Family planning in dermatology

By Emily Margosian, Assistant Editor, March 1, 2025

Physician parents agree: There is no perfect time to have a baby.

Pinpointing the right time to start a family is always a complex decision, but for those with a career in medicine, welcoming a new addition during medical training and early career often presents an additional set of challenges requiring a careful balance of personal and professional priorities.

“When planning a family, it would be ideal if we could allow this part of our otherwise very structured lives to be a bit more poetic and not beholden to a set plan. For some, that’s the way it works out,” said Elizabeth Jones, MD, FAAD, associate professor of dermatology at Thomas Jefferson University Hospital. “Others are forced to be more calculated regarding factors such as income, the cost and availability of childcare, the pursuit of a fellowship, punitive financial losses depending on practice productivity models and metrics, the ability to publish, complete research, travel to conferences, and advance toward promotion.”

This month, dermatologist parents discuss key considerations for family planning while working in medicine and share their tips for staying on top of their two most important jobs.

Choosing the right career stage

Most physicians start families during medical school, residency, fellowship, or their early career years. Choosing the right stage for their individual circumstances can involve important considerations regarding workload, finances, exams, applications, time for research, and completing training on time.

“Both my pregnancies were almost over-planned,” said Samantha Pop, MD, FAAD, a dermatologist in private practice in Voorhees, New Jersey. “I’m board-certified in both dermatology and internal medicine. Both my daughters were born in June because historically during residency training you change from year-to-year on July 1. I was able to time it so that I would deliver, graduate residency, and maximize my vacation time without jeopardizing having to extend my training.”

For others, timing may be more inadvertent. “My boys were born about five days before I moved from my internship to residency. So, I started dermatology residency and became the father of newborn twins all at the same time,” recalled Markus Boos, MD, PhD, FAAD, associate professor of pediatrics and program director of the dermatology residency program at the University of Washington School of Medicine. “The days were long, and the sleep was short during residency and fellowship.”

Dr. Jones planned to have her first child a year out of residency. “My husband is also a physician, and we wanted to enjoy some time post-training before becoming pregnant,” she explained. “I knew I wanted to stay in academics and didn’t have a fellowship planned, so I had the security of knowing a 12-week parental leave would be possible when the time came. Having knowledge of the maternity policy ahead of time offered me a huge sense of security.”

While an estimated 50% of women who enter the field of medicine give birth to their first child during residency (https://doi.org/10.1542/peds.2021-055988), having a child during training is not without its challenges.

“Studying and sitting for your board exams while pregnant or nursing adds an extra layer of complexity. I had my second daughter at the end of my second year of derm residency and ended up taking my core exams two weeks after she was born,” said Dr. Pop. “I tried to do the bulk of studying before she arrived. I ended up taking my dermatology board exam this past July while I was still nursing and had to plan to navigate how I was going to pump to get through the test.”

“Looking back, now knowing the mental and physical demands of parenting, I may have considered starting a family earlier,” said Dr. Jones. “However, I witnessed some of my coworkers in residency go through pregnancies, and although they didn’t complain, it was obvious that it wasn’t easy for them. They had to keep up with the pace and volume of a demanding clinic in residency, but these women scored some of the highest scores on our board examinations nationwide. To this day I am impressed with how they balanced it all during that time.”

Having children during fellowship or during your early career can pose its own advantages and challenges. “I became pregnant with my oldest child during my Mohs fellowship, which was a very physically demanding time. You’re always on your feet; you have long hours, and there are high expectations,” said Bridget McIlwee, DO, FAAD, chair of the AAD Young Physicians Committee. “My daughter was born less than a month after I completed my fellowship, and about two years into practice I was pregnant with my second child. I had my youngest a year ago, by which time I was a partner in my current practice.”

Factoring in fertility, health, and well-being

If you are the parent delivering the child, it is also important to factor in the physical demands of pregnancy and post-partum within a high-stress working and training environment. “I personally found being pregnant very challenging all three times,” said Dr. McIlwee. “I was physically sick and exhausted. Many people talk about pregnancy as this beautiful experience, but I was constantly nauseated and required lots of medication just to be functional at work.”

“Training is mentally and physically demanding,” agreed Dr. Jones. “Often our own health takes a backseat to our careers, and that’s the reality we face. Young physicians planning families feel pressure to keep working, worried about the unavoidable lapse in patient care or reduced availability to patients.”

Fertility is also an important consideration. Medical training is long and coincides with a physician’s late 20s, often stretching into the early 30s. For female physicians, waiting to have children until completing training may not always be biologically feasible.

“I tell younger residents that there is never a good time to have a baby. It’s always going to be hard. However, biologically, doing it earlier you at least lessen the chance of infertility. Continuing to delay sometimes results in issues conceiving down the line,” said Dr. Pop.

