WOMEN IN SURGERYWOMEN IN SURGERYPast, Present and Future Past, Present and Future

Dixie Mills, M.D., FACS

Department of Surgery

Maine Medical Center

September 19, 2003

Women in SurgeryWomen in Surgery

Brief history of Women in Surgery Rise of Women in Medicine Characteristics of Women in Surgery Association of Women Surgeons Future

Women in SurgeryWomen in Surgery - History - History

Ancient History– Egyptian and BC evidence

Middle Ages– Women of Salerno and the Crusades– Tortula’s Gynecological Text

The 1400’s to 1800’s - The “Surgeoness”

The “Beardless Lad”The “Beardless Lad”Dr. James Barry - 1795-1865Dr. James Barry - 1795-1865

Attended Edinburg Medical School

During the Napoleonic Wars was an Army Surgeon

Performed one of the first successful C/Ss

At burial was found to be a woman

Dr. Elizabeth BlackwellDr. Elizabeth Blackwell1821-19101821-1910

1st woman medical graduate in the US - 1849

Women’s Medical College of Women’s Medical College of Pennsylvania - 1903Pennsylvania - 1903

Women in SurgeryWomen in Surgery - History - History

Turn of the Century-6% of physicians were women - the number never went higher until 1970

The ACS admitted one woman in 1913 and from 0 to 5 (<2%) each year until 1975

1st woman governor-Lillian Farrar 1925-1947 Army Hospitals and WWW II

Women in SurgeryWomen in Surgery

History of Women in SurgeryHistory of Women in Surgery Recent rise in Women in Medicine

Women in MedicineWomen in Medicine

A rise in women applying to medical school began in the 1970’s due to

- Increase in medical schools and slots

– The “Women’s Movement” – The Equal Opportunity Act was passed– Growing number of “baby boomer girls” were

finishing college

Medical School GraduatesMedical School Graduates

0

2

4

6

8

10

12

14

16

1960 1970 1980 1990

WomenAll

Percent Distribution of Total US Percent Distribution of Total US Physicians by Age and Sex, 2001Physicians by Age and Sex, 2001

0 5 10 15 20 25 30 35

Under 35

35-44

45-54

65 and over

MenWomen

U.S. Physicians 1970-2001U.S. Physicians 1970-2001

0%

20%

40%

60%

80%

100%

Men 305,317 413,395 511,227 603,253

Women 25,507 54,284 104,194 205,903

1970 1980 1990 2001

Women in SurgeryWomen in Surgery

History of Women in SurgeryHistory of Women in Surgery Recent rise in Women in MedicineRecent rise in Women in Medicine Women in Surgery today

Surgeons – 2001*Surgeons – 2001*N = 157,669N = 157,669

*AMA Physician Characteristics 2003*AMA Physician Characteristics 2003

0

10000

20000

30000

40000

50000

60000

W = 25,563 4421 15032 3715 2395

M =132,106 33,114 26010 24410 48572

GenSurg Ob/Gyn Opt/Ot Other

Surgeons - 2001Surgeons - 2001N = 157,669N = 157,669

0%

20%

40%

60%

80%

100%

GenSurg Ob/Gyn Opt/Ot Other

Surgeons – 2001Surgeons – 2001N = 157,669N = 157,669

0%

20%

40%

60%

80%

100%

Men = 132,106 Women = 25,563

Opth/OtoOB/GOtherGeneral S

Other Surgical Specialties - 2001Other Surgical Specialties - 2001

0

5000

10000

15000

20000

25000

Women 857 358 675 239 142

Men 22,056 10,039 5747 4773 4884

ORS Uro Plas Neuro Thor

General Surgeons over TimeGeneral Surgeons over Time

0%

20%

40%

60%

80%

100%

Men 32884 35870 34257 33178

Women 1150 2406 3302 4429

1980 1990 1995 2001

ACS Membership by Gender ACS Membership by Gender

0%

20%

40%

60%

80%

100%

Men 41543 52330 47007

Women 1742 2431 2628

1998 2000 2002

Women Surgeons in Illinois-2001Women Surgeons in Illinois-2001N= 1,285/6,398N= 1,285/6,398

0

200

400

600

800

1000

1200

1400

Total General OB/GYN Other

SurgeonsResidents

Characteristics of Women SurgeonsCharacteristics of Women Surgeons

Published in the American Journal of Surgery - September 1998

Erica Frank, MD, Michelle Brownstein, MD, Kimberly Ephgrave, MD, Leigh N eumayer, MD

4,501 US women physicians from the Women Physicians Health Study were studied

134 surgeons or 4% of total

Characteristics of Women SurgeonsCharacteristics of Women Surgeons 19941994

Worked more clinical hours and call nights Personal health habits were similar, however exercised

more Did not feel they worked too much, nor had too much

stress Satisfaction in their specialty was greater Higher personal and family income Younger, white, single and childless than other women

physicians

Women in SurgeryWomen in Surgery

WHY WOMEN CHOOSE SURGERY– ROLE MODELS– LIKE THE INTELLECTUAL CHALLENGE,

TECHNICAL ASPECTS, DECISIVENESS– MUCH THE SAME REASONS AS MEN– “SURGICAL PERSONALITY”

Women in SurgeryWomen in Surgery

WHY WOMEN DON’T CHOOSE SURGERY– PERCEIVED AS TOO “DIFFICULT” “MALE”– NOT ENCOURAGED– TOO TIME CONSUMING– NOT FAMILY FRIENDLY

