Compatibility of Procreation, Pregnancy, and Early Parenthood in Female and Male Surgeons During Surgical Training in Switzerland: National Survey Study
Academic Background
The lengthy training periods and high-stress work schedules of surgeons, particularly during their optimal childbearing years, often lead them to forgo part-time work or delay pregnancy, thereby increasing the risk of infertility and pregnancy complications. Women experience a significant decline in fertility after the age of 30, with prolonged time to conception and higher infertility rates. Advanced maternal age (35 years and older) is associated with increased risks during pregnancy. In Switzerland, becoming a general surgeon requires at least 12 years of basic education, 6 years of medical school, and 6 years of surgical training. Further specialization in fields such as thoracic or vascular surgery requires an additional 4 years of training, meaning that specialization is typically not achieved until around the age of 38. Although 62% of medical school graduates in Switzerland are women, only 40% of candidates in surgical board exams are female. The role of gender in surgery has garnered increasing attention, with many women opting out of surgical careers due to concerns about balancing childbirth and professional development.
Source of the Paper
This paper was co-authored by Joana Ferreirinha, Markus Weber, Nicolas Attigah, and Seraina Faes from the City Hospital Zurich in Switzerland and published in 2025 in the British Journal of Surgery (BJS). The study was first presented at the annual meeting of the Swiss College of Surgeons in 2024.
Research Design and Methods
Research Objective
The study aimed to evaluate the challenges faced by young surgeons in Switzerland during their training regarding part-time work, childbearing, pregnancy, and early parenthood, while exploring the impact of gender differences on these factors.
Research Methods
The study employed an anonymous online survey conducted among surgeons in Switzerland using Google Forms. The questionnaire was available in German and French, and participation was voluntary and uncompensated. The survey covered demographics, training status, part-time employment, childbearing, parenting experiences, and perceptions of gender’s influence on careers. It also included the definition of infertility (based on the World Health Organization’s criteria: failure to achieve pregnancy after 12 months of trying).
Study Participants
The study targeted Swiss surgeons who had completed general surgical training or were within one year of board certification. Surgeons from other specialties (e.g., orthopedics, urology) were excluded, except for those in vascular and thoracic surgery, which could be pursued either through general surgical training or direct certification. The study obtained email addresses of 680 surgeons from public information on Swiss surgical departments and sent survey links in August 2023, with follow-up reminders in October and November 2023. Ultimately, 375 surveys were completed, with 308 meeting the inclusion criteria and used for further analysis.
Data Analysis
Data were analyzed using GraphPad Prism 10. Categorical variables were compared using Fisher’s exact test or the chi-squared test, while continuous variables were analyzed using the t-test or Mann-Whitney test. All statistical tests were two-sided, with a significance level set at p < 0.05.
Research Findings
Part-Time Work
Female surgeons were more likely to choose part-time work (37.6% vs. 18.5%, p < 0.001) and had longer durations of part-time employment (mean 5.5 years vs. 1.8 years, p < 0.001). The primary reason for part-time work was family time, while men were more likely to choose part-time work to increase leisure or research time.
Childbearing and Parenthood
Female surgeons had significantly lower fertility rates (44.6% vs. 70.2%, p < 0.001) and were older at the time of their first childbirth (median 35 years vs. 33.5 years, p < 0.001). Women were more likely to delay pregnancy due to training (74.0% vs. 20.3%, p < 0.001), had higher infertility rates (23% vs. 10.4%, p = 0.032), and were more likely to use assisted reproductive technology (14.2% vs. 4.3%, p = 0.009).
Gender’s Influence on Careers
66.9% of female surgeons perceived their gender as a negative influence on their careers, compared to only 6.0% of men (p < 0.001). Female respondents cited issues such as gender discrimination by superiors, incompatibility of work with childcare, adverse effects of work hours on pregnancy, and the negative impact of maternity leave on their careers.
Research Conclusions
The study highlights the significant challenges faced by young surgeons in Switzerland in balancing childbearing, pregnancy, and early parenthood with their training, particularly for female surgeons. Providing equal career opportunities, improving working conditions, and promoting gender equality are crucial to ensuring the quality of surgical training for future generations.
Research Highlights
- Significant Gender Differences: Female surgeons showed notable differences from their male counterparts in part-time work, fertility rates, and career perceptions.
- Risks of Advanced Maternal Age: Female surgeons often delayed pregnancy due to training, leading to higher rates of advanced maternal age, infertility, and use of assisted reproductive technology.
- Conflict Between Career and Family: The study revealed the incompatibility of surgical careers with family life, particularly for female surgeons.
- Policy Recommendations: The study calls for improved working conditions and more flexible work arrangements to support surgeons’ professional development and family life.
Research Significance
This study provides critical empirical data on the challenges faced by Swiss surgeons in balancing childbearing and career development, emphasizing the importance of gender equality and professional support. The findings not only inform the Swiss surgical training system but also offer valuable insights for similar research in other countries and regions. By improving working conditions and supportive policies, future efforts can attract more talented individuals to the surgical field and ensure a balance between their professional and family lives.
Additional Valuable Information
The study also noted that while female surgeons were more likely to choose part-time work, they did not require significantly more time to complete board certification compared to men. This suggests that part-time work does not necessarily prolong training but provides women with greater flexibility. Additionally, the study found that many full-time surgeons desired part-time work but never raised this with their superiors due to concerns about its impact on their career progression.
This research not only uncovers the challenges faced by Swiss surgeons in balancing childbearing and career development but also provides a foundation for future policy-making and professional support.