Discrimination against female surgeons is still alive: Where are the full professorships and chairs of departments?

BACKGROUND: Although half of all medical students are now and women are increasingly filling surgical residency positions, few ascend the academic ladder to become chairman of their departments, much less full academic professors.
METHODS: We queried PubMed to search for the number of women surgeons in different subspecialties, and asked how many were chairman or full academic professors?
RESULTS: Data coming out of largely general or cardiothoracic surgery departments cited no substantial gains for women surgeons over the years; there were few chairmanships or full professorships. In one study of 54 female cardiothoracic surgeons, 60% of academic appointments were at the instructor or assistant professor level; only 18% were full professors. In another study looking at 12-year data from major academic medical institutions in the US, women constituted only 9.2% of chairs, only 14.7% of full professors, and just 9.3% of deans. In a third study, out of 270 female general surgeons, there were only three who were chairman, and just 12.4% were tenured professors. In Great Britain/Ireland, of 315 neurosurgeons (25 females), all 16 full professors were males. Two medical/surgical series speculated it would take until 2096 or 2136 for females to attain 50% of full professorships. The American Association of Neurological Surgery (U.S. 2017; personal communication) showed that of 287 Board-certified female neurosurgeons, there is just one female surgeons chairman.
CONCLUSIONS: Few female physicians/surgeons were chairs of departments or full professors at their academic institutions. Do women in medicine/surgery really need to wait until 2136 to achieve equality?

INTRODUCTION

How many times during our surgical residency training programs did our male chairman tell us that they tried to train women surgeons, but they just dropped out? When asked how many of their male trainees failed, they were at a loss for words. Now that half of the medical students are women, and many fill surgical residency training programs, we ask how many women are chairs of surgical departments or are full professors?

MATERIALS AND METHODS

In this study, we utilized PubMed to search for women in different surgical subspecialties. We assessed the numbers who were chairs or full professors of their departments, and whether they were treated equally (e.g. financially, administratively, academically). Additionally, through a personal communication (February 2017), data was obtained from the American Association of Neurological Surgery (AANS) regarding the number of board certified female neurosurgeons in the US.

RESULTS

Few women are full professors or chairs of cardiothoracic surgery

In two studies involving female cardiothoracic surgeons, few became full professors, even fewer were chairs of their departments, and they were also more likely to be underpaid.[34] In 1996, Dresler et al. found that 27% of academic female and male cardiothoracic surgeons were assistant professors, but 27% men vs. just 13.6% of women were full professors [Table 1].[4] Additionally, 58% of women but only 21% of men were underpaid, while 32% of women 62% of men were adequately compensated. Donington et al. (2012) assessed 50 years of data regarding women cardiothoracic surgeons (boarded by the American Board of Thoracic Surgery (ABTS)); notably, >60% (33 of 54) of women with academic appointments were just instructors or assistant professors, while only 18% (10 of 54) were full professors [Table 1].[3]

Table 1

Women medical/surgeon data in the US 1996-2012

Few women are full professors or chairs of general surgery departments

Five studies documented how women in general surgery fell below their male counterparts in numbers of full professorships, chairman, and administrative appointments.[127811] In 2004, Schroen et al. surveyed 371 academic general surgeons, (e.g., members of the American College of Surgeons (ACS) (1998-1999)); they found that 150 of 168 (94%) men, but only 64 of 149 (42.9%) women were in tenure-track positions [Table 1].[7] When Wyrzykowski et al. (2006) evaluated academic appointments for 270 female academic general surgeons (e.g., boarded/eligible for the American Board of Surgery), although full-time academic appointments were held by 86.7% of respondents, most were assistant professors or on a clinical track, and just 12.4% were tenured professors, while only three were chairman [Table 1].[11] Using the Women in Medicine Annual Reports (American Association of Medical Colleges (AAMC)), Sexton et al. (2012) documented that 50% of women filled medical school classes (50%), and large numbers were in residency training programs, but few became full professors of surgery [Table 1].[8] They also calculated that at this rate, it will take until around 2096 for 50% of full professorships to go to women. As of 2013, Cochran et al. emphasized that women comprise 50% of US medical students and one third of US surgical residents, but rarely have senior academic or administrative titles [Table 2].[2] Using a modified Career Barriers Inventory-Revised (CBI-R) given to senior surgical residents and early-career surgical faculty at 8 academic medical centers (70 women and 84 men), they documented that women perceived active discrimination and sexual bias that negatively impacted their aspirations to become female surgeons.[2] Additionally, utilizing the Association of American Medical Colleges FACTS and Faculty Administrative Management Online User System, Abelson et al. (2016) confirmed the “glass ceiling” in surgery for women (1994 to 2015) is still alive; they confirmed that women made up less than 10% of all full professors, and calculated they would not achieve gender parity until 2136 [Table 2].[1]

