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The Cost No One Talks About · Lean Out Podcast

• 0:01
  Welcome to the lean out podcast.
• 0:03
  I'm your host, Dr.
• 0:04
  Don baker.
• 0:05
  Are you looking for a new approach to finding authentic and sustainable work-life balance?
• 0:10
  You've come to the right.
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  Place.
• 0:11
  For inspiration.
• 0:12
  information.
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  and a community.
• 0:14
  community.
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  of like-minded.
• 0:15
  Professionals.
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  Let's get to the show.
• 0:23
  Hello?
• 0:23
  Hello.
• 0:24
  Thanks for being here.
• 0:25
  Today, I'm bringing you chapter three of my book, lean out a professional woman's guide to finding authentic work-life balance.
• 0:32
  But before I do that, I want to let you know something exciting.
• 0:35
  If you're a physician and you happen to work somewhere that provides you with a CME budget, I'm now able to offer my coaching services with CME credits through CME EFI.
• 0:44
  So, if you've been thinking about exploring coaching, this might be the nudge.
• 0:48
  You need to take it to the next step.
• 0:50
  You can book a coaching consult with me by going to the website, www.practicebalance.com/get in touch.
• 0:59
  And while you're there, take a moment to sign up for my once or twice monthly newsletter and you'll receive a free instant download exercise to help you clarify your core values.
• 1:10
  Onto lean out.
• 1:12
  This chapter is titled the cost.
• 1:14
  No one talks about.
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  So much so that I pitched and gave a talk about this topic at a very large physician conference, a couple of years back.
• 1:21
  I was so excited about my talk.
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  I knew the research right and left, and I had impactful stories to share.
• 1:27
  Get hardly anyone showed up to watch the talk.
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  I can only hope it's now helping people when they purchase the recordings.
• 1:33
  As a course.
• 1:35
  It's such a difficult issue, rife with stigma and shame.
• 1:39
  The classroom referring to is infertility.
• 1:42
  Infertility is likely more common than you realize.
• 1:44
  And it's surprisingly common in the world of professional women.
• 1:48
  Some studies show in fertility rates for doctors and lawyers double the general population.
• 1:54
  Even if you're not interested in becoming a parent or you're done having your babies infertility will affect you because it will affect someone, you know, someone you love or someone you work with.
• 2:04
  It's a workplace wellness issue that we all need to be aware of.
• 2:08
  At the end of this chapter, you'll also hear the story of Shilpa, who I featured in one of the early episodes of this podcast.
• 2:15
  I'll link the episode in the show notes in case you missed it, or you want to revisit it or know more about her journey after hearing this snippet from the book.
• 2:23
  As always.
• 2:24
  Thanks for listening.
• 2:28
  Chapter 3.
• 2:30
  The Cost No One Talks About.
• 2:33
  The time to scale back is when a break is needed or when a child arrives, not before and certainly not years in advance.
• 2:41
  Sheryl Sandberg.
• 2:43
  It might be a case of if, not when, a child arrives.
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  Professional women are heeding Sandberg's advice to lean in, and it's costing their fertility.
• 2:54
  This encouragement to keep pushing harder now and worry later assumes that you can start a family at any time along the way.
• 3:02
  However, the reality of modern family building tells a different story.
• 3:06
  You might not see a family in the vision you have for your life, but if you do presently, or if there is any chance you might in the future, you need to be aware of this hidden cost.
• 3:19
  Married at 25 to a fellow rock climber, I spent the latter half of my 20s and the first half of my 30s living a life of adventure.
• 3:27
  We traveled by camber truck, RV, and plane with backpacks in tow to climbing locales across the world.
• 3:35
  Medical school became part of that adventure, and we planned climbing projects and trips around my school schedule.
• 3:41
  I looked, felt, and performed great, so I assumed I'd have no problem getting pregnant whenever I wanted.
• 3:48
  I figured that motherhood could wait until after residency.
• 3:52
  Little did I know, female fertility does not work that way.
• 3:56
  Infertility is on the rise in this country, and high achieving women professionals are suffering most.
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  At present, approximately 13 percent of U.
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  S.
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  couples have infertility.
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  Astonishingly, this rate doubles for couples that include a woman physician.
• 4:13
  There is no published research to date on infertility among female attorneys, but according to the American lawyer, the issue is becoming increasingly recognized as a problem in the law profession.
• 4:26
  Amman is an attorney who, at the time of announcing her pregnancy on social media, took a leap of vulnerability and disclosed her struggles to conceive.
