Ep 52: The Silent Struggle of Women Physicians

with Ariela Marshall, M.D. and Arghavan Salles, M.D., Ph.D.

October 27, 2021


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Ariela Marshall, M.D.
Director, Women's Thrombosis and Hemostasis, University of Pennsylvania

Dr. Ariela Marshall is a hematologist and Director for Women’s Thrombosis and Hematology at the University of Pennsylvania. Dr. Marshall’s research has also touched on gender bias and physician work-life balance. Dr. Salles and Dr. Marshall were recently featured in The New York Times for their comments on the unique fertility challenges physicians experience.

Arghavan Salles, M.D., Ph.D.
Special Advisor for DEI Programs, Department of medicine; Sr. Research Scholar, Clayman Institute, Stanford University

Dr. Salles is a minimally invasive and bariatric surgeon. She completed medical school and residency in general surgery at Stanford prior to completing her fellowship in minimally invasive surgery at Washington University in St. Louis. She stayed on faculty at Washington University for three years prior to moving back to Stanford. Dr. Salles obtained a PhD in education from Stanford University during her residency training, and her research focuses on gender equity, implicit bias, diversity, inclusion, and physician well-being. Dr. Salles became a COVID Frontliner in 2020 and served in ICUs in New York and Arizona. She has written and spoken about these experiences in popular press outlets such as Newsweek, NBC, and CBS. She is a sought-after speaker and has given over 80 national and international invited talks related to gender equity, physician well-being, and weight bias.


Often the people listening to these conversations (about family planning and fertility) are not the ones who have the power to make decisions about insurance coverage or parental leave. There's a disconnect.



Sanjula Jain  00:20

It’s my pleasure to welcome Dr. Ariela Marshall, hematologist at the University of Pennsylvania, and Dr. Arghavan Salles, surgeon at Stanford in this very special edition of her story where we’ll discuss some of the unique challenges that women physicians face in their career paths, and the toll that it takes on reproductive health and infertility. Arghavan and Ariela, thanks so much for being with us today.


Ariela Marshall  00:42

Thanks so much. We’re excited.


Arghavan Salles  00:44

Yeah, thanks for having us.


Sanjula Jain  00:46

In particular, what we’re gonna talk about today is really that you’ve been champions of this big issue that we’re talking about that faces not only just women in medicine, but really kind of women across career paths. And the starting point, now, you both published a lot on this, but most recently, back in September, you were both published in a New York Times article on kind of the cost of a career in medicine, and the implications on fertility. Kind of walk us back to the beginning. When did you know you wanted to pursue a career in medicine and why?


Arghavan Salles  01:14

I am the least inspiring person on this point. I was a biomedical engineer as an undergraduate and kind of decided that I didn’t think I saw my future in engineering and thought, well, what else can I do with these courses that I’ve taken? Medicine seems like it worked out because I had all the prerequisites. So yay. That was it. Very uninspiring. Of course, I love science, and I was a math and science nerd my whole life. I also did a lot of volunteer work and love working with people. So it was a way to kind of bring together the science and helping people.


Ariela Marshall  01:51

It’s somewhat similar for me, I wasn’t one of those kids who at age five knew they wanted to be a doctor, I actually went into college majoring in economics and intending to go into business. But I took, you know, classes in economics and electives and biology and realized pretty quickly that my mind did not work in the right way to be an economist, but it seemed to lean more toward the sciences. And then I did some shadowing and work in different labs and with different positions, trying to decide if I wanted to do kind of more of a Ph.D. type of track or the M.D. track. And I really did like the combination of the research and also the patient care that you get with the M.D. track, as opposed to being a pure researcher. And I think the biggest thing is I had an amazing mentor who was really a source of inspiration. I think that’s why a lot of us go into medicine or pick a certain field in medicine. And so I think it was really the kind of hands on exposure that got me into it.


Sanjula Jain  02:54

Absolutely. So for both of you at that time, as you were kind of starting out thinking about going into medical school, and then residency and fellowship. Did you kind of process at that time how long the journey would take? Is that something that you kind of actively thought about?


