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Why we need more casual feminism in surgery

Great surgeons come from all different backgrounds and genders. With still so few women surgeons, the profession is missing out on talent, narrowing its horizons, and arguably operating one-handed. Andy Murray reached the top of his sport, aided in large part by female coaches, and is lauded for his casual feminism. The surgical profession would do well to take note and follow his lead.

In the business world, companies with women on the board may be more profitable. It has even been suggested that female surgeons might have better post-operative outcomes than male surgeons. 
Edinburgh is the base for eoSurgical. Its founders have all benefited from its undergraduate and postgraduate surgical education. It was also in Edinburgh, in 1869, that seven students led by Sophia Jex-Blake, faced unbelievable opposition to their wishes to become doctors including the assertion of inferior intellect (swiftly banished by them scooping a number of the medical school prizes). Entrenched sexism even resulted in a riot in which a drunken mob of male students prevented their entry into the RCSEd’s Surgeon’s Hall for an anatomy exam. It was only in 1877 that five of these women finally had their names added to the medical register. 
What about today? In the UK in 2017, 59% of those accepted to medical school were women. But by the end of medical school, there is already a significant gender separation with 22% of men and 13% of women declaring surgery their first choice long-term career. At the consultant level in the UK, surgeons show a persisting, embarrassing, 8:1 ratio of men to women.

Organisations such as Women in Surgery are working hard to redress the balance but progress is painfully slow. Why? Bullying and undermining at work is a major issue in surgery and whilst certainly not the sole preserve of male surgeons, a work environment dominated by men is clearly largely responsible. Perhaps women are rightly more intolerant and pre-emptively seek a different path. Time out of program raising a family also adds to the challenge of a career that demands time in the operating theatre. A cultural change towards parity of parental leave is needed.
There is a recent, generational perception that the antisocial aspects of surgical training and a surgeon’s life are simply not outweighed by the rewards of the job. This is reflected by competition for surgical training posts plummeting in recent years.  The message that surgery is challenging but also enjoyable and hugely rewarding needs to re-invigorated by those in positions of authority; and crucially this must be done in a way that appeals to trainees of different backgrounds and genders. We need to ensure a diverse workforce that brings in the best talent and delivers the best results for our patients.
Mark Hughes
Director, eoSurgical 
Clinical Lecturer in Neurosurgery, University of Edinburgh