Qualitative Exploration of the Impact of Workplace Culture on Belonging, Burnout, and Career Exit for Women in Cardiothoracic Surgery.

Abstract

Gender disparities exist in cardiothoracic (CT) surgery, although qualitative investigations are lacking. We aimed to explore the impact of workplace culture on belonging, burnout, and career exit for women in CT surgery. We conducted virtual semi-structured interviews with women CT surgeons in practice for 5 years or more across the US from September 2024 to December 2024. The interview asked about macro (national) and micro (institutional) workplace cultures, including belonging, burnout, and decisions to change positions. Interviews were transcribed, coded, and analyzed thematically. Participants (n = 25) included thoracic (40%), adult cardiac (36%), and congenital (16%) surgeons. Six themes were identified to produce a conceptual model. Broadly, elements of macro (national) culture were either augmented or mitigated by the micro (institutional) culture to influence career trajectory. Macro-level themes included (1) a shared ethos-CT surgery is a high-intensity, but rewarding field; (2) babies and burnout-pregnancy and motherhood conflict with work demands; and (3) death by a thousand cuts-gender bias, microaggressions, and discrimination are common. Micro-level themes were (1) setting the tone-leaders drive institutional culture, (2) playing nice-relationships with colleagues influence the working environment, and (3) being heard-having a voice to advocate for changes contributes to belonging and career satisfaction. Both macro and micro workplace cultures influence one's decision to remain in or leave a position. Inclusive leadership characterized by equity and transparency, collaborative working relationships that prioritize group objectives, and channels to shape the workplace through open communication can be leveraged to retain a diverse workforce.