Ariela Marshall  03:08

Yeah. And I think it’s exactly that, you know, you always hear when you say, oh, I’m going into medicine, like, oh, that’s a long career path. But even when you get that, okay, this is going to take me about 10 years, you don’t really, as a 20 year old, understand what that means in terms of every other aspect of your life. You’re like, okay, I can do the math. I know I’m going to be in my early thirties when I finish, but what that means, kind of from a social and emotional and growth and personal perspective, nobody can predict that just like anything else, you know, somebody who goes into business and says I need 10 years to establish myself or into law and I need 10 years to become an early partner, you can’t really predict what does that mean for you personally.


Arghavan Salles  03:08

I mean, I definitely didn’t. Listen, when you’re 21, if you go kind of straight through as I did, you have no concept of like, you have a concept of four years, right? Because you’re you’re in college, or near the end of that. So you understand what four years is, but that you’re entering into something that’s going to be four, and sometimes more years, just for the medical school part, and then another, at least three years, if not more, depending on your specialty after that, like, I definitely did not have a concept of what that was. I just was like, okay, this is the next step. And then you know, one step at a time, as they say, and then, little do you know, like 13 years later or whatever, you’re still on the path. It’s kind of bonkers.


Arghavan Salles  04:33

I felt this the most with my residency because I matched in general surgery, which is a five year clinical residency, but at most academic centers, it’s seven total years because they incorporate two years of kind of research or some other activity. In that, it was definitely a time when I was like, oh yeah, like this is what people do. If you’re going into surgery, this is what you do. Seven years. Who cares? Wow, those seven years from age 26 to 33 are like really critical years of a person’s life, that’s when many people are meeting their person or settling down with their person and like becoming who they are in the world. And I definitely did not appreciate that aspect of it. And I definitely didn’t have a sense either of like, what transitions would occur in my life over those seven years, or really, any seven years, I had not done anything for seven years before, you know, so that was where it really struck me, like, once I was further into it. Wow. Like, what a crazy thing at age, you know, 25, to be committing to something that’s gonna take me the next seven years. That’s kind of nuts.


Sanjula Jain  05:39

Well, so that’s exactly where I wanted to go next. And that’s a really good point. So at that point, when you were deciding, you know, what specialty to pursue, were you ever dissuaded by others, whether it was mentors or family to say, you know, hey, actually, these are like prime years, so to speak, maybe as a female, like, maybe you don’t want to do that specialty, or maybe you don’t want to be trained that long. Was that a factor at all?


Ariela Marshall  06:01

For me, pretty much any type of training was going to take through the peak reproductive years. I always knew I wanted to be a specialist in something. So if I went into, you know, medicine, it will be three years of residency plus another three years of fellowship. If you want to do surgery, it’s the same thing, as Arghavan was saying, so pretty much anything was going to, you know, carry me into my early to mid 30s. So it wasn’t a decision based on how long it would take. I think some of specialty choice is kind of the personalities that you see in the exposure that you get early on. So I think I mentioned when we talked before, but I did hear, you know, my very first week of surgery rotation, which was my very first rotation, some medical students, our chief resident, you say, oh, I got home early from the hospital yesterday and I was able to spend time with my child. And he asked me in the morning, Daddy, why did you sleep at home? You know, it’s just the norm to be sleeping in the hospital. And so that kind of thing, you know, maybe dissuaded me from a career in surgery, because the perception is oh, that’s what the lifestyle of a surgeon is like. But it wasn’t the length of time necessarily. It was kind of the lifestyle.


Sanjula Jain  07:14

That makes sense. Well, so one of the stats that I found super fascinating, I think it really clicked for me personally as a non physician in the article that you both wrote, was this idea at the average age of a female physician who’s kind of at the age of childbirth is, what, 32, compared to a non physician, which is about 27. Did I get that right?


Ariela Marshall  07:32

Yeah, the disparity might even be a little bit more, I think it’s something like a seven year difference in when people have their first child.


Sanjula Jain  07:40

So how has that played out for each of you? Arghavan, you’ve been very open about this fact, you know, you were so focused on training, and then by time that you actually had some time and space to think about building a life with a partner and a family, all of that, like you encountered some challenges, like, what was that actually like for you?


