Is Surgical Culture Changing?

As a new generation enters surgery and as the number of women in the field is (slowly) increasing, one could hope that this also changes surgical culture. But does it? Judith Belle Brown and colleagues asked themselves exactly this question and conducted an interview study with academic surgeons.

Despite the fact that women still reported more struggles to achieve a good work-life-balance, participants overall noted that surgical culture was indeed changing and that surgeons were no longer expected to devote every waking hour to their jobs. For example, one participant noted: “I think things have changed over the years…I mean surgery in the past has been you just work hard, this is your life, and I think it’s changing a little bit … you are allowed to have a life outside. I think that’s good.”

Moreover, participants stated that this change did not only affect attitudes towards work-life-balance in general, but also attitudes towards childcaring responsibilities. One surgeon said: “I think the younger male colleagues, like my generation, it’s a bit different. We’re seeing more and more male surgeons who are doing more stuff at home … and they’re also having to leave early to pick up their kids because their wife is working too… So it’s changing. It’s not like how it used to be, 20 or 30 years ago.”

So let’s hope that these changes prevail!

Why Do Women Leave Male-dominated Professions?

Concerns about childcare are an often cited reason for women to leave (or never enter) male-dominated fields such as surgery – and these concerns need to be addressed. However, a recent study by Nadya Fouad suggests that childcare concerns might not be the main culprit that drives women away.

In her survey with women who held engineering degrees the author found that most women who had left engineering had not done so in order to stay at home and raise a family but had rather left the industry to work someplace else. Moreover, the reason these women cited were very similar to those that men usually cite for leaving their jobs – inhospitable work climate and a lack of opportunities for career advancement (although caregiving responsibilities were also an often cited reason).

This demonstrates once again that leaving certain occupations is not due to some inherent lack of interest among women. On the contrary, women and men are looking for quite similar things in their careers – but men might just have an easier time achieving these goals in male-dominated fields.

The Effects of Perceived Gender Discrimination

Gender discrimination has obvious negative effects such as keeping women from rising to leadership positions or achieving equal pay. That alone should be enough reason to address these issues but there is also evidence that demonstrates the negative impact of perceived gender discrimination on women’s motivation – one of the key ingredients to high quality work.

Sharon Foley and colleagues investigated these issues in a sample of solicitors. Not surprisingly, they found that women perceived higher levels of gender bias against women and more personal gender discrimination compared to their male counterparts. This perceived personal gender discrimination was directly linked to two important motivational outcomes. First, it predicted solicitors’ organisational committment, and second, higher perceived gender discrimination was associated with higher intentions to leave the organisation.

This study shows how important gender equality is not just for its own sake but also for keeping women motivated and committed and ultimately ensuring that their talent and expertise is not lost.

Patients May Not Be All That Biased

There is a lot of research on how women in male-dominated areas (e.g. management or politics) are in a somewhat “damned if you do, damned if you don’t” situation. When they present themselves in a warm and feminine way their demeanor is at odds with what the field requires (e.g. they’re not perceived as “real leaders”), but if they present themselves in a masculine, assertive way, they’re not perceived as “real women” and thus disliked. So is that also the case in surgery? A recent study by Marie Dusch and colleagues suggests that this may not necessarily be the case, at least not from the patients’ perspective.

They presented patients in a general hospital with short scenarios describing either a male or a female surgeon who presented themselves in either a feminine or masculine way. Moreover, they were described as either performing breast cancer surgery or lung cancer surgery. Somewhat surprisingly (at least to me) patients did in general not prefer male surgeons over female surgeons or masculine surgeons over feminine ones. Neither did they prefer masculine male surgeons to feminine male surgeons or feminine female surgeons to masculine female surgeons – nor the opposite. In fact, the only significant result they found was that for lung cancer surgery, masculine surgeons were seen as more competent regardless of gender.

While it is important to replicate these results before drawing strong conclusions, this study nevertheless shows that gender stereotypes in surgery may be slowly changing or at least not be as pervasive among patients as we might assume.

Guest blog: Gender Discrimination in the Workplace

As I am currently on vacation, my lovely colleague Helena Radke from the University of Queensland has agreed to step in and provide this week’s post. Thanks a lot, Helena, and to the rest of you: enjoy.

There are many reasons why women might not feel comfortable speaking up about gender discrimination in the workplace. One reason why women might not want to attribute an outcome to discrimination is because they experience disapproval from others when doing so. Regrettably this apprehension is not unsubstantiated. Social psychological research conducted by Kaiser and Miller (2001) has found that a person who attributes their treatment to discrimination (in this case an African American student failing a test) is evaluated more negatively than someone who does not attribute their treatment to discrimination even when it is clear that the person is being discriminated against. This is why, while many women say that they would confront sexism when presented with a hypothetical scenarios of discrimination, they are actually much less likely to do so in real life (Swim & Hyers, 1999).

