There are a number of benefits of involving patients in medical decision making, from legal concerns to quicker recovery in surgery patients. But do surgeons themselves see these benefits? And if so, to what degree do their actual interactions with patients reflect this? Are there gender differences? A study by Garcia-Retamero and colleagues can give us some answers.
They collected data from a diverse sample of surgeons from 60 different countries and found that the majority of surgeons agreed that involving patients in medical decision making was desirable. The preference for a collaborative role was more pronounced among female compared to male surgeons. However, when asked about their usual (rather than ideal) role in medical decision making, women were much less likely to be collaborative compared with men – 81% of female surgeons reported that their role was usually “active” (rather than collaborative), compared to 45% of men.
The authors suggest that this discrepancy between preferred and usual roles might be due to the fact that women may feel the need to act in a more “masculine” way in order to be seen as an authority but another possibility might be that female surgeons are simply more critical of their own behaviour.
Just as any are within surgery, pediatric surgery struggles to recruit women. But what might be some of the barriers women in this field face and how do they influence job satisfaction? In order to investigate this issue, Donna Caniano and colleagues sent out a questionnaire to 95 female pediatric surgeons in the US.
They found that, in line with what female medical students might fear, women in pediatric surgery did express a desire to spend more time with their families and more room for personal interests in their lives. This is obviously an important issue which needs to be addressed. Offering part-time work may be an option and about half of participants showed interest in reduced hours. Moreover, about a third of female pediatric surgeons expressed interest in fixed-time schedules. However, women working in academic surgery were concerned that this would interfere with their career.
On a more positive note, regardless of these issues most women reported high career satisfaction, perceived their career to be rewarding and would make the same career choice again. Nevertheless, the issues raised above need to be addressed in pediatric surgery, but also in surgery in general.
About half of all new medical students in most Western countries are now female. However, are there differences in how they perceive their future jobs? Eva Johansson and Katarina Hamberg explored this question by analyzing the essays on the theme “to be a doctor” of Swedish medical students. While, overall, the essays written by men and women had a lot of themes in common, there were some interesting differences.
For example, female medical students seemed to approach the identity of being a doctor in a somewhat different way than male medical students. They more often expressed discomfort at “being” a doctor and constructed it as a job rather than an identity. As one participant put it: “If you say ‘to be’ it has a tendency to extend to much more than a job, to comprise your whole personality. At the same time it reduces your personality to what you achieve at work and nothing else. I think I am so much more than a med student.”
This is an interesting point as the degree to which something is part of one’s identity can have a plethora of consequences and the fact that female medical students struggle to integrate their job identity into their general identity may prove problematic. However, it is equally possible that over time these gender differences disappear.
Please feel free to share your own experiences on this matter in the comments.
Research in achievement domains such as the workplace and education shows that while men over-estimate their performance, women under-estimate how well they are doing. This is especially true in areas that are stereotyped as being “masculine”. It could thus reasonably be expected that this would also be the case in surgery.
However, Rebecca Minter and colleagues investigated this issue in a study and found that this wasn’t the case. While they did find a trend such that female general and plastic surgery residents under-estimated their performance to a greater extent than their male counterparts, this difference did not reach significance. There were also no gender differences with regards to actual performance.
Together with the study we reported on last week, this is promising. It seems that the perception of women in surgery as less competent is changing not only in the general public, but also in the eyes of those women who are involved in surgery themselves.
While women are generally seen as more warm and caring, men are perceived to be more competent. Unfortunately, these stereotypes are especially pronounced in male dominated fields such as surgery. However, a study by Kamyar Noori and Allyson Weseley gives hope that these stereotypes are slowly changing.
In their experimental study they presented men and women with the profile of either a male or a female physician who was either a surgeon (and thus a member of a male dominated field) or a dermatologist (a member of a female dominated field) and then asked them about their perceptions of warmth, competence and willingness to see the physician. Surprisingly, neither specialty nor gender influenced the perception of competence. Women, even those in a male dominated field, were perceived as just as competent as their male counterparts. Interestingly, the stereotypes around how caring the physicians were perceived to be depended on who was asked: While men rated female physicians as more caring regardless of specialty, women tended to rate those in counter-stereotypical fields (i.e. the female surgeon and the male dermatologist) as more caring.
