Are there women surgeons

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Save Preferences. Privacy Policy Terms of Use. Twitter Facebook. This Issue. Citations 1. View Metrics. February 2, Valerie A. Author Affiliations Not Available. Q: Why do you think there aren't more women surgeons? Q: How do you feel about your career choice? Any regrets? Access your subscriptions. Access through your institution. Add or change institution. With the majority of low- and middle-income countries struggling to build an adequate surgical workforce, expanding the participation of women in surgery is a powerful way to help alleviate the global burden of surgery [ 6 , 7 ].

The experiences of women in medicine and how they differ from men is well documented. The majority of this work has focused on barriers such as discrimination, pay gaps, and promotion inequality [ 8 , 9 , 10 , 11 ]. Surgery continues to be a male-dominated field with the disparate experiences between genders not well documented worldwide. Understanding career experiences of women in surgery is essential to expand the female workforce, improve the professional surgical environment, and retain existing female surgeons.

This scoping review seeks to understand the experiences of female surgeons around the world and how they differ based on geography, national income World Bank income level and cultural beliefs of gender equity Global Gender Gap Index GGGI.

The experience of female surgeons is a very broad topic for which we hope to synthesize the current knowledge and identify where gaps in gender equity are evident globally. Our analysis can inform future training programs and professional, educational and institutional initiatives and policies. We hope to inspire new strategies to increase surgical capacity through empowering women globally.

A detailed protocol has been provided as Additional file 2. Included were original, peer-reviewed, full-text articles published in English that studied female surgeons, female surgical residents, and female medical students considering surgery. All study types were included, such as cross-sectional analysis, questionnaires, longitudinal analysis, and controlled trials.

Editorials, case reports and personal anecdotes were excluded due to potential bias. No restriction was placed on the year of publication to assess the complete literature on female surgeons. One author M. Two authors M. Full-text articles were individually reviewed by two authors M. Studies that did not meet the inclusion criteria were excluded. Any inclusion discrepancies between authors was resolved through discussion. Data from included studies was compiled into a single spreadsheet for analysis independently.

Studies were sorted into four key categories based on main focus: careers challenges, residency and training, family and work—life balance, and other. The Global Gender Gap Index is a weighted rating comprising of scores for economic participation and opportunity, educational attainment, health and survival, and political empowerment.

GGGI ratings contextualize the experiences of women around the world in a social and professional capacity. Lower scores and rankings correspond to less equality for women [ 14 ].

Summary and descriptive statistics were calculated using Microsoft Excel The PubMed search yielded 12, total articles. A total of 12, articles were excluded as duplicates, having incorrect study focus, or not being original studies published in peer-reviewed journals Fig. The process yielded studies meeting inclusion criteria and published between and Fig. Included study details appear in Table 2.

Fifteen studies examined populations from multiple countries Table 2. No studies evaluated female surgeons in Central or South America Fig. Populations from HICs were represented in The number of studies per country overlaid on a heat map of the Global Gender Inequality Index. Eighty-nine percent of articles 42 of 47 articles focusing on career challenges studied only populations from HICs Tables 2 and 3. Female surgeons from different countries had different perceptions of their career barriers.

US surgeons attributed their career barriers to ineffective mentorship, gender stereotypes, unclear expectations, a perceived lack of belonging, and sexism in the workplace [ 21 , 22 ]. Barriers to career success in Europe were ineffective mentorship, gender stereotypes, a lack of part-time career availability, and work—family conflicts [ 23 , 24 ]. In Nigeria, female surgeons listed limited time with family, workload, physical effort, a lack of women in surgery, and a lack of role models as deterrents from surgical careers [ 25 ].

Two studies recommend steps to increase women in surgery. Kass et al. Two studies examined populations from multiple income levels [ 15 , 18 ]. Gender-based discrimination was described as negative stereotyping, exclusion from networking, and physical, emotional and sexual harassment.

In Australia and New Zealand, the attrition of female surgical trainees was caused in part by bullying, sexual harassment, sexism, fear of repercussion, poor mental health, and a lack of support pathways [ 46 ]. Three studies compared the surgical skills of male and female trainees in six HICs [ 47 , 48 , 49 ].

In Rwanda, The absence of interactions with other women in surgery was a noted reason why female trainees left surgical training in Australia and New Zealand [ 46 ]. Female surgeons in Japan had 3. Rwanda had two female surgeons in the country as of ; role models for female surgical trainees in Rwanda were male surgeons and female peers [ 30 ].

