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Page 83 Capelli et al. Art Int Surg 2023;3:80-9 https://dx.doi.org/10.20517/ais.2022.40

partners of their male colleagues (65.0% vs. 11.5%, P = 0.0002) or female non-surgical residents
[10]
(P = 0.0329) . The authors attributed the results to variable compliance with maternity leave policies
among surgical schools, with residents often working beyond their due hours to “spare” time to spend with
[40]
the newborn after childbirth. Similar results have been reported among Japanese and American women
surgeons: 63.0% of the respondents to a survey distributed among residents who had a child during surgical
school reported concern that their work schedule could affect their health or the health of their unborn
child .
[41]

These factors may contribute to the postponement of pregnancy among women surgeons, with the
inevitable implication of fertility-related issues . Ponzio et al. reported a higher need for fertility
[42]
treatment in female orthopedic surgeons (32.0% vs. 11.9%; P < 0.001) compared with males and/or their
partners, along with a higher requirement for fertility drugs (19.6% vs. 7.2%; P = 0.001) and in vitro
fertilization (17.6% vs. 4.1%; P < 0.001) .
[11]

Delaying childbearing is just another facet of the difficulties faced in managing work-life balance. An
interview conducted among vascular surgery trainees and program directors on the impact of pregnancy [43]
on life and career pointed out the many and complex reasons why women surgeons often choose to
postpone pregnancy. Among others, the negative impact of a child on professional advancement was
reported by 42.0% of women vs. 14.0% of men (P < 0.001), the lack of time for children by 60.0% of women
vs. 39.0% of men (P = 0.001) and the regret for career choices by 22.0% of women vs. 12.0% of men
(P = 0.028). Female vascular surgeons also more often reported that their choice to delay pregnancy was
partly due to a desire to avoid increasing their colleagues’ workload (36.0% women vs. 13.0% men; P <
0.001), the amount of stress it could bring into their lives (67.0% women vs. 30.0% men; P < 0.001), the
negative perception of peers and program directors towards pregnancy (29.0% of women vs. 1% of men; P <
0.001) and the pressure not to have children from peers or attendings (15.0% women vs. 2.0% men; P <
0.001). For all of these reasons, most studies reported that women surgeons were more likely to postpone
pregnancy after completing surgical training [38,44,45] .

The challenges women face when returning to work following maternity leave are another powerful
deterrent to motherhood. The requirement to preserve surgical skills and high-performance expectations,
regardless of months of absence, were only some of the unsettling issues surgeon mothers have to face,
[46]
according to the narrative inquiry by Offiah et al. . The absence of a supportive surgical system, difficulties
in maintaining an effective work-life balance, the need to make career sacrifices and extend the training
period, loss of respect from colleagues and the feeling of exclusion from the team were other highlighted
issues.

Overall, 24.0% of female and 11.0% of male parent surgeons reported a belief that their work environment
did not support having a family, with women surgeons fearing the negative impacts of childbearing on their
professional growth (P = 0.004); when asked to rethink their career path, 21.0% of female surgeons,
compared to 13.0% of male surgeons, declared a willingness to choose another occupation .
[17]

Burnout among women surgeons
The difficulty of conciliating professional and family life is not without consequences for women surgeons.
A survey distributed among members of the American College of Surgeons, the results of which were
published in 2011, showed that more than half of women surgeon respondents experienced conflict with
their spouse or partner regularly. Burnout and depressive symptoms were reported by 43.3% and 33.0% of
women surgeons, respectively, and were mainly attributed to work-home conflict and high workload