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Women in Surgery

Luciali72x721Lucia Li -- Q: What’s the definition of a randomised double-blind study?

A: 2 orthopaedic surgeons looking at an ECG.

God bless orthopaedic surgeons… This particular joke got me thinking about all the stereotypes in medicine -– not least of which is that of the male surgeon. I know it’s hardly fashionable these days to admit that women still don’t have the same opportunities in work as a man, but one only needs to look around the operating theatre to realise that 9 times out of 10, the females in there are either scrub nurses, the anaesthetist or the patient. Why is surgery still such a male-dominated speciality? Here’s my tuppence.

1) Our generation simply hasn’t gotten there yet. It’s only been a relatively recent phenomenon that female medical students outnumber male medical students, so maybe, given another decade, the slow trend of increasing numbers of women consultants will also begin to be seen in surgery.

2) Women aren’t suited to surgery. A Cambridge surgeon caused quite a furor in 1998 when, in a Lancet article, he suggested that women simply weren’t suited to surgery; one of the reasons he gave was that men cope better with sleep deprivation than women. As a woman, I obviously find this idea unpalatable, but it did get me thinking about it more seriously. Traditionally, medicine is a brutal career. Before the laws controlling the number of working hours were introduced, being a junior doctor often equated to sacrificing a home life for a good few years. This was no more true than for surgery, which even now demands long hours of its trainees and consultants. Given a traditional nuclear family set-up, which I think is still widely pervasive, when it came to childcare, it would be the female partner who took time off work. It is thus perhaps unsurprising that men have dominated surgery for some time. However, as flexible training and job-share is increasingly a real workable option, it has allowed women to see surgery as a real option. Rather than women being unsuited for surgery, it was perhaps the lifestyle which was unsuitable for them.

3) Specialties attract their own kind. For every female who felt uncomfortable in the surgical environment, there is probably a male who felt uncomfortable in the OB & GYN environment. Pity the male whose patient would rather have a female doctor as much as the female whose patient was expecting a male surgeon. Surgeons have the stereotype of being extremely self-assured and ruthless. Whether this has anything to do with the way that surgeons must be to be successful is largely irrelevant. The important consequence is that a very macho and competitive environment is fostered. Some people love this sort of environment, love cut and thrust, and it is the world they wish to enter as much as the professional challenge of surgery. Equally, some people hate the vibe this creates and don’t want to be that ruthless. The flip-side is that when it comes to selection of candidates, those who display similar characteristics as the surgeons making the selection will more likely be chosen. This is equally applicable to males as to females, it’s just that when this happens to a female, she and others are more likely to attribute this to her gender rather than her personality.

In one of my regional placements, I met a surgeon who said that “women are killing surgery”; what he meant was that as the majority of medical graduates are now women, most of them will shun surgery for its stereotypes. This will reduce the number of good candidates going into surgery, lowering its standards. Surgery needs to attract women for continued excellence in practice. I am uncertain about the benefits, or even the need, for positive discrimination, but educational initiatives which promote surgery as a realistic career option for women are vital. Both the patients and the profession can but benefit from a world where females are encouraged to explore surgery, building up a "surgical CV" to enter and compete on an equal footing with male candidates.

Editor's Note: This is Lucia Li's inaugural post on The Differential. To learn a bit more about her background, read her short biography.

August 1, 2008 in Lucia Li | Permalink

Comments

Great article, Lucia! And welcome to the crew!

Posted by: Kendra | Aug 3, 2008 5:04:12 AM

welcome!!! in the hospital where i had my internship in surgery, the chief resident and the senior were females... and i did notice that they had to work harder, exert more effort for them to get the same respect as other male surgical residents get not only from their department but even from patients... but they were really good!!!

Posted by: ninette_umpa | Aug 3, 2008 5:41:17 PM

Welcome !

Posted by: Jeff W | Aug 3, 2008 6:03:01 PM

Interesting blog...but it comes down to personality. Men draw more to Sx as it suits their personality better but even so not all men have this characteristic. I have met many residents who "look the type and act the type" but say they would never do Sx. If women want to do Sx they should me encourage there are a lot of good female surgeons.

Posted by: Clive G | Aug 5, 2008 1:30:28 PM

Hi Lucia,
Thank you for your article on this important subject - it was very thought-provoking. But I just have to play devil's advocate a bit, and challenge your assertion that there should be programs which encourage women to view surgery as a realistic career option. It smacks of the kind of patronizing attitude that caused that surgeon to say that 'women are killing surgery'. Special interest groups of the kind you're suggesting may end up encouraging that thinking rather than helping it, by 'packaging' the surgery specialization into something women are able to manage afterall.

