Women at the Cutting Edge

[ht_fancy_title color=”colordefault” title=”‘‘The perfect surgeon must have the heart of a lion and the hands of a lady…’’

–  Lord Moynihan of The Royal College of Surgeons, Leeds.”]

Quite so. Incidentally, it was reported that in 2012 that 59% of successful medical student applicants in Leeds were female. Why is it then, that in a modern era full of ambitious and talented women, only 10% of UK consultant surgeons are female?

The annual ‘Women in Surgery’ conference was set up by Cutting Edge, the Leeds medical school surgical society, who invited a group of renowned, female surgeons to offer their pearls of wisdom to the next generation. Keynote speakers this year included; Linda de Cossart CBE Emeritus Consultant Surgeon, Honorary Professor University of Chester, and Professor Shervanthi HomerVanniasinkam, Consultant Vascular Surgeon & Professor of Translational Vascular Medicine, University of Leeds.

The audience comprised of both female and male students of various ages. Interestingly, the speakers did not focus on how out-numbered or gender-discriminated they might have been in their careers. Instead, they celebrated the successes of how far the field of surgery had come – and that women have been a prominent part of it. It seems poignant to observe that in 1970, only 6% of doctors were female. By 2011, that figure had risen to 48%.

Nevertheless, surgery is still generally perceived as a male-dominated, competitive field; understandably, female members of the audience hoping to join the fray wondered if they have what it takes.

So what does it take to succeed in becoming a female surgeon?

The keynote speakers responded in agreement with one another. The answer was to be ‘‘indisputably excellent in their work, to be resilient, determined and passionate…but surely men need the same?’’ Valid point. What is it, then, that makes surgery in particular, so a) competitive and b) male-dominated? Mrs de Cossart answered the former.

As Director of Medical Education at the Countess of Chester NHS FT until 2014, de Cossart has observed that over the past 10 years, medicine has evolved into a hoop-jumping culture that has forced ‘junior doctors’ (post-graduate medics) to apply too early for specialist training in a profession they are often unsure about – mostly due to fear of being out-competed. Mrs de Cossart described this as a hindrance to helping young doctors flourish in their chosen profession, and said that universities should be creating better training programmes conducive to good teaching in clinical practice.

Arguably, the difficulty for women embarking upon a career in surgery is that they have to decide too soon whether they want to choose a career in surgery, or a career which would accommodate starting a family. Published in 1993, a NHS survey in the BMJ concluded that women were not directly discriminated against, but indirect discrimination, for example the inopportunity to work part time, influenced a woman’s choice of speciality. At present, there are increasing opportunities to resume a surgical post part-time – but this is by no means the norm.

All medical students, after graduating from their five year undergraduate course, complete two ‘foundation years’ of general training. During these two years they are urged to decide what they want to specialise in, apply and begin competing for the available speciality training posts.

The time commitments required during the typical twelve-year process of becoming a consultant surgeon post-med-school demands hours that would, frankly, make being a full-time parent impossible. Comparatively, becoming a GP requires a total of 6 years after graduating from medical school. Understandably, whilst this is still not an easy career to juggle with parenthood, it’s perceived as a much more accommodating option.

The conventional, out-competing nature of racing to consultancy is certainly not coveted by all. Indeed, part of the conference involved students rotating round workshops where female vascular, orthopaedic and neurosurgeons described their own experiences of balancing family life with their surgical career. Most had hired nannies, a few had been able to resume their posts part-time and others had started a family while taking time off from their clinical posts to do a PhD. Unavoidably, this set back their consultancy a few years; however, seeing as they would eventually spend the rest of their careers as consultant surgeons, there was a general consensus that admittedly – there was no need to rush.

So the question of the day was not, ‘why are there no female surgeons?’ but instead, ‘how can I become a surgeon?’ Mrs de Cossart put things in perspective, ‘‘to be a good surgeon, you first need to be a good doctor. In being a good doctor you have to understand yourself better.” For both male and female medics, it’s a long, arduous road. Excelling at medical school and working hard throughout your career is the name of the game.

At present, women are still out-numbered by men in this field, but rarely because of inopportunity or doubts cast upon a woman’s capabilities. Interestingly, case studies of female consultants have revealed that direct discrimination is commonly experienced from female nurses. In any case, due to society’s lingering stereotypes, the next generation of female surgeons will still have to get used to being mistaken for a nurse or pharmacist by their patients, but perhaps less often than previous generations. Hopefully, with more women entering the medical profession, a newer, more accommodating culture will grow to allow surgeons – both female and male – to have more control over their work:personal life balance. Potentially, women may then feel more inclined to choose a surgical career path.

However, no matter how forward-thinking your employer may be, women will always have those tough decisions to make: ‘how much time can I afford to take off?’ then ‘How many children can I afford to have?’ and crucially, ‘…do I really want children?’ A California-based study, “Women Surgeons in the New Millennium”, found that ‘maternity-leave’ as a general concept was more important to women than men, insinuating that spending time as a parent was of more concern, or worryingly, more intrinsically applicable to mothers than fathers. Indisputably, compromise is the bedrock for any career-driven couple who want to start a family. In some, this can undoubtedly take its toll – as the study also found that more female surgeons than male are divorced.

The residual assumption that women must have the dominant domestic role can often force our careers into the default back-seat when starting a family. Surgery is as seductive a field for women as it is for men – but like most high-pressure careers – it’s almost impossible to have the best of both worlds without some sacrifice.

Nilo Monfared

Feature Image: themominmemd

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