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.

Climbing the Surgical Career Ladder as a Woman

While women are under-represented in surgery in general, this under-representation is even more pronounced among surgical leaders. Nevertheless, there are women who have made it to the top of the surgical career ladder. How did they do it and what can we learn from them?

Rena Kass and colleagues can give us some answers. They interviewed ten female surgical leaders and asked them about barriers for women in surgery and how to overcome them. Almost all participants mentioned overt discrimination as a major barrier. For example, one participant explained:

“I would go on interviews and people would ask ‘What makes you think that you can tell a group of … mostly male surgeons, what to do and that they are going to listen to you?’ They would phrase it in various ways but … they were all really asking ‘Look, you’re a woman, you’re soft spoken, you don’t look like what we expect, what makes you think … you can come here and run the place?”

Other obstacles mentioned included the lack of effective mentors, a hostile work environment and personal illness.

So what do you need to overcome these barriers and make it to the top? The majority of participants mentioned perseverance and resilience as one of the most important attributes necessary to overcome barriers. As one of them put it:

“perseverance and not taking ‘no’ for an answer. When I was in high school the guidance counselor told me that women did not become doctors … then, when I did not get into medical school, the pre-med advisor … said ‘why don’t you just settle down and be an engineer?’ I said no, I want to be a doctor … I reapplied and got in. When I got out of my training and didn’t have any publications, my chairman said, ‘it’s going to be an uphill battle, being an academic surgeon’. I said, well that’s what I want to be. So I would say … the thing that distinguishes the ones who make it through to the end is perseverance, desire, and drive.”

Other important attributes included being hard-working and passionate, having a good support structure and communication skills.

The Best Thing about Being a Surgeon III

Surgery is a very varied career and different people have different reasons for liking it. Here are some more things that people see as the best things about working in surgery:

“I think it’s the patients, definitely. Being able to diagnose somebody with a problem, take him to the theatre, fix it and come back and say ‘I fixed your problem’ or at least ‘I made it easier for you’ if it’s something that you can’t cure. But it’s definitely the communication with the patients.”

“On a day-to-day basis it is very varied. You never really know what you’re doing. You know your schedule but you don’t know the patients, you meet them for the first time sometimes and that is exciting.“

“It’s a fantastic job. It’s different from what people from the outside think. I don’t spend all my time operating. I operate four days a week, but often it’s only a half day rather than a full day. … I see people who are considered for an operation or who I’ve operated in the past to see how they are getting on and that sort of thing. So it’s not up to your elbows in muscles and guts all the time. It’s quite a balance and I like that.”

“It’s a very independent job. So if you don’t like to have a boss, people telling you what to do, then surgery in the UK is perfect because once you are consultant and you have the chance to work in a team that works with you rather than against you then if you need somebody to give you a hand, you can, and if you want to do things on your own and be completely independent, then you can do that, too.”

The Best Things about Being a Surgeon II

We have already talked about some of the things that make surgery a great career in a previous post. One of the major things that people cite as being great about surgery is the impact that you have on patients. Here are some quotes about the difference that you can make as a surgeon:

“I think the most rewarding aspect of my job is seeing patients satisfied with their treatment; patients thanking you for what you have done for them. This is my job, this is what I do, but to actually get a patient say ‘thank you’, getting a thank you card or a present is something so rewarding and very touching to come from a patient because this is what we’re trained to do.”

“I think there are quite a few moments in neurosurgery when you can stand at the bedside of someone who has just woken up from a major brain tumour operation. I can remember a twelve year old boy, just recently, had gone to his grandfather’s funeral and actually become unconscious at that funeral having been unwell for a few weeks. He had a big brain tumour, lots of pressure in his head and his parents, as you might imagine, were terrified. They had been told all sorts of things that might happen. I came in and told them what I was going to do during the surgery and I told them there was a risk of death and there was a risk of major neurological damage – but I was able to stand at the bedside, not only just after he had woken up after his operation and he was fine and I could tell them that he was fine and that I got all of the tumour out, but actually a few days later I could tell them that it was a benign tumour and because I had gotten it all out on the first operation he was cured, the problem was over. So they had gone in the space of a week from thinking their child was going to die to thinking ‘oh, he’s going to go back to school in a couple of weeks and everything is going to be just fine’. And I remember the father standing next to the bed and just extending his hand to me. He didn’t even know how to really shake it because he was so overcome with emotion. … He was speechless and motionless in his gratitude.”

