Why We Need More Women Surgeons

The research suggests patients fare better when females are operating, but that isn’t the only reason we need better representation in our ORs.

Surgery is still largely a male-dominated profession across all service lines, but nowhere in the industry is the disparity more pronounced than orthopedics. Just 5.9% of orthopedic surgeons in the U.S. are women, according to the American College of Surgeons.

Michelle S. Caird, MD, a pediatric orthopaedic surgeon and chair of the department of orthopedic surgery at Michigan Medicine in Ann Arbor, is part of that minority. For Dr. Caird, the journey to become an orthopedic surgeon — and the first woman appointed chair of the Michigan Medicine Department of Orthopedic Surgery in the health system’s history — started in her childhood. She spent a lot of time around the hospital watching her father, a vascular surgeon, work and realized, This is something I can see myself doing.

There are very complex problems to be solved in health care, and to best address these problems, we need lots of different perspectives.
Michelle S. Caird, MD

Paying it forward

Now that she’s become an important and influential part of a service line in which women are drastically underrepresented, Dr. Caird sees it as her responsibility to show others — many of whom wouldn’t even know a career like hers is a possibility — that there’s a path to becoming an orthopedic surgeon. “I feel really lucky to be able to help more women, and more people from diverse backgrounds, to envision themselves as orthopedic surgeons, to consider this as a specialty and then to actually enter into orthopedics,” she says. “I feel like I have a tremendous opportunity to tell more people how great this is and what an exciting career choice orthopedics is.”

Dr. Caird’s reason for working diligently to bring more women into her field speaks to the foundation of why so many healthcare facilities are now placing a premium on diversity, equity and inclusion. “The need for diversity is in understanding that there are very complex problems to be solved in health care, and to best address these problems, we need lots of different perspectives,” she says.

In health care, decisions are driven by data, and the data offers some compelling reasons for working to grow the percentage of women surgeons. In fact, a series of recent comprehensive research papers found that patients treated by female surgeons were less likely to experience adverse complications and readmissions at 30 days, 90 days and one year post-op. Specifically, the research found that at 90 days post-op, patients treated by male surgeons experienced complications around 14% of the time, compared to 12.5% of the time when treated by female surgeons. At one year post-op, the gap was even larger, with male-treated patients experiencing complications 25% of the time, whereas for female-treated patients, that percentage dropped to 20%. The research also found that patients treated by female surgeons had lower healthcare costs at 30 days, 90 days and one year following surgery compared with those treated by male surgeons.

Granted, we’re not talking about glaring disparities and major differences in outcomes here, but the findings are notable — especially when you consider the depth of the data. Researchers used the records of more than 1.3 million male and female patients operated on by almost 3,000 Ontario, Canada, surgeons over a 12-year period. What’s more, researchers made it a point to account for as many factors as possible, including age, income, health status, the age and experience of the surgeons and the location of the procedure (small community hospital, major medical center, etc.).

As you can imagine, the findings spread well beyond the medical community and were picked up by major news outlets that leaned into the women-are-better-than-men angle. Such comparisons, however, obscure the more important and beneficial findings in the research, according to Angela Jerath, MD, a study coauthor and anesthesiologist and associate professor at the department of anesthesiology and pain medicine at the University of Toronto. “The discussion needs to move away from a battle of the sexes and move toward what we can learn from the data,” says Dr. Jerath. “This is a patient safety issue. What can we learn to have better outcomes?”

Instead of arguing about the details or the merits of the data — data that Dr. Jerath points out has come from millions of patients and is among the best in the world — the next steps should revolve around examining the attributes of male and female surgeons that are slightly different and why patients appear to be buying into the latter.

“It’s about analyzing the characteristics that are germane to males and females, whether they are biological, learned and environmental, and trying to find out what we can learn from them,” says Dr. Jerath. “Again, the ultimate goal is to provide the best patient care with the cost restraints that we have.”

Culture shift

Dr. Jerath’s research certainly gives credence to the need for increasing the percentage of female surgeons — particularly in subspecialties like Dr. Caird’s.

For such an increase to occur, however, Dr. Jerath says it’s critical for leadership of surgical facilities to take a long, hard look at their organizational culture and for those in positions of power to start thinking about policies that encourage women to apply. “There are plenty of organizations that bring women in but don’t allow them to flourish,” she says. “Inequities in funding, promotion and leadership need to be addressed, and all of it needs to be done through a transparent and merit-based process.”

For her part, Dr. Caird is committed to addressing all these things. The key to increasing representation, she says, is doing the outreach early on in prospective orthopods’ formative years.

“There’s a long list of ways that we reach out at all different levels, so that we can really encourage people of all ages — not just the individuals who are already in medical school — and expose them to what a fun and exciting career choice orthopedic surgery can be,” she says.

That exposure ranges from doing outreach to middle schoolers in the community to partnering with the university’s Office of Health Equity and Inclusion to offer scholarships to medical school students for a trial clerkship to determine if they can see themselves working for the health system for their residency.

Of course, not every organization has the resources and funding of an academic facility like Michigan Medicine. Still, there are plenty of things being done at Dr. Caird’s organization that any surgical facility leader can do at their own center to attract, recruit and retain more female surgeons. For starters, you may want to offer some training and guidelines to ensure implicit biases aren’t negatively impacting your hiring process. “We have some really nice checklists that address bias, and we train all of our residents and our faculty on this,” says Dr. Caird. “We’re also extremely careful with our recruitment, and we went through a standardized process so that whenever we post a job it’s seen by as many diverse applicants as possible.” For instance, whenever a position in Dr. Caird’s department becomes available, in addition to the usual sites, it’s posted with the Ruth Jackson Orthopaedic Society, an organization dedicated to promoting the professional development of women in orthopedics throughout all stages of their careers.

And what does Dr. Caird think of the research pointing to women surgeons achieving better overall outcomes than their male counterparts? She sees research like Dr. Jerath’s as proof of the power of diversity in surgery. “I think different communication styles probably do result in different outcomes for any complex situation,” she says. “If I personalize it, I try really hard to work with people who acknowledge everybody’s contributions, knowing that I can’t do everything, that I would never presume a good outcome or a bad outcome comes from just me.”

Approaching every patient situation as the sum of an entire team’s efforts and expertise, she adds, is one way to improve patient safety and ensure that everyone is sticking to the treatment plan. “If more women surgeons have that type of communication style, then I think that’s probably where the findings in that research stem from,” says Dr. Caird.

Regardless of the “whys” behind the research, the fact that it exists is more than enough reason for facilities to step up their efforts to grow the number of women surgeons. OSM