We need more female consultant surgeons

Lu Tze

I was reading this article this morning

https://www.irishtimes.com/opinion/we-need-more-female-consultant-surgeons-1.3234588?mode=amp

Which states

The fact that just 7 per cent of our consultant surgeons are women is a striking and unacceptable statistic in modern Ireland. It is all the more striking when you see that 34 per cent of core surgical trainees are women, and that more than half of medical graduates are female.

And also

We have had 20 years of gender parity among medical graduates.

The article goes on to explain that this must be due to culture, training methods etc. Which are inherently geared toward men or not accommodating towards women.

What strikes me though, from the above statements, that there must be areas in medicine where men are very much in the minority also, if we have more female graduates now following 20 years of gender parity, and this is all but confirmed in the article.

Why then is the focus of the article solely on the area where women are in the minority? I'm struggling to think of articles which are presented in a balanced way when it is self evident like the above that there are other specialisations where the situation is reversed.

Am I just reading the wrong newspapers?

evolving_doors

Lu Tze wrote: »

I was reading this article this morning

https://www.irishtimes.com/opinion/we-need-more-female-consultant-surgeons-1.3234588?mode=amp

Which states


And also


The article goes on to explain that this must be due to culture, training methods etc. Which are inherently geared toward men or not accommodating towards women.

What strikes me though, from the above statements, that there must be areas in medicine where men are very much in the minority also, if we have more female graduates now following 20 years of gender parity, and this is all but confirmed in the article.

Why then is the focus of the article solely on the area where women are in the minority? I'm struggling to think of articles which are presented in a balanced way when it is self evident like the above that there are other specialisations where the situation is reversed.

Am I just reading the wrong newspapers?

Yes

FishOnABike

... or do we need more balanced reporting?

It strikes me that the article is strong on the what but offers very little on the why. It appears full of gender stereotypical statements and assertations supported by little more than anecdotal evidence. I find it highly ironic that an article which claims women "make evidence-based decisions more consistently than men" is so weak on evidence-based decisions itself.

TimeToShine

I would say, on the whole, that men are more likely to enjoy slicing people open and dealing with their blood and innards. The same way they are more likely to hunt, fish, course, lift cinderblocks and collect waste.

speedboatchase

I think in general we should try to remove the stigma surrounding any roles that are dominated by one gender. What I find strange is how some roles get pushed to the forefront and some don't - eg. STEM for women and pretty much nothing else. Why don't we encourage female tradespeople, or encourage women to work in waste management? It may not be headline-grabbing, but they're smart roles that pay well. 


Similarly, why are we fine with the fact that 87 percent of primary school teachers are women? I saw a Newstalk story that said that 'despite this large majority, a little over 50 per cent of women act as principals within primary schools.' Does that mean we need to get female principals up to 87 percent too? 'A little over 50 per cent' isn't enough 'equality'? Shouldn't we try to get everything, where feasible, closer to 50/50 - you know, what the term 'equality' is meant to infer?

Wibbs

I recall reading that though there are more women doctors graduating than men, this gender shift actually means that the medical profession needs more doctors overall. Women are more likely to go into general practice, more likely to not progress beyond a certain position and less likely to go the full consultant path. The obvious reason would be taking time off to start families. Something that men can do without dropping the career ball so much and of course can do so later after they're fully established, when taking a break won't impact their careers nearly so much. A relative of mine was a consultant way back and she told me - and this would be in the mid 90's - that she could see this trend with more women coming into the profession. She also said that her career path had not been easy and that she'd missed out on a lot family wise, though she was able to juggle kids, husband and work.

The other angle might be that women are actually more sensible than similar careered men in this regard. That they get to a certain career point and think "OK great, but is this all there is?" and try to achieve a more balanced life/work ratio?

johnnyskeleton

FishOnABike wrote: »

... or do we need more balanced reporting?

It strikes me that the article is strong on the what but offers very little on the why. It appears full of gender stereotypical statements and assertations supported by little more than anecdotal evidence. I find it highly ironic that an article which claims women "make evidence-based decisions more consistently than men" is so weak on evidence-based decisions itself.

