Negative Stigma Surrounds Female Surgical Residences Balancing Training, Motherhood

Erika Rangel, MD, MS, FACS, Associate Surgeon, Brigham and Women's Hospital

Erika Rangel, MD, MS, FACS

According to a new survey published by Brigham and Women’s Hospital in JAMA Surgery, pregnancy and childcare support may have significant influence on the decision to pursue or maintain a career in surgery.

Survey results revealed a lingering negative stigma surrounding pregnancy, and although more women are beginning families during surgical residency, limited studies have assessed the perspectives of surgeons who were pregnant during residency.

“Over half of medical school graduates are women,” lead study author, Erika Rangel, MD, MS, FACS, surgeon and researcher in the division of trauma, burn and surgical critical care, Brigham and Women’s Hospital, said in a statement. “If we want to educate and retain the best surgeons, we need to create a better training experience for women who wish to start families during their training.”

Women constitute more than half of today’s medical school graduates yet remain underrepresented in general surgery, making up 40% of residents and only 18% of faculty members in the US, the study says. Causes of the gender discrepancy include the lack of female role models, gender discrimination, and pregnancy and child care concerns.

A 74-question survey was electronically distributed to active members of the Association of Women Surgeons (AWS), members of the Association of Program Directors in Surgery listserv and targeted groups on Facebook and Twitter like Physician Moms Group and Surgeon Moms Group — membership numbers of the 2 social media groups at the time of survey distribution were 67,156 and 960 respectively.

Qualitative information was obtained from 2 open-ended questions that inquired about the experience of childbearing during residency.

The national survey included 347 general surgery residents who had at least 1 pregnancy during residency. The mean age of women was 30.5 years, and there were 452 total pregnancies.

Information collected included demographic and residency program information that assessed perceptions on working while pregnant, maternity leave policies, breastfeeding and lactation, childcare and motherhood, job satisfaction, perceptions of stigma, attitudes of colleagues and satisfaction with training program support.

Several themes emerged from survey results: the desire for work modifications during late stages of pregnancy due to health concerns; inadequate duration of maternity leave; perceived stigma of pregnancy and motherhood in surgery; importance of greater program/institutional support for breastfeeding and childcare; and a wish for stronger mentorship on work-family integration.

Findings revealed significant cultural challenges and infrastructure shortcomings that led 39% of respondents to seriously consider leaving residency and 30% to report they would advise a female medical student against a career in surgery.

Social media played a critical role in the study, providing platforms for female surgeons to discuss experiences during pregnancy and challenges faced.

The lingering negative stigma surrounding pregnancy led to 75% of respondents witnessing faculty members or other residents making negative comments about pregnant trainees or childbearing during training. Sixty percent of participants reported there was a negative stigma associated with being pregnant as a surgical resident, with just more than half perceiving pressure to plan pregnancies during nonclinical time.

A total of 297 (85.6%) of women worked an unmodified schedule until birth and 220 (63.6%) were concerned work schedules would adversely affect their health or the health of the unborn child.

Challenges also included inadequate workplace infrastructure like lactation support and child care options, and a lack of mentorship on balancing career with pregnancy and motherhood. While breastfeeding was important to 329 (95.6%) of women, 200 (58.1%) stopped earlier than intended because of poor access to facilities and challenges leaving the operating room to express milk. Sixty-four women (18.4%) had institutional support for childcare and 231 (66.8%) reported a greater desire for mentorship.

A total of 251 women (78.4%) received maternity leave of 6 weeks of less, and 250 (72%) perceived the duration to be inadequate.

Eighty-two percent of participants cited the American Board of Surgery (ABS) Leave Policy as a major barrier to obtaining desired length of leave time, as only a third of participants reported the existence of a formal surgical program maternity leave policy at their programs.

“There is a misconception that the ABS is an obstacle to getting longer maternity leave,” Rangel said. “In general, about 78% of women were getting 6 weeks or less of maternity leave, and about 72% thought this time wasn’t enough. Most people thought it was because ABS didn’t allow more time. However, the goal of the Board is to ensure the adequate training of surgeons to be prepared to take care of patients, and they offer several leave options to make this feasible for everyone, even with longer maternity leave.”

Since Rangel presented the study results, the ABS clarified its leave policy and the Association of Program Directors in Surgery are scheduled to meet in May to help improve the training experience for pregnant residents.

The challenges of having children during surgical residency may have significant workforce implications and these findings demonstrate areas where targeted interventions may reduce the burden of childbearing on residents.

The survey characterizes these issues in order to design interventions in support of residents.

"As the profession works to build the surgical workforce, the call to invigorate the field requires assessment and acknowledgment of the needs of an increasing population of women surgeons beginning families during training," Rangel concluded. "Open discussion among surgical leaders and educators must develop strategies for workforce shortages, improvements in the working environment, flexible leave policies and preservation of the integrity of education for the pregnant resident and her colleagues."

Rangel will soon publish a qualitative analysis of the survey that facilitates better targeting of potential interventions by general surgery program directors.

The study, "Pregnancy and Motherhood During Surgical Training" was published in JAMA Surgery.