Nineteen studies reported on the pregnancies of female surgeons [ 19 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ]. In the US, In Canada, Female surgeons in the US who were pregnant during training reported feeling poorly judged In contrast, female surgeons in Nigeria who had children gave birth more often during training Ten studies evaluated access to childcare and maternity leave policies for female surgeons from only HICs [ 54 , 55 , 57 , 61 , 62 , 63 , 66 , 69 , 70 , 71 ].

A study by Walsh et al. In this study, Chinese female surgeons were the least likely to reduce their workload while pregnant [ 19 ]. Nine studies exclusively from HICs [ 57 , 64 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ] found that women had a higher proportion of household and childcare responsibilities.

Female surgeons from the US reported one to ten more hours of housework per week versus male surgeons [ 72 ]. In Germany, female surgeons spent 7. Twenty-seven percent of female surgeons in Switzerland completed all housework themselves [ 75 ]. Japanese female surgeons also had the least amount of personal time [ 76 ].

In Hong Kong, female surgeons reported less time for community participation and rest compared to male counterparts [ 71 ]. Female surgeons in Poland had shorter life expectancies than the general female population The demographics of included studies alone provide unique insights into the literature on women in surgery. With only 26 countries in this review, we have demonstrated a large shortage of literature on female surgeons experiences compared to the reported 53 countries where female surgeons exist [ 19 ].

In particular, no literature on female surgeons was available from Central and South America, despite evidence of women working as surgeons in this region [ 82 ]. The first step in training and retaining more women in surgery is to support the current cohort of female surgeons worldwide, as female surgeons in North America, Europe, Oceania, Asia, and Africa identified lack of mentorship, particularly female mentorship, as a barrier to career advancement and a reason for attrition in surgical training [ 23 , 27 , 28 , 30 , 32 , 36 , 46 , 52 , 75 ].

One possible solution for this barrier is to increase the mentorship and visibility of women in surgical specialties, which has been demonstrated in the US to positively influence young women to enter surgical specialties [ 50 ]. Increasing the number of female surgeons through mentorship is less feasible in some countries. Despite evidence that women and men have equivalent physical strength and skills, the limited number of female surgeons currently in countries like Rwanda, along with the societal belief that women are less suited for the demands of surgery, limits the availability of mentors for new female surgeons [ 30 , 47 , 48 , 49 ].

Rwanda is a LIC with a high ranking for global gender equality but very low ranking for educational attainment; negative attitudes towards female surgeons may stem from a deeper sociological mindset towards the educational achievements and career choices of women. Zimbabwe has a moderate GGGI ranking overall but a low ranking in educational attainment; there, both male and female surgeons believe that cultural and religious attitudes need to change in order to achieve gender equity in surgery [ 27 ].

In low-and-middle income countries with lower GGGI educational attainment rankings, working to change cultural attitudes about female education and stereotypical gender roles may be the first step towards increasing the prevalence of women in surgery. Regardless of country income level, lower GGGI rankings can predict restrictive gender norms that limit female attainment in surgery. This dichotomy may highlight cultural structures less inclusive of female advancement. Unlike female surgeons from western countries, Japanese female surgeons reported less familial support for their careers and less leisure time.

Seen as the responsibility primarily of women in countries with lower GGGI rankings and low female economic participation, domestic duties are in direct conflict with medical systems that rewards long hours and increased overtime work [ 76 ]. Therefore, the medical fields in countries with low GGGI rankings, regardless of income status, may be designed to favor the male workforce. Female surgeons did more household work than male counterparts.

Child-related barriers were reported more by Europeans than Americans [ 21 , 22 , 23 , 24 ], which was surprising given the abundance of state and hospital sponsored childcare in Europe [ 84 ]. The ubiquity of childcare in Europe may have created an environment where small gaps in childcare services are a perceived barrier, while childcare in the US is completely privatized.

Countries with extended family support systems do not face the same childcare challenges. With older relatives living in the home, Nigerian women can rely on an extended family system to run households [ 53 , 85 ]. This extended family system is common in countries with similar cultural norms, allowing female surgeons from lower income and lower GGGI countries to achieve greater work—life balance at earlier stages of their careers.

Discrimination and harassment were perpetuated most commonly by male colleagues in positions of power, which increases work-related stress and burnout while decreasing retention rates among female surgeons [ 33 , 41 ].

High GGGI ranked countries may have more awareness towards discrimination against professional women. In lower ranked GGGI countries, the lack of studies on gender-based discrimination against female surgeons underrepresents the extent of the problem. A lack of awareness or minimal consequences for discrimination in low GGGI countries contributes to the absence of advocacy against discrimination.