• 4:35
  After more than 1.
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  5 years, Blood tests, bodily fluid tests, ultrasounds, and two rounds of fertility treatments.
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  My husband and I are thrilled to share the arrival of our baby, she disclosed.
• 4:49
  Her post garnered several responses from attorney colleagues who said they too had undergone fertility treatments to have children.
• 4:57
  One commented, Almost everyone I know who started to have kids after 30 has had some kind of fertility issue, us included.
• 5:05
  When you graduate law school at 25 or older, it makes it hard to have kids earlier than 30.
• 5:11
  The age issue.
• 5:13
  A myriad of factors contribute to infertility, and the exact mechanisms for the current rise in its incidence aren't yet well understood.
• 5:21
  More than one third of infertility cases also include a male factor as part of the cause.
• 5:26
  However, one foundational fact stands out among the many explanations.
• 5:31
  Women are delaying their childbearing years to pursue further education, training, and careers.
• 5:37
  Compared to women in the 1970s, women today are delaying childbirth by an average of 5 years.
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  The mean age of an American woman when she becomes a mother is currently 26.
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  However, a woman physician on average has her first child at age 31, tacking on another five years.
• 5:55
  Strong pathophysiological evidence exists to explain a woman's age related decline in fertility.
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  A woman is born with the absolute number of eggs she will ever have in her lifetime.
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  And as she ages, she continues to lose them through menstruation.
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  In addition, eggs incur DNA damage over time, leading to decreased efficacy.
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  Clinically, this translates to markedly lower pregnancy rates and higher miscarriage rates for women over 30, but especially women over 35.
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  Aging ovaries are less sensitive to the hormones from the brain, or the in vitro fertilization medications, that signal ovulation.
• 6:35
  In addition, there is an age related increase in incidence of diseases that affect the uterus and ovaries, which, even if resolved, can in turn affect fertility.
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  The evidence for age related fertility impairment is so strong that the American Society for Reproductive Medicine and other groups now recommend early evaluation at the slightest hint of trouble conceiving if you're over the age of 35.
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  Instead of having unprotected sex for one year before seeking help, the typical recommendation, reproductive specialists now tell older women to seek evaluation no later than six months after concerted trying.
• 7:16
  There's no doubt that the effects of stress can also impair ovulation and other functions needed to achieve and maintain pregnancy.
• 7:23
  One study found that the miscarriage rate among female surgeons is more than double the national average.
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  An often cited study of physician fertility asked survey respondents how they would have changed their behaviors had they known fertility would be a problem for them.
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  More than half the women surveyed said they would have attempted to build families earlier.
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  However, doing this in today's lean in culture requires courage to go against the norm.
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  A perfect storm.
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  If a woman goes straight to medical school from her undergraduate schooling, she will graduate around age 26.
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  By the time she's finished with residency, she'll be at least 30.
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  After that, she's working to hone her newly acquired clinical skills, complete her board certification, and establish herself as a team player in her practice.
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  Likewise, a woman who goes straight to law school will graduate around age 25.
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  She will then sit for the bar and start working as an associate at a law firm.
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  By the time she makes partner, she'll be in her early 30s.
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  This timing presents a huge problem for women who want to have careers and families.
• 8:33
  The prime years to build your family coincide with the prime years to build your career.
• 8:38
  Throw infertility treatments into the mix and you have a perfect storm of stressors that are likely to affect your fertility in a negative way.
• 8:47
  The age related fertility issues discussed above typically begin to manifest in a woman's 30s, but they magnify exponentially after age 35.
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  Unfortunately, many healthy high achievers assume they have until this time before they need to worry much about family building.
• 9:05
  I was one of these women.
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  With an athletic build and a healthy weight, I assumed I had until my late 30s to really get moving on motherhood.
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  I also didn't start medical school until I was 28.
• 9:17
  When I turned 35, halfway through my residency, my husband and I decided we needed to get serious about having children.
• 9:24
  At the same time, I couldn't bear the thought of adding anything to my plate, even if it was just a thing in the planning stages.
• 9:32
  I was already trying to be everything to everyone.
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  My fatigue, later explained by an endocrine tumor, was setting in.
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  My burnout was raging, and every day felt like a chore.
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  Additionally, I had stopped having my period.
• 9:47
  Yes, an innocent fertility workup is what led to my cancer diagnosis.
• 9:52
  After my brain surgery and recovery, I still wanted to become a mother.
