We need more female consultant surgeons

Martina1991 · 27-09-2017 05:53PM

Wibbs wrote: »

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.

This is what came to my mind when I read the OP. Becoming a consultant requires a lot of time and dedication. Some women probably have to choose between having a family and furthering their career.

FishOnABike · 27-09-2017 08:10PM

drkpower wrote: »

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').

Do those figures (50:50, 75:25 and 94:6) all refer to the people who graduated with you only or do they include the current general medical / surgical / consultant population?

Saruhashi · 28-09-2017 10:37AM

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 it really a problem though?

If there are X number of female graduates but only Y number of female consultant surgeons then questions should be put to those (X-Y) number of graduates that did not become consultant surgeons.

Were they all determined to become consultant surgeons but were overlooked in favor of male candidates?

Did they "drop out" or abandon their careers for some reason?

Do these women themselves see the fact that they have not become consultant surgeons as a problem or are they happy with their lives?

drkpower · 28-09-2017 10:44AM

Losing almost all of the talent from a cohort that represents half of your talent pool is always a problem, regardless of who that cohort is made up of, the sector or business. To be honest, that is so obvious a proposition i'm surprised it needs re-emphasis.

But you are right to ask the questions why; and that is part of what this is all about.

silverharp · 28-09-2017 10:56AM

If it comes down to choices then I don't see an issue unless the choices are making these women feel disgruntled . Ive 2 neighbours where the wives are doctors, 1 a GP and the other is a specialist but seemed to be more a "9-5" job. My assumption is that they are happy with their choices, they have great jobs objectivly and a life , work to live and all that.

Saruhashi · 28-09-2017 11:13AM

speedboatchase wrote: »

Similarly, why are we fine with the fact that 87 percent of primary school teachers are women?

I think something people overlook here is that there are only a finite number of people available to work at any given time.

Let's take a very simplified system first.

There is a national work force of 1,000 people. 490 men and 490 women and 20 non-binary people.

There are 3 careers available to each citizen.
Career A has 250 jobs available. High pay.
Career B has 500 jobs available. Average pay.
Career C has 250 jobs available. Low pay.

So we can employ everyone, which is good.

200 men go into low paying Career C.
45 women and 5 non binary people work in Career C also.
The low paying job has a 200/45/5 split and nobody says anything about that.

The average paying Career B has a workforce of 90 men, 400 women and 10 non binary people. They are nice comfortable jobs in nice offices with convenient hours. Unsurprisingly, there is no societal push to get some of the men in low paying Career C to move into into Career B, at the expense of the women who will have to move down to a lower paying Career C to make way.

Now, we find out that 200 men, 45 women and 5 non binary people are working in high paying Career A. This is unacceptable. We need equality in Career A.

The problems are obvious. There are only a certain number of people to go around. If we make Career A equal then it follows on that Career B and Career C need to become equal also.

If there is a much lager workforce of millions but 45,000 of those are female teachers then that's 45,000 women who cannot work as surgeons or scientists because they have chosen to work as teachers.

Further to that if the workforce is split 50-50 but 95% of teachers are women then there are 20,000 "spare" men who are looking for a career that isn't teaching. Where do you put them?

How can we have equality at all if even one career has a massive imbalance?

Another question here is if there are only a finite number of workers and 87% of jobs in some professions are occupied by women then where do we find the female headcount to occupy the 50% of the jobs in different professions?

Do we have to force some women to take up careers they don't really want in the name of equality?

Can a women only leave her job when there is another female replacement lined up to take the role?

Are we actually giving people too much choice in which career they can choose?

If people choices are down to "unconscious bias" or "learned gender roles" then do we have to control and regulate the desire males and females must have to enter certain careers? Is brainwashing an option here?

Would it be better if we just had a computer total up and categorize every single job in Ireland and allocate jobs to people in such a way that we have a 50-50 gender split in each category? Maybe anyone who refuses could be liquidated and fed intravenously to the next generation?

If 50-50 is unrealistic then what is acceptable and what is unacceptable? 60-40? 40-60? 20-80?

If 90% of dangerous or low skilled jobs are occupied by men then this is acceptable?

Or are we only really concerned with equality in the high paying jobs due to some misguided loyalty to our own gender?

