characteristics of women surgeons in the united states

Characteristics of Women Surgeons in theUnited States

Erica Frank, MD, MPH, Michelle Brownstein, MD, Kimberly Ephgrave, MD, Leigh Neumayer, MD,Atlanta, Georgia

BACKGROUND: Women surgeons are becoming in-creasingly prevalent. Despite this, there havebeen few studies of personal or professionalcharacteristics of US surgeons of either gender.

METHODS: Data were taken from the WomenPhysicians’ Health Study, a nationally represen-tative random sample (n 5 4,501 respondents) ofUS women physicians, and data were analyzedin SUDAAN.

RESULTS: Surgeons were younger, and morelikely to be US born, white, unmarried, and child-less than were other women physicians; theirpersonal health behaviors were similar to thoseof others. They worked significantly more clinicalhours and call nights, but were not more likely toreport feeling that they worked too much, hadtoo much work stress, or had less control oftheir work environment. Their career satisfactionwas similar to that of other women physicians,and satisfaction with their specialty was greater.They were less avid preventionists than were pri-mary care practitioners, and somewhat less avidthan other specialists.

CONCLUSIONS: Women surgeons differ in interest-ing and important ways from other womenphysicians. Am J Surg. 1998;176:244–250.© 1998 by Excerpta Medica, Inc.

Although the prevalence of women surgeons hasbeen even lower than women’s prevalence amongphysicians as a whole, women’s presence has be-

come more noticeable in surgery, and continues to in-crease.1 The percentage of women general and subspecialtysurgeons grew from 1.1% and 1.3%, respectively, to 3.6%and 2.3% between 1970 and 1980, and to 6.4% and 4.4%by 1988.1 Women represented 10% of surgery residentsnationally in 1980, 12% in 1985, 14% in 1990,1 and 18%

in 1996.2 Although surgery’s prevalence of women is stillsubstantially lower than those of many other specialties,1

the continued growth in the proportion of women insurgical training programs means that women surgeons willhave an increasing impact on the profession.

The entry of women into traditionally predominantlymale professions does not necessarily imply that their livesor career paths will be identical to those of their malecolleagues. Debate continues regarding whether a “glassceiling” exists and will persist within medical academia,3–6

although some evidence suggests that women’s career pathsmay more resemble men’s once a “critical mass” isachieved.7,8 Female and male surgeons’ characteristics canalso affect their interpersonal interactions and the way theydeliver patient care. Physician characteristics are impor-tant predictors of patient outcomes,9 but the personal andprofessional characteristics of US surgeons of either genderhave not been extensively studied. Previous studies of USfemale surgeons have relied on small and/or selected sam-ples and have not compared female surgeons with otherfemale physicians.10–15 To explore the characteristics ofUS female surgeons and compare them with other USfemale physicians, we analyzed data from the Women Phy-sicians’ Health Study (WPHS), a national questionnaire-based study of 716 characteristics of 4,501 US womenphysicians.9,16,17

METHODSThe design and methods of WPHS has been more fully

described elsewhere, as have basic characteristics of thepopulation.9,16,17 WPHS surveyed a stratified random sam-ple of US women medical doctors; the sampling frame isbased on the American Medical Association’s PhysicianMasterfile, a data base intended to record all MDs residingin the United States and possessions. Using a samplingscheme stratified by decade of graduation from medicalschool, we randomly selected 2,500 women from each ofthe last 4 decades’ graduating classes (1950 through 1989).We over-sampled older women physicians, a populationthat would otherwise have been sparsely represented byproportional allocation because of the recent increase innumbers of women physicians. We included active, part-time, professionally inactive, and retired physicians, aged30 to 70, who were not in residency training programs inSeptember 1993, when the sampling frame was con-structed. In that month, the first of four mailings was sentout; each mailing contained a cover letter and a self-administered four-page questionnaire. Enrollment wasclosed in October 1994 (final n 5 4,501).

Of the potential respondents, an estimated 23% wereineligible to participate because their addresses were

From the Department of Family and Preventive Medicine,Emory University School of Medicine, Atlanta, Georgia.

This research was supported by the American Medical Associ-ation’s Education and Research Foundation, the American HeartAssociation, an NIH (NHLBI) institutional National Research Ser-vice Award (#5T32-HL-07034), the Emory Medical Care Founda-tion, and the Ulrich and Ruth Frank Foundation for InternationalHealth.

Requests for reprints should be addressed to Erica Frank, MD,MPH, Emory University School of Medicine, 69 Butler Street,Atlanta, Georgia 30303-3219.