Particularly weak on survey based evidence i.e. actually asking Female doctors why they arent consultants and asking female consultants whether they percieve any gender challenges.

In every other area of feminism we see the mantra "listen to women". But the problem there is that these women are serious people with professional qualifications and they didnt waste their time in college studying gender studies, so these women if surveyed may give the wrong answers to the questions, presumably due to internalised misogyny.

Pat Mustard

FishOnABike wrote: »

... or do we need more balanced reporting?

It strikes me that the article is strong on the what but offers very little on the why.

Nail on head.

Has that journalist (who quoted Justin Trudeau) ever met a surgeon? Do surgeons have a mindset of self doubt, where they commonly think (per Trudeau quote): ‘Really? Why me? Do you think I’m good enough? Are you sure?’ Not bloody likely.

What would be useful if somebody looked at the working conditions under which all junior doctors work, not just surgeons. The hours are an absolute killer. The conditions don't get better when they become a consultant. They get worse.

Consultant surgeons get well paid. But in addition to working the hours where home life and other activities suffer, they also shoulder the responsibility for the patients. The buck stops with them. For people who get little enough sleep during the week anyway, it can keep them awake at night if they are responsible for the life or death of patients when those surgical consultants have to rely on other doctors with questionable qualifications and experience, largely recruited from abroad.

Who wants to do those consultant surgical jobs with the lack of sleep and the limited social outlets and the all too common 75+ hours per week?

Answer: some men and proportionally fewer women.

One eyed Jack

Pat Mustard wrote: »

Nail on head.

Has that journalist (who quoted Justin Trudeau) ever met a surgeon? Do surgeons have a mindset of self doubt, where they commonly think (per Trudeau quote): ‘Really? Why me? Do you think I’m good enough? Are you sure?’ Not bloody likely.

The author of the article isn't a journalist though? Given that John Hyland is the President of the Royal College of Surgeons in Ireland, I'd imagine he has a considerable amount of experience in what he's talking about.

To be honest I thought the article was fairly well balanced, and it didn't claim this -

FishOnABike wrote: »

I find it highly ironic that an article which claims women "make evidence-based decisions more consistently than men" is so weak on evidence-based decisions itself.

What it pointed out was this -


There are practical reasons why growing the number of women in surgery is important. Evidence from other sectors says it will result in better decision-making. There is evidence suggesting male and female doctors practice differently. It says women follow clinical guidelines and make evidence-based decisions more consistently than men. There also seem to be better survival rates among elderly patients in the care of female practitioners.

We men may have some advantages too. The point is that a diverse surgical profession will include the diverse range of human attributes, and better meet the needs of patients and of society.


Which speaks for itself really, and then it goes on to address the four main areas it identifies as needing attention.

Pat Mustard

One eyed Jack wrote: »

The author of the article isn't a journalist though? Given that John Hyland is the President of the Royal College of Surgeons in Ireland, I'd imagine he has a considerable amount of experience in what he's talking about.

Not only are you correct but the author of the article is a general and colorectal surgeon.

As President of the RCSI, he presides over the prevailing state of affairs and I don't see how gender neutrality solves any of the issues which are a systemic part of the job for both men and women.

silverharp

One eyed Jack wrote: »

There are practical reasons why growing the number of women in surgery is important. Evidence from other sectors says it will result in better decision-making. There is evidence suggesting male and female doctors practice differently. It says women follow clinical guidelines and make evidence-based decisions more consistently than men. There also seem to be better survival rates among elderly patients in the care of female practitioners.

We men may have some advantages too. The point is that a diverse surgical profession will include the diverse range of human attributes, and better meet the needs of patients and of society.

Over all of medicine I'd agree but surgeons seem to be the "formula 1" of medicine. This is where there will be the most competition the most pressure etc. The best surgeons will be the most focused and ones most prepared to give their work 100%
There have been reports along the lines that you need to train 2 female doctors to do the work of a male doctor because of drop out rates, women going part time etc. So there is a balance to be had but at the high end let be down to competition.

knipex

speedboatchase wrote: »

Why don't we encourage female tradespeople,

They do. An employer gets a "grant" for employing a female apprentice..

speedboatchase

knipex wrote: »

speedboatchase wrote: »

Why don't we encourage female tradespeople,

They do. An employer gets a "grant" for employing a female apprentice..

