Building support for pregnancy and parenthood in surgery

On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham explore the structural and cultural barriers faced by surgical residents and early career surgeons in balancing parenthood with their careers. The conversation centers around the points raised in the CMAJ article “Policies to better support childbearing surgeons”, which outlines the need for reforms to better accommodate surgical residents during pregnancy and early parenthood.

The discussion highlights how surgeons experience higher rates of infertility and pregnancy complications, independent of age or other potential risk factors. Dr. Caroline Cristofaro and Dr. Maryse Bouchard, the article’s co-authors, propose solutions such as flexible call schedules, protected time for prenatal and postnatal appointments, and clear institutional guidelines supporting the needs of pregnant surgeons.

Beyond structural barriers, the prevalent culture within surgical departments, such as the glorification of exhaustion and the perception that taking time off is a weakness or a burden to fellow residents, contributes to the unsupportive environment. The co-authors argue that gradual, transparent, and detailed policy reforms based on evidence are necessary to avoid resistance and ensure successful integration into surgical practice.

Dr. Omole’s personal experience, marked by significant support from her department during her pregnancy and postpartum recovery, serves as an example of what a compassionate and well-supported environment can look like. Her story highlights how proactive leadership and peer support can make a profound difference, benefiting both surgeons and their patients.

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Transcript

Dr. Blair Bigham::
I'm Blair Bigham.

Dr. Mojola Omole:
I'm Mojola Omole. This is the CMAJ podcast.

Dr. Blair Bigham:
On this episode, we're going to be tackling an issue that, Jola, you know a thing or two about.

Dr. Mojola Omole:
I think so…

Dr. Blair Bigham:
That is pregnancy as an early career surgeon or physician. We're going to be speaking with the authors of a commentary in the CMAJ that explores the obstacles to becoming a parent while also wielding a scalpel.

Dr. Mojola Omole:
The article is entitled “Policies to better support childbearing surgeons.” And to be quite honest, it was really a disappointing read for me. It described a lack of support for pregnancy for those surgeons who are in their childbearing years, where most of us, when we are both in the end of med school and residency, is our optimal childbearing years. And I would say that for me, it was a different experience from myself and other colleagues that I trained with at the time and other friends that I have in different programs. However, it's still an experience that I do think is more common across surgical specialties.

Dr. Blair Bigham:
And I remember during residency and fellowship being friends with a lot of people who became pregnant during that period. And I just remember how much of a struggle it was. Even finding a place to pump, finding a place to rest. It was really, really challenging. And so Jola, we're going to talk about your experience, but first, we'll be speaking to the authors of the paper.

Dr. Mojola Omole:
Dr. Caroline Cristofaro and Dr. Maryse Bouchard are co-authors of the paper in the CMAJ titled “Policies to better support childbearing surgeons.” Dr. Cristofaro is the resident chair of the wellness committee in the orthopedic residency program at the University of Toronto, and Dr. Maryse Bouchard is the associate program director of the orthopedic residency, also at the University of Toronto. Maryse and Caroline, thank you so much for joining us today.

Dr. Caroline Cristofaro:
Thank you so much for having us.

Dr. Mojola Omole:
So I'm just going to start off with, we can talk about orthopedics, but just in general surgical training, how supportive is the environment for people who are pregnant or people who want to be parents?

Dr. Caroline Cristofaro:
I think for surgery in general, it can definitely vary depending on which specialty you are in. So, speaking with my co-residents who've had the experience of being pregnant during residency specifically, there's definitely been concerns around negative perceptions from their co-residents or staff while being pregnant, in terms of concerns with possibly overburdening their co-residents because they would have to take on extra call responsibilities or extra inpatient rounding responsibilities. And then from the staff attendings, being concerned about pregnancy having an impact on their orthopedics careers or their academic work. In terms of the literature, it seems more female-dominated surgical specialties, such as obstetrics and gynecology, have a much better experience from their residents going through pregnancy and parenthood during residency. But for other surgical specialties that are more male-dominated, it tends to be more negative.

Dr. Mojola Omole:
I want to touch on the part about peer-to-peer versus staff-to-peer in terms of the feelings, but I just want to first find out what inspired you both to write this paper. I'll start with you, Maryse.