Arghavan Salles  07:56

Yeah, no, but for sure, challenges. That’s putting it kind of lightly. But I was very busy, right, as a surgical resident. I mean, I think whatever specialty you’re in, residency is a very busy time. The main difference, I think, in surgery, is that during that time that you’re super busy and have very little autonomy lasts a little bit longer than it does for a lot of other people. Although, like Ariela said, a lot of our training pathways are long. But yeah, I just every once in a while would try to date but really found it so difficult because, when was I ever going to be able to meet anybody, you know, when you have one day off every two weeks, it’s pretty challenging to, like, schedule in dates when you have to, like, you know, go to the grocery store and put gas in your car and clean the house. So I didn’t really prioritize definitely my personal life or my personal development, really, was just very focused on the job and the career. And then when I finished my fellowship, I was 36, because I did a Ph.D. as well. So even though I didn’t have any other career before going into medicine, that Ph.D. added a little bit of time to my training as well. So I finished everything at age 36. And then I knew, you know, cognitively, that I needed to kind of figure out what I was going to do in terms of trying to have a family, but I thought I could focus on dating and maybe find somebody and maybe it was too soon to like, give up, I guess, is what I felt like, and try to just do it on my own, if you will. And then I think that was all denial by the way. Like I think I just didn’t want to face the reality that I probably wasn’t going to find someone, you know, very easily or very quickly and that does feel like a failure when so many people are partnered in the world. So anyway, then I thought about seeing an REI, reproductive endocrinologist. And then it took me about a year from the time I started thinking about that to the time I actually had an appointment. And then from the time I had my appointment to the time we started any sort of cycle of anything was, I think, at least eight or nine months just because of the, I had been on oral contraceptives for many years because of ovarian cysts that I was diagnosed with when I was very young. And so we had to stop those and then see how long it would take till I got a regular cycle. And then like a lot of fertility treatments are related to the timing of your cycle. So that’s another factor where we don’t have control. And that’s like, the key thing, I think, for all this fertility stuff is just realizing that we have no control over really any of it. But yeah, so even once I decided, which I decided too late I would say, to pursue any kind of consultation and then potential cryopreservation, even once I decided that it was still very lengthy until we could even try to do it. And then ultimately, I tried three different times with three different protocols to try to do, you know, what people call egg freezing, and unfortunately, was not able to get any eggs out of that process.


Sanjula Jain  10:49

When you kind of had that realization, I guess, right, that it was, you know, maybe too late for that. You went through all of that and that’s emotionally a lot, that’s financially a lot. Like, how did you reconcile all of that? And, you know, maybe a loaded question is like, what advice then would you have given kind of the younger Arghavan, given what you could maybe control, to your point on, some of this is beyond all of our control,


Arghavan Salles  11:09

Right. And I think we have to, like with all things in life, we really have to try to not beat ourselves up over these things, because we really can’t go back in time, right? And we all do the best that we can in the moment that we’re in and, you know, with the information we have available, make the best choices we know how. I feel a little bit lucky that I can say, well, egg freezing wasn’t a huge thing when I was in residency. It’s true, I can use that excuse, like, it was considered experimental at the time. And I definitely didn’t really think about it, although I will say I had one faculty member who I’m super grateful to who was very vocal. She’s a single mom, has had two kids on her own. And she made it a point, especially with the women residents, to be like, what are you doing? What’s your plan? And at the time, we were all like, what are you talking about? We’re just trying to do our residency, like, we really need to like learn how to do the surgeries and, you know, get board certified. And like, you know, I think a lot of us didn’t hear the message that she was sending. But anyway, so what advice I would give to people is definitely think very early on. And I think Ariela and I have talked about this. And both of us, I think speak about this. Start thinking even as early as medical school, what it is that you want your family to look like whether you have a partner or don’t have a partner, or you want a partner, or you don’t want to partner, whatever those things are, or that you don’t want kids, fine. You know, whatever that is, just think about it and be intentional. Just like we’re intentional about pursuing our careers, the way that Ariela and I have described, and the way that everyone in our field does, we need to be intentional about cultivating our families. And we have to do that starting very early. And so that can look like egg freezing. It can look like embryo freezing. It can look like having kids during medical school. It can look like having kids during residency or fellowship. It can look any number of ways, depending on what people want. But we need to really think about it and make it happen the way that we want it to because no one will help us do that, really. And we’re hoping to change that, you know, but for now, that’s how it is.


Arghavan Salles  11:10

Well, I think the starting point is exactly bringing awareness to it, you know, through stories like both of yours. So I guess similarly, Ariela, I know you’ve had your fair share of challenges along the way, too. What has the process been like throughout your training?


