Pregnancy and parenthood among US surgical residents

Published in JAMA Surgery. Here is a link to the article.

Regenstrief Institute authors: Karl Y. Bilimoria, M.D., M.S.

Abstract

Importance

The ability to pursue family planning goals is integral to gender equity in any field. Procedural specialties pose occupational risks to pregnancy. As the largest procedural specialty, general surgery provides an opportunity to understand family planning, workplace support for parenthood, obstetric outcomes, and the impact of these factors on workforce well-being, gender equity, and attrition.

Objective

To examine pregnancy and parenthood experiences, including mistreatment and obstetric outcomes, among a cohort of US general surgical residents.

Design, Setting, and Participants

This cohort study involved a cross-sectional national survey of general surgery residents in all programs accredited by the Accreditation Council for Graduate Medical Education after the 2021 American Board of Surgery In-Training Examination. Female respondents who reported a pregnancy and male respondents whose partners were pregnant during clinical training were queried about pregnancy- and parenthood-based mistreatment, obstetric outcomes, and current well-being (burnout, thoughts of attrition, suicidality).

Main Outcomes and Measures

Primary outcomes included obstetric complications and postpartum depression compared between female residents and partners of male residents. Secondary outcomes included perceptions about support for family planning, pregnancy, or parenthood; assisted reproductive technology use; pregnancy/parenthood-based mistreatment; neonatal complications; and well-being, compared between female and male residents.

Results

A total of 5692 residents from 325 US general surgery programs participated (81.2% response rate). Among them, 957 residents (16.8%) reported a pregnancy during clinical training (692/3097 [22.3%] male vs 265/2595 [10.2%] female; P < .001). Compared with male residents, female residents more frequently delayed having children because of training (1201/2568 [46.8%] females vs 1006/3072 [32.7%] males; P < .001) and experienced pregnancy/parenthood-based mistreatment (132 [58.1%] females vs 179 [30.5%] males; P < .001). Compared with partners of male residents, female residents were more likely to experience obstetric complications (odds ratio [OR], 1.42; 95% CI, 1.04-1.96) and postpartum depression (OR, 1.63; 95% CI, 1.11-2.40). Pregnancy/parenthood-based mistreatment was associated with increased burnout (OR, 2.03; 95% CI, 1.48-2.78) and thoughts of attrition (OR, 2.50; 95% CI, 1.61-3.88). Postpartum depression, whether in female residents or partners of male residents, was associated with resident burnout (OR, 1.93; 95% CI, 1.27-2.92), thoughts of attrition (OR, 2.32; 95% CI, 1.36-3.96), and suicidality (OR, 5.58; 95% CI, 2.59-11.99).

Conclusions and Relevance

This study found that pregnancy/parenthood-based mistreatment, obstetric complications, and postpartum depression were associated with female gender, likely driving gendered attrition. Systematic change is needed to protect maternal-fetal health and advance gender equity in procedural fields.

Authors:

Ruojia Debbie Li, MD, MS^1,2; Lauren M. Janczewski, MD, MS^1,2; Joshua S. Eng, PhD¹; Darci C. Foote, MD, MS^3,4; Christine Wu, MD⁵; Julie K. Johnson, PhD¹; Sarah Rae Easter, MD⁶; Eugene Kim, MD⁷; Jo Buyske, MD⁸; Patricia L. Turner, MD⁹; Thomas J. Nasca, MD¹⁰; Karl Y. Bilimoria, MD, MS^1,9; Yue-Yung Hu, MD, MPH^1,2,11; Erika L. Rangel, MD, MS¹²

Affiliations:

¹Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University School of Medicine, Indianapolis

²Northwestern Quality Improvement, Research, and Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois

³Department of Surgery, University of Michigan, Ann Arbor

⁴Department of General Surgery, Beaumont Health, Royal Oak, Michigan

⁵Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

⁶Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts

⁷Division of Pediatric Surgery, Cedars Sinai Medical Center, Los Angeles, California

⁸American Board of Surgery, Philadelphia, Pennsylvania

⁹American College of Surgeons, Chicago, Illinois

¹⁰Accreditation Council for Graduate Medical Education, Chicago, Illinois

¹¹Division of Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois

¹²Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston