An Unequal Burden: The Impact of Inadequate Childcare Resource on Surgical Trainees

Background: The impact of parental support systems on surgeons has been documented, yet the relative impact on trainees, including gender differences, has been less studied. This study aimed to assess the personal, financial, educational and career impact of childcare resources available to surgical trainees nationally. Methods: Male and female surgical trainees with/without children (n=24) participated in semi-structured, thematic interviews, eliciting their perspectives on training, career, parenthood, support structure and available resources. Responses were quantified using phenomenology and thematic analysis. Interviews were independently coded by three team members to capture participant responses, with discordant codes discussed by all members until consensus was reached. Results: Female trainees with children had a mean age of 33.2, most had one child (83.3%); male trainees with children had a mean age of 35.3 and most had two to three children (66.7%). Of women with children, 66.7% required daycare or a paid provider, costing 8.3% of annual income, compared to 16.7% of men who spent 8% of their annual income on childcare. Most women had a partner working full or part-time (83.3%), compared to 66.7 % of male trainees, half of whom endorsed performing less than 50% of domestic labor. Most trainees, regardless of gender, reported inadequate childcare negatively impacting training and education (66.7%), and causing missed shifts (33.3%). 66.7% of women also reported interference with studying. 66.7% of women and 16.7% of men indicated that parenthood helped them bond with colleagues, but 50% of women reported that having to request shift coverage due to childcare demands negatively impacted their workplace dynamic. 66.7% of women and 33.3% of men reported experiencing conflict between career and family goals, with 83.3% of women stating that parenthood influenced their career trajectories, compared to 66.7% of men, Female trainees without children had a mean age of 31.8; male trainees had a mean age of 29.7. The following were cited as influencing their decision to not have/delay having children: career (100%), financial concerns (83.3% of women, 66.7% of men), and available personal time (66.7% of women, 100% of men). 66.7% of women and 100% of men anticipated conflict between career and family goals, with 33.3% of women and 50% of men expecting parenthood to influence their career trajectories. All women and 83.3% of men with and without children cited concerns with a lack of institutional childcare resources, particularly onsite facilities, and extended hours compatible with work schedules. Conclusions: Lack of affordable, accessible childcare constitutes a source of personal and career conflict for surgical trainees, with a quantifiable impact on education and training, and a disproportionate impact on women. Systemic and practical solutions to these unmet childcare needs will be necessary to adequately support surgical trainees.