Australian and Irish researchers have identified six new factors they say contribute to why there are so many more male than female surgeons, despite the increasing number of females in medicine as a whole. In the UK and Australasia, women account for just 11% of consultant surgeons despite about 60% of medical students being women.

The qualitative research, Why do women leave surgical training? A qualitative and feminist study, was conducted by Gold Coast general surgeon Dr Rhea Liang, Professor Tim Dornan of Queens University Belfast and Professor Debra Nestel of Melbourne University, and published in The Lancet. It asked women to describe in-depth why they had chosen to leave surgical training soon after they had started it, despite having aspired to the profession since childhood.

Women are at least as able on entry to surgical training but only a minority complete it, indicating a deep-rooted issue in the discipline, said Prof Dornan. “Previous research has assumed that those who continue to train as surgeons can provide answers to this vexed question. This is fraught with problems when so many senior surgeons are men. This [study] was novel, first, because a young female surgeon did the research and, second, because she asked those who know best – women who had chosen to leave. This provided new insights.”

The study found women didn’t complete their surgical training due to unavailability of leave, a distinction between valid and “invalid” reasons for leave, poor mental health, absence of interactions with other women in surgery, fear of repercussion and lack of independent and specific support pathways. It also confirmed factors previously identified, such as insufficient role models and institutional support, gender discrimination and harassment, sleep deprivation, adverse interactions with seniors, pregnancy and childbirth and child-rearing duties.

“It is already known that young surgeons endure fatigue, long working hours, difficulty taking time off, strains on personal relationships and bullying,” said Prof Dornan. “By analysing leavers’ experiences in depth, we were able to show how these factors discriminated selectively against women. One female former surgical trainee told how she was denied time off to care for her child when a male counterpart was given time off. The request was apparently valid when made by a man and invalid when made by a woman.”

This is just one example of women being treated differently, said Dr Liang. “Rather than being treated as a surgeon requesting leave, they were first and foremost treated as a woman requesting leave, which automatically put them at a disadvantage.”
Overall, the research showed women leave because of a variety of factors which accumulate like a tower of stacked blocks, she said. “Eventually, an individual’s tower can reach a height that it will topple in the absence of efforts to stabilise it, often the final ‘toppling’ precipitator appearing relatively minor.”