So female surgeons get fewer opportunities to build up their skills MARGARET ANN BULKLEY, who became, in 1812, the first woman to receive modern surgical training, achieved that distinction by pretending to be a man. No medical school at the time admitted women. She practised under the name of Dr James Barry and performed one of the first successful Caesarean sections (successful in that both mother and baby survived). Much has changed since then, but female surgeons remain few and far between. That is especially true at the top of the profession. Among surgeons in general, about a fifth are women in America and just over a tenth in Britain. The percentage of women holding professorial chairs in surgery departments is in the single digits. A working paper by Heather Sarsons of Harvard University suggests that one reason for this may be bias in the way other doctors refer their patients for surgery. Ms Sarsons examined surgical referrals covered by Medicare, America’s public insurance system for the elderly, that took place between 2008 and 2012. She measured how referrals from a given doctor to a given surgeon changed when the outcome of a particular referral to that surgeon was unusually good or bad. An unusually good referral was one in which a patient from the riskiest 1% survived the operation and was not readmitted within a month. An unusually bad one was when the patient died within a week. Ms Sarsons used a statistical matching procedure to create pairs of surgeons—one male and one female. Both members of the pair had performed the same surgery on similar patients (taking into account sex, age, race and pre-existing medical conditions) with either unusually good or unusually bad outcomes. And, at the time of the referrals in question, they had had similar professional characteristics, such as length of experience and number of procedures completed. Altogether she came up with 7,757 matched pairs of surgeons whose patients had died quickly and 6,979 pairs whose patients had lived unexpectedly. She then looked, in each case, at the subsequent relationships between the referring doctor and the surgeon in question. Because of the matching process, the female and male surgeons in each pair had, in the year leading up to the successful or failed procedure being examined, almost the same number of referrals from the doctor who had chosen them for that procedure. If the procedure had resulted in rapid death, though, the number of referrals made by the doctor to the surgeon in question fell by 34%—but only if the surgeon was a woman (see chart). Male surgeons saw no lasting fall in subsequent referral rates. On top of that, even when a female surgeon did receive subsequent referrals from the doctor, these tended to be less complicated cases than those referred to men. Nor was this bias affected by the sex of the referring doctor. Female doctors exhibited it as much as male doctors did. Bias in favour of the abilities of male surgeons also emerged from the data on those surgeons who had had an exceptionally good patient outcome. Following such an event, the doctors who had referred the lucky patients more than doubled their referrals if the surgeon was male. They also increased them if the surgeon was female, but only by 72%. That surgeons are not exempt from such biases is hardly surprising. But the consequence—that female surgeons probably receive fewer opportunities to treat complicated cases than men do—doubtless makes it easier for men to build the skills and recognition necessary for professional advancement. Source