Ariela Marshall  13:19

Yeah. So yeah, I was a little bit different, because I was not a woman who, I guess it’s similar to my not knowing for sure that I wanted to be a doctor from a young age. I was never a woman who said, I know I want to be a mom. So I was fairly ambivalent, I have to say, about whether I wanted children or not. Now, looking back, if I had known the statistics and known what the process would have been like, and knew that I couldn’t say 100% I did not want to have children, would I have frozen my eggs? Potentially, yes. But it wasn’t one of those situations where, you know, I was thinking, I definitely, you know, want to have kids, I’m just gonna wait for the right time. I actually didn’t meet my now husband until I was a resident and he was a fellow. And, you know, it took, you know, a couple years of dating and, you know, deciding that we’re going to be together and finally I said, okay, I do want to have children because this is a person I want to have children with. I know he’s going to be a dad, we’re going to be good parents together. And so you know, that’s what made me decide I wanted to have kids. It wasn’t kind of an abstract “I want to have kids”. But you know, even at that point, we were both still in training, and it kind of didn’t make sense. We were long distance. I was in Boston, and he was in Minnesota, and so it kind of didn’t make sense. So we decided that we would wait until I finished my training. We found jobs together, which happened to be me going out to Minnesota. Snd then the first couple years of my job involved me doing a fair amount of night shifts. So even at that point I was done with my training, but it kind of didn’t make sense when I was doing a week of nights a month. So he said, okay, this is going to be two or three years, we’ll just wait. And so then you hit 35, 36, realize there’s now a problem. I was no longer having regular cycles. I pretty much lost them because of the stress of going through, you know, all those nights, you know, I wasn’t a resident age anymore, you know, doing nights in your mid 30s, is not quite the same. And so then getting in, taking the time to do the workup, finding out that I had polycystic ovarian syndrome. And then you know, you don’t jump straight to IVF, you have to try other methods first. So that takes a while. And then you get to a point where you say, okay, we’re going to do IVF. But the process is definitely, as Arghavan said, it’s not smooth, you have no control over it. The first time we try to, you know, for IVF, you have to get out of the eggs essentially, fertilize them, and then put them back in. So the first time we tried, we got one embryo, which didn’t look healthy, and then tried a couple more times, and the dosing of the medications led to too much estrogen. So they had to abort the cycle in the middle, but every single time you’re trying takes more time, you know, more financial support. And so it becomes very, you know, draining, I would say, emotionally, financially, physically. And so it was almost the point, you know, where I said I don’t think this is gonna work. So we tried one more time. And luckily, we were able to get embryos, and then you have to go through the process of implanting the embryos, which is more time and injections, and, you know, financial drain, and it doesn’t always work. So it didn’t work the first time. And then the second time, you know, we’re super lucky, because our clinic was actually about to shut down for COVID. So I got a call on the phone that basically said, you know, we’re about to shut down tomorrow, you know, you’re scheduled for tomorrow, it’s your choice, whether you want to do this implementation or not. And I’m very glad that we did, but it just, you know, there’s so many things that are out of your control. So much stress, you never know if anything’s going to work out or not. But again, I think it would have been helpful to have the information at a younger age, you know, to be able to make informed decisions, but I don’t know if I would have specifically done something differently. It’s always hindsight 20/20, right?


Sanjula Jain  17:33

Well, I guess to both of your points, I mean, with that said, I mean, just the process of training, right? Like it is long hours, it is really intense. And so I get the point that thinking about it is step one, right? And I think there are a lot of steps that you can take in between, but are there tangible things that one could do as a medical student or a resident to approach it differently? Right, so I’ll pick on you know, I get this question a lot from some of our listeners, right? You mentioned dating, Arghavan, right? Like if you only have one day off every few weeks, like practically like what is in the realm of possibility there? Like what advice do you both have for others who are really kind of, they may be thinking about it, but it’s also, you’re up against the constraints of the system, so to speak?