Dr. Maryse Bouchard:
It actually came from the work that we were starting to do within our department to try and have better policies or a better approach to supporting our residents when they are seeking to be pregnant, to become pregnant, or parents, whether male or female. As parents, we had a couple of residents have very difficult experiences, and that was really the trigger to tell us like, wow, we're really not meeting the bar to support them, and we need to do better. So when I started looking into how we would go about that, there wasn't a ton of literature out there and very little about the Canadian experience. And so, this issue was something I brought to our wellness committee where Caroline is a chair, and we ultimately decided that it was probably worth actually sharing what we found in terms of the literature and that this would be a great first step in terms of giving us some legs to stand on as we try to make these changes within our own department.

Dr. Mojola Omole:
Is the feeling of being unsupported during pregnancy or trying to become pregnant, does it carry on for residents and staff even as they try to juggle practice and also being in parenthood?

Dr. Maryse Bouchard:
Yeah, I would say it does. I think the experience is a bit different because in residency you really have very little autonomy on your schedule, and you're really dependent on your peers. In fellowship, you have a one-year program, and so timing is everything, and you might miss a lot of the content of your one-year fellowship. And then as staff, what's nice is you can have a little autonomy as to what you want to do with your practice and how you want to schedule things, but I think it's very institution-dependent. Where I worked previously in the U.S., we were 11 surgeons and five were women. Most had children either as a trainee or in practice. And even then, it was really difficult for the female surgeon who became pregnant in practice. She was the first surgeon in the hospital to become pregnant. And I'm hearing very similar stories from my plastic surgery colleagues where I work now, that nothing's really ever been written for surgeons because traditionally there just weren't that many women, and a lot of women do get pregnant in training instead. And so it's really actually, shockingly, a new issue that women are facing in surgery.

Dr. Mojola Omole:
For sure, to look at obstacles that are there for supporting surgeons and surgical trainees. You had mentioned, Caroline, a little bit about peer-to-peer versus peer-to-staff. Is the level of being unsupported coming from their peers, or is it coming from a top-down type of environment?

Dr. Caroline Cristofaro:
I think hearing from my co-residents, as well as looking at the literature that's been done on this, it's both but for different reasons. So, they have done surveys asking residents what types of negative perceptions they felt from their co-residents versus what they felt from attendings or program department heads. And for co-residents, it was very much the fear of being overburdened with extra responsibilities, whereas the staff and division heads or residency program directors were mainly concerned with the academic career side. But I think for the residents themselves, having the day-to-day interactions with their co-residents, and for them to have those negative perceptions and feel that, is a really big burden for them.

Dr. Mojola Omole:
To be honest, I feel like it's absolutely bonkers because we're in this together, right? There's a reason that modern surgery was created on a military system where it's like there's a bunch of us working through things together to support each other, but we can talk more about that later. What are some structural changes you think we can make to better support surgical residency and also when people become staff, maybe earlier on in their career, who want to have children?

Dr. Maryse Bouchard:
I can start, and Caroline, if I forget anything, go for it. But I think there are a few things that are pretty easy to tackle. So, one is call conditions. So, call frequency, length of a call shift. For example, as staff here, we take seven straight days, and that might not be feasible, but as a resident as well, maybe a 24-hour shift can be difficult. Or if there is, then you just need to have them better spread out. And so having some consistency and clarity as to what are appropriate call requirements or call duties and at what point, as well, in the pregnancy. I think a lot of places will say, well, once you're in your third trimester, you don't need to take call. And maybe that's good, it's a great start, but a lot of women don't feel well at the beginning of pregnancy as well, and we rarely have any accommodations at that period.

The other is the length of time standing or in a surgical case, being able to take breaks, being able to sit down at various intervals. And it sounds so crazy to have to spell that out and say, well, after four hours, a pregnant resident must sit down for at least five minutes. But in fact, if it's not written down and it's not clear, then just like post-call going to 8:00 AM from noon, it really needs to be on paper, and it really needs to be clear. Others are actually around dehydration, so making sure that there is ample time, opportunity, and accessible food, water, snacks for pregnant women at work is really critical. And then I think the other area is really around time away, and that, I think, will vary dramatically for staff surgeons versus surgical trainees. But everything from having it spelled out that you can take time off for appointments and that time is not necessarily meant to be paid back to their peers.
That call is organized so that it can either be, we can have fly-in call residents, for example, at our institution. There are other ways to get around decreasing the frequency of call or having call or rotations at sites that are less demanding, like our level one trauma centers. And the one thing that I learned from Dr. Rangel, who is at Mass General, and her experience of trying to implement policies like this in Boston was that they really, in order to be as successful as possible to get accommodations around leave implemented for a resident, they really need to know ahead of time. In other words, as soon as someone is pregnant, hopefully they are comfortable enough to disclose this to the program so that there is ample time to make arrangements for a maternity leave, for decreased call or work duties towards the end of pregnancy, or even at the beginning if someone isn't doing as well.
And so that's something I think traditionally, which is what really breaks my heart, is I don't know that our trainees necessarily always feel comfortable disclosing it. And it's very, I think, challenging in educational leadership to be as supportive as possible when we don't know what the residents are going through. And so trying to at least, I think having the policies will hopefully create some psychological safety and shift the culture a little bit to enable those conversations more comfortably, sooner, and hopefully for peers as well to be more accepting of the fact that we will be accommodating their pregnant colleague.