Manuscript submitted January 27, 1998 and accepted in re-vised form May 1, 1998.

SURGICAL EDUCATION

244 © 1998 by Excerpta Medica, Inc. 0002-9610/98/$19.00All rights reserved. PII S0002-9610(98)00152-4

wrong, or they were men, deceased, living out of thecountry, or interns or residents. Our response rate is 59% ofphysicians eligible to participate. We compared respon-dents and nonrespondents in three ways: we used ourphone survey (comparing our phone-surveyed random sam-ple of 200 nonrespondents with all the written surveyrespondents), the AMA Physician Masterfile (contrastingall respondents with all nonrespondents), and an exami-nation of survey mailing waves (all respondents, from wave1 through 4) to compare respondents and nonrespondentsregarding a large number of key variables. From these threeinvestigations, we found that nonrespondents were lesslikely than were respondents to be board-certified. How-ever, respondents and nonrespondents did not consistentlyor substantively differ on other tested measures, includingage, ethnicity, marital status, number of children, alcoholconsumption, fat intake, exercise, smoking status, hoursworked per week, frequency of being a primary care prac-titioner, personal income, or percentage actively practicingmedicine.

Based on these findings, we weighted the data by decade

of graduation (to adjust for our stratified sampling scheme),and by decade-specific response rate and board-certificationstatus (to adjust for our identified response bias). Theanalysis weights (within decade) for board certified andnon-board certified respondents, respectively, are 3.4 and5.5 (1950s), 9.3 and 17.7 (1960s), 17.9 and 36.5 (1970s),and 28.3 and 63.9 (1980s). Using these weights allows us tomake inference to the entire population of women physi-cians who graduated from medical school between 1950and 1989. All analyses were conducted using SUDAAN(Research Triangle, North Carolina).

RESULTSPersonal Characteristics

Surgeons were younger, more likely to be US born, morelikely to be white, and less likely to be Asian than wereother physicians (Table I; owing to multiple testing, onlycharacteristics significant at P #0.01 are discussed for thisand other Tables). They were more likely to be single/never married and less likely to be married now than otherphysicians; this was true even when adjusted for age (not

TABLE IDemographic and Personal Characteristics of US Women Physicians*

Surgeons Nonsurgeons

P Valuesn n

Total, % (SE) 134 3.9 (0.4) 4311 96.1 (0.4)Age, mean years (SE) 134 39.1 (0.6) 4311 42.3 (0.1) 0.0000Ethnicity, % (SE) 0.0000

African-American/black 3 3.3 (2.1) 127 4.3 (0.4)Asian-American/Pacific Islander 7 4.9 (2.0) 690 12.9 (0.6)Hispanic/Latina 5 4.4 (2.3) 161 5.1 (0.5)Other 2 0.4 (0.3) 123 2.9 (0.3)White/non-Hispanic 115 87.0 (3.5) 3141 74.9 (0.8)

Born out of the US, % (SE) 15 9.2 (3.2) 1178 24.0 (0.8) 0.0000Current relationship status, % (SE) 0.002

Unmarried couple 4 3.6 (2.1) 113 3.7 (0.4)Single 33 26.0 (4.7) 462 12.0 (0.7)Widowed 2 0.3 (0.2) 132 1.2 (0.1)Separated/divorced 13 10.2 (3.3) 463 9.4 (0.5)Married 80 60.0 (5.2) 3037 73.7 (0.9)

Partner’s education, % (SE)†

Medical school graduate 32 40.7 (6.6) 1359 46.0 (1.1) 0.7Graduate school graduate 27 34.4 (6.4) 939 32.5 (1.1)Less than or equal to college graduate 17 24.9 (6.4) 591 21.6 (1.0)

Percent with children 67 43.3 (5.1) 3201 70.9 (0.9) 0.0000Number of children (for those with), mean

(SE) 2.0 (0.1) 2.3 (0.0) 0.02MD was main preschool caretaker, % (SE) 7 13.6 (5.6) 613 17.9 (0.9) 0.5Home stress 0.003

Severe 4 1.8 (1.0) 198 5.8 (0.5)Moderate 53 42.4 (5.2) 1557 42.6 (1.0)Light 73 55.8 (5.3) 2374 51.6 (1.0)

Political characterization, % (SE) 0.07Very liberal 8 4.3 (1.7) 351 9.0 (0.6)Fairly liberal 33 25.8 (4.7) 1151 28.6 (0.9)Moderate 43 34.5 (5.1) 1550 36.6 (0.9)Fairly conservative 33 26.5 (4.8) 895 20.2 (0.8)Very conservative 14 8.9 (2.8) 250 5.6 (0.5)

* Chi-square test for prevalences and t test for means.† Includes married and unmarried couples.

