if you want the surgery done well, get a woman to do it!

2
If you want the surgery done well, get a woman to do it! In 1989 McBride, a federal Australian Medical Association counsellor wrote women remain under-represented in the full specialist ranks, particularly in surgical areas’. 1 In 1997, the Australian Medical Workforce Advi- sory Committee reported to the government that ‘Females consti- tuted only 14Æ4% of all specialists. There was a low preference for surgery with females constituted 3Æ1% of surgeons.’ 2 Has anything changed? If it hasn’t, should it? If so, whose responsibility is it for the change? Williams and Cantillon, who interviewed 15 junior female doctors, argue that things have not changed and that women are still not contemplating a career in surgery. Further, they rec- ommend that we should encourage them to do so and that this is a role of undergraduate medical education. 3 But some things have arguably changed. Twenty per cent of Williams and Cantillon’s study group are contemplating a career in surgery. 3 This may well translate into bet- ter figures in the UK and Australia where currently women only make up 2Æ5% and 3Æ1% of specialist surgeons, respectively. 3,4 In Australia, women constitute 13Æ6% of general surgical trainees. 4 Further, Pringle, an Australian sociologist who interviewed over 100 women doctors, argues that the increasing number of women doctors in the work force is having a major impact on the way medicine is practised, in particular, greater democracy and sharing of pow- er. 5 She argues that there is time for a paradigm shift in how we think about women and medicine and that much of the previous discourse is too simplistic. ‘Women doctors did not self-con- sciously or as a unified group set out to transform medicine but their presence is pro- ducing differences beyond what any but a tiny minority may have ever visua- lised.’ 5 So too are major Government established advi- sory committees discussing the ‘feminisation of the medical work- force’. 6 ‘Within the next genera- tion women will dominate the medical workforce. Employers and Colleges need to come to grips with this reality and not sim- ply assume that the past, male dominated (both numerically and culturally) sys- tem, will some- how adapt to the new order.’ 6 Women are mak- ing their mark on medical practice. Whilst the rhetoric supports increasing female participation and impact on the medical workforce and specialists careers, the num- bers of women currently entering or practising in surgery are low. Should this change? Whilst there has been an increase of women into the paid work- force, there has been no change in the relative contribution by men and women in the unpaid domestic sphere. 7 ‘The consequences of women’s increased involvement in paid work has thus been an increase in the total hours women work’. 8 Given this scenario, teamed with rare opportunities for part- time training and job sharing in spe- cialty training, why would women choose to do a job where 50% of its current practitioners work an average of greater than 60 h per week in the paid workforce? 4,6 Is Showalter right when she wrote in her editorial ‘Women doctors want the same things other women and other doctors want – chal- lenging work and fulfilling personal lives.’? 9 Women in Williams and Cantillon’s study spoke of lack of ‘determination’ as a barrier to enter- ing surgery. 3 Is this women really saying that they couldn’t nor wanted to give a commitment to work 80 h per week in addition to their high unpaid workforce participation? The complex structural and cultural issues around women and work and lifestyle are very much at play here in women’s decision making. Many have highlighted the highly procedural and practical components of a surgical specialty, maybe to the exclusion of a more ‘holistic’ approach to patient care. It is never a surprise to see the surgical contribution to a clinical OSCE being a sutur- ing station. Is that what women doctors want to do? Or are choices made on the way surgery is currently modelled and stereotyped? Would 50% of women in the specialty see it practised differently? Would it be as procedural driven? It is after all, ‘surgery’. Correspondence: Dr Judy Searle, Department of Obstetrics, Gynaecology and Reproduc- tive Medicine, Flinders University of South Australia, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia the increasing number of women doctors in the work force is hav- ing a major impact on the way medicine is practised there is time for a paradigm shift in how we think about women and medicine the numbers of women currently entering or practising in surgery are low. Should this change? Women doctors want the same things other women and other doctors want – challenging work and fulfilling personal lives Commentaries 598 Ó Blackwell Science Ltd MEDICAL EDUCATION 2000;34:598–599

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If you want the surgery done well, get a woman to do it!

In 1989 McBride, a federal Australian

Medical Association counsellor wrote

`¼ women remain under-represented

in the full specialist ranks, particularly

in surgical areas¼'.1 In 1997, the

Australian Medical Workforce Advi-

sory Committee

reported to the

government that

`Females consti-

tuted only 14á4%

of all specialists.

There was a low

preference for surgery with females

constituted 3á1% of surgeons.'2 Has

anything changed? If it hasn't, should

it? If so, whose responsibility is it for the

change? Williams and Cantillon, who

interviewed 15 junior female doctors,

argue that things have not changed and

that women are still not contemplating

a career in surgery. Further, they rec-

ommend that we should encourage

them to do so and that this is a role of

undergraduate medical education.3

But some things have arguably

changed. Twenty per cent of Williams

and Cantillon's

study group are

contemplating a

career in surgery.3

This may well

translate into bet-

ter ®gures in the

UK and Australia

where currently

women only make up 2á5% and 3á1% of

specialist surgeons, respectively.3,4 In

Australia, women constitute 13á6% of

general surgical trainees.4 Further,

Pringle, an Australian sociologist who

interviewed over 100 women doctors,

argues that the increasing number of

women doctors in the work force is

having a major impact on the way

medicine is practised, in particular,

greater democracy and sharing of pow-

er.5 She argues that there is time for a

paradigm shift in how we think about

women and medicine and that much of

the previous discourse is too simplistic.

