More on Overcoming Barriers in Surgery

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.”

 

Barriers Faced by Women in Surgery

Surgery is a challenging career path for everyone, but what makes it apparently more challenging for women? What obstacles are in their paths that men don’t have to overcome? A study by Amalia Cochran and colleagues investigated this question by asking men and women at the end of their surgical training or at the beginning of their surgical career about a number of potential obstacles such as sex discrimination, lack of confidence, conflict between children and career demands and job market constraints.

While both female and male participants reported similar levels of structural barriers and career preparation, women reported that they anticipated or perceived to be treated differently from men, including negative comments about their sex. Female participants also mentioned having children as a career barrier.

These results are perhaps not surprising. However, they illustrate once more the importance of addressing gender inequality in surgery on many levels – from helping women with children to achieve a good work-life-balance to fostering a more egalitarian work environment in general.

More on Work-Life-Balance in Surgery

Juggling a successful career in surgery and your life outside of work can be challenging. However, it is not impossible. Here is what those working in surgery have to say about their work-life-balance:

“My children strike my work-life-balance for me. So the best thing I could have done for a work-life-balance is have a family, so that I know that I have to go home. And as soon as I open that front door, unless there is a major catastrophe at work, it all just completely melts away. And suddenly it’s geography homework or parents evening or I haven’t got anything to wear for Phoebe’s party on Friday and neurosurgery becomes a distant memory until the next day starts.”

“What do I enjoy doing? Cooking and having people over for dinner. Being a hostess as well as going out for dinner. And sort of de-stressing by that. I go to the gym, I get whipped into shape by my twin sister and try to go swimming and that sort of thing. I do enjoy spending time with the children and getting dragged to lighthouses and Roman forts by my husband. So I definitely do enjoy the time with the children and the family because it sort of keeps you sane. Work is one thing, but you have to sort of counterbalance that.”

“I’m catholic so I’m quite involved with my church and I am part of a couple of groups and we meet monthly, so that is a big part of my life. And I really like singing, particularly in groups, so I’m well known for dragging unwilling people to piano bars in whatever city we’re in for our research.”

 

If you want some more advice on this issue, check out our previous post on the topic.

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.

And Yet Some More Advice for Future Surgeons

Getting into surgery can seem a bit scary, especially if you are not 100% sure what you are getting into. Luckily there are people who have gone through it before you. Here is some advice they have to share about building your skill set and keeping your eye on the goal:

“What I’d say to a medical student or a junior doctor is that they have to be very flexible in their approach to the work. They have to have an interest in a variety of things. It’s not just the actual subject content that you should be interested in. There are so many facets to medicine these days which are very much different from what they were so you have to have a teaching role, a political role, a research role and a sort of general knowledge role so you actually get to know your patient, to understand communities, to understand disease processes

“I think for someone considering a career in surgery they have to realise, first and foremost, it is a very competitive field out there. And they have to understand that to be part of the game they have to get ready and prepared and know what they need to do to deliver to be part of the game. So building a portfolio is essential and if they can try to do that at medical school level that is so important. So publishing, presenting, going to meetings, (…) – really it’s just understanding that you need to know what skills you need before you actually embark on a surgical career. And to understand whether you are going to be able to cope with the challenges which are changing all the time.”

“Look at the job at the end of it rather than just the training. Often people can’t relate to the people who have the job at the end of it because we are older, but they need to look at the job and whether that is something that they want to do. And if they want to do it, they’ve got to be the best. They’ve got to try to work hard on all different levels. It’s not just operating or getting through the exams. It’s things like teaching, leadership, research. It’s all the other things you need on your CV.  (…) You do need to have your CV be as good as it can possibly and take opportunities.”

“The consultant job is good. The consultant job is actually fun and doable. I don’t do private practice, I’ve got loads of time. I collect my youngest daughter from school twice a week. It’s fun. You don’t operate at night anymore. Lots of that sort of thing has changed. We just need to get the women through the training.”

 

If you’d like to read more advice, you can also check out our previous posts on the topic by clicking here and here.

The Importance of Role Models in Medical Education

Role models are important for a number of reasons. Not only can they teach us important skills, they can inspire us to reach for more ambitious goals or consider a new career path altogether as well. In medical education, they have also been linked to speciality choice, making them especially interesting with regards to the under-representation of women in surgery.

But what are medical students looking for in a role model? Who do they choose as that inspiration that might influence their career path so strongly? A study by Wright an colleagues suggests that it is not necessarily status or success, but that other attributes such as personality and competence might be more important. They also showed that role model choice was indeed related to speciality choice and that students generally chose their role model before they had made up their mind about their future speciality. This highlights, again, how important role models are for shaping our future. With regards to surgery, this may be somewhat problematic – only 63% of participants indicated that they had encountered a sufficient number of role models from that discipline (compared to an average of 87% in the other specialities). And – although the authors don’t report on it – this number is likely to be even lower for women who generally prefer female role models.

