Letters to the Editor

Editor’s note: The following comments were received regarding recent articles published in the Bulletin.

Letters should be sent with the writer’s name, address, e-mail address, and daytime telephone number via e-mail to dschneidman@facs.org, or via mail to Diane Schneidman, Editor-in-Chief, Bulletin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611.

Letters may be edited for length or clarity. Permission to publish letters is assumed unless the author indicates otherwise.

The future of surgery is female

Over the last decade, the number of women entering surgical training has increased. In the U.S., the number of women in general surgery residency programs has doubled from 20 years ago.¹ On the other side of the globe, the College of Surgeons of East, Central and Southern Africa saw a drastic increase in women trainees from 8 percent to 23 percent just in the last three years (see related story).² Moreover, aspiring and new surgical trainees are emerging leaders, as shown in the student session on trainee involvement in global surgery at the American College of Surgeons Clinical Congress 2019, which was entirely organized by women medical students and residents.

Thanks to many trailblazing women, progress is clearly being made toward parity. With women often outnumbering men in medical schools, the future is promising for gender balance in surgery. However, has the surgical training environment and culture kept pace with this change? Can these women climb the ladder from trainee, to consultant, to professor in the same way as their male counterparts do?

A recent survey of practicing women surgeons in the U.S. showed that nearly 60 percent reported having experienced sexual harassment, versus 25 percent of men.³ Another study revealed gender bias in evaluations of women residents in surgical training programs.⁴ Beyond gender-based discrimination and aggression at the micro-level, systemic inequities and structural sexism persist in surgery.

Women are still paid significantly less than men. In Canada, women surgeons were found to be paid 24 percent less per hour spent operating than men.⁵ Itum and colleagues also found that only half of U.S. residency programs offer paid parental leave.⁶ These disparities create a toxic working environment that makes balancing surgical training with family life more difficult for women. It is no surprise that the attrition rate for women surgical trainees is higher than for men.⁷

The further we look on the hierarchical ladder, the fewer women we find. In the U.K., the percentage of women consultant surgeons in 2019 was 12.9 percent.⁸ In 2017, Epstein analyzed the literature on full professorships in surgery and found that the number of women was so low, and the increase so slow, that it would take 120 years to reach gender parity.⁹

It is important to celebrate the increase in the number of women entering surgery. However, we need to do more to retain, nurture, and maximize their potential. Women trainees and surgeons must be treated better. Accountability measures for sexual harassment, microaggressions, and all forms of gender-based discrimination must be implemented.

Policy changes should be made to accommodate family planning and to prevent the penalization of childbearing. This step will not only encourage more women to climb the career ladder, but also may improve their male colleagues’ quality of life because men also benefit from parental leave. The relationship between physician wellness and patient outcomes is clear.¹⁰ Thus, surgical training programs owe it to patients to make surgical training a period when trainees can thrive both professionally and personally, regardless of gender.

As we start a new decade, we should acknowledge that the future of surgery is female. It is time for surgery to shift away from its patriarchal norms and better accommodate the new, eager female workforce. Bringing gender parity to the surgical workforce is an opportunity to increase the attractiveness of surgical training and improve patient care.

Zineb Bentounsi, MD Oxford, U.K.

Eliana E. Kim San Francisco, CA

Xiya Ma, MSc Montréal, QC

References

1. Abelson JS, Chartrand G, Moo TA, Moore M, Yeo H. The climb to break the glass ceiling in surgery: Trends in women progressing from medical school to surgical training and academic leadership from 1994 to 2015. Am J Surg. 2016;212(4):566-572.
2. Odera A, Tierney S, Mangaoang D, Mugwe R, Sanfey H. Women in Surgery Africa and research. Lancet. 2019;393(10186):2120.
3. Nayyar A, Scarlet S, Strassle PD, et al. A national survey of sexual harassment among surgeons. American Surgical Congress 2019. Abstract 85.06. Available at: www.asc-abstracts.org/abs2019/85-06-a-national-survey-of-sexual-harassment-among-surgeons/. Accessed June 5, 2020.
4. Gerull KM, Loe M, Seiler K, McAllister J, Salles A. Assessing gender bias in qualitative evaluations of surgical residents. Am J Surg. 2019;217(2):306-313.
5. Dossa F, Simpson AN, Sutradhar R, et al. Sex-based disparities in the hourly earnings of surgeons in the fee-for-service system in Ontario, Canada. JAMA Surg. 2019;154(12):1134-1142.
6. Itum DS, Oltmann SC, Choti MA, Piper HG. Access to paid parental leave for academic surgeons. J Surg Res. 2019;233(1):144-148.
7. Liang R, Dornan T, Nestel D. Why do women leave surgical training? A qualitative and feminist study. Lancet. 2019;393(10171):541-549.
8. The Royal College of Surgeons of England. Statistics. Women in surgery. Available at: www.rcseng.ac.uk/careers-in-surgery/women-in-surgery/statistics/. Accessed June 5, 2020.
9. Epstein NE. Discrimination against female surgeons is still alive: Where are the full professorships and chairs of departments? Surg Neurol Int. 2017;8:93.
10. Scheepers RA, Boerebach BC, Arah OA, Heineman MJ, Lombarts KM. A systematic review of the impact of physicians’ occupational well-being on the quality of patient care. Int J Behav Med. 2015;22(6):683-698.