How pregnancy and childbirth affect the working conditions and careers of women surgeons in Japan: findings of a nationwide survey conducted by the Japan Surgical Society

Challenges in pregnancy and lactation among surgical residents and attendings: A systematic review

BACKGROUND

With more women entering surgical training, barriers concerning pregnancy and breastfeeding are pertinent issues that have not been addressed adequately in a specialty with more men. An increasing body of evidence for the consequences of these challenges is emerging but has not been reviewed thoroughly. This study aims to provide a comprehensive review of the physical, emotional, and practical challenges of pregnancy and breastfeeding during surgical training and career and to elucidate the main difficulties and barriers female surgeons experience.

METHODS

A systematic review was conducted (PROSPERO ID CRD42022365022) in PubMed, Embase, Google Scholar, and Cochrane up until October 2022. Literature search, data extraction, and quality and risk of bias assessments were performed by 2 reviewers independently.

RESULTS

Forty-four studies from 7 countries (United States of America, Australia, Canada, Ireland, Japan, New Zealand, and the United Kingdom) were included. Female surgeons were significantly more likely to have undergone artificial reproductive treatments and reported more pregnancy-associated complications. Negative stigma, harassment, discrimination regarding parenthood, and incompatibility of surgical work with childbearing were seen across different countries. Difficulties during lactation caused by high work demands, too little time to express milk, and feeling unsupported resulted in shorter duration and greater dissatisfaction.

CONCLUSIONS

Female surgeons have a high risk of experiencing a myriad of fertility and childbearing complications during their career. Pregnant female surgeons and trainees face widespread issues of stigma, discrimination, and harassment. This review emphasizes the need to address the lack of support and shortage of facilities to create a more inclusive training and working environment.

Motherhood penalty for female physicians in Japan: evidence from a medical school's alumni data

BACKGROUND

Female physicians with children often work fewer hours and take fewer shifts due to additional family responsibilities. This can contribute to a gender pay gap in the medical profession. However, limited research in Japan has quantitatively examined the factors contributing to this gap. This study aims to address this gap in the literature.

METHODS

We analyzed the alumni data from a medical school in Hokkaido, Japan, for 260 physicians (198 males and 62 females). We used multivariable regression models to identify factors influencing earnings from medical practice, with a focus on gender, work schedules, parenthood, and any career interruptions related to childcare.

RESULTS

Our analysis revealed a 25.0% earnings gap between male and female physicians. Nearly all female physicians with children experienced career interruptions due to childcare, while this was uncommon for male physicians. When these childcare-related interruptions were factored in, the gender pay gap narrowed by 9.7%. After adjusting for work schedules and specialty choices, female physicians with children still earned 37.2% less than male physicians, while those without children earned only 4.4% less. This suggests that motherhood is a significant driver of the gender pay gap among physicians.

CONCLUSIONS

These findings highlight the negative impact of motherhood on female physicians' earnings. This emphasizes the need for policy measures to mitigate the disadvantages faced by mothers in the medical profession.

How long will it take to reach the gender diversity goal for orthopaedics in Japan?

BACKGROUND

In Japan, orthopaedics is one of the medical fields with the lowest proportion of women. This study analyses the change in gender diversity over the past decade and estimates the time required to achieve the 30% gender diversity goal, according to the critical mass in Japan in 2020.

METHODS

We investigated the demographic composition of orthopaedic surgeons in 2020 by age group, the gender ratio of the main clinical fields from 2010 to 2020, and estimated the time required for the bottom 10 (i.e., least diverse) medical departments in Japan to reach the proportion of 30% women. We used simple linear regression analyses to clarify the number of years.

RESULTS

In 2020, the population pyramid of orthopaedic surgeons showed that those in their 50s were the largest component with 24.1%, followed by those in their 40s and 30s with 22.3% and 19.4%, respectively. The percentage of women orthopaedic surgeons increased slightly from 4.1% in 2010 to 5.7% in 2020. This means that to achieve the proportion of 30% women at the current annual increase rate, orthopaedics would require up to 160 years, cardiovascular 149 years, and neurosurgery 135 years.

CONCLUSION

Contrary to the recent increase in the number of women physicians, there has been only a slight increase in the number of women orthopaedic surgeons over the past decade. Moreover, the number of young male orthopaedic surgeons has decreased. As current orthopaedic surgeons age and retire, Japan will soon face an overall shortage of orthopaedic surgeons. Issues that must still be addressed in Japanese orthopaedics include educating men and women about gender diversity and bias, changing stereotypes about surgical lifestyles, improving work-life balance, and diligent and collaborative efforts at both the individual and community levels.

Gender Gap in Parental Leave Among Physicians in Japan

Objective

To investigate the gender gap in parental leave uptake among physicians and explore the burden of childcare on female physicians compared with their male counterparts.

Methods

The focus was on the rate for taking childcare leave as an indicator of the gender gap in the burden of childcare. Data from the Japanese Ministry of Health, Labor and Welfare's national database were analyzed to investigate the population ratio of physicians who took parental leave. The study included male and female physicians from different years and prefectures.

Results

Gender disparity in parental leave uptake among physicians was observed. On average, male physicians take parental leave at a rate of 0.05%, while female physicians have a much higher rate of 4.5%. Around 1,400 to 1,700 female physicians took parental leave annually, compared with only 20-70 male physicians. This highlights the disproportionate burden of childcare on female physicians.

