Societal Preferences for Gender of Surgeons: A Cross‐Sectional Study in the General Population of Pakistan

Abstract

Background Sociocultural norms and gender biases may result in surgeon gender preferences among the general public. This study aimed to understand preferences and perceptions related to surgeon gender among the general population in Pakistan, a lower-middle-income country. Methods A cross-sectional study was conducted by the Aga Khan University, Karachi, among the adult general population in Pakistan. Sequential mixed-mode data collection was performed via online dissemination on social media platforms and in-person surveying at different geographic locations in Karachi. Results Among 1604 respondents, 50% did not report having surgeon gender preferences in general. Among respondents with gender preferences, there was a highly significant preference for gender concordance across all surgical subspecialties (p \0.001) except cardiothoracic surgery and neurosurgery. Exceptions where women preferred a male surgeon were neurosurgery (59.7% vs. 40.3%; p \0.001) and cardiothoracic surgery (53.1% vs. 46.9%; p \0.001). Moreover, respondents felt more comfortable communicating with (67.6%) and being examined by (73.3%) gender concordant surgeons. Men more commonly perceived male surgeons as more competent (26% vs. 14.5%; p \0.001) and warmer (18.3% vs. 9.8%; p \0.001) than female surgeons. Nevertheless, the most important factors influencing selection of a surgeon were the surgeon's reputation (69.6%) and experience (50.5%). Most respondents (84.5%) believed that more females should practice surgery. Conclusion While around half of respondents do not have gender preferences, a significant proportion prefers a gender concordant surgeon across subspecialties. In a society where conservative sociocultural norms play a significant role when seeking health care, this makes yet another compelling argument for gender parity in surgery.

Factors Influencing the Intention to Pursue Surgery among Female Pre‐Medical Students: A Cross‐Sectional Study in Pakistan

“…The College of Physicians and Surgeons of Pakistan (CPSP) reports that only 14% (327/2319) of surgeons who completed surgical and surgical subspecialty training in Pakistan since 1967 are women [4]. While this number is comparable to reports from higher‐income countries such as the United Kingdom (19%) [5], and the United States (14%) [6], it is especially concerning because patients in Pakistan prefer gender concordant surgeons for most surgical subspecialties [7]. This clear global disparity between the number of female and male surgeons may be attributed to the presence of deterrents and/or the lack of motivating factors, that prevent women from entering surgical professions.…”

Sex‐based Disparities Among Surgical Faculty Positions Across Medical Colleges in Pakistan

“…The complete domination of women in breast surgery is not surprising especially in a conservative society such as in Pakistan, whereby female patients feel hesitant to undergo breast procedures or examinations by a male surgeon, thus discouraging men from pursuing this subspecialty in Pakistan. A survey conducted in the country confirms this rationale, revealing that over 70% of female patients would prefer a female breast surgeon for themselves and over 95% of men would prefer a female breast surgeon for a female family member [ 32 ]. Thus, in the case of breast surgery, the sex-based disparity among surgeons is reversed and driven primarily by patient preference based on sociocultural and religious conservatism.…”

“…Given the conservative setup of Pakistani society, integration of women into the surgical field becomes even more important, as a considerable proportion of women patients in Pakistan may be reluctant to, or even be prohibited by their family to, seek healthcare from male surgeons. This preference for gender concordance between patient and surgeon has been decisively demonstrated in Pakistan for most surgical subspecialties [ 32 ]. Thus, it is vital for women to be adequately represented at the top so that others may receive the much-needed guidance and mentorship to become surgeons, which may subsequently help alleviate Pakistan’s unmet need for surgical healthcare.…”

Understanding Societal Preferences Can Inform the Discussion Seeking to Promote Gender Equity in Surgery

“…In their study, Martins et al . [4] not only used standard online platforms (including Facebook®, Twitter®, and Instagram®) to administer their survey (in English and Urdu) seeking to understand preferences and perceptions related to surgeon gender to adults in Pakistan, they also ensured that the survey was presented to individuals of all economic strata using 15 data collectors to survey people who did not have access to the internet in the metropolitan city of Karachi. Thus, the survey may have not included a sufficient rural representation (as highlighted as a limitation by the authors); however, it is still relevant in terms of gathering important pilot data to inform future endeavours of this kind.…”

“…A factor, often ignored, when considering the problem of gender equity in medical professions is societal preferences. The study by Martins et al [4] from Pakistan provides a bold initial step to enlighten the global readership of the World Journal of Surgery about this additional factor that significantly impacts the progress of gender equity.…”