Estimates suggest that one in four female physicians will suffer from infertility, well above the estimated incidence in the general population (https://doi.org/10.1111/acem.14463). The causes of this are theorized to be related to the psychological and physical stress of the job — an additional factor that may impact when a female physician decides to start trying to become pregnant.

“Many women form a plan depending on their age, ovulation, and fertility. While everyone’s clock varies and depends on several factors, fertility can be a deciding factor. The desired family size can also affect when you might start trying,” said Dr. Jones. “In the later stages of pregnancy, you also have to account for frequent visits with the OB who may not have convenient hours and may involve significant travel time, all of which factors into a reduced ability to remain in the clinic as a physician.”

Institutional policies and support

The Family and Medical Leave Act (FMLA) provides certain employees — who work for employers with more than 50 employees — with up to 12 weeks of unpaid, job-protected leave per year, including the birth of a child. However, for many physician parents, the reality is more complicated.

“Paternity leave was never offered, but I didn’t ask for it either,” said Dr. Boos. “There are many dermatology residents or trainees who are like this. You work hard to distinguish yourself so you can match dermatology because it’s such a competitive specialty, and you get used to this idea that you have to do what it takes. I didn’t even want to mention that I had two newborns at home because I didn’t want people to assume I would not be able to pull my weight.”

Dr. Pop estimates she took six weeks of total maternity leave. “I went out a week before my daughter was born. I also pooled some of my elective time, which was still working time. I was doing research and writing articles remotely.”

“My institution offered 12 weeks maternity leave. Six weeks were paid through disability insurance; the rest unpaid,” said Dr. Jones. “For our institution at the time of my pregnancies, your total leave was allowed for up to 18 weeks for a vaginal delivery or 20 weeks for a C-section.”

While historically family leave has varied by institution across medical training programs, in 2021, the Accreditation Council for Graduate Medical Education (ACGME) updated its regulations to provide trainees with at least six weeks of paid parental leave that cannot be subtracted from their normal sick or vacation time.

This was a major win, according to Dr. McIlwee. “Up until a few years ago, there was no requirement for residencies or fellowships to give female or male physicians time off after having children — which is contradictory. We’re responsible for caring for others, but we didn’t protect ourselves with the same amount of recovery time that you recommend for the average patient?”

Outside of the training environment, dermatologists should be aware of the leave policy offered by their employer or organization — and be prepared to advocate for themselves if needed. “Prior to becoming a partner in my current group, I was paid for the time that I was out with my second child. It wasn’t a defined maternity leave policy; it was simply considered an expense to the organization,” explained Dr. McIlwee. “When I became a partner in my group, I discovered that while they offered short-term disability (up to six weeks leave, starting after 30 days of disability) to all employees, they excluded partner physicians from this policy. I asked our HR department why, and they said, ‘Well, physicians should make enough to cover their disabilities.’ This illustrates the lack of understanding many administrators have about the financial burden on early-career physicians. I met with the head of HR to discuss how this policy was ignorant of the financial hurdles that young physicians face. We may graduate from medical school with a half a million dollars in loans, soon to perhaps take on a mortgage, and then have a child. After some back and forth, several months later, they announced that over 30% of the partners were interested in short-term disability. They started offering it, and paying for a portion of it, for all our partner physicians.”

Although paternity leave wasn’t offered during his training, since becoming a residency program director, Dr. Boos hopes to instill a new culture around parenthood in medicine. “I think it’s important for the program to let people know that their family is equally important as their training. For our female residents, if they’re breastfeeding or pumping, we want them to feel like they can take those breaks without having to tiptoe around,” he explained. “What I try to communicate to all our residents is that your life is not on hold while you’re here. I wish family leave policies were more generous for everyone across all professions in the United States. Most of the time we will accommodate 12 weeks. Once we had two residents out who had babies back-to-back at the same time. We just made it work.”

Support for lactation and breastfeeding

Both the American Academy of Pediatrics and the World Health Organization recommend breastfeeding or provision of pumped human milk for at least two years, and longer if the mother and child desire. For physicians who choose to breastfeed after giving birth, institutional support can be lacking — or in some cases, downright hostile.

“For my first pregnancy, any time blocked for pumping counted against my productivity and income,” said Dr. Jones. “Because my productivity would decrease due to taking pumping breaks, I would try to work it into the schedule if there happened to be a lull, or worse, would skip pumping altogether to maintain the schedule. By my second and third pregnancy, the organization updated the policy so that pump breaks did not count against RVU productivity. This policy fostered a greater ability to use much-needed pump breaks and continue breastfeeding.”

