By Virginia R. Litle MD and Mara B. Antonoff MD
Our upcoming Tweet Chat will take place on Monday February 26th, 8 pm ET.
“Take your full maternity leave,” writes Myriam Curet in Navigating Your Surgical Career: The AWS Guide to Success. In what other fields do women have to be reminded to take what they are owed? Why would we not take full maternity leave? What is full maternity leave? It depends where you live. In Canada, Scandinavia or Japan that could be one year. In the U.S. it is a minimum of six to eight weeks of paid leave. Why is there such variability? There is a spectrum of cultural differences about optimal duration for parental bonding, about time to initiate external childcare, about availability of extended family support. This is not unique to surgeons.
What is unique to surgeons is that there are multiple internal and external pressures to return to work after the birth or adoption of a child. Internal pressures include our strong work ethic, which is both a friend (that’s how we got to where we are) and a foe (that’s why we don’t always take what we’re legally allotted). Our commitment to our patients and our clinical partners represent another way in which our strong work ethic can act against us. We do however allow others to take care of our patients all the time: when not on call, when on vacation, when attending society meetings. It’s a slight sign of hubris to think that only we can take care of our own patients or only we are qualified to manage a particular clinical problem.
Another factor creating pressure unique to surgeons include a concern that we will be unable to maintain our operative skill set if we take too much time off. That maximum time one should be away from practice likely varies between types of surgical specialties but it is universally accepted that we must practice to practice well. Nonetheless, this concern might be lessened by recognizing that a considerable number of surgical residents take breaks in their clinical activity to pursue research and routinely matriculate back into the operating room after being away for sometimes several years.
Early return to work after maternity leave may also reflect the perception (and probable reality in many instances) that if you snooze you lose. You won’t be selected for a departmental committee or position because of a misperceived lack of availability or interest. These concerns certainly apply to other fields and are also a societal challenge, as highlighted in the book “Lean In” (and the topic of a previous AWS blog).
There is a gray zone between these described internal pressures and the external pressures which we also face. We experience self-derived internal commitment to our partners, but they can provide external “peer” pressure to share the workload with call and clinic. There are concrete external pressures unique to surgery, which include potential loss of referrals, loss of block time in the operating room, and the inability to achieve clinical volume goals to maintain a salary or bonus potential.
Policy and Reality: Time to Align What We Should Take with What We Do Take
These are institutional challenges that can be changed by institutional leaders. However, in order to establish a new norm, leaders need to hear from surgical voices. It is not that there isn’t a consensus on the minimum amount of time mothers should take; the AWS has a policy on maternity leave for residents and faculty. The issue, rather, is that there is a lack of procedural consensus: some surgeons only take two – four weeks. Why is there variability? Because women likely only take what they were reasonably able or allowed to take. Ultimately, it’s very personal, as we describe in our own experiences below.
Personal experiences vary but emotions surrounding the circumstances are similar. At the time of parental leave, we both felt that any leave (ours or that of our partners) was a gift, albeit an opaque gift that passed in a blur. There was pressure to get back to work, the feeling of not wanting to let anyone down, or to be forgotten during leave, can be very daunting. However, with hindsight, it’s interesting to look back and wonder if, perhaps, it would have been healthier to have more time, and if there might have been ways to make the transitions back to work with growing families easier. Between the two of us, we’ve taken six maternity leaves, ranging in duration from 4 to 12 weeks. Some of the shortest leaves were after complicated deliveries with preterm infants being sent to daycare, to enable us to get back to work as soon as possible. Some of our leaves were partially paid at anywhere from 50-70%, and some were unpaid. Some call obligations during leave were passed on to our partners, while others were “made up” beforehand. Our spouses took between 3 days-2 weeks off of work to support us, again, some of it fully paid and some unpaid. There clearly exists a broad range of parental leave policies based on whether one is in training or out in practice, based on one’s employer, and based on one’s practice.
