The many barriers to being a female surgeon

Slowly, imperceptibly, the air had been let out of my ambition tyre to work in surgery

I am not a surgeon.

I nearly was. When I filled in my CAO form in 1994, I had a very clever plan to move to Dublin, attend the RCSI, and become a kick-ass general surgeon (I didn’t know of any other kind). I would be away from home, swishing my crisp white medical coat down oak-lined hallowed halls, and sharpening my scalpel at the back of lofty lecture theatres.

But then my parents informed us that they were selling our house and sailing around the world for two years, so I suddenly had the option to stay in Cork and still be free from parental scrutiny. And let’s face it, no right-minded Cork person ever actually leaves.

So, I changed my CAO preference to UCC, but held on to the notion of surgical ass-kicking.

It is hard for me to pinpoint the exact moment when I re-wrote my own narrative and convinced myself that I had never really wanted to be a surgeon, that I had just said that because my grandfather had been one, and it sounded cool. I told myself (and three consecutive training scheme interview panels) that my true calling was to general practice, because I loved the continuity of care and the “cradle-to-grave approach” (not the first time the panels had heard that old chestnut).

Did it happen on my first surgical rotation as a medical student, when I was partnered with another female classmate, and we both commented on how much time our consultant spent tutoring our respective cleavages? Or was it later on, when we moved to a bigger hospital, and noticed that out of the 15 or so surgeons in the place, not a single one was a woman? And that the theatre changing rooms were marked ‘Nurses’ and ‘Doctors’?

It could have been something to do with the response I got from senior clinicians when I hinted that I might be considering a surgical career. They ranged from “Why?” to “Don’t,” with very little in between.

I remember with exquisite clarity the moment when I copped on that I never wanted to work in a hospital environment again – hour 36 of my first weekend on call as an intern – but my surgical aspirations had been incrementally squished to nothingness long before that. Slowly, imperceptibly, the air had been let out of my ambition tyre, with only a tiny little subconscious ‘hiss’ to alert me to it. I wasn’t strong enough to carry the SUV-load of microaggressions and unconscious biases. I just “knew” that I couldn’t be a surgeon.

So, when I read recently that a large Canadian study  found that patients treated by female surgeons have lower rates of adverse post-operative outcomes, compared with those treated by male surgeons, I was suddenly a little bit wistful. I could have been one of those kick-ass women who were providing excellent care to their patients, with lower rates of post-op complications. Of course, the study created a bit of a stir in the surgical community. While it is societally entirely acceptable to say that women are “naturally better” at such things as cleaning toilets and wiping bottoms, it seems it is less, em, palatable to society in general to suggest that women may simply be superior surgeons. Of course, there is far more to it than biology and who has longer X chromosomes, and the researchers encourage further exploration and analysis of these (statistically significant and replicated) findings.

And then another piece of research about surgeons was published in the British Journal of Surgery. This time, there was not so much to cheer about. A study of UK surgical workforce members found that women were statistically more likely to have experienced sexual harassment and sexual assault than their male colleagues. 30 per cent of women had been sexually assaulted compared to 7 per cent of men, with rape being eight times more likely to happen to women.

In Ireland, IMO research in 2021 revealed that 40 per cent of female and 14 per cent of male doctors had experienced sexual harassment in the workplace. The Central Statistics Office also published the findings of their sexual violence survey last year. It showed 52 per cent of Irish women have experienced sexual violence in their lifetime, compared to 28 per cent of men.

The UK study has been covered widely in the media, with many professional bodies and regulators announcing ‘strategic overhauls’ and ‘prompt action’.

The response to the IMO report was significantly less strident, despite the findings being equally appalling.

I worry that my tyre of ambition to campaign for gender equality might have a slow puncture.