In addition to her work as an acute care and general surgeon at Mass General Brigham (MGB), Erika Rangel, MD, has taken on an equally demanding role in recent years: Tireless advocate for female surgeons who run a gauntlet of challenges trying to reconcile their work with the rigors of family.
Nowhere is the load heavier than on surgeons in training who are pregnant and trying to start a family, says Rangel. Many feel compelled to work long, arduous hours and maintain unmodified schedules right through their last trimester.
Others delay becoming mothers until after their training, often at an age when they become more vulnerable to pregnancy complications.
A Personal Experience That Shaped Her Mission
Rangel can speak from experience. She confronted her own pregnancy challenges 16 years ago while in her fourth year of general surgical residency at Brigham and Women’s Hospital (BWH).
“At the time, pregnancy during clinical training was rare and not normalized,” she recalls. “There was little infrastructure in place to accommodate someone having a child. As a result, I pushed myself hard, harder than I should have.”
Her first child, and a second one later on, were born prematurely, spending considerable time in neonatal intensive care.
“You suddenly realize there’s this profound work-life incompatibility because of the nature and culture of the field we’ve chosen.”
The Data Tells a Deeper Story
The long-standing constraints facing surgeons navigating motherhood and career are easing at MGB and health care centers nationwide, with Rangel playing a central role in that progress.
As a clinician-scientist, she has bolstered her advocacy with scientific evidence. A study of 690 female surgeons led by Rangel and published in JAMA Surgery found that:
- 42% of female surgeons suffered a pregnancy loss, more than twice the rate of the general population
- Nearly half experienced major pregnancy complications
- More than half worked over 60 hours per week during pregnancy, and only 16% reduced their hours
- 75% had witnessed negative comments about pregnant trainees or childbearing during training
“The culture is that we pride ourselves on being self-sufficient, so we don’t burden our colleagues,” observes Rangel, who is also the medical director for Well-Being, Surgical and Perioperative Services at MGB.
“It’s very much a zero-sum game where we know if the work isn’t done by us, it falls on the shoulders of someone else.”
That culture was on full display for Rangel when she worked with a fellow in the intensive care unit whose water had broken during her rounds.
The fellow was still determined to continue her duties until Rangel intervened.
Through her advocacy and lectures around the country, Rangel is building awareness of a subject that is often kept private. Her work has helped fuel policy changes within residency programs and surgical departments nationwide.
Rules around parental leave are being rewritten, including mandates for at least six weeks of paid leave for trainees, separate from vacation time.
There are also recommendations for reduced clinical duties in the third trimester without penalty and for coverage during leave by moonlighting physicians or advanced practice nurses.
At MGB, Rangel's research has informed policies addressing family-building, including time off following miscarriage, limits on shift length after 30 weeks of pregnancy, lactation support, and leave for both childbearing and non-childbearing parents.
Translating Research Into Meaningful Support
A new clinical trial of 143 childbearing trainees, led by Rangel and published in JAMA, outlines a four-part support package to address fatigue, limited lactation support, difficulty attending prenatal appointments, and the lack of mentorship on work-family integration.
The package includes a responsive smart bassinet, a wearable breast pump, access to a 24/7 virtual support network, and mentorship from a faculty member who is also a mother.
Among trainees who did not receive the package, burnout scores increased substantially from pregnancy to six months postpartum. Among those who received the intervention, burnout scores remained essentially unchanged, suggesting the supports were protective.
Together, the findings show that practical, structured interventions can translate research into meaningful change.
“My last two residents had term pregnancies,” Rangel says. “We made sure they were off-call at 30 weeks of pregnancy as part of our policies.”
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