Dr. Blair Bigham:
A lot of programs are very small. They might only have two or three or four residents a year.

Dr. Mojola Omole:
Sorry, I'm going to disagree with you. Most orthopedic, most of the big programs, they're big. Even in general, there might be many sites that you're spread around, but I would say that most of our programs are not two or three. I don't know what they're doing out in Newfoundland, but in general, I feel like that is an excuse that is used by programs. Well, there's not enough of us.

Dr. Blair Bigham:
But what I want to get to is that the residency programs, whether there's five or 10, there may be multiple sites. There's no slack in the number of residents compared to the number of shifts that need to go on. What have you learned from Massachusetts in terms of actually building in that up-staff ability so that residents aren't pitted against each other when all of a sudden three people have to do the work of four, or something like that?

Dr. Maryse Bouchard:
Right, yep. So that was actually one of, in my conversations with Dr. Rangel, what seemed to be the most challenging—how to combat that feeling of the other residents feeling burdened by this person's absence, whether it's a short-term or a longer-term absence. And they've tried things like, for example, if you are switching a rotation with a resident, so you're now going to have to do your trauma rotation a year early, and now you've done two in the same year, and that's very burdensome and exhausting, to pay a stipend to the resident who volunteers to switch. To reward someone who's taking on perhaps the extra patient load or missing the time away for appointments is maybe getting an extra day off call at some point or gets to choose. I think one of the things they did was in the following year’s call schedule, you could choose which statutory holiday you did not want to be on call for. There was some...

Dr. Blair Bigham:
Sort of a little bit, there was sort of a reward for the extra workload that was being distributed.

Dr. Mojola Omole:
Can I just push back a little bit on that? Because I feel like the one about taking a statutory holiday, that's fine. I would actually like that, but the concept of rewarding people, I feel like it sets up a culture in medicine that it's tick for tat. I don't want to work with someone who is... We will all get sick, maybe not—like, God willing, we all don't get sick. We will all have different life challenges, whether it's to be a caregiver, whether it's to have a baby, that we would need our colleagues to step up for. To me personally, I actually find it is the antithesis of why we are physicians.

Dr. Blair Bigham:
What I'm trying to get at, Jola, is should a large university system hire a float surgeon to replace residents who are off sick or on mat leave, for example, so that there's somebody there? And I don't know, maybe they don't have to be a surgeon, maybe they can be a PA or a nurse practitioner, but somebody who can actually participate in that absorption of shifts as opposed to redistributing the way a group of staff surgeons might bring in a locum instead of just taking on more call themselves. Is that something that's been done anywhere?

Dr. Maryse Bouchard:
I don't know that it has, and I haven't really heard of that really in a residency program. And I think that's where maybe as residents and as staff, it gets a little bit different because it's kind of hard to just find another resident if one person is off from nowhere. But I think when we think about the fact that we've had to change how we function as a service with more strict post-call at 8:00 AM, that's one less body that's in the hospital the next day. We've had to adapt as groups. And some programs, like in Quebec, their residency programs went dramatically down in number, and they really had to adjust. And it was a bit, as you said, it's incorporating mid-level providers and practitioners to help with some of the non-surgical stuff. It's the surgeons taking more of the workload on themselves and not just the residents or fellows.

Dr. Maryse Bouchard:
And I think, Jola, to your point, it is a culture change. We are going to need to shift how we think about this, how we support our colleagues as they go through this. And I think till now it's something we always just hide and ignore, and that poor resident is just trying to do the best they can to not make it look like they're pregnant or about to have a family and yet taking on all this stress. And I think it will take some time for us to figure out how we manage. But Toronto, we're exceptionally lucky. We have residents going off all the time for a master's degree or a PhD or other even academic reasons, let alone needing personal time for families or for sickness. And so we're quite used to having our numbers of residents each year fluctuating. And I think if we can't do it in that setting, something is really wrong because from a body's perspective, that should be the least of our barriers.

