Talk & Surg – Women Surgeon Series, created by AIS Channel, aims to teach, encourage and motivate young female surgeons, residents and scientists so that they are able to achieve their medical professional goals.
Medicine has historically been one of the professions most difficult for women to access, specially surgical practice. Despite their active role in medicine since ancient times, the first female surgeons made their way into medical schools and residency education in the first decades of the twentieth century.
From a historical point of view, women were not allowed in surgical practice when modern surgical training was introduced by Halsted in North America. Pretending to be a man was the only way for Miranda Stewart, the “beardless lad”, to become a military surgeon after graduating from medical school in 1812 under the name of Dr. James Barry.
The first female physicians graduated in the United States and Canada in the mid nineteenth century, and the first female surgeons did so in the beginning of the twentieth century. Barbara Stimson, a pioneering orthopedic surgeon, was the first woman certified by the American Board of Surgery.
In the 1970s a process of feminization started globally, increasing the percentage of female physicians in the early 21st century up to 28% in the United States, 37% in Britain and over 40% in Spain. Nowadays some medical schools have more than 50% of female students.
Regarding the papers published in medical journals in the past decades the proportion of lead authors who were women increased from 5% in 1970 to near 30% in 2004, and the proportion of senior authors who were women increased from around 4% to 20% in the same period.
Nevertheless, when it comes to surgery, feminization has been slower. This has also been the case in academic medicine. It is thought that women have opted not to choose surgery as a career because of reasons such as the lack of role models and mentorship, and the feeling that it is not family-friendly, and that it involves a non controllable lifestyle. Having a female role model, or being regularly exposed to women surgical faculty, is positively associated with the number of women choosing a residency in General Surgery.
Many factors influence the choice of the specialty by medical graduates. A study by Davis et al. showed that the number of medical graduates (in the United States) starting a General Surgery residency increased over the years covered by their research (2000 – 2005). Also, a study by Stain et al. in which the characteristics of applicants for general surgery residency programs were analyzed, showed that 45.2% of highly ranked applicants were women.
Social stereotypes which are unconsciously harbored by both men and women have been described as a challenge by junior female faculty and women in leadership positions. Disparities in remuneration and promotion are a growing concern.
A National Survey published in JAMA in 2009 showed that men were more likely to report being satisfied with residency training than women. A recent systematic review and meta-analysis on the prevalence and causes of attrition among surgical residents showed an overall rate of attrition of 18%. Female residents had a significantly higher rate of attrition (25%) than male residents (15%). If exposure to role models is important in career choice and to lower attrition rates, we must make the appropriate role models available to residents and faculty members on a regular basis.
Another factor to take into account for female residents and careers is pregnancy and the difference in parental responsibilities compared to their male counterparts. Recently an article was published by Rangel et al. on pregnancy and motherhood during surgical training. Results showed that 85.6% of female residents worked an unmodified schedule up to birth. Also, only 34.9% of participants in residency programs reported maternity leave policies. This led 39.0% of participants to strongly consider leaving the surgical residency, and 29.5% would discourage female medical students from a surgical career, specifically because of the difficulties of balancing pregnancy and motherhood with training. Another study reports obstetrical complications in pregnant medical and surgical residents; when residents were compared to women of similar age in the general population, residents had higher rates of miscarriage, high blood pressure during pregnancy, placental abruption, and intrauterine growth restriction. A study by Troppmann et al. showed that female surgeons and younger surgeons were less likely to have children. But also, male surgeons and younger surgeons were less likely to favor part-time work opportunities for surgeons. It should be borne in mind that the surgeon’s spouse was the primary caretaker of their offspring for 26.9% of women surgeons versus 79.4% of male surgeons.
Little research exists on the differences in learning and the acquisition of skills for female and male surgeons. Recent studies have suggested that female doctors are more likely to take a patient-centered approach with better communication and to follow evidence-based guidelines routinely. A recent comparison of postoperative outcomes among patients treated by male and female surgeons showed a significantly lower likelihood of death within 30 days of surgery for those patients treated by female surgeons in elective procedures.
The primary surgeon’s number of procedures, specialization and skills have a direct effect on patient outcomes. But surgery is a team-based practice that includes many other non-individual factors. As a historically male-dominated profession, surgery has important implications for sex equality and for both individual- and team-based quality outcomes.