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Objectives In Germany, the 2018 amended Maternity Protection Act frequently leads to fundamental restrictions for female physicians, especially surgeons, and now even also for students impeding the progress of their careers. Our goal was to assess the current situation for pregnant female physicians and students, respectively, and their perspective on this amendment regarding their career path. Methods A nationwide survey was conducted in Germany from December 2020 to February 2021. The questionnaire included 790 female physicians and students who were pregnant after the inception of the amended Act. Those women pregnant after the beginning of the corona pandemic were excluded. Results The survey revealed that two thirds of female physicians worked a maximum of 50% in their previous professional activity as soon as they reported pregnancy. Amongst medical students this amounted up to 72%. 18% of the female physicians and 17% of the female medical students respectively could not follow the sense of these restrictions. 44% of female medical physicians and 33% of female students felt their career impeded. This led up to 43% amongst female medical doctors and 53% amongst female medical students, respectively, who were concerned to announce their pregnancy. As a consequence, pregnancies were reported at 12 weeks in female physicians compared to 19 weeks in medical students. Conclusions Analyses of the current survey revealed that a relevant number of female physicians and medical students felt impeded in their career path through the application of the amended Maternity Act.

BACKGROUND At least two thirds of medical students are female. How can they be won over in the competition for the best heads and hands in the field of orthopedics and trauma surgery? 25% of the inpatient surgeons are female, while the proportion of women in managerial positions is only 5%. GOAL OF THE WORK (QUESTION) How do the specialist field and the specialist society have to change in order to be attractive for the younger generation, and be regarded as a dream job? MATERIAL AND METHODS With the help of surveys and scientific literature, the following problem areas are identified and highlighted: What do today's young doctors want? How should employers and superiors behave in relation to the women-specific life events of pregnancy, maternity leave and breastfeeding? How to enable female surgeons to continue operating as desired in accordance with the law? Often in clinics, care is not taken to provide female surgeons with individually sized instruments. A manufacturer survey was carried out for this purpose. How can we counteract the sexual harassment and discrimination in the workplace? How can male and female professionals achieve a more equal balance between family and work in the clinic and practice? RESULTS The Gender Bias, the glass ceiling, the lack of female role models and female mentors mean that female surgeons do not have equal opportunities. The gender pay gap and the gender care gap are discussed and presented with data. Significantly, there is a specific lack of data on the gender pay gap in Germany. The everyday clinical practice and the professional society are still a man's world. In order to attract a sufficient number of young professionals, the working environment and participation in committees must be transformed into a world that is equal for male and female surgeons. DISCUSSION With regard to the identified problem areas, suggestions for improvement for active implementation are listed.

At least two thirds of medical students are female. How can they be won over in the competition for the best heads and hands in the field of orthopedics and trauma surgery? 25% of the inpatient surgeons are female, while the proportion of women in managerial positions is only 5%.How do the specialist field and the specialist society have to change in order to be attractive for the younger generation, and be regarded as a dream job?With the help of surveys and scientific literature, the following problem areas are identified and highlighted: What do today's young doctors want? How should employers and superiors behave in relation to the women-specific life events of pregnancy, maternity leave and breastfeeding? How to enable female surgeons to continue operating as desired in accordance with the law? Often in clinics, care is not taken to provide female surgeons with individually sized instruments. A manufacturer survey was carried out for this purpose. How can we counteract the sexual harassment and discrimination in the workplace? How can male and female professionals achieve a more equal balance between family and work in the clinic and practice?The Gender Bias, the glass ceiling, the lack of female role models and female mentors mean that female surgeons do not have equal opportunities. The gender pay gap and the gender care gap are discussed and presented with data. Significantly, there is a specific lack of data on the gender pay gap in Germany. The everyday clinical practice and the professional society are still a man's world. In order to attract a sufficient number of young professionals, the working environment and participation in committees must be transformed into a world that is equal for male and female surgeons.With regard to the identified problem areas, suggestions for improvement for active implementation are listed.HINTERGRUND: Mindestens zwei Drittel der Medizinstudierenden sind weiblich. Wie können sie im Wettbewerb um die besten Köpfe und Hände für das Fach Orthopädie und Unfallchirurgie gewonnen werden? Stationär sind 25 % Chirurginnen tätig, in leitenden Positionen beträgt ihr Anteil nur noch 5 %.Wie muss sich das Fachgebiet – und die Fachgesellschaft – verändern, um für den Nachwuchs attraktiv zu sein bzw. als Traumberuf zu gelten?Anhand von Umfragen und wissenschaftlicher Literatur werden folgende Problembereiche herausgefiltert: Was will der ärztliche Nachwuchs? Wie sollten sich Arbeitgeber und Vorgesetzte in Bezug auf die frauenspezifischen Lebensereignisse Schwangerschaft, Mutterschutz und Stillen verhalten, wie Chirurginnen entsprechend ihren Wünschen gesetzeskonform das Operieren ermöglichen? Oft wird in Kliniken nicht darauf geachtet, auch für Frauen individuell größenangepasstes Instrumentarium bereitzustellen. Hierzu wurde eine Herstellerbefragung durchgeführt. Wie kann gegen sexuelle Belästigung und Diskriminierung am Arbeitsplatz vorgegangen werden? Wie kann eine gleichberechtigte Vereinbarkeit von Familie und Beruf besser erreicht werden.Die Chancengleichheit von Chirurginnen ist durch den Gender Bias, intransparente Beförderungskriterien, also die Gläserne Decke, und zu wenige weibliche Rollenvorbilder und Mentorinnen nicht gegeben. Der Gender Pay Gap und der Gender Care Gap werden thematisiert und auf mangelnde deutsche Daten hingewiesen. Der klinische Alltag und die Fachgesellschaft sind noch eine Männerwelt. Um ausreichenden Nachwuchs zu gewinnen, muss sich das Arbeitsumfeld und die Teilhabe in Gremien in eine für Chirurgen und Chirurginnen gleichberechtigte Welt wandeln.Bezüglich der herausgearbeiteten Problembereiche werden Verbesserungsvorschläge zur aktiven Umsetzung aufgelistet.

