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