation are damning with faint praise, while they convey their real opinions in telephone calls … If women want real opportunities to lead and influence medicine, we need to step up to the plate, not demand special privileges … Maybe in the future, technology will allow us to freeze our 20-year-old eggs and time pregnancies whenever it suits us.

In the last sentence, after threatening pregnant residents with hidden hatred and retribution from peers and mentors, she proposes a solution to the problem of pregnancy:  egg freezing.

While Dr. Sibert writes that egg freezing would allow pregnancy to happen when it “suits us,” implying the collective of female physicians, what she really means is that technology could delay pregnancy until the timing “suits the institution of academic medicine.”  And this is where egg freezing as a solution for the ambitious female becomes extremely problematic — especially for the female physician.  Instead of opting for the solution of egg freezing — one which could spare hospitals, private practices and patients the headache of a maternity leave — will a physician who chooses a natural pregnancy be seen as selfish and be met with even more resentment?

Getting pregnant in residency or in the early stages of a medical career is no doubt stressful on the system.  Physician coverage, loss of income, and interruption of care, among others, are all real concerns.   But so, too, is creating a culture in which life does not exist separately from medical training.  When I had my son in residency, I was given 30 days of medical leave — a woefully inadequate amount of maternity time.  As I dragged my C-section-recovering body back to an 80-hour workweek, I thought that as physicians, we should know better.  Yet, we continue to make it incredibly difficult for women to be caregivers at both work and at home.  And with the elusive promise of prolonging fertility with egg-freezing, I fear that we will make it even harder for women to achieve success in medicine and motherhood.

Alexandra Sowa McPartland is an internal medicine physician.  She can be reached on Twitter @AlexandraSowaMD.

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