Conclusion

The study demonstrates a considerable childcare burden on female physicians due to the rarity of male physicians taking parental leave. The findings underscore the urgency of addressing the gender gap in parental leave uptake among physicians and promoting gender equality in childcare responsibilities. Future research and policy initiatives should focus on achieving a more equitable distribution of parental leave to alleviate the burden on female healthcare professionals and improve work-life balance in the medical profession.

Family planning and parity among pediatric surgeons — it is time to confront a serious problem (a survey among Brazilian female pediatric surgeons)

Background

Obstetric problems and infertility affect female surgeons. Family perspectives influence specialty choice and attrition rates. We aim to study parity, fertility, and family planning among female pediatric surgeons. A questionnaire was filled out by licensed BFPS to evaluate pregnancy/motherhood among Brazilian female pediatric surgeons (BFPS). The professionals were divided into two groups that were compared (< 40 and ≥ 40 years of age).

Results

Eighty-three < 40 and 91 ≥ 40-year-old BFPS were included, of which 2/3 were mothers. Most planned children after being hired as consultants. Almost a tenth (8.87%) reported marital conflicts secondary to the refusal to get pregnant. A fifth reported a high-risk pregnancy, and 12.73% had miscarriages. Half reported no adverse consequences of postponing pregnancy, but 6.9% stayed childless, 16.67% had fewer children than planned, and 10.92% needed infertility treatment. Professional problems related to pregnancy/motherhood were reported by 59.09%, and 86.36% of the women who were mothers had difficulties conciliating professional duties and motherhood.

Conclusion

BFPS parity was 1.38, lower than Brazilian women (mean 1.77 children/woman). Most BFPS start their families by late 30s or early 40s. Unfavorable consequences of postponing pregnancy affected a third of BFPS. Time off after pregnancy and protection during pregnancy remain problematic. A hostile environment and life-career conflicts may lead to the abandonment of the specialty.

Early Barriers to Career Progression of Women in Surgery and Solutions to Improve Them: A Systematic Scoping Review

OBJECTIVE

This study aims to summarize the evidence concerning the barriers that exist to the career progression of women in surgery and to provide potential solutions to overcome these obstacles.

BACKGROUND

Visible and invisible impediments can hinder female doctors' pursuit of a surgical career, from choosing a surgical specialty to training opportunities and all the way through career progression.

METHODS

Database search of original studies about barriers for female surgeons during choice of surgical career, residency, and career progression. A query including possible solutions such as mentorship and network was included.

RESULTS

Of 4618 total articles; 4497 were excluded as duplicates, having incorrect study focus, or not being original studies; leaving 120 studies meeting the inclusion criteria. Of the articles included, 22 (18%) focused on factors affecting the pursuit of a surgical career, such as surgical work hours and limited time for outside interests, 55 (46%) analyzed the main barriers that exist during surgical residency and fellowship training, such as discrimination and sexual harassment, 27 (23%) focused on barriers to career advancement, heavy workloads, ineffective mentorship, unclear expectations for advancement, inequality in pay or work-home conflicts. Among studies reporting on possible solutions, 8 (6.5%) articles reported on the role of effective mentorship to support career advancement and to provide moral support and 8 (6.5%) on the emerging role of social media for networking. Our analysis showed how different impediments hinder surgical career progression for women, with notable consequences on burnout and attrition.

CONCLUSIONS

Identification and recognition of obstacles to career progression is the first step to addressing the gender gap in surgery. Active strategies should be improved to promote a culture of diversity and to create equal opportunity for women in surgery, while implementing structured mentoring programs and investing on an adequate communication on social media to engage the future generations.

Clinical course and outcome of differentiated thyroid cancer patients with pregnancy after diagnosis of distant metastasis

PURPOSE

There is no sufficient data about the clinical course and outcome in thyroid cancer patients who become pregnant after diagnosis of distant metastasis (DM). The current study was conducted to collect information regarding the clinical and reproductive characteristics, and outcomes in thyroid cancer patients who became pregnant after being diagnosed with DM.

METHODS

Records of 125 differentiated thyroid cancer (DTC) patients with age ≤45 years at DM diagnosis who had visited Ito Hospital from January 2005 to June 2021 were retrospectively reviewed. Among those 125 patients, 28 who became pregnant after DM diagnosis were classified as pregnancy group, and the remained 97 patients were classified as comparator group.

RESULTS

In pregnancy group, the median age at malignancy diagnosis, DM diagnosis, and first pregnancy after DM diagnosis was 25 years (range, 4-41 years), 27 years (range, 11-41 years), and 32 years (range, 25-45 years), respectively. Fifty-five pregnancies and 40 live births were reported. Other pregnancy outcomes were miscarriage (n = 14) and induced abortion (n = 1). The 10-year progression-free survival (PFS) rates of pregnant and comparator group were 92.1% and 74.4%, respectively (p = 0.018). The multivariate analysis showed that multiple ¹³¹I treatment was independent negative prognostic factor for PFS (p = 0.046).

CONCLUSIONS

DTC patients with age ≤45 years at DM diagnosis had good survival even though they became pregnant. Our results add to the information required for counseling thyroid cancer patients who have concerns about their fertility in the future.