Public health is currently a field which is dominated by women, and thus considered to be a 'soft science'. Should more post-baccalaureate male students be encouraged to go into public health so that it can be taken seriously?

I think the more compelling argument would be to introduce the notion that women may change the field in a positive way rather than hoping the field will change to accommodate women. You know better than I do that the quickest way to lose all respect is to ask for special treatment.

Thanks for the article, keep blogging!
Sharon

Posted by: Sharon Wu | Aug 5, 2008 2:12:04 PM

Simply, either you feel you are a surgeon or you are not. Ascribing certain qualities to gender alone is a narrow perspective on the field. There is a culture of discipline surrounding surgery because that's what is required. Discipline in study and technical practice is the only way to consistently yield the good outcomes the patients deserve.

I've just completed my first of 3 sub-i's in general surgery - and I find tremendous variety in the staff. You aptly put that only certain types of people are drawn to the field. I have met sculptors, musicians, mechanics, engineers, architects, military personnel, chemists, and clergy in my short time in surgery - all pursuits unified by passion and discipline. I feel at home in surgery because I share those qualities. I am not judged solely on my gender outside of the OR because I am so much more than that... So inside the OR, I focus on the learning, focus on training and I am respected like everyone else.

Posted by: Julie P. | Aug 5, 2008 3:13:50 PM

I am glad that finally somebody has come up with this ever-controversial topic, especially now in the light increasing number of female physicians.
I must also commend Sharon Wu's comments abt the topic. They make a great deal of sense.

Posted by: haritha | Aug 5, 2008 3:19:25 PM

As an incoming first year medical student, who is considering a surgical career (and a woman), it pleases me and gives me a sense of relief that this topic is being addressed. While I too, even this early in my career path, have heard about the reputation of the surgical field, I have been fortunate to have shadowed a wonderful female pediatric surgeon who inspired me to not give up on my surgical interests.

It was amazing to watch her not only because she is a great and compassionate surgeon, but also because at the time that I shadowed her she was 6 months pregnant! She was a prime a example of how the female energy can truly elevate and further positively contribute the surgical field. The future is bright and we will no doubt learn from pushing ourselves and the stereotypes beyond the limits. Thank you for addressing this topic.

Posted by: jayne | Aug 5, 2008 7:25:57 PM

I agree wholeheartedly. As a female surgical sales rep I see both sides of the story. It is obvious that personality traits come out in women which imitate the expected 'ruthlessness' of a MALE surgeon. Why do they feel the pressure to do this? Stigma, circumstance, the list goes on. I have even felt pressure to change my personality on the sales side. Sometimes the surgeons I sell to don't even know how to react to a woman being there who isn't a nurse - I'm sure the male reps don't get all the jokes I get in cases. I have seen female surgeons on the more 'caring' side build stronger rapport and have the same skill level as a male surgeon so I would encourage any female to pursue surgery, and forget the rest of them. Times are changing and who says being 'ruthless' is the key to surgical success?

Posted by: christine | Aug 5, 2008 7:47:47 PM

As a second year male medical student aspiring to a career in surgery and also as someone who has been under the knife for repeat surgical procedures done by both male and female surgeons, I have to say that in my experience the latter seem to take more care when 'patching you up'as it were:)

Posted by: mark | Aug 6, 2008 7:37:50 AM

Well-written.

Posted by: Rebecca | Aug 6, 2008 7:46:12 AM

that is soooo trueee!! i am a 5th yr med student and was thinkin bout wut i wana specialize in, n i am more interested in surgery, but i KNOW its a male dominated area! i wish that would change soon! thnx for a great article!

Posted by: Tina | Aug 6, 2008 7:46:46 AM

stress is the keyword
more males r able to withstand stress
more females r not

it's a simple physiology we all learnt in 1st medical years

Posted by: khaled | Aug 6, 2008 8:01:37 AM

Hi
That was a really nice article , I wondered before about that , in our country (Iraq) females rarely take surgery as a specialty
I think they don't because the patients won't chose a female doctor to perform the operation.
well , I am a female & studying medicine and I decided to be a surgeon so I really liked the article , thanks lucia

Posted by: Shayma | Aug 6, 2008 8:02:40 AM

Congratulatios on your first article Lucia! I enjoyed it a lot, specially because I am a female fourth year medical student and I´m interested in surgery. I think that after reading your post I feel more encouraged to specialize in it. Thanks!

