Pediatric resident perceptions of family-friendly benefits

Symptoms of depression and anxiety and stress among postgraduate trainees in Sri Lanka: Risk factors and implications for practice

High workload, long working hours, and the need to study and work simultaneously put postgraduate trainee doctors at a high risk of depression, anxiety, and stress. A cross-sectional descriptive study was conducted among all postgraduate trainees registered at the Postgraduate Institute of Medicine (PGIM), Sri Lanka, using the 21-item Depression Anxiety Stress Scale (DASS-21). Eleven-point two percent (11.2%) had depressive symptoms, 8.9% had anxiety symptoms, and 1.9% had high levels of stress. Being female, having a past or current mental illness, not being supported by the trainers, being unfairly treated by trainers, dissatisfaction with the work environment, difficulty in coping with long working hours, and poor peer support were significantly associated with symptoms of depression and anxiety, and stress (P < 0.01). Given the association between psychological distress and the characteristics of training and work environment, the postgraduate training programs should be reviewed to ensure the psychological well-being of trainees.

Parental leave during pediatric fellowship training: A national survey

BACKGROUND

Until recently, no uniform requirements for parental leave (PL) existed in graduate medical education. We implemented a national survey, with the objective of ascertaining fellows' perceptions of PL policies and their impact. This is the first study to focus exclusively on pediatric subspecialty fellows.

METHODS

An online survey instrument was created targeting pediatric fellows.

RESULTS

The survey was accessed by 1003 (25%) of the estimated 4078 pediatric subspecialty fellows and 853 (21%) submitted surveys. Respondent demographic data paralleled the data reported by the American Board of Pediatrics. Half of respondents did not know whether their program had a written PL policy. Over 40% reported ≥ 5 weeks of paid PL. Most indicated that fellows use vacation, sick leave, and unpaid time for PL. Almost half of respondents (45%) indicated that their program's PL policy increases the stress of having a child. Fellows chose establishing/extending paid leave and intentionally fostering a more supportive program culture as the most crucial candidate improvements. The importance of equitable PL polices between parent fellows and co-fellows was an important theme of our qualitative data. Fellows feel there is a moral misalignment between the field of pediatrics' dedication to maternal and child health and current PL policies governing pediatric trainees.

CONCLUSIONS

PL policies vary widely among pediatric fellowship programs and are often not known by fellows. Fellows are not satisfied with PL policies, which often exacerbate stress for new parents and burden their co-fellows. Targeted modification of several aspects of PL policies may improve their acceptance.

Parental leave policy information during residency interviews

BACKGROUND

During interviews, medical students may feel uncomfortable asking questions that might be important to them, such as parental leave. Parental leave policies may be difficult for applicants to access without asking the program director or other interviewers. The goal of this study is to evaluate whether parental leave information is presented to prospective residents and whether medical students want this information.

METHODS

Fifty-two program directors (PD's) at 3 sites of a single institution received a survey in 2019 to identify whether parental leave information is presented at residency interviews. Medical students received a separate survey in 2020 to identify their preferences. Fisher exact tests, Pearson χ² tests and Cochran-Armitage tests were used where appropriate to assess for differences in responses.

RESULTS

Of the 52 PD's, 27 responded (52%) and 19 (70%) indicated that information on parental leave was not provided to candidates. The most common reason cited was the belief that the information was not relevant (n = 7; 37%). Of the 373 medical students, 179 responded (48%). Most respondents (92%) wanted parental leave information formally presented, and many anticipated they would feel extremely or somewhat uncomfortable (68%) asking about parental leave. The majority (61%) felt that these policies would impact ranking of programs "somewhat" or "very much."

CONCLUSIONS

Parental leave policies may not be readily available to interviewees despite strong interest and their impact on ranking of programs by prospective residents.

Parenthood, Parental Benefits, and Career Goals Among Pediatric Residents: 2008 and 2019

OBJECTIVES

Examine reported availability of parental benefits for pediatric residents and impact of parenthood on reported importance of characteristics of post-training positions and career goals in 2008 and 2019.