Importance of Parental Leave for Surgeons
So why is this topic important to discuss? We truly believe that surgeons need to be supported both in and out of the operating room. Surgeons may commit vast periods of their lives to their training and to the care of patients, but they also have lives of their own, which are unfortunately all too often neglected. We want to support surgeons as members of their families, recognizing that it will also benefit our patients. Happy, healthy surgeons perform better on the job. Moreover, there are a number of touted benefits to having a surgeon who is also a parent, acknowledging that some of the traits (both acquired and innate) that help one succeed as a parent are also incredibly valuable in the field of medicine. In addition, recognizing that women remain under-represented in a number of surgical specialties, we want to encourage the best and brightest trainees to enter our fields. To do so, we must show them support, modeling for them that parenthood and successful careers in surgery are not mutually exclusive. This aspect is not only important for encouraging women to enter surgical fields; it’s also quite relevant for men who desire to have families. Lastly, this topic of parental leave merits our attention as part of a broader scope of piqued interest in surgeon well-being. It is time to change the dialogue regarding the issues of physician health, family engagement, and clinician happiness, conceding that these areas have been long neglected.
We look forward to addressing many of the issues highlighted here in our upcoming Tweet Chat. During this chat, we hope to provide an environment in which those who have taken parental leave can share their experiences, and those who are curious about what it might be like to have children as a surgeon or surgeon-in-training can get their questions answered. We are engaging in this critical discussion in order to identify some of the barriers to surgeons successfully taking work leave and subsequently re-entering the workforce, with the ultimate goal of eventually creating a culture that nurtures and enables those surgeons desiring to grow their families. Our upcoming Tweet Chat will take place on Monday February 26th, 8 pm ET.
Who should participate? We are eager to have a well-rounded discussion, with opinions from surgeons who have had children and those who hope to do so, those who have covered for partners on leave, and those who may have taken parental leave in other fields of practice. This conversation pertains to women and to men, to those who have labored and delivered, as well as to those who adopt, use a surrogate, and have same-sex partners who bear children. There are so many voices relevant to this chat, and we hope to hear from you all!
We look forward to welcoming you to the first AWS-WTS join Tweet Chat, covering the topic of Parental Leave for Surgeons. We plan to cover the following topics:
- What are the obstacles to surgeons taking parental leave? There may be a number of challenges, related to one’s skills, one’s clinical practice, and one’s finances, not to mention our own concerns—valid or not—regarding perceptions of others.
- What are the unique aspects of surgical practice that may make parental leave different compared to other medical specialties? The way that our clinics and inpatient services work, not to mention our call schedules, are somewhat different than those of clinicians in non-surgical fields. All of these issues can impact the ease of taking a parental leave.
- What are the goals of parental leave? Here we will consider the needs of mothers after delivery, as well as those of babies, fathers, adoptive parents, and all others involved in bringing a new baby into the world.
- How can we best support re-entry after parental leave? This is an important issue for all surgeons coming back to work, and there may be unique caveats after complicated deliveries or pre-term deliveries, which we know happen more frequently following surgeons’ pregnancies.
The joint TweetChat with @WomenInThoracic will be 2/26/18 at 8 pm ET. To participate, be sure to follow the moderator for this chat, @maraantonoff, and to tag all of your tweets with the hashtag #AWSChat.
Dr. Mara Antonoff is a mother of 4 and Assistant Professor in Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center. She is the Website Editor and Social Media Director for Women in Thoracic Surgery. At MD Anderson, Dr. Antonoff is also the Associate Program Director for the Thoracic Surgery Training Program. Her twitter handle is @MaraAntonoff.
Dr. Virginia Litle is a mother of 3 and Professor of Surgery at Boston University School of Medicine. She is a Past President of the Women in Thoracic Surgery. At BU, Dr. Litle holds the titles of Director of the Center of Minimally Invasive Esophageal Therapies; Director of the Barrett’s Esophageal Program; and Director of Thoracic Surgery Clinical Research. Her twitter handle is @WtsPres