– LIFESTYLE NOT CONTROLLABLE– NO ROLE MODELS

Residents - 2001Residents - 2001N = 93,674N = 93,674

0

5000

10000

15000

20000

25000

Medical Surgical Other Family

W=37428M=56246

Surgical Residents- 2001Surgical Residents- 2001N= 20,839N= 20,839

0

1000

2000

3000

4000

5000

6000

Women=6442Men=14,397

Women=6442 1847 3363 603 629

Men=14,397 5883 1375 1871 5268

Gen Surg OB/GYN OP/OT Other

Other Specialties - 2001Other Specialties - 2001Residents/FellowsResidents/Fellows

0

500

1000

1500

2000

2500

3000

3500

ORS Uro Plas Neuro Thor

WomenMen

Surgical Residents - 2001Surgical Residents - 2001N=20,839N=20,839

0%

20%

40%

60%

80%

100%

Men 5883 1375 3164 847

Women 1847 3365 291 121

General OB/GYN Ortho Uro

Women in SurgeryWomen in Surgery

History of Women in SurgeryHistory of Women in Surgery Recent rise in Women in MedicineRecent rise in Women in Medicine Characteristics of Women in SurgeryCharacteristics of Women in Surgery Association of Women Surgeons

Association of Women SurgeonsAssociation of Women Surgeons

Founded in 1981 Membership grew to over 1200 by 1990 Seat on the ACS Board of Governors in 1995 Increasing numbers on committees, boards and as

speakers Members serve on over half of ACS State

Chapters

Association of Women SurgeonsAssociation of Women Surgeons

Mission Statement-

To inspire, encourage and enable women in surgery to realize their professional and personal goals

Association of Women Surgeons -Association of Women Surgeons -GoalsGoals

To promote professional growth and advancement To enhance and facilitate interaction among female

surgeons throughout the world To foster an environment supportive of personal

values and individual diversity To advocate the highest standards of competence

and ethical behavior

AWS - Membership 2003AWS - Membership 2003

1614 members 63% are board certified 61% are fellows of the college 60% are general surgeons 30% are academic officers 23% are students or residents Member is each state and many international

AWSAWS

Membership Directory Quarterly Newsletter Website, E-zine, listservs Pocket Mentor Fall Conferences Networking Meetings at other conferences

Women are SurgeonsWomen are Surgeons Video Video

AWSAWS AWS-Ethicon Endoscopic Fellowship Award AWS Outstanding Woman Resident Award AWS Visiting Professor Code of Conduct approved by ACS Family Leave Policy

Surgical Leadership -2003Surgical Leadership -2003

ACS Officers - 1/8 women ACS Board of Regents - 3/19 women ACS Officers of the Board of Governors -1/3 250 residency program - 4 women directors Editorial Boards - 12/223 (5%) for 5 journals RRC - 1/12 Two Chairs of Department of Surgery

Women in AcademicsWomen in AcademicsNEJM - 2/00 - Associate ProfsNEJM - 2/00 - Associate Profs

0%10%20%30%40%50%60%70%80%90%

100%

Surgery ObGyn Radiology Anesthesia Peds

MenWomen

Academic MedicineAcademic Medicine

Women join academic ranks post graduation at higher rates than men

However they advance to senior ranks less Leave academic ranks at higher rates Perceived reasons why- micro-inequities

less mentoring, publish less, less support and resources lack of visibility and isolation, failure of support

more attractive alternatives

Issues in the recruitment and success ofIssues in the recruitment and success of women in academic surgerywomen in academic surgery - - Colletti Colletti Surgery Surgery 8/2002 8/2002

Presented at the Society of University Surgeons Nat’l survey completed by 386 W, 338 M Women report similar objective experiences, but

very different perceptions of issues Women perceived that opportunities for

collaboration, networking and support are missed A quarter of respondents were considering leaving

academic surgery

The FutureThe Future

Is there a problem? Can it be fixed? Where to “attack” it Where in the pipeline to start?

Medical StudentsMedical Students

Applicants to general surgery programs have been dropping over the last 10 years

Women medical students (almost 50% of total) exhibit less interest in surgery from entrance, through and in graduating medical school

There are 1000+ categorical slots (75%men, 25%women)- this means we are recruiting only 3% of women and 10% of men senior students

Women in Surgery- TrendsWomen in Surgery- TrendsMedical Students to Surgical ResidentsMedical Students to Surgical Residents

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

W Medstud 3894 17248 24286 30853

W SurgRes 800 2850 4200 6442

1970 1980 1990 2001 2010

Women General Surgical ResidentsWomen General Surgical Residents

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

1983 1990 1998 2001 2002 2003

WomenMen

Top Specialties - 2001Top Specialties - 2001

MEN

- Internal Medicine

- Family Practice

– Pediatrics

– OB/GYN

– Psychiatry

– General Surgery

WOMEN– Internal Medicine

– Pediatrics

– Family Practice

– OB/GYN

– Psychiatry

– …10th - General Surgery

Possible SolutionsPossible Solutions

Enhance the surgical environment for both men and women – in the hospital and office

Reduce gender discrimination/sexual harassment Increase the number of women in leadership positions –

Woman president of ACS???? Increase the visibility of women surgeons Changes in surgical training – hours, length, programs –

look at the GYN/OB residency programs

The FutureThe Future

Much can be done to encourage women to Much can be done to encourage women to pursue surgery. Surgery cannot remain pursue surgery. Surgery cannot remain competitive, attracting the best and the competitive, attracting the best and the

brightest if the selection pool is reduced by brightest if the selection pool is reduced by half. Promoting a surgical lifestyle that half. Promoting a surgical lifestyle that allows individuals to balance family and allows individuals to balance family and work, enabling both male and females to work, enabling both male and females to fulfill parenting and life roles is essential.fulfill parenting and life roles is essential.