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Earn Continuing Education (CME) credit online at cme.lww.com. This activity has been approved for AMA PRA Category 1 credit. TM Funding/Support: None reported.

Readmissions after colorectal resection occur frequently and incur a significant financial burden on the health-care system. Future studies aimed at targeted interventions for high-risk patients may reduce readmissions and curb escalating health-care costs.

The benefits of breastfeeding for both women and infants are well established. 1 Despite recommendations from the American Academy of Pediatrics and the World Health Organization, initiating and sustaining lactation remains a challenge for many women. 2 Although 79% of mothers in the United States initiate breastfeeding, only 27% are still breastfeeding at 12 months postpartum. 3 Physicians who are mothers face substantial challenges that may undermine efforts to sustain lactation after they return to work. Elsewhere, we demonstrated that the career satisfaction of physicians who are mothers was negatively affected by the short duration of maternity leave, associated financial losses, and inflexible work schedules. 4-6 Given the paucity of data on lacta-tion practices among physicians who are mothers, the aim of this study was to use a large representative nationwide cohort to evaluate the barriers to breastfeeding for physicians who are mothers.

Female physicians lose significant income during maternity leave and report high rates of career dissatisfaction, particularly those in procedural specialties. Given these findings, improved family leave policies may help improve career satisfaction for female physicians.

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Desmoid tumors (DTs) are nonmalignant neoplasms of mesenchymal origin that mainly contain fibroblast lineage cells. These tumors often occur in Familial Adenomatous Polyposis Coli (FAP) patients who have germline mutations in the APC gene. Given emerging data that has implicated multipotent mesencyhmal stromal cells (MSCs) in the origin of mesenchymal tumors, we hypothesized that DTs may arise in FAP patients after MSCs acquire somatic mutations during the proliferative phase of wound healing. To test this idea, we examined 16 DTs from FAP-associated and sporadic cases, finding that all 16/16 tumors expressed stem cell markers whereas matching normal stromal tissues were uniformly negative. DTs also contained a subclass of fibrocytes linked to wound healing, angiogenesis and fibrosis. Using a MSC cell line derived from a FAP-associated DT, we confirmed an expected loss in the expression of APC and the transcriptional repressor BMI-1 while documenting the co-expression of markers for chondrocytes, adipocytes and osteocytes. Together, our findings argue that DTs result from the growth of MSCs in a wound healing setting that is associated with deregulated Wnt signaling due to APC loss. The differentiation potential of these MSCs combined with expression of BMI-1, a transcriptional repressor downstream of Hedgehog and Notch signaling, suggests that DTs may respond to therapies targeting these pathways.

IMPORTANCE Physicians who are mothers face challenges with equal distribution of domestic duties, which can be an obstacle in career advancement and achieving overall job satisfaction. OBJECTIVES To study and report on the association between increased domestic workload and career dissatisfaction and if this association differed between proceduralists and nonproceduralists. DESIGN, SETTING, AND PARTICIPANTS Data for this study were gathered from April 28 to May 26, 2015, via an online survey of 1712 attending physician mothers recruited from the Physician Moms Group. Statistical analysis was performed from August 25, 2017, to November 20, 2018. MAIN OUTCOMES AND MEASURES Univariate analysis was performed for respondents who reported sole responsibility for 5 or more vs fewer than 5 main domestic tasks. Independent factors associated with career dissatisfaction or a desire to change careers were identified using a multivariate logistic regression model. RESULTS Of the 1712 respondents, most were partnered or married (1698 [99.2%]), of which 458 (27.0%) were in procedural specialties. Overall, respondents reported having sole responsibility for most domestic tasks, and there were no statistically significant differences between procedural and nonprocedural groups. Physician mothers in procedural specialties primarily responsible for 5 or more domestic tasks reported a desire to change careers more often than those responsible for fewer than 5 tasks (105 of 191 [55.0%] vs 114 of 271 [42.1%]; P = .008). This difference was not noted in physician mothers in nonprocedural specialties. In multivariate analysis of the proceduralist cohort, primary responsibility for 5 or more tasks was identified as a factor independently associated with the desire to change careers (odds ratio, 1.5; 95% CI, 1.0-2.2; P = .05). CONCLUSIONS AND RELEVANCE Physician mothers report having more domestic responsibilities than their partners. For proceduralist mothers, self-reported higher levels of domestic responsibility were associated with career dissatisfaction. Increasing numbers of mothers in the medical workforce may create a demand for more equitable distribution and/or outsourcing of domestic tasks.