Saruhashi · 28-09-2017 11:23AM

drkpower wrote: »

Losing almost all of the talent from a cohort that represents half of your talent pool is always a problem, regardless of who that cohort is made up of, the sector or business. To be honest, that is so obvious a proposition i'm surprised it needs re-emphasis.

But you are right to ask the questions why; and that is part of what this is all about.

Is there a difference between losing talent and talent choosing to leave because they have an option that is, in their mind, better?

One could argue that my employer loses me for 3 full weeks every single summer. Or one could argue that I choose to go and lie on a beach with no hassles or worries for 3 weeks.

It's not actually reasonable for my employer to view that as a problem if the solution is to prevent me from taking my annual holiday.

The solution there would have to be how can my employer make the work so compelling and wonderful that I wouldn't even want to ever leave. That's never going to happen.

You have to establish FIRST the reason why women are choosing to not pursue these careers.

Otherwise you are stating that it's a problem that women choose to leave the sector or the business without asking the actual women who are leaving if they see it as a problem.

If I left my career to go and open a nice, profitable, pet-friendly bar on a beach somewhere then my employer might see that as a problem but I certainly would not.

If the women are leaving an industry to start families then good luck to that industry that needs to convince women that a high stress, time consuming job, with terrible work-life balance, is a more attractive prospect than raising a family.

From the industry's perspective it is bad but is it bad from the women's perspective?

silverharp · 28-09-2017 11:41AM

^^

did you have to bring non binary into it, makes the math more complicated

If people choices are down to "unconscious bias" or "learned gender roles" then do we have to control and regulate the desire males and females must have to enter certain careers? Is brainwashing an option here?

there might be an element of learning but the learned is just reinforcing biological inclinations. Also you have to throw economic rewards in here as well. Families don't seek to maximise wealth or income at the high end especially. If the choice is work life balance and a salary of 150K versus not seeing your kids or husband for 250K , the saner choice is to go for work life balance which is better than burned out and divorced at 40. the husband no doubt will be pulling in similar coin which make the life /work balance easier again.

drkpower · 28-09-2017 12:29PM

Saruhashi wrote: »

From the industry's perspective it is bad but is it bad from the women's perspective?

So we can all agree its a bad thing then...!

From the woman's perspective, clearly there will be many stories; some happy, some sad, some in the middle. From my own anecdotal knowledge, knowing many who have gone to greener pastures, i would say the dominant emotion amongst those who leave surgical training before getting to consultancy is regret; regret that a very interesting, challenging and rewarding career is structured in such a way as to make it a very difficult choice for many. I should say that that is a feeling not exclusive to women; many men feel the same. So that's bad too. And that is the issue Hyland/RCSI is trying to address.

All of this is not new; similar dynamics apply in other fields and similar attempts are being made to address these issues (some successful, others not).

Sleepy · 28-09-2017 02:02PM

So, if the option isn't there to turn the position of Consultant Surgeon into a profession with a more family-friendly 40 hour week (due to aforementioned de-skilling) and we're losing too many skilled surgeons due to their personal preference to have a work/life balance or to raise a family, what's the solution?

Stressing at early stages of medical education that surgery is only a career for those who don't want to have children?
Quotas preventing the most likely cohort to leave the career from making up a significant number of the entrants to that career? (i.e. gender discrimination) :eek:

Is there a grade between "trainee" and Consultant Surgeon akin to that of a "Journeyman" surgeon? One who's fully qualified to perform surgery but who never takes the step to "Consultant"? Could some of the women entering as trainee surgeons be remaining at this level rather than going for promotion? Or are they leaving the field entirely?

If not, is there a possibility to create such a position? Hearing horror stories about waiting lists I presume there's a need for more capacity in the system so is the answer to introduce a position a level below Consultant where surgeons could work 40 hour weeks, perhaps performing some of the more routine procedures (e.g. tonsillectomies) in order to reduce the chances of de-skilling and preventing the loss of talent from the area as doctors choose to prioritise family life?

iptba · 28-09-2017 03:04PM

I read in one of these discussions that to recruit and retain women, women with children generally didn't have to work during unsocial hours in the police in the UK or at least in some police forces there*. I imagine working and being on call during unsocial hours is an issue in many branches of surgery. I wonder could something like this happen. Not convinced it's that fair.

