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Survey results identify challenges of balancing motherhood with surgical training

Balancing career and motherhood is a challenge for all women. But for women in surgery, it’s particularly challenging to start a family while in surgical residency. A new study, led by Brigham and Women’s Faulkner Hospital’s Director of Surgical Critical Care and Inpatient Programs Erika Rangel, MD, MS, FACS, identifies some of the issues these women face and seeks to open the conversation around the issue.

Published recently in JAMA Surgery, “Pregnancy and Motherhood During Surgical Training” examines the results of a nation-wide survey. The survey was given to nearly 350 general surgeons who had one or more pregnancies during their residency. Their responses revealed much about the challenges, some unique to surgeons and some faced by all working mothers, that come with starting a family and building a career at the same time. The women questioned reported concerns about unmodified work schedules during pregnancy, the negative stigma associated with pregnancy during training, dissatisfaction with maternity leave options, inadequate lactation and childcare support and a desire for greater mentorship on work-life integration.

Dr. Rangel says she was most struck by how these concerns influence career and residency satisfaction. Thirty-nine percent of the women surveyed said they seriously considered leaving their residency and 30 percent said their experience would lead them to advise female medical students against pursuing a career in surgery.

While 50 percent of medical students are female, only about a third of applications to general surgery residencies come from women. For Dr. Rangel, the ultimate goal of her investigation is to recruit the best and brightest to the field she loves. “It’s important to understand what the challenges are so that we can talk about possible solutions openly,” she says.

Dr. Rangel had her first child as a fourth-year surgical resident. “The residency years are tough for everyone whether you are planning to start a family or not,” she says. “The hours are long and there is limited time for personal pursuits. But there is a light at the end of the tunnel.”

To the residents who seek her advice, Dr. Rangel stresses finding what works best for you and your family. “There really is never an ideal time to have a baby. The right time is whenever it happens for you and you will find your own unique balance,” she says. “I tell women to try to outsource as much as you can. Invest in great childcare and make sure to schedule time in your calendar for your family and for yourself. And the most important thing is to learn to forgive yourself—it’s ok to ask for help from your partner, your village, your community. No one is perfect.”

She also promises women that it does get better and there is no reason to choose between motherhood and the career you are passionate about. “My kids are my universe, but being a surgeon is very much at the core of who I am,” she says. “It saddens me to think that anyone would think being a great mother and an accomplished surgeon are mutually exclusive things. They are not.”

With the results of the survey, Dr. Rangel feels confident things can change. “For many of these challenges, the solutions are actually low-hanging fruit. I hope the data we show will help to move the needle forward so that we can pursue some of these easier solutions,” she says. “And at the national and program level, the hope is to address some of the more difficult questions such as maternity leave, which can impact education and workforce. It really is time to open this conversation.”

Erika Rangel

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