Interesting. Just saw a Times article from 2016 that stated that only 14 of 3,708 new craft apprentices in the UK were female in 2016. Crazy numbers.

alchemist33

The article is wrong on stating that we have gender parity among medical graduates. 62% of medical graduates between 25 and 34 years old are women. I'm sure the Times will soon be publishing an article on how outrageous this imbalance is.

One eyed Jack

Pat Mustard wrote: »

Not only are you correct but the author of the article is a general and colorectal surgeon.

As President of the RCSI, he presides over the prevailing state of affairs and I don't see how gender neutrality solves any of the issues which are a systemic part of the job for both men and women.

I didn't read it as an attempt at gender neutrality, but more identifying the ways in which diversity could be achieved in the medical profession in Ireland, because greater diversity leads to a greater input of different opinions, and I would say that in order to address the issue of consultants and junior doctors and even those in other areas of the medical profession, the solution is to be found in finding ways for everyone to work smarter, not longer.

silverharp wrote: »

Over all of medicine I'd agree but surgeons seem to be the "formula 1" of medicine. This is where there will be the most competition the most pressure etc. The best surgeons will be the most focused and ones most prepared to give their work 100%
There have been reports along the lines that you need to train 2 female doctors to do the work of a male doctor because of drop out rates, women going part time etc. So there is a balance to be had but at the high end let be down to competition.

I suppose it depends upon what criteria you determine what surgeons are and aren't the best. By that I mean I'm more concerned with quality of patient outcomes and patient satisfaction rather than a consultant or doctor who puts in 70 hours a week at the clinic. I wouldn't want a surgeon operating on me when they are tired and stressed, I wouldn't care how committed they are to coming top of the leader board for surgical procedures performed this month or whatever measure you're using to determine commitment.

The overall point I think John Hyland was making is that they need to find ways to work smarter, diversify the people coming into the profession, in order to better serve their patients and society as a whole.

Pat Mustard

One eyed Jack wrote: »

I didn't read it as an attempt at gender neutrality, but more identifying the ways in which diversity could be achieved in the medical profession in Ireland, because greater diversity leads to a greater input of different opinions, and I would say that in order to address the issue of consultants and junior doctors and even those in other areas of the medical profession, the solution is to be found in finding ways for everyone to work smarter, not longer.

One eyed Jack wrote: »

I'm more concerned with quality of patient outcomes and patient satisfaction rather than a consultant or doctor who puts in 70 hours a week at the clinic. I wouldn't want a surgeon operating on me when they are tired and stressed,

I would be genuinely interested to hear from a junior hospital doctor in relation to these issues, rather than the President of the RCSI, who represents the authority over the current situation.

By the way, my understanding is that 70 hours a week is normality for many surgeons, depending on their specialty. This is anecdotal but from what I've heard, these guys would be content with 70 hours per week on the roster.

Maybe we should be training more Irish doctors at University level instead of recruiting foreign medical students and maybe we should continue to offer our own men and women the training and pay to keep them here, so they don't go abroad for such pay and training. Maybe if we had these additional Irish doctors in our hospitals in the first place, those same hospitals wouldn't have to draft in doctors with substandard training and qualifications, from abroad.

If we had more Irish doctors who were here to do the job, surgical registrars would have more backup and might get a few more hours sleep in the week.

tretorn

I was told by my dentist recently that in one recent year the entire class of dentists graduating were female.

The ratio of men to women entering under graduate medicine used to be thirty/ seventy in favour of women. The hPAT was introduced I believe to favour boys and immediately after its introduction the ratio of medical students was 60% men and 40% women.

Is the relative strength of women a factor, is there a lot of physical work involved in surgical procedures, ie a 5ft, eight stone woman operating on a twenty stone man. There is also the fact that once a woman has children her focus shifts in the way that mens doesnt, this is a fact of life and there is no way to eradicate the maternal instinct. To be a successful surgeon you have to give about nine years of your life after you have completed maybe seven years of undergraduate medicine, this means you are probably thirty four or thirty five when your surgical training is complete, this is the time women think about conceiving and many women put planning their families before all other considerations. They are answering a biological urge and if they dont the human race will die out.