So how can we ensure that women feel comfortable speaking up about instances of discrimination? One way in which we can answer this questions is by considering gender discrimination in the workplace to be a microaggression. According to Professor Derald Wing Sue from Columbia University, microaggressions are a brief and commonplace instances of indignity which, either intentionally or unintentionally, communicate hostile slights towards another person because of the social groups they belong to (Sue, 2007). He argues that they can be overcome by being aware of our own biases, knowing that our reality is different to others reality, not being defensive when someone reveals an incident of discrimination, discussing our own biases and being an ally against discrimination (see this video). Creating an organisational climate which is aware of the microaggressions women experience could be one way in which we can overcome the barriers women face to confronting gender discrimination in the workplace.

Do Men and Women Have Different Career Goals?

Initiatives aiming at addressing the under-representation of women in certain domains often include flexible or part-time working arrangements. The idea behind this seems to be that women often find it harder – and more important – to achieve a good work-life-balance, while other career goals such as prestige and a high salary are important to men.This of course makes sense, as women still take over a disproportionate amount of childcare and household work, while men are still seen as being the main earner of the family’s income. But times are changing – so is it really still the case that men’s and women’s career goals are that different?

A study that we conducted with academic staff at the University fo Exeter indicates that this isn’t necessarily the case. We asked them to rate the importance of different career goals on a scale from 1 to 7 and as you can see in the figure below, patterns were pretty similar for men and women. So it seems that it isn’t so much that women and men (at least in our sample) have different goals – but it might still be harder for women to achieve some of them.


How Do Role Models Work?

We’ve highlighted the importance of role models in general and female role models in particular in a number of quite a few of our past posts. Research suggests that role models serve different functions and lead to different outcomes and that gender is not necessarily important for all of them. However, other studies suggest that gender does matter, especialy in domains in women are under-represented, and one reason why that might be the case is that they can change stereotypes.

STEM/M fields in general and surgery in particular are stereotypically associated with men and maleness. The first person one might imagine when thinking about a surgeon is likely to be a man and when asked to describe a surgeon, stereotypically masculine traits such as “cold” might be used. The so called Stereotype Inoculation Model developed by Nilanjala Dasgupta argues that role models might act as a “social vaccine” and inoculate against these stereotypes which prevent women from entering or staying in STEM/M fields.

She proposes that when exposed to other minority members in one’s domain (e.g. other women in surgery), minority members can identify with this person, which then leads to changes in stereotypes and a stronger identification with the field (e.g. with surgery), but also a more positive attitude towards the field, social belonging in the field, perceived threat and one’s perceptions of one’s own abilities.

Thus, while male role models might be just as effective in some regards (e.g. for learning by emulation), visible female role models in surgery are important – not just for those women already on their path to becoming surgeons, but also for those who might not have made their career choices yet.

Harassment and Career Satisfaction of Female Physicians

Sex-based harassment at work has been a problem since women started entering the workplace. But how much of a problem is it in the medical profession and how detrimental is it for job satisfaction? In a survey with a large and representative sample of female US physicians, Erica Frank and colleagues give an answer to this question.

Quite shockingly – and we sincerely hope that this fact has changed in the 15 years since this study was conducted – almost half of the over 4000 participants report a history of sex-based harassment in a medical setting. Younger physicians were especially likely to report a history of sex-based harassment. Moreover, this was predictive of all three measures of career satisfaction: whether they felt satisfied, whether they would choose to become a physician again and whether they would like to change their specialty.

This shows that sex-based harassment is indeed a problem in the medical profession and the fact that especially younger women reported experiences of sex-based harassment in the workplace suggests that there is not necessarily a decline in sex-based harassment in medicine. The topic therefore needs to be addressed.



What matters to female and male medical students?

In order to address the under-representation of women in surgery it is important to understand what female medical students deem important in their future careers. Do they value the same things as their male counterparts and just don’t think that they can achieve those goals in a surgical career or are they actually looking for different things in their careers? A study by Nancy Baxter and colleagues suggests that the latter is the case.

They sent out a questionnaire to Canadian medical students and found that men and women named different factors as important for choosing their specialty. Women placed more importance on the availability of part-time work and parental leave as well as residency conditions, while men valued technical challenge, prestige and earning potential. As both male and female students agreed that surgeons earn a lot of money but do not have high quality family lives, it is not surprising that of the participants, men were more likely to choose surgery as the specialty they were pursuing or considering to pursue.

This study once again highlights two facts: First, it is important to make surgery a career in which family related goals can be achieved by both men and women, and second, the fact that a family and a career in surgery can be combined needs to be communicated effectively to medical students.

Marriage, Children and Happiness at Work

Work-life-balance or the anticipated and actual lack thereof is a widely cited cause for the under-representation of women in surgery. This is especially true for women who have a family or are planning to have one as women continue to carry most of the weight when it comes to childcare and household chores.

A study by Sullivan and colleagues investigates this issue in a large sample of surgical residents in the US. They found that generally married residents and those with children have the highest levels of work satisfaction. However, this difference was driven by male participants. As expected, female residents reported high levels of stress regarding home life as well as finances when they were married or had children.

These results once again stress that while creating equal opportunities at work is important, it is not enough to tackle gender inequality. As long as women continue to be responsible for more family related work, it is thus crucial to go beyond that and provide them with opportunities to combine both work and family and still achieve a good work-life-balance.