“Scalpel, please”. For how long hearing this from a woman will be a surprise?

This article was exclusively written for The European Sting by Ms. Beatriz Arrais Silva and Maria Eduarda Comunello are 20 year old students in the 4th semester of medical school at University Cesumar, in Southern Brazil. They are affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

In 1865, the headline published by the Manchester Guardian surprised the entire medical society of the time by reporting that James Barry, renowned surgeon in the British Armed Forces for more than 40 years, was actually a woman.

Just as in others society’s segments, the possibility of women being included in the medical labor market was a process that reflected social inequalities in gender, since their performance in medicine was prohibited until the 1850s. Until nowadays, with a largest number of women entering Medical Schools, it’s possible to identify a smaller number of female surgeons when compared to men’s proportion working at the same sector.

The Brazilian Medical Demography of 2020 indicates that 26,874 male physicians in the country are general surgeons, compared to 7,605 women in the same profession. The difference in access to this medical specialty is not only reflected in the numbers, but also in inequalities related to the confidence of co-workers and patients themselves regarding the efficiency of women’s surgical abilities, when compared to male surgeons. For the same reason, newly graduated female doctors choose careers considered more socially appropriate for women.

Male physicians transmit approximately 25% more confidence to patients than women in the same specialty. It means that, regardless of the chosen residency, a woman needs to demonstrate at least 25%, more capability doing the service, in order to have the same acceptance as men. Even personality traits are placed on the scale when questioning their competence in professional sphere. Characteristics such as self-belief, questioning nature and leadership are well seen in men, but are often reasons for doubt when dealing with women.

The higher expectations linked to gender roles disregard women’s personal desires and ambitions and just see them as a procreators and housewives. This retrograde concept results that women who are exhaustively dedicating themselves to their specialty still are questioned, since even heads of medical services hesitate to hire female surgeons.

However, current scientific evidence indicates that patients who were operated by women had a better postoperative follow-up, since the mortality rates at 30 days were lower when compared to patients seen by male surgeons.

In view of the data presented, It is possible to conclude that women are equally or even more able than men for performing the exercise of surgical specialty. However, men still dominate this area, because structural patriarchy still is very present in the most diverse areas of medicine, especially in surgery.

But how to change something that has been rooted in society since its beginnings? Despite all the difficulties in the process, reversing this situation is extremely important, so that becomes possible to reduce the occupational segregation of gender in surgery. Nevertheless, changes must come mainly from male professionals, since they have more voice in the eyes of society. This way, female surgeons will be gradually able to gain the recognition they deserve or at least improve the situation for the next generations of surgeons who will still come.

References

Rizzi Milton. Doctor James Barry (1795-1865): Inspector General of Hospitals of His British Majesty. Revista Médica del Uruguay. 2012; 28 (1), 66-74. Available in http://www.scielo.edu.uy/scielo.php?script=sci_abstract&pid=S1688-03902012000100010&lng=es&nrm=iso&tlng=en

Paulo D, Assis MS,  Kreuger MRO. Analysis of the factors that lead medical women to not choose surgical specialties. Rev Med (São Paulo). 2020; 99(3): 230-235. Available in https://www.revistas.usp.br/revistadc/article/view/150416

Franco T, Santos EG. Women and surgeons.Revista do Colégio Brasileiro de Cirurgiões. 2010; 37(1): 072-077. Available in https://www.scielo.br/scielo.php?script=sci_abstract&pid=S0100-69912010000100015&lng=en&nrm=iso

Wallis CJD, Ravi B, Coburn N, Nam RK, Detsky AS, Satkunasivam R. Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study.BMJ. 2017; 359: j4366. Available in https://www.bmj.com/content/359/bmj.j4366

Gargiulo DA, Hyman NH, Hebert JC. Women in surgery: do we really understant the deterrents.  Arch Surg. 2006; 141(4): 405-408. Available in https://jamanetwork.com/journals/jamasurgery/fullarticle/398312

Troppmann KM, Palis BE, Goodnight Jr JE. Women surgeons in the new millennium. Arch Surg. 2009; 144(7): 635-642. Available in https://jamanetwork.com/journals/jamasurgery/fullarticle/405169

About the authors

Beatriz Arrais Silva and Maria Eduarda Comunello are 20 year old students in the 4th semester of medical school at University Cesumar, in Southern Brazil. They are part of IFMSA Brazil Unicesumar, since their second year at the university. In 2021, Beatriz, joined the Local Director of Finance of IFMSA Brazil Unicesumar. Also, she is a member of Academic League of Rheumatology in her University. Maria Eduarda, in 2021, joined the local activity team of IFMSA Brazil Unicesumar and she is a member of Academic League of Family and Community Medicine of Maringá.