METHODS

We analyzed data from American Academy of Pediatrics surveys of graduating residents in 2008 and 2019 querying (1) parenthood, (2) benefits during residency, (3) importance of parental benefits and job characteristics in post-training position, and (4) subspecialty career goal. Logistic regression was used to estimate independent effects of gender, partner status, and parenthood via derived predicted values (PVs).

RESULTS

Of 1021 respondents, three-fourths were women. Respondents in 2019 were less likely than in 2008 to have children (24.5% vs 33.8%, P < .01). In 2019, respondents were less likely to report availability of maternity (PV = 78.5% vs 89.5%, P < .001) or parental leave (PV = 42.5% vs 59.2%, P < .001) and more likely to report availability of lactation space (PV = 77.8% vs 56.1%, P < .001.). Most residents reported control over work hours, family considerations, and number of overnight calls per month as essential or very important characteristics in post-training positions. Controlling for resident characteristics, parenthood was associated with importance of family considerations and overnight calls in post-training position. Parenthood did not associate with subspecialty career goals, but gender did.

CONCLUSIONS

Residents are less likely to report availability of parental benefits during residency training in 2019. Most residents, both those with children and those without, consider parent friendly characteristics important in post-training positions. Parenthood does not correlate with subspecialty career goals independent from gender.

Parenthood and Parental Leave Decisions in Pediatric Residency

OBJECTIVES

The demands of residency training may impact trainees' decision to have children. We examined characteristics of pediatric residents' decisions regarding childbearing, determinants of resident parental leave, and associations with well-being.

METHODS

A survey of 845 pediatric residents at 13 programs was conducted between October 2019 and May 2020. Survey items included demographics, desire for future children, and logistics of parental leave. Outcomes included parental leave length, burnout and depression screening results, satisfaction with duration of breastfeeding, and satisfaction with parental leave and parenthood decisions.

RESULTS

Seventy-six percent (639 of 845) of residents responded to the survey. Fifty-two percent (330) of respondents reported delaying having children during residency, and 29% (97) of those were dissatisfied with their decision to do so. Busy work schedule (89.7%), finances (50.9%), and a desire not to extend residency (41.2%) were the most common reasons for delay. Of respondents, 16% were parents and 4% were pregnant or had pregnant partners. Sixty-one parental leaves were reported, and 67% of parents reported dissatisfaction with leave length. The most frequently self-reported determinant of leave duration was the desire not to extend residency training (74%). Program mean leave length was negatively associated with burnout, measured as a dichotomous outcome (odds ratio = 0.81 [95% confidence interval 0.68-0.98]; P = .02).

CONCLUSIONS

Many pediatric trainees delay parenthood during residency and are not satisfied with their decision to do so. Pediatric resident parental leave remains short and variable in duration, despite the positive association between longer leaves and overall well-being.

Pediatric Trainees as Parents: Perspectives on Parenthood From Pediatric Resident Parents

OBJECTIVES

Prior work across medical and surgical specialties shows that parenthood during residency training is associated with challenges including limited parental leave, lack of accommodations for breastfeeding, and concerns about career impact. Less is known about the experience of parenthood during pediatric residency training. The objective of this study was to identify themes related to the experience of parenthood during pediatric residency.

METHODS

In this qualitative study using thematic analysis, we performed semistructured interviews with participants who were currently in pediatric residency or had graduated in the previous 3 years and were parents during residency. Participants were recruited by e-mail. Data were collected and analyzed iteratively until thematic saturation was achieved. Two independent reviewers coded each transcript. Codes were grouped into categories and then into dominant themes.

RESULTS

Thirty-one residents were interviewed from 13 pediatric residency programs. Four major themes regarding the experience of parenthood during pediatric residency were defined by the data: 1) the struggles of parenthood and residency exacerbate each other; 2) institutional modifiers strongly influence the experiences of resident parents; 3) resident parents develop skills and perspectives that enhance their pediatric training; and 4) although levels of support for pediatric resident parents vary, the culture of pediatrics positively influences the experience of parenthood in residency.