Table 2

Women medical/surgeon data in the US 2013-2016

Few minorities are full professors or chairs of academic departments

Women, along with Asians, African Americans, and Hispanics (e.g., minorities) hold few academic or administrative positions in medicine/surgery.[5912] Southwick in 1999 was one of the first to initiate pioneering efforts to bring African Americans and other minorities into the Yale University Orthopedic Surgical Residency Training Program [Table 1].[9] In 2013, Yu et al. looked at the number of minorities found in academic medicine over a 12-year period utilizing the Association of American Medical Colleges’ data (1997 to 2008) [Table 2].[12] Women represented 9.2% of chairman 14.7% of full professors, and 9.3% of deans. They also noted that “at the current rate, it would take nearly 1000 years for the proportion of Black physicians to catch up to the percentage of African Americans in the general population”. Analyzing a database of US physicians with medical school faculty appointments in 2014 (91,073 physicians; 9.1% of all US physicians), Jena et al. (2015) documented that although there were 30,464 women vs. 60,609 men, many fewer women were full professors; 3623 women (11.9%) vs. 17,354 men (28.6%) [Table 2].[5]

International inequity (Japan, Great Britain/Ireland) in the treatment of women in medicine/surgery

Two international studies from Japan and Great Britain/Ireland also confirmed how few women were full professors or chairs of medical/surgical departments.[610] Okoshi et al. (2014) noted that the number of women in medicine in Japan had increased from 10.6% in 1986 to 19.7% in 2012, but they were underrepresented regarding academic appointments, particularly in surgery [Table 2].[6] Furthermore, a review of data from Kyoto University Hospital (KYU) (2009–2013), revealed there were no female associate or full professors in surgery. Wilkes et al. used the Society of British Neurological Surgeons (SBNS) database (e.g., including Great Britain and Ireland: 2015) to identify 315 neurosurgeons, 25 of whom were females; they found all 16 full professors were men [Table 2].[10]

Personal communication with American Association of Neurological Surgeons (February 22, 2017: Chris Ann Philips, Director, AANS Member Services) for U.S. data on board certification of women in neurosurgery

Presently, there are 287 board certified female neurosurgeons in the US [Table 3]. Of these, 216 are practicing, two are in the military, 33 have retired, and 34 are board certified but non members of the AANS (e.g., aware numbers do not completely add up) [Table 3]. Of these, there is only one female chairman of a neurosurgical department. There are also 51 female neurosurgeons who are now board eligible, another 123 who have an “unknown” certification status, and 246 who are residents (226) or fellows (20). Perhaps the high numbers in the pipeline will increase the number of female chairman in the future, as well as full professors.

Table 3

Gender = Female Neurosurgeons with USA Address

CONCLUSIONS

Although we wish women were making more forward strides in becoming full professors and chairman of medical/surgical academic departments, the data simply do not support this notion. In fact, few women in academic centers have appointments beyond the instructor or assistant professors levels; even fewer are full professors (14.7% to 18%) or chairman (3 of 270 = 1.1%). In neurosurgery (February 22, 2017: Personal Communication, Chris Ann Philips, Director, AANS Member Services), there are 287 board-certified female neurosurgeons in the US., but only one chair of neurosurgery [Table 3]. Two other non-neurosurgical medical/surgical series speculated that it would take until 2096 or 2136 for women to achieve equity (e.g., 50% of full professorships) in medical/surgical departments; do we women really need to wait that long?

I am not sure amusing is the emotion I experience when reading this. I remember talking with Mary Louise Spencer nearly 29 years ago and wondering why there were so few women in practice and in training at that time. There are definitely more women now, but certainly not at the 50% level seen in medical schools. That doesn’t bother me, not everyone has the ability to rise to the level of a neurosurgeon nor does every medical student want to. When my son was in medical school and his friends would be at our house they’d talk about going into cardiovascular surgery, pediatric oncology, and even neurosurgery but when they finished their 4 years and matched they went into anesthesiology, family practice, and emergency medicine (the direction my son went). I don’t know of any of his classmates who went into neurosurgery (graduating class of about 120). Is that OK? I think so, regardless of gender, not everyone is the best of the best.

The politics of academic rank is a whole other thing. Not every gifted neurosurgeon has the business or political acumen nor desire to go the academic route. I’m OK with that, too.

Just because I’m OK with these things or understand them, doesn’t mean that if one of my grand-daughters wants to become a neurosurgeon and chairman of her department that I wouldn’t do everything I can to make that happen (not that I have any influence or will even be around when they get to that age). I think it's really sad that they project equality so far in the future but then I’m not much inclined to believe that global warming is all the fault of mankind.

Interesting to think about, but I’ll get off my soapbox now. Although my opinion is valid based on my experience, I’m not in the trenches and seeing it firsthand so I appreciate the opinion of those who are.