CHARACTERISTICS OF U.S. WOMEN SURGEONS/FRANK ET AL

THE AMERICAN JOURNAL OF SURGERY® VOLUME 176 SEPTEMBER 1998 245

shown). They were not significantly more likely to becurrently divorced than were others, and were less likely tohave severe stress at home. They were also less likely tohave had children; this was true even when controlled forage and marital status (not shown). Surgeons’ politics, theirpartners’ educational levels, and the percentage that werethe primary preschool caretakers for their children weresimilar to other physicians’.

Personal Health HabitsOther than for exercising more than did other physicians,

surgeons were not significantly more or less likely to reporthealthy habits or good health (Table II). Their diets,vitamin use, cigarette and alcohol use, and compliancewith examined US Preventive Services Task Force recom-mendations18 were similar to other physicians’. Surgeonsreported better health than did other physicians; age-ad-justing did not change these relationships. General andsubspecialist surgeons did not differ significantly in theirpersonal health practices.

Training- and Practice-related CharactersticsAll surgeons responding were residency trained. Those

graduating from medical school in the 1950s to 1970s weremore likely to be board certified than were other physicians(Table III). Those graduating in the 1980s were less likelyto be board-certified than were other physicians, but many(57.3%) of these women were board-eligible. All surgeonswho were board certified in another specialty were alsoboard certified in surgery (not shown). Women surgeonswere more likely to practice in a medical school settingthan were other women physicians, and they spent moretime on continuing medical education, especially on textreading. Surgeons reported higher personal and householdincomes than did other physicians, primarily due to higher

income among subspecialized surgeons. Both general andsubspecialized surgeons worked significantly more clinicalhours and call nights than did other physicians. Despitetheir higher number of work hours, they were not morelikely to report feeling that they worked too much, had toomuch work stress, or that they had less control of theirwork environment (Table IV). Their career satisfactionwas similar to that of other women physicians, and satis-faction with their specialty was greater.

Patient Counseling PracticesFor most of the 14 counseling practices examined, the

amount of counseling they report performing, the clinicalrelevance they ascribe to those practices, their self-confi-dence in performing the practices, and the amount oftraining they have received was significantly lower thanthat of primary care practitioners and somewhat lower thanthat of other specialists (Table V). Of these four outcomes,surgeons differed least often from other physicians inamount of training received. In all four outcomes for colo-rectal cancer, skin cancer/sunscreen, and mammographycounseling, surgeons were equivalent to or better thanother specialists, and in many HIV, exercise, and smokingcessation counseling outcomes they were equivalent toother specialists.

COMMENTSAlthough there have been some investigations into the

lives of US women surgeons, this study is the first nationalsample of women surgeons compared to other women phy-sicians with respect to their personal characteristics, per-sonal health habits, and practice-related issues. Prior stud-ies have had limited generalizability and applicability toUS women surgeons, owing to low response rates (21%),10

limited subspecialties (plastic,12,13 cardiothoracic,14 or

TABLE IIPersonal Health Practices of US Women Physicians*


P Valuen n

General health status, % (SE) 0.0001Excellent/very good 111 86.6 (3.5) 3140 78.3 (0.8)Good 19 12.5 (3.4) 831 17.2 (0.7)Fair/poor 3 0.9 (0.6) 221 4.5 (0.4)

Compliance with USPSTF guidelines, % (SE)† 78 65.7 (5.2) 2557 67.2 (0.9) 0.8Cigarette smoking, % (SE) 0.8

Current 6 4.7 (2.3) 177 3.6 (0.4)Exsmoker 30 20.8 (4.1) 889 18.6 (0.7)Never 95 74.5 (4.5) 3069 77.7 (0.8)

Cigarettes/day for smokers, median (SE) 6 8.0 (—) 177 9.5 (1.4)Alcohol drinking ever, % (SE) 104 78.3 (4.5) 2858 72.1 (0.9) 0.2Drinks/week for drinkers, median (SE) 91 1.6 (0.3) 2463 1.3 (0.1) 0.6Exercise minutes per week, median (SE) 120 238 (13) 3786 173 (4) 0.002Block fat score, median (SE) 122 19.1 (1.6) 3943 21.1 (0.3) 0.3Fruits and vegetables servings per day, median (SE) 123 2.6 (0.2) 3852 3.1 (0.1) 0.03Vitamin supplementation, % (SE) 73 58.3 (5.3) 2444 58.4 (1.0) 0.9