My dd did her leaving cert last year, not a single one of her female pals went into Computer science or engineering, thi is in spite of all the STEM talks, lectures, visits to Universities etc. The girls choose teaching, nursing, physiotherapy, psychology, Arts , Art College, Law, Business. A few went for medicine but none were successful. The boys put engineering and Computer science business, and law down as first choce, none choose teaching or nursing. My own dd choose a health science course, there are thirty in the class and they are all young women.

silverharp

One eyed Jack wrote: »

I suppose it depends upon what criteria you determine what surgeons are and aren't the best. By that I mean I'm more concerned with quality of patient outcomes and patient satisfaction rather than a consultant or doctor who puts in 70 hours a week at the clinic. I wouldn't want a surgeon operating on me when they are tired and stressed, I wouldn't care how committed they are to coming top of the leader board for surgical procedures performed this month or whatever measure you're using to determine commitment.

The overall point I think John Hyland was making is that they need to find ways to work smarter, diversify the people coming into the profession, in order to better serve their patients and society as a whole.

you can always tweak the system but on the assumption that Surgery is an area where there is a lot of competition then I dont want "diversity" being a factor. I would trust the system to monitor quality and output.
Medicine is a strange area because it is so regulated and or controlled by the state, something needs to give hopefully a tech revolution which automates/simplifies a lot of medical tasks which would get the cost down and thus waiting lists.

Pat Mustard

tretorn wrote: »

Is the relative strength of women a factor, is there a lot of physical work involved in surgical procedures, ie a 5ft, eight stone woman operating on a twenty stone man.

There must be few enough twenty-stone men who are not verging on morbidly obese. My limited understanding is that a such a man is likely to be advised to lose weight or they won't operate.

Physical strength may be necessary for certain orthopaedic surgeons, perhaps. I doubt that it would be in other specialties, especially these days.

Sleepy

Honestly, I'd suggest the real issue is that we need more surgeons full stop.

If we're currently having to pay huge salaries for 70 hour weeks surely there's an obvious solution to pay more surgeons less for 40 hour weeks. The gender gap would likely take care of itself within a generation of such a scenario given that the working hours would be far more family friendly.

There may be a counter-argument that someone working 40 hours a week for 7 years isn't going to gain the same experience or level of expertise as someone working 70 hours a week for the same duration but surely the suggestion is worth putting to the experts?

Pat Mustard

Sleepy wrote: »

If we're currently having to pay huge salaries for 70 hour weeks surely there's an obvious solution to pay more surgeons less for 40 hour weeks. The gender gap would likely take care of itself within a generation of such a scenario given that the working hours would be far more family friendly.

That's what I thought too until I was corrected by somebody who works in the area, recently.

My understanding now is that the seventy hours a week include ward rounds and consultations which are necessary before surgery and that a certain amount of surgery time on a regular basis is required in order to prevent de-skilling. People point to the UK system where you have surgeons on 40/50 hour weeks but where the level of fatalities is higher than in Ireland. So I am told.

If this information is correct, what would help is if the SHOs (senior house officers) and registrars who assist the specialist surgical registrars were of sufficient quality (and perhaps quantity), rather than more surgeons.

Not being a doctor, I only have this information second hand.

Sleepy

Knowing how inefficient both the HSE and the NHS can be, I'd wonder if there's a lot of paperwork / admin that could be made more efficient to reduce the hours worked without impacting on surgery hours... I'd also wonder if the level of surgery time required to "prevent de-skilling" is inflated as a means of gatekeeping by consultant surgeons who like the current arrangement of mental hours and mental money.

silverharp

I heard of one example where a surgeon in Dublin hired an operating theatre at weekends, brought in his own staff and he treated more patients for the 2 days than he could during a normal 5 day week. You can imagine the inefficiencies that go on at hospitals, operations being cancelled because there are no porters available etc.

drkpower

Pat Mustard wrote: »

What would be useful if somebody looked at the working conditions under which all junior doctors work, not just surgeons. The hours are an absolute killer. The conditions don't get better when they become a consultant. They get worse.