CONCLUSIONS

There are numerous challenges navigating parenthood and residency, but institutional policies and culture can modify the experience. Importantly, the educational value of parenthood to pediatric training was immense. Our findings may be used to design interventions to support parenting during residency.

Challenges and Solutions for Physician Mothers: A Critical Review of the Literature

Physician mothers face unique challenges related to family planning, pregnancy, childcare, work-life integration, inequities, and biases that may have serious widespread implications. There is a paucity of available information on the extent and ramifications of such challenges and related solutions. The purpose of this critical review of the literature was to identify and summarize challenges and solutions pertaining to physician mothers. A comprehensive literature search of databases (PubMed, CINAHL, EBSCO MegaFILE, and APA PsycInfo on Ovid) from January 1, 2008, to December 31, 2018, identified empirical articles that addressed challenges, policies, or solutions specific to physician mothers. Search terms included: physician, doctor, surgeon, specialist, hospitalist, pediatrician, woman, female, gender, mom, mother, maternity, breastfeed, pregnant, baby, infant, parent, parenthood, child,bias, status, stigma, inequity, discrimination, equal, unequal, justice, childcare, daycare, babysit, and nanny in various combinations. Seventy-one articles met inclusion criteria and were analyzed to identify categories and themes related to challenges and solutions for physician mothers. Themes for challenges were categorized by level of influence (individual, organizational and health care system, and societal); themes for solutions were categorized by approach and intervention (mentorship, childbearing and child-rearing support, addressing barriers to career satisfaction and work-life integration, and identification and reduction of maternal bias in medicine). Physician mothers face challenges that have negative implications for individuals, organizations and the health care system, and society. Clear understanding of associated challenges and potential solutions is a critical first step to address biases and barriers affecting physician mothers.

Child-rearing During Postgraduate Medical Training and Its Relation to Stress and Burnout: Results From a Single-institution Multispecialty Survey

INTRODUCTION

Child-rearing is difficult for medical trainees, but much of the available evidence is limited to individual specialties or lacks an analysis of well-being. In light of this, we sought to examine current perspectives across a wide range of medical specialties, determine associations with stress and burnout, and identify potential supportive solutions.

METHODS

After Institutional Review Board approval, a voluntary and anonymous survey was sent to all residents and fellows at a large academic medical center with a U.S. Air Force joint training agreement in 2019. Frequency tables were generated for survey responses, using χ2 test for analysis between groups.

RESULTS

One hundred and eighty-four physician trainees completed the survey (21.6% response rate), of which 38.0% were parents. Overall, 90.8% of trainees want children but 68.5% plan to wait until after training to start or grow their families, mainly due to insufficient time or inadequate child care. Less than 2% cited lack of program support as the reason. Among trainee parents, 72.0% reported that child care was at least quite stressful. Child care contributes to burnout for 68.6% of trainee parents, and there was no difference between medical and surgical trainees or between military and nonmilitary trainees. Day care was the most common primary child care strategy, and 37.1% of trainee parents reported spending >25% of their household income on child care. Proposed helpful solutions include on-site day care and subsidies.

CONCLUSIONS

Most medical trainees in this sample want children, yet many are delaying growing their families due to time and financial constraints. For trainee parents, child care causes stress and family and financial strain and contributes to burnout. Physicians in training, including military members training at civilian medical centers, could benefit from child care assistance in order to relieve stress, reduce burnout, and improve well-being. Furthermore, by expanding existing resources and implementing new creative solutions to the challenges of child-rearing among medical professionals, the U.S. military has an opportunity to improve members' well-being and be a model to civilian graduate medical education programs nationwide.

Motherhood and medicine: systematic review of the experiences of mothers who are doctors

OBJECTIVE

To synthesise what is known about women combining motherhood and a career in medicine by examining the published research into their experiences and perspectives.

