If you were given the choice to go under the knife with a female surgeon or a male surgeon, which would you choose? And would your surgeon’s gender even make a difference?
Even though more females are entering medical school than males these days, women are often quite scarce in the surgical field. In the US, only about 19 per cent of surgeons are female, while in the UK, women make up nine per cent of the surgical specialty. These numbers are also slow to rise with a measly one per cent increase every four years.
Some surgical specialties with the least number of women are cardiac surgery, neurosurgery and especially orthopaedic surgery where female surgeons represent five per cent of the workforce. In my own field of obstetrics and gynaecology, the only surgical specialty where women outnumber men, it is well known that gynae-oncology, a surgical subspecialty, is still very much male-dominated.
Historically, the demanding nature of a surgical job requiring compromising of family life was thought to be discouraging to women who considered surgery as a career.
Indeed, women are commonly subjected to gendered expectations about work-life balance and steered away from a career that could take time away from starting a family and raising children. Surgical training is often prolonged, and women are frequently faced with inflexibility and obstacles around taking time off.
In addition to the family “sacrifice”, women in surgery may also face discrimination, sexual harassment, and false assumptions about their abilities. A study published in April 2019 in Annals of Surgery showed that while sexual harassment in surgical training does happen, it often goes unreported.
An inherent bias toward women in surgery may even come from other healthcare workers. A July 2019 study in JAMA Network Open found that regardless of gender, doctors were more likely to associate men with surgery and women with family medicine.
However, despite some of these negative connotations, there is now emerging evidence that women may in fact make better surgeons than men.
A recent Canadian study included over 100,000 people who had surgery performed by 3,314 surgeons (2,540 male and 774 female) and matched them by age and experience as well as matched the patients for complexity of their surgery. It was found that the patients of female surgeons had lower death rates, fewer complications and a lower readmission back to the hospital a month after the procedure, when compared to the patients of male surgeons.
Another similar study in the US had comparable findings of better outcomes with female surgeons. These were attributed to the female doctors’ ability to better communicate and engage with their patients, their willingness to collaborate with colleagues, and their tendency to more closely adhere to guidelines when offering treatment.
It was also generally felt the female surgeons represented a select group of the gender’s best as many may have had to overcome barriers in what is a traditionally male-dominated field in order to rule the operating theatre. Therefore, their superior results may be reflective of them being the very best women in their craft. Of course, many of these factors are indeed hard to test, and ultimately, surgery is typically dependent on the skill of the surgeon and his or her ability to assess someone’s likelihood of surviving or developing complications.
My pathway which included a surgical fellowship in gynae-oncology was by no means easy. Long hours, minimal free time and having to deal with the most surgically challenging and difficult cases did sometimes feel like an uphill struggle. Nonetheless, I was lucky to be well-supported and encouraged.
I am still acutely aware however of the preconceived notions that exist. Even now, after spending quite a bit of time carefully explaining details of a surgical procedure to my patients, many of them then politely ask who is actually doing their surgery.
My feeling is always to encourage women to excel in all fields, not just medicine and not to shy away from the perceived male-dominated specialities just because you are wary of the inherent challenges.
In the end, it is always about offering the best possible care and recruiting the best talent possible, regardless of gender.