Why Women in Surgery Face Discrimination and How to Overcome It

Why Female Surgeons Face Extra Challenges: Breaking Barriers in the Operating Room

The journey to becoming a surgeon is one of the most demanding paths in medicine, requiring years of intense study, dedication, and sacrifice. Yet, for female surgeons, the road is often steeper, filled with additional challenges that their male counterparts may not face. From overcoming gender biases to balancing family life, female surgeons encounter unique hurdles that make their experience in the medical field particularly demanding. This article explores the extra challenges female surgeons face, shedding light on why these obstacles exist and how they can be addressed to create a more equitable environment in surgery.

Historical Context: The Long Struggle for Women in Surgery

Historically, surgery has been a male-dominated field. For centuries, women were excluded from medical education and practice, let alone surgical specialties. Even as women began to enter the medical profession in the 19th and 20th centuries, surgery remained an arena where female participation was limited. This long-standing exclusion created a cultural perception that surgery was not a field for women, a stereotype that continues to affect female surgeons today.

Many pioneers had to fight their way into the operating room. Women like Dr. Mary Edwards Walker, the only woman to receive the Medal of Honor during the American Civil War, and Dr. Gerty Cori, a Nobel laureate in Physiology or Medicine, paved the way for future generations. Despite their achievements, women in surgery still face challenges rooted in this historical context.

Gender Bias and Discrimination: A Persistent Problem

One of the most significant challenges female surgeons face is gender bias. Studies have consistently shown that female surgeons are often viewed as less competent than their male colleagues, regardless of their actual performance. This bias can manifest in several ways, from subtle microaggressions to overt discrimination.

• Patient Perceptions: Some patients may assume that female surgeons are less capable than male surgeons. A study published in JAMA Surgery found that patients were more likely to trust male surgeons over female ones, even when both had the same qualifications (https://jamanetwork.com/journals/jamasurgery/fullarticle/2752456).
• Workplace Discrimination: Female surgeons may face discrimination from colleagues and superiors. This can include being passed over for promotions, receiving lower salaries, or being excluded from important decision-making processes. A report from the American College of Surgeons found that women in surgical specialties earn significantly less than men, even when accounting for factors like experience and hours worked (https://www.facs.org/media/press-releases/2022/gender-gap-surgeon-salary/).
• Bias in Leadership Roles: Leadership in surgery remains predominantly male. According to a survey published in The Annals of Surgery, women hold only a fraction of the leadership roles in academic surgery programs (https://journals.lww.com/annalsofsu..._Academic_Surgery__Current_Status_and.24.aspx). This lack of representation in leadership positions makes it more difficult for female surgeons to advocate for themselves and their colleagues.

The Glass Ceiling in Surgery: Barriers to Career Advancement

While many female surgeons excel in their field, they often encounter a "glass ceiling" that prevents them from reaching the highest levels of their profession. This phenomenon refers to the invisible barriers that keep women from advancing to leadership roles, even when they are qualified.

• Fewer Mentorship Opportunities: Mentorship is crucial for career advancement in surgery, but female surgeons often have fewer mentorship opportunities than their male counterparts. Male surgeons in leadership positions may be more likely to mentor other men, perpetuating the cycle of male dominance in the field. A study from The American Journal of Surgery found that female surgical residents were less likely to have access to mentors who could help them navigate their careers (https://www.americanjournalofsurgery.com/article/S0002-9610(22)00177-5/fulltext).
• Promotion Disparities: Female surgeons are less likely to be promoted to senior positions than male surgeons, even when they have similar qualifications and experience. The New England Journal of Medicine reported that female surgeons are significantly underrepresented in positions such as department chairs and program directors (https://www.nejm.org/doi/full/10.1056/NEJMsa1916036).

The Work-Life Balance Struggle: Unique Pressures on Female Surgeons

Balancing a demanding surgical career with family life is a challenge for all surgeons, but it can be particularly difficult for women. Society often places higher expectations on women to be the primary caregivers in their families, which can create additional stress for female surgeons.

• Maternity Leave and Childcare: The surgical profession is notoriously demanding, with long hours, overnight shifts, and high levels of stress. For female surgeons who wish to have children, maternity leave and childcare become significant issues. Many female surgeons report feeling pressured to take shorter maternity leaves or to return to work sooner than they would like, fearing that extended time off could harm their careers. In fact, a study published in The BMJ found that female surgeons who took maternity leave were more likely to experience career setbacks, such as being passed over for promotions or losing out on key opportunities (https://www.bmj.com/content/367/bmj.l6574).
• Lack of Institutional Support: Many hospitals and surgical centers do not provide adequate support for female surgeons who are also mothers. This can include a lack of on-site childcare, inflexible schedules, and limited options for part-time work. The American Journal of Surgery highlights how female surgeons are more likely to leave the field early due to the inability to balance work and family life (https://www.americanjournalofsurgery.com/article/S0002-9610(22)00177-5/fulltext).
• The "Second Shift": Female surgeons often face the "second shift" — the expectation that they will take on the majority of household and caregiving responsibilities after their workday is over. This double burden can lead to burnout, mental health struggles, and reduced job satisfaction. A report from the Journal of Surgical Research found that female surgeons were more likely to experience burnout than their male colleagues, largely due to the pressures of balancing work and home life (https://www.journalofsurgicalresearch.com/article/S0022-4804(22)00541-6/fulltext).

