Family and Fertility in Plastic Surgery Residents and Fellows
Debra A. Bourne, MD1, Wendy Chen, MD1, Benjamin Schilling, MS2, Elizabeth Littleton, PhD2, Kia M. Washington, MD3, Carolyn De La Cruz, MD1.
1University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 2University of Pittsburgh, Pittsburgh, PA, USA, 3University of Colorado, Denver, CO, USA.
Female fertility decreases by 50% from the early twenties to late thirties which is when women undergo plastic surgery residency and fellowship training. Physicians are high risk for pregnancy complications. Only 36.5% of Plastic Surgery Residency Programs have a formal parental leave policy. This is the first study to assess the current status of pregnancy, breastfeeding and impaired fertility in plastic surgery trainees
Following IRB approval, an anonymous, electronic survey was distributed to all current plastic surgery residents and fellows in the United States. Data was collected regarding demographics, pregnancies, parental leave, breast feeding, and use of assisted reproductive technology (ART).
The survey was completed by 307 respondents (54.3% female, 45.7% male). Mean age was 31.7 ± 3.8 years and 58.6% were married. 35.3% reported a pregnancy.
Both males (67.4%) and females (76.5%) intentionally postpone having children due to demands of career. Females were significantly more likely to report stigma attached to pregnancy during residency (70.4% vs 51.1%, p=0.003). Female trainees married to non-physicians are significantly more likely to plan to have children after training, whereas males are more likely to plan to have children during training (p=0.007). 55.6% of female trainees reported a complication with their pregnancy compared to 14.5% in the general US population. The most common complication was hyperemesis gravidarum which was reported in 17% of trainees compared to 0.3-2% in the general population.
The American College of Obstetricians and Gynecologists recommends at least 6 weeks parental leave. The mean maternity leave was 5.5 weeks with 44.4% taking less than 6 weeks. Mean paternity leave was 1.1 weeks. 62.2% of females and 51.4% reported dissatisfaction with leave.
The American Academy of Pediatricians recommends breastfeeding for 12 months. 61% of female trainees breastfed for 6 months and 22% continued breastfeeding for 12 months. Lactation facilities were available near the operating rooms for 29.4% of respondents.
Assisted reproductive techniques (ART) were utilized in 19.6% of trainees compared to 5.6% in the general US population, suggesting greater difficulty conceiving. ART use was significantly correlated with older age (p=0.022) and female gender (p=0.0387).
Plastic surgery trainees postpone childbearing due to career. Rates of overall complications and hyperemesis are high in plastic surgery trainees. Most trainees take shorter leave and breastfeed for a shorter duration than recommended. Plastic surgery trainees are four times more likely to utilize ART than the general population.
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