Sex and the orthopaedic surgeon: A survey of patient, medical student and male orthopaedic surgeon attitudes towards female orthopaedic surgeons

doi:10.1016/S1479-666X(09)80023-1

The Surgeon

Volume 7, Issue 2, April 2009, Pages 89-95

https://doi.org/10.1016/S1479-666X(09)80023-1 Get rights and content

Objective: To ascertain whether perceived negative attitudes regarding female orthopaedic surgeons impact on female medical student career choice of orthopaedic surgery and determine to what extent these perceptions hold true among orthopaedic surgeons and patients. Subjects and methods: A structured questionnaire, distributed to three study cohorts; 311 medical students, 182 patients and 54 orthopaedic surgeons from two specialist orthopaedic hospitals, asked questions pertaining to views regarding female orthopaedic surgeons. Binary questions and 5-point Likert scale statements were scored. Analysis was undertaken using Fisher's exact test and the trend test for proportions. Qualitative responses were categorised into themes and reported. Significance levels were set at ≤ 0.05. Results: Only 24% of female students would consider orthopaedic surgical careers, differing significantly from male students (p=<0.01). The reasons given included disinterest and male domination. Significantly greater female students had been exposed to negative attitudes regarding female surgeons (p=<0.01), of which 62% would not consider surgery. Most patients (89%) had no sex-preference for orthopaedic surgeon. Seventy-five percent believed women are surgically as skilled as men and 4% of the patients stated they had more confidence in female orthopaedic surgeons compared to males. Fifty-eight percent of the surgeons had never encountered negative attitudes. Of those that had, skill and family responsibilities were questioned. All agreed there is a place for women in orthopaedic surgical careers and welcomed diversity. Conclusion: Rumoured negative attitudes regarding female orthopaedic surgeons still exist among some orthopaedic surgeons, but not patients, influencing the undergraduate teaching experience and ultimate career choice in orthopaedic surgery.

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Male surgeons were found to hold an explicit bias associating women with careers in family medicine and men with careers in surgery, while surgeons regardless of gender shared this bias implicitly.10 Negative attitudes towards female surgeons were also found among male orthopedic surgeons, claiming that women do not have the skill or strength for surgery.11 Female medical students were also most likely to experience gender discrimination and sexual harassment in male-dominated fields, experienced greater levels of gender discrimination during their medical training than men, were 2.2 times more likely to report an effect of such experiences on their specialty choice and were 1.8 times more likely to report an effect on their residency program ranking.12
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Overall, study participants across all racial and ethnic groups did not overtly consider the race or ethnicity an important factor in choosing their surgeon, consistent with prior studies demonstrating that a majority of patients did not have a preference for race of their surgeon, but those that did, tended to prefer surgeons of the same racial background.37 Our study also demonstrated respondents did not have a gender preference when choosing a TJR surgeon, consistent with a prior study demonstrating that 89% of patients did not have a gender preference for their surgeon, and 75% of patients believed women are surgically as skilled as men.38 Such attitudes reflect a patient demographic that places importance on a surgeon's skill and ability.
Previous research has shown that patients from historically marginalized groups in the United States tend to have poorer outcomes after joint replacement surgery and that they are less likely to receive joint replacement surgery at high-volume hospitals. However, little is known regarding how this group of patients chooses their joint replacement surgeon. The purpose of this study was to understand the factors influencing the choice of joint replacement surgeon amongst a diverse group of patients.
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MD referral/recommendation appears to be the strongest factor influencing joint replacement surgeon choice. Other key considerations are hospital reputation and surgeon attributes—including operative experience, communication skills, and participation in shared decision-making. Gender/ethnicity of a surgeon, industry payments to surgeons, number of publications and cost did not play a large role in surgeon choice.
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In a survey with AAOS members, 66% of men and only 38% of women agreed with the sentence “women are treated fairly in orthopedics” [16]. In addition, another survey demonstrated that 85% of male orthopedic surgeons disagreed that discrimination against women exists at application for surgical posts [26]. Similar results were observed in a European neurosurgery study, where the majority of women believed that the gender argument was moderately important/important/very important, whereas most men believed it to be of little importance/unimportant [1].
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Persistent barriers to career advancement of women cited include gender roles, sexism in the medical environment, and lack of mentors.44,45 Many of these potential causes have been studied.42,46-64 Suggested causes by those who believe no bias is present include the “pipeline effect” in which there are an insufficient amount of women who have been in academia long enough to warrant reaching higher ranks, inherent lack of leadership skills, and less productivity.
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Citation Excerpt :
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Sex and the orthopaedic surgeon: A survey of patient, medical student and male orthopaedic surgeon attitudes towards female orthopaedic surgeons

AM J Surg

Soc Sci Med

Who wants to be a surgeon? A study of 300 first year medical students

BMC Med Educ

Surgery still an ‘old boys’ club?

Surgery

Career and life experiences of New Zealand women medical graduates

N Z Med J

Undergraduate experience of surgical teaching and its influence on Career Choice

ANZ J Surgery