Importance of Workplace Support for Surgeon Parents: A Mixed-Methods Analysis of Challenges and Their Impact on the Surgical Workforce.

Abstract

Balancing surgical careers with family life is linked to risk of pregnancy complications, mistreatment, and attrition. Despite national policy recommendations, institutional support is inconsistent. A survey was distributed by the American College of Surgeons to 32,890 members. An explanatory mixed-methods design was used, combined multivariate logistic regression with thematic analysis of free-text responses. The primary outcome was lack of workplace support (LOWS), a composite measure reflecting inadequate childbearing-related accommodations or cultural support, including stigma, reputational concerns, financial loss, anxiety about burdening colleagues, or concern that family building might hinder advancement. Of 3,539 participants (10.8% response rate), 1,487 parents (525 men, 962 women) were included in the quantitative analysis and 1,059 in the qualitative analysis. LOWS was associated with female sex (odds ratio [OR] 2.52, 95% CI 1.91 to 3.33, p < 0.001), having children during training (OR 1.68, 95% CI 1.03 to 2.75, p = 0.039) or practice (OR 1.87, 95% CI 1.08 to 3.20, p = 0.024) vs during medical school, third-trimester workweeks more than 60 hours (OR 1.45; 95% CI 1.64 to 1.97, p = 0.019), reducing workload during pregnancy (OR 3.62; 95% CI 2.69 to 4.86, p < 0.001), and having fewer children than desired (OR 2.03, 95% CI 1.60 to 2.58, p < 0.001). Risk factors were similar for male and female surgeon parents, except for third-trimester work hours, which were only significant among women. Four qualitative themes emerged: (1) workplace support mitigates perinatal challenges, (2) workplace support shapes surgeons' reproductive decisions, (3) workplace support is essential to work-family integration, and (4) modern surgical practice must support surgeons' dual caregiving and clinician roles. Although LOWS is more common among female surgeon parents, both sexes face support gaps. Sustainable change requires institutional support policies and cultural shifts enabling usage.