By Taylor Sullivan, DO

Women Surgeons:

Current Surgical Training in a Male-Dominated Field

By Taylor Sullivan, DO

he first surgery I ever scrubbed in was during my second year of medical school. It was a mastectomy with lymph node dissection. After resection of the tumor, the surgeon used paint, borrowed from pathology, to mark the surgical borders of the specimen. She then used a handheld gamma detector to find the sentinel lymph node. This surgery was a beautiful display of chest wall anatomy, neurovascular supply to the upper extremity and use of technology. Not only was this patient cancer-free thanks to this skilled breast surgeon, but it also changed my life and career trajectory.

For the time in U.S. history, females make up the majority of medical students at 52.9%.1 Though only 35% of the active physicians are women, this is a significant stride in equalizing the workforce.1 The percentage of women in surgical specialties, however, is only 22%.2 (See Figure 1.) Additionally, Doctor of Osteopathic Medicine physicians are even further underrepresented in surgery. Combining genders, DOs account for 5.6% of surgeons in orthopedic surgery, 4.6% for general surgery, 4% for ENT and vascular surgery, 2.5% for urology and <2% for plastic surgery and neurosurgery.2

There are several reasons as to why women don’t make up more of the surgical workforce. Most students list the perceived lifestyle, inabil-

Tity to balance work life with family life, extended length of training and discrimination/sexual harassment as reasons not to pursue a surgical career. Personally, I have yet to observe or receive gender discrimination from faculty or other residents. Rather it comes harmlessly from patients or ancillary staff, of both genders, assuming I am anyone but the physician, much less the surgeon. Gentle education and repetitive use of the word “doctor” typically helps get the point across. As of July 2021, women make up 38% of general surgery residents nationwide, and it continues to grow each year.3 As more faculty positions are awarded to female surgeons, opportunism for mentorship opens. I believe ways to increase women in surgery is to provide mentorship and examples of how women can make it all work: they can have their career and their family. I once attended a surgical interest group meeting in medical school and distinctly remember the surgeon advising us to never choose a specialty based off of the perceived lifestyle. Anything can be negotiated in a contract to ensure the balance you want. Several of my classmates from medical school did not give surgery a second thought due to the extended length of training during childbearing years. Seeing female surgical residents ahead of me start a family while in residency makes it seem not easy, but possible. Having mentorship, even from the resident level, can make a big difference, especially for those students on the fence about logistical questions. Lastly, organized medicine, such as the Association of Women Surgeons and the Bexar County Medical Society, typically have mentor programs for students who don’t have one at their home program. One of my original mentors was a female physician whom I

Figure 1

worked for while in college at Texas A&M. I still remember the exact time and place when she told me about her breast cancer diagnosis. She then experienced an arduous course of neoadjuvant chemotherapy, followed by a mastectomy and lymph node dissection, followed by more chemo and radiation. I also remember the shockingly immediate effects that lymphedema had on her quality of life. To this day, she still must wear an upper extremity compression sleeve, even while seeing patients, even outside in the hot, Texas heat. After having rotated in various aspects of general surgery during medical school and now intern year, I can’t help but think back to my mentor and the first surgery I participated in. It has inspired me to pursue a career in plastic and reconstructive surgery where I can be part of surgical planning, starting the conversation about reconstruction and microsurgery options from the beginning. I believe that reconstructive surgery will allow me to make patients feel beautiful and confident about themselves after cancer or a traumatic event and can improve their quality of life.

Though working eighty hours per week without much time for eating or sleeping was an adjustment, I believe surgery is the most rewarding and challenging area of medicine. Surgical training in 2021 is different for me than it was for my female predecessors, even just a few short years ago. Though more change should occur, the progress made thus far should be celebrated, steriley, of course.

References 1. Women close med school enrollment gap, but others remain.

Women Close Med School Enrollment Gap, but Others Remain. (2020, February 28). Retrieved October 4, 2021, from https://www.aafp.org/news/blogs/leadervoices/entry/20200228lv -diversity.html. 2. Data & Reports. AAMC. (2021, June 11). Retrieved October 5, 2021, from https://www.aamc.org/data-reports. 3. Women surgeons: defining the future of surgery. (2021, July 30).

Retrieved October 4, 2021, from https://uofuhealth.utah.edu/ notes/postings/2021/07/women-surgery-residents.php#.YVtG 90bMJH0

Taylor Sullivan, DO is graduate of the inaugural class at UIWSOM, current General Surgery resident at UTHSCSA and member of the BCMS Publications Committee.