Has the Increase of Women in Surgical Training Programs Led to a Concomitant Increase in Female Leadership Positions? A 10-Year Analysis

Abstract

IntroductionWomen represent greater than 50% of medical students in America and are becoming increasingly well represented in surgical fields. However, parity at the trainee level has yet to be accomplished, and surgical leadership positions have remained disproportionately biased toward men. To date, there have been no comparisons on the progress within plastic surgery and other surgical specialties. This investigates the gender disparity in resident and leadership representation over the past 10 years within surgical specialties and how these disparities compare to plastic surgery.MethodsCounts of female and male residents and surgical society leaders were collected from 2008 to 2018. Surgical fields included plastic, vascular, urologic, neurologic, orthopedic, cardiothoracic, and general surgery. Leadership positions were defined as board seats on executive committees of major surgical societies or board associations. Data were acquired from publicly available sources or provided directly from the organizations. Resident data were obtained from the Accreditation Council of Graduate Medical Education residents' reports. Individuals holding more than 1 leadership position within a year were counted only once.ResultsIn our aggregated analysis, the proportion of women in surgical leadership lags behind women in surgical residency training across all specialties (13.2% vs 27.3%, P < 0.01). General surgery had the highest proportion of female residents and leaders (35% and 18.8%, P < 0.01), followed by plastic (32.2% and 17.3%, P < 0.01), vascular (28.2% and 11.3%, P < 0.01), urologic (24.3% and 5.1%), and cardiothoracic surgery (20.5% and 7.8%, P < 0.01). Women in surgical leadership, however, increased at a faster rate than women in surgical training (11% vs 7%, P < 0.05). Plastic surgery showed the greatest rate of increase in both residents and leaders (17% and 19%, P < 0.05) followed by cardiothoracic surgery (16% and 9%, P < 0.05) and general surgery (8% and 14%, P < 0.05). For neurologic and orthopedic surgery, neither the difference in proportions between residents and leaders nor the yearly growth of these groups were significant.ConclusionsBetween 2008 and 2018, women in plastic surgery training and leadership positions have shown the most significant growth compared with other surgical subspecialties, demonstrating a strong concerted effort toward gender equality among surgical professions.

A Descriptive Analysis of Integrated Plastic Surgery Residency Program Directors in the United States

“…Previous research has also shown that the proportion of women in surgical leadership lags behind the number of women training in surgical specialties. However, plastic surgery had the second highest proportion of both female residents and female academic surgical leaders, behind general surgery 19 . In addition, all current female PDs have been appointed in the last 7 years.…”

“…The more recent appointments and shorter terms served by female PDs could indicate a trend in hiring more female PDs, as well as represent the increase in women training as plastic surgeons. Between 2008 and 2018, there was a great increase in both the number of women entering plastic surgery training, as well as tremendous growth in the number of women in plastic surgery leadership positions 19 . Previous research has also shown that sex representation in plastic surgery departments favors male surgeons, and that there is a paucity of women in leadership roles 20,21 .…”

Hegemonic masculinity: representation of women surgeons in leadership positions in Pakistan

“…Women make up more than half of medical doctors in several countries across the globe including the USA, the UK and Australia. Yet, despite gender equity in medical schools (Jena et al , 2015; Radunz et al , 2020; Sexton et al , 2012; Singh et al , 2020; Silver, 2018 and Silver et al , 2017; Temkin, 2020), there is a disparity in surgery and women remain disproportionally underrepresented in leadership positions in surgical specialties including professors, chairpersons or medical school deans (Battaglia et al , 2020; Burdine et al , 2019; Giuffrida et al , 2020; Keane et al , 2021; Olson, et al , 2021; Mueller, 2016; Sexton, 2012; Skinner et al , 2019; Yin et al , 2021). In the USA, studies have shown that 12% of Professors in academic surgery and 25% of surgical faculty are women (Battaglia et al , 2020).…”

“…Moreover, there is evidence that women practice medicine differently than men. They are more likely to use more patient-centered communication, provide more psychosocial counseling and adhere more closely to clinical guidelines (Yin et al , 2021). Patients treated by female physicians compared with those treated by men within the same hospital have shown significantly improved outcomes, including lower mortality and readmission rates (Tsugawa et al , 2017).…”

“…Patients treated by female physicians compared with those treated by men within the same hospital have shown significantly improved outcomes, including lower mortality and readmission rates (Tsugawa et al , 2017). During COVID-19 countries having women political leadership had more effective responses over the pandemic (Yin et al , 2021). Hence, there is a need to research women’s representation in surgery and surgical leadership to understand the challenges encountered and explore strategies to overcome these challenges.…”