Identifying Barriers: Current Breastfeeding Policy in Orthopedic Surgery Residency.

Background: Family planning is a challenge for physicians at all stages of their careers but can be particularly difficult during residency. As the field of orthopedic surgery strives to increase diversity and recruit exceptional female candidates, barriers to entry should be identified. For many women, successful family planning including pregnancy, breast-feeding, and childcare, presents a daunting endeavor during residency training and a difficult topic to broach with superiors when planning future careers. Prospective residents often look to websites to obtain information regarding potential residency programs. We sought to identify current breast-feeding policies available at orthopedic residency programs via a thorough review of individual programs websites.

Methods: Residency program websites from 178 ACGME-accredited orthopedic surgery residencies were reviewed to determine currently available departmental lactation policies and facilities. Region and number of female staff and residents were recorded and organized into a central database. Descriptive analyses to determine programs with available resources was performed. Logistic regression to determine association between region and number of programs written policy available was also performed.

Results: 178 ACGME-accredited orthopedic surgery programs were reviewed. Five (2.8%) programs were found to have written breastfeeding policies available on the orthopedic surgery residency website. Thirty-six (20%) programs provided links to institutional GME websites which gave written lactation policies. Dedicated lactation facilities were mentioned for 3 (1.7%) programs. The average number of female attendings per program was two (range 0-19), and the average number of female residents per program was three (range 0-14). The odds of a program having a written breastfeeding policy increased along with an increasing number of female attendings, OR 1.1 (CI 1.03-1.24, p=0.01). Programs in the Southwest region of the U.S. were found to have a higher association with presence of a written breastfeeding policy, OR 3.7 (CI 1.01-13.4, p=0.04).

Conclusion: Scarce information is available to prospective orthopedic surgery residents regarding breast-feeding policies and available lactation facilities. Only 2.8% of current programs have website information discussing breastfeeding support. Ensuring available breastfeeding support for female orthopedic surgeon trainees and the transparency of these policies by orthopedic departments could contribute to an improved perception of childbearing during residency. IV.