Objectives Worldwide, not only the number of female medical students, but also of female surgeons increases. Simultaneously, younger generations take a closer look to their work-life balance. With this in mind, it seems necessary to evaluate the expectations of female surgeons in particular with respect to pregnancy during their surgical career. Methods Therefore, a nationwide survey was conducted in Germany from July to December 2016 under the auspices of the German Society of Surgery as well as the Professional Board of German Surgeons. The questionnaire involved 2,294 female surgeons and 1,843 complete records were evaluated. Results Of the analyzed answers, 62% of the women (n=781) were operating during pregnancy. The joy of surgery (91.6%), followed by team spirit (57.1%), were the main motivations to perform operations while pregnant. Operative activity decreased from 30.8% in the first 3 months of pregnancy to 21.5% during the last three months. Regarding the possible complaints, e.g., leg edema, back pain, premature labor and vaginal bleeding, there were no significant differences between the women with or without activity in the operating room. Sick leave due to pregnancy (1–10 days) was stated by 40.4% of respondents. Conclusion Despite strong legal regulations for pregnant surgeons, the survey showed that most female surgeons are eager to operate despite their pregnancy. The results also demonstrate no significant differences regarding complications during pregnancy- or pregnant-dependent absence from work. Hospitals and surgical departments are asked to establish proper working conditions for pregnant surgeons and pregnancy should not be an obstacle for a career in surgery.

Wird der Begriff „Burnout“ inflationar verwendet und verschwimmt dadurch die Abgrenzung zur Diagnose Depression? Oder ist er ein Phanomen des Zeitgeistes und ermoglicht haufiger Therapie und mehr Akzeptanz? XX stellt Ihnen zwei Blickwinkel auf das Burnout-Syndrom vor.

Work–life balance is an upcoming issue for physicians. The working group “Family and Career” of the German Society for Gynecology and Obstetrics (DGGG) designed a survey to reflect the present work–life balance of female and male gynecologists in Germany. The 74-item, web-based survey “Profession–Family–Career” was sent to all members of the DGGG (n = 4,564). In total, there were 1,036 replies (23 %) from 75 % female gynecologists (n = 775) aged 38 ± 7 (mean ± standard deviation [SD]) years and 25 % male (n = 261) gynecologists aged 48 ± 11 years. Statistical analyses were performed using the mean and SD for descriptive analysis. Regression models were performed considering an effect of p ≤ 0.05 as statistically significant. 47 % women and 46 % men reported satisfaction with their current work–life balance independent of gender (p gender = 0.15). 70 % women and 75 % men answered that work life and private life were equally important to them (p gender = 0.12). While 39 % women versus 11 % men worked part-time (p gender 0.05). At least 37 % women and men neglected both their partner and their children very often due to their work. Female physicians often described their work situation similar to male physicians, although important differences regarding total work time, overtime work and appreciation by supervisors were reported. Work life affected private life of women and men in a similar way.

Thank you for your response [1] to our manuscript [2]. Indeed we agree with the dilemma of satisfaction with work–life balance. It is very interesting, that young students choose to be a gynecologist because of the expectation of having a work–life balance but then realize that this is not the case. I think this is the biggest problem, which we need to be concerned of and need to address in future. The question is—WHY does the expectation for a good work– life balance does not come true? Is it the amount of time, which needs to be spent at work? Is it the scarce opportunity for part-time work? Or is it the total number of ‘‘on duty’’-calls? Or even the kind of work, that itself is not what young professionals expected? Is it the heavy responsibilities in obstetrics and/or the amount of emergencies? We need to address all these questions in future to find a solution on how to improve the work–life balance and raise the attractiveness of the gynecologic profession. Otherwise I expect, we will not find committed young physicians who choose the profession of gynecology and obstetrics.

Although depression and symptoms of depression belong to the most common disorders in private practice, affected patients are not always diagnosed as early as possible in Germany and often not sufficiently treated. In order to improve the care for persons with depression it is necessary that family doctors are prepared to guide these patients with empathy, treat them adequately pharmacologically both in respect to the depression and to all other somatic aspects and to refer them in time to specialists for psychiatry, psychosomatic medicine or psychotherapy. Political and social conditions that have pathogenic effects should be changed and the shortage of psychotherapy needs to be overcome. In future, the integrated care in ambulant and clinical settings will probably be successful, first trials and test setups have shown good results.

Although depression and symptoms of depression belong to the most common disorders in private practice, affected patients are not always diagnosed as early as possible in Germany and often not sufficiently treated. In order to improve the care for persons with depression it is necessary that family doctors are prepared to guide these patients with empathy, treat them adequately pharmacologically both in respect to the depression and to all other somatic aspects and to refer them in time to specialists for psychiatry, psychosomatic medicine or psychotherapy. Political and social conditions that have pathogenic effects should be changed and the shortage of psychotherapy needs to be overcome. In future, the integrated care in ambulant and clinical settings will probably be successful, first trials and test setups have shown good results.

Dr. med. Astrid Buhren hat sich als Vorsitzende des Deutschen Arztinnenbundes und durch ihre Mitgliedschaft in zahlreichen Gremien intensiv dafur eingesetzt, die Burn-out-Problematik der Arzteschaft in das Bewusstsein der Fachoffentlichkeit zu rucken. Wir sprachen uber Moglichkeiten, der Gefahr des inneren Ausbrennens entgegenzuwirken.