STUDY DESIGN

We reviewed peer-reviewed articles published or available in English reporting original research into motherhood and medicine and published during 2008-2019. Two researchers screened each abstract and independently reviewed full text articles. Study quality was assessed.

DATA SOURCES

CINAHL, MEDLINE, PsycINFO, Web of Science, and Scopus abstract databases.

DATA SYNTHESIS

The database search identified 4200 articles; after screening and full text assessment, we undertook an integrative review synthesis of the 35 articles that met our inclusion criteria.

CONCLUSIONS

Three core themes were identified: Motherhood: the impact of being a doctor on raising children; Medicine: the impact of being a mother on a medical career; and Combining motherhood and medicine: strategies and policies. Several structural and attitudinal barriers to women pursuing both medical careers and motherhood were identified. It was often reported that women prioritise career advancement by delaying starting a family, and that female doctors believed that career progression would be slowed by motherhood. Few evaluations of policies for supporting pregnant doctors, providing maternity leave, and assisting their return to work after giving birth have been published. We did not find any relevant studies undertaken in Australia or New Zealand, nor any studies with a focus on community-based medicine or intervention studies. Prospective investigations and rigorous evaluations of policies and support mechanisms in different medical specialties would be appropriate.

PROTOCOL REGISTRATION

PROSPERO CRD42019116228.

Medical School Location and Sex Affect the In-State Retention of Pediatric Residency Program Graduates in Hawai'i

The objective of this study was to assess the impact of medical school, sex, career choice, and location of practice of one pediatric residency program on physician workforce. This is a retrospective study of all categorical pediatric graduates of a residency program located in Honolulu, Hawai'i from 1968 to 2015. Information on medical school training, sex, career choice (general pediatrics or specialty), and location of practice were studied by examining data into five 10-year graduation periods. The program graduated 319 residents over nearly a 50-year timespan. Of these, 181 (56.7%) residents remained in Hawai'i to practice (adjusted odds ratio [OR] = 7.46, 95% confidence interval [CI]: 3.61-15.43). There were 125 (39.1%) graduates who relocated to the continental US with the majority moving to the West (55.2%), while other graduates moved to the South, Midwest, and Northeast (25.6%, 13.6%, and 5.6%, respectively). The remaining 13 (4.1%) graduates moved internationally. Female residents steadily increased over time (P < .001), with females significantly choosing general pediatrics (OR = 3.05, 95% CI: 1.91-4.89). In the time periods with the highest percentage of University of Hawai'i medical school graduates, there was an increased percentage of graduates staying in Hawai'i. This study examined the regional and national impact of a small residency program. The results indicated that trends in gender and the impact of medical school location were important in establishing a pediatrician workforce for local communities. Support of both medical school and residency education should be considered when assessing future workforce needs.

A Structured Neonatal Parenting Elective: An Approach for Parenting Leave During Residency

OBJECTIVE

Pregnancy is common during residency, yet the duration of allowed paid leave is inadequate and utilizing unpaid family medical leave act (FMLA) time has financial and professional consequences. We evaluated the effectiveness of a novel parenting elective, consistent with educational goals for pediatric residents, on resident parents' financial, academic, and family outcomes.

METHODS

In 2010, a 2-4 week structured at-home elective of outpatient neonatal care with full pay was implemented. Data were collected from all new parents in a large academic pediatric residency from 2002 to 2018, including duration of leave, on-time graduation, choice to pursue postresidency training, and unpaid FMLA leave. Data were compared from before/after implementation and by parent type (mothers or resident partners of mothers).

RESULTS

Twenty-two pregnancies occurred prior to implementation and 42 afterward. In mothers, leave duration was similar (7.9 ± 3.5 weeks before, 8.0 ± 0.3 after, P = .50) but the minimum time increased from 2 to 6 weeks and those taking ≥7 weeks increased (54% vs 96%, P = .002). Mothers using unpaid FMLA time decreased (38% vs 7%, P = .04) although on-time graduation (69% vs 93%, P = .13) and postresidency training rates were similar. Among partners, leave duration increased (0.8 ± 0.4 weeks vs 4.0 ± 1.7, P < .001) and 79% took ≥4 weeks, compared to 0% pre-elective (P < .001). In partners, postresidency training, FMLA, or on-time graduation rates did not change.