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  On top of having permanent infertility related to my brain tumor, I had age related fertility impairment.
• 10:03
  After three years of infertility treatments and one miscarriage, I finally had a child, all while working as a physician.
• 10:12
  Navigating infertility while working.
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  Consider what it's like to undergo a typical cycle of in vitro fertilization, IVF.
• 10:21
  You administer nightly hormone injections to grow your follicles.
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  in preparation for an egg retrieval procedure.
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  The process usually takes one to two weeks, but you don't know exactly how fast your follicles will grow.
• 10:34
  For the first week, monitoring consists of just a single blood draw, but during the second half of your stimulation cycle, you must physically go into the clinic for daily transvaginal ultrasounds.
• 10:47
  The final call of when the follicles are mature enough for ovulation trigger and egg retrieval is completely out of your control.
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  Every day you head into the clinic wondering, will I have a surgical procedure 36 hours from now?
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  Once you get the go ahead to take the injection that triggers all those eggs to ovulate at once, the clock is ticking.
• 11:08
  You must undergo your egg retrieval, a surgical procedure with anesthesia, before precious time runs out.
• 11:16
  Does this process sound compatible with your typical work schedule, to the point where you could complete an IVF cycle without any help from colleagues or notice to managers?
• 11:26
  Beyond the uncertainty in timing, things sometimes go wrong.
• 11:30
  Cycles get canceled.
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  Complications occur.
• 11:33
  Sure, you could use all your vacation time if you're allowed to ask on that short of notice.
• 11:39
  It's no wonder that women undergoing fertility treatments meet clinical criteria for depression and, or anxiety more than half the time.
• 11:47
  Ingrid is a 49 year old physician mom of two young children.
• 11:51
  She met the love of her life a few years after focusing all her energy on a residency and fellowship in family medicine.
• 11:59
  Because they were both almost 40 years old, she and her husband went right to work building the family they desired.
• 12:05
  That family was realized through a long journey of infertility treatments, eventually involving donor eggs.
• 12:12
  Moving to donor eggs was a difficult decision that required the processing of grief and loss, but on top of this stressor, Ingrid also experienced pushback in her workplace.
• 12:22
  In Ingrid's practice group, she had the task of coordinating and delivering monthly continuing education lectures.
• 12:30
  This involved designing a curriculum, choosing relevant topics, and coaching speakers prior to the monthly events.
• 12:37
  During one of her IVF cycles, she asked her boss if he would be willing to stand in for her as the coordinator if her cycle fell during the days of the planned lectures.
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  The work had already been done, the dates were set, and the presenters were lined up.
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  All she needed was a standby person, and she had done the same for him in the past.
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  But he vehemently refused.
• 12:58
  This frustrating conflict eventually led to a very uncomfortable meeting in the presence of her HR representative.
• 13:05
  When pressured to disclose more than she was willing about her medical situation, she resigned on the spot.
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  If it comes down to having a family or being a good doctor, I'm going to choose the first, she told me.
• 13:18
  I could have persisted in that job.
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  But there was no trust.
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  I needed to drop anything that was in my way and let it go.
• 13:26
  In a survey I conducted of more than 150 women physicians with infertility, 68 percent admitted they had trouble scheduling their treatments around their work schedules.
• 13:36
  30 percent of respondents had changed to jobs like my friend Ingrid or had decreased their workload substantially due to their infertility.
• 13:44
  This unfortunate loss occurs on top of the tragic losses of infertility.
• 13:49
  But these women rearranged their priorities out of biological necessity.
• 13:54
  When the window to have a child closes, it closes.
• 13:58
  Career opportunities will always be there, hopefully with more flexible opportunities in the future.
• 14:04
  An outright abandonment of leaned in culture will not magically improve women's fertility.
• 14:10
  Further, not all women professionals list motherhood as a life goal.
• 14:14
  Nevertheless, having children is an important choice for many.
• 14:19
  Infertility affects everyone in the workplace.
• 14:21
  Spouses, co workers, schedulers, and administrators.
• 14:26
  Unfortunately, it is both a cause and an effect of the high stress lives of many women professionals.
• 14:33
  If the current culture doesn't provide enough flexibility to start our families, we will need to redefine the culture one woman at a time.
• 14:42
  Exercise.
• 14:44
  What do you really want?
• 14:46
  What do you really want in your life?
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  Answer this very specifically by visualizing the details.
• 14:53
  What does your family look like?
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  What How many children, if any, do you have?
