For most of my professional life I have avoided writing about gender inequity in the field of surgery – not because I believe it does not exist, but because the reasons it does exist are manifold and complicated.
To be sure, implicit and explicit bias remain important reasons why only a minority of female medical students still choose surgery as a career in 2018, why female surgeons still earn only 82% of the salary of their male counterparts, and why women occupy only 12% of the chairs in academic surgical departments in the United States. It has long been tempting to lay the blame for those inequities on a stereotypical macho surgical culture that prevailed as the 20th century came to a close. But the factors that perpetuate male/female imbalance in our profession are complicated and run deep in the psyches of both men and women. We are all products of our generations, our culture, upbringing, and environment – men as well as women. Correcting the imbalance requires much more than simply passing laws that require equitable pay or treatment.
I realized how deeply ingrained biases are in all of us while still in my surgical residency in the 1970s. On a rare occasion when neither my husband (also a surgical resident) nor I was on call, we had a dinner party with friends at our house. The telephone rang (no iPhones, just a land line), and I ran to answer our only telephone in another room. It was the hospital operator, who asked, “Is Dr. Deveney there?” Without thinking, I answered, “Just a moment, I’ll get him!” I had taken only three steps away from the phone when it occurred to me what I had just said. I turned back, picked up the phone, and asked, “Which Dr. Deveney were you looking for?”
If even I had been conditioned to think automatically of “doctor” being a man after all of my effort to earn a place in the ranks, was there any hope that equality could be achieved? When I finished my residency and was offered a surgery position at our VA, I asked no questions about salary or other particulars; I was simply grateful that I had been given a job.
That was 1978 – a different time, a different generation. Since then, women have made dramatic progress toward equity in our profession, as in many others. The support, mentoring, and consciousness-raising efforts of the Association of Women Surgeons (AWS) are responsible for much of this progress. The American College of Surgeons was very supportive of the AWS early on and continues to encourage female medical students to choose surgery as a career and to help the advancement of women into leadership roles in surgery. Many surgical residency programs have 50% women in their ranks; half of our residents in Oregon have been women for over a decade. Our program director is a woman, as are 28% of the faculty; not 50%, but definitely progress, since I was the lone woman on the faculty when I arrived in 1987.
Although women occupy only 12% of the surgical chairs in U.S. surgical departments, this number has soared in the past 2 years from 7 in 2016 to 21 this year after languishing in the low single digits since 1987, when the late Olga Jonasson, MD, FACS, became the first female chair at Ohio State University. And yet, women have not reached full equality with men across the United States in surgical training, leadership, or pay. Why not?
Multiple factors have played roles in impeding the progress of women in achieving equality in surgery. Traditional cultural expectations of male and female roles in society affect both genders as they grow up, even when their parents make deliberate efforts to raise their children in as “gender-neutral” a way as possible and encourage their daughters to strive for success to the same degree as their sons. Explicit bias against women remains easier to recognize and combat than implicit or unconscious bias, to which we are all subject.