CONCLUSIONS

Parenting a neonate provides learning opportunities for pediatric residents that can be encompassed in an elective consistent with training requirements. This elective improved outcomes for mothers and partners and is generalizable to any training program.

What Proportion of Orthopaedic Surgery Residency Programs Have Accessible Parental Leave Policies, and How Generous are They?

BACKGROUND

Parental leave during graduate medical education is a component of wellness in the workplace. Although every graduate medical education program is required by the Accreditation Council for Graduate Medical Education (ACGME) to have a leave policy, individual programs can create their own policies. The ACGME stipulates that "the sponsoring institution must provide a written policy on resident vacation and other leaves of absence (with or without pay) to include parental and sick leave to all applicants." To our knowledge, a review of parental leave policies of all orthopaedic surgery residency programs has not been performed. QUESTION/PURPOSES: (1) What proportion of orthopaedic surgery residency programs have accessible parental (maternity, paternity, and adoption) leave policies? (2) If a policy exists, what financial support is provided and what allotment of time is allowed?

METHODS

All ACGME-accredited orthopaedic surgery residency programs in 2017 and 2018 were identified. One hundred sixty-six ACGME-accredited allopathic orthopaedic surgery residency programs were identified and reviewed by two observers. Reviewers determined if a program had written parental leave policy, including maternity, paternity, or adoption leave. Ten percent of programs were contacted to verify reviewer findings. The search was sequentially conducted starting with the orthopaedic surgery residency program's website. If the information was not found, the graduate medical education (GME) website was searched. If the information was not found on either website, the program was contacted directly via email and phone. Parental leave policies were classified as to whether they provided dedicated parental leave pay, provided sick leave pay, or deferred to unpaid Family Medical Leave Act (FMLA) policies. The number of weeks of maternity, paternity, and adoption leave allowed was collected.

RESULTS

Our results showed that 3% (5 of 166) of orthopaedic surgery residency programs had a clearly stated policy on their program website. Overall, 81% (134 of 166) had policy information on the institution's GME website; 7% (12 of 166) of programs required direct communication with program coordinators to obtain policy information. Further, 9% (15 of 166) of programs were deemed to not have an available written policy as mandated by the ACGME. A total of 21% of programs (35 of 166) offered designated parental leave pay, 29% (48 of 166) compensated through sick leave pay, and 50% (83 of166) deferred to federal law (FMLA) requiring up to 12 weeks of unpaid leave.

CONCLUSIONS

Although 91% of programs meet the ACGME requirement of written parental leave policies, current parental leave policies in orthopaedic surgery are not easily accessible for prospective residents, and they do not provide clear compensation and length of leave information. Only 3% (5 of 166) of orthopaedic surgery residency programs had a clearly stated leave policy accessible on the program's website. Substantial improvements would be gained if every orthopaedic residency program clearly outlined the parental leave policy on their residency program website, including compensation and length of leave, particularly in light of the 2019 American Board of Orthopaedic Surgery changes allowing time away to be averaged over the 5 years of training.

CLINICAL RELEVANCE

Parental leave policies are increasingly relevant to today's trainees []. Applicants to orthopaedic surgery today value work/life balance including protected parental leave [].

The Relationship Between Institution-Affiliated Childcare and Employee Stress

OBJECTIVE

To evaluate the relationship between utilization of institution-affiliated childcare and employee stress among parents working at a large, academic medical center.

METHODS

Cross-sectional analysis of the relationship between institution-affiliated childcare and employee stress. Survey questions asked about personal stress related to job, relationship with spouse, parental responsibilities, childcare, finances, and personal health.