*if I recall correctly (there is a chance it wasn't an official policy)

Pat Mustard · 28-09-2017 03:23PM

Sleepy wrote: »

Is there a grade between "trainee" and Consultant Surgeon akin to that of a "Journeyman" surgeon? One who's fully qualified to perform surgery but who never takes the step to "Consultant"? Could some of the women entering as trainee surgeons be remaining at this level rather than going for promotion? Or are they leaving the field entirely?

Subject to correction, I think that the grades/ranks of hospital doctors are roughly as follows:

1. Intern
2. Senior House Officer (SHO)
3. Registrar
4. Specialist Registrar (SpR)
5. Consultant

Those registrars who want to be consultants apply for a specialist training scheme. If successful, they become Specialist Registrars (SpRs). In relation to surgery, these surgical SpRs are the surgical trainees mentioned in the article.

SpRs are not consultants and they are still considered to be junior doctors. SpRs are supported by ordinary registrars, SHOs (and interns).

The surgical trainees which were mentioned are leaving at SpR level.

DEFTLEFTHAND · 28-09-2017 04:16PM

I want the best of the best operating on me. I don't care if they're male, female, intersex, black, white, asian.

Having quotas in such an important profession is scary tbh as invariably quotas breed mediocrity.

evolving_doors · 28-09-2017 08:03PM

Don't forget... this all hinges on the correlation that women appear to do x better.
Is there a citation for this correlation? I haven't read his article as it's behind a pay wall.
This might end up using a banana to crack a nut.

evolving_doors · 28-09-2017 08:10PM

drkpower wrote: »

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').

So by following Hyland's hypothesis... and your sample ...due to the falling number of female surgeons the outcome for those surgeon's patients has worsened!

silverharp · 29-09-2017 09:25AM

Im a bit of a biological essentialist here but there seems to be an assumption that everyone who starts a career has an equal chance of "getting to the top" . Going by bell curves of achievement there are going to be in most situations a bigger pool of high achieving men even if overall there are more women in a particular profession, Law firm partners, Financial directors etc.

drkpower · 29-09-2017 10:56AM

evolving_doors wrote: »

Don't forget... this all hinges on the correlation that women appear to do x better.
.

I don't think it hinges on that correlation at all. It hinges on the fact that where a cohort representing c. 50% of your talent pool only makes up c. 5% of your top-line talent, you are leaking talent somewhere. Its that simple.

drkpower · 29-09-2017 11:00AM

silverharp wrote: »

Im a bit of a biological essentialist here but there seems to be an assumption that everyone who starts a career has an equal chance of "getting to the top" . Going by bell curves of achievement there are going to be in most situations a bigger pool of high achieving men even if overall there are more women in a particular profession, Law firm partners, Financial directors etc.

You raise an interesting area to look at.

c. 30% of partners in large corporate law firms in Ireland are female. That is coming off a very low base traditionally and is growing rapidly. That compares against 6% consultant surgeons.

Law in large corporate law firms wouldn't be famous for its family-friendly work environment, yet that sector has recognised that losing talent that you have invested in is wasteful, bad for business and bad for service. There is a way to go for law firms in this regard, but you can see the gaping difference between high end law and high end surgery.

Sleepy · 29-09-2017 12:24PM

Could that simply be a case of rather different professions attracting rather different women? i.e. those attacted to Law being more prepared to sacrifice family life for professional success? It'd certainly fit the stereotype of lawyers...

From what I've seen of my friends in the industry, the Legal professions wouldn't appear to have made any changes to their work practices in order to be more family friendly or to attract more women into the top tier of the industry?

Thinking about it, could it simply be a case of age profile? Senior partners in corporate law firms would tend to be past their child bearing / rearing years. Could it be a case that there's more room for a lawyer to keep their career ticking over during those years before putting the foot back on the pedal and climbing to the top once they're over?

My gut suggests it's more likely to be down to the personality types attracted to the two different professions tbh. I'd expect someone going into medicine to be more caring and therefore more invested in their own family life than someone going into a career where the sole focus is on money.

drkpower · 29-09-2017 01:23PM

No offence sleepy, but your gut is wrong on most levels and seems to rely on stereotypes that i had hoped were long debunked!

