Are you sure?
The Challenges of Being A Female (Acute Care) Surgeon
My 17-year journey to become an Acute Care Surgeon started when I applied for medical school in my senior year of high school. I went to a 6-year combined-degree medical school and then completed a 6-year surgical residency. At age 29, I began my practice as a General Surgeon. After 3 years as a Staff Surgeon, during which I had one combat deployment and one medical readiness exercise in Africa, I then chose to complete an acute care surgery fellowship. Our acute care surgery department was comprised of 14 surgeons, only 3 of whom were female.
Surgery has historically been a male-dominated specialty, and female surgeons continue to face significant obstacles.(1) There has been a noticeable shift with more females choosing surgical specialties, although they continue to be under-represented in trauma. This can create a sense of rivalry or competition, the need to be seen as equally competent as our male colleagues. On top of the difficulties inherent to surgical training and practice, the constant pressure to live up to expectations can foster stress and doubt. Imposter syndrome, which is "a psychological pattern in which people doubt their accomplishments and have a persistent, often internalized fear of being exposed as a ‘fraud’," can result.(2)
Are You Sure This is What you Want to Do?
Twelve years ago, during my internship, I was in the process of reapplying for the remaining 5 years of my surgical residency (a phenomenon that was subsequently eliminated from military surgery residencies). As I asked one of the senior (male) surgeons for a letter of recommendation, he discussed the issue with me in the middle of a busy clinic, with other residents and staff present. He asked if I was sure I wanted to do a surgery residency, and he encouraged me to consider other career paths. Thankfully, I did not experience this discrimination from any of my other staff. But I do wonder if there was discrimination of omission...were my male co-residents provided encouragement or advantages that I was not afforded? In my small residency, with a total of 18 residents, we had a total of 5 females during my first year, including another female intern. I felt encouraged that 2/3 of my class was female, but this was the exception and not the rule.
Eight years ago, during my surgical residency, I was at a very busy Level 1 trauma center. I can't recall the exact ratio of male to female surgeons, but I know women were in the minority. During a non-emergent trauma case, there was a product representative in the room. During a casual conversation, he was clarifying who was the surgeon. When the senior surgeon in the room (a female), introduced herself, he actually stated "Oh I didn't know women could be trauma surgeons."
In an article published in the American Journal of Surgery in 2019, half of all hospitals with emergency general surgery services reported no female surgeons. For the subset of hospitals with EGS services who have an ACS Model, they reported a higher median proportion of women surgeons (17%).(3) Specifically in trauma surgery, women are still under-represented. 28% of surgeons who are board-certified in critical care are female. Thankfully, our voice is gaining strength. More women are going into surgical disciplines, and there are more woman in leadership positions in surgical organizations.(4) 29% of EAST members and 13% of AAST members are female, although there has been an increase in female executive leaders in AAST.(5)
"Why should women have to sound like men to get people to listen to them? Why isn't it that everyone in the room should be quiet when she asks for quiet because she is a doctor asking for quiet?"
"The theme was clear. Women physicians do not get the same respect men get when dealing with emergencies."(6)
Women bring unique strengths to this discipline. It's not a matter of competing to prove that we are superior, but women are inherently different from men and this should be nurtured, not belittled, or ridiculed. Improved communication and patient engagement are just a few of the benefits we can bring to the team.
Researchers Find Women Make Better Surgeons Than Men. "The authors attribute the favorable patient outcomes to the female doctors’ ability to communicate and engage with their patients to ensure compliance with medications and therapy, their adeptness at collaborating with colleagues and their tendency to adhere to guidelines when treating patients."
This is not a simple problem, and it won't have a simple solution. So what can you do to combat the stereotypes and respectfully establish and maintain your position comparable to your male surgical colleagues? I've learned a few things over the years, with a handful of specific things over the years of my fellowship.
Introduce yourself with your Title and name. Previously, I introduced myself as "Christina, part of the surgical team". I regarded my introduction as a display of humility. But I was actually unintentionally undermining my role in the team. I now introduce myself as "Dr ----, one of the trauma surgeons/ acute care surgeons" or "Dr ----, the trauma surgeon/ acute care surgeon who will be taking care of you."
Find your team. Seek out mentors, or be a mentor for a younger trainee. Seek support from those who have led the way in this specialty.
Get involved. This can be done at all levels, from hospital-level leadership and committee membership, city/ state/ national trauma organizations/ associations
Counteract the negative thoughts that can accompany Imposter Syndrome. Keep a list of your strengths and the reason why you chose this specialty.