* Chi-square test for prevalences, t-test for means, and median split tests for medians.† Percent complying with all screening recommendations from the U.S. Preventive Services Task Force regarding cholesterol (check every #5 years), bloodpressure (every #2 years), Pap smears (every #3 years if uterus is present), clinical breast exam (every #3 years if age 30–39, every #1 year if $40 years old), andmammography (every #2 years if 50–70 years old.18


246 THE AMERICAN JOURNAL OF SURGERY® VOLUME 176 SEPTEMBER 1998

oral/maxillofacial15 surgery only), or selection bias (due toorganizational membership requirements11). Further, thesestudies do not compare women surgeons with nonsurgeons.

We found that women surgeons are more likely white, USborn, single, and childless compared with other femalephysicians, and these demographic characteristics persistedafter controlling for their younger age. Women physiciansas a whole are less likely to be married than men physi-cians,1 and women surgeons were even less likely thanother women physicians to have ever married (althoughthey were no more likely to be divorced). One explanationfor this finding, as well as the relative lack of children,could be the long training time and its overlap with wom-en’s childbearing years.19–21 Women surgeons may also beless likely to have families because of stronger professionalinterests or lesser interest in traditional families, feelingthat they had to choose between careers and families, orperceived job inflexibility; women surgeons also reportedworking significantly more clinical hours and call nightsthan did other physicians. Some physicians choose to betheir children’s primary caretakers; women physicians ininternal medicine, pediatrics and family practice havepaved the way for more creatively structured hours with

part-time, flex-time and job sharing, yet these strategieshave not been widely adopted by the surgical communi-ty.22 Women medical students choosing surgery may alsofundamentally differ from other women students, beingmore likely to be single and childless. Women medicalstudents may also more resemble males choosing surgerythan they do other women students, having similarly highfamily socioeconomic status, career orientation, self-confi-dence about career choice, and willingness to sacrificepersonal lives for career.23,24 Such differences might alsopertain to practicing surgeons.

Despite these demographic differences, women surgeonswere similar to other women physicians in most otherexamined respects. Despite their higher number of workhours, they were not more likely to report feeling that theyworked too much, had too much work stress, or that theyhad less control of their work environment; their careersatisfaction was similar to that of other women physicians,and they were less likely than were others to want tochange their specialty if they were reliving their lives. Thehigh degree of satisfaction with specialty that we found iscorroborated by previous studies of women surgeons.10,11,25

One possible explanation is the high degree of self-confi-

TABLE IIITraining and Practice Characteristics of US Women Physicians*


P Valuesn n

Residency trained, % (SE)Graduated medical school 1950–1979 76 100 (0.0) 2832 91.6 (0.6) n/aGraduated medical school 1980–1989 58 100 (0.0) 1189 97.4 (0.6) n/a

Board certified in principal specialty, % (SE)Graduated medical school 1950–1979 76 89.4 (4.8) 3090 63.6 (1.1) 0.0000Graduated medical school 1980–1989 58 43.4 (6.7) 1215 62.2 (1.6) 0.02

Board eligible in principal specialty, % (SE)Graduated medical school 1950–1979 76 9.0 (4.8) 3078 23.8 (1.0) 0.003Graduated medical school 1980–1989 57 57.3 (6.7) 1209 32.0 (1.6) 0.004

Primary worksite, % (SE) 0.0000Solo practice 28 15.6 (3.4) 858 16.7 (0.7)Two-physician practice 11 8.7 (2.9) 226 6.2 (0.5)Group practice 39 31.9 (4.9) 954 26.3 (0.9)Hospital 19 15.9 (4.0) 878 23.5 (0.8)Medical school 25 21.9 (4.6) 421 9.5 (0.6)Government facility 5 4.8 (2.7) 416 9.0 (0.6)Not now active 1 0.2 (0.2) 219 2.9 (0.3)Other 3 1.1 (0.9) 287 6.0 (0.4)

Personal income in $1,000s, median (SE) 116 $111 (7) 3465 $72 (1) 0.0000Household income in $1,000, median (SE) 116 $161 (13) 3503 $130 (3) 0.01Clinical hours per week, median (SE) 132 48.3 (2.8) 4136 35.8 (1.0) 0.0000Nonclinical hours per week, median (SE) 124 6.6 (1.1) 3994 4.9 (0.2) 0.3On-call nights per month, median (SE) 131 9 (0.6) 4087 4 (0.2) 0.0000Hours of sleep when on call, mean (SE) 113 5.4 (0.2) 2702 5.6 (0.0) 0.4Continuing medical education

