Gender, Marital, and Parental Barriers to Pursuing Gastroenterology Fellowship: A Multicenter Analysis of a National Survey and Actionable Solutions

Introduction Female gastroenterologists comprise 19% of the gastroenterology (GI) workforce, despite females making up 30% of GI fellows and over 50% of medical students in the USA. Barriers to pursuing GI fellowship have not been studied at the resident level. We aimed to determine multiple barriers that may prevent internal medicine (IM) residents from pursuing GI fellowship. Methods Our multi-center team distributed an IRB-approved electronic survey to residents in IM residency programs nationwide. Multiple rounds of emails with survey description and link were sent to program directors and coordinators to forward to their residents. Four-point Likert barrier scales were used where "not a barrier" was analyzed as "no" and "somewhat a barrier" to "extreme barrier" was analyzed as "yes." Frequencies and Chi-square tests (p < 0.05) were used to compare barriers by gender. Results The mean age was 29.9 years. 287 (52.9%) were female. Compared to males, female residents were more likely to report concerns regarding maternity/paternity leave, child care during or after training, fertility, and delaying pregnancy as significant barriers to applying for GI fellowship (Fig. 1). Lack of mentorship, lack of same-sex mentorship, lack of gender diversity, and compensation inequality were greater concerns compared to males (Fig. 1). Financial obligations, job availability, debt burden, family obligations, and paternity/maternity leave were significant barriers for trainees with 1 or more children compared to trainees with no children (p < 0.05) (Fig. 2). In a gender-based sub-analysis, female married trainees perceived paternity/maternity leave, childcare, delayed pregnancy, and lack of same-sex mentors to be greater barriers compared to male married trainees (p < 0.05). Conclusion Our study revealed several gender-specific, parental, and marital-based barriers that may prevent IM residents from pursuing fellowship training in GI. Potential interventions for female trainees include structured mentorship pathways, better resources for parental leave, and interventions to reduce stress/burnout and improve work-life balance.