Women plastic surgeons are overlooked in the new era of webinars

Dear Sir,

The COVID-19 pandemic has greatly affected our clinical work and research since it first emerged in the beginning of 2020. Thankfully, several Plastic Surgery societies have worked tirelessly to continue educational activities to supplement stunted operative and clinical practice with online seminars. These have proven greatly valuable to both residents and consultants, and have enabled a perhaps never-before-seen opportunity to gain knowledge and experience from the world's leading experts. However, if analyzed deeper, one sees an unbalanced breadth of speakers in webinars, where a predominantly male surgeon population is represented. “Where are all our women plastic surgeon experts?”, one might ask.

A detailed analysis of eight official plastic surgery webinar and seminar organizers from the UK and abroad reveals a concerning statistic, worth sharing with the wider plastic surgery community. In a total of 234 webinars/seminars from March 2020 to February 2021, women represented 13.5% of speakers (see Table 1 ), with an average of 6 women invited per organizer, and with one organizer not having invited any women to the faculty at all (see Figure 1 ). This might of course be representative of the actual lower number of female plastic surgery consultants worldwide, although we doubt that the discrepancy is as large as 13.5 vs 86.5%. Even so, should this very fact not be the reason for inviting women even more? Arguably, it is more convenient to invite the more regular speakers, and indeed expert knowledge should be delivered by expert surgeons. However, webinars are in fact the perfect platform to diversify both topics and speakers, and find and promote expert women surgeons who perhaps modestly flourish in the shadow of their male counterparts.

Table 1.

Detailed information of men and women speakers in relation to number of webinars.

Organizer	1	2	3	4	5	6	7	8	Total	Average
Number of webinars	23	42	36	34	2	43	22	32	234	29
Men speakers	27	38	95	34	33	41	22	29	319	40
Women speakers	7	5	22	0	5	4	3	4	50	6
Invited speakers	34	43	117	34	38	45	25	33	369	46
% Women speakers	20.6%	11.6%	18.8%	0%	13%	9%	12%	12.1%	13.5%

Figure 1.

Number of Men and Women surgeon speakers at eight official plastic surgery webinar organizers in 2020.

This year of 2021 marks 100 years since Sweden first legalized women voting in the national general election (with the UK following shortly thereafter) but only 6 years since the Royal College of Surgeons of England appointed their first female president, and the first year of our first female vice president of the United States. In business, since 2017, the presidencies and most powerful positions on Wall Street (NASDAQ and the New York Stock Exchange) and the European Central Bank have been held by women. Women are clearly achieving in high powered positions across disciplines, but how is it that so many talents go unnoticed, or worse, are lost? In surgery, NHS statistics from 2018 showed a decline in women at senior surgeon level, with 41% women in core surgical training and only 12% women as consultants. On the contrary, male surgeons showed to increase at senior levels, with 59% men in core surgical training and 88% men as consultants.¹ Women at senior surgeon level are only marginally increasing in numbers, with the Royal College of Surgeons stating 13.1% women surgeons in 2020 (a 1.1% increase in 2 years); of which 21% are plastic surgeons.² Somewhere along the career pathway men and women diverge in their achievements, but is this the result of a lack in ambition or a lack in opportunity? Silva et al. describe two phenomena that provide great insight.³ Women do not lack ambition, as evidence supports equal academic achievements in residency. However, a so called “Ambition Gap” seems to strike, where some women fail to progress due to less networking opportunities, fewer official appearances, less institutional support, and fewer female mentors and role models. The second obstacle described is the “Confidence Gap”, and speaks of the unfortunately adverse effect of some women's overt self-criticism, resulting in suboptimal self-advocacy and arguably less self-exposure to the wider surgical community. Indeed, evidence has shown feedback to women to be less academic and constructive in nature and more personal.⁴ Furthermore, male surgeons have not only been found superior at seeking promotions, but also better at rating themselves higher than perhaps their actual merit.³

The old surgical “boys club” mentality is on its way out as modern surgical practice teaches anything but arrogance, nepotism and exclusiveness. In that regard, women can and should provide a breath of fresh air in the otherwise hard-to-rock community. There should be no doubt that women surgeons can contribute in the profession, and have in fact been shown to be preferred by patients and have a lower surgical morbidity and mortality rate.⁵ Indeed, meritocracy should govern promotion, however as reality shows it is unfortunately not as simple. We still risk inequality unless we change the actual opportunity for merit. This starts by realizing that opportunity needs to be given equally, and efforts need to be made to ensure to enlist those to whom (because of work culture, previous experiences, and/or inherent characteristics) self-promotion does not come easily. As such, Plastic Surgery societies must actively stimulate and endorse a culture where surgeons from all backgrounds and genders are not only inspired to, but importantly also shown it is possible to, achieve greatness.

Declaration of Competing Interest

None.