Hours per month, mean (SE)Total 130 15.8 (1.3) 4167 12.4 (0.2) 0.007Journal 129 5.6 (0.6) 4138 5.1 (0.1) 0.4Text 128 5.6 (0.7) 3950 3.0 (0.1) 0.0005Lecture 123 4.3 (0.6) 3869 3.6 (0.1) 0.2Audio 120 0.5 (0.2) 3716 0.7 (0.0) 0.2TV/video 120 0.2 (0.1) 3706 0.4 (0.0) 0.003

* Chi-square test for prevalences, t test for means, and median split test for medians.



dence that has been described as part of the “surgeon’spersonality.”26 This trait, combined with surgeons’ recog-nized ability to handle emotional situations with littlestress,27,28 might cause US women surgeons to have ahigher degree of satisfaction with their specialty, despitelonger hours and higher work stress. This potential differ-ence in handling stress is supported by investigations intosurgical residency programs; despite these programs’ rigor,surgery residents showed no more emotional stress, andwere less likely to use illicit drugs than were other resi-dents.28 Another possible explanation for their high satis-faction with their specialty might be that when womenconsider surgical careers, they may undertake considerableself-examination to prepare themselves for professionalstressors, including that of being a woman in a man’sfield.29 Such preparation may improve their ultimate jobsatisfaction. Finally, women surgeons may derive particularsatisfaction from providing dramatic clinical outcomes,from their positions as heads of teams, or from their statusas especially high wage-earners.

Some could think that working in a male-dominated fieldmight have more negative consequences. In fact, we foundin prior analyses30 that while gender-based and sexualharassment were more common while in training for sur-geons than for other women physicians, these negativeexperiences are not much more likely to have occurredonce in practice. During internship, residency, or fellow-ship, 63.1% of generalist and 48.4% of subspecialized sur-geons had experienced gender-based harassment (versus28.7% of all women physicians) and 33% of generalist and32% of subspecialized surgeons had experienced sexual

harassment (versus 18.9% of all women physicians). Oncein practice, however, 27% of generalist and 33.2% ofsubspecialized surgeons had experienced gender-based ha-rassment (versus 25% of all women physicians) and only13.9% of generalist and 11.4% of subspecialized surgeonshad experienced sexual harassment (versus 11.4% of oth-ers).

Women surgeons were more likely to practice in a med-ical school setting than were other women physicians. Thisaffiliation may be an attempt to increase job flexibility byhaving residents provide some patient management.Women surgeons report more time spent on continuingmedical education, especially text reading, than do otherphysicians. Older women surgeons were more likely to beboard certified than were other older physicians. This couldbe related to the higher proportion of women surgeonscompared with other women physicians on medical schoolfaculties, or may perhaps reflect the severe minority statusolder women surgeons experienced when they were only asmall proportion of practicing surgeons, resulting in morepressure to become board certified. Older women surgeonswere also more likely to be board certified than were theyoungest women surgeons; it is likely that those graduatingfrom medical school in the 1980s had less of an opportunityto be board certified by the time of the questionnaire’sadministration.

The amount of counseling surgeons reported performing,the clinical relevance they ascribed to those practices, theirself-confidence in performing the practices, and theamount of training they received was significantly lowerthan that of primary care practitioners and somewhat lower

TABLE IVCareer Satisfaction of US Women Physicians*

Surgeons Nonsurgeons PValuesn % (SE) n % (SE)

Work amount 0.9Too little 3 1.5 (1.0) 84 1.9 (0.3)A comfortable amount 68 55.9 (5.2) 2235 53.9 (1.0)Too much 50 36.0 (5.0) 1530 38.2 (0.9)Far too much 11 6.6 (2.1) 257 6.0 (0.5)

Control of work environment 0.5Always/almost always 37 24.9 (4.5) 1269 27.5 (0.9)Usually 51 42.9 (5.3) 1689 40.6 (1.0)Sometimes 31 20.4 (3.9) 863 24.7 (0.9)Rarely/never 12 11.8 (3.7) 291 7.2 (0.5)

Career satisfaction 0.9Always/almost always 67 50.1 (5.3) 2224 48.9 (1.0)Usually 42 33.7 (5.0) 1404 35.7 (0.9)Sometimes 21 14.8 (3.6) 472 13.5 (0.7)Rarely/never 2 1.4 (1.0) 70 1.9 (0.3)

Change specialty 0.009Definitely/probably 14 10.7 (3.2) 924 21.0 (0.8)Maybe 22 15.8 (3.7) 728 17.9 (0.8)Probably not/definitely not 97 73.5 (4.6) 2532 61.1 (0.9)

Work stress 0.4Severe 23 18.1 (4.1) 514 13.0 (0.7)Moderate 91 67.6 (5.1) 2693 68.9 (1.9)Light 16 14.4 (4.1) 866 18.1 (0.7)

* Chi-square test for prevalences.