By the way, we have also discussed role models in surgery in particular before. Click here to read that post.

Gender Equality of Surgeons at Home

There are a number of studies about gender differences of surgeons out there – but are there gender differences in surgeons’ spouses? Although we have never asked ourselves this question before, we stumbled across a survey which investigated just this and thought it quite interesting. After all, spousal support is without a doubt an important factor in career satisfaction or life satisfaction more generally.

Interestingly, there was no gender difference in percentage of respondents who had children or in number of children. The myth of the childless career woman thus seems to be just that – a myth. There was, however, a gender difference in whether or not spouses had a job outside of the home. While 88% of male spouses worked outside of the home, only 55% of female spouses did so. Both male and female spouses indicated that they would be happier if their spouse worked less. Maybe unsurprisingly female spouses indicated that they carried most of the responsibilities for home and childcare whereas this was not the case for male spouses – and this held true regardless of the working hours of the spouse. This is problematic, as it indicates that female surgeons have an overall higher workload than their male counterparts – and while a number of initiatives aim at improving work conditions for women at work, the differential work load outside of the workplace remains largely unaddressed.

The Rejection of Successful Women as Role Models

Women in fields in which they are under-represented often name the lack of female role models as a barrier in their careers. Yet, research often finds that the successful women who are available are often rejected. They are seen as pushy, overly masculine and cold and generally not as someone most women can identify with – even when no information indicating these traits is given. But why is that?

A study by Parks-Stamm and colleagues suggests that this might be a strategy to protect our beliefs about our own competence. In other words, if we saw a successful woman as highly competent and on top of that as nice and likable, this might undermine our own confidence. After all, how are we supposed to compete with that? The authors tested this idea by presenting men and women with information about a highly successful woman. In some cases, this woman was described as warm and likable, whereas in other cases no such information was given. Unsurprisingly, both men and women in the former condition described her as less pushy and cold than those in the latter condition. What was interesting, however, was that those women who had been told that the successful target was warm and nice, rated their own competence as lower compared to those who were able to penalise the potential role model.

So what does this mean? Should successful women be presented as unlikable and cold? Certainly not. It is, however, important, that they are described in ways that make them seem attainable. Evidence for this claim comes from a second study by the authors in which they show that the negative effect of preventing women from penalising the role model disappears when they are given positive information about their own future success.

Where Does the Gendered Interest in Different Occupations Come From?

While women remain underrepresented in certain areas such as surgery, other occupations struggle to recruit men. There are a number of potential explanations for this phenomenon out there, including the idea that we show greater interest in occupations associated with our gender role (e.g. because we see a lot of women in childcare, we associate childcare with being female), and the idea that we seek out jobs that are in line with our values (e.g. because women have more altruistic values, they are more interested in childcare). It is of course hard to disentangle these two explanations – after all, while it might be the case that women rate altruistic values as higher, this could just as well be the result of seeing women in “altruistic” occupations.

However, Weisgram and colleagues investigated this question in a clever study which used fictional occupations rather than real-life jobs with which everyone has already formed aforementioned associations. They presented children, adolescents and adults with fictional descriptions of new jobs that were described as fulfilling a randomly assigned value and being mainly done by men or women.

They found that, indeed, the sex of the typical worker in the new occupation affected the degree to which participants associated certain values with these occupations. For example, if a job was presented as being mainly done by women, participants believed that these were jobs associated with a better work-life-balance. Interestingly, this was only true for adolescents and adults but not for children. The authors also found that both the sex of the workers and the values influenced participants’ interest in the new job.

With regards to women in surgery this is particularly interesting, as it suggests that it is not enough to point out the “feminine” values in the occupation (e.g. helping others), but that it is most of all necessary to change the image of the male surgeon.

Patients’ Perceptions of Female Doctors

Female doctors, especially those in their early careers, might be worried about being judged as less competent than their male counterparts by colleagues and patients alike. However, research by Shah and Ogden suggests that young female doctors should be more confident in how they are perceived, at least by patients.

In their study they presented patients with one of eight pictures of a doctor who was either young or old, male or female and Asian or White and asked them about their perceptions of and reactions to those doctors, for example how comfortable they would feel with the doctor physically examining them or how good they thought the doctor would be at explaining the cause of their symptoms to them. While Asian and White doctors were perceived quite similarly, young and female doctors were overall evaluated more positively. For example, patients believed that younger doctors were more likely to have a positive personal manner and better technical skills. They also stated that they would have more faith into the younger doctors’ diagnosis. Similarly, female doctors were – maybe not surprisingly – rated as more likely to explore the emotional aspects of health and having a better personal manner. However, contrary to stereotypes, they were also rated as having better technical skills and patients had more faith in their diagnoses.

So can we hope that we are slowly moving away from the stereotype of the old, white, male doctor? Patients certainly seem to do so!