Structural barriers to work-family reconciliation in surgery: a gendered analysis of career disruption and care responsibilities.

Despite increasing numbers of women entering surgical training, gender disparities in surgical careers persist. Female surgeons remain underrepresented in leadership roles and face challenges related to family responsibilities. This study investigates gender-specific differences in surgical careers, family planning, caregiving responsibilities, and perceived institutional support in Germany. A nationwide cross-sectional survey was conducted among 432 board-certified surgeons and residents from various surgical specialties in Germany. A 68-item questionnaire assessed demographics, career stage, family planning, childcare responsibilities, work models, and perceived career barriers. Analyses included descriptive statistics, chi-square tests, t-tests, and regression models adjusted for age and institutional background. Female surgeons were significantly more likely to work part-time (OR 12.03, 95% CI 4.19-50.87), interrupt training due to parental leave, and experience prolonged specialization (OR 1.74, 95% CI 1.03-2.96). Nearly half (46.2%) postponed childbearing for career reasons (OR 4.72, 95% CI 2.34-10.23), and 82.5% reported negative career impacts from motherhood (OR 11.22, 95% CI 4.77-30.0). Women also reported greater domestic burdens, physical (OR 2.32, 95% CI 1.32-4.17) and emotional exhaustion (OR 2.61, 95% CI 1.39-5.20). Reassignment to non-surgical duties during pregnancy occurred in 46.4% (n = 44). Structural and cultural barriers constrain gender equity in surgery. Family responsibilities disproportionately affect female surgeons' careers, contributing to slower advancement and increased burnout. Reforms such as flexible work models, accessible childcare, transparent promotion pathways, and mentorship are critical for fostering equal opportunity and retaining female talent for surgical leadership.