Table 1.

Experiences of maternal discrimination as described by self identifying physician mothers among 947 qualitative excerpts, by theme and subtheme

Theme and subtheme	Exemplary quotes
Gendered job expectations
Higher standards for physician mothers	“Was held to a higher performance than my peers when pregnant”—Participant 426 “Despite meeting my RVU goals (even with 10 weeks of maternity leave), I was told I did not qualify for a raise because I hadn't been productive enough”—Participant 234
Lower expectations or presumed disinterest	“Unconscious bias is prevalent. 'You don't want to deal with that,-you have small kids'”—Participant 459 “My impression is that I'm not invited to some 'extra'-type work things because it's assumed that I'll opt out because I have young children. Basically, someone else is opting out for me”—Participant 978 “I was not considered for the assistant medical director position because it was felt it would 'take away from my time at home' by my director. I am part time right now, but would have considered increasing my hours for this new opportunity. Instead, the position was given without anyone's input to a fresh out of residency male graduate with years less of clinical and administrative experience”—Participant 671
Limited opportunities for advancement
Excluded from decision making	“During my maternity leave, a lot of administrative decisions or changes were made in my absence because I was 'too busy' taking care of the new baby. I would have still appreciated being included in the workplace decisions and changes that were made”—Participant 554 “Frequently not included in projects and/or decisions after I announced I was pregnant. Again not included in decisions after I returned from maternity leave”—Participant 202
Excluded from leadership or career advancement	“I have been 'passed over' for activities which could have helped me with promotion which were provided to male colleagues”—Participant 280 “[I] didn't get chief resident though selected by majority due to pregnancy”—Participant 6 “Most times when a leadership opportunity presents I volunteer. For many years, all I hear is that a male peer has more experience or needs to find his 'niche' or that I need to spend more time with my family”—Participant 738 “Although I was the senior neurointensivist in our hospital, my colleague (male, fresh out of fellowship) was given the directorship position when the previous director left”—Participant 516
Job or contract changes or termination	“I had my contract changed upon return from maternity leave while on FMLA…. Went from working day shifts to night and weekends. They also said while I was gone, they are no [longer] having part time and I would need to work full time. After talking with some lawyers it seemed that even though they were breaking the contract and going against FMLA, it would be a difficult course. I left and got another job after being there for almost 9 years”—Participant 402 “I was told the practice would lose money because of my pregnancy and mat[ernity] leave. I was told my ankles would swell, my baby would end up in the NICU, and then I would want to be there with her so the practice would lose even MORE money and because of all this I need to accept a new contract with lower pay, no partner track, and no right of first refusal if the practice was ever sold. This is just a small amount of what happened and what was said to me. I signed the new contract because I was threatened I would lose my job and believed I really had no choice”—Participant 292 “I was given an ultimatum when out on maternity leave to return under a contract that was different than when I left or not return at all. I was a part-time salaried physician and forced to return full time”—Participant 406 “I was fired 2 weeks after having a baby without any warning whatsoever. Not only that, they did it over the phone, then had all my hospital privileges revoked overnight since I no longer had a physical office”—Participant 276
Financial inequalities
Lower pay than equal or less qualified colleagues	“I was given a smaller raise than my male colleague at the same level despite bringing in more revenue. When I asked for a raise my Chair told me that my husband should get a job. When I got back from maternity leave, he had given one of my OR days to another colleague”—Participant 666 “I definitely have been paid less than male counterparts. I even discovered that recent graduates I had trained were making more money than I did (10 years more experience)”—Participant 205
More work for no more pay	“There exist some hospital committees that have paid stipends for membership. These are split between the male partners- not one male partner is unpaid for his administrative work…have asked the group multiple times to just strike stipends and pay a set hourly rate for any and all administrative tasks.... met with a great deal of push-back”—Participant 43 “As a resident, our GME office decided that residents taking leave (would only apply to maternity leave essentially) would have to make up the time without benefits or pay”—Participant 16 “When I was working as a hospitalist (which I am not anymore because of burnout), there were 4 in our group who worked part time. We were all women and all mothers. The group’s director (who was a single man without children) wanted to require us to take the same amount of holiday call as our full time counterparts. He also would not allow us to take our CME day (to which we were contractually obligated) because he felt that working part time should allow us plenty of time to do CME on our own time”—Participant 1007
