By: 5 August 2014


Scarlett McNally--14-11-13While the NHS has made huge strides to improve gender equality among medical practitioners in recent years – there are now more female GPs than male – there is still one vital area where the number of women falls well below the number of men – surgery. Although the number of women surgeons doubled between 2000 and 2012, they still only account for 9.3% of the total. A study1 conducted by the Nottingham University Hospitals NHS trust offers some of the reasons why, despite the majority of medical school graduates being female, women choose alternative medical careers.

The study revealed that women are significantly less likely to express interest in a surgical career than men – 42% of male graduate students were interested in surgery compared to 25% of female students. While it is natural that not all medical students have an interest in surgery to begin with, even when a woman does want to go into surgery, she faces more barriers than an aspiring male surgeon. Women students cited male domination (18%), difficulty in maintaining family life (12%), limited flexible training (12%) and few female role models (7%) as the main reasons for not pursuing surgery as a career.

Historically, surgery is a masculine career and scalpel-wielding women in operating theatres around the world still raise eyebrows. Scarlett McNally, pictured, consultant Orthopaedic Surgeon at Eastbourne District General Hospital, the youngest member of the Royal College of Surgeons’ council and the chairwoman of Royal College of Surgeons’ Opportunities in Surgery Committee, has overcome those burdens. She has successfully balanced being a mother of four with a very demanding career. “There used to be this image that you have to be big and strong to be able to bang in hips and only men could do that. However, there has been a critical mass of women going into surgery and the perceptions have changed – trauma and orthopaedics is now much more welcoming to women.”

Mrs McNally says that although it has become easier for women to strike a good work-life balance, as there is less nocturnal operating, reduced working hours and less pressure on being a perfect doctor all the time than before, there is still a lot of pressure on women surgeons to ‘prove’ themselves. “I have experienced opposition from theatre nurses as they are used to surgeons being male,” She says: “Although it has been just a few instances, it was just enough to make me realize that I’m not expected to be doing it. Sometimes women surgeons have to be more alpha female to prove themselves than what would be considered normal.”

Not only has the competency of women surgeons been scrutinized, they have also been blamed2 for increasing the financial burden on the NHS by working part-time after having children. A Royal College of Physicians Census of 2011 reported that 48% of female specialists work part-time compared to 6% of the males, thus yielding ‘poor return on investment’ for the NHS. Yet Mrs McNally doesn’t agree: “I personally never worked part-time and studies have found that some 40% of female surgeons never have children, thus sacrificing themselves in favour of career. What people don’t realise is that the phase of having babies is very short in one’s career, albeit it most often occurs at the time of the most difficult surgical training. We need to get women through this phase to have the best surgeons in the future.”

The Royal College of Surgeons has proclaimed that it seeks to support its members, who are going through the years when childbearing coincides with surgical training. Though women are still underrepresented on the Specialist Register (31%), their number has increased by 18% in just five years, whereas the number of male specialists has declined by 6%. Mrs McNally thinks that this trend will continue: “Over a third of our surgical trainees are women. In fact, you are statistically more likely to be appointed if you are a woman, because fewer of them apply. Once you get through the hurdle of being appointed, you just get on with it and do your job.”

Yet, being appointed as a consultant is becoming increasingly difficult. With fewer jobs being advertised by NHS trusts, there is a 25% chance of getting onto a core training post and only a 9% success rate of getting onto a specialty post. And although it might appear that the admission criteria are objective, it might be more difficult for women to publish as many research papers, for example, than for men, as childbearing often coincides with their postgraduate training. Lauren Bolton, a medical student at University of Manchester, an aspiring ENT surgeon and the president of Scalpel (UK’s largest undergraduate surgical society), is hopeful. “Our members are around 50% female and 50% male. However, one of the main issues is keeping up this interest at higher training levels, because that is where the proportion of male to female surgeons seems to shift. I think the main issue is that there are not many female surgical consultants and when you can’t identify with someone and use them as a role model. It would be good to see how they balance their life and reach their goals.”

A lot is currently being done to increase the appeal of a surgical career to women. For example, the nationwide Women in Surgery initiative seeks to increase the visibility of female surgeon role models and challenge the perceptions of what kind of person a surgeon needs to be. However, Mrs McNally thinks that even more could be done to accommodate women in surgery. She says that one of the major solutions has to be offering more funding and opportunities to trainee women surgeons, who wish to work part-time to raise a family. “This would be a major step forward, as well as challenging the perception that being a woman in a surgery role or a senior position is so rare.”

The recent appointment of Miss Clare Marx as the first female President of the Royal College of Surgeons in its 214 year history is surely a step in the right direction. Despite the many hurdles that women in surgery face, the number of female trainees and consultants is rising and the societal perception of them is improving. “Gender equality is important in every speciality, not only surgery. Otherwise, we would be missing out on so many talented people,” Bolton thinks. Indeed, the National Clinical Assessment Service disclosed in 2013, that women doctors are three times less likely to be suspended. Bolton continues: “All workplaces should support their staff and having staff with a good work-life balance means they are happier, work better and provide a better service.” Thus, rather than speaking of women surgeons of what they are worth in terms of return on investment for their medical training, we must ensure that the best specialists are encouraged to apply and be employed, regardless of their gender.

1. Fitzgerald JE, Tang SW, Ravindra P, Maxwell-Armstrong CA. Gender-related perceptions of careers in surgery among new medical graduates: results of a cross-sectional study. Am J Surg. 2013 Jul;206(1):112-9. doi: 10.1016/j.amjsurg.2012.04.009. Epub 2012 Aug 14.
2. Why having so many women doctors is hurting the NHS: A provocative but powerful argument from a leading surgeon. Mail Online.