Why are there fewer female women surgeons? Residency programs are partially to blame, Bloomberg reports.

The demands of medical residency can make it difficult to have children, particularly for female residents with children—and that may be exacerbating the gender gap in more time-intensive specialties, such as surgery, Rebecca Greenfield and John Tozzi write for Bloomberg.

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The difficulties of being a pregnant resident

According to Greenfield and Tozzi, aspiring physicians are typically in their mid-20s after graduating medical school, and they then must complete a residency that could last anywhere from three to seven years, depending on the specialty. Specializing further requires another year or two of fellowships. For a woman seeking to become a surgeon, which involves at least five years of residency, she could be in her early 30s by the time her training is complete.

The onerous schedule makes it difficult for women to have children during their residencies, at an age when young couples often start their families, Greenfield and Tozzi write. As a result, research suggests women are opting for more flexible specialties. A survey of 347 surgeons who had been pregnant during their residencies found that nearly half of respondents said they had considered quitting while they were pregnant, and about one-third said that they would not recommend female medical students become surgeons.

Ramifications

According to Greenfield and Tozzi, this difficulty for women to have children while in residency is causing a disparity in the proportions of men and women in certain specialties. Greenfield and Tozzi explain that while men and women are attending medical school in equal numbers, women continue to earn less than their male counterparts—often because they opt for lower-paying specialties, such as pediatrics and family medicine, which have shorter, more flexible residency programs.

For instance, research has found that while 44% of all medical residents in 2016 were women, only 36% of surgical residents were women—and more than 66% of pediatric residents were women. Erika Rangel, study co-author and a trauma surgeon at Brigham and Women's, said, "There is a perception that the field isn't compatible with the desire to have a family."

And that perception, according to Rangel, has exacerbated women's attrition rate from surgical residencies. According to a 2016 study, 25% of female surgical residents dropped out of their programs, compared with 15% of men. The most common reason that both men and women dropped out of their residencies, the study found, was the "uncontrollable lifestyle." And residents who left surgical residencies most frequently shifted to programs with more predictable schedules, such as family medicine, the study found.

That said, the field has progressed a bit, Greenfield and Tozzi write. Jo Buyske, the executive director of the American Board of Surgery, explained that just 25 years ago, it was still "extraordinary and rare" for women to have kids while surgical residents. At the time, "the idea of a pregnant surgeon or surgical resident was shocking, although male surgeons and residents commonly had children," she wrote in a 2005 article.

Not an easy problem to solve

People throughout the health care industry recognize the problem, Greenfield and Tozzi write, but the issue is not easy to address. For instance, surgical residents are required to receive 48 weeks of clinical training each year. Therefore, stepping back for a few months to have a baby could potentially disqualify a resident from taking her board exams, which are given just once a year.

In comparison to such a time-intensive speciality, the pediatrics residency program at the University of California-San Francisco (UCSF)—one of the most flexible in the country, according to Greenfield and Tozzi—allows residents to take off up to six months for any reason, including for maternity leave. If opting for maternity leave, a resident will receive six weeks' paid leave, in addition to regular paid vacation time—the rest of the time period is unpaid. "It's been very helpful for a lot of women in our training programs," Dan West, the director of the program, said.

That said, stakeholders for more time-intensive specialties have taken steps to be flexible, Greenfield and Tozzi report. The American Board of Surgery, for instance, in 2009 began permitting residents to take an additional year to finish training in general surgery.

But according to Buyske, the number of residents who take advantage of the extra time remains in the "low double digits." Not only do residents have to get individual approval from their programs, they often have to lump together all of their four weeks of vacation time, plus two weeks of paid medical leave, to get just six weeks off after delivering a child, Greenfield and Tozzi write. "There's no slack built into the system," Buyske said (Greenfield/Tozzi, Bloomberg, 10/10).

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