There really isn't a cigarette paper between the personality types who enter law or medicine (male or female) - the stereotype of the lawyer (regardless of sex) who sacrifices their family for the cash is just that; the idea that doctors are more naturally 'caring' (whatever that means anyway!) is a pure stereotype also. Of course both subtypes exist, but they exist in both professions and in similar numbers.

The age profile is broadly similar; a talented lawyer in a corporate firm will typically be looking to make (salaried) partner about 7-8 years post qualification (equity maybe 1-3 years after that). A talented surgeon will typically be looking to make consultancy perhaps a year or two later. So age profile really isn't a differentiator.

There are a load of reasons why law firms have a better record than surgery in retaining female talent (and their record is far from perfect!) but in my view the main one is that they are businesses focussed on the bottom line, and they have recognised the commercial cost of putting resources into identifying & training talent, and then losing them. Surgery, being a creature of the public health service, is not run as a business and has failed to recognise that hard fact (until now, hopefully).

silverharp · 29-09-2017 01:45PM

drkpower wrote: »

You raise an interesting area to look at.

c. 30% of partners in large corporate law firms in Ireland are female. That is coming off a very low base traditionally and is growing rapidly. That compares against 6% consultant surgeons.

Law in large corporate law firms wouldn't be famous for its family-friendly work environment, yet that sector has recognised that losing talent that you have invested in is wasteful, bad for business and bad for service. There is a way to go for law firms in this regard, but you can see the gaping difference between high end law and high end surgery.

the comparison breaks down after a point. Partner is a career path level, surgeon isnt, its a completely different job to a GP or hospital consultant. You still end up with who knows what the "right" number is?

drkpower · 29-09-2017 01:55PM

silverharp wrote: »

the comparison breaks down after a point. Partner is a career path level, surgeon isnt, its a completely different job to a GP or hospital consultant. You still end up with who knows what the "right" number is?

I dont understand your point.

In simple terms, a partner in, say, banking law in a large corporate firm, equates to a consultant in surgery (in promotional terms). A consultant surgeon IS a hospital consultant.

silverharp · 29-09-2017 02:04PM

drkpower wrote: »

I dont understand your point.

In simple terms, a partner in, say, banking law in a large corporate firm, equates to a consultant in surgery (in promotional terms). A consultant surgeon IS a hospital consultant.

in terms of job , not every doctor that ends up working in a hospital sees being a surgeon as being the peak of their career. Diagnosing and treating patients is a very different job to operating on them. I don't know much about IT must there must be pockets in IT that are overly male dominated compared to other parts, software V hardware etc.

drkpower · 29-09-2017 02:09PM

sorry, still dont understand the point you are making.

for the vast majority of hospital doctors, consultancy is the peak of their career. Surgery is just a hospital specialty.
for the vast majority of corporate law firm lawyers, partnership is the peak of their career. Banking law is just a law firm specialty.

silverharp · 29-09-2017 02:38PM

drkpower wrote: »

sorry, still dont understand the point you are making.

for the vast majority of hospital doctors, consultancy is the peak of their career. Surgery is just a hospital specialty.
for the vast majority of corporate law firm lawyers, partnership is the peak of their career. Banking law is just a law firm specialty.

but I thought the focus was on surgery , that's how it started out?

Sleepy · 29-09-2017 02:43PM

drkpower wrote: »

No offence sleepy, but your gut is wrong on most levels and seems to rely on stereotypes that i had hoped were long debunked!

There really isn't a cigarette paper between the personality types who enter law or medicine (male or female) - the stereotype of the lawyer (regardless of sex) who sacrifices their family for the cash is just that; the idea that doctors are more naturally 'caring' (whatever that means anyway!) is a pure stereotype also. Of course both subtypes exist, but they exist in both professions and in similar numbers.

My experience clearly differs from yours, and when discussing such things at a macro level, of course stereotypes come into play. Stereotypes often exist precisely because they hold true at a macro level. It's at the micro level where they become ridiculous.

