• Wed, Aug 31 2011

Are Women Being Cut From The Field Of Surgery?

“In 6500 B.C., some guy looked at his sick friend and said, ‘I have an idea. Why don’t I drill a hole in your skull? It’ll make you feel better.’ Thus, surgery was born. It takes a certain brand of crazy to come up with an idea like drilling into somebody’s skull, but surgeons have always been a confident bunch. We usually know what we’re doing. And when we don’t, we still act like we do. We walk boldly into undiscovered country, plant a flag, and start ordering people around. It’s invigorating, and terrifying.”

That quote was from one of Meredith Grey’s somewhat annoying but usually accurate monologues on Grey’s Anatomy. Meredith Grey is perhaps the most famous female television surgeon, if not the most famous, television surgeon. Meredith is just one of many female surgeons on Grey’s, and though creator and producer Shonda Rhimes does highlight the characters’ struggles with their difficult jobs, the show is more focused on their turbulent love lives and emotional evolutions. But what the show doesn’t really tackle is the work/life balance that female surgeons are faced with, nor that they are told in medical school that they are pursing the most  difficult  field of medicine because of their gender. What the show leaves out is how they’re simply told they can’t handle it instead of supporting them and preparing them for the fact that, as women, there will be greater hurdles, more compromises and gender politics with which to contend.

When it comes to medicine the majority of female doctors tend to opt for a career that is more patient related, and one that doesn’t require the excessive hours that surgery entails. According to the American College of Surgeons and the American Association of Medical Colleges, of the 50% of female physicians, only 20% of surgeons are women.

The preparation to become a surgeon is an educational process that is far longer than that of regular medicine. It’s an additional five years of training following medical school, with an additional two years on top of that depending on which surgical field is being sought. There is also the notion that women can’t “handle” being a surgeon. Says Dr. Linda Brodsky, “women are dissuaded from the field being told that they won’t make as good a surgeon as a man.”

Dr. Brodsky told me about how common it was for women in medical schools to actually be counseled by deans and advisers against pursuing surgery. There is an echoing theme that it’s “too hard” for a woman. A sentiment with which, Dr. Brodsky, who when she was a full tenure professor, was one of only 20 ENT pediatric surgeons in the country, doesn’t agree. Although to date, there are now roughly 400 ENT surgeons, around 100 of which are women – so at least some of these women weren’t listening to that negative advice.

In 2003, there was a mandatory implementation of 80-hour resident work weeks, which was a major deterrence when it came to women wanting to join the field. Says Dr. Mary Ann Hopkins, an attending general surgeon and assistant professor of surgery at New York University Medical Center, in regards to why women aren’t running out to become surgeons at the rate men are:

It’s probably because of the long hours and the family sacrifices that you have to make. Since it is such a male-dominated field, it’s hard to say, ‘Well I only want to work three days per week or part time.’ It’s simply the hours that are intimidating . . . to anyone, male or female. If you are planning to have a family and children, you may have to commit to a full-time nanny.

If the struggle to find a work-life balance isn’t enough, surgery is still considered by many as an old boy’s club. Although some surgeons, like Dr. Alexis Chiang Colvin, who works for The Department of Orthopeadics at Mount Sinai, says “Luckily, I am in a work environment where women are welcomed.” Not all female surgeons have had such positive experiences. Says Hopkins:

There is a military ethic in surgery that may not be as appealing to a woman’s mentality. There’s a lot of yelling and humiliation that goes on with the junior residents, and you have to accept this hierarchical mentality to fit in. Things are slowly changing, but the military mentality may be off-putting to female medical students.

It’s the “yelling and humiliation” that is regarded as unlady-like, and as with many professions there is the double standard. While an opinionated and strong-willed male surgeon is regarded as “great,” says Dr. Brodsky, the same can’t be said from a female surgeon. Women are expected to be polite, they’re supposed to compromise at the whim of the stereotypes of their gender. A woman who breaks out of this society-imposed role is regarded as “unreasonable.”

