Trade-offs and tensions: work-life balance in female neurosurgeons and cardiothoracic surgeons.

OBJECTIVE: Work-life balance (WLB) is a persistent challenge in surgical practice due to long hours, high workload, and unpredictable schedules. Emerging evidence suggests these challenges are not experienced equally, with women surgeons disproportionately affected by the combined demands of surgical careers and societal expectations related to caregiving. These pressures have implications for career progression, workforce retention, and the sustainability of the surgical workforce. This study aimed to investigate the WLB experiences of female neurosurgeons and cardiothoracic surgeons, and to identify the challenges, barriers, and strategies that influence their ability to maintain both professional and personal roles. METHODS: A qualitative study utilizing semi-structured, in-depth interviews was conducted with female cardiothoracic surgeons and neurosurgeons in North America (N = 22). Participants were asked about their experiences balancing personal and professional demands. Data were analyzed using thematic analysis informed by a Grounded Theory approach, with themes generated inductively from participant accounts. RESULTS: Three overarching domains were identified: (1) challenges to achieving WLB; (2) structural and interpersonal barriers; and (3) strategies to navigate competing demands. Participants described significant trade-offs, including impacts on health, relationships, and career trajectories. Intense occupational demands (e.g., long hours, unpredictable schedules, and staffing constraints), combined with the unequal distribution of domestic and caregiving responsibilities, were key barriers. While strategies such as negotiating schedules, reducing workload, hiring domestic support, and protecting family time were described, these approaches often required additional effort and personal compromise. CONCLUSIONS: Female surgeons in high-intensity surgical subspecialties face substantial and persistent challenges to achieving sustainable WLB. Current approaches rely largely on individual adaptation rather than systemic support. Interventions targeting modifiable workplace factor, such as workload, scheduling predictability, and institutional support for family responsibilities, may improve retention and long-term sustainability of the surgical workforce.