While I've known many who've studied medicine for the social status and potential high earnings, I've known very few who've entered law for anything else and that few would tend to be those whose ambitions wouldn't involve the "partner track" and would be more focused towards "saving the world" as human rights lawyers (though few enough of those ever seem to qualify professionally, finding other roles with their undergraduate degrees or becoming in-house counsels etc.)

The age profile is broadly similar; a talented lawyer in a corporate firm will typically be looking to make (salaried) partner about 7-8 years post qualification (equity maybe 1-3 years after that). A talented surgeon will typically be looking to make consultancy perhaps a year or two later. So age profile really isn't a differentiator.

I'll take your word for it, I was purely speculating out loud as to whether that was the case. I'd have thought law would be a career where stepping back for a few years would be less damaging to one's career prospects than surgery however?

There are a load of reasons why law firms have a better record than surgery in retaining female talent (and their record is far from perfect!) but in my view the main one is that they are businesses focussed on the bottom line, and they have recognised the commercial cost of putting resources into identifying & training talent, and then losing them. Surgery, being a creature of the public health service, is not run as a business and has failed to recognise that hard fact (until now, hopefully).

I'd fully agree with the reasoning behind this but what actions have they actually taken to achieve this? And can those actions be copied in the sphere of surgery?

I'm open to correction but I've certainly never heard of anyone making partner in a legal firm that wasn't putting in crazy hours, so what actions have they taken to keep the women interested in progressing to that level?

Looking at the Brightwater Salary Survey for 2017, a salaried partner in a legal firm would earn between €90,000 and €200,000+. It's a pretty broad range, though I believe fairly equivalent to the salary levels a consultant surgeon might expect to achieve (a bit lower on the low end if anything - though public sector roles probably come with better pension entitlements)?

So if not lower hours, or vastly more money, what are the legal industry doing that's leading to more women attaining the top rung of the career path there than in surgery? More structured hours perhaps? At least in law one is less likely to be working or on-call in the early am?

Nonoperational · 29-09-2017 02:44PM

A large factor is personal preference. Surgical training is an extremely unattractive life for 10 years or so. Perhaps females value other areas of their lives more than putting themselves through that.

From personal experience, if a female is better than a male they get the job and vice versa.

evolving_doors · 29-09-2017 03:45PM

drkpower wrote: »

I don't think it hinges on that correlation at all. It hinges on the fact that where a cohort representing c. 50% of your talent pool only makes up c. 5% of your top-line talent, you are leaking talent somewhere. Its that simple.

But what's the issue with that? Yes it is a fact that more women leave.
Let's look for other facts that might exist so.
Maybe 70% of the initial cohort happen to like marmite, but only 1% of the marmite eaters end up in the top line.
Why are we ascribing gender to a problem that may or may not exist.... I.e. patient outcomes.
As I said, it goes back to his initial feelings on a correlation.

So is this about having equal genders at the top line because it appears to be the right thing to do... or is it about better patient outcome.
It would seem he's hinging the former on the latter.
I would just like to see a citation of some sort for the latter. He mentioned it as if it were something he overheard at the lunch table.

drkpower · 29-09-2017 04:13PM

evolving_doors wrote: »

But what's the issue with that? .

If you cant see any issue with a profession losing almost all of its talent from a cohort that makes up 50% or 35% of its talent pool, I dont think any further elaboration or citations will help. That, by the way, applies regardless of the cohort from which talent is being lost.

Talent is not limitless; not easily replaceable. Just because someone else fills a vacant position does not mean that it is being filled by someone of equal ability.

evolving_doors · 29-09-2017 04:27PM

drkpower wrote: »

If you cant see any issue with a profession losing almost all of its talent from a cohort that makes up 50% or 35% of its talent pool, I dont think any further elaboration or citations will help. That, by the way, applies regardless of the cohort from which talent is being lost.

Talent is not limitless; not easily replaceable. Just because someone else fills a vacant position does not mean that it is being filled by someone of equal ability.

Yes but his assertion was that we needed a gender balance because....
Because why exactly?

Edit: Don't get me wrong though, any drop out from such an intensive, lengthy and valuable training needs to be looked at.
But to say we 'need more women because women are better at getting better outcomes' is a on shakey ground. I'd just like to see where he's getting this from.
I also believe that all the candidates for the training were initially storable and up to it no matter the gender.

We need more female consultant surgeons

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