It’s something every physician wants to prevent whenever possible: obstetric complications.
But recently published research suggests that some physicians’ own work environment may be contributing to higher rates of such complications. According to a JAMA Surgery study published in March, there was a higher likelihood of obstetric complications among female surgeons who reported having low workplace support in academic practice, as well as pregnant resident and fellow surgeons working more than 60 hours a week.
For the study, “Mixed-Methods Evaluation of Surgeon Workplace Support and Obstetric Complications,” researchers surveyed 1,473 surgeons who were also parents—a group that included physicians in residency or fellowship training—and asked them about their obstetric outcomes. They also asked about the respondents’ occupational risk factors, such as how many hours they worked and what kind of support they received at their workplace.
The researchers found that more women surgeons reported pregnancy complications than did the female partners of male surgeons. But once the researchers accounted for whether the surgeons had support in their workplace, those gaps disappeared.
“There are always those times in medicine that you need the study so you have something to point to, but you look at it and go: We’ve known this. We should have known this. We should be acting on this,” said Nariman Heshmati, MD, an ob-gyn at Lee Health in Fort Myers, Florida, who did not take part in the study.
“I’m glad the study came out … and I think it's going to be a good thing” for physicians, he said.
Lee Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Dr. Heshmati said the study serves as another reminder that physicians pay an at-times physical toll when their well-being is not prioritized.
“We've always had this cognitive dissonance with the advice that we provide, and then how we actually treat and support ourselves and each other,” said Dr. Heshmati, who is chief physician executive of Lee Physician Group. “We take physicians who we put in quite grueling conditions, who have to be at the top of their game—sometimes for 24 hours, 30 hours straight, doing really high-stakes management to take care of people—and we don’t turn around and say: Are you getting enough sleep? Do you have access to food? Is there stress that we can remove and reduce?”
Work environment linked to pregnancy outcomes
In the JAMA Surgery study, female surgeons were more likely to have obstetric complications—which included placental insufficiency, placenta previa and intrauterine growth restriction—than were the female partners of male surgeons, even after the researchers adjusted for demographics, multiple gestation, work hours and time spent standing at work.
Researchers found that female surgeons were more likely to report low workplace support than were male surgeons, with 64.4% of the female surgeons surveyed saying they had a lack of workplace support. Of the female surgeons, 31.1% had complications during a pregnancy, compared with 22.9% of the partners of male surgeons. Once researchers factored in workplace support, however, female surgeons were no more likely to experience pregnancy complications than were the partners of male surgeons.
Interestingly, the researchers noted that workplace environments influenced surgeons in residency and fellowship differently. Working more than 60 hours a week was linked to a higher risk of obstetric complications for residents and fellows—but not for practicing physicians.
The result may be due to the reality that physicians in residency and fellowship training frequently have heavy clinical responsibilities that often include physically demanding work, the authors wrote. Practicing physicians, meanwhile, are more likely to have a balance of work that includes administrative and academic duties that are often less physically strenuous.
“Previous work demonstrates that most childbearing surgeons worry about the impact of their work schedules on obstetric health but feel unsupported when seeking duty modifications, particularly without obstetrician-prescribed bed rest,” says the study, which notes that such rest is no longer endorsed by the American College of Obstetricians and Gynecologists.
Another difference was in the way that workplace support affected those in residency and fellowship training.
Lack of workplace support “was associated with pregnancy complications among practicing surgeons but not trainees, suggesting greater vulnerability among practicing surgeons who lack standardized protections,” the study’s authors wrote. “While accrediting organizations and boards mandate paid parental leave for trainees, only half of practicing surgeons report having it.”
In 2025, the AMA House of Delegates adopted policy supporting reasonable periods of parental leave for physicians.
A move toward well-being
There has been a shift, Dr. Heshmati said, in how well-being is understood to affect not just physicians but their patients and the healthcare system as a whole. Work remains to be done, though.
“We need to have a system that makes people understand that it's OK to ask for help,” he said. “Because I think the thought always is: Well, if you’re asking for help, you’re either burdening somebody else, you’re weak or you can’t cut it. We've got to design that system so that it's OK to do that.”
Dr. Heshmati said that working within a healthcare system such as Lee Health gives physician leaders the opportunity to create a team that can support doctors when they need to temporarily step back to manage their health or well-being.
Simple steps can improve well-being, he said, actions such as ensuring round-the-clock access to nutritious food and encouraging physicians to take breaks and the time off that they have earned.
“If you talk to any healthcare system leader, they'll tell you about how many weeks of vacation and CME a physician has,” Dr. Heshmati said. “What you should ask them is how many weeks of vacation or CME do your physicians actually take?”
Ultimately, he said, healthcare leaders will find that improving well-being offers tangible benefits to more than just the physician.
“Definitely there has been a palpable change in the culture in healthcare, where people really are embracing: How do we make healthcare sustainable? And part of that is not only taking care of our patients, but how do we take care of each other?”