Dr. Mojola Omole:
Yeah, I agree. I was going to say, if we can absorb people going to assess the surgical scientist program, then I would argue, Caroline—not, no offense to your master's that you're getting right now—that for some people, being able to have a baby is just as important and probably will pay off in the long run better than the master's.

Dr. Blair Bigham:
Probably more important than doing a master's is starting a family.

Dr. Mojola Omole:
Just listen, I'm not a career, I'm not an academic surgeon, so I can't speak on that.

Dr. Blair Bigham:
Caroline, we've done a podcast before on motherhood during residency and specifics. A lot of people talk about IVF or delaying or deferring. Caroline, what does the literature show about the attitudes of residents when it comes to being able to have a baby when they want to? Are people putting it off? Are they trying to do it before medical school, or are they just trying to get by in residency while getting pregnant?

Dr. Mojola Omole:
21 when they get into medical school, I hope.

Dr. Blair Bigham:
Not always. Well, maybe. I don't know. Maybe they're delaying medical school because they want to have a family first. The average age is 22. It's absolutely standard, but there's a standard deviation somewhere.

Dr. Caroline Cristofaro:
So yeah, to Blair's question. There's a very large proportion of female surgical residents that are voluntarily delaying having children and waiting until fellowship or early practice or just not having children at all. The same cannot be said for male surgeons, however; there's definitely a discrepancy between both. So male surgeons, according to the literature, have shown to be much more successful in having children during residency, but they also take a lot less time off. And obviously they don't have the same role as a female, but having given birth and also having the entire postpartum period. So there's a big discrepancy between both. And yeah, a large proportion are voluntarily delaying childbirth.

Dr. Maryse Bouchard:
And to add to that, from the literature, there's not a lot of evidence to say what it is about being pregnant and being a surgeon that puts you more at risk, but definitely higher rates of infertility, higher rates of pregnancy complications in women that are surgeons as opposed to women who have other professions.

Dr. Blair Bigham:
What type of complications? Sorry, just by association of being a surgeon. Miscarriage?

Dr. Maryse Bouchard:
Yeah, so it's very—exactly—the only variable that they can really look at when they are comparing different cohorts is people whose profession is being a surgeon and people whose profession is anything else. And so it's not clear, you can't prove that it's radiation exposure or anesthetic exposure or the number of hours on call. None of that has really borne out. Probably, it's assumed that work hours, prolonged standing, dehydration, and the amount of stress are all potential factors leading to complications, particularly in early pregnancy. But yeah, miscarriage, infertility rates, use of IVF, and other assistive reproductive technologies are all higher in women that are surgeons.

Dr. Caroline Cristofaro:
And I think it's important to note too, the studies that did report that did control for age. So we just talked about surgeons voluntarily delaying childbirth, but it's not just because they're older when they're having children.

Dr. Mojola Omole:
So how can residency programs or surgical departments manage the structural challenges of having... we talked a little bit about residency depending on what size your program is, but what about just surgical departments? How do we manage that? Having people be able to take time off for parental leave—whether, to be honest, I also think we should include those who are not giving birth—but encouraging our male colleagues to also take parental leave because it takes two. So what are some of the things that we can do to change that structurally?

Dr. Caroline Cristofaro:
So I think, like Maryse mentioned, clarity as well as flexibility in these policies is very important. Clarity, being very specific in the points that the policies include, will allow people to not misinterpret and to respect that policy. Dr. Rangel did amazing work prior to releasing the MGH pregnancy policy for general surgery residents in that she surveyed hundreds of these general surgery residents across the country to see what the gaps were, to see where the lack of support really lay, and then what we could do to improve that support. So identifying the gaps that are already in your institution's program is very important so that you know how to improve those supports for pregnant residents or young parents. And then after Dr. Rangel identified all of these gaps in support, she subsequently crafted the policy through discussion with lots of different people from the general surgery department. So it was a team effort. Then people feel heard and, again, they're more likely to respect the policy, and then everyone in the department will be aware of the policy. So I think those are very important points.

Dr. Mojola Omole:
Do we know from what's been done at Mass General, do we know if there's been a cultural shift, a change in even residents' perception that they can take some time off?

