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very little time away from work immediately following pregnancy. For many women, this poses an incredible emotional dilemma. First, women who do choose to begin families during residency face conflicting desires with regard to spending time nourishing and cultivating a new family versus managing career and patient responsibilities. In addition, rapid return to work that is both physically and mentally demanding may limit her ability to recover from the physical and emotional aspects of pregnancy and childbirth itself. Moreover, care of a new child requires ample support from a partner or spouse, childcare, or other family members as well as financial resources. Alternatively, many women choose to postpone starting a family until after residency training or early career development. Unfortunately, for many women, this may also mean difficulty with fertility, pregnancy, and increased risk of child birth defects secondary to advanced maternal age.29,30 Despite the long-term, long-hours commitment with time away from family that might deter surgical interest, most women surgeons are satisfied with their careers and its impact on their personal lives.31 A recent physician survey found plastic surgeons to be more satisfied with work than doctors in any other specialty. Additionally, respondents in plastic surgery were found to have high levels of self-esteem as well as happy marriages.32 Accordingly, one would expect continued professional growth of women in later academic practice years. However, female surgical faculty members are far more likely to be represented at lower-ranking academic levels.33 In a 2012 report by the Association of American Medical Colleges on women in academic medicine, women surgeons represented only 5% of full professors compared with 28% of instructors, 22% of assistant professors, and 15% of associate professors.16,34 Sasor et al17 conducted a similar study examining male versus female distribution within professor rankings in academia and reasons for observed discrepancies. Of 206 full professors examined, only 4.4% were women. Approximately 60% of women in t by guest on 14 February 2020 4 Aesthetic Surgery Journal professors, whereas men were more evenly distributed among academic ranks (34% assistant professor versus 22% associate professor versus 29% full professor). In this study, women were noted to be subjected to higher levels of discrimination and harassment, have lower levels of career satisfaction, and have higher rates of burnout, contributing to high rates of attrition. Similar findings have been reported in other studies linking high rates of female attrition to increasing clinical demands, dissatisfaction with work-life balance, low institutional support, and burnout.15,17 Overcoming these challenges with successful productivity is made more difficult by smaller physical work spaces as well as a lack of academic resources, grant assistance, protected research time, and secretarial staff allocated to women.33 Furthermore, studies have shown that, even when equal opportunities for career growth and academic achievement exist, women receive fewer awards and grants, are cited less, and have their research regarded as less valuable than that produced by men.19,35-37 These findings all contribute to what is known as the “leaky pipeline,” which describes a precipitous decline in the numbers of women compared with men at each step up the academic ladder.19,38 The aforementioned studies highlight the continual obstacles women face throughout the duration of early education in medical school and spanning into later professional years. Without reprieve from such challenges, it is not surprising that many women physicians are subject to burnout at some point in their careers. In recent years, physician burnout has been extensively examined. Numerous studies have underscored the impact of paperwork and computerization of practices; low level of respect from administration, colleagues, and staff; long work hours with poor work-life balance; lack of autonomy; and insufficient compensation as primary factors affecting burnout.32,39,40 Interestingly, within plastic surgery, the subspecialty of aesthetic surgery has the highest burnout rate alongside microsurgery.41 In addition to the demands of marketing, operating privately owned facilities, and the business of medicine, this is thought to be attributable to ever-increasing patient expectations of aesthetic surgery results, creating greater long-term dissatisfaction levels for patients and physicians alike.41 The overall result in both the hospital and private sector is more demand placed on fewer providers. For most physicians, burnout peaks during midcareer, though many of those affected may not be aware of burnout until the effects have already had a significant, far-reaching impact with devastating consequences both personally and professionally.32,41-43 Physicians are historically perfectionists, with those in plastic surgery arguably being the most extreme in this regard, and they continue to place patients’ needs above personal needs despite exhaustion and sleep deprivation.44 As a result, physicians’ health suffers from chronic
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