Lack of support during pregnancy or postpartum period
Maternity leave disparaged	“Generally being made to feel guilty about taking 'so much' time off for maternity leave. Often people equating maternity leave to vacation”—Participant 170 “My son was born premature and was in the NICU when I was an intern. The upper level resident I was on a rotation with asked me how I was 'enjoying my vacation' in reference to my maternity leave. I spent that maternity leave in the NICU. It wasn't a vacation. And I finished residency 2 months later than everyone else, as well as using all of my vacation/sick leave”—Participant 111 “After coming back from a mere 6 weeks of maternity leave my boss said, 'Must have been nice to have had all that time off. I've never had that much time off!'”—Participant 9 “Told that taking maternity leave was a bother to everyone and that I can't just 'keep going on vacation for 6 weeks'”—Participant 30
“Punishment” for maternity leave	“Unpaid maternity leave AND obligation to makeup missed calls. However, partners who take medical leave are not required to repay call”—Participant 150 “The office manager informed me that my partners wanted to charge me more overhead cost while I was on maternity leave. Meanwhile a male partner took all of July off every year for over 20 years”—Participant 369 “I took the same time off afforded to any resident in my program (3 weeks vacation + 1 month reading elective), yet somehow was made to suffer considerably since I was on 'maternity leave'”—Participant 164 “My male coworker and I both work as 0.8 FTEs but he was able to keep full-time status and benefits while I was suddenly changed to part-time after returning from maternity leave. We work in the same practice. When I brought this up with my department administration, I was told that I could just add myself to my husband's benefits package”—Participant 321
No support for breastfeeding or pumping	“I was also given extra patients in the ED to compensate for my [pumping] breaks (double hit before I went for my 15 minutes and double hit again when I came back) even though I could see on the tracking board that the other team didn't get any patients”—Participant 66 “As a resident pumping for my 3 month old child (after coming back to work 4 weeks postpartum) I was told by my associate program director that my 'personal life was interfering with my ability to do perform my work responsibilities' because of taking breaks to pump every 4-6 hours. Despite the fact that I was pumping in a public work space surrounded by attendings, residents, medical students, and occasionally consultants from other services so as not to miss any important clinical work or decisions rather than pump in private”—Participant 166
Challenging work or life balance
Childcare challenges	“I am part of a leadership group that moved their meeting day to a day I do not work, and therefore do not have childcare. I asked admin if there were a call in option or if I could bring my child to the meeting (it is a pediatrics leadership group, after all). I was told no on both counts”—Participant 49 “I was routinely criticized for taking off days when my son's asthma flared and at one academic center was told my child had better be hospitalized (not just in the ER) if I called in sick. I was then told by these same academic centers that it was not acceptable to bring my child into the workplace and why couldn't I find 'a nanny or little old lady to take care of him when he is sick?'”—Participant 205 “I was offered a position as Medical Director of my department for a part time 3 day a week position. However they would not commit to which 3 days per week, and it was impossible with my child care situation to not have somewhat of a commitment so that childcare could be planned around my work schedule”—Participant 641
Taking work home	“I was so completely burned out after 8 years of practice. Charting until midnight, charting on weekends, charting on Christmas. I felt like I was in a burning building and I had to find a place to land when I jumped. So I took a six week sabbatical and came back to work part time. Now working 20 hours of direct patient care (outpatient internal medicine). I am home by 3, to see my children, I am exercising regularly, sleeping more than 5 hours/night. I feel like I am on vacation. I have no idea how I made it through the hell I was going through. Every aspect of my life had been taken over by work”—Participant 286
Lack of alternative work arrangements	“Administration unwilling to consider alternate work arrangements to allow working physician mothers to obtain improved work/life balance”—Participant 508 “When I was a resident and was breastfeeding/pumping at work: my program director said: 'Oh it's too bad you have to miss part of the lectures etc every day (because I was pumping).' And I thought to myself, 'Well you could let me start clinic (with 3-6 other residents) 15 minutes late, especially since you've told me multiple times that I am faster/see more patients than any of the other residents'”—Participant 37