It’s 4:57 p.m., and I’m anxiously tapping my foot in a stuffy cubicle, trying to ignore the pain of my compression socks seemingly cutting off circulation to my feet. I quickly glance at the timer. Thirty-one seconds. I close my eyes and say a quick prayer as I feel the agile kicks of my daughter, who this week is measuring the size of a cucumber! I do one final pass of the questions marked with a small red flag before hesitantly hitting submit. Do you wish to end your exam? I didn’t have this on my Bingo card – thirty-three weeks pregnant and sitting for a nine-hour medical licensing exam. Pursuing a medical degree is a taxing sacrifice, but as a nontraditional student who had dabbled in various other career paths before returning to my childhood dream of becoming a doctor, I felt fortunate to be given a chance. The sacrifice felt deeper, however, when I learned I was expecting a baby, and with it came the challenge of navigating motherhood in medicine.

There is an undeniable value of women – and particularly mothers – in medicine. Research has shown that female physicians spend more time with their patients than their male counterparts and have lower rates of mortality, morbidity, and readmission. Women now constitute over half (55.4%) of medical school matriculants in the United States, and the average age at matriculation is slowly increasing, necessitating the need for more emotional support, fertility education and benefits, and clarity in parental leave policies. As an aspiring obstetrician/gynecologist, I was keenly aware of the harsh reality of starting a family during medical training, as well as the potential detriment that comes with waiting until training is complete. Among U.S. female physicians who graduated from medical school between 1995 and 2000, nearly one quarter (24.1%) were diagnosed with infertility by their mid-30s. Similarly, a study of 692 women revealed that 42% had suffered at least one miscarriage, almost double the rate of the general population. Despite these statistics, fertility education is lacking in medical school curriculums. Only a minority of surveyed medical students received lectures on infertility (32.5%), in vitro fertilization (18.7%), or oocyte cryopreservation (9.2%). So, as I watched that second pink line come into view, I recalled the dozens of mentors who told me, “There is never a good time.”

There is a lack of standardized maternity leave among medical schools, residency programs, and hospitals. Current policies, if they exist, are deemed inadequate. In 2022, the Accreditation Council for Graduate Medical Education mandated a minimum of six paid weeks off for medical, parental, or caregiver leave once during residency training but does not stipulate that these weeks have to be separate from existing vacation or sick time. In a similar regard, the Family Medical Leave Act entitles eligible employees to up to twelve weeks of unpaid, job-protected leave, but for many, this amount of time away from work necessitates extending training. As a result, physicians take shorter maternity leave than nonphysicians (10.9 weeks vs. 12.0 weeks, p = 0.017), and 34% of physicians feel their health was negatively impacted by their length of leave. We must do better. Fortunately, the landscape is beginning to change: The American Medical Association has been studying the feasibility of a minimum twelve-week leave allowance as well as policies for those who have experienced miscarriage or stillbirth. There are also other effective ways in which we can support mothers in the workplace, such as flexible rostering, lactation rooms, and on-site childcare.

When I was on my internal medicine clerkship, deep in the trenches of the first trimester, I stuffed my scrub pants pockets with ginger chews and sour candies to keep the nausea at bay during morning rounds. I concealed my growing belly with one of my husband’s oversized quarter zips in fear that my colleagues would view me as less serious about my education. Unfortunately, this feeling is far from uncommon. One study examined the workplace discrimination faced by female physicians and found that those who had children were often seen as disinterested, unavailable, and unwilling to work extra hours. This perspective has measurable negative effects. Among 22 program directors, 45% reported that their hiring decisions were influenced by the pregnancy plans of potential employees when this information was disclosed. This judgment is an unfortunate reality that so many face, despite the fact that many physician mothers feel their roles are intimately intertwined, with one job simply strengthening the other.

Now, I’m mere weeks into motherhood, and here I am, sitting alone at 3:00 a.m. under harsh hospital lights with a choir of monitors beeping as my only company. EKG leads are peppered across my daughter’s seven-pound body, ready to alert us should things go awry once again. I stare at her lower lip – quivering, yet perfectly at peace – a far cry from the piercing screams they echoed earlier in the day. I can’t help but think about the sixteen-year-old patient on my trauma rotation who suffered a traumatic brain injury after a motor vehicle accident and the eight-year-old on my pediatrics rotation – who was now eleven – and remained hooked up to life-support with no hopes of ever waking up. At this moment, it’s impossible for me not to worry about my own daughter’s long-term prognosis as I am reminded how quickly good fortune can change. Numerous factors play into the difficulty of pursuing motherhood and a medical career simultaneously, namely stressful work environments, poor sleep hygiene, advanced maternal age, lack of institutional support, student loan debt, and more. Yet, physician mothers are innately valuable to the profession and possess unique and desirable qualities that positively contribute to patient outcomes. Motherhood is teaching me selflessness, humility, empathy, and sacrifice, with both roles requiring I put another’s needs before my own. It is teaching me to be more acutely aware of my environment and trust my intuition, yet still support it with my medical knowledge. The synergy of the two allowed me to recognize when my daughter’s skin quickly transitioned from its ruddy newborn red and took on a sullen gray-blue hue. I knew how to act quickly, administer oxygen in the ambulance, and remain calm when at least a dozen health care providers attempted to access her pinpoint-sized veins. In medical school, I’ve spent countless hours objectively assessing patients, developing differential diagnoses, answering UWorld questions, and flipping through Anki flashcards, but there is no study tool for maternal instinct. Medical school has taught me the science needed to be a physician, but motherhood is teaching me how to be a good one.

Gone are the days when middle-aged men were the only ones in the hospital donning a long white coat, as the image of a “physician” has expanded, and society must get on board. Motherhood breeds compassionate, diligent, attentive, and thoughtful physicians. Medical training often coincides with prime childbearing years, and the profession must work to help women excel in their dual roles as parents and physicians. Because, after all, no one works harder than a mom.

Nicolette Siringo is a medical student.