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July 8, 2020

The Current Status of Women in Surgery: How to Affect the Future

Author Affiliations
  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
  • 2Departments of Obstetrics and Gynecology and Urology, University of Wisconsin School of Medicine and Public Health, Madison
  • 3Gynecologic Specialty Surgeons, Anne Arundel Medical Center, Annapolis, Maryland
  • 4Departments of Surgery and Medicine, Rush University Medical Center, Chicago, Illinois
JAMA Surg. 2020;155(9):876-885. doi:10.1001/jamasurg.2020.0312

Importance  Despite women composing half of current medical school classes, surgical specialties still struggle to attract and retain women. Even after successful recruitment into training, women surgeons continue to face gender bias and various obstacles to career advancement, including lower rates of surgical residency completion, board certification, and professional advancement. Gender inequality in medicine has drawn attention; particular consideration regarding the status of women in surgery is warranted. We review research delineating disparities and investigating the causes underlying such issues, and most importantly, we propose recommended action.

Observations  Recruitment of women into surgery is increasing as more women are visible in the specialty, and forthcoming measures to encourage mentorship and rectify issues related to pregnancy and burnout will likely improve this. However, obstacles to career development for women surgeons, including residency/fellowship support, mentorship/sponsorship, leadership, work-life balance, and pay equity remain. More importantly, gender discrimination continues, originating from conscious and unconscious bias, which is remedied only by recognition and deliberate correction. Several organizations have proactively recommended measures to cultivate gender equity for women surgeons, which require implementation to effect meaningful change. While the first step is recognition of the issues and underlying etiologies, further action is needed in combating such disparities and establishing a culture of equity for women in surgery.

Conclusions and Relevance  Opportunities for women in surgery have improved, although much work remains to make the surgical workplace supportive of women, empowering them to optimally contribute. These efforts will benefit organizations, the community, future generations of surgeons, and most importantly, profoundly and positively affect the care of patients.

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    1 Comment for this article
    Women Orthopedic Surgeons in India are sparse in numbers
    Raju Vaishya, MS, MCh, FRCS | Institute of Orthtopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, INDIA
    We concur with the views of the authors of a recently published survey on the ‘current status of women in surgery’ [1]. It is indeed a well-known fact that there is a significant gender disparity, in various surgical specialties across the world, in favor of men. In spite of the fact that the number of women going to the undergraduate course in the medical school is equal or higher to the men, their numbers in the surgical branches in the postgraduate course are significantly less. This survey has pointed out several challenges, strategies to address and recommendations to overcome this gender disparity.
    Amongst all the surgical specialties, perhaps Orthopedic Surgery has attracted the least number of women for various reasons. Apart from the reasons mentioned in this survey, we believe that there is a fixed mindset that the Orthopedic surgeons need to strong and the orthopedic surgery is very heavily manual and requires brutal force, which is incorrect as the orthopedic and trauma surgery have evolved and modernized substantially and use more of technology than the force and the ‘muscle power’. Furthermore, it has been said before that a “typical orthopedic surgeon is as strong as an ox but half as bright” [2], raising severe concerns regarding the intelligence of Orthopedic surgeons, which are largely untrue as most of the postgraduates entering into the orthopedic surgery training these days, across the world, are usually the topmost and bright students of their curriculum.
    In India, the women population of Orthopedic surgeons is only around 1% of the total number of around 20,000 Orthopedic surgeons [3]. That too, these numbers have picked up only very recently in the last couple of decades. Even in developed countries like the USA, where the female trainees have achieved some parity with their male colleagues in various medical disciplines [3], their representation in Orthopedics was lesser than 14% in 2016–2017 [4].

    There are several important reasons for the non-interest of women in the Orthopedic specialty. These could be due to the fact that they achieve higher ranks, so as to pick up an alternative branch of their choice, partly due to the lack of mentorship for them in the discipline [5, 6] and they also consider work-life balance as an important deterrent.
    It is worrying to note from the findings of a recent survey of these women in India, that even among those few who are in this discipline, many regret their decision, despite of the fact that they ‘feel competent’ to carry out their work. Other factors like discrimination at work inability to achieve their full potential, sexual harassment etc.play an important role in this matter.

    1. Stephens EH, Heisler CA, Temkin SM, Miller P. The Current Status of Women in Surgery: How to Affect the Future. JAMA Surg. Published online July 08, 2020. doi:10.1001/jamasurg.2020.0312.
    2. Subramanian P, Kantharuban S, Subramanian V, Willis-Owen SAG. Willis-Owen CA. Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study.BMJ 2011;343:d7506. doi: 10.1136/bmj.d7506.
    3. 3. Madhuri V, Khan N. Orthopaedic Women of India: Impediments to Their Growth. Indian J Orthop 2020; 54:409–410. Doi:10.1007/s43465-020-00130-6.
    4. Chambers CC., Ihnow SB, Monroe EJ, Suleiman L I. Women in Orthopaedic surgery: Population trends in trainees and practicing surgeons. J Bone Joint Surg (Am). 2018; 100 (17), e116.
    5. Rohde RS, Wolf JM, Adams JE. (2016). Where are the women in Orthopaedic surgery? Clinical Orthopaedics and Related Res