TABLE VPrevention-related Screening: Practices, Perceived Relevance, Self-Confidence, and Amount of Training*

Screening SpecialtyDo or Discuss at

Least Yearly % (SE)Highly Relevant

% (SE)Highly Confident

% (SE)Highly Trained

% (SE)

Cholesterol Surgeons 5.9 (2.6) 5.2 (2.0) 23.4 (5.0) 2.8 (2.2)Other specialists 18.8 (1.3) 11.7 (1.0) 28.1 (1.6) 12.8 (1.2)Primary care 38.5 (1.8) 62.5 (1.8) 65.7 (1.8) 23.1 (1.5)P value 0.0000 0.0000 0.0000 0.0000

Blood pressure Surgeons 26.1 (5.1) 6.4 (2.1) 20.8 (4.6) 3.8 (2.4)Other specialists 49.5 (1.7) 33.4 (1.6) 41.9 (1.8) 20.7 (1.5)Primary care 94.6 (0.8) 81.0 (1.6) 74.4 (1.7) 38.3 (1.8)P value 0.0000 0.0000 0.0000 0.0000

Colorectal cancer Surgeons 13.7 (4.0) 25.5 (4.8) 43.5 (6.0) 28.4 (5.4)Other specialists 11.6 (1.1) 8.1 (1.0) 21.6 (1.5) 10.5 (1.1)Primary care 55.9 (1.8) 50.9 (1.9) 53.3 (1.9) 20.1 (1.5)P value 0.0000 0.0000 0.0000 0.0000

Skin cancer/sunscreen Surgeons 19.6 (4.5) 22.0 (4.8) 47.1 (5.9) 23.2 (5.3)Other specialists 18.0 (1.3) 12.4 (1.1) 29.6 (1.7) 15.3 (1.3)Primary care 33.8 (1.7) 32.8 (1.7) 46.3 (1.9) 15.4 (1.3)P value 0.0000 0.0000 0.0000 0.4

HIV risks/testing Surgeons 5.3 (2.9) 20.2 (4.8) 31.4 (5.6) 8.9 (3.8)Other specialists 8.8 (0.9) 20.8 (1.4) 36.8 (1.8) 0.9 (1.5)Primary care 22.1 (1.5) 43.2 (1.9) 58.5 (1.9) 29.1 (1.7)P value 0.0000 0.0000 0.0000 0.0000

Flu vaccine Surgeons 5.7 (2.5) 3.1 (1.6) 8.0 (2.6) 0.6 (0.6)Other specialists 24.2 (1.5) 17.6 (1.3) 30.4 (1.7) 12.0 (1.2)Primary care 62.5 (1.8) 54.1 (1.9) 60.6 (1.9) 22.2 (1.5)P value 0.0000 0.0000 0.0000 0.0000

Nutrition Surgeons 14.8 (3.8) 15.2 (4.1) 26.7 (5.2) 13.7 (4.4)Other specialists 28.0 (1.5) 26.3 (1.5) 35.9 (1.7) 17.8 (1.4)Primary care 48.1 (1.8) 58.4 (1.9) 44.8 (1.9) 17.9 (1.5)P value 0.0000 0.0000 0.0001 0.6

Weight Surgeons 15.4 (4.1) 19.7 (4.7) 36.8 (5.7) 14.3 (4.4)Other specialists 31.6 (1.6) 28.7 (1.5) 36.9 (1.8) 16.8 (1.4)Primary care 64.2 (1.7) 61.8 (1.9) 49.7 (1.9) 20.2 (1.5)P value 0.0000 0.0000 0.0000 0.2

Exercise Surgeons 22.5 (4.8) 19.3 (4.5) 40.7 (5.8) 15.1 (4.4)Other specialists 30.8 (1.6) 24.9 (1.5) 40.4 (1.8) 18.3 (1.4)Primary care 57.6 (1.8) 57.8 (1.9) 49.7 (1.9) 19.0 (1.5)P value 0.0000 0.0000 0.0000 0.7

