Researchers at Queen’s University Belfast, in collaboration with the Gold Coast Health and the University of Melbourne, have produced a study that provides an insight into why there are so many more male than female surgeons, despite the increasing number of females in medicine as a whole.

The findings show that initiatives taken to improve the gender gap must address the multiple underlying factors or they risk making the issue worse.

In the UK and Australasia, women account for just 11% of consultant surgeons despite the fact that approximately 60% of medical students are women.

Women are at least as able on entry to surgical training but only a minority complete it, indicating a deep-rooted issue in the discipline.

The research, published by leading medical journal The Lancet, asked women to describe in-depth whey they had chosen to leave surgical training soon after they had started it, despite having wanted to be surgeons for much of their young adult lives.

Professor Tim Dornan from the School of Medicine, Dentistry and Biomedical Sciences at Queen’s University Belfast explains: “Previous research has assumed that those who continue to train as surgeons can provide answers to this vexed question.

This is fraught with problems when so many senior surgeons are men.

This was novel, first, because a young female surgeon did the research, and second because she asked those who know best – women who had chosen to leave.

This provided new insights.

“It is already known that young surgeons endure fatigue, long working hours, difficulty taking time off, strains on personal relationships, and bullying.

By analysing ‘leavers’ experiences in depth, we were able to show how these factors discriminated selectively against women.

One female former surgical trainee told how she was denied time off to care for her child when a male counterpart was given time off.

The request was, apparently, valid when made by a man and invalid when made by a woman.” 

Dr Rhea Liang, Female Surgeon and Principal Researcher at the Gold Coast Health, comments: “This is just one example of women being treated differently.

Rather than being treated as a surgeon requesting leave, they were first and foremost treated as a women requesting leave, which automatically put them at a disadvantage.”

A number of initiatives have been taken to bridge the gender gap and retain women in the profession, which have been ineffective as the gender gap prevails.

Professor Nestel of Melbourne University, also a member of the research team, said: “Female surgeons experience a wider identity gap between being a member of society and being a surgeon.

This has been addressed by trying to improve the situation for women, which risks leaving women feeling even more ostracised.

“In other words, well intended but ill-informed initiatives may have unintended consequences that aggravates the very situation they are trying to improve.

Encouraging female retention may only increase the identity gap as it makes them more aware of the different gender.”

Professor Dornan adds: “For the first time, we can hear the voices of those who have left surgery and understand deep-seated issues that need to be addressed in the long-term. It is only through understanding why or how the problem exists, that we can fix it.”

This qualitative research, published today (Friday 8 February) in The Lancet is part of a special edition “Advancing women in science, medicine, and global health.” 

This edition highlights that gender equity in science is not only a matter of justice and rights but is crucial to producing the best research.

By publishing new evidence, commentary and analysis, the journal calls on researchers, clinicians, funders, institutional leaders and medical journals to examine and address the systemic barriers to advancing women in science, medicine and global health.

Dr Liang concludes: “It is crucial that women have a voice, particularly in male-dominated fields. We are delighted that our research has been selected as part of the Lancet special edition to shine a light on the gender issues that prevail in the science, medical and global health fields.”