From the get-go girls are surrounded by negative female stereotypes, said Dr.Brodsky. Even in Saturday morning cartoons it’s hard to find a woman character that climbs outside of the conventional box of what a woman “should be.” That nurturing early on only hinders in women being “decisive” and” forceful.”

Statistics show that the surgical field with the highest number of women is in Obstetrical and Gynecological Surgery at 47%, with Dermatological Surgery falling second in line at 31.8%, then Ophthalmologic Surgery coming in third at 20.3%. And although those numbers are growing, the fact remains that female surgeons are still few and far between and that can mostly be attributed to that rigorous work life.

When I asked Dr. Sabrina Strickland who is board-certified in Sports Medicine at the Women’s Sports Medicine Center at the Hospital for Special Surgery in New York City if, while during her studies to become a surgeon, anyone suggested she choose another field, she explained:

Prior to med school some of my friends encouraged me to look at different careers with a ‘better’ lifestyle, I pondered this for a few weeks and then never looked back.

I also asked Dr. Colvin, whose specific field of surgery is only 10% women, if there were any people in their life that tried to dissuade her from choosing surgery, she said:

I was fortunate to train with men (and women) who were both very supportive of female surgeons. I believe one of the most important things you can do is seek out mentors/role models who can support and guide you.  My mother had (and still has) a full career, in addition to raising 3 kids… I also worked with women surgeons who have busy practices and families—it’s great to have these types of role models.  (I myself also have 2 kids.)

Having a solid mentor is definitely an echoing point for most of these women surgeons. Without proper mentoring the ability to breakdown that male to female gender in regards to surgeon numbers is difficult. Said Dr. Susan Pannullo a neurosurgeon and attending neurologist at Staten Island University Hospital:

One major barrier is a fear of not being accepted into a surgical program. This may be due to the fact that women receive fewer excellent performance ratings in surgical rotations, partly because they are not mentored or encouraged as much as they are in other specialties. In addition, there are more subtle barriers such as the physical challenge that surgery presents for women who are smaller and often less strong than men. Most surgical instruments were not designed with small operators in mind. Earlier in my career I was counseled by well-meaning male attendings not to go into neurosurgery because I was a woman.

However, mentoring can only go so far and upon finishing their residencies, female surgeons also come face to face with the ever prevalent gender pay gap. A study showed that the gender gap for physicians, on average, has grown to “nearly five times from 1999 to 2008 from a $3,600 difference to a $16,819 difference,” although their education and experience may be identical to that of their male counterpart. In surgery, this gap is even higher.

Although there are barriers that are being broken down in the world of surgery, the fact remains that as a male-dominated field, there’s much work to be done in making equality a standard. Yes, there are downsides to the field, but Dr. Brodsky is also quick to point out that surgeons have a very high rate of job satisfaction — they’d have to in order to take on all those hours and sacrifices for a career they truly love, a career in which they make lives better.

Expediting the Inevitable, the name of Dr. Brodsky’s organization that’s “dedicated to working with women physicians to create a more flexible healthcare workplace without sacrificing quality of patient care,” is hoping to change the way the medical community divides men and women. Sometimes these groups are created not even purposely, but absent-mindedly, out of habit and a long line of tradition where men reigned supreme and dominated higher positions on boards.

Once the medical community can open its eyes to the human resources they have at their fingertips when it comes to the pools of surgeons, both men and women, from which to choose, perhaps then, more women will join the ranks of surgeons.

 

Image via ABC

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  • Jo Hannafin, MD PhD

    I must respectfully disagree with the tone and some of the content of this article. I am an orthopaedic surgeon who completed residency 21 years ago. There is a clear bias in this article which focuses on the negatives of pursuing a career as a surgeon. Regardless of gender, a certain type of personality and skill set is required to be successful as a surgeon. You have to be decisive, focused and ready to work long hours. Surgeons by nature are competitive and driven to succeed. Depending on the area of specialization and the type of practice a surgical sub-specialty can provide flexibility in life style and work hours. Students need to seek out mentors who love their work and want to share that experience with other …regardless of gender.