July 7, 2017 / 7:33 PM / 3 months ago

Surgeon moms face special challenges

(Reuters Health) - Dr. Jennifer Davids went straight from high school to college to medical school and into training to become a colorectal surgeon. Even without a break, she wasn’t finished with her studies until she was 34 years old – at the beginning of the end of most women’s reproductive years.

She gave birth to her first child during her surgical training and her second at the start of her practice, challenging times in both cases, and wondered when the optimal time might be for doctors, particularly those in the most demanding medical specialties, to become mothers.

So Davids, a professor at the University of Massachusetts in Worcester, conducted a survey. The responses she got from physician moms showed that there might not be an ideal time for a woman doctor to have a child.

“We didn’t find a great window where everything would seamlessly fall into place,” Davids said in a phone interview. “There is no perfect time.”

But her study did find that physician mothers seemed happier with their careers when they picked specialties requiring fewer years of training and allowing more flexible schedules.

Surgeons, anesthesiologists, gastroenterologists and obstetricians were more likely to wish they’d chosen less demanding specialties than physician mothers in primary care and other generally less demanding specialties, according to the report in the Journal of the American College of Surgeons.

Davids and her colleagues recruited 738 physician mothers who had children during their post-graduate clinical medical training through Facebook’s Physician Moms Group in the spring of 2015. They compared the mothers in surgery and other so-called “procedural” specialties, who made up 30 percent of respondents, to other physician mothers who spent less time training for their specialties.

Participants were nearly all married and lived in almost every state in the U.S., the study found.

Women in procedural fields were more likely to use assisted reproduction to become pregnant and to take shorter maternity leaves. Procedural trainees were also more likely to have to make arrangements for their own substitutes when they missed work, as opposed to having their chief residents or department chairs find substitutes.

The physicians in procedural fields were less likely to have chosen their field based on considerations around pregnancy and childcare, and they were nearly twice as likely to report they wished they were in a less demanding specialty.

The findings point to a need for possible changes in training for procedural specialties, said Davids and her co-author, Dr. Nelya Melnitchouk, a colorectal surgeon at Brigham and Women’s Hospital in Boston.

More flexibility and competency-based training models, as opposed to those that require trainees to perform a certain number of procedures, might ease the difficulties procedural trainees encountered in becoming mothers, Melnitchouk said in an email.

“There are some unique challenges of women in procedural specialties,” Davids said. “There needs to be flexibility and support so we can be there for our patients while also being there for our families.”

Dr. Shanda Blackmon, a cardiothoracic surgeon at the Mayo Clinic in Rochester, Minnesota, believes inappropriate expectations can lead to career dissatisfaction. Blackmon, who was not involved in the new study, stressed the need for a circle of support.

“If you survey who has a husband that stays at home and supports the family,” she said in an email, “the results may be different.”

“Those without a village of support will get out of the specialty to save their families,” she said.

In-hospital childcare and childcare that begins as early as 4 a.m., when trainees are expected to report to the hospital, might help, Blackmon said.

Women comprised just 7 percent of U.S. medical school graduates in 1965, according to the Association of American Medical Colleges. Today that rate hovers near 50 percent. A majority of surgical residents, however, continue to be male.

Previous studies have shown that women in surgical specialties are less satisfied with their careers than their male counterparts.

But Davids has no regrets.

“I certainly wouldn’t change my specialty or my job,” she said. “What I do is my passion. My advice to others would be, ‘make sure you’re proactive in seeking the support you need to accomplish your goals.’ ”

SOURCE: bit.ly/2s3pcsr Journal of the American College of Surgeons, June 13, 2017.

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