Pregnancy stigma, lack of maternity leave may drive women from surgery careers

Women training for careers in surgery are more likely to abandon the profession when they experience pregnancy discrimination or have insufficient time for maternity leave, a U.S. study suggests.

Researchers surveyed 347 women who had given birth at least once while training to become a surgeon in the U.S. These women had a total of 452 pregnancies and were around 31 years old at the time of the survey.

Surgical trainees who perceived pregnancy discrimination were 79 percent more likely to say that given a chance to revisit their choice, they would opt for a nonsurgical career, the survey found.

And when training programs lacked a formal maternity leave, women were 83 percent more likely to consider leaving the profession than when leave policies were more supportive to new mothers.

The numbers looked worse for women who did more than just think about making a career change. Women who had switched their surgical specialty because of difficulties balancing motherhood with the demands of training were more than twice as likely as other survey participants to consider leaving the entire field and to say they would advise female medical students against a career in surgery.

“These women most commonly chose to forgo subspecialty training altogether and pursued general surgery instead,” said lead study author Dr. Erika Rangel, a surgeon and researcher at Brigham and Women’s Hospital and Harvard Medical School in Boston.

“Discontent from this decision may be due to a belief among many surgical residents that subspecialty training is needed to improve future lifestyle and marketability for jobs,” Rangel said by email. “Women who feel compelled to sacrifice career prospects and the rewards of a preferred specialty to reconcile domestic responsibilities may be less enthusiastic to complete the rigorous training.”

Even though men and women enter medical school in roughly equal numbers, women represent just one-third of applicants to surgery training programs, the study authors note in JAMA Surgery.

Roughly one in four women leave these training programs, and they often cite perceptions of a stressful career causing conflict between their personal and family responsibilities, researchers note. For men, the discontinuation rate is closer to 15 percent.

More than half of the survey participants said their training program lacked a formal maternity leave policy and that pregnancy was associated with stigma in the workplace.

Fifty women, or about 15 percent, altered their plans for surgical training. This happened most often among women training in transplant surgery, surgical oncology and pediatric surgery.

“Stigma related to pregnancy and maternal discrimination are distinct phenomena from gender discrimination, and have been linked to higher levels of burnout among female physicians,” Rangel said. “Fortunately, there are straightforward workplace interventions that can mitigate perceived stigma, including increasing duration of maternity leave, hiring extra workforce support to cover the expectant resident, improving childcare assistance, and providing lactation support.”

One limitation of the study is the possibility that women with more career dissatisfaction might have been more likely to respond than women who were content. It’s also possible that factors unrelated to pregnancy and motherhood may have influenced participants’ decisions to contemplate or make a career change.

By 2030, the U.S. is projected to have a shortage of 29,000 surgeons, and losing women from the profession will worsen an already widespread and growing gap between the supply of surgeons and the demand for surgery in this country, the authors note.

Fewer female surgeons may also be worse for patients, said Dr. Constance Guille, a researcher at the Medical University of South Carolina in Charleston who wasn’t involved in the study.

“Recent work demonstrates that physician-patient gender concordance increases the probability of patient survival, and the effect is driven by increased mortality when male physicians treat female patients,” Guille said by email. “The retention of female surgeons may improve patient outcomes.”