Overall, this study gives hope that gender stereotypes in medicine may indeed be changing. Go humanity!
No. No they aren’t. Although it is often claimed that career motivation suffers from having children – at least for women – a study by Berber Pas and colleagues from the Netherlands finds that this is not necessarily the case. Neither being a mother nor the age of the youngest child significantly predicted career motivation.
What did matter, however, was one’s view on motherhood. Those who had more traditional views on what a mother ought to be (e.g. spending most of their time with their children) were less motivated than those who had more modern views on this issue. Moreover, a supportive work environment – especially supervisor’s support for one’s career goals – was beneficial for career motivation of female doctors.
This clearly shows that the negative attitude of some employers towards working mothers – or those who might one day become mothers – is quite unwarranted. Instead, it is important to focus on supporting female doctor’s career goals and changing unrealistic expectations of what a “good mother” is.
Despite the low number of women in surgery, those who do decide to become surgeons generally report high job satisfaction that does often not differ very much from that of their male counterparts. However, do they achieve their satisfaction in different ways? A study by Nasim Ahmadiyeh and colleagues investigates this issue.
They interviewed a sample of male and female surgeons who were all married and had children using semi-structured interviews and found, among other things, that men and women in surgery did indeed report similar levels of career satisfaction. In addition to that they also did not differ in the degree to which they had made trade-offs between their careers for their personal lives or vice versa. However, when talking about the reasons for their satisfaction and dissatisfaction, men and women differed. While male surgeons mostly named internal job characteristics as reasons for dissatisfaction, female surgeons spoke much more often about a lack of support and lack of credit. Furthermore, women also seem to rely on different strategies for success. They stressed the importance of social networks – professional as well as personal – far more than men did. This, of course, makes sense if they experience a lack of support.
These findings indicate that networking opportunities such as Women in Surgery are indeed very important and beneficial for female surgeons as they address the lack of support experienced by them.
Surgery is not just struggling to recruit women – there has been a decline in the popularity of surgery among medical students in general. Luckily it seems that even brief and easy to organise interventions can make a difference. Rosemary Kozar and colleagues report on such an intervention in a short and interesting paper.
In their intervention, first year medical students listened to a panel of surgeons speak about their career satisfaction and lifestyle. The authors found that this did indeed change the perception of surgery. For example, the length of training was seen as less deterring after the intervention.
This study indicates that interest in different sub-disciplines of medicine might often be based on stereotypes and prejudices and that it is important for surgeons to be proactive and share their experiences with the next generation of doctors.
Surgery is not the only discipline struggling to increase its number of women and while there are certainly differences in the reasons why girls lack interest in surgery compared to other disciplines such as engineering or physics, we can still learn from successful attempts to recruit more women into areas in which they are under-represented.
Robogals is an organisation that aims at increasing the number of women in engineering by showing young girls what engineering actually is and why it is fun. In her short and inspiring Tedx talk, Robogals founder Marita Cheng talks about how to spark interest in young minds – something that surgery could certainly benefit from as well.
Click here to check out her talk.
As mentioned in a number of our recent posts, women still confront more hurdles in their surgical careers than their male counterparts. Here is some advice from some women in surgery on how to deal with these hurdles:
“You got to believe in yourself. And I think that is something that women in surgery are generally really bad at. And I think we suffer more from performance anxiety than many of our male counterparts do. I look at most of the women I know in surgery and most of them are at or above the level of their male counterparts. I think women have to be that little bit better to get on throughout their training. But I think [they] just [need] to believe that they can do it.”
“Both between girls and boys – you need to have buddies throughout training and I guess as a twin I had a buddy right from day one revising through A-levels and things, and through medical school revising with people. And I guess I’ve always found someone to always talk to which has suited me well, whether it is a boy to talk to or a girl to talk to. And maybe that’s sort of the quality of a female if you like to be able to talk through a problem and happier talking through something to get through a solution. But that sort of worked for me so far.”
“Actually, the bad times that you have through training are really kind of where some of the more inspirational people that I’ve met have come into my life and people that have seen that perhaps you’ve had a hard time. I’ve been quite humbled by some of the people who have actually come along and pick you up and go ‘No, you are good enough to do this. We really want you to do this. We think that you’re good enough and we want you as a colleague.’ That can be pretty amazing.”