“One day a lad came in, nineteen, with retention of urine, which is very unusual. Usually people are sixty or seventy. And in fact he had a very rare tumour at the prostate and I found out the best person in paediatric urology surgery in England and he said ‘well, he’ll be dead in six month but this is what you do to operate’ and so on, I wrote to Philadelphia and to Toronto children’s hospitals and they wrote back and said ‘there is surgery, chemotherapy and radiotherapy. If you use one of those three or two of those three you’ll have no survivors. But if you use all three according to our protocol you’ll get a survivor’. We did quite radical surgery on him, have him chemotherapy ourselves, he had radiotherapy then – and he lived into his 40s. He married, he had two children by AID, he had a wonderful life. And in the end, when he was dying in his 40s, in our hospital, I asked him ‘was it worth it?’ and he said ‘of course it was!’“

Why Medical Students Choose Surgery – And Why They Don’t

In order to understand why women do or do not go into surgery, it is important to understand what motivates medical students to go into surgery in general. A questionnaire study by Glynn and Kerin from 2010 looked at just that.

Overall, about 20% of respondents said that they would like a career in surgery. Interestingly, this was true regardless of gender. However, when asked about whether it was likely for them to actually end up in surgery, the number dropped to 13% and was significantly higher for men than women. The most important factors that influenced planning to go into surgery were employment, career opportunities and intellectual challenge. Moreover, prestige was an important factor for those who could see themselves becoming surgeons. Medical students who highly valued their lifestyle during training, on the other hand, were less likely to indicate an interest in a future career in surgery.

But what about women in particular? Well, the authors found that on-call schedules, patient relationships and lifestyle after training were more important for female compared to male medical students. Also, for medical students with medical family backgrounds gender mattered more than for those who did not come from medical families. This is interesting, as it points to the fact that family members might not only work as positive role models who show what is possible, but can rather also strengthen existing gender stereotypes in medicine.

Why Surgery?

Surgery is a demanding career, but it is also very exciting and rewarding. But what attracts people to the career initially? Why do they choose surgery and not something else? Here are only a few examples of why people have chosen a surgical career:

“I have to admit that when I chose medical studies I was very young and maybe I wasn’t thinking about becoming a surgeon, not at the beginning. But I think what drove me there is the possibility to work with people, to talk to them, to support them and then over the years I realised that surgery was the best option to do that.”

“I knew from about the age of sixteen, when I first did anatomy in school, that I really liked this subject. So throughout medical school I was trying to see whether I did still enjoy that sort of thing on a day-to-day basis and actually in a hospital – which I did. But I guess a further moment that confirmed it was a medical student I was asked to participate in an operation and I really enjoyed the whole feel of my hands inside the warm abdominal cavity and I thought to myself ‘this is definitely what I want to do’.”

“When I got to medical school I sort of realised that I was surrounded by people who wanted to be doctors and wanted to help people and were very nice. And there was a bit of the feeling that I didn’t quite fit in. I mean, I do want to help people, but I wanted to actually fix something that needed fixing rather than just talk about it all the time. And when we went into the anatomy room which we did after first couple of weeks – it was the ability to open up, see that there is a problem and physically take it out or fix it or mend it and then sew the person back up again. It just fitted exactly with what I wanted to do.”

“I think I was inspired by a distant relative, to be honest. I’m from a very different background, I think. I think it’s changing now, that you have people from working class backgrounds. My mother was a single parent and I wasn’t connected to lots of family members but this distant family member was a cardiothoracic surgeon and I was really inspired by that – how do you transplant a heart and keep the body alive etc. And I think is persona inspired me more than anything.”


Some Advice for Future Surgeons

Just as any other career, surgery has its good and bad sides. While it is very rewarding, it can also be very challenging. Here is some advice from people working in surgery to those who might consider surgery as a career:

“I think surgery is a fantastic career if you love it. If you’ve done a bit of surgery or seen some of the ways that surgical patients are treated – it’s quite a quick process very often compared to medicine. If someone comes in and needs an emergency operation, everything happens very quickly. And I think if you love that, it’s a fantastic thing to do and worth spending the time, if that is something you love. If you were to do it because somebody else wanted you to, you’d be better of choosing something else because it takes a lot of effort. “

“Have a life plan. Where do you see yourself in 10-15 years? What kind of hours do you see yourself doing? Do you see yourself wanting to spend more time with friends and family? Are you willing to make the sacrifice, depending on specialty, when you just have to get up and go because you are on call, you can’t sit at home watching TV. You’ve got to have a clear idea of what you want in your life and how you would probably feel at that age. If still you are committed to performing surgery, wanting to be a surgeon and willing to make those sacrifices then absolutely do surgery. … for me, I think I made the right choice. … the fact that it makes such a difference in someone’s life fairly immediately is very satisfying.”

“Just think about the next step, what you need to do for that step to get forward, rather than being daunted by the whole long process, which actually, when you go through it, doesn’t seem all that daunting as long as you as long as you keep your horizon at a manageable scale.”

“I have no hesitation to say: If you love it, go for it. You have to keep your enthusiasm up. You have to be enthused about wanting to do this specialty and I think it’s probably the same with any career choice. You have to love it to continue because there are down times and great times and you have to take the down times, too. And it requires hard work – so you have to be motivated.”