Navigating Gendered Expectations in the Operating Room

The operating room (OR) can be a challenging environment for female surgeons due to the expectations and stereotypes that surround gender roles in this high-pressure space. Despite their qualifications and skill, female surgeons often encounter skepticism from both colleagues and patients.

• Physicality in the OR: Surgery is sometimes perceived as a field that requires physical strength, which can reinforce gendered stereotypes. Female surgeons may be unfairly judged for their physical abilities, despite the fact that modern surgical techniques emphasize precision and dexterity over brute strength. In robotic and minimally invasive surgeries, for example, fine motor skills and technical expertise are far more important than physical size or strength.
• Authority and Leadership: Female surgeons are often perceived differently when they take on leadership roles in the OR. While male surgeons may be seen as assertive and authoritative, female surgeons exhibiting the same behaviors may be labeled as "bossy" or "difficult." This double standard can make it harder for women to assert their authority in the OR without facing pushback. A study in The Lancet highlights that female surgeons are more likely to have their leadership styles questioned by colleagues, which can affect the dynamics of the surgical team (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01653-2/fulltext).

Sexual Harassment and Microaggressions in Surgery

Sexual harassment and microaggressions are a significant issue for female surgeons. Despite progress in gender equality, many women in surgery continue to experience inappropriate behavior and comments from colleagues, superiors, and even patients.

• Prevalence of Harassment: A survey published in The New England Journal of Medicine found that nearly 60% of female surgeons had experienced some form of sexual harassment in the workplace (https://www.nejm.org/doi/full/10.1056/NEJMc1900478). This harassment can range from inappropriate comments to unwanted physical contact, creating a hostile work environment for female surgeons.
• Impact on Career and Mental Health: Sexual harassment can have a profound impact on a female surgeon's career and mental health. Women who experience harassment are more likely to suffer from anxiety, depression, and burnout, which can affect their performance and job satisfaction. Additionally, some female surgeons may leave the field entirely due to the toxic work environment created by harassment.
• Microaggressions: In addition to overt harassment, female surgeons often face microaggressions — subtle, often unintentional comments or behaviors that reinforce stereotypes. These can include being mistaken for a nurse or other non-physician role, receiving unsolicited advice on how to balance work and family, or having their opinions dismissed in professional settings. While microaggressions may seem minor, they can accumulate over time and contribute to a sense of being undervalued and disrespected.

Addressing the Challenges: Steps Toward a More Inclusive Surgical Field

Despite the challenges, there are steps that can be taken to create a more inclusive and supportive environment for female surgeons. Many institutions and organizations are beginning to recognize the need for change and are implementing policies to address gender disparities in surgery.

• Mentorship Programs: Mentorship is key to supporting female surgeons. Establishing formal mentorship programs that pair female surgical residents with experienced female surgeons can provide invaluable guidance and support. These mentors can help navigate the challenges of the profession, offer career advice, and serve as role models for the next generation of female surgeons.
• Gender Bias Training: Hospitals and medical institutions can implement gender bias training for all staff members, from surgical teams to administrative personnel. This training can help raise awareness of unconscious biases and microaggressions, fostering a more respectful and inclusive work environment.
• Flexible Work Policies: Offering flexible work arrangements, such as part-time schedules, telemedicine options, and on-site childcare, can help female surgeons balance their careers with family responsibilities. These policies not only benefit women but also contribute to a more diverse and satisfied workforce overall.
• Addressing the Pay Gap: Transparent pay structures and regular salary audits can help address the gender pay gap in surgery. By ensuring that female surgeons are compensated fairly for their work, institutions can promote greater equity and retain top talent in the field.
• Zero-Tolerance Harassment Policies: Establishing and enforcing zero-tolerance policies for sexual harassment is essential in creating a safe and supportive work environment for female surgeons. Institutions must take complaints of harassment seriously, investigate thoroughly, and hold offenders accountable.

Conclusion: A Path Forward for Female Surgeons

The challenges female surgeons face are numerous and multifaceted, but progress is being made. By recognizing and addressing the barriers to success for women in surgery, the medical field can move toward a more inclusive future. Female surgeons have proven time and again that they are just as capable, skilled, and dedicated as their male counterparts. With continued efforts to promote gender equality in surgery, the next generation of female surgeons will have the opportunity to thrive in an environment that values their contributions and supports their success.