In a Turkish example, increasing the number of female surgeons in leadership is one way to reduced gender-based discrimination [ 29 ]; this model could be replicated in similar environments. Studies from HICs reported that female surgeons had higher rates of cancer, alcohol consumption, and musculoskeletal ailment accompanied by lower life expectancies across European and North American countries [ 77 , 78 , 79 , 80 ]. But, the difference between female surgeons and the general population may be less obvious in environments where average health and lifespan standards are lower [ 86 ].

It is also possible that a career as a surgeon may provide a higher standard of living in lower income countries, which can counteract some of the health detriments from the profession seen in HICs. However, further studies would be needed to validate these hypotheses.

This study is limited by its design as a scoping review, as such there was no formal evaluation of the quality of evidence or risk of bias in the studies. The lack of studies from South or Central America likely has to do with our inclusion and exclusion criteria, specifically with regards to literature available in English. During the review many studies on South America emerged, one discussed the proportions of female surgeons in Brazil [ 82 ], but none specifically discussed the experiences of female surgeons from any country in this region.

The lack of reporting from lower income and lower GGGI countries limits the ability to provide definitive, context-specific recommendations to improve female surgeon experiences and participation. Different geographic regions along with cultural and societal norms influence gender equity and the experiences of women in surgery. Universally, women from all regions reported a lack of mentorship as a barrier to advancement.

In HICs, surgical trainee abilities are seen as equal between men and women, but women endure discrimination from male co-workers and reported more child-related barriers to their careers than their male counterparts. While female surgeon abilities were seen as inferior in some lower income countries, limited studies suggest that women may have more child rearing support and be less likely to delay childbearing.

The effects of income and GGGI are complex, as neither independently predict gender equity in surgery. More studies in lower income and lower GGGI countries are needed to understand this relationship and how to improve the female surgical experience to increase surgical capacity worldwide. Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Women were more likely than men to have experienced sexism or bias, and were less likely to feel recognised for ideas, authorship, promotions, or pay rises. Women also felt that their sex was a disadvantage in career advancement Plast Reconstr Surg , — As Isabel Rubio points out, role models are important here. Her own mentor, Suzanne Klimberg, was an important influence during her US Fellowship — and afterwards. Seeing a woman who can achieve anything — give talks at big congresses, be president of societies, be chief of breast surgery — helped me a lot.

We can do it our own way and be just as good. Malin Sund agrees that role models help young female surgeons see a way of navigating the system.

Until they become more common and visible, there may be problems making any ambition seem realistic. But she points to another problem continually pulling that kind of aspiration back. The UEMS survey showed that women feel excluded from the male-dominated networks where promotions are unofficially discussed and decided.

Facing such issues is key if women are to be properly represented in the highest echelons of cancer surgery, according to cancer surgeon Peter Naredi, Professor of Surgery at the University of Gothenburg and Sahlgrenska University Hospital, Sweden. He points out that, while socioeconomic factors may still explain the gender imbalance in those seeking a career in surgery in many areas of Europe, this is no longer a major factor in countries like Sweden — and yet the gender ratio remains stubbornly weighted towards men.

Yet even if parents share the social responsibilities, it is still hardly changing the ratio of female to male surgeons. But Naredi worries that there is still a considerable and subtle barrier preventing this — the unconscious discriminatory force which he recognises he himself, as a male, is part of.

And then you find arguments why this person has more merits than the female surgeon who has also been working with you for 15 years. And so, the male dominance of senior positions continues. Besides being outnumbered, women in surgery also often face discrimination, sexual harassment, and false assumptions about their abilities.

A study published in April in Annals of Surgery shows that while sexual harassment in surgical training does happen, it often goes unreported. And implicit bias toward women in surgery may even come from other surgeons. A July study in JAMA Network Open found that regardless of gender, surgeons more strongly associated men with surgery and women with family medicine. But amid these obstacles, efforts are underway nationally and institutionally to encourage more women to go into surgery and help them thrive in their careers, from creating peer support networks to mentoring the next generation of women surgeons.

But we're just going to keep the pressure up until we fix it. Even as women have made significant inroads in medicine, surgery remains a specialty with numerous hurdles for women.

A article in the International Journal of Surgery Global Health highlighted some of the social deterrents to surgical careers among women. It noted that women can be subjected to gendered expectations about work-life balance and steered away from a career that could take time away from starting families and raising children.