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What I wish I knew in medical school about planning a family

Brendan Murphy , Senior News Writer

AMA News Wire

What I wish I knew in medical school about planning a family

Jan 11, 2023

When it comes to having a family, things don’t always go as expected. AMA member Sarah Marsicek, MD, a pediatrician in Gainesville, Florida, can speak to that firsthand.

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At 27, Dr. Marsicek had her first child, Maddox, when she was a resident intern in 2015. She and her husband then spent years going through fertility treatments, trying to have a second child. They also spent years as foster parents. In 2020, the family adopted Miller, a baby boy. Dr. Marsicek and her husband, Steven, are in the process of finalizing the adoption of their daughter, Sutton, born this past December.

The process of having a newborn, then trying to conceive and going through private adoptions at the same time is certainly demanding. It’s further complicated by the fact that Dr. Marsicek was trying to forge excel in here pediatrics training at the same time.

For medical students thinking about having a family, Dr. Marsicek offered some perspective on what she wishes she had known about planning her family when she was in medical school.  

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Physicians are in the habit of “constantly trying to find the right time for everything,” said Dr. Marsicek, an assistant professor in the division of pediatric hospital medicine at the University of Florida. “Someone told me a long time ago, there is no perfect time to have a baby in medicine, and it's so true. When it took us forever to get pregnant with Maddox, we realized that we really just can't go with what works with my professional schedule. It really just has to go with what works for us personally.”

“I had always known I wanted to be a mom, and so I met my husband through a very bizarre blind date [during medical school]. And we were married two years later. But we actually started to try to conceive before then because I did have some high-risk factors. I had cancer when I was younger. So we knew that we wanted a family, and we knew it would probably take us a little bit longer. And so we were hoping for a fourth-year medical school baby and I had Maddox during my intern year.”

“I tell all my residents: There will always be reasons to not have a baby, but if it's something that's important to you and you can make it work personally, don't wait. You don't want to be 40 years old and finding out that you can't have children. If it's something that you know might want to wait for, then look at the fertility preservation options.”

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“When I got pregnant with Maddox, I actually had one of my attendings—who I loved and adored and I still do to this day—basically tell me that we can't help the situations we find ourselves in ... meaning that she thought it was a total mistake that I got pregnant with my son, which I just was appalled by,” said Dr. Marsicek.

“She had no idea the hell we've gone through to have this baby. And I just couldn't believe that someone would say that,” Dr. Marsicek added. “She was a working mom and she said that to me.”

Sarah Marsicek, MD, and family
Sarah Marsicek, MD, and her husband Steven at the hospital with her sons Maddox (age 6), Miller (19 months) and Sutton (2 weeks), a baby girl the family is in the process of adopting.

When having Maddox, Dr. Marsicek felt added pressure that “came from the stigma around having a baby in residency. I felt like I was constantly having to prove myself. I felt like I had to take on more burden as far as doing more research projects, doing more QI [quality improvement] projects because I didn't want to be seen as the mom who doesn't show up and doesn't do things.”

Having an infant during residency gave Dr. Marsicek “more of a need for me to prove that I could be a mom and be a resident. And a functional resident.”

Now as an attending physician, she tries to “very, very supportive ...  of my pregnant residents because everyone deserves to have a family and female physicians are disproportionately affected by infertility.

Dr. Marsicek said she knows quite a few colleagues who “have gone through infertility and failed infertility treatments” and has one colleague who also adopted.

“It's an important conversation to have in medicine,” she said. “Because we deserve to have families—and we deserve to have full lives outside of medicine.”

“Because I married outside of medicine, it was a lot easier for me to say: I don't really care [about the timing]. I want to have a baby as soon as I can," Dr. Marsicek said. “My husband's an accountant, and so I didn't have to wait because I had someone supportive of me to have children.”

When dating her husband, Dr. Marsicek recalled, she asked him: “I'm in medical school—do you know what that means?”

He responded that it means hard work and “long hours.”

“You have no idea,” Dr. Marsicek responded, noting that “people married to physicians have an understanding of different roles than people outside of medicine.”

“Your partner needs to be willing to step in and help out a little bit more maybe than a traditional 50/50,” Dr. Marsicek said. “Sometimes you will be able to be there and kind of do your 50/50 role, but then there are going to be other times if you're on an intensive care rotation or an inpatient rotation or your partner's going to be lugging more 80 [percent], and you're going to be doing the 20.”

If you are considering starting a family during medical school or residency, “have a very frank conversation with your partner. Tell them: I will be there when I can be there, but know that this is going to ebb and flow and that you're going to have to be accepting of that or this is not going to work.”

Dr. Marsicek said she feels fortunate to have married “a wonderful, very understanding man who just takes it as it comes. Raising children is a full-time job and someone has to show up and someone has to be there to make it work. And sometimes that can't be the physician. A lot of times, especially in training, it cannot be the physician.”

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“We always knew we wanted a really big family and we decided to start trying for baby No. 2 two when Maddox was 2 years old and it just never happened,” Dr. Marsicek said, recounting expensive and ultimately futile efforts at assisted reproduction, trying everything but in vitro fertilization.

“The ticking time clock and the fertility issues are coming more to light as we get a little bit more progressive with talking about having families as physicians,” Dr. Marsicek said. “I would've never thought that I wouldn't be able to have more than one baby. I would've never thought that I would've had to go through infertility treatments. I always wanted to adopt at some point, but I didn't realize that was going to be the main modality that we could grow our family.

In medical school, “you can have your life planned out perfectly and you can say: I'm going to have this baby at this point, and it's going to all go well. I’ve learned that we have very little say over our biology at times, and then sometimes we just have to accept the fact that things don't always work out the way that you want them to,” Dr. Marsicek said.

“A big part of that is recognizing that we have really look very little control over our own fertility status.”

“Find a physician mentor whose life looks like what you want yours to look like,” Dr. Marsicek advised. “I really seemed to congregate during residency towards the other physician moms. One of the physician moms even put on a play group once a month.

“There'd be all these younger attendings with their little kids and then the residents had little kids, and we'd all go to a children's museum for a couple hours. And that was so awesome for me because I got to talk through some of the challenges and also some of the rewards of being a physician mom.

“There are also a ton of social media outlets. The Physician Moms Group on Facebook is tens of thousands of members strong. And a lot of topics as far as raising children and balancing the work-life pendulum, it all gets brought up on that. And so I think that that's also really helpful. There are also groups for breastfeeding physician moms, adoptive physician moms and physician moms of multiples. As social media becomes more and more prevalent, there are a lot of online resources and a lot of ways to connect to people through the social media that can be very helpful.

“In fact, a dermatologist just reached out to me and she lives halfway across the country. She saw that I was an adoptive mom and was asking me about my adoptive journey.

“That's one great parts of social media: You can connect with people through the parenting journey as well as the people who are going through the similar mode of life.”