Smoking Surgeons 43.8 (5.5) 35.6 (5.4) 48.5 (5.8) 17.6 (4.8)Other specialists 44.7 (1.7) 37.9 (1.7) 45.4 (1.8) 21.4 (1.5)Primary care 83.8 (1.3) 71.4 (1.8) 63.3 (1.8) 25.5 (1.6)P value 0.0000 0.0000 0.0000 0.09

Alcohol use Surgeons 14.0 (4.2) 15.3 (4.3) 29.8 (5.6) 11.0 (4.0)Other specialists 32.8 (1.6) 39.2 (1.7) 45.3 (1.8) 27.6 (1.7)Primary care 49.4 (1.8) 52.0 (1.9) 46.1 (1.9) 20.2 (1.5)P value 0.0000 0.0000 0.02 0.0001

Clinical breast examination Surgeons 30.8 (5.3) 36.6 (5.5) 55.6 (6.0) 39.1 (6.2)Other specialists 23.2 (1.5) 11.0 (1.2) 28.6 (1.8) 17.0 (1.6)Primary care 86.6 (1.2) 84.8 (1.5) 84.9 (1.5) 52.5 (2.1)P value 0.0000 0.0000 0.0000 0.0000

Mammography Surgeons 28.3 (5.2) 33.5 (5.3) 43.9 (6.1) 29.0 (5.8)Other specialists 19.4 (1.4) 10.5 (1.2) 24.7 (1.7) 13.8 (1.4)Primary care 75.3 (1.6) 79.8 (1.7) 82.1 (1.6) 50.2 (2.1)P value 0.0000 0.0000 0.0000 0.0000

Hormone replacement therapy Surgeons 6.5 (2.8) 7.8 (2.4) 9.7 (2.8) 2.2 (1.4)Other specialists 14.1 (1.2) 10.5 (1.2) 16.8 (1.4) 11.0 (1.2)Primary care 63.2 (1.8) 72.1 (1.8) 72.1 (1.8) 46.3 (2.1)P value 0.0000 0.0000 0.0000 0.0000

Number varies slightly by question; minimum n were 90 (surgeons), 980 (other specialists), and 806 (primary care).* Chi-square test.



than that of other specialists. Of these four outcomes,surgeons differed least often from other physicians inamount of training received, suggesting that it may not justbe residencies or continuing medical education programsproviding less counseling training, but also surgeons’ per-ception of counseling as a low priority. This suggestion iscorroborated by our finding that surgeons repeated per-forming as well as or better than other specialists in all fourcounseling outcomes for topics with direct surgical rele-vance (ie, colorectal cancer, skin cancer/sunscreen use, andmammography).

Surgeons’ personal health behaviors were generally excel-lent, and generally similar to those of other physicians.Like other women physicians, less than 5% reported smok-ing, and those who drank alcohol reported drinking anaverage of less than two drinks per week. The surgeons alsoreported exercising more than did other women physicians,and were more likely to rate their health as excellent orvery good and less likely to rate it as good, fair, or poor.This effect persisted (although weakened) when age-ad-justed. This may be a “healthy surgeon effect,” as thephysical strains of surgery may hamper physically restrictedmedical students’ and physicians’ participation.

General limitations of the WPHS include being limitedto women, and to a 59% response rate, although the fewother large (n .500) studies of US physicians (primarily orexclusively male) conducted in the past 20 years have usedsimilar methods for determining eligibility and have re-ported similar response rates: 43%,31 47%,32 59%,33 63%,34

and 75%.35 The major limitation of this particular analysisis subset sample size: Since our sample only includes 134surgeons (42 general surgeons and 92 specialty surgeons),some cell sizes were too small to analyze potential interac-tions such as children, ethnicity, and work stress.

By comparing women surgeons with other female physi-cians with respect to personal and practice lifestyle as wellas some practice characteristics, we have been able toprovide some information about the female surgical work-force. This information can be helpful for women in med-ical school who are considering a surgical career, andwomen in residency considering practice opportunities.Furthermore, the practice characteristics provide impor-tant data for future surgical workforce planning, as we tryto anticipate the effect of the increasing number of womensurgeons.

REFERENCES1. Women in Medicine in America: In the Mainstream. Chicago, IL:AMA; 1991.2. Jolly P, Hudley D, eds. Association of American Medical CollegesData Book: Statistical Information Related to Medical Education.Washington, DC: AAMC; January 1997.3. Levinson W, Tolle SW, Lewis C. Women in academic medicine:combining career and family. NEJM. 1989;321:1511–1517.4. Nickerson KG, Bennett NM, Estes D, Shea S. The status ofwomen at one academic medical center: breaking through the glassceiling. JAMA. 1990;264:1813–1817.5. Tesch B, Wood H, Helwig A, Nattinger AB. Promotion ofwomen physicians in academic medicine: glass ceiling or stickyfloor? JAMA. 1995;273:1022–1025.6. DeAngelis CD, Johns M. Promotion of women in academicmedicine: shatter the ceilings, polish the floors. JAMA. 1995;273:1056–1057.