Changes in Surgery

We have alluded to a number of barriers that women still face in the workplace in general and in surgery in particular in a number of posts (e.g. here, here and here). Luckily, times are a-changing and many things are not as difficult as they used to be. Here is what some men and working in surgery have to say about that:

“I think things have changed quite a lot, partly because there are more women in all spheres of life whereas there weren’t 25 years ago. And that has had a bearing on what people expect women to do. They don’t expect you to stop working when you get married or stop working when you have children. And a lot of people are now married to men that earn less than they do. So again, you have a personal discussion around who is the one who collects the kid from school if the kid is ill and that sort of thing.”

“I think times will be changing. The NHS and the political climate change on a regular basis. The number of women coming through on a higher level of surgical training changes the gender ratio. There won’t be as many men to women as there have been and therefore female leaders will almost automatically be selected inevitably from the positions they’ve got to.”

“Things have changed over the last 20+ years that I’ve been a consultant, certainly. Prior to that, when I was a trainee, things were very different because we weren’t in the strange long hour culture that’s now being pretty much abolished, but it has changed. … I’ve seen more and more female graduates coming through and it is no longer unusual to see women in training in surgery – only today I’m interviewing for a consultant post in London and the two best candidates we have shortlisted are both women.”

“I think things are changing. I think these old style female surgeons have done a lot and maybe there is a new style female surgeon coming through who will try to multitask lots of different things like academia, clinical work and children. That makes life interesting. “

How Do Newly Qualified Graduates Perceive Surgery?

Misogyny, a bad work-life balance, the “old boys’ club” – there is a long list of reasons cited for the lack of women in surgery. However, a recent study conducted in the UK by Edward Fitzgerald from the University of Nottingham and his colleagues (which, by the way, also mentions WinS!) suggests that the main reason lies somewhere else: Women just seem to be uninterested in surgery itself.

In their study they gave out surveys to female and male newly qualified graduates from the University of Nottingham Medical School asking about interest in a career in surgery as well as reasons for this. Not surprisingly, men generally reported more interest in surgery than women (42% vs. 25%). The number one reason for this was a lack of interest in surgery itself. This was, however, followed by negative attitudes towards women in the field.  The latter reason was backed up by the fact that 59% of male and 68% of female participants believed that surgery was not a career that was welcoming to women. When asked the open question why this was the case, the fact that surgery was male-dominated was the number one reason cited, followed by the difficulty of maintaining a family life and limited flexible training opportunities.

This study shows that even among newly qualified female graduates, the perception of surgery remains stubbornly stereotypical masculine and unattractive for women. It is therefore not just a matter of time until more and more women will enter surgery – it remains important to show women in medical schools that surgery is not just for men and that it is an exciting and welcoming place to work.

More on Role Models in Surgery

As discussed in a previous post, role models for women need not necessarily be female to be inspirational to women. Here are some interesting quotes from men and women in surgery talking about female and male role models and who inspired them along their career path:

“Role models are really important but when I was trained there weren’t many women role models. The few women that had made it into surgery were really quite daunting characters and they weren’t necessarily inspirational. They were very committed to their jobs and they weren’t doing something I necessarily wanted to do, whereas there were an awful lot of men in surgery who were inspirational. They were very well balanced, they had a lot of interests, they were very intelligent, sensitive men – and they were role models at that time. And they were also the ones who were saying ‘look, there is no reason why you can’t do this’.”

“I think what you need is someone senior who takes you under their wings from a young age and says ‘we think that you can do this, we think you have the potential, we are interested in you as a neurosurgeon’. I had that in neurosurgery, so when I left my neurosurgical post to go to take up an ENT post they said ‘I don’t think you’re doing the right thing’ and they were right. And of course that is a huge influence. In fact, I think they had more influence than my parents did in terms of my future ultimate role. I didn’t have the opportunity to have female role models at this stage. There wasn’t another female neurosurgeon who I could ask about the practicality of running a life, having babies and being a neurosurgeon. But I had enough support from the male counterparts that I came across to know that wasn’t an insurmountable problem.”

“I have many female consultants in my department in Spain. I’m thinking of two of them because I really enjoy working with them. One of them is a breast surgeon and mother to two children and I’ve been operating with her during a long microsurgery with her pregnancy belly and it was really fun. She is really committed to her job and to her family. The other one is a lower limb surgeon and she performs the best surgeries I’ve seen. It’s a real pleasure to work with her.”

“I didn’t have any medics in my family to get the stories so surgery is something you see on TV and they’re always depicting men in surgery and then the women who are struggling to be at the same level as them. And then as a student I’d come to the hospital and I’d have my placements and every time in general surgery I’d see these old school surgeons and the top ones were always male. I hardly saw any females. My female role models came from elsewhere in medicine. Eventually I started reading about female surgeons out there. When I went to the Royal College of Surgeons to take my exams, there is this amazing mural on the wall in one of the rooms and it has all the female surgeons in the whole country who are eminent. And as cheesy as it sounds – I’d often look up to that mural in times when I just couldn’t revise anymore for my exams and I’d think ’one day I want my name to be up there’.”