Summary
To ensure equitable representation of women and BIPOC (Black, Indigenous, person of colour) individuals in surgical specialties, it is first necessary to understand the presence and extent of the disparities that exist. We explored the websites of the 17 Canadian faculties of medicine to examine sex and racial diversity in surgical specialties and in surgical leadership positions in Canada. We categorized faculty members of each department of surgery as either male or female and White or BIPOC. The relative percentage of female academic surgeons was very low compared with Canadian demographic data, and the relative percentage of BIPOC academic surgeons was similar to Canadian demographic data. Our observations suggest that actions must be taken to improve diversity and inclusion in surgery.
Sex and racial diversity is becoming an increasingly important topic in today’s society. American studies have reported a deficit of women and racial minorities among physicians, including those in leadership positions, within both surgical and medical specialties.1,2 In order to address any deficit of women and BIPOC (Black, Indigenous, person of colour) individuals in surgical specialties, it is first necessary to understand the presence and extent of the disparities that exist. We sought to examine sex and racial diversity in Canadian academic surgery, including specifically within leadership positions.
Categorization of sex and race
In July and August 2021, we explored the websites of the 17 Canadian faculties of medicine and categorized faculty members of each department of surgery as either male or female and White or BIPOC. Sex and race were determined by a single author (R.H.V.) using a combination of online profiles, first names, surnames and photographs. To confirm the validity of this approach, a sample of 50 surgeons was categorized in the same fashion by a second, blinded reviewer (S.R.T.). There was 100% concordance in both sex and racial categorization. A different sample of 50 surgeons was categorized by a third, blinded reviewer (Y.V.). Again, there was 100% concordance in categorization. The 11 specialties reviewed were general surgery, cardiac surgery, thoracic surgery, vascular surgery, neurosurgery, orthopedic surgery, plastic surgery, urology, ophthalmology, otolaryngology and pediatric surgery.
Faculty characteristics
In the 17 Canadian faculties of medicine, 4891 academic surgeons were identified, including 161 division heads and 18 department chairs. One centre’s website did not list any division heads, and when emailed, there was no response. One centre had a neurologist listed as head of a combined neurology/neurosurgery division; we did not include this individual in our assessment. One centre had separate department chairs for surgery and for ophthalmology/otolaryngology.
Of the 4891 academic surgeons identified, 2734 (56%) were male and White, 1145 (23%) were male and BIPOC, 739 (15%) were female and White, and 273 (6%) were female and BIPOC (Figure 1). Among those identified as division heads, 111 (69%) were male and White, 33 (20%) were male and BIPOC, 15 (9%) were female and White, and 2 (1%) were female and BIPOC (Figure 2). Of the 18 department chairs identified, 13 (72%) were male and White, 3 (17%) were male and BIPOC, 2 (11%) were female and White, and none were female and BIPOC (Figure 3). Grouping division heads and department chairs together, the sex and race distribution of surgeons in leadership positions was significantly skewed toward White males.
Fig. 1.
Sex and race distribution of academic surgeons in Canada. BIPOC = Black, Indigenous and person of colour.
Fig. 2.
Sex and race distribution of division heads of surgical programs in Canada. BIPOC = Black, Indigenous and person of colour.
Fig. 3.
Sex and race distribution of chairs of surgical departments in Canada. BIPOC = Black, Indigenous and person of colour.
Sex and racial representation was examined according to surgical specialty and academic centre. In all categories, women and BIPOC surgeons were a minority. The distribution of sex and race by surgical specialty is shown in Table 1. Pediatric (37%), plastic (29%) and general surgery (28%) had the largest proportions of female surgeons, and cardiac surgery (7%), neurosurgery (9%) and urology (11%) had the smallest proportions of female surgeons. Cardiac surgery (35%), general surgery (33%) and ophthalmology (33%) had the largest proportions of BIPOC surgeons, and orthopedic (19%), plastic (22%) and vascular surgery (27%) had the smallest proportions of BIPOC surgeons.
Table 1.
Sex and racial representation by surgical specialty in Canada
| Specialty | Categorization, no. (%) | |||
|---|---|---|---|---|
| Male and White | Male and BIPOC | Female and White | Female and BIPOC | |
| General surgery | 475 (45) | 285 (27) | 227 (22) | 65 (6) |
| Cardiac surgery | 124 (60) | 67 (33) | 10 (5) | 4 (2) |
| Thoracic surgery | 63 (56) | 32 (29) | 13 (12) | 4 (4) |
| Vascular surgery | 91 (63) | 36 (25) | 14 (10) | 3 (2) |
| Neurosurgery | 156 (62) | 74 (29) | 15 (6) | 7 (3) |
| Orthopedic surgery | 571 (68) | 150 (18) | 105 (13) | 13 (2) |
| Plastic surgery | 223 (55) | 64 (16) | 91 (23) | 25 (6) |
| Urology | 274 (64) | 107 (25) | 36 (8) | 10 (2) |
| Ophthalmology | 406 (51) | 184 (23) | 128 (16) | 82 (10) |
| Otolaryngology | 283 (55) | 126 (24) | 67 (13) | 42 (8) |
| Pediatric surgery | 68 (49) | 20 (14) | 33 (24) | 18 (13) |
BIPOC = Black, Indigenous and person of colour.