Posted by: Vicky | Aug 6, 2008 8:21:23 AM

i'm a third year medical student who aspires to become a surgeon. thank you for the article ;) even though it is a male-dominated circle, i do remember a consultant neurosurgeon telling me, that he thinks women can be better surgeons. "the ones that i know, they have steadier hands, and better soft-skills, and they see a better picture." inspired me a lot, coming from someone whom i respect a lot.

Posted by: nyrac | Aug 6, 2008 8:32:10 AM

Good article, although lets not forget that the anaesthetists are probably the most important people in the OR and it is one of the most competitive specialties so if women are doing that then they could do any job in my opinion

Posted by: Geoff | Aug 6, 2008 8:35:32 AM

hey Lucia,
I loved your article, I too am a female fourth year medical student interested in surgery. Eecently I've been trailing an orthopedic surgeon and it has been my most awesome clinical experience yet...He is extremely positive and encouraging and often goes out of his way to show me ways in which I can still be a successful orthopod, even though im only 5ft2. There have been a few of the orthopods who are discouraging, rude and mocking, but the fact that one person believe I can do it has really given me a push to follow my dreams:)
Thanks for your article...it's nice to have a female perspective on surgery:) Take care

Posted by: Trish | Aug 6, 2008 8:37:18 AM

I think females not make over 20% of surgeons. Yes, a small number, but ever growing. Just as many women want a female ObGyn, a lot would prefer a female surgeon. So, there is a lot of demand. There is an intersting book The woman in the surgeon's body, by Joan Cassel which is an anthopological review of women surgeons. Pretty interesting read that looks at different stereotypes as well...

Posted by: Liz | Aug 6, 2008 8:54:19 AM

Hi Lucia,
Welcome to the world of blogging!!!
firstly you are absolutely correct, the surgical field is male dominated, its a tough field and its an area that requires dedication and the ability to withstand criticism and at times harsh feedback. Women defintitely have a place inside the surgical field, there is no reason to keep them out... and most surgeons I believe, also have this view. I'm a 5th year medical student and a male and extremely motivated to pursue the area of surgery as a place to rest this weary head.
The fields are quite diverse depending on the hospital you're at, each institute has its own micro-cosim and can either be male, female or a unique mixture of the two. I know where I work, the O&G team are predominately male - a stark contrast to your article. I believe that as the years pass on, we'll see a greater multitude of women entering this illustrious field - i know that about 30% of my year's female population have an interest in surgery. As the older and more stubborn surgeons move on, we'll see a greater acceptance of the opposite sex within this field. However, remember not everyone is cut out for it. just as not everyone is cut out to be a GP. Its a matter of choice and something which each person needs to decide for themselves. I hoped you enjoyed your first blog, and again WELCOME!

Posted by: Joel | Aug 6, 2008 8:58:47 AM

hey Lucia,
i guess ur rite... i'm still not at d cross roads - but even then ppl r shocked tht i wanna do surgery... cos they think gals r not fit 4 it... well... but i guess its time 2 change all tht... All da Best...

Posted by: Meenakshi | Aug 6, 2008 9:07:41 AM

Do people think that there are less women in surgery because they make less proportionally fewer applications (for whatever reason), or because there is an element of discrimination in the selection process?

Posted by: mark | Aug 6, 2008 9:21:48 AM

Hi Lucia! i really liked ur article, specially because i want to be a surgeon myself. I think its really accurate and realistic, not only regarding the enviroment in the USA, but in other countries as well; i went to med school in the Dominican Republic and the same thing happens here. I believe the only way to get over this arcaic and mistaken way of thinking is for us female doctors who want to become surgeons to prove we can do just as good as men, in some cases, better. I was lucky enough to get myself many good friends who are general surgery trainees (im not sure if thats correct) and they always encouraged me to scrub in with them and thaught me a lot, they really made me fall in love with surgery... My point is, PRACTICE, thats what makes a good surgeon and a good doctor, not ur gender. Great article!

Posted by: Carol | Aug 6, 2008 9:40:48 AM

All this talk is because pipo are indifferent about the many differences btn men and women. Men and women will never be equal, one always above the other in one way or another.

How do female Surgeons look, behave, act, live, associate and who behaves more a man at their homes?

Think twice Lucia.

Posted by: Dien | Aug 6, 2008 10:11:26 AM

Hi Lucia!

Great article and a very interesting topic chosen. There is definately an increase in the number of female surgeons and I also believe that in the future, we may even reach a point where surgery will no longer be male-dominated. I am, myself, interested in Surgery and now there are also support groups for females looking for a surgical career. I just hope, I'm not discriminated against for being a female! (That's just being plain old sexist)!

Posted by: fozia | Aug 6, 2008 10:15:57 AM

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