Dr. Maryse Bouchard:
I don't know that they have surveyed folks post-implementation to know if perceptions have changed. You're bringing up a really good point that I think Dr. Rangel felt was key to success. And they wouldn't say that it's perfect in any way, shape, or form yet, but you kind of need to start tipping the scales before you just plop these new policies. So that's part of why we wrote this paper—I knew that if I suddenly put, if I walked up to the residents on Monday and said, "Here you go, here are 15 new policies that we need to adopt to support our pregnant residents, and you know what, staff? We're going to do the same thing at all the hospitals"—it's just not going to fly. So you have to set the stage. In other words, first we're going through the literature, we're going to publish it, we're going to publish it in an orthopedic journal, we're going to publish it here, we're going to prove that there's actually a problem.
And then, using the same methodology that Dr. Rangel used, we just received our ethics approval to do a similar study to get data on Canadian surgeons and trainees to really understand their perceptions and what policies exist in their experiences with pregnancy or attempting to be pregnant and parenthood, so that we actually have our own data. And I have found whenever we tried something new in our department, it really helps when people realize the problem is also in our backyard. I think there's a lot of hesitance when it's like, "Well, it's not us. Our residents don't worry about being pregnant. They're super supported, they don't know. And of course, our female surgeons go and have kids and feel totally comfortable about it." And so it's not until we really get it out and in front. So we're having a grand rounds in October, we're bringing Dr. Rangel from Mass General, we're going to get the survey data, and then with all of that, build a policy that will hopefully engage our residents. The wellness committee is working on it. Our educational leadership is already aware. And so I think it needs that ground-up approach. But I do think you need top-down buy-in; it will not work if leadership is not engaged either in our post-grad offices or from our hospital surgeons, chiefs, and CEOs. They all need to be involved, and they all need to be educated on it. So I think it's going to take quite a bit of time to get there because I think a slow ooze of seeping this information into people will make acceptance a little easier when it comes.

Dr. Blair Bigham:
Maryse, you mentioned this top-down approach that's needed or top-down support. I want to talk about a bottom-up strategy. A lot of house organizations... So in Ontario, we have PAIRO; every province has their own house union, so to speak. There are already contracts, there are already rules, and there is this unwritten—or at some universities, and I'll call out Western for their bravado—that there's this attitude amongst the resident surgeons that, "Oh, I don't need a contract, I don't need a union. I break PAIRO rules all the time because I'm tough enough." Caroline, maybe it's different in Toronto or elsewhere or in other specialties, but how do you, as a resident, try to influence your peers and shift that culture that, no, it's not about being tough enough?

Dr. Caroline Cristofaro:
I mean, I think we definitely still have that culture, whether it's my residency program or friends in different residency programs. I think in surgery, working very hard, staying post-call, all these things—we sort of glorify that. The incredibly hard work that we put into things—the more exhausted you are, the better resident you are. But I think in terms of supporting my co-residents or having this sort of attitude to say, no, no, we shouldn't be like that, and we should be taking care of our wellness, we should be supporting our co-residents who really need to take care of their health, who are pregnant. I think it's just spreading awareness. So when I first started with the literature search that Maryse and I did for this paper, reading the articles that Dr. Rangel published in JAMA and the incredibly alarming statistics of the pregnancy complications, the rates of infertility, the rates of miscarriage—I mean, just educating myself, I was like, whoa, this is a real problem. So I think having or putting across the message that us not having policies or us not supporting our co-residents with their pregnancy, with parenthood, is actually causing harm. So I think seeing it from that stance or from that lens really changed my attitude. And I think when you explain it to others that way, then they really see the importance of it.

Dr. Maryse Bouchard:
And I think we have gotten a lot better. I feel like the generations are different, and I think our more junior residents are actually really good at supporting each other when it comes to things like they're exhausted, or they have an exam, or they have a big event in their life. Even if it's positive, like they're getting married, I get the feeling that they are much more supportive of each other than we were when I went through residency. And so hopefully that continues to shift as well in this topic.

Dr. Caroline Cristofaro:
And in addition, shifting that attitude will help improve the gender diversity within surgery, especially orthopedics in general. We had a women in orthopedics night a few months ago, and we had medical students who were interested in orthopedics hear from staff, orthopedic surgeons, and residents about their experiences. And I remember one medical student said, "Well, I am planning to have a family during either residency or at some point in my training, and I don't really want to be a trailblazer. I just want to be able to have children and be a parent during my time, but I don't want to be the first one crafting policies or the first one going through all of this." And I really resonated with her. I thought that's such an eloquent way to explain that it's about time that we have these policies and for everyone to feel supported, and then improve the gender diversity that we have—or don't have.

