Erika L. Rangel

Objective: This study aimed to investigate the transparency of parental benefits available to US surgical residency applicants. Background: Medical students prioritize work-family balance in specialty selection. Those applying to surgical residency programs also place a significant value on parental leave policies when deciding where to train. However, little is known about the amount of information that surgical training programs publicly offer to potential applicants regarding family support policies. Methods: Publicly available websites for 264 general surgery training programs were accessed to determine the availability of information on parental benefits. Twenty-six “items of transparency” included types of leave, contract flexibility, salary, lactation, and childcare support. Programs with fewer than the median items of transparency were contacted to inquire about additional public resources. Academic programs were stratified by their associated medical school rankings in the US News & World Report. Results: A total of 144 (54%) programs were academic and 214 (81.4%) had male program directors. The median number of items of transparency was 8 (29.6%). Of the 131 programs contacted, 33 (25.9%) replied, and 2 (6.1%) improved their transparency score. Academic programs associated with medical schools in the upper third of the rankings were more likely to have ≥8 items of transparency (70.8% vs. 45.6%; P=0.002). In the adjusted analysis, academic programs [odds ratio (OR): 3.44, 95% confidence interval (95% CI): 1.87–6.34], those with female program directors (OR: 2.09, 95% CI: 1.01–4.33), and those located in the Western (OR: 3.13, 95% CI: 1.31–7.45) and Southern (OR: 2.45, 95% CI: 1.21–4.98) regions of the country were more likely to have ≥8 items of transparency. Conclusions: There are significant deficits in publicly available information related to parental benefits for many surgical training programs, which may impact applicants’ decision making. Attracting the most talented candidates requires programs to create and share policies that support the integration of professional and personal success.

Objective: We sought to assess whether lack of workplace support for clinical work reductions during pregnancy was associated with major pregnancy complications. Background: Surgeons are at high risk of major pregnancy complications. Although rigorous operative schedules pose increased risk, few reduce their clinical duties during pregnancy. Methods: An electronic survey was distributed to US surgeons who had at least 1 live birth. Lack of workplace support was defined as: (1) desiring but feeling unable to reduce clinical duties during pregnancy due to failure of the workplace/training program to accommodate and/or concerns about financial penalties, burden on colleagues, requirement to make up missed call, being perceived as weak; (2) disagreeing colleagues and/or leadership were supportive of obstetrician-prescribed bedrest. Multivariate logistic regression determined the association between lack of workplace support and major pregnancy complications. Results: Of 671 surgeons, 437 (65.13%) reported lack of workplace support during pregnancy and 302 (45.01%) experienced major pregnancy complications. Surgeons without workplace support were at higher risk of major pregnancy complications than those who had workplace support (odds ratio: 2.44; 95% confidence interval: 1.58–3.75). Bedrest was prescribed to 110/671 (16.39%) surgeons, 38 (34.55%) of whom disagreed that colleagues and/or leadership were supportive. Of the remaining surgeons, 417/560 (74.5%) desired work reductions but were deterred by lack of workplace support. Conclusions: Lack of workplace support for reduction in clinical duties is associated with adverse obstetric outcomes for surgeons. This is a modifiable workplace obstacle that deters surgeons from acting to optimize their infant’s and their own health. To ensure the health of expectant surgeons, departmental policies should support reduction of clinical workload in an equitable manner without creating financial penalties, requiring payback for missed call duties, or overburdening colleagues.

Export BACKGROUND: Postpartum depression has well-established long-term adverse effects on maternal and infant health. Surgeons with rigorous operative schedules are at higher risk of obstetric complications, but they rarely reduce their workload during pregnancy. We evaluated whether lack of workplace support for work reductions during difficult pregnancies or after neonatal complications is associated with surgeon postpartum depression. STUDY DESIGN: An electronic survey was sent to practicing and resident surgeons of both sexes in the US. Female surgeons who had at least one live birth were included. Lack of workplace support was defined as: (1) disagreeing that colleagues/leadership were supportive of obstetric-mandated bedrest or time off to care for an infant in the neonatal intensive care unit; (2) feeling unable to reduce clinical duties during pregnancy despite health concerns or to care for an infant in the neonatal intensive care unit. Multivariate logistic regression was used to determine the association of lack of workplace support with postpartum depression. RESULTS: Six hundred ninety-two surgeons were included. The 441 (63.7%) respondents who perceived a lack of workplace support had a higher risk of postpartum depression than those who did not perceive a lack of workplace support (odds ratio 2.21, 95% CI 1.09 to 4.46), controlling for age, race, career stage, and pregnancy/neonatal complications. Of the surgeons with obstetric-related work restrictions, 22.6% experienced loss of income and 38.5% reported >$50,000 loss. CONCLUSION: Lack of workplace support for surgeons with obstetric or neonatal health concerns is associated with a higher risk of postpartum depression. Institutional policies must address the needs of surgeons facing difficult pregnancies to improve mental health outcomes and promote career longevity.

Intensive care uses a disproportionate quantity of US health care resources, accounting for 13% of hospital costs, 15% of hospital beds, and 4% of National Health Expenditures.¹ With the COVID-19 pandemic placing tremendous strain on intensive care unit (ICU) capacity,² optimizing critical care utilization has faced increasing scrutiny. A predictive model for ICU admission such as the one presented by Rozeboom et al³ may help hospital leadership with daily elective surgical schedule smoothing and reduce undesirable downstream effects of planned ICU admissions on emergency department diversion. Identify all potential conflicts of interest that might be relevant to your comment. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Err on the side of full disclosure. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details.

Societal values and gender roles have evolved throughout the last several decades, with an increase in dual-career families,¹ an emphasis on egalitarian division of household responsibilities,² and greater expectation of paternal involvement in child rearing.^1,2 Four decades ago, married fathers spent a mean of 2.6 hours per week caring for their children, an amount of time that has now tripled.³ These generational changes have affected the surgical profession as well, with medical students deterred from the career by the perception of incompatibility with childrearing.⁴ Among working surgeons, the ability to integrate work and family commitments is an important mediator of burnout.⁵

As medical school graduate rates approach sex parity,¹ women are entering the surgical profession in greater numbers, making up 38% of residents² and 21% of practicing surgeons in the US.³ Despite increasing numbers, female surgeons continue to face challenges in reconciling work and family demands, particularly early in their careers. Among US surgical residents, national surveys describe pregnancy-related stigma, unmodified work schedules during pregnancy, inconsistent and brief maternity leave options of usually 6 weeks or shorter, and little support for childcare and lactation needs after delivery.^4,5 As a result, most female surgeons postpone starting a family until after training.^6,7 This timeline coincides with acquiring the diagnosis of advanced maternal age at age 35 years, when the risks of infertility and adverse pregnancy outcomes rise sharply.⁸ Compared with their male counterparts, female surgeons are more likely to be childless⁹ but little is known about the risks of infertility and pregnancy complications for female surgeons.

Up to 50% of physicians plan to become parents during clinical training,¹ a life event that has important implications for career development, work-life balance, and burnout.² Studies of surgical resident perceptions on childbearing have described stigma and negative attitudes against parenthood, guilt over the burden placed on peers to cover leave, variable presence of maternity leave policies, a paucity of mentorship on balancing family priorities and work duties, and deficits in breastfeeding and childcare support.^3,4 These difficulties may have negative implications for the surgical workforce, with nearly 40% of women who had a child during training reporting that they seriously considered leaving their training program and 30% reporting they would counsel a female medical student against a surgical profession owing to the challenges of becoming a mother during training.⁴