The distribution of sex and race within each academic centre is shown in Table 2. The Université de Montréal (32%), Western University (25%) and Université de Sherbrooke (24%) had the largest proportion of female surgeons, and Dalhousie University (12%), Memorial University of Newfoundland (15%) and Queen’s University (16%) had the smallest proportion of female surgeons. McMaster University (40%), University of Saskatchewan (38%) and University of Toronto (35%) had the largest proportion of BIPOC surgeons, and Dalhousie University (16%), Université de Sherbrooke (17%) and Memorial University of Newfoundland (18%) had the smallest proportion of BIPOC surgeons.
Table 2.
Sex and racial representation by Canadian academic centre
| University | Categorization, no. (%) | |||
|---|---|---|---|---|
| Male and White | Male and BIPOC | Female and White | Female and BIPOC | |
| Université de Sherbrooke | 158 (62) | 37 (14) | 54 (21) | 7 (3) |
| University of Toronto | 375 (53) | 185 (26) | 80 (11) | 61 (9) |
| Université de Montréal | 255 (50) | 90 (18) | 133 (26) | 30 (6) |
| Université Laval* | 11 (35) | 3 (10) | 16 (52) | 1 (3) |
| Memorial University of Newfoundland | 108 (69) | 24 (15) | 20 (13) | 4 (3) |
| Northern Ontario School of Medicine | 87 (52) | 49 (29) | 25 (15) | 7 (4) |
| University of Alberta | 165 (57) | 70 (24) | 32 (11) | 21 (7) |
| Dalhousie University | 129 (73) | 26 (15) | 19 (11) | 2 (1) |
| McMaster University | 84 (47) | 62 (34) | 24 (13) | 10 (6) |
| Queen’s University | 60 (65) | 18 (19) | 10 (11) | 5 (5) |
| McGill University | 180 (62) | 52 (18) | 46 (16) | 14 (5) |
| Western University | 105 (51) | 50 (24) | 39 (19) | 13 (6) |
| University of Saskatchewan | 102 (47) | 73 (34) | 31 (14) | 9 (4) |
| University of Ottawa | 144 (60) | 49 (20) | 34 (14) | 15 (6) |
| University of Manitoba | 103 (57) | 44 (24) | 26 (14) | 8 (4) |
| University of Calgary | 182 (64) | 54 (19) | 34 (12) | 16 (6) |
| University of British Columbia | 486 (53) | 259 (28) | 116 (13) | 50 (5) |
BIPOC = Black, Indigenous and person of colour.
Université Laval had data available for only 1 division (ophthalmology).
Observations on diversity and their implications
Women and BIPOC individuals are underrepresented in Canadian academic surgery compared with White men. The disproportionality among surgical leadership roles is even greater. Action needs to be taken to address these demographic disproportionalities.
In 2016, 51% of Canadians were women, and 22% identified as a visible minority.3,4 In our observations, women made up just 21% of academic surgeons, while BIPOC individuals made up 29%. Female representation in surgical specialties is significantly lower than Canadian demographic proportions, whereas BIPOC representation matches or even exceeds Canadian demographic proportions. However, diversity is a strength, regardless of underlying population demographics, and increasing representation of BIPOC surgeons may have multiple benefits. Within medicine, racial and/or language concordance can improve the quality of communication in the patient–physician relationship, ultimately resulting in improved health outcomes.5 Additionally, presence of a wider spectrum of role models and leaders within academic surgery will likely have tangible benefits in medical education and in the recruitment of future surgical leaders by providing a more inclusive and welcoming environment and limiting systemic discrimination.
Our observations are limited to Canadian academic surgical centres and may not be representative of non-academic surgeons. In addition, we relied on publicly available data from institutional websites, which may vary in accuracy and completeness. Some institutions did not provide data on division heads or members in some divisions on their websites. Self-reported data on racial and sex identity were unfortunately not available in many cases, but would be the most accurate method of categorization. Similarly, the concepts of sex and race are not truly binary, but our observations are presented in a binary fashion for simplicity.
Conclusion
The number of female academic surgeons in Canada is relatively small compared with the number of males and is much smaller proportionally than Canadian demographic data. Additionally, the number of BIPOC academic surgeons in Canada is relatively small compared with the number of White academic surgeons, though the proportion is more closely in keeping with Canadian demographics. Action should be taken to improve diversity and inclusion in surgery.
Footnotes
Competing interests: S. Turner has participated on an advisory board for AstraZeneca and has receive honoraria from AstraZeneca for lectures, presentations, manuscript writing or educational events. No other competing interests were declared.
Contributors: All of the authors contributed to the conception and design of the work, drafted the manuscript, revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.
References
- 1.Aggarwal A, Rosen CB, Nehemiah A, et al. Is there color or sex behind the mask and sterile blue? Examining sex and racial demographics within academic surgery. Ann Surg 2021;273:21–7. [DOI] [PubMed] [Google Scholar]
- 2.Active physicians by sex and specialty, 2019. Washington: Association of American Medical Colleges; 2019. Available: https://www.aamc.org/data-reports/workforce/data/active-physicians-sex-and-specialty-2019 (accessed 2022 Feb. 23). [Google Scholar]
- 3.Data tables, 2016 Census. Ottawa: Statistics Canada; 2016. Available: https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/imm/Table.cfm?Lang=E&T=41&Geo=00&SP=1&vismin=2&age=1&sex=1 (accessed 2021 Sep. 24). [Google Scholar]
- 4.Age and sex highlight tables, 2016 Census. Ottawa: Statistics Canada; 2016. Available: https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/as/Table.cfm?Lang=E&T=21 (accessed 2021 Sep. 24). [Google Scholar]
- 5.Simms C. Voice: the importance of diversity in healthcare. Int J Clin Pract 2013;67:394–6. [DOI] [PubMed] [Google Scholar]