International Women’s Day 2021 - #ChooseToChallenge

International Women’s Day 2021 - #ChooseToChallenge
2021 presents an unprecedented time for women in surgery, exemplified by the fact that the BSSH, BAPRAS, BAAPS, and the ABS all currently have female Presidents, with a female Vice President Elect currently in post at the BOA. In order to celebrate this incredible milestone, each President has very kindly shared their experience as a woman in surgery, including how they have challenged and overcome certain expectations and stereotypes in their respective specialties, and their advice for future budding female surgeons. A female Trainee from each Association has also shared their own account to provide a comparison of experience between the generations.

BAPRAS President – Ruth Waters
When I was a 3^rd year medical student I was able to go to theatre to watch an operation to remove a carotid body tumour. By the end of that day I knew I wanted to be a surgeon. I knew that not many women went in to surgical specialties at that time but the more I saw of it, the more inspired I became and knew I had to pursue it, despite more than a few people telling me it was not a career for a woman. I have now been a consultant plastic surgeon in Birmingham for nearly 25 years and have found the no conflict in combining family life and a demanding career. Both have brought me great happiness and I feel very privileged to have been able to do this. What surprises and troubles me now is that some medical students still tell me that they have been told that as a woman they will not be able to pursue a career in surgery.

It seemed wrong when I was told that all those years ago, but with so many more women now doing it I can’t understand why they should be discouraged in this way. There is so much evidence now that women, married or otherwise, make great surgeons and all surgeons should be supported to have the family life they choose. My own daughters have grown up to be confident wonderful people who, together with my husband, are my best friends. I think the fact that Eve has also chosen to pursue a surgical career is great because I know she will excel in it and I hope it will bring her all the fulfilment that I have been fortunate to experience.

Plastic surgery, I am pleased to say, currently has one of the highest percentages of female trainees of all the surgical specialties. BAPRAS welcomes and supports anyone who has the enthusiasm and dedication to pursue a career in plastic surgery regardless of who they are. I am delighted to have been elected to be President of this pioneering association with its long history of innovation and excellence. The only previous woman President was Anne Sutherland in 1987 who was also the first woman to be appointed as a consultant plastic surgeon in the UK. I hope there will be many more.

Orthopaedic Trainee – Eve Robertson-Waters
Despite growing up in a ‘medical’ family, my sister and I have been encouraged at every step to ‘do what we love’, whatever that may be. As it happened, I found it impossible not to be fascinated by surgery. Mum is what I imagined a surgeon to look like, and so throughout my life I never doubted that I could do that too. Applying for medical school, I had heard people suggest that this might not be the most compatible career for a woman, especially one who wants a family. Surprisingly, at the age of 17, having a family was not top of my agenda. I found it strange that anyone should make me think about this, and was confused that this did not fit with the evidence available to me: my mum is a surgeon. Not just that, she is the best mum; and, judging by the kitchen adorned with ‘thank you’ cards, a great surgeon. I decided to politely ignore those people.

In Bristol, I was fortunate enough to meet the (all-male) academic orthopaedic team who came to be friends and mentors, and inspired me to choose orthopaedic surgery as a career. They demonstrated to me that orthopaedics was a team sport, advocating robust collaborative surgical research, with the National Joint Registry. I realised this was a field in which I could apply my love for science to hopefully improve surgical practice. At no moment, from founding the University Orthopaedic Society with my colleague and friend Dr Elizabeth Wilson, to writing my first publication, to attending theatre or fracture clinic, did anyone from that team do anything but offer their wisdom and support; and this has been the same here in Cambridge.

I have been lucky to have only met those who have supported rather than pushed me away from orthopaedics. As a medical student in 2015, my friend was told that the orthopaedic theatre was not a place for women, after which she, understandably, left.

Faced with a hypothesis, a good surgeon should look at the data. Women make up only 20% of surgeons in England; in orthopaedics it is just 6%, with severe attrition at every training grade(1). The reasons for this and ways to mitigate it have been explored in a recent systematic review(2). It’s an eye-opening read – even academic output is lower for women in orthopaedics.

So, it seems I am not necessarily taking the path most trodden, but if Robert Frost is to be believed, that won’t be such a bad thing. In fact, I think it is up to our generation to pave the path, and I am proud to see that could be happening. There is a great social media presence from trainee orthopaedic surgeons such as @orthopodreg who are aiming to flatten the surgical hierarchy, and promote campaigns such as #CutItOut and #HammerItOut. These are now regular feature sessions at national surgical conferences, advocating the discussion surrounding and prevention of bullying and discrimination of all kinds.

This is an excellent way to engage those who are the future of surgery: medical students and foundation doctors. The evidence suggests that early exposure to surgery increases the likelihood of applications for training (2). Indeed, my passion for surgery certainly started at medical school, and mentors helped me at every step. I think it is really important for trainees to engage with mentorship and teaching, and be the bridge for medical students to become part of the surgical team. This could be as simple as proactively bringing a student to theatre and getting them involved. I am confident that if every trainee did that, we’d start bringing about the cultural change required to make the stats above a thing of the past.

1. Moberly T. A fifth of surgeons in England are female. BMJ. 2018 Oct 30;363:k4530.

2. Halim UA, Elbayouk A, Ali AM, Cullen CM, Javed S. The prevalence and impact of gender bias and sexual discrimination in orthopaedics, and mitigating strategies. Bone Jt J [Internet]. 2020 Oct 31 [cited 2021 Mar 3]; Available from: https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620X.102B11.BJJ-2020-0982.R1

Find out more about the experiences of women in surgery at the following Associations/Societies:

British Association of Aesthetic Plastic Surgeons - BAAPS
Association of Breast Surgery
British Society for Surgery of the Hand – BSSH
British Orthopaedic Association - BOA