Hyland's recommendations in the main do apply to male and female surgeons (see below).

But he is right to raise this issue; when you have >50% female medschool grads, 34% female surgical 'trainees' [in this context, 'trainee' means qualified doctors, some with years of surgical experience] and only 6% female consultants, you cant ignore that kind of drop-off. No business/profession can afford to haemorrhage talent from any cohort without it affecting service, and that applies regardless of cohort (whether women, athiests, people with beards or northsiders).

This really isn't about gender; its about recognising you are losing talent from a significant cohort and doing something to identify and address the reason. That's just good business.

Firstly,.....we must engage with prospective students while they are still at school, breaking down the notion that surgery is a predominantly male choice.

Secondly, ..... we need to knock on the head forever the assumption that if you have children as a young trainee or surgeon, you will be left behind or overtaken in your career progression.

Thirdly, surgical training posts will be allocated more than 12 months in advance, and should be for a duration of 4-6 years, giving trainees an opportunity to plan a life that balances career with family responsibilities.

Finally, we recommend measures to ensure female surgeons have equal access to high-quality surgical training fellowships .... including Research funding to support the career development of female academic surgeons would greatly support that.

Sleepy

I think he's probably framing this as a gender issue rather than the work/life balance issue it is to appeal to feminist politic tbh.

Any career that involves hours that aren't family friendly will end up with a gender imbalance as long as women are predominantly the parents that take on the role of primary carer and that won't change any time soon for a myriad of reasons:

1) The trend for women to only form relationships with men of equal (or higher) status and earning power to their own.
2) The trend for women to desire the role of primary care giver.
3) The trend for the Courts to award primary custodian status to the mother.
4) The imbalanace between Paternity and Maternity Leave.
5) The trend for woment to place a higher value on work-life balance than career attainment.

For a career with such a heavy demand on one's time, it's even less likely to balance out simply because most taking on such a role, would require a partner who's happy to be a stay-at-home parent and IME, very few men desire to be stay-at-home parents, and even fewer high achieving women desire such men.

FishOnABike

drkpower wrote: »

Hyland's recommendations in the main do apply to male and female surgeons (see below).

But he is right to raise this issue; when you have >50% female medschool grads, 34% female surgical 'trainees' [in this context, 'trainee' means qualified doctors, some with years of surgical experience] and only 6% female consultants, you cant ignore that kind of drop-off. No business/profession can afford to haemorrhage talent from any cohort without it affecting service, and that applies regardless of cohort (whether women, athiests, people with beards or northsiders).

This really isn't about gender; its about recognising you are losing talent from a significant cohort and doing something to identify and address the reason. That's just good business.

This is not comparing like with like. A valid comparison would need to look at the number of female medschool graduates possibly five to ten or fifteen years ago and the number of consultants who were medschool graduates fifteen years ago or more and compare the m/f ratios.

Alternatively it could look at current graduated only and examine the ratio of each who go on to be surgical trainees.

It also not valid comparison as it stands as it needs to take into account the length of time it takes post graduation as a surgical trainee, time to become a consultant and the length of tenure of a consultant. A simple comparison of the current gender distribution only, needs to look at a pipeline almost a generation long and factor that historical data into account.

drkpower

FishOnABike wrote: »

This is not comparing like with like. A valid comparison would need to look at the number of female medschool graduates possibly five to ten or fifteen years ago and the number of consultants who were medschool graduates fifteen years ago or more and compare the m/f ratios.

Alternatively it could look at current graduated only and examine the ratio of each who go on to be surgical trainees.

It also not valid comparison as it stands as it needs to take into account the length of time it takes post graduation as a surgical trainee, time to become a consultant and the length of tenure of a consultant. A simple comparison of the current gender distribution only, needs to look at a pipeline almost a generation long and factor that historical data into account.