• 14:58
  How many days do you want to work, ideally?
• 15:01
  What other boundaries do you envision related to protecting your family time?
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  Examples could be no phone calls after 7 p.
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  m., no charting at home, and no emails on weekends.
• 15:13
  Shilpa's journey.
• 15:15
  It took stepping into the void before realizing that's what my future was.
• 15:21
  Shilpa knew she wanted to be a doctor from an early age.
• 15:24
  Driven by an intense desire to serve others, she chose the specialty of Pediatric Oncology.
• 15:31
  She describes this area of medicine as intense.
• 15:34
  Oncologists follow their patients from the clinic to the hospital and the ICU, and they even sometimes treat them in their homes.
• 15:42
  It is a serious commitment that is only feasible if you have a strong support network to take care of people in a way that doesn't prevent you from being able to take care of yourself, she said.
• 15:54
  Shilpa loved her job in a small private practice.
• 15:57
  But some family circumstances caused her to question her identity as a physician.
• 16:02
  Her mother was diagnosed with multiple cancers, which led her family to seek genetic testing.
• 16:08
  Shilpa found out she inherited a gene from her mother that significantly increases her risk for multiple types of cancer.
• 16:16
  Thus, she and her husband made the choice to use IVF with genetic screening to build their own family.
• 16:23
  I tried doing IVF when I was in clinical medicine, and it was really challenging, Shilpa said.
• 16:29
  Working in a small group, she found it very difficult to make sure her patients were getting the care they needed while she was undergoing cycles.
• 16:36
  I felt like I wasn't able to give my patients the quality care that I wanted to give and still pursue the IVF path, she said.
• 16:45
  She knew she wanted children in her future.
• 16:47
  And she at least wanted to give the whole IVF process a try.
• 16:52
  Her second round of IVF had very poor results.
• 16:55
  No euploid, genetically normal embryos.
• 16:58
  At the same time, Shilpa had become her mother's primary caregiver after a diagnosis of leukemia, the cancer that ultimately took her life.
• 17:07
  The stress was overwhelming.
• 17:10
  It wasn't fair to my group, and it wasn't fair to my patients, Shilpa said.
• 17:14
  The group tried to accommodate her needs, but all the members carried tremendous clinical loads.
• 17:20
  She also admitted, Sometimes I need to be there for myself and not be available for others.
• 17:27
  Looking down the long road of using the IVF process to have multiple children, along with the uncertainty of her own future health, I had to change my work environment so I could do what I wanted to do, in a way that made me feel like I could do it with integrity.
• 17:43
  She made the difficult decision to leave clinical medicine when she found an alternative job as a remote research physician for a pharmaceutical company.
• 17:52
  Shilpa took two months off all work duties and resumed her IBF treatments after starting the new job.
• 17:58
  Fortunately, her most recent egg retrieval was much more successful.
• 18:03
  To what extent does she think a shift in her stress levels played a part in the success?
• 18:08
  I think it was huge, she said.
• 18:11
  While there is evidence on both sides, for me, I saw a big difference.
• 18:16
  The most difficult part of this whole journey for Shilpa was separating herself from the vision of her career she had held since childhood.
• 18:24
  I had to go through that process cognitively and then feel okay about it emotionally, she said.
• 18:30
  She leaned on her background in spirituality and personal growth to remember that she is not defined by her external circumstances.
• 18:37
  See Chapter 6 for more on this subject.
• 18:41
  In addition to having the ultimate flexibility, Shilpa is loving the work she's doing in her new job.
• 18:47
  Her research focuses on immunotherapy, an area of cancer treatment where she already had great interest.
• 18:54
  I love the work I'm doing right now.
• 18:56
  I'm able to help people on a much larger scale than I was before, she said.
• 19:01
  She is honored to do her job and feels it is still in service to her patients.
• 19:06
  She's now looking forward to getting pregnant with one of her stored embryos.
• 19:12
  Thanks for listening to the lean out podcast.
• 19:15
  If you find these conversations inspiring and useful, please forward them to a friend and also leave a review on iTunes or Spotify so that other people can find them easier.
• 19:27
  If you want to get in touch with me, you can find me at my website, practice balanced.com, where you can subscribe to my newsletter and get updates regularly about new podcast episodes, blog posts, speaking, engagements, and coaching services.
• 19:43
  You can also support my work by buying my book, lean out a professional woman's guide to finding authentic work-life balance for yourself, a friend, family member, or coworker.
• 19:56
  Have a great day and we'll see you next time