Arghavan Salles  18:15

Well, I think dating is its own thing, you could do a whole episode or two or 10 on dating. But I will say that I think some people, actually I know some people were much better at setting boundaries for their work lives, even during residency, than I was. And they would be very intentional about scheduling dates, even when they weren’t necessarily sure if they were going to be out on time or whatever. They didn’t necessarily wait for their day off. They would do it on days that they were working and just hope that it worked out and then cancel if it didn’t, and, whatever, they made it work because they made it a priority. And I definitely did not. And I don’t know for me personally, if I would change that, like I had a hard time just keeping up with the work. So I don’t know if I could have managed like, another person at that time. But what I definitely would have done if things were different, and we went back in time is I would have frozen eggs at a young age, like, in medical school, I probably would have done it if I’d known. And of course, that’s the thing, like as Ariela said, the hindsight is 20/20. Of course, I didn’t know then that here I would be, you know, many years later in this situation. But I think now what’s amazing is that the technology really has advanced so much and so I think, one, you know, this is something we frequently say is, if you know that you want to have kids and the time that’s right for you is in med school or residency or whatever, do that. The system will, like, figure it out. It’s not your job to make it easy on everyone else because you have to have your family the way you want your family. That’s priorities number 1, 2, 3. But for people who are like me and, you know, didn’t have a partner, didn’t want to have, I mean, even if all the technology in the world, like I said, I would not have wanted to have a child on my own, certainly, during residency, but I would have loved to freeze my eggs and maybe some embryos at that time. You know, if I were going back in time, that’s what I would do. And that’s what I recommend to people now is like, if you know you want to have kids and you don’t want to have them now freeze whatever you have available to you. If you’re a single person, freeze the eggs. If you’re partnered, freeze those embryos, and then you do it whenever feels right for you. But that’s what I would say.


Ariela Marshall  20:28

It really is on the system to change as well. And I think, you know, both Arghavan and I talk about this a lot that, you know, we would love for all medical students who want to freeze their eggs to have that ability. But if the insurance doesn’t cover it, then we’re essentially saying, hey, here’s something you can physically do to try and ameliorate this problem. But you may not be able to afford it because you’re also taking out loans to pay for medical school, and then you’re going to be in residency and not making a very big salary either. And so we really advocate for the system to recognize this is important, this is medical care, you know, if it’s going to cover blood pressure medications for hypertension, and cholesterol medications for high cholesterol, then the system should be also covering fertility treatments for those who want to preserve or, you know, make changes in their fertility prospects. So it really needs to be taken seriously. And I think medical students need to look into that, right, medical school should be looking for insurance that provides coverage for fertility benefits for their students and residency programs. And, you know, training and people need to be aware of this as a problem and look to try to find the coverage for it.


Arghavan Salles  21:49

Sometimes we get pushback about, well, should we be really focusing on cryopreservation and delaying childbearing? Or is that just a way for like tech companies and anyone else who offers that to take advantage of us and keep us more productive, and serving their needs with this idea that, oh, we can have the children later. And I think both things are true, right? It may be that some people choose to have children later. And they should be able to do that with the financial support of their organization, wherever it is that they work. And if people want to have their kids whenever they want to have them, that should be supported to. So it’s not a trade off of one or the other.


Sanjula Jain  22:33

Really what the two of y’all are doing are showing tremendous leadership in this space to raise awareness and try to push for some of these systemic changes. I’m curious, you know, you’ve been writing about it for some time now and openly talking about it. What traction are you getting? Are people asking questions from organizations, whether your own institutions or others? Like are you optimistic about the potential for some of these policies and financing mechanisms to make this a reality going forward?


Ariela Marshall  22:59

I think I’m optimistic for sure. I think the first step is getting the conversation going. And certainly I think both of us, you know, after having come forward with this information hear from tons of colleagues, you know, both at our own institution and across the nation, you know, people who’ve been through this say, thank you for talking about this, I don’t feel as alone that I’ve been through this process. So that has been eye opening, for sure. So for, you know, I think we are getting traction, starting that conversation, making people feel more comfortable with talking about it and finding other colleagues, so they don’t feel as alone. So emotionally, hopefully, the process will become, you know, easier. But institution wise, I think it takes a lot more commitment on the part of institutional leaders, because, you know, often the people who are listening and reading about this are women who are relatively early in their career. Those are not the people who are in leadership positions in big medical institutions and have the power to make decisions about who they go to for insurance coverage and what their time away policies are and their parental leave. So there’s a little bit of a disconnect there. So we want to make sure that the leadership is also hearing the message.


