I spent many hours empowering and educating a patient and her husband, and operated on her twice in just 1 year. The first time after I finished my operation, I told her husband everything went well. The second time, despite having an identical conversation about her surgery, her husband asked me if her surgeon was also coming to speak to him.
I replied, “I am her surgeon.” He looked shocked and eventually thanked me, but he didn’t apologize.
I posted this anecdote on social media and received thousands of comments such as, “He had a bad day,” “His stress made him forget who you were,” “You didn’t introduce yourself properly,” and my favorite, “I guess you need all the credit.”
Stress doesn’t make people forget women — particularly women of color — are surgeons. And no, I didn’t fail to introduce myself. In fact, to avoid this exact scenario, I always repeatedly introduce myself and wear my ID with my name and title in giant letters plus scrubs with my name and degrees embroidered. And no, I don’t care about “getting credit,” I care about my patient’s family knowing who operated on her and not feeling their surgeon didn’t make time to speak with them.
There is no explanation for his behavior other than his overwhelming gender bias.
Women surgeons are more likely to receive complaints from patients and families who feel they haven’t been seen by a doctor. Women surgeons are also more likely to have patients preferentially speak to male trainees or staff because they assume the male in the room must be the surgeon. During my surgical residency I saw one of my attending surgeons spend extra time making her patient feel special for weeks post-op, only to have the patient thank her for being a great social worker. The nurses, therapists, residents, and actual social worker taking care of the patient knew about the assumption but didn’t bother to correct it. I can also relate to Carrie Rosario, DrPH, MPH, being publicly mistitled during a virtual zoning commission meeting in North Carolina — I’ve also been routinely mistitled by other members of the healthcare team.
Women surgeons are underrepresented in all surgical subspecialties because the system is designed for men, and patient perceptions haven’t changed because men still get the stage. This year on Match Day, I was inspired to see more women, and especially women of color, joining the ranks as surgeons, but I was disappointed that the system hasn’t changed enough to support them. For example, many of the commenters on my post defending gender bias were other people with medical careers. At one of the hospitals in which I currently operate, there is an exclusively male physician dressing room in the OR while the women physicians share a dressing room with other OR staff. One of my colleagues has small hands and needs size 5.5 gloves. The OR materials manager only sometimes remembers to order them for her, so she doesn’t always have the privilege of wearing gloves that fit her hands. In residency, the attrition rate is higher for women surgical residents because of bullying and being told women “do not belong” in surgery. Women are subsequently underrepresented in the workforce and in leadership, and comprise only 7% of surgical chairs, according to a 2020 JAMA Surgery study.
When women do get the stage, we are misrepresented. For example the New York Times op-ed, “When the Surgeon is a Mom,” perpetuates biases such as: women’s concerns for their children impedes their focus as surgeons; multitasking makes them less competent; and childrearing is exclusively a woman’s responsibility. A 2021 exploratory assessment from the Association of American Medical Colleges into women surgeons’ experiences of gender biases found most respondents had never witnessed a colleague defend another person against a gender-based microaggression. Women surgeons were also found to be adaptive and resilient; more likely to view their failures as merit-based rather than be seen as victims; and most commonly experienced gender biases from patients, physicians in a position of authority, and nurses. Many trainees were probed about their fertility plans and pressured to delay childbearing. All participants also had the additional challenge of avoiding overly feminine or revealing clothing that would invite more stereotypes, and noted a constant need to prove their ability and intellect, which were naturally assumed of their male peers. Despite these hurdles, a 2017 BMJ study showed women surgeons have fewer complications and concluded in support of sex equality and diversity in traditionally male-dominated fields.
If we want patients and their families to recognize women as surgeons, healthcare systems need to do it first. At the very least, every facility should have an equivalent, inclusive private dressing room in the OR for surgeons who are not male. All surgical residency programs should make sure there is a private bathroom that trainees who are not male can comfortably use. All students, residents, staff, and faculty should be trained on recognizing microaggressions, addressing them, and documenting or reporting them. All OR employees should be educated on double standards that apply to women surgeons’ leadership and rewarded for creating a collaborative rather than competitive environment. Every hospital employee should be a mandatory reporter of sexual abuse. Women who wish to bear children should be actively supported with resources and schedule flexibility, and no one should ask us our plans. And finally, healthcare administrators need to establish consequences for gaslighters, such as fellow healthcare professionals who excuse harassment and discrimination with, “That person just had a bad day.”
No, they didn’t. They had an overwhelming gender bias.
What are you going to do about it?
Amani Jambhekar, MD, MBA, is a breast surgical oncologist in Houston, Texas, who is focused on making the operating room and field of medicine more inclusive and patient-centered.
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