Dr. Mojola Omole:
Right. Thank you guys so much for being part of this.

Dr. Caroline Cristofaro:
Thank you.

Dr. Maryse Bouchard:
Thanks for inviting us.

Dr. Mojola Omole:
Dr. Cristofaro is the resident chair of the wellness committee in the orthopedic residency program at the University of Toronto, andnd Dr. Maryse Bouchard is the associate program director of orthopedic residency, also at the University of Toronto.

Dr. Blair Bigham:
Jola, you know something about being pregnant as an early career surgeon? I do. But your story is pretty positive. It offers a glimpse into the future of what Maryse Bouchard is trying to build at U of T.

Dr. Mojola Omole:
For sure. And I would say that the caveat is that, in general, general surgery tends to have more cisgender females and tends to have much less of the—I call them bone bros—than orthopedic surgery. And so therefore, we're a little bit more open to the concept of support, being supportive during pregnancy and then being supportive after pregnancy, like postpartum.

Dr. Blair Bigham:
What exactly did that department head or other people in the department say or do? What exactly made that environment supportive for you?

Dr. Mojola Omole:
I would say that first, they were all like, "Great, have fun. Great. We'll get a locum for when you go off call." But then I had to go off call because of COVID, because the lockdown happened in March when I was supposed to be delivering in May or June. And initially, I was like, "Okay, I'm going to try and take call." And they were like, "No, you're not going to take call. You're pregnant. You'll be fine. We'll be fine without you." And so they wouldn't even let me consider it. It was just, "We're going to take call. You're fine."

Dr. Blair Bigham:
So it's early on in COVID, you are in your third trimester, you're not working much. I imagine it's a stressful time for you. What did having that sort of automatic support—it sounds so unwavering, the way you describe it—what did that mean to you?

Dr. Mojola Omole:
It meant the world to me because that support didn't actually just end after that. I had significant postpartum depression and anxiety. And when I called, I think I was supposed to go back, I can't remember, maybe five, six months—I can't remember how long I was going to take off—and I was just like, yeah, I can't come back. And his name is Graham Gibbs. He was like, "Okay, we'll just continue with the locum. Whenever you're ready. I'm so sorry you're going through that. Whenever you're ready, we're here." And I think that to have a department head that was extremely supportive—it was like, I was obviously nervous to tell him. It's like telling your dad that you did something wrong, but instead, you got met with an amazingly lovely response from someone who just embraced where you were at. And I would say all my colleagues embraced that for me, and they were all just unwavering. So it felt really good, and it was very affirming that we can do hard things. I chose to operate and be vomiting. That was my personal choice, but that's not for everybody. If you're laid up and you just feel too terrible to work, we should also support that too. And honestly, I think they would've supported that too. It's more of our time for them, so that’ll be fine.

Dr. Blair Bigham:
Was there something miraculous about the environment at McMaster or Peterborough, or what is it that people like Maryse Bouchard, who are trying to really embed this across surgical residencies at U of T, or for people listening at other universities or community sites, or even just a small group of surgeons who want to get something in place, what advice would you have based on these excellent experiences that you've had?

Dr. Mojola Omole:
I would say that you need to be a compassionate leader. I think it's important that what is lacking in healthcare leadership and surgical leadership is compassion, and we are each other's allies. We're not enemies, we're not competitors. You have to have radically compassionate leaders who really see that if you support your residents, if you support each other, this is going to be better for the program and a hundred percent better for the patients. When people are able to live all sides of their life, whether that is to be a parent or to run marathons or whatever it is, if we support each other in all aspects, we do better. The environment we work in is happier, and our patients do better.

Dr. Blair Bigham:
What more could we ask for? That's it for this episode of the CMAJ podcast. If you like what you heard, please give us a five-star rating wherever you download your audio, share it with your networks, leave a comment, tell your colleagues, reach out to us on Twitter. Our handles are in the show notes. The CMAJ podcast is produced for CMAJ by PodCraft Productions. Thanks so much for listening. I'm Blair Bigham.

Dr. Mojola Omole:
I'm Mojola Omole. Until next time, be well.