Sanjula Jain  24:19

That’s really well said. I’m curious and we talked a little about this earlier. I mean, you both are starting this conversation that in some ways, it’s like it’s just not what people talk about. A lot of people think about it, right? But they’re not openly talking about it in their workplace, with their superiors and others. Like, how has that kind of felt for you just as individuals, like is it uncomfortable to have the kind of those personal family type conversations in the workplace as you’re also trying to establish your careers? Have you gotten comments back from peers or colleagues, male or female, like anything to that extent?


Arghavan Salles  24:50

I mean, I think it’s important to normalize these conversations. I do want to acknowledge that there are some boundaries, right, and we don’t want to…I would never expect anyone who doesn’t want to talk about these things to share, you know, what their thoughts are, what their desires are. But I think it’s dangerous when we don’t ever have these conversations, because we don’t want to, you know, offend anybody or whatever, we don’t want to violate some policy. And then we’re acting like none of us have families or care about families. And that puts out, I think, the wrong message, so I think there’s a balance somewhere in between where we offer our own thoughts and experiences and create a space where people can have the conversation. And that normalizes that, really fundamentally, we’re all humans before we’re doctors or whatever other profession we are. And most of us desire to have some kind of family, whether that’s a partner or a partner in kids, or with our parents, or whatever, you know, family is like the heart of everything, I think, for most of us. And so just acknowledging that and creating space and validating that can be helpful, I think, again, without necessarily violating any rules. And certainly when we’re interviewing people, we’re not to be asking about, you know, their family planning. I totally agree with that, and I’m on board with that. But I don’t think that means that we can’t ever talk about family, or normalize the fact that so many of us want to have one.


Sanjula Jain  26:18

Absolutely. So to that point, you know, Ariela, I know that you, after going through all of that treatment and processes, you know, you and your family are also growing, and you’ve made some recent decisions in terms of logistics to mov and all of that to have some of that support in place. Will you just talk a little bit about kind of how you’ve thought about that?


Ariela Marshall  26:36

Yeah, absolutely. I think something that we don’t, or haven’t to this point talked about enough is that if you do go through IVF and are able to get pregnant, you know, many of us have complications with pregnancy, again, some of that related to age, stress at work, this, so it wasn’t, yeah, I’m blessed that my pregnancy was fairly easy until the very end. But then I had some pretty severe complications. And I was hospitalized for several days. And my infant son was at home, thank God, Dad was there taking care of him. Dad was trying to figure out how to, you know, visit me in the hospital with COVID and what to do with the baby and all of this. And it just, it made us feel, you know, really how kind of isolated we were because we were, you know, in the middle of the country, and all of our family is on the coasts. And so it really struck home during that time. I think that, you know, you can’t overstate, as Arghavan was saying, you know, the importance of family as the center of everything. And, you know, we’d always talked about, hey, it would be nice to move back to the east coast where most of our family is, but this really solidified that, yes, and this is the time we’re going to do it. So you know, it’s oh, let’s wait for kind of the perfect opportunity for both of us. And you know, that might never come up, right. But this I think really solidified the fact that we wanted to be near to family and friends. And so we’ve actually just moved to Philadelphia and near to our parents and many other family members and good friends.


Sanjula Jain  28:14

Yeah, I think having that support system is really key as you go through that process regardless. Yeah, another interesting thing that I think, Arghavan, you had mentioned, in particular, was the idea that this is a lot for women in particular to bear, right, like, you gotta think about it, it’s part of the planning a lot of choices. But this idea of fertility and thinking about starting a family, all of this, it applies to men as well. What’s your point of view on kind of the role that kind of both genders play as we think about kind of training and leadership and our career development?


