Study Reveals Disparities Between Male and Female Surgical Residents in the Experiences of Pregnancy and Parenthood

In a new study led by investigators from Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system, that surveyed more than 80% of all surgical residents in the United States, females were more likely to suffer obstetric complications and postpartum depression than male residents’ partners.

Female residents were also more likely to experience pregnancy/parenthood-related mistreatment than male residents, and such mistreatment was associated with burnout, thoughts of leaving the profession, and thoughts of suicide. The findings are published in JAMA Surgery.

“This study is the most comprehensive assessment of the experience of pregnancy and parenthood in any specialty training program to date. Although many training programs have achieved gender parity, gender disparities related to the experience of parenthood during general surgery residency persist,” said senior author Erika Rangel, MD, MS, an acute care and gastrointestinal surgeon and the Associate Program Director for the General Surgery residency at Massachusetts General Hospital.

“This study highlights the magnitude of parental discrimination and adverse maternal health outcomes in surgical training, providing evidence that pregnancy during clinical training involves measurable risks. Consequently, improving support is essential for advancing gender equity.”

For the study, 5,692 residents from 325 US general surgery programs provided survey responses, with 957 residents (16.8%) reporting a pregnancy (for themselves or their partner) during clinical training (22.3% male and 10.2% female). Responses revealed that, compared with male residents, female residents were more likely to delay having children due to training (46.8% vs. 32.8%) and experience pregnancy/parenthood-based mistreatment (58.1% vs 30.5%). Female residents had a 42% higher odds of experiencing obstetric complications and a 63% higher odds of developing postpartum depression compared with male residents’ partners.

Pregnancy/parenthood-based mistreatment was linked with a 2.0-times higher odds of experiencing burnout and a 2.5-times higher odds of having thoughts about leaving the profession. Postpartum depression—whether in female residents or male residents’ partners—was linked with a 1.9-times higher odds of burnout, a 2.3-times higher odds of thoughts of leaving the profession, and a 5.6-times higher odds of thoughts of suicide.

“These data are a compelling call to action for our profession. In the American College of Surgeons Board of Governors, I co-chair a workgroup focusing on pregnancy complications and infertility in surgeons. To safeguard maternal-fetal health, we developed recommendations for restricting 24-hour and overnight call for surgeons during the third trimester,” said Rangel.

The statement was issued by the American College of Surgeons in mid-May and has been endorsed by the American Board of Surgery, American Board of Colon and Rectal Surgery, American Board of Neurological Surgery, American Board of Oral and Maxillofacial Surgery, American Board of Plastic Surgery, and American Board of Thoracic Surgery.

Rangel noted that next steps include pushing for national advocacy for maternal health support across all specialties, for both trainees and practicing physicians and surgeons, and extending research beyond “talking about the challenges” to finding solutions.

Rigorous research is needed to understand which interventions are helpful and how much they impact meaningful measures of well-being. For example, we are conducting a clinical trial, The 4th Trimester Initiative, that aims to understand whether a package of support for pregnant and postpartum medical and surgical trainees can reduce burnout, postpartum depression, and career dissatisfaction.

Erica Rangel, MD
Department of Surgery

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Authorship: Ruojia Debbie Li MD MS, Lauren M. Janczewski MD MS, Joshua S Eng PhD, Darci C. Foote MD MS, Christine Wu MD, Julie K. Johnson PhD, Sarah Rae Easter MD, Eugene Kim MD, Jo Buyske MD, Patricia L. Turner MD, Thomas Nasca MD, Karl Y Bilimoria MD MS, Yue-Yung Hu MD MPH, and Erika L. Rangel MD MS.

Disclosures: Disclosure forms provided by the authors are available with the full text of this article.

Funding: The Surgical Education Culture Optimization based on National comparative Data (SECOND) Trial is supported by the American College of Surgeons and the Accreditation Council for Graduate Medical Education, with support in-kind from the American Board of Surgery. RDL is supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health. LMJ is supported by a grant from the National Cancer Institute. YYH is supported by a grant from the Agency for Healthcare Research and Quality.