“I feel physicians are woefully undereducated about pregnancy, childbirth, and lactation. I know I was until I had my first child and experienced it all first-hand,” said Dr. McIlwee. “Until our physician colleagues — especially those in positions of leadership and power — have a better understanding of what pregnancy and postpartum is really like, and how difficult it is, we’re probably going to have trouble building adequate institutional support systems.”

“As a new mom, if you want to breastfeed your child it takes a lot of grit and effort to really commit to it,” said Dr. Pop. “Having more guidelines around that to standardize break times for nursing mothers would help.”

It should be noted that the Fair Labor Standards Act (FLSA) requires employers “to provide reasonable break time for an employee to express breast milk for their nursing child for one year after the child’s birth each time such employee has need to express the milk. Employees are entitled to a place to pump at work, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public.” Recently, the PUMP for Nursing Mothers Act was passed, extending to more nursing employees “the rights to receive break time to pump and a private place to pump at work.” Learn more.

Navigating the social impact of parenthood on colleagues

Residency and training are a time of interconnected social responsibility among colleagues. Taking much needed time to care for a new baby can cause tension amid long hours and heavy workloads.

“I think there’s a stigma in certain programs that if you do have a child during residency, you’re not as committed. You’re always going to have competing demands,” said Dr. Pop. “I tried to plan my pregnancies to put as little burden on my colleagues as possible. However, I can imagine in very small programs, if you’re out on leave that means that your colleagues are covering the call volume while you’re out.”

“We have a lot of room to grow as a society, and standing up for parental rights in the workforce takes strength from those who experience the journey firsthand.”

“The social impact of a pregnancy or parental leave is hard, because we balance the joy of a new child with the socially ingrained guilt of taking a ‘break’ or ‘backseat’ from work,” agreed Dr. Jones. “I think it is important to talk with leaders if there is a perceived culture that is not supportive or negative. During training, I overheard comments that a new mom should simply pump in a communal bathroom. At a graduation party, residents made jokes about a male attending parent taking the full parental leave. We have a lot of room to grow as a society, and standing up for parental rights in the workforce takes strength from those who experience the journey firsthand.”

“Unfortunately, many young physicians are faced with an unfair choice between prioritizing their family or prioritizing harmony at the workplace,” said Dr. McIlwee. “A 12-week maternity leave may be considered a luxuriously long leave for most U.S. physicians, despite being considered an inadequate time for physical recovery, bonding, and postpartum care in most other developed countries. Taking this amount of time off work, whether via FMLA or other means, may upset work colleagues. I think this speaks to a larger issue in medicine — an unwillingness to acknowledge and accommodate the physical and mental toll pregnancy and postpartum takes on humans, especially fellow physicians. When I told my group that I was going to take a 12-week leave with my son, somebody said, ‘Wow, 12 weeks, huh?’ and it was not a comment of approval. There’s a huge lack of support for parents who are physicians. I had to remind myself that even though I love my job, a job is just a job. Your job would replace you in an instant. You must invest in your family first. Your family is forever.”

Financial considerations

Children are expensive. According to recent data from the U.S. Bureau of Labor Statistics, a single child costs families approximately $12,980 per year, not factoring in cost of education — totaling over $230,000 by age 18.

Like all parents, physicians must consider a variety of financial factors when timing the start of their families. Many trainees must contend with fixed salaries and significant medical school debt. “I thought the best time to have a child would be after residency, and this notion was largely out of financial concerns, as the increase in salary after residency would help balance the costs of childcare along with paying off student loans,” said Dr. Jones. “Our biggest financial considerations once we became pregnant were balancing our debt with buying a townhome outside of the city and planning for childcare. To be transparent, combined, my husband and I carried over half a million in debt from medical school loans. Little of that is paid off during residency. Many dual-physician households may carry similar debt.”

However, for some, fixed salary during residency is seen as an advantage. “It’s not going to change based on productivity. Once you’re out in the workforce, depending on what model you have for reimbursement — whether it’s salary-based or production-based — you might run the risk of losing out on production if you have a child after training,” according to Dr. Pop.

The cost and availability of childcare is also an important consideration. In the United States, the estimated cost of childcare can range from the hundreds to thousands each month.

“Early in my first pregnancy, I looked at about five daycares and felt comfortable with three of them, all of which had six-month wait lists, and only one of which was employer-sponsored,” said Dr. Jones. “As a society, we need to put a lot of innovation and consideration into advancing childcare options for working families.”

“Not having a support network or access to childcare can be extremely difficult,” said Dr. McIlwee. “We relocated two months before COVID started and neither of us have any family within a several-hour drive. At that time, my oldest was six months old. My husband made the decision to stay home with my daughter because we couldn’t find a childcare center with openings, and we had no other options. He has continued to stay home with the kids through present day and is the Superman keeping our family afloat. It’s been a huge sacrifice for him career-wise. However, ultimately that’s the choice we had to make for me to be able to continue to work.”

Work-life balance

Physician parents in training and early career must navigate rigorous schedules, overnight shifts, and on-call duties — all while juggling an additional (and sometimes more demanding) role as mom or dad. “To reach a better balance, my husband and I pursued parent-child interaction therapy last year. With three kids, each with different needs and responses to our parenting style, we recognized we were struggling,” said Dr. Jones. “We did telehealth visits once a week as a family as the therapist coached us using iPhone and air pods to learn how to praise communicate more effectively. This was game-changing for our family.”

For some physician parents, clearly delineated “family” and “work” time is critical to maintaining a healthy balance. “I have an unconventional family and an unconventional story. I’m gay and came out after our boys were born. I co-parent so I have my kids half the time,” explained Dr. Boos. “As a parent, you’re always trying to navigate what percentage of your attention goes to your family versus your work. Since I split my time with my kids, the weeks I don’t have them is when I write my papers and get my talks together. If it’s my week with them, and they need help with their homework, that’s where my focus is. That can be a challenge when you’re in training and even in practice. It’s easy to think, ‘I have a deadline. I have to make sure this gets done,’ but your kids are on a deadline too in the sense that someday they’re going to move out of the house. You don’t want to take from them to give to professional productivity.”

Establishing a solid support network is also key, according to Dr. Jones. “We moved to an area where three grandparents lived within a 20-minute radius. I often refer to my mom as a third parent in our family. We also currently have a nanny, who has been a godsend, and intentionally moved from the city to a town with a particular school district in mind. We bought a house five minutes from the school to reduce commute times.”

“It’s easy to think, ‘I have a deadline. I have to make sure this gets done,’ but your kids are on a deadline too in the sense that someday they’re going to move out of the house. You don’t want to take from them to give to professional productivity.”

Outsourcing unwanted tasks at home can also help clear valuable time spent at home. “One valuable piece of advice I got many years ago was, as far as possible, to outsource anything you don’t enjoy,” recommended Dr. McIlwee. “For example, my husband and I don’t particularly enjoy trying to keep our house clean. Last year, we had our third child and finally decided to hire a cleaning service to come in every two weeks. That has been such a worthwhile expenditure for us rather than stressing about it and not being able to get it done.”

“Outsource where you can,” agreed Dr. Pop. “When I transferred, I ended up with a longer commute. This created a gap in the morning where it was difficult to get our children to daycare, so we hired a nanny who would come help get the girls ready and get them to school. That was something that made our lives functional and was so worth it.”

Inevitably, personal and professional milestones will sometimes clash. “The year before my promotion, I threw myself into research and committee work. I developed several projects with students, contributed to a talk at the AAD, and had four publications that year,” recalled Dr. Jones. “In hindsight, I never was able to make it to a ‘Mommy and Me’ class with my middle child. It was one of the most rewarding and creative years of my career, but I sacrificed potential bonding time with my child. However, he did wake me up at 5 a.m. each day that year so we bonded for two hours before the day began!”

Dr. McIlwee is also familiar with the challenges of pursuing professional goals while raising a young family. “The beginning of last year when I was newly pregnant with my youngest, I had to fly out from the Midwest to speak at the American College of Mohs Surgery meeting on the West Coast. I broke out in shingles while I was traveling because I was just so incredibly stressed by my work, my kids, meeting my ACMS leadership program, and my presentation. It was the first point in my career where I really felt like I had too many balls in the air to juggle anymore,” she said. “One of my mentors said to me once, ‘You can have it all; you just can’t have it all at the same time,’ and I now realize the wisdom of that advice. Prioritization — and learning to say no — are key.”

The power of community

While starting a family and balancing a career in medicine can be challenging, support from mentors and colleagues who have walked the same path can be invaluable, dermatologist parents say.

“My colleagues were extremely supportive in their willingness to cover during my parental leave and allowed me the space and time to grow as a first-time mom. The staff surprised me with a baby shower before my parental leave. I still remember feeling overwhelmed with gratitude walking into the breakroom to all of their support. For those memories and actions, I am forever grateful,” said Dr. Jones.

“What helped me is that my co-residents were all amazing,” agreed Dr. Boos. “I happened to be the only man in my residency cohort of five, and only one with brand-new babies, and I never felt isolated because of that. My program director at Penn, Dr. Bill James, is best known for teaching, but the way that he talks about his kids, his wife, his grandchildren, and how much he loves them always stuck with me. As committed as he was to dermatology, he did not forget the family that supported, sustained, and brought him joy. Dermatologists are people who do well in medical school, and you get so used to this idea of striving to prove yourself, you can neglect other areas of your life. What I take from his example is he was one of the best dermatologists, but also still a dad and a husband. That spoke volumes to me that you can be a great physician and a great parent too.”

Additional DermWorld Resources