Many trainee female surgeons consider leaving field after pregnancy

(Reuters Health) - Many female surgeons who become pregnant or have children during their training years consider abandoning their surgical careers before they even start, a U.S. study suggests.

For the study, researchers examined survey data collected from 347 female surgeons who were 31 years old on average and had a total of 452 pregnancies between them. Overall, 86 percent of the women worked an unmodified schedule up until birth and roughly two-thirds said they were concerned that their job hours might have negatively impacted their babies.

“The women surveyed reported concerns about unmodified work schedules during pregnancy, dissatisfaction with maternity leave options, stigma and fear of loss of reputation from being pregnant during training, inadequate lactation and childcare support and a desire for greater mentorship on work-life integration,” said lead study author Dr. Erika Lu Rangel of Brigham and Women’s Hospital in Boston.

“This emphasizes that pregnancy and childcare support may have a significant influence on the decision to pursue or maintain a career in surgery,” Rangel said by email. “To attract and retain the most talented candidates, surgical leaders must address the challenges facing new mothers in residency.”

A total of 251 women, or 78 percent, said they got six weeks or less for maternity leave, researchers report in JAMA Surgery, online March 21. Roughy the same proportion of women said the duration of their leave was inadequate.

While 329 women, or 96 percent, said breastfeeding was important, 58 percent said they stopped nursing their babies sooner than they wanted to because of challenges such as a lack of lactation facilities or time to express milk at work, the study also found.

Only 64 women, or 18 percent, said they had childcare provided or subsidized by their employers.

A total of 135 women, or 39 percent, said they strongly considered leaving their surgical training programs due to challenges with pregnancy and becoming mothers.

In addition, 102 women, or 30 percent, said they would discourage female medical students from a surgical career, specifically because of the challenges of balancing pregnancy and motherhood with training.

Beyond its small size, another limitation of the study is that the online survey might not be representative of all women or mothers in the surgical field or in medicine, the authors note.

There are also many female surgeons who do successfully juggle both motherhood and medical training, Dr. Kelly McCoy of the University of Pittsburgh and colleagues write in an accompanying commentary. Good mentorship during training might help some women figure out how to navigate this, they note.

For some parents, the prospect of having to choose between caring for a patient needing urgent surgery and caring for kids might be too challenging, and might mean they should consider a different specialty, they write.

“If the prospect of leaving a recital, fencing match or tickle-fest to perform urgent surgery is enough to sway a young doctor away from a particular specialty, their gut may be guiding them in the right direction,” McCoy and colleagues write.

Even so, the results add to evidence that a variety of challenges may deter women from pursuing both surgical careers and motherhood even when they might be willing to try to juggle both, said Dr. Constance Guille, a researcher at the Medical University of South Carolina in Charleston who wasn’t involved in the study.

“While none of the study findings are unexpected, the work is laudable and underscores an important reason why women are underrepresented in surgical specialties in our country,” Guille said by email. “If we want to close this gender gap, medical institutions will need to make an initial investment to support mothers in surgical training with adequate maternity leave, daycare with appropriate hours, lactation facilities, etc.”

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JAMA Surg 2018.