7. Etzkowitz H, Kemelgor C, Neuschatz M, et al. The paradox ofcritical mass for women in science. Science. 1994;266:51–54.8. Sonnert G, Holton G. Career patterns of women and men in thesciences. Am Sci. 1996;84:63–71.9. Frank E. The Women Physicians’ Health Study: background,objectives, and methods. JAMWA. 1995;50:64–66.10. Ramos S, Feiner C. Women surgeons: a national survey.JAMWA. 1989;44:21–25.11. Neumayer L, Konishi G, L’Archeveque D. Female surgeons inthe 1990s. Arch Surg. 1993;128:669–672.12. Capek L, Edwards D, Mackinnon S. Plastic surgeons: a gendercomparison. Plast Reconstruct Surg. 1997;99:289–299.13. Eskenazi L. The pregnant plastic surgical resident: results of asurvey of women plastic surgeons and plastic surgery residencydirectors. Plast Reconstruct Surg. 1994;95:330–335.14. Dresler CM, Padgett DL, Mackinnon SE, Patterson GA. Ex-periences of women in cardiothoracic surgery. Arch Surg. 1996;131:1128–1135.15. Risser MJ, Laskin DM. Women in oral and maxillofacialsurgery: factors affecting career choices, attitudes, and practicecharacteristics. J Oral Maxillofacial Surg. 1993;54:753–757.16. Frank E, Rothenberg R, Brown WV, Maibach H. Basic demo-graphics and professional characteristics of US women physicians.Western J Med. 1997;166:179–184.17. Frank E, Brogan DJ, Mokdad AH, et al. Health-related behav-iors of U.S. women physicians versus other U.S. women. ArchIntern Med. 1998;158:342–348.18. Clinician’s Handbook of Preventive Service. Washington, DC:US Department of Health and Human Services; 1994.19. Guinan M. Child care—a women’s health issue. JAMWA.1989;44:27–28.20. Bryant H, Jennet P, Kishinevsky M. Gender, family status, andcareer patterns of graduates of the university of calgary faculty ofmedicine. Acad Med. 1991;66:483–485.21. Fried L. Career development for women in academic medicine:multiple interventions in a department of medicine. JAMA. 1996;18:898–905.22. Froom J, Bickel J. Medical school policies for part-time facultycommitted to full professional effort. Acad Med. 1996;71:92–96.23. Burnley CS, Burkett GL. Specialization: are women in surgerydifferent? JAMWA. 1986;41:144–152.24. Baxter N, Cohen R, McLeod R. The impact of gender on thechoice of surgery as a career. Am J Surg. 1996;172:373–376.25. Mizgala C, Mackinnon SE, Walters BC. Women surgeons:results of the Canadian population study. Ann Surg. 1993;218:37–46.26. Yurt R. The making of a surgeon revisited. Arch Surg. 1992;127:16–20.27. Coombs RH, Fawzy F, Daniels M. Surgeons’ personalities: theinfluence of medical school. Med Ed. 1993;27:337–343.28. Bunch WH, Dvonch VM, Storr CL, et al. The stresses of thesurgical residency. J Surg Res. 1992;53:268–271.29. Walters B. Why don’t more women choose surgery as a career?Acad Med. 1993;68:350–351.30. Frank E, Brogan D, Schiffman M. Prevalence and correlates ofharassment among U.S. women physicians. Arch Intern Med. 1998;158:352–358.31. Buring JE, Hennekens CH. Cost and efficiency in clinicaltrials: The U.S. Physicians’ Health Study. Stat Med. 1990;9:29-33.32. Bensing J. Doctor-patient communication and the quality ofcare. Soc Sci Med. 1991;32:1301–1310.33. Hughes PH, Brandenburg N, Baldwin DC, et al. Prevalence ofsubstance use among US physicians. JAMA. 1992;267:2333–339.34. Shea S, Gemson DH, Mossel P. Management of high bloodcholesterol by primary care physicians. J Gen Intern Med. 1990;5:327–334.35. Schwartz JS, Lewis CE, Clancey C, et al. Internists’ practices inhealth promotion and disease prevention. Ann Intern Med. 1991;114:46–53.



characteristics of women surgeons in the united states

Documents