The American College of Surgeons (ACS) recognizes that a successful surgical career should not preclude a surgeon’s choice to be a parent. Surgeons who choose to have children (whether through a pregnancy of the surgeon or the surgeon’s partner, surrogacy, fostering, or adoption) have made an equivalent investment in their surgical careers as those individuals who choose not to have children. Choosing to become a parent does not detract from one’s full professional commitment to being a surgeon. The ACS is supportive of healthy pregnancy outcomes and emphatically condemns imposition of punitive repercussions or bias toward those surgeons who choose to have children.
The ACS also recognizes that surgeons have increased rates of infertility and pregnancy complications as compared with the general population. Complications include conditions that affect both mother and fetus, such as spontaneous abortion, preterm delivery, growth restriction, and congenital abnormalities (Anderson and Goldman, 2020).
The following guidelines offer ACS recommendations for a framework to support a pregnant surgeon or a surgeon attempting to become pregnant and workplace accommodations:
- The ACS encourages individualized assessment of requests for reasonable support for pregnancy-related conditions, in accordance with applicable federal and state laws. This includes but is not limited to prenatal appointments, reproductive technology, and treatment for infertility.
- Practicing surgeons should be allowed to take time off to attend necessary appointments for consultation, lab draws, and imaging.
- Practicing surgeons should be allowed to, but not forced to, use sick leave for relevant procedures.
- The ACS is supportive of the unique requirements of practicing surgeons undergoing assisted reproductive technology (ART) treatment for infertility. The recommendations contained in this document are intended to extend to ART procedures, testing and relevant appointments.
- The ACS encourages individualized assessment of requests for reasonable schedule and duty modifications based on pregnancy-related conditions in accordance with applicable federal and state laws.
- It is appropriate to consider accommodations to call schedule, duty hours, and operative schedule after 30 weeks of pregnancy including cessation of overnight call duties and 24-hour call shifts. Pregnant surgeons should be allowed to take short breaks as needed.
- Pregnant surgeons should avoid exposure to radiation in the operating room. Those in the first trimester of pregnancy should be excused from fluoroscopy cases given the high risk of radiation exposure.
- A complicated pregnancy may need additional modifications of the surgeon’s schedule. There is significant variation in how pregnancy is experienced across individuals, thus differing flexibility may be necessary to provide needed support.
- The ACS supports the surgeon's ability to self-determine needed schedule and duty modifications.
The following guidelines offer ACS recommendations for a framework on parental leave policies. These guidelines also offer accommodations for non-birthing parents, as pregnancy and early infancy are important periods for all parents for infant bonding and/or supporting a birthing partner.
- Parental leave, including childbearing and non-childbearing parents, should be provided equally for individuals who are new parents through pregnancy, surrogacy, fostering, or adoption.
- Parental leave terms should be explicitly included in all employment contracts and should not be reserved for only those who may request parental leave terms.
- The ACS supports parental leave of no less than six weeks (vaginal delivery), eight weeks (cesarean section), and domestic partner leave of not less than six weeks.
- The Family Medical Leave Act (FMLA) of 1993 allows employees to take up to 12 weeks of unpaid leave for the birth or adoption of a child, presuming the surgeon is employed by an organization meeting the criteria of the law, and the surgeon meets the eligibility criteria for FMLA, and has FMLA time available.
- The ACS encourages institutions and practices that are exempt from the FMLA to voluntarily allow new parents the opportunity to take unpaid leave consistent with what is provided by the FMLA, if requested
- Payment for parental leave should be negotiated between the surgeon and the employer.
- The surgeon should inform appropriate colleagues and supervisors of the pregnancy or anticipated adoption in a timely fashion to allow for schedule changes to cover anticipated absence from professional duties. The surgeon’s team has a responsibility to support the medical needs of the surgeon and to keep health care information confidential.
- The surgeon should work with the team to create a schedule that is flexible and equitable for the surgeon taking leave and those team members who will be affected by the absence.
- Surgeons should not be expected to make up for call missed during leave.
- The surgeon should not be responsible for costs to the practice during the period of leave. If the surgeon’s compensation is based in part or entirely on work RVUs (relative value units), the surgeon should not be penalized for the decrease in RVUs directly related to the period of parental leave.
- Parental leave should not be a factor in decisions regarding surgeon career progression, assessment and evaluation, access to leadership or research positions, or academic promotion.
The following guidelines offer ACS recommendations for a framework in support of a breastfeeding surgeon and workplace accommodations:
- Surgeons who intend to breastfeed should be allowed flexibility to support expressing breast milk. Guidelines on breastfeeding by physicians in the workplace are available from several sources, including the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Academy of Family Physicians.
- For most individuals, expressing milk for 30-40 minutes every three to four hours provides sufficient milk for the infant. This accommodation also reduces the risk of developing engorgement, pain, or mastitis. Covered employers are required to provide eligible employees with reasonable breaktime in a private, safe, and convenient place (other than a bathroom) to express breast milk or breastfeed for one year following the birth of a child. These requirements were set forth by the Patient Protection and Affordable Care Act of 2010, which amended Section 7 of the Fair Labor Standards Act.6 Access to a safe, hygienic, and convenient place for the secure storage of expressed milk should also be provided.
- Individuals should have protected time to express breast milk and have clinic and operating schedule adjustments without bias or penalty.
- Postpartum depression is a common and serious complication with negative consequences for maternal health and infant development. Consideration of postpartum mental health is important, and our surgical colleagues should be provided with mental health support and given the time to attend any relevant appointments as needed.