The figures are stark - and broadly unchanged over the last 20 years (I went through medshool and surgical 'training' >20 years ago) - so while the level of indepth analysis you suggest might help to further define the precise extent of the problem, it simply isnt required to know there is a problem.

Sleepy

drkpower wrote: »

The figures are stark - and broadly unchanged over the last 20 years (I went through medshool and surgical 'training' >20 years ago) - so while the level of indepth analysis you suggest might help to further define the precise extent of the problem, it simply isnt required to know there is a problem.

Is a gender disparity amongst consultant surgeons actually a problem? Is it leading to patients dying on tables or sub-optimal outcomes from surgery? Or is it more that it's "problematic" in the opinion of those of a certain political spectrum?

I can see how a lack of female doctors choosing surgery as the focus of their studies could lead to staffing problems in the future (given the growing gender disparity in entry to medicince in 3rd level). But that would be a staffing, rather than a gender problem, surely?

I can even understand the argument for diversity of viewpoints in the boardroom (or management in general) - even if I don't fully buy into it in every case - but surely we aren't wasting consultant surgeon's talents in roles that can be filled with administrators / managers whose skillsets are significantly more available.

drkpower

Sleepy wrote: »

Is a gender disparity amongst consultant surgeons actually a problem? Is it leading to patients dying on tables or sub-optimal outcomes from surgery? Or is it more that it's "problematic" in the opinion of those of a certain political spectrum?

I can see how a lack of female doctors choosing surgery as the focus of their studies could lead to staffing problems in the future (given the growing gender disparity in entry to medicince in 3rd level). But that would be a staffing, rather than a gender problem, surely?

I can even understand the argument for diversity of viewpoints in the boardroom (or management in general) - even if I don't fully buy into it in every case - but surely we aren't wasting consultant surgeon's talents in roles that can be filled with administrators / managers whose skillsets are significantly more available.

As I mentioned before, having that kind of attrition rate of talent from any particular cohort is a problem. Talent isn't a limitless or equal commodity; if you are losing almost all your talent from one cohort, just because you replace those people with others doesn't mean you are replacing like-for-like. In any business/profession, that kind of attrition rate from any cohort would be identified and efforts made to address it; surgery of all things should be no different.

FishOnABike

drkpower wrote: »

The figures are stark - and broadly unchanged over the last 20 years (I went through medshool and surgical 'training' >20 years ago) - so while the level of indepth analysis you suggest might help to further define the precise extent of the problem, it simply isnt required to know there is a problem.

Those on the inside might recognise the figures are stark and recognise a problem but the statistics as they are presented are too confounded to demonstrate a problem to those on the outside.

With your experience you might be able to indicate how many of your fellow undergraduates m/f completed undergrad medicine, how many of each went on to surgical training and how many went on to be surgical consultants.

A number of such longitudinal studies would clarify the extent of the perceived problem. If such quantitative methods were accompanied by qualitative studies, evidential based reasons for any undue imbalance might be determined and appropriate remedial measures put in place where waranted.

AS it stands the statistics presented in the article are of little more use then suggesting a need for more in depth analysis.

drkpower

FishOnABike wrote: »

Those on the inside might recognise the figures are stark and recognise a problem but the statistics as they are presented are too confounded to demonstrate a problem to those on the outside.

With your experience you might be able to indicate how many of your fellow undergraduates m/f completed undergrad medicine, how many of each went on to surgical training and how many went on to be surgical consultants.

A number of such longitudinal studies would clarify the extent of the perceived problem. If such quantitative methods were accompanied by qualitative studies, evidential based reasons for any undue imbalance might be determined and appropriate remedial measures put in place where waranted.

AS it stands the statistics presented in the article are of little more use then suggesting a need for more in depth analysis.

The figures are broadly the same now.

When i was undergrad (c.25 years ago), male female split of undergrads was pretty much 50:50 (so broadly the same).
When i left medicine (c. 15 years ago), male female split of surgical trainees was pretty much 75:25 (so broadly the same).
Now, male female split of consultants is 94:6.

That is over a 25 year period and is the kind of longtitudinal data you are looking for. It doesn't take a rocket surgeon to spot the problem (either on those figures or Hylands').