RESULTS

558 (68%) respondents were predominantly women (76.9%). Fifty-four percent had non-institution-affiliated childcare and 45% had institution-affiliated childcare. Use of institution-affiliated childcare was associated with less overall stress (-4.86 [95% confidence interval -8.01, -1.72], P = 0.003), and less stress related to finances, childcare, and personal health. Differences between groups related to job, relationship with spouse, or parental responsibilities were not statistically significant.

CONCLUSIONS

This study demonstrated an association between institution-affiliated childcare and lower stress, highlighting the centrality of employer-affiliated childcare to employees' stress.

Is It Safe to Ask the Questions That Matter Most to Me? Observations From a Female Residency Applicant

Tens of thousands of senior medical students interview for medical residency positions each year. As the applicant pool shifts to include more women, married individuals, and young parents, the criteria by which interviewees evaluate programs are also changing. Concerns including parental leave policies, lactation facilities, access to childcare, partner recruitment resources, and inclusivity in the work environment are important in selecting an ideal program. However, the National Resident Matching Program Match Communication Code of Conduct prohibits interviewers from addressing gender, marital status, and intent to bear children, so the burden of introducing such topics falls on the interviewees. These topics can be difficult to discuss with potential employers, especially when weighed against the pressure to obtain a competitive position through the Match.In this Invited Commentary, the authors draw on personal experience to examine the questions that residency programs need to answer, encouraging both applicants and programs to improve communication during the residency interview process.

Parenthood During Graduate Medical Education: A Scoping Review

PURPOSE

To conduct a scoping review of the literature on parenthood during graduate medical education (GME) and to develop a conceptual framework to inform policy and guide research.

METHOD

The authors searched PubMed and Embase for articles published from January 1993 through August 7, 2017, using a query framework that combined the concepts of "person" (e.g., "trainee") and "parenthood" (e.g., "breastfeeding"). They included studies describing parenthood or pregnancy of trainees in U.S. GME training programs. Two authors independently screened citations and abstracts and performed kappa coefficient tests to evaluate interreviewer reliability. Two authors performed a full-text review of and extracted data from each included article, and 4 authors coded data for all articles. The authors used descriptive statistics and qualitative synthesis to analyze data.

RESULTS

Ninety articles met inclusion criteria, and nearly half (43/90; 48%) were published between 2010 and 2017. The authors developed 6 themes that surround resident parenthood: well-being, maternal health, others' perceptions, relationships, program preparation, and policy. They mapped these themes by relationship of stakeholders (e.g., infant and family, institutions) to the resident-parent to create a conceptual framework describing parenthood during GME.

CONCLUSIONS

The findings from this scoping review have implications for policy and research. Those authoring parental leave policies could collaborate with national board leaders to develop consistent standards and include nontraditional families. Gaps in the literature include the effect of resident parenthood on patient care, postpartum health, and policy execution. Research in these areas would advance the literature on parenthood during residency.

Productive Pumping: A Pilot Study to Help Postpartum Residents Increase Clinical Time

BACKGROUND

Many female residents choose to start families during training, and they want to breastfeed their infants. Continuing lactation while balancing service and education demands can be challenging.

OBJECTIVE

We hypothesized that the presence of a dedicated and fully equipped lactation room with a hospital-grade pump (HGP) would increase ease and efficiency of lactation during residency.

METHODS

A quiet HGP was purchased for resident use, and it was stored in a designated room with a computer, telephone, and dictation system. Lactating residents provided information about pumping time and production using their own portable double electric pump (PP) versus the HGP based on the first pump of the morning (for consistency), averaged over the first month back from maternity leave.

RESULTS

Among 6 residents, lactation time with PP averaged 24 minutes (range, 15-40 minutes) versus 15.5 minutes with HGP (range, 10-32 minutes). Use of the HGP reduced total pumping time by 8.5 minutes (95% confidence interval 3.8-12.2, P = .045). Production volume increased from 6 ounces (range, 3.5-8.5 ounces) with PP to 8.8 ounces (range, 8-11 ounces) with HGP, for a mean increase of 2.8 ounces (95% confidence interval 1.2-4.3, P = .06) despite decreased lactation time.

