WOMEN IN SURGERY Past, Present and Future Dixie Mills, M.D., FACS Department of Surgery Maine...
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Transcript of WOMEN IN SURGERY Past, Present and Future Dixie Mills, M.D., FACS Department of Surgery Maine...
WOMEN IN SURGERYWOMEN IN SURGERYPast, Present and Future Past, Present and Future
Dixie Mills, M.D., FACS
Department of Surgery
Maine Medical Center
September 19, 2003
Women in SurgeryWomen 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 SurgeryWomen in Surgery - History - History
Ancient History– Egyptian and BC evidence
Middle Ages– Women of Salerno and the Crusades– Tortula’s Gynecological Text
The 1400’s to 1800’s - The “Surgeoness”
The “Beardless Lad”The “Beardless Lad”Dr. James Barry - 1795-1865Dr. 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 BlackwellDr. Elizabeth Blackwell1821-19101821-1910
1st woman medical graduate in the US - 1849
Women in SurgeryWomen in Surgery - History - History
Turn of the Century-6% 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 SurgeryWomen in Surgery
History of Women in SurgeryHistory of Women in Surgery Recent rise in Women in Medicine
Women in MedicineWomen 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
Percent Distribution of Total US Percent Distribution of Total US Physicians by Age and Sex, 2001Physicians by Age and Sex, 2001
0 5 10 15 20 25 30 35
Under 35
35-44
45-54
65 and over
MenWomen
U.S. Physicians 1970-2001U.S. Physicians 1970-2001
0%
20%
40%
60%
80%
100%
Men 305,317 413,395 511,227 603,253
Women 25,507 54,284 104,194 205,903
1970 1980 1990 2001
Women in SurgeryWomen in Surgery
History of Women in SurgeryHistory of Women in Surgery Recent rise in Women in MedicineRecent rise in Women in Medicine Women in Surgery today
Surgeons – 2001*Surgeons – 2001*N = 157,669N = 157,669
*AMA Physician Characteristics 2003*AMA Physician Characteristics 2003
0
10000
20000
30000
40000
50000
60000
W = 25,563 4421 15032 3715 2395
M =132,106 33,114 26010 24410 48572
GenSurg Ob/Gyn Opt/Ot Other
Surgeons - 2001Surgeons - 2001N = 157,669N = 157,669
0%
20%
40%
60%
80%
100%
GenSurg Ob/Gyn Opt/Ot Other
Surgeons – 2001Surgeons – 2001N = 157,669N = 157,669
0%
20%
40%
60%
80%
100%
Men = 132,106 Women = 25,563
Opth/OtoOB/GOtherGeneral S
Other Surgical Specialties - 2001Other Surgical Specialties - 2001
0
5000
10000
15000
20000
25000
Women 857 358 675 239 142
Men 22,056 10,039 5747 4773 4884
ORS Uro Plas Neuro Thor
General Surgeons over TimeGeneral Surgeons over Time
0%
20%
40%
60%
80%
100%
Men 32884 35870 34257 33178
Women 1150 2406 3302 4429
1980 1990 1995 2001
ACS Membership by Gender ACS Membership by Gender
0%
20%
40%
60%
80%
100%
Men 41543 52330 47007
Women 1742 2431 2628
1998 2000 2002
Women Surgeons in Illinois-2001Women Surgeons in Illinois-2001N= 1,285/6,398N= 1,285/6,398
0
200
400
600
800
1000
1200
1400
Total General OB/GYN Other
SurgeonsResidents
Characteristics of Women SurgeonsCharacteristics 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 SurgeonsCharacteristics of Women Surgeons 19941994
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 SurgeryWomen 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 SurgeryWomen 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 - 2001Residents - 2001N = 93,674N = 93,674
0
5000
10000
15000
20000
25000
Medical Surgical Other Family
W=37428M=56246
Surgical Residents- 2001Surgical Residents- 2001N= 20,839N= 20,839
0
1000
2000
3000
4000
5000
6000
Women=6442Men=14,397
Women=6442 1847 3363 603 629
Men=14,397 5883 1375 1871 5268
Gen Surg OB/GYN OP/OT Other
Other Specialties - 2001Other Specialties - 2001Residents/FellowsResidents/Fellows
0
500
1000
1500
2000
2500
3000
3500
ORS Uro Plas Neuro Thor
WomenMen
Surgical Residents - 2001Surgical Residents - 2001N=20,839N=20,839
0%
20%
40%
60%
80%
100%
Men 5883 1375 3164 847
Women 1847 3365 291 121
General OB/GYN Ortho Uro
Women in SurgeryWomen in Surgery
History of Women in SurgeryHistory of Women in Surgery Recent rise in Women in MedicineRecent rise in Women in Medicine Characteristics of Women in SurgeryCharacteristics of Women in Surgery Association of Women Surgeons
Association of Women SurgeonsAssociation 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 SurgeonsAssociation of Women Surgeons
Mission Statement-
To inspire, encourage and enable women in surgery to realize their professional and personal goals
Association of Women Surgeons -Association of Women Surgeons -GoalsGoals
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 2003AWS - 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
AWSAWS
Membership Directory Quarterly Newsletter Website, E-zine, listservs Pocket Mentor Fall Conferences Networking Meetings at other conferences
AWSAWS AWS-Ethicon Endoscopic Fellowship Award AWS Outstanding Woman Resident Award AWS Visiting Professor Code of Conduct approved by ACS Family Leave Policy
Surgical Leadership -2003Surgical 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 AcademicsWomen in AcademicsNEJM - 2/00 - Associate ProfsNEJM - 2/00 - Associate Profs
0%10%20%30%40%50%60%70%80%90%
100%
Surgery ObGyn Radiology Anesthesia Peds
MenWomen
Academic MedicineAcademic 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 ofIssues in the recruitment and success of women in academic surgerywomen in academic surgery - - Colletti Colletti Surgery Surgery 8/2002 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 FutureThe Future
Is there a problem? Can it be fixed? Where to “attack” it Where in the pipeline to start?
Medical StudentsMedical 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- TrendsWomen in Surgery- TrendsMedical Students to Surgical ResidentsMedical Students to Surgical Residents
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
W Medstud 3894 17248 24286 30853
W SurgRes 800 2850 4200 6442
1970 1980 1990 2001 2010
Women General Surgical ResidentsWomen General Surgical Residents
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
1983 1990 1998 2001 2002 2003
WomenMen
Top Specialties - 2001Top 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 SolutionsPossible 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 FutureThe Future
Much can be done to encourage women to Much can be done to encourage women to pursue surgery. Surgery cannot remain pursue surgery. Surgery cannot remain competitive, attracting the best and the competitive, attracting the best and the
brightest if the selection pool is reduced by brightest if the selection pool is reduced by half. Promoting a surgical lifestyle that half. Promoting a surgical lifestyle that allows individuals to balance family and allows individuals to balance family and work, enabling both male and females to work, enabling both male and females to fulfill parenting and life roles is essential.fulfill parenting and life roles is essential.