Background: The number of women entering orthopaedic surgery is steadily increasing. Information regarding pregnancy and childbearing is important to understand as it increasingly affects residency programs, clinical practices, and the female surgeons and their offspring.

Methods: One thousand and twenty-one female surgeons completed an anonymous, voluntary, 199-item online survey distributed via individual female surgeon interest groups and word of mouth in nine specialties: general surgery, gynecology, neurosurgery, ophthalmology, orthopaedics, otolaryngology, plastic surgery, podiatry, and urology. Two hundred and twenty-three survey responses from orthopaedic surgeons were compared with those of the other surgical specialists as well as American Pregnancy Association national data to assess differences, if any, in pregnancy characteristics, demographics, and satisfaction.

Results: The overall reported complication rate for all pregnancies among orthopaedic surgeons was significantly higher than the rate in the general American population (31.2% [eighty-two of 263] compared with 14.5%). There was an increased risk of preterm delivery among orthopaedic surgeons compared with a cohort of the general U.S. population matched according to age, race, health, and socioeconomic status (risk ratio, 2.5; 95% confidence interval [CI], 1.3 to 4.6). There was an increased risk of preterm labor and preterm delivery among women who reported working more than sixty hours per week (odds ratio, 4.95; 95% CI, 1.4 to 36.6). Female orthopaedic surgeons took shorter maternity leave during training than during clinical practice (median, four compared with seven weeks). The mean duration of breastfeeding was significantly shorter during training than during clinical practice (4.7 compared with 8.3 months, p = 0.03).

Conclusions: Female orthopaedic surgeons had an increased risk of pregnancy complications, particularly preterm delivery, compared with the general U.S. population. We found an increased risk of increased risk of preterm labor and delivery in surgeons working more than sixty hours per week during pregnancy.

Childbearing and Pregnancy Characteristics of Female Orthopaedic Surgeons

Background Women are increasingly entering the surgical profession. Objective To assess professional and personal/family life situations, perceptions, and challenges for women vs men surgeons. Design National survey of American Board of Surgery–certified surgeons. Participants A questionnaire was mailed to all women and men surgeons who were board certified in 1988, 1992, 1996, 2000, or 2004. Of 3507 surgeons, 895 (25.5%) responded. Among these, 178 (20.3%) were women and 698 (79.7%) were men. Results Most women and men surgeons would choose their profession again (women, 82.5%; men, 77.5%; P  = .15). On multivariate analysis, men surgeons (odds ratio [OR], 2.5) and surgeons of a younger generation (certified in 2000 or 2004; OR, 1.3) were less likely to favor part-time work opportunities for surgeons. Most of the surgeons were married (75.6% of women vs 91.7% of men, P P P P P Conclusions Women considering a surgical career should be aware that most women surgeons would choose their profession again. Strategies to maximize recruitment and retention of women surgeons should include serious consideration of alternative work schedules and optimization of maternity leave and child care opportunities.

https://jamanetwork.com/journals/jamasurgery/articlepdf/405169/sws90011_635_642.pdf

Women surgeons in the new millennium.

Importance Previous work shows women who have children during surgical residency face difficulty balancing childbearing with training, which negatively affects residency and career satisfaction. Little is known about the factors that drive professional discontent. Objective To determine factors associated with professional dissatisfaction for childbearing residents. Design, Setting, and Participants Self-administered survey questionnaire electronically distributed through the Association of Program Directors in Surgery, the Association of Women Surgeons, and targeted Twitter and Facebook platforms. The survey was distributed in January 2017 to surgeons who delivered at least 1 child during a US general surgery residency and was available online for 4 weeks. Main Outcomes and Measures Respondents were reported to be dissatisfied with their residency if they indicated agreement that they considered leaving residency owing to challenges surrounding childbearing (considered leaving). Respondents were reported to be unhappy with their career if they indicated agreement with statements that (1) given an opportunity to revisit their job choice, they would choose a nonsurgical career more accommodating of motherhood (revisit career choice) or (2) they would advise a female medical student against a surgical career owing to difficulties balancing motherhood with the profession (advise against surgery). Logistic regression was used to determine predictors of agreement with each of the 3 statements of professional dissatisfaction. Results In total, 347 women responded to the survey and reported 452 pregnancies, and the mean (SD) age was 30.5 (2.7) years. One hundred seventy-nine respondents (51.6%) agreed with at least 1 statement of residency or career dissatisfaction. Lack of a formal maternity leave policy was associated with “considered leaving” (odds ratio [OR], 1.83; 95% CI, 1.07-3.10). Perception of stigma during pregnancy was associated with “revisit career choice” (OR, 1.79; 95% CI, 1.01-3.19). Changing fellowship plans owing to perceived difficulty balancing motherhood with the originally chosen subspecialty was associated with all 3 markers of residency and career dissatisfaction (“considered leaving” OR, 2.68; 95% CI, 1.30-5.56; “revisit career choice” OR, 2.23; 95% CI, 1.13-4.43; and “advise against surgery” OR, 2.44; 95% CI, 1.23-4.84). Conclusions and Relevance Surgery residents who perceived stigma during pregnancy, did not have a formal institutional maternity leave policy, or altered their fellowship training plans because of challenges of childbearing expressed greater professional dissatisfaction. Mentorship in subspecialty selection and work-life integration, interventions to reduce workplace bias, and identification of obstacles to establishment of maternity leave policies are needed to enhance professional fulfillment for childbearing residents.

/pdf/factors-associated-with-residency-and-career-dissatisfaction-2ipox8eabf.pdf

Factors Associated With Residency and Career Dissatisfaction in Childbearing Surgical Residents.

Gender Differences in Compensation, Job Satisfaction and Other Practice Patterns in Urology.

Recent trends in the urology workforce in the United States.

Background As the number of women entering urology grows, so should discussions and awareness about pregnancy. To understand if urology training and practice potentially put women and their pregnancies at risk, we set out to assess the childbearing differences between the average American woman and the female urologist. Study Design A 114-item anonymous survey was sent to all 365 American board certified female urologists in 2007. Data concerning birth trends, pregnancy, assisted reproduction, and complications were analyzed. Findings were compared with 2004 CDC data. Results Two mailings yielded a 69% (n = 243) response rate; average age was 43 years; 67.4% had biologic children (average 2.0 children). Women urologists were older by 7 to 8 years for all births. An assisted reproduction technology birth was nearly 10 times more likely. Pregnancy complications were high, with a prevalence greater than that in the lowest income brackets in the United States. The induction rate was above average; the rate of cesarean deliveries was similar, with only 21 elective procedures performed. Ninety-two percent of women urologists would choose to have the same number of children: 66% at the same point in their career; 16%, earlier; 4%, later; 15%, uncertain. Conclusions Women urologists have children later in life, a smaller number, a higher induction rate, and a higher incidence of pregnancy complications. These are likely related to the older age at pregnancy, which certainly contributes to the higher number conceived by assisted reproduction technology. Cesarean delivery rates, which were expected to be higher, were similar. To avoid complications, childbearing should not be delayed, and residency programs and practice groups will need to develop programs that support the growing number of women urologists.

https://www.medschool.vcu.edu/media/vcu-medicine/content-assets/documents/urologistbirthtrends.pdf

Vanessa D. Gulla

Papers

Birth trends and pregnancy complications among women urologists.