CONCLUSIONS

In our pilot, an HGP significantly decreased lactation time, while increasing expressed milk volume. Residents completed clinical and educational tasks while pumping. Providing an HGP and equipped lactation space helped residents continue breastfeeding and decreased the burden of lactation on patient care and educational tasks.

Equal Pay for Equal Work: Medicare Procedure Volume and Reimbursement for Male and Female Surgeons Performing Total Knee and Total Hip Arthroplasty

BACKGROUND

The observed sex gap in physician salary has been the topic of much recent debate in the United States, but it has not been well-described among orthopaedic surgeons. The objective of this study was to evaluate for sex differences in Medicare claim volume and reimbursement among orthopaedic surgeons.

METHODS

The Medicare Provider Utilization and Payment Public Use File was used to compare claim volume and reimbursement between female and male orthopaedic surgeons in 2013. Data were extracted for each billing code per orthopaedic surgeon in the year 2013 for total claims, surgical claims, total knee arthroplasty (TKA) claims, and total hip arthroplasty (THA) claims.

RESULTS

A total of 20,546 orthopaedic surgeons who treated traditional Medicare patients were included in the initial analysis. Claim volume and reimbursement received were approximately twofold higher for all claims and more than threefold higher for surgical claims for male surgeons when compared with female surgeons (p < 0.001 for all comparisons). A total of 7,013 and 3,839 surgeons performed >10 TKAs and THAs, respectively, in 2013 for Medicare patients and were included in the subset analyses. Although male surgeons performed a higher mean number of TKAs than female surgeons (mean and standard deviation, 37 ± 33 compared with 26 ± 17, respectively, p < 0.001), the claim volume for THAs was similar (29 ± 22 compared with 24 ± 13, respectively, p = 0.080). However, there was no significant difference in mean reimbursement payments received per surgeon between men and women for TKA or THA ($1,135 ± $228 compared with $1,137 ± $184 for TKA, respectively, p = 0.380; $1,049 ± $226 compared with $1,043 ± $266 for THA, respectively, p = 0.310).

CONCLUSIONS

Female surgeons had a lower number of total claims and reimbursements compared with male surgeons. However, among surgeons who performed >10 THAs and TKAs, there were no sex differences in the mean reimbursement payment per surgeon.

CLINICAL RELEVANCE

The number of women in orthopaedics is rising, and there is much interest in how their productivity and compensation compare with their male counterparts.

Pediatricians Working Part-Time Has Plateaued

OBJECTIVE

To examine trends in pediatricians working part-time and residents seeking part-time work and to examine associated characteristics.

STUDY DESIGN

The American Academy of Pediatrics (AAP) Periodic Survey of Fellows and the AAP Annual Survey of Graduating Residents were used to examine part-time employment. Fourteen periodic surveys were combined with an overall response rate of 57%. Part-time percentages were compared for surveys conducted from 2006-2009 and 2010-2013. The AAP Annual Surveys of Graduating Residents (combined response rate = 60%) from 2006-2009 were compared with 2010-2013 surveys for residents seeking and obtaining part-time positions following training. Multivariable logistic regression models identified characteristics associated with part-time work.

RESULTS

Comparable percentages of pediatricians worked part-time in 2006-2009 (23%) and 2010-2013 (23%). There was similarly no statistically significant difference in residents seeking part-time work (30%-28%), and there was a slight decline in residents accepting part-time work (16%-13%, aOR .75, 95% CI .56-.96). Increases in working part-time were not found for any subgroups examined. Women consistently were more likely than men to work part-time (35% vs 9%), but they showed different patterns of part-time work across age. Women in their 40s (40%) were more likely than other women (33%) and men in their 60s (20%) were more likely than other men (5%) to work part-time.

CONCLUSIONS

There has been a levelling off in the number of pediatricians working part-time and residents seeking part-time work. Overall, women remain more likely to work part-time, although 1 in 5 men over 60 work part-time.