Thursday, August 21, 2008

Women in Surgery

 Updated 3/2017--photos and all links removed as many are no longer active and it was easier than checking each one.

I have noticed several posts / articles on women (or the lack) in surgery.
Women in Surgery; The Differential: Medscape Med Students; Lucia Li; August 1, 2008
In one of my regional placements, I met a surgeon who said that “women are killing surgery”; what he meant was that as the majority of medical graduates are now women, most of them will shun surgery for its stereotypes. This will reduce the number of good candidates going into surgery, lowering its standards. Surgery needs to attract women for continued excellence in practice. I am uncertain about the benefits, or even the need, for positive discrimination, but educational initiatives which promote surgery as a realistic career option for women are vital.
WSJ article: Women Remain Scarce in Neurosurgery; Jacob Goldstein; August 14, 2008
WSJ article: For Female Surgeons, Barriers Persist; Jacob Goldstein; August 16, 2008
Mothers Don't Let Your Daughters Grow Up to be Doctors; posted by Fizzy, Mothers in Medicine Blog; August 18, 2008 [not just don't let them be surgeons, but don't let them be doctors]

I went looking for more information:
Women in Neurosurgery, WINS
Association of Women Surgeons
Women in surgery: do we really understand the deterrents?; Arch Surg. 2006 Apr;141(4):405-7; Gargiulo DA, Hyman NH, Hebert JC
MAIN OUTCOME MEASURES: Potential deterrents to a surgical career.
RESULTS: Men and women had a similar interest in a surgical career before their surgical rotation (64% vs 53%, P = .68). A similar percentage developed a mentor (40.0% vs 45.9%, P = .40). Women were far more likely to perceive sex discrimination (46.7% vs 20.4%, P = .002), most often from male attending physicians (33.3%) or residents (31.1%). Women were less likely to be deterred by diminishing rewards (4.4% vs 21.6%, P = .003) or workload considerations (28.9% vs 49.0%, P = .02). They were also less likely to cite family concerns as a deterrent (47.8% vs 66.7%, P = .02) and equally likely to be deterred by lifestyle during residency (83.3% vs 76.5%, P = .22). However, women were more likely to be deterred by perceptions of the "surgical personality" (40.0% vs 21.6%, P = .03) and the perception of surgery as an "old boys' club" (22.2% vs 3.9%, P = .002).
Women in General/ Trauma Surgery; The Student Doctor Network Forum; thread began in 2007 and continues
Women in Surgery--Past, Present and Future; Dixie Mills MD; Department of Surgery, Maine Medical Ctr; Sept 2003 (PDF)
Website of the week--Women in surgery; BMJ. 1999 September 25; 319(7213): 860; Douglas Carnall
Women in Non-Traditional Residencies; P&S Journal: Spring 1995, Vol.15, No.2; By Kristen Watson
The daughter of a neurosurgeon, Dr. Epstein claims that following in her father's footsteps was a "congenital defect." Aspiring to be a surgeon since age 4, ..........
Dr. Epstein says most women in medicine do not pursue academic posts because they are actively discriminated against in the university setting. She also claims that female neurosurgical attendings in university positions are assigned less interesting cases and are given less operating time. "You have to have tremendous determination and work twice as hard for the recognition," Dr. Epstein says. And she does work hard, with more than 80 published works to her credit, some in collaboration with her father.
"We need more women to go into surgery and stay in it," Dr. Epstein says, "women who don't choose the 'mommy track'-working 9 to 5 just three days a week. We need more women in surgery full time." Dr. Epstein says it is not impossible for female doctors to manage both a full-time career and a family, but, like most of her peers, she has no children.

There are many more articles, but I'll stop there. It would appear that things have not changed much over the course of time.   I'm not sure I agree with Dr Epstein on managing a full-time career and a family.  As with the male surgeon, I think that would greatly depend on your spouse.  I do think it has to be very tough to do, but balancing life's responsibilities is tough anyway you look at it. 

I can't say that I was encouraged to become a surgeon. There was one female general surgery resident, one female orthopedic resident, one female ENT resident, no female urology residents, and no female neurosurgery residents at UAMS when I was a student and no female surgeons on staff in any surgery department. [I left out the Ob-Gyns simply because they are in a department of their own, not because I don't consider them surgeons.]  Currently at UAMS the dean is a female pediatrician, Debra Fisher MD. Here are the current female surgeons on staff at UAMS.
General Surgery
  • V. Suzanne Klimberg, M.D. (Surgical Oncology--Breast)
  • Anne Mancino, M.D. (Surgical Oncology -- Breast)
  • Diane H Rhoden, M.D. (General/Endoscopic Surgery)
  • Ronda Henry-Tillman, M.D. (Surgical Oncology -- Breast)
ENT (Otolaryngology)
  • Lisa Buckmiller, M.D.
  • Laurie Gray Barber, M.D.
  • Romona L. Davis, M.D.
  • Inci I. Dersu, M.D.
  • Bhairavi V. Kharod, M.D.
  • Nicola M. Kim, M.D.
Orthopedic --
  • Ruth L. Thomas, M.D.
Urology -- None
Plastic Surgery (there wasn't a plastic surgery dept when I was a student and still no residency program)--None
Neurosurgery -- none

When I was a student, I looked up to the two female surgery  residents (the general and orthopedic mentioned above). I did receive a small amount of mentoring from the orthopedic resident, but had no true contact with the general surgery (she was finishing up when I was a 3rd year student). I fell in love with surgery as a third year student. I wish I had used the female ortho resident more as a mentor and maybe found a staff surgeon to use as a mentor. I wish there had been more encouragement along the way, but there is no reason to rehash the past here.
I would encourage any female student interested in surgery to actively find a mentor (male or female). Don't let anyone talk you out of it.  We need good surgeons, male or female.


ER's Mom said...

It is tough, to be female in the OR setting. I love the OR, was probably my second choice for type of practice but there is a definite something against females operating. And it is hard to put my finger on exactly what it is.

Everything from the lowest table level to being too high (and many of us STILL needing a step even with the table all the way down) to many of the gadgets are not user friendly to smaller hands (I'm thinking of you, Ligasure and endo-GIA). We also have to adapt techniques due to size - for example, when I do laparoscopy, I never do direct insertions - my upper arm strength isn't enough to penetrate the fascia. I do Hassan's technique every time since I know that between my short stature and lack of UE force the direct insertions are far more difficult for me.

Lots of thoughts percolating today!

make mine trauma said...

Around here there are female surgeons as follows:
Orthopaedics, one
ENT, two
Plastics, one
Neuro, one
Cardiac, zero
Trauma, one (also general)
Gynecology, six (that I can think of, there may actually be more. It's a service I, fortunately, am not involved in!)
Vascular, one
General, five
Thoracic, one (also general)
Urology, one

That's out of appx. 150 not counting eyes.

Bruce said...

One of my medical school classmates, Julie Freischlag, is a vascular surgeon and chair of Surgery at Johns Hopkins. She is a great person, a terrific surgeon, a natural teacher, editor of the Archives of Surgery, a leader in the American College of Surgeons, and a role model for all surgeons, both male and female. She will certainly raise the profile of women in surgical fields.