Ariela Marshall, MD, aged 42 years, consultative hematologist at the University of Minnesota, Minneapolis, thought she would be married with two kids by her early thirties. That was before she began 10 years of medical training.

Marshall, also chief innovation officer at Women in Medicine and curriculum chair at IGNITEMED, ended up marrying at 32 years. When she was 36 years old, she and her husband began trying to conceive. After fertility struggles, the couple pursued in vitro fertilization treatments, and Marshall gave birth to their son at 39 years.

Like many physicians, Marshall felt she needed to defer aspects of her personal life while establishing herself professionally. “You put things off due to the intensity of training and trying to achieve financial stability and get your life together,” she said. “I’m someone who doesn’t want to start something unless I can do it well and finish it.”

“Delayed gratification can help with getting through training, but it comes with a tremendous set of costs,” said Annia Raja, PhD, licensed clinical psychologist specializing in therapy for physicians. One is feeling behind on the “social clock”: culturally ingrained ideals for achieving certain life milestones by certain ages.

Young doctors might be racking up career markers like completing their residency but feel delayed when it comes to common life events like buying a home. Meanwhile, non-MDs around them seem to be in full “adulting” mode.

No Time Is the Right Time

The mindset of delayed gratification in medicine is no accident. Medical training’s “hidden curriculum” teaches prioritizing career and patients over personal life, which leads to achieving common “adult” markers later in life.

“It’s this weird dichotomy,” said Marshall. “On the one hand, you’re helping patients make life-or-death decisions. But at the same time, you could be a 30-year-old with debt living off ramen in a studio apartment, like a college student.”

Professional achievements can create an image of success that rings hollow for some doctors. “You might really be struggling,” said Gail Gazelle, MD, MCC, doctor coach, part-time assistant professor of medicine at Harvard Medical School, and associate scientist at the Brigham and Women’s Hospital, Boston. “But everyone around you is saying, ‘Wow, you are doing so well; you’re a surgeon.’”

It can be difficult for doctors to avoid comparisons with peers, even when they are on vastly different career paths. Doctors are “socialized to be hypercompetitive and compare ourselves to others,” said Robert M. Arnold, MD, vice chair for Professional Development, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City. “It’s hard to give that up even when it is no longer effective as a coping style.”

All of this can contribute to a sense of playing catch-up or even failing at life. “Feeling ‘behind’ is an existential theme that shows up for people who put their head down for years or decades and go from one thing to the next,” Raja said. “There is this sense it will all be worth it when they graduate med school or finish their residency or become an attending and that their lives will start once their training ends.”

Yet, as Marshall found, no time seems like the right time for personal life — even after becoming an attending. “The first few years of practicing, especially when you’re in academics, is the time to build your career and focus on research and publication. I thought, ‘I can’t start a family now. I don’t have the time or resources, and I’m still paying off my medical school debt.’”

The Family-Finance Connection

Social clock angst for MDs is especially loaded around family and finances, and the two can be interrelated. It’s an unfortunate reality that medical training allows little time for dating while coinciding with years of peak fertility. Research has suggested that medical schools actively discourage family building during training, especially for those in surgical specialties. Meanwhile, young doctors have incurred student debt that can take decades to pay off — a good reason to delay parenthood.

A significant amount of research has documented fertility issues among doctors. According to a 2023 JAMA research letter, the median age physicians have their first child is 32 years vs 27 years for non-MDs. And 25% of female physicians who attempt to conceive report infertility, noted a 2021 JAMA original investigation compared with 13.4% of women in the general population, according to the CDC.

In certain specialties, the data are even more concerning. More than 40% of female surgeons experience pregnancy loss, and almost half encounter serious pregnancy complications, found a 2021 JAMA Surgery study.

Male doctors are affected too. According to a small study from 2024, nearly 44% delayed starting a family, and about 23% have seen or considered seeing a fertility doctor.

Lack of financial stability may be an underlying cause. Medical training tends to require about “8 years of lost earning potential,” said James M. Williams, MS, DO, FACEP, clinical professor of emergency medicine at Meritus Medical Center and Texas Tech University Medical School.

It’s also hard to imagine becoming a parent with over $150,000 in medical school debt. More than half of residents carry at least that figure, according to Medscape’s Resident Salary and Debt Report 2025. Unfortunately, first- and second-year residents earn an average stipend of just $65,000, increasing to about $78,000 in their fifth year.

Williams described seeing his friends from college after their undergraduate years. They were working in business while he was a resident. “There was a big disconnect,” he said. “They were making a lot of money, while I was making the same amount as someone flipping burgers at a fast food restaurant.”

How to Stop the Social Clock

When it comes to navigating worries about the social clock, there is no easy solution, largely because they are based on the reality of medical training. But acknowledging the stress of feeling left behind and normalizing those feelings can help, said Arnold. One way is to confide in peers, who will likely relate.

“Normalization is important,” said Gazelle. “There is nothing wrong with you if you feel you can’t juggle training with getting married or having kids or if you are concerned about your debt or need to put off remodeling your kitchen.”

Another approach is to deeply examine your personal values apart from anyone else’s expectations. “Doctors are doers and fixers,” said Raja. “There’s a strong urge to go, go, go and accomplish and take the next step. And in that rush, most of my clients have not stopped to ask themselves what they want their lives to look and feel like. Often, they have lost touch with themselves or have this binding principle that [being a doctor] is ‘who I am.’” They have not necessarily reflected on their identity outside of medicine.

“If you are set on having your first child by a certain age, “let yourself listen to that,” she added. “But if [that pressure] is coming from social expectations that do not reflect your desires, that can create unnecessary struggles. Do not be washed away by social or societal expectations in a way that silences your voice.” Try to differentiate between intrinsic and extrinsic goals and desires.

Acknowledge the many structural factors that are beyond your control (like long hours), said Raja. But also take ownership of what you have control over. “Telling yourself you will change when your circumstances change is a trap we are all susceptible to,” she said. “External factors changing do not always correlate with internal changes.”

Some of Raja’s clients have experienced existential crises a few years post-fellowship or residency. “They reach out to say they are miserable and overwhelmed or thought their life would be so different. They imagined, ‘Once I’m done with training, life can begin.’”

Raja tries to dismantle this notion for doctors who are struggling. Attempt to live a little right now, she advises, even though maintaining a personal life during training can feel next to impossible. The passage of time might feel different during these years, but the reality is: Time is passing.

“Many people wait to take a vacation until they have enough money or things are slow,” said Arnold. “But that isn’t the way life works. Things are never slow, and you need to enjoy the journey.”

In the process, doctors should aim to strike a balance between their present and future selves. Save money to pay off loans, but not to the extent that ramen dinners become the norm. During down times, catch up on sleep and venture on a date or two. “You don’t have to be full throttle all the time,” said Raja. “There is always work to be done. Cultivate a habit of titrating according to priority…Not everything can be a priority at once.”

By tuning out the social clock and tuning in to her priorities, Marshall found balance. She and her husband decided not to pursue a second pregnancy due to medical risks and the demands of her work schedule. She might have one child fewer than she had originally planned. But her life is replete with meaning.

“If you chose medicine, you already know the clock wasn’t built for us,” wrote Tasia Isbell, MD, pediatric resident physician at Boston Children’s Hospital and Boston Medical Center, Boston, in a recent essay. “Measuring ourselves against [the social clock] steals joy from a journey that deserves to be honored. As clinicians, we’re not behind. We’re just on a different timeline.”