Arghavan Salles  28:43

Yeah, I mean, we all know, this is a fact of science that we need both an egg and a sperm to make a human. And so anytime we’re talking about bringing people into the world, we’re talking about something that affects people of all genders, really. And yet, it seems like these conversations are dominated by, you know, people who look like the three of us, women, or at least people with a uterus. And I think that’s super bizarre, like, why are we acting like it doesn’t affect the people who make the sperm. They’re part of the process and male factor infertility, for sure, also contributes to fertility challenges for couples. But also, there are all different ways of bringing people into the world, right? Not every pairing is heterosexual. And there are gestational carriers, there’s adoption, there are lots of ways to grow a family. And it seems like the conversation tends to focus on this one very specific way, which is the union of a, you know, man with a woman or a male with a female if we want to talk about reproductive organs, which is more accurate. And I think that, really, to make any kind of change. We have to get everyone on board. So whether we’re talking about, you know, parental leave, right, which everybody used to talk about maternity leave. But really the term is parental leave because any parents, and we’ve seen this in the news, right, with Pete Buttigieg and his family, any parent should have time to be with the new addition to their family, regardless of how that new little person came into the family. And I think it’s the same hear in conversations about fertility, that people of all genders are affected and relegating it to something that matters only to women, it really prevents progress. It prevents policy changes that are needed to change both the stigma around pregnancy. And also, you know, the real truth, which is that, like I said earlier, we all value our family more than our work. And yet we show up and masquerade as though work is the only thing that matters, because that’s what’s demanded of us in the work culture. And so it’s going to take all of us to change that. It’s not going to be something that women alone can fix.


Sanjula Jain  30:57

Absolutely. Well so, in that vein, I mean, I want to be mindful of time, there’s so much more we could unpack here. But thank you both first, for just your leadership and speaking up on this and and helping normalize this conversation. I know it already has made a difference for many and will continue to do so. As you think about, I guess, kind of the legacy that you both want to leave behind, kind of raising more awareness around some of these issues that we’ve talked about today, what does…I want to put success in air quotes, but like, what does progress look like in the near term? Like, what are some of the quick wins, I guess, that we can start seeing and kind of take responsibility for as, you know, individual women’s or women in leadership roles of these institutions? Then, of course, there’s the systemic view. But what do you hope to see in the near term?


Ariela Marshall  31:39

I think something fairly achievable in the near term is to say, every medical school should have a discussion on fertility as part of their curriculum. So all medical students should be aware of this, and just know the basic statistics and have that discussion. There are longer term goals like optimizing parental leave, and improving fertility coverage and benefits that we all, you know, would love to see put into place. But I think the education piece of it is free. It doesn’t take that much time, but it can really change people’s lives. And so I would, you know, consider us successful if, you know, five years from now, every medical school had, you know, just a 30 minute or an hour long session on fertility, you know, and challenges to fertility as a physician.


Arghavan Salles  32:34

Yeah, I would I would add on to that, I totally agree that would be a success. And I think a lot of schools will say, oh, we talk about fertility, because, you know, we talked about it in our OB-GYN block or whatever. And I will just share that we have some data that’s not out yet, but on, like, knowledge about fertility related topics amongst physicians. And that knowledge is poor. It’s not just the two of us. And I’ve gotten nasty comments, actually, on my Twitter when I posted about this, like, duh, you’re a doctor, you should have known. It’s your own fault, stupid, like, I’ve gotten comments like that. And the thing is, I’m not an OB-GYN. And so I have what I was taught in medical school, and I love my medical school, not at all down on it, on my medical school, but the focus in those lectures, and again, you have to remember they’re talking to people who are like 22, 23, 24, is very much the patient perspective. Oh, yeah, like a 35 year old woman. I remember, it was like, a 35 year old woman? Yeah, that is kind of old. At the time, that’s what you’re thinking, you’re not thinking I too, will be 35. And I may be in this position. So Ariela’s point about, you know, from the perspective of physicians, not from like this vague other person who you might treat someday, but that this could be you. And so here’s what you need to know, as someone who’s in this very demanding career, I think is really important. And then the only other thing I would say, also adding to what Ariela said is, I see policies around parental leave, remote work, flexible work, fertility coverage, all of that as being interrelated and a way of normalizing the other things that happen in our lives that don’t take away from our ability to work, but do require a little bit more flexibility in how and when we do that work. So I would love to see those kind of be hand in hand in all these conversations. Parental leave is important and critical. But sometimes that’s the only thing people talk about when we’re having these conversations. And really, I’ve seen it all as a bundle.


Sanjula Jain  34:34

Well, it might be my bias. But as a researcher, I am very appreciative to the two of you for really bringing in data and insights to really kind of help educate everyone about this because I think that’s really powerful and to your point. So thank you for all that you do, really excited to continue tracking your work and help spreading the word and we’ll have to have you both back on soon to kind of keep us updated.


Arghavan Salles  34:52

Thanks so much.


Ariela Marshall  34:53

Thank you.

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