Well over half of students enrolled in Canadian medical schools are women and that’s been the case for 30 years. However, women continue to be underrepresented in surgical specialties. While parity has been achieved in OBGYN, trends in Canadian medicine and surgery anticipate gender parity will not be achieved for general surgery until 2043, plastic surgery in 2053, otolaryngology in 2062, ophthalmology in 2070, urology in 2123, orthopedics in 2124, neurosurgery in 2125, and cardiac surgery in 2237. VCH stats indicate that 42.8 per cent of our surgeons are women. That drops to 31.7 per cent when OBGYN is excluded.

To address this disparity and to seek opportunities to move the needle, the VCH Medical Staff Equity, Diversity and Inclusion Committee’s Culture and Environment Subcommittee presented Women in Surgery: 2024 – Where Are We Now? two days prior to this year’s International Women’s Day. Committee Co-chair Dr. Helen Kwoo, a family physician and surgical assist at Richmond Hospital, facilitated this session with panelists Dr. Amanda Hu, an ENT surgeon at VGH, Dr. Lynn Fedoruk, chief of cardiac surgery at Royal Jubilee Hospital, and Dr. Fay Leung, an orthopaedic surgeon at Richmond Hospital.

Dr. Kwoo noted that discussions of this nature can be divisive and may make some individuals feel targeted. She emphasized this was not the intention of the session; rather the committee’s objective is to help build stronger teams that can provide even better patient care.

The conversation began with the three surgeons talking about what inspired them to pursue their careers. They all referred to people who had mentored them early on and the passion they felt for their specialities. While it could be intimidating when there was no one else who looked like them in their areas, they all found someone who cultivated their interest and encouraged them to carry on.

Dr. Kwoo asked if any of them felt they had to hide their true selves in order to fit in. Dr. Hu recalled an instance in her first year of medical school during the SARS outbreak in Toronto. A patient did not want her to treat him because of her race. She was told to take the day off; there was no debriefing. The recent pandemic saw another wave of anti-Asian racism; this time Dr. Hu felt there was more support thanks to EDI measures. Dr. Fedoruk recalled her days at the University of Virginia, where she did not hide that she is gay, but she did downplay it. It was impossible for Dr. Leung to hide her two pregnancies—first when applying for residency and next when she was a junior staff member. She recalled being asked a lot of questions about how her personal life would affect her professional life. To this day, she tries to steer her professional conversations away from personal matters.

As a surgical assist, Dr. Kwoo recognizes that the surgeon often sets the tone in the operating theatre. She asked our panelists about their leadership styles and whether they felt theirs was different from men surgeons. Dr. Hu said she is a time pacer—she values efficiency and meeting deadlines. Dr. Fedoruk believes she is more collaborative than authoritarian but holds people accountable for their actions and lets them know if they are acting inappropriately. Dr. Leung remarked that she feels she has to ride a line between being seen as too aggressive or too passive. She finds communication important, and that people respond better to her when she is collegial. Men, she notes, have an inferred level of authority.

Patients with women surgeons, Dr. Kwoo noted, had less complications in a study published in JAMA Surgery (August 30, 2023). This is a modest but consistent finding. Why then, she asked, are there so few women in the specialties our panelists represented. According to Dr. Hu, ENT is a hidden specialty that is often discovered serendipitously. While it may be the best kept secret in surgery, Dr. Hu also acknowledged that there are long hours, you are expected to be there when needed, and unexpected emergencies happen. While Dr. Fedoruk questions the projection that it will take until 2237 for there to be gender parity in cardiac surgery, she did note that there are long hours with long surgeries in her specialty. Cardiac surgeons, she suggested, are still learning how to balance their professional and personal lives. Dr. Leung, meanwhile, finds there are many biases about orthopedics from other medical areas as well as people not working in health care. Women surgeons are expected to be nurturing.

Citing recent media reports of sexual assaults on women surgeons, trainees, and students, Dr. Kwoo asked the panelists what barriers they have faced and how they overcame these. Dr. Hu recalled many microaggressions that were not intended to be malicious. These include being called honey, dear, or sweetheart, and being mistaken for a nurse. She always introduces herself as the patient’s surgeon. Dr. Fedoruk does her best to ignore questions such as what does your family think, or have you talked with other women about what you’re getting into. She advices others to come up with their own defence mechanisms. Dr. Leung struggles with shrugging off microaggressions; while this may be easier, she feels it makes her complicit. Most of the microaggressions she encounters come from allied staff and patients and their families. She suggested building a toolbox and to think of how to respond to a situation before you find yourself in it. (Dr. Leung also shared a link to a video from the American Association of Hip and Knee Surgeons Women in Arthroplasty Committee that gathered actual comments spoken to women surgeons by colleagues and patients to bring awareness to discrimination in the workplace.)

Dr. Kwoo inquired whether our panelists had noticed staff being more attentive to men surgeons. Dr. Hu replied that this has been a challenge for her, partly because of how society expects women to act. While men are often seen as leaders and assertive, women are often described as bossy and difficult to work with. She noted that she will sometimes assist nurses to try to build bridges, whereas she doubts her male counterparts do the same. Dr. Fedoruk recalled a different experience: she just does her thing and hasn’t noticed if it’s different. Dr. Leung suggested that women have to try harder and sees expectations put on her that men don’t experience.

In a call to action, Dr. Kwoo asked the panelists what they think needs to be done for there to be more women in surgery. It needs to start in medical school, replied Dr. Hu, with women students encouraged to pursue their interests. We need to mentor more women, be role models, and encourage our male allies to speak up for women. The VGH ENT Department, she mentioned, has a network of surgeons and trainees who meet quarterly to share experiences as women in surgery. At past meetings, members have reviewed journal articles on gender pay inequity as well as on misidentification as a microaggression. Dr. Fedoruk is part of a women in cardiac surgery national group. She said we need to understand that women are coached and trained differently, and we need to go back to our medical schools and change the way this is done. We need techniques that are gender neutral and more positive; we need to be better at training our teachers. Dr. Leung would like us to shift the concept of leadership exclusivity and to see the successes of other women as successes we all can share. We need to embrace that we are allies rather than competitors. She is conscious of genderized roles and what she models to her two sons.

Our panelists provided their insights on what advice to give women considering their specialties. They agreed that it’s vital to encourage people to choose something they love and that they can continue to feel passionate about well into their careers. Finding someone whose career resonates with you is a great first step to finding a mentor.

Feedback from the event

Thirty of the 75 attendees completed the post-event evaluation. Comments about what resonated most from the session included:

• I am not the only one going through the experiences as a female surgeon.
• Women in medicine are making global progress.
• I am very proud of my female colleagues. They are making the world a better place.
• The gender gap in BC is closing but there’s still a lot of work to do in certain specialties.
• We all need to role model.
• The honest opinions and the differences experienced between each of the surgeons.