WOMEN IN SURGERY

EDITORIAL

Surgery has traditionally been considered a very male dominated specialty in spite of the increasing numbers of women that are graduating from medical schools over the years.

The situation would appear to be similar with both developed and developing countries. Could it be that in the past five years, trends have changed in Surgery? What is the evidence fuelling the above named perceptions or realities? What accounts for these gender differences?

In North America, A survey of surgeons carried out at the turn of the current century showed 20.3% of surgeons were female1.

Gone are the days when being a woman surgeon meant being ‘sexually invisible’ as most women then concentrated on being accepted as a surgeon, not a woman surgeon 2.

Times are changing.

Other issues that were mentioned, particularly for women in academia, and that may still exist in some countries are that women surgeons felt excluded from mentoring, informal networking and collaboration which hindered their advancement 2.

In the Western world, the history of women in surgery dates back to 3500BC in Egypt, Italy and Greece. Then women held prominent positions in medicine but this was soon to change. Historically women had to ‘impersonate men’ in order to practise medicine and surgery. This was during the Middle Ages, which era was considered a very difficult and disappointing time for women in medicine in general and surgery in particular, as it was then held that a woman could not hold a leadership role professionally 2,3. Until 1970, only up to 6% of medical school admissions were women and the American College of Surgeons admitted its first woman in 1913. In 2001 the number of physicians who were female, rose to 24%. However since then till now, most medical school applications show gender parity2 and in some instances even female preponderance2,4.

In spite of these improvements, in the sub specialties of Surgery, women in the USA continue to constitute only 15% of applicants to residency training programmes in thoracic surgery, urology, orthopaedic surgery and neurosurgery3. In academia generally, the picture has not improved much even in the Western world. In the USA although 41% of Assistant Professors (the equivalent of our Senior Lecturers/Readers) are female, only 29% are Associate Professors, 17% are full Professors and only 19% of tenured Faculty are females3.

Jo Busch in 2005 suggested women in Surgery went through a process of ‘ learning the surgical skills, developing a body of research learning to work on a committee, to mediate, negotiate, chair a group and finally emerge a leader’4.

In Canada, a survey of 459 female surgeons with a response rate of 91.3% found that 82.3% were in active full time surgical practice. Interestingly the commonest surgical subspecialty was Obstetrics and Gynaecology which was practiced by 40.9% , followed by Ophthalmology (21.2%) and General Surgery (12.1%)6. In this same survey, 88.3% of the female surgeons were satisfied with their decision to follow a career in Surgery 5.

What is the situation in Africa? This subject formed the basis for a thesis by Liana Roodt6 which was published by the University of Cape Town. She set out to examine 3 main parameters which were the status of female general surgeons compared to their male counterparts, perceptions when it came to female general surgeons as opposed to their male counterparts as well as the challenges faced by female general surgeons. Out of 29 consultant surgeons who responded, 20.7% were female, out of whom, 2 were heading firms/teams and the female surgeons were on the average six years younger than their male counterparts. Although the average number of publications by the females was almost equivalent to those of their male counterparts, none of the females had been on the Board of a peer reviewed journal, nor had any of them supervised any postgraduate research - this she referred to “a masculine top and feminine bottom “6. Of the 28 surgical registrars who responded, 39.3% were female.

In Nigeria, a study conducted by Makama et al7 studied the local factors that determined the most likely specialties female doctors in Nigeria would prefer. They had 105 respondents who were Registrars or Consultants. The choice of specialty by the respondents was mainly determined by impact on their family lives and social engagements (27.6%) whilst only 3.8% complained of the lack of role models.

In Ghana, the Ghana College of Physicians and Surgeons has since its inception in 2011, graduated a total of 403 Members out of which 142 were females - women constituted 35.2% of the body of Members. The College has 360 Fellows, out of which 88 are women - women constituted 24.4% of Fellows . These figures were for both Physicians and Surgeons. The percentage of Members who were female surgeons out of the total number of Members were 53 (37.32%) and of female Fellows who were female Surgeons were 30 (34.09%)8.

Conclusions

More research needs to be carried out into the reasons why Surgery still remains male dominated and to understand the issues facing women as they wear their various hats and manipulate their multiple arms of their professional, family and in our sub-region, socio-cultural lives1. More National studies need to be carried out to enable a better understanding of the issues and barriers to more rapid progress in rise in the surgical specialties.

It is obvious that the numbers of women in Surgery is generally increasing but not at the same rate as the numbers of females being enrolled in medical schools. The ‘glass ceiling’ in Surgery whether apparent or real still needs to be interrogated and shattered.