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Why Surgery Remains a Male-Dominated Field

Written by Lydia Zapusek

I’m a medical student currently in my last year of studies, and was very happy to accept when Anna asked me to write a post for her series of diverse feminist guests. The story of sexism in medicine is a long one, but I wanted to write about the specific question of why surgery remains a male-dominated field. 

Surgeons enjoy a high reputation and work in a field where large amounts of money are involved – the responsibility is high. One has to deal with relatively little paperwork and results are immediately visible after a successful surgery. This would make surgery a very attractive profession for everyone. But it is a remarkably male-dominant field. Female doctors tend to choose branches like psychiatry, anesthesiology or pediatrics (doctors specialized on narcosis or children’s medicine, statistics here[1]). This fact confirms a general societal trend: the proportion of women in an individual field sinks the higher income, prestige and the authority to give directives become.

At first, I was bewildered by this trend, and asked myself why disproportionately few women wanted to specialize on surgery, and why the surgeons with the highest reputation were almost always men. After completing an internship in a surgical department, I gained insight into various practices, which I believe to be responsible for this discrepancy.

I’m going to give the example of one of my routine workdays to demonstrate how one feels as a woman in surgery. I was asked to assist at a surgery with the head of department and another surgeon who were both male. We had to rush into the operating room and there was no time to introduce myself. So I got called „Mädel“ (which is “girlie” in German) instead. Fortunately, this particular demonstration of a lack of respect ended when I introduced myself, but the sexist comments did not:

The head of department complimented the operating technical assistant, saying that he was her “fan”. This could be a positive remark, however he asked me whether this was still something “one was allowed to say nowadays” or whether it was inappropriate. I wanted to tell him that he had to ask someone of equal rank if he was interested in an honest answer. Being a student, I didn’t dare responding in defense of my colleague. After all, I depended on him to complete my internship successfully.

As the surgery proceeded, the head of department complained that one of his colleagues lost his job because he crossed the line of harassment towards a female anesthesiologist multiple times. He also communicated his objection to quotas in medical departments and mentioned that the assisting surgeon was his preferred successor. This assisting surgeon was good, but still this behavior might be an example of the Thomas-cycle, a term that has its origins in the German financial market and states that directors tend to support successors who remind them of themselves – a tendency that becomes particularly important when attempting to explain the low percentage of women as heads of medical departments (statistics here, [2]). I’m convinced that the Thomas-cycle also exists in medicine. In Austria, 60% of medical students and almost 50% of all doctors working in hospitals are women. However, 90% of heads of department are men [3].

In the surgical department where I completed my internship, there were more male than female trainees. I immediately noticed that the male trainees had a better reputation, so at first I thought the department might actually have had coincidentally better experiences with some of the male trainees. But then I experienced how differently trainees were treated in training situations based on their gender. When the male trainee performed surgery under supervision, communication was productive and professional. Mistakes were corrected in an objective and polite manner. In contrast, I observed a similar situation where a female trainee was performing surgery with the same supervisor. She made a mistake (with no serious consequences for the patient) and was told off harshly. When she tried to explain herself, she was told that she shouldn’t be “so cheeky”. The situation escalated without her saying much more and the supervisor yelling at her for a full two minutes.

I found these experiences quite alienating and they definitely influenced my choice of specialization. In surgery, one has to rely on learning manual skills from more experienced colleagues, which is hard when one is treated like the abovementioned trainee. A study has shown that women who choose male-dominant fields experience significantly more frequent and more severe microagressions and are less satisfied with their choice of profession [4]. In non-surgical fields, one doesn’t depend that strongly on experienced colleagues, can study independently from books and papers, and the work environment is less discriminatory in general.

I’m pretty sure that I only witnessed the tip of the iceberg during 8 weeks of work at a surgical department. Femal surgery trainees probably have to deal with difficulties I can’t quite grasp yet, especially those who do not have the privileges of being white, wealthy, native speakers of German and/or able-bodied. I’ve experienced that young, female surgeons have to live up to higher standards to get the same appreciation as their male colleagues for the same work. But what’s horrifying is that most look for the mistakes in themselves instead of seeing a structural problem.

Surgery is an interesting and rewarding field, in which conditions should be the same for men, women and everyone else. In my eyes, the scarcity of female surgeons is a vicious cycle, starting at patients’ – and thus society’s – perception of the typical surgeon as male, continuing with a lack of role models for female medical students interested in surgery, higher drop-out rates of female trainees resulting from dissatisfaction due to bad treatment and finally, most licensed surgeons being men. The first step of breaking through this vicious cycle is investigating and naming its structure, and communicating it throughout the medical society. I believe that, besides encouraging women* to be surgeons, increased awareness of gender stereotypes in medicine would help everyone on all levels of medicine.

Sources:

  1. Physician Specialty Data Report: Active Physicians by Sex and Specialty. (2017) URL: https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2017 [12.2.2020]
  2. Dembowski A: Männliche Monokultur – Der Thomas-Kreislauf (2019), URL: https://fondsfrauen.de/maennliche-monokultur-der-thomas-kreislauf/ [12.2.2020]
  3. Der Nachwuchs ist weiblich (2010), URL: https://www.derstandard.at/story/1262209610908/medizin-der-nachwuchs-ist-weiblich [12.2.2020]
  4. Barnes KL, McGuire L, Dunivan G, Sussman AL, McKee R. Gender Bias Experiences of Female Surgical Trainees. J Surg Educ. December 2019; 76(6), p.1–14.

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