Participant characteristics and working conditions

Among 814 society members, 292 (35.9%) responded. The demographic characteristics of the respondents are summarized in Table 1. Most respondents were male (262 men and 30 women). The response rate was 35.0% for men and 45.5% for women. The mean age was 48.6 years (range, 27–74 years), and most respondents (94.8%) were employed full-time. After excluding one unemployed female respondent, women were significantly more likely to work in part-time or non-full-time positions compared with men (16.7% vs. 3.8%; OR, 5.25; 95% CI, 1.64–16.83; p = 0.004; Fisher’s exact test). Physicians accounted for the majority of respondents (n = 278, 95.2%), followed by nurses (n = 4, 1.4%), and other professions (n = 10, 2.7%), including pharmacists, psychologists, social workers, rehabilitation professionals, radiologic technologists, and non-physician researchers. Of the 278 physicians, 250 were neurosurgeons, nine were radiologists, eight were pathologists, and six were pediatricians. Mean weekly working hours were 56.7 h ± 15.3 h, and 45.5% of respondents reported working ≥ 60 h per week. The mean number of night duties per month was 2.4 for men and 1.0 for women. Most respondents (85.3%) had children. Overall, 43.2% of respondents held managerial/leadership positions. Women were significantly less likely than men to hold managerial/leadership positions (6.7% vs. 47.3%; OR, 0.08; 95% CI: 0.02–0.35; p < 0.001; Fisher’s exact test).

Table 1 Participant characteristics and working conditions among neuro-oncology professionalsConcerns regarding career development and perceived barriers

Career-related concerns were reported by 33.2% of male respondents and 56.7% of female respondents (Table 2A). A significant association was observed between sex and career-related concerns (χ2(2, N = 292) = 7.53; p = 0.023), with women more likely than men to report such concerns, although the effect size was small (R2 = 0.012). “Physical condition or stamina” and “personal abilities or skills” were frequently reported as barriers to career development by both male and female respondents. Women more frequently reported “workplace interpersonal relationships,” “childbirth and childcare,” “workplace gender discrimination,” and “spouse’s job transfer or overseas assignment” as barriers to career development (Table 2B). Multivariable logistic regression analysis, including an age-by-sex interaction term, demonstrated a significant interaction (Table 2C). Career-related concerns decreased with age among men but increased with age among women (Supplementary Fig. 1).

Table 2 Concerns regarding career development and perceived barriersJob satisfaction among Neuro-oncology professionals

Figure 1 illustrates job satisfaction across six domains, overall and by sex. Among all respondents, 40.5% were satisfied with their job position/status, 30.6% with income, 27.1% with working hours, 12.0% with their use of skills and abilities, 46.7% with relationships with superiors or colleagues, and 31.3% with work-life balance. No significant sex differences were observed in satisfaction with income (29.8% vs. 37.9%; p = 0.40), working hours (26.7% vs. 31.0%; p = 0.66), work-life balance (31.3% vs. 31.0%; p = 1.00), or professional relationships (46.2% vs. 51.7%; p = 0.70). In contrast, female respondents were significantly more likely than male respondents to report satisfaction with use of skills and abilities (41.4% vs. 8.8%; p < 0.001). In multivariable logistic regression analysis, long working hours were significantly associated with lower satisfaction with income, working hours, and work-life balance (Table 3). Conversely, holding a managerial/leadership position was significantly associated with greater satisfaction with income, working hours, and job position (Table 3).

Fig. 1

Job satisfaction across six domains, overall and stratified by sex. Radar charts illustrate the proportion of respondents who answered “very satisfied” or “satisfied” across six domains: position/status, income, working hours, use of skills and abilities, work–life balance, and relationships with supervisors and colleagues. The results are shown for the overall sample (n = 291, excluding missing responses) and separately for men (n = 262) and women (n = 29). Percentages represent the proportions within each subgroup. Missing responses are excluded from the denominator

Table 3 Factors associated with job satisfaction across six domainsFactors associated with perceived workplace discrimination and promotion-related inequity

Among all respondents, 15.4% reported experiencing workplace discrimination, and 15.8% perceived promotion-related inequity. Female sex was independently associated with stronger perceived workplace discrimination (adjusted OR, 2.71; 95% CI: 1.23–5.98; p = 0.013, Table 4A). Caregiving responsibilities, long working hours, and managerial status were not significantly associated with perceived discrimination. For perceived promotion-related inequity, female sex was not significantly associated with the outcome (OR, 1.86; 95% CI: 0.87–3.96; p = 0.108, Table 4B). Managerial/leadership position showed a marginal inverse association (OR, 0.65; 95% CI: 0.42–1.01; p = 0.053, Table 4B). Caregiving experience and long working hours were not significantly associated with promotion-related inequity.

Table 4 Factors associated with perceived workplace discrimination and promotion-related inequityWorkplace support systems for childbirth, childcare and caregiving responsibilities and related emotional responses

Regarding workplace support systems for childbirth, childcare, and caregiving responsibilities, 80.1% of respondents reported access to maternity leave, 63.7% to childcare leave, and 34.9% to caregiving leave (Supplementary Table 1A). The perceived availability of workplace support systems was significantly higher among respondents in managerial/leadership positions than among those in non-managerial/leadership positions across multiple items, including maternity leave, exemption from night duty during pregnancy, childcare leave, employment protection during childcare leave, and exemption from radiation-related duties (Supplementary Table 1B). Overall, 43.8% of respondents reported experiencing an increased workload when colleagues took maternity, childcare, or caregiving leave, or used reduced working-hour arrangements (Supplementary Table 2A). Among those reporting increased workload, 63.6% expressed willingness to cooperate, whereas 16.4% perceived the situation was unfair (Supplementary Table 2B). Respondents working long hours (≥ 60 h per week) were significantly more likely both to express a willingness to cooperate and to perceive the situation as unfair (Supplementary Table 2C and 2D). Perceptions of workplace supportiveness differed significantly by managerial/leadership position (p = 0.036; Supplementary Table 3). A higher proportion of respondents in managerial/leadership positions reported that their workplace was supportive (53.7%) compared with those in non-managerial/leadership positions (46.2%). Regarding potential solutions to situations in which remaining staff experienced excessive workloads when colleagues use caregiving or childcare leave or related support systems, managerial respondents tended to emphasize staffing and system-level challenges, whereas non-managerial respondents highlighted personal workload, emotional burden, and the need for transparency and recognition (Supplementary Table 2E).

Positive actions to improve work-life balance

Policies, systems, and support measures considered necessary to achieve a balance between work and childcare or caregiving responsibilities are summarized in Supplementary Table 4. Many respondents indicated that increasing the number of physicians, expanding the non-physician workforce, reviewing the primary physician system, and providing exemptions from night or on-call duties were necessary. Female respondents were significantly more likely than male respondents to report the need for exemption from overtime work, expansion of reduced working hours, provision of sick childcare services, expansion of after-school childcare programs, and promotion of men’s participation in housework, childcare, and caregiving.