Invited Commentary
December 13, 2023
Fertility, Family, and a Career in Surgery—Time to Change the Narrative
J. Elaine Tang, Melina C. Vassiliou, Liane S. Feldman
JAMA Surg. Published online December 13, 2023. doi:10.1001/jamasurg.2023.6397
Medical training usually falls within the window of optimal fertility for most trainees.1 Operating within the rigid confines of residency programs, the perceived realities of family planning can strongly bias medical students when making career choices about specialties.
“So you want to be a surgeon? Don’t you want a family?” remains a common line of questioning posed to (usually female) medical students. Dason et al2 examine this hidden curriculum around family planning at a single academic Canadian institution. Specifically, they explore factors that may prevent medical students from achieving their family goals. The findings, in short, reveal that a medical career, and especially a surgical one, is viewed to be incompatible with parenthood. Throughout residency and into independent practice, a culture exists such that any “time away from work” is frowned upon. This was found to be particularly prevalent in surgical specialties.2The attitudes and perspectives of medical students in this study mirror the prevailing culture: as a profession, we value work and productivity above all else. It comes as no surprise that there is an epidemic of burnout3 and a looming mental health crisis among surgeons.4
Raising children and having a medical career are both demanding and time intensive—and deeply worthwhile. The mythical work-life balance implies a false binary; instead, it is a constant ebb and flow with constantly changing priorities. A family has varying pressures and demands throughout the phases of a family’s growth. Concurrently, the career pressures of medicine begin early in medical school, fostered within a stringent medical training system that offers little flexibility. These career pressures extend into residency, with its heavy clinical load and research obligations, and into independent practice, where administrative burdens take us away from what attracted us to surgery in the first place—the joys of procedural mastery and the rewards of changing patients’ lives through our knowledge and skills.5
The impact of family building on career development is not unique to medicine and surgery. It exists across society and affects all genders.6 However, it is possible and even necessary to have both a meaningful surgical career and a fulfilling life away from work. Clinical and academic work, family, friends, community involvement, and taking care of our bodies, spirits, and minds are all vital parts of life. We need to move away from our society’s workism mentality and recognize, value, and celebrate other metrics for success outside of productivity. Tough choices will be required, but we and the patients will all benefit from a cultural shift that makes real commitments in supporting us all to have full lives.
