Leadership in American Surgery: Women Are Rising to the top

Susan E. Pories, MD; Patricia L. Turner, MD; Caprice C. Greenberg, MD, MPH; Maya A. Babu, MD, MBA; Sareh Parangi, MD


Annals of Surgery. 2019;269(2):199-205. 

In This Article

The Future

The field of surgery has been changed forever by the contributions of remarkable women who have pushed through sexual barriers at local and national levels. Sexual equity and inclusion of URMs in surgery is critical to the survival of our specialty, particularly now that more than half of all American medical students are female. We cannot forget that diversification and inclusion of women and especially URM women in American Surgery is ultimately what is best for patients and for our profession as a whole.[12] A number of pioneering women surgeons have fought personal and professional barriers to be able to stand alongside men at the pinnacles of surgical leadership, we must now all stand on the shoulders of these giants to move our specialty forward. We need to embrace key policy changes in our departments and medical societies to allow women surgeons and in particular underrepresented minority women achieve equity at the highest positions in surgery. Chairs and Division Chiefs should be encouraged to allocate resources to closing sex-related gaps in academic promotion, compensation, departmental resources, and research funding.

The Council on Graduate Medical Education (COGME) published a report on Minorities in Medicine in 2005 reflecting on progress made and making recommendations for the future.[24] The COGME was authorized by Congress in 1986 to provide ongoing assessments of physician workforce trends and recommend Federal and private sector efforts to address identified needs. Reports addressing URMs in medicine were published in 1990, 1998, and again in 2005. Although some progress has been made, as noted above, there are still opportunities for improvement. In fact, in 1997, Libby et al[25] estimated that reaching racial and ethnic population parity would require a doubling of Hispanic and African American physicians. It is of utmost importance that we continue to increase the number of URM women in surgery so that culturally competent surgical care can be provided to our increasingly diverse population. The efforts to this regard have to start early in the educational process. To this end, the yearly Women in Surgery conference led by Dr Sharona Ross and co-sponsored by the American College of Surgeons and industry support now includes a special session for high school students interested in surgery.[26] Women medical students, and especially URM women, need encouragement and affirmation about surgical careers.[27,28] Women surgical residents need exposure to a diverse faculty, equal treatment, ongoing flexibility, support, and mentoring to complete rigorous training.[29,30] Also, young faculty need mentoring and sponsorship to not only juggle clinical responsibilities but also start their families, and/or research careers, and also preparing to assume leadership positions locally and nationally. Other issues that will need ongoing attention to increase the number of URM women in the pipeline to surgical leadership include lessening the enormous debt accumulated by undergraduate and medical students, better support and preparation for academics and standardized testing including the USMLE and board examinations, and addressing systemic and institutional barriers faced by URM women in surgery.

How can we change the status quo? We need to educate young women, and men, as to the importance of inclusion and what this does to improve the surgical workforce. In addition, we need to acknowledge the concept of "second-generation sexual bias," which can be subtle assumptions or organizational barriers limiting women from assuming leadership roles. For instance, gendered career paths which seem to fit males more than females, and women's lack of access to sponsors within hospitals can be examples of this bias.[31] Mentorship is often cited as a need especially for young surgeons. Being a mentee carries a responsibility; to seek advice from seasoned surgeons as to career and family. Mentors who want to help promote inclusion can reach out to trainees or young surgeons whom they identify as having an aptitude for leadership. There are data to suggest that many young women are not told they can be leaders, and shy away from leadership roles for myriad reasons including family responsibilities or confidence concerns.[32] In addition, department leaders and mentors need to help women navigate unprofessional behavior, sexual bias, and exclusion from informal activities that create networking activities.[33] Reinforcing to our young surgical trainees, especially our young women and particularly URM women, that they can, and should be, leaders will help build their "leadership identity."

Every surgical society should look at increasing equity by examining the data on women in leadership positions such as committees, task forces, officers, and governing boards. Research on diversity and inclusion within all specialty societies in surgery should be a priority for our shared mission of training surgeons and providing excellent care.

Program committees in charge of meetings need to strive for equity when choosing speakers for symposia and sessions, panelists, moderators, and plenary/keynote speakers. Award/nominations committees should be tasked with finding worthy recipients for recognition and leadership that includes a broader perspective and avoids looking through a narrow lens to define accomplishments or only choosing from the inner "power circles."[34] Courses in leadership development programs, clear paths to leadership, mentoring programs, career coaching, and sponsorship are all additional ways to keep moving the needle on equity in surgery. Data showing the successes and failures of these endeavors should be tracked and shared publicly.

Finally, it is important to recognize the need for flexibility, accommodation, and support for all surgeons to meet their responsibilities outside of work. Surgeons have traditionally represented the sole breadwinners for their families and extended, inflexible work hours were possible as there was most often someone at home to manage all aspects of childcare, eldercare, and household duties. As women have increasingly entered the workforce, both men and women face increasing challenges in this area. The current data on burnout suggest that we are not meeting the needs of our changing workforce in this area. It is critical to recognize that both men and women need this support and will benefit from increased flexibility.

So, let us be the first to stand up in appreciation of the progress we have made in the American surgical community for advancing the goal of sexual equity in leadership. And let us keep the momentum going!