Background: Female representation in medicine has surged in recent years, yet balancing career aspirations with family planning remains a formidable challenge. Understanding how fertility planning influences career decisions among medical professionals, particularly female physicians, is crucial for optimizing workforce dynamics and individual well-being.

Objective: This study aimed to assess the impact of fertility planning on career choices among medical professionals, identifying influencing factors such as specialization, practice setting, and work-life balance.

Methods: A survey was administered to residents and fellow physicians across various specialties at Cedars-Sinai Medical Center. Data on demographic characteristics, career status, childbearing considerations, workplace support, infertility diagnosis, and fertility preservation exploration were collected and analyzed.

Results: Among the 91 participants, a majority were female (62.6%), with diverse racial backgrounds. Family planning significantly influenced career trajectories, leading to extended career breaks (23.1%), delays in fellowship (18.7%), and specialty switches (14.3%). Participants indicated a median ideal of 2 children. Among the 12 individuals who had children, the median age for their first child was 31.5 years. A significant proportion anticipated or experienced the need to delay childbearing due to career considerations (75.4% and 66.7%, respectively). Dissatisfaction with workplace support for family planning was prevalent (79.1%), despite high interest in fertility benefits (92.6%).

Conclusion: Fertility planning exerts a profound influence on the career decisions and well-being of medical professionals, particularly female doctors. Addressing workplace support gaps and implementing supportive policies are imperative to mitigate the negative impact of fertility-related challenges on career trajectories and individual well-being.

Family Planning and Career Trajectories in Medicine

Background: 
Tricuspid endocarditis (TE) associated with intravenous drug use (IVDU) presents unique management challenges, including recurrent infections and poor treatment adherence. The pathophysiology involves direct inoculation of pathogens through contaminated injection equipment, leading to valve colonization and infection. While most cases of tricuspid valve infective endocarditis can be managed with antibiotics alone, surgical intervention is considered in specific circumstances. The choice between prolonged oral (PO) antibiotics and intravenous (IV) antibiotics in patients with active IVDU requires careful evaluation of risks and benefits. 

Case Presentation: 
We present the case of a 49-year-old female with active IVDU and TE, complicated by infective endocarditis and treatment noncompliance. Initially, the patient was not recommended a prolonged course of IV antibiotics due to concerns about the risk of relapse. However, the patient's father, recognizing her high-risk profile for suicide and death, emphasized the need for IV antibiotics, further complicating the decision-making process. Five months later, the patient's noncompliance with PO antibiotics resulted in a severe decompensation, leading to admission into the intensive care unit. The patient ultimately underwent tricuspid valve replacement and pacemaker placement, followed by another prolonged course of antibiotics. 

Discussion: 
This case underscores the challenges of balancing treatment options and addressing patient and family concerns in the context of active IVDU. Treatment noncompliance and relapse pose significant hurdles in addiction management, contributing to recurrent infections and complications. Strategies such as close follow-up, addiction counseling, and multidisciplinary support are crucial in optimizing treatment adherence and outcomes. Successful examples include programs like the Boston Health Care for the Homeless Program and Vermont Hub-and-Spoke Model which integrate medical treatment, addiction counseling, harm reduction strategies, and social support, resulting in improved outcomes like reduced mortality rates, lower reinfection rates, and increased treatment engagement. 

In conclusion, tricuspid endocarditis in the setting of IVDU requires comprehensive care and individualized treatment approaches. The decision between prolonged PO or IV antibiotics should consider factors such as treatment adherence, severity of infection, and close monitoring. Effective management necessitates open communication, shared decision-making, and ongoing support to mitigate treatment noncompliance and relapse risks. Collaboration with community organizations and care coordination are vital for success in providing comprehensive care. It underscores the need for further research, innovative approaches, and enhanced collaboration among healthcare providers, addiction specialists, and support networks to improve outcomes in this challenging patient population.

Tricuspid Endocarditis in the Setting of Active Intravenous Drug Use: Navigating Complexities for Comprehensive Care and Addressing Treatment Challenges

Advocacy and Health Equity / Public Health / Data Science Health Systems (Medical Education Innovation)

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 Internal Medicine

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### Grand Prize Sponsor

AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on February 4, 2024 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

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Gloria Hong

2

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Family Planning and Career Trajectories in Medicine

Tricuspid Endocarditis in the Setting of Active Intravenous Drug Use: Navigating Complexities for Comprehensive Care and Addressing Treatment Challenges

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