Importance of Workplace Support for Surgeon Parents: A Mixed-Methods Analysis of Challenges and Their Impact on the Surgical Workforce

BACKGROUND: Balancing surgical careers with family life is linked to risk of pregnancy complications, mistreatment, and attrition. Despite national policy recommendations, institutional support is inconsistent. STUDY DESIGN: A survey was distributed by the American College of Surgeons to 32,890 members. An explanatory mixed-methods design was used, combined multivariate logistic regression with thematic analysis of free-text responses. The primary outcome was lack of workplace support (LOWS), a composite measure reflecting inadequate childbearing-related accommodations or cultural support, including stigma, reputational concerns, financial loss, anxiety about burdening colleagues, or concern that family building might hinder advancement. RESULTS: Of 3,539 participants (10.8% response rate), 1,487 parents (525 men, 962 women) were included in the quantitative analysis and 1,059 in the qualitative analysis. LOWS was associated with female sex (odds ratio [OR] 2.52, 95% CI 1.91 to 3.33, p < 0.001), having children during training (OR 1.68, 95% CI 1.03 to 2.75, p = 0.039) or practice (OR 1.87, 95% CI 1.08 to 3.20, p = 0.024) vs during medical school, third-trimester workweeks more than 60 hours (OR 1.45; 95% CI 1.64 to 1.97, p = 0.019), reducing workload during pregnancy (OR 3.62; 95% CI 2.69 to 4.86, p < 0.001), and having fewer children than desired (OR 2.03, 95% CI 1.60 to 2.58, p < 0.001). Risk factors were similar for male and female surgeon parents, except for third-trimester work hours, which were only significant among women. Four qualitative themes emerged: (1) workplace support mitigates perinatal challenges, (2) workplace support shapes surgeons' reproductive decisions, (3) workplace support is essential to work-family integration, and (4) modern surgical practice must support surgeons' dual caregiving and clinician roles. CONCLUSIONS: Although LOWS is more common among female surgeon parents, both sexes face support gaps. Sustainable change requires institutional support policies and cultural shifts enabling usage.