New data reveal that more women general surgeons are becoming pregnant during training, but substantial negative biases persist. The findings may have important ramifications for the surgery workforce.
The number of women applicants to medical school has increased steadily over the past few decades, rising to 50.8% of all American medical school applicants in 2003 to 2004. Despite this increase, women have historically been underrepresented across some medical fields when compared with men. Studies indicate that academic faculty women comprise a large percentage of primary care specialties, but only about 15% of faculty in general surgery are women. Data from 2008 demonstrated that women represented just 32.3% of residents in general surgery. While the number of women medical students pursuing a career in surgery has increased steadily since 1997, there are still disproportionately fewer women than men pursuing general surgery and surgical subspecialties.
“Many factors may deter women from careers in surgery,” explains Patricia L. Turner, MD, FACS. “One potential concern is accommodating pregnancy and childbirth during training and practice. That’s because medical school and training typically occurs during the years when women are most fertile. The demands associated with the longer length of training in surgery and persistent negative attitudes toward pregnancy from colleagues may dissuade students from choosing surgery as a career.”
Taking a Deeper Look at Surgeons & Pregnancy
To further explore female surgeon experiences relating to childbirth and pregnancy, Dr. Turner and colleagues conducted a survey of women general surgeons in training and in practice that was published in the February 20, 2012 Archives of Surgery. The survey questionnaire aimed to provide descriptive data on the timing of pregnancy and perceptions of stigma. Data were collected according to the date of medical school graduation for respondents:
0 to 9 years since graduation.
10 to 19 years since graduation.
20 to 29 years since graduation.
30 or more years since graduation.
“Not surprisingly, women who trained in an earlier period were less likely to have been pregnant during training than their younger counterparts,” says Dr. Turner. “In general, most women in our study deferred pregnancy until after their training was completed. However, more of the recent graduates had pregnancies during residency training.” During fellowship, the frequency of pregnancies increased in all study groups assessed. The most likely time for women to have been pregnant was while working as a surgeon after the completion of training. As the length of time after completion of residency training increased, the relative number of women becoming pregnant also generally increased (Table).
Social Stigma of Pregnancy & Childbirth Among Surgeons
The perception of stigma associated with pregnancy during training decreased from 76% in the most remote cohort to 67% in the most recent graduation cohort in Dr. Turner’s study, but stigma was still largely prevalent. “Even though the number of positive influences among peers and faculty increased for the most recent graduates, residents and faculty provided negative influences across the board in all respondent age groups and in every category,” says Dr. Turner (Figure). In addition, residents and faculty exerted more negative influences than positive influences. External influences, including women resident colleagues, were perceived as evincing negative instead of encouraging positive attitudes toward childbearing during residency.”
Implications on Female Surgeon’s Careers
Previous research has suggested that women in other fields of medicine typically become pregnant earlier in their careers. “Unfortunately, the demands of a surgical career often lead women surgeons to delay their first childbirth until they’ve entered clinical practice, and this may make female students less inclined to consider surgery as a career,” Dr. Turner says. “The rigors of surgery training programs have a significant impact on all applicants when they’re deciding whether or not to become surgeons. Surgery programs articulate a desire to recruit ‘the best and the brightest’ to their institutions. By failing to address this important quality-of-life issue—pregnancy during training—an opportunity is being missed to attract the most talented and skilled residents to a career in surgery, regardless of gender.”
In the past, trailblazing women in surgery have reported overwhelmingly negative attitudes toward childbearing in residency. Although the stigma associated with pregnancy during training has decreased, Dr. Turner says it is problematic that overall negative attitudes remain. “To overcome these attitudes, faculty leaders should make efforts to address this issue and take steps to improve communication during surgery residencies. Over the past decades, improvements have been made with the development of policies that are designed to accommodate pregnant residents, including maternity leave and increased flexibility by national accreditation and examining bodies. The next step is to develop targeted interventions that aim to change the negative attitudes associated with pregnancy during surgery residencies. This is a worthwhile effort worthy of greater exploration so that we can positively influence the number of women entering general surgery, and, as a result, expand the pool of excellent candidates.”
Turner PL, Lumpkins K, Gabre J, et al. Pregnancy among women surgeons: trends over time. Arch Surg. 2012 Feb 20 [Epub ahead of print]. Available at: http://archsurg.ama-assn.org/cgi/reprint/archsurg.2011.1693.
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