WOMEN IN SURGERY Past, Present and Future

WOMEN IN SURGERY Past, Present and Future Dixie Mills, M.D., FACS Department of Surgery Maine Medical Center September 19, 2003 Women 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 Surgery - History  Ancient History – Egyptian and BC evidence  Middle Ages – –  The Women of Salerno and the Crusades Tortula’s Gynecological Text 1400’s to 1800’s - The “Surgeoness” The “Beardless Lad” Dr. 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 Blackwell 1821-1910  1st woman medical graduate in the US - 1849 Women’s Medical College of Pennsylvania - 1903 Women in Surgery - History  Turn of the Century6% 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 Surgery  History of Women in Surgery  Recent rise in Women in Medicine Women 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 Graduates 16 14 12 10 8 6 4 2 Women All 0 1960 1970 1980 1990 Percent Distribution of Total US Physicians by Age and Sex, 2001 65 and over 45-54 Men Women 35-44 Under 35 0 5 10 15 20 25 30 35 U.S. Physicians 1970-2001 100% 80% 60% 40% 20% 0% Men Women 1970 305,317 25,507 1980 413,395 54,284 1990 511,227 104,194 2001 603,253 205,903 Women in Surgery  History of Women in Surgery  Recent rise in Women in Medicine  Women in Surgery today Surgeons – 2001* N = 157,669 *AMA Physician Characteristics 2003 60000 50000 40000 30000 20000 10000 0 W = 25,563 M =132,106 GenSurg 4421 33,114 Ob/Gyn 15032 26010 Opt/Ot 3715 24410 Other 2395 48572 Surgeons - 2001 N = 157,669 100% 80% 60% 40% 20% 0% GenSurg Ob/Gyn Opt/Ot Other Surgeons – 2001 N = 157,669 100% 80% 60% 40% 20% 0% Men = 132,106 Women = 25,563 Opth/Oto OB/G Other General S Other Surgical Specialties - 2001 25000 20000 15000 10000 5000 0 Women Men ORS 857 22,056 Uro 358 10,039 Plas 675 5747 Neuro 239 4773 Thor 142 4884 General Surgeons over Time 100% 80% 60% 40% 20% 0% Men Women 1980 32884 1150 1990 35870 2406 1995 34257 3302 2001 33178 4429 ACS Membership by Gender 100% 80% 60% 40% 20% 0% Men Women 1998 41543 1742 2000 52330 2431 2002 47007 2628 Women Surgeons in Illinois-2001 N= 1,285/6,398 1400 1200 1000 800 600 400 200 0 Total General OB/GYN Other Surgeons Residents Characteristics 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 Surgeons 1994  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 Surgery  WHY WOMEN CHOOSE SURGERY – ROLE MODELS – LIKE THE INTELLECTUAL CHALLENGE, TECHNICAL ASPECTS, DECISIVENESS – MUCH THE SAME REASONS AS MEN – “SURGICAL PERSONALITY” Women 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 - 2001 N = 93,674 25000 20000 15000 10000 5000 0 Medical Surgical Other Family W=37428 M=56246 Surgical Residents- 2001 N= 20,839 6000 5000 4000 3000 2000 1000 0 Women=6442 Men=14,397 Gen Surg 1847 5883 OB/GYN 3363 1375 OP/OT 603 1871 Other 629 5268 Women=6442 Men=14,397 Other Specialties - 2001 Residents/Fellows 3500 3000 2500 2000 1500 1000 500 0 ORS Uro Plas Neuro Thor Women Men Surgical Residents - 2001 N=20,839 100% 80% 60% 40% 20% 0% Men Women General 5883 1847 OB/GYN 1375 3365 Ortho 3164 291 Uro 847 121 Women in Surgery  History of Women in Surgery  Recent rise in Women in Medicine  Characteristics of Women in Surgery  Association of Women Surgeons Association 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 Surgeons Mission Statement- To inspire, encourage and enable women in surgery to realize their professional and personal goals Association of Women Surgeons Goals  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 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 AWS  Membership Directory  Quarterly Newsletter  Website, E-zine, listservs  Pocket Mentor  Fall Conferences  Networking Meetings at other conferences Women are Surgeons Video AWS  AWS-Ethicon Endoscopic Fellowship Award  AWS Outstanding Woman Resident Award  AWS Visiting Professor  Code of Conduct approved by ACS  Family Leave Policy Surgical 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 Academics NEJM - 2/00 - Associate Profs 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Surgery ObGyn Radiology Anesthesia Peds Men Women Academic 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 of women in academic surgery - Colletti Surgery 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 Future  Is there a problem?  Can it be fixed?  Where to “attack” it  Where in the pipeline to start? Medical 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- Trends Medical Students to Surgical Residents 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 W Medstud W SurgRes 1970 3894 800 1980 17248 2850 1990 24286 4200 2001 30853 6442 2010 Women General Surgical Residents 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 1983 1990 1998 2001 2002 2003 Women Men Top 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 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 Future Much can be done to encourage women to pursue surgery. Surgery cannot remain competitive, attracting the best and the brightest if the selection pool is reduced by half. Promoting a surgical lifestyle that allows individuals to balance family and work, enabling both male and females to fulfill parenting and life roles is essential.