What is the problem?
Achieving and maintaining a diverse surgical workforce is essential to eliminate healthcare disparities in patient care, improve patient outcomes, increase innovation in health research, and cultivate future generations of surgeons. Nevertheless, considerable gender-based inequities persist for women in surgery. As of 2014, only 19% of Associate Professors, 10% of Full Professors and less than 5% of Department Chairs in Surgery were women, despite women comprising nearly half of the surgical workforce. While some argue this trend as reflective of demographic inertia, the expected time lag before the full effects of the gender workforce change are seen, the rate of advancement for women still remains disproportionality slower than expected. By current estimates, it will take over 100 years to attain gender parity in surgery.
While existing data for surgery are limited, they suggest work-life integration, unconscious bias, prescriptive gender norms, variable academic opportunities and differential mentorship and sponsorship opportunities continue to perpetuate gender inequities. For instance, women are more likely than men to bear family responsibilities disproportionately (e.g., disruption in child care, elder care), less likely to attain and renew federal grant funding, and are less likely to benefit from sponsorship.
What are the principles needed to mitigate gender disparity in surgery?
While evidence-based data for targeted interventions to mediate the gender achievement gap in surgery are sparse, the effort to promote gender equity is not. In recent years, the media, surgical societies and leaders within surgery have given considerable attention to developing strategies to close the gender achievement gap. For example, several prominent national surgical societies such as the American Surgical Association and the Society of Surgical Chairs have publicly committed to improving the representation of women in the national ranks through committee appointments and the assurance of gender balanced speaker panels. Additionally, the Association of Women Surgeons continues to address the unique challenges women face related to work life integration, pay equity and promotion through systematic mentoring programs, resources such as their pay equity toolkit and policy statements tackling the critical issue of sexual harassment. On a local level, institutions are also participating in diversifying the optics of who belongs in medicine and surgery. Recently, Brigham and Women’s Hospital removed 31 portraits of white male leaders in an effort to better reflect the diversity of their current environment. Despite these efforts, a tremendous opportunity remains to study the gender achievement gap in order to develop, disseminate and study evidence-based interventions to eliminate gender inequity in surgery.
How were they applied?
Through the Michigan Promise, the Department of Surgery at the University of Michigan has adopted and developed strategies to promote an environment of gender equity. While this remains a work in progress, interventions addressing specific identified barriers are currently under investigation as shown in the table below.
Michigan Women's Surgical Collaborative
Additionally, the pressing need to close current knowledge gaps on how to eliminate gender inequity in surgery stimulated the formation of the Michigan Women’s Surgical Collaborative (MWSC). Launched in 2016, and housed under the Environment arm of the Michigan Promise, the MWSC is working to better understand disparity in achievement for women in surgery as compared to men and inspire real change in the field of surgery.
The MWSC is composed of diverse women surgeons across a spectrum of disciplines and ranks. Through research and national outreach, the express goal of this collaborative is to identify and overcome factors impeding the success of women in surgery and develop widely adaptable tools to break through identified barriers.
In the first year of activity, MWSC has made notable progress receiving grant support to rigorously study the barriers and facilitators to promotion for early career academic women surgeons. This work will be disseminated as an oral presentation at the 2018 American College of Surgeons Meeting held in Boston, MA and in manuscript form shortly. Additionally, the first annual leadership conference was held in November of 2017. The symposium, themed “Becoming who you want to be”, engaged attendees with local and national experts in leadership and career building. Participants not only heard speakers address issues and challenges confronting women as they seek to advance in the field of surgery but were also provided individualized coaching opportunities based on self-evaluation of their own leadership and conflict styles. Attendees gained a strengthened network of support and mentorship, as well as acquired new leadership skills to apply at their local institutions. The meeting was well received with 125 in person attendees and robust engagement along social media platforms.
What did we learn?
The Michigan Promise and the MWSC will continue their rigorous academic pursuit to identify and overcome barriers for women in surgery and promote best practices to attain an environment of gender equity. Additionally, we will continue to disseminate this knowledge on a national platform. The 2nd Annual Michigan Promise MWSC Leadership Conference, sponsored entirely by University of Michigan Department of Surgery, will be held November 30th-December 1st, 2018 in Ann Arbor, MI. The theme this year will be “Leading from Your Best Self” and feature local and national experts; including 7 women chairs of surgical departments. Also new this year will be a “He-for-She” track led by Justin B. Dimick, MD, MPH and a resident leadership track led by Karin Hardiman MD and Lynn Frydrych MD.
- Abelson JS, Chartrand G, Moo TA, Moore M, Yeo H. The climb to break the glass ceiling in surgery; trends in women progressing from medical school to surgical training and academic leadership from 1994 to 2015. Am J Surg. 2016;212(4):566-572.
- Westring A, McDonald JM, Carr P, Grisso JA. An Integrated Framework for Gender Equity in Academic Medicine. Acad Med. 2016;91(8):1041-4.
- Jagsi R, Griffith KA, Jones RD, Stewart A, Ubel PA. Factors Associated With Success of Clinician-Researchers Receiving Career Development Awards From the National Institutes of Health: A Longitudinal Cohort Study. Acad Med. 2017. [Ahead of print]
- Patton EW, Griffith KA, Jones RD, Stewart A, Ubel PA, Jagsi R. Differences in Mentor-Mentee Sponsorship in Male vs Female Recipients of National Institutes of Health Grants. JAMA Intern Med. 2017;177(4):580-582.
- Harris C, Banarjee T, Dimick JB, Telem DA. Gender composition on high-impact surgical journal editorial boards. 2017. Ann Surg. 2018. Ahead of print.
- Sanfey H, Crandall M, Shaughnessy E, Stein SL, Cochran A, Parangi S, Laronga C. Strategies for Identifying and Closing the Gender Salary Gap in Surgery. J Am Coll Surg. 2017 ;225(2):333-8.
- Burgess DJ, Joseph A, van Ryn M, Carnes M. Does stereotype threat affect women in academic medicine? Acad Med. 2012 ;87(4):506-12.
- Zhuge Y, Kaufman J, Simeone DM, Chen H, Velazquez OC. Is there still a glass ceiling for women in academic surgery? Ann Surg. 2011 Apr;253(4):637-43.
Article by Dana Telem, MD, MPH (Twitter: @DanaTelem)
Reach out to join the conversation or to learn more about how to implement the Michigan Promise. Connect with the Department of Surgery or our faculty on Twitter to share your ideas or get in touch with the Office of Faculty & Resident Life to schedule a Michigan Promise presentation at your institution. You can also fill out our Michigan Promise Inquiry Form with any questions or comments.
Department of Surgery Office of Faculty & Resident Life
2210F Taubman Center
1500 E. Medical Center Dr.
Ann Arbor, MI 48109