`Women doctors

did not self-con-

sciously or as a

uni®ed group set

out to transform

medicine but their

presence is pro-

ducing differences beyond what any but

a tiny minority may have ever visua-

lised.'5 So too are major Government

established advi-

sory committees

discussing the

`feminisation of

the medical work-

force'.6 `Within

the next genera-

tion women will

dominate the medical workforce.

Employers and Colleges need to come

to grips with this reality and not sim-

ply assume that

the past, male

dominated (both

numerically and

culturally) sys-

tem, will some-

how adapt to

the new order.'6

Women are mak-

ing their mark on medical practice.

Whilst the rhetoric supports

increasing female

participation and

impact on the

medical workforce

and specialists

careers, the num-

bers of women

currently entering

or practising in surgery are low. Should

this change? Whilst there has been an

increase of women into the paid work-

force, there has been no change in the

relative contribution by men and

women in the unpaid domestic sphere.7

`The consequences of women's

increased involvement in paid work has

thus been an increase in the total hours

women work¼'.8 Given this scenario,

teamed with rare opportunities for part-

time training and job sharing in spe-

cialty training, why would women

choose to do a job where 50% of its

current practitioners work an average of

greater than 60 h per week in the paid

workforce?4,6 Is Showalter right when

she wrote in her editorial `Women

doctors want the same things other

women and other doctors want ± chal-

lenging work and ful®lling personal

lives.'?9 Women

in Williams and

Cantillon's study

spoke of lack of

`determination' as

a barrier to enter-

ing surgery.3 Is

this women really

saying that they couldn't nor wanted to

give a commitment to work 80 h per

week in addition to their high unpaid

workforce participation? The complex

structural and cultural issues around

women and work and lifestyle are very

much at play here in women's decision

making.

Many have highlighted the highly

procedural and practical components

of a surgical specialty, maybe to the

exclusion of a more `holistic' approach

to patient care. It is never a surprise

to see the surgical contribution to a

clinical OSCE

being a sutur-

ing station.

Is that what

women doctors

want to do? Or

are choices

made on the

way surgery is currently modelled and

stereotyped? Would 50% of women in

the specialty see it practised differently?

Would it be as procedural driven? It is

after all, `surgery'.

Correspondence: Dr Judy Searle, Department

of Obstetrics, Gynaecology and Reproduc-

tive Medicine, Flinders University of South

Australia, Flinders Medical Centre, Bedford

Park, South Australia, 5042, Australia

the increasing number of women

doctors in the work force is hav-

ing a major impact on the way

medicine is practised

there is time for a paradigm

shift in how we think about

women and medicine

the numbers of women

currently entering or practising

in surgery are low. Should this

change?

Women doctors want the same

things other women and other

doctors want ± challenging work

and ful®lling personal lives

Commentaries

598 Ó Blackwell Science Ltd MEDICAL EDUCATION 2000;34:598±599

If increasing women's representation

in the surgical specialty is the goal, then

where must this change come from?

The context and thus the potential

solutions are much more complex than

suggested by Williams and Cantillon.3

The culture and socialization of women

and work, paid and unpaid, the choices

women make about how to live their

lives, the way women use power and the

existence still of real structural barriers

to specialist training for women in

particular are all factors in this issue.

Thus, there are many players who may

contribute to the change process, not

only those involved in undergraduate

medical education. Women are already

making choices in the medical work-

force. They are choosing to work part

time when they are able (in Australia

43á7% of women specialists work part

time),2 work more in urban practice,

work more in general practice, return to

the workforce after parenting leave and

retire earlier (women specialists in

Australia will retire on average 5 years

earlier than their male colleagues).2

For medical educators the lesson is

clear. Seek to take note, better under-

stand and work with the largely hidden

curriculum that truly informs women's

career choices in medicine.

Judy Searle

Australia

References

1 McBride A. Women in Medicine.

Aust Med 1989;1:421.

2 Australian Medical Workforce Advisory

Committee. Female participation in the

Australian medical workforce. Sydney:

AMWAC; 1997.

3 Williams C, Cantillon P. A surgical

career? The views of junior women

doctors. Med Educ 2000;34:602±607.

4 Australian Medical Workforce Advisory

Committee. The general surgery work-

force in Australia. Sydney: AMWAC;

1997.

5 Pringle R. Making some difference:

Women in medicine. Queensland:

Grif®th University; 1996.

6 Medical Training Review Panel.

Trainee selection in Australian medical

colleges. Canberra: Australian Govern-

ment Printing Service; 1998.

7 Bittman M, Pixley J. The double life of

the family. Myth, Hope and Experience.

Sydney: Allen & Unwin; 1997.

8 Bittman M. The land of the lost weekend?

Trends in free time among working age

Australians. 1974±92. Social Policy

Research Centre discussion paper no.

83. Sydney: University of New South

Wales; 1998: 56.

9 Showalter E. Improving the position

of women in medicine: Will not be

achieved by focusing only on

the problems of women. BMJ

1999;318:72.

Ó Blackwell Science Ltd MEDICAL EDUCATION 2000;34:598±599

If you want the surgery done well, get a woman to do it! · J Searle 599