Physician mothers return to work sooner than many Canadian parents, study finds

By Tarun Sai LomteReviewed by Susha Cheriyedath, M.Sc.May 11 2026

New Ontario data show that pregnant physicians often increase work early in pregnancy, then take widely variable and often short parental leaves, raising urgent questions about medical culture, workforce planning, and gender equity in healthcare.

Study: Physician Work Patterns in Pregnancy, Parental Leave, and Return to the Workforce. Image Credit: Gorodenkoff / Shutterstock

In a recent study published in JAMA Network Open, researchers investigated physician work patterns before, during, and after pregnancy.

Pregnant Physician Workload and Leave Background

Pregnancy and parental leave in medicine are poorly supported in medical culture, despite the fact that females are projected to constitute about 50% of the Canadian physician workforce by 2030. Parental leave can lead to better parental mental health and longer breastfeeding. Given that support and policies for leave and after-hours work reduction during pregnancy are lacking for practicing physicians, pregnant physicians often maintain high workloads and have short parental leave.

Physicians also face maternal discrimination after returning to work, with limited accommodation for lactation. Moreover, income loss during leave can contribute to dissatisfaction, which may cause significant problems for new physicians with loans. The additional burden imposed on colleagues during leave also remains a major concern for physicians. Therefore, understanding work-leave patterns is crucial to planning the physician workforce, particularly as leaves of absence should be anticipated as part of a sustainable medical workforce.

Ontario Physician Pregnancy Study Design

In the present study, researchers examined physician work patterns before, during, and after pregnancy. Data from the licensing body in Ontario, Canada, were used to identify deliveries at more than 20 weeks’ gestation among practicing physicians between April 2002 and November 2018. Billing claims submitted by physicians to the Ontario Health Insurance Plan were used to determine the amount of work activity, as well as work cessation and resumption. Physicians were followed until November 2023, allowing the researchers to assess longer-term return-to-work patterns.

Physicians who submitted claims within 2 years prior to conception were included. The cohort was stratified into eight groups according to specialty: diagnostic imaging, psychiatry, obstetrics and gynecology, emergency medicine or anesthesia, pediatrics, surgery, family medicine, and medical specialties. Billing claims were assessed between conception and delivery by each trimester.

The researchers assessed work activity before and during pregnancy. They evaluated the overall workload (24 hours) and the overnight workload (midnight to 7:00 AM). Further, the absence of claims after delivery reflected leave, while resumption of ≥ 10 claims within a week indicated return to work. The rates of days and nights worked during pre-pregnancy and pregnancy were calculated per 100 person-days. The pre-pregnancy comparison period was matched to the same calendar period in the prior year, helping account for seasonal variation in work patterns.

The work rate ratio was computed for each trimester using a negative binomial regression model. Further, the proportion of physicians resuming work and the time to return to work were estimated. The cumulative probability of returning to work at 180 and 365 days postpartum was calculated for each specialty group by era (2002-09 and 2010 or later).

Pregnancy Workload and Specialty Findings

In total, 5,948 deliveries were identified among 3,932 physicians, with a median age at delivery of 35 years. About 80% of deliveries were first- or second-time deliveries, while the remaining were ≥ third-time deliveries. The median duration between workforce entry and conception was 3.6 years. Most deliveries occurred in the family medicine group (59%), followed by medical specialties (13.2%).

In the referent pre-pregnancy period, median overall workload across specialty groups ranged from 44 to 67 days. It increased or remained stable in the first and second trimesters for nearly all specialties but declined in the third trimester. A similar trend was observed for overnight work activity, with workload ranging from zero to nine days. Across the overall cohort, work rate ratios increased during pregnancy compared to pre-pregnancy.

The overall work rate ratios increased in the first two trimesters but decreased in the third trimester relative to pre-pregnancy. Notably, the overall work rate ratios for medical specialties, obstetrics and gynecology, and diagnostic imaging groups in the third trimester were similar to pre-pregnancy levels. Overnight work was lower across pregnancy overall, but increased modestly in the first two trimesters before declining in the third trimester, except for the diagnostic imaging and psychiatry groups.

The overnight work rate ratio increased in all trimesters for the psychiatry group, whereas it remained stable throughout pregnancy for the diagnostic imaging group. However, the authors noted that psychiatry had very low absolute rates of overnight work, which is important for interpreting this increase. All specialty groups had high return-to-work rates. Surgeons had the earliest return to work (133 days), while psychiatrists returned the last (270 days). The cumulative probability of returning to work by 180 days was 47.2% in 2002-09 and 39.6% in 2010 or later. It was comparable for both eras by 365 days.

Parental Leave and Workforce Equity Implications

In sum, the workload of Ontario physicians increased in the first two trimesters of pregnancy, likely to frontload work before leave. The authors suggested this pattern may reflect financial pressures, group practice obligations, or a perceived need to offset the burden placed on colleagues during leave. Parental leave varied widely and was substantially shorter than leave among Canadians receiving parental leave pay.

The study has several limitations: leave patterns were not assessed among resident physicians, male physicians, and physicians who become parents through adoption or surrogacy. Local workplace policies, practice-group arrangements, and the possible influence of the COVID-19 pandemic on leave duration were also not assessed. Ensuring equitable and adequate parental leave is essential to advancing gender equity in medicine and supporting workforce planning and physician retention.