A fifth of surgeons in England are femaleBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4530 (Published 30 October 2018) Cite this as: BMJ 2018;363:k4530
All rapid responses
During the last decade, the percentage of women graduates in medicine has increased considerably, in Italy and Europe, and therefore inevitably also those who specialize in general surgery and specialized branches.
The data provided by the Statistical Office of the Ministry of Education of the University and Research (MIUR) for the academic year 2014/2015 show that 45.3% of those enrolled in schools of specialization in general surgery are women.
This figure is certainly positive but, in Italy as in the UK, the percentage of women surgeons who hold top positions in both hospital and university is still very low. The figure for ordinary general surgery professors in Italian universities is exemplary: out of 108 members of the college of ordinary general surgery professors, only 3 are women and as many are those who run a specialization school in general surgery.
Although theoretically today the career and career opportunities offered to women in the surgical world are similar to those of male colleagues, the objective difficulties that women have in reconciling work and family life make career progression much more difficult for them. And the training possibilities. From a cognitive survey conducted by the Italian Society of Surgery (1st SIC Report of Women in Surgery), it emerges that 56% of women believe that having had children has reduced their career path, compared to 16.4% of men.
From the 1st SIC Report Women in Surgery, the future of surgery sees women as protagonists of the scene. The change is now a fact: the percentage of medical women under 50 is 57.2%; this reflects the professional trend of the future.
This scenario reflects the importance of the professional role on women's private life: to date, many colleagues have renounced a family, motherhood and distance from their country of origin, as well as those who have given up their professional career due to lack of practical help in facilitating family management.
A concrete example is the need to manage offspring, in most situations the full load of the woman. For example, this is not easily combined with working hours and school schedules.
The role of the mother could be better reconciled if there were available company creches that could reconcile organizational and work needs, improving work and personal well-being. This kind of organization would also mean anticipating the return from maternity more easily and with less psychophysical discomfort, favoring the transition from maternity to work reintegration.
The time has, therefore, come to develop new policies, new initiatives and a new organization of work that can take into account the needs of female doctors.
Competing interests: No competing interests
NHS Digital information - not quite right, although total females across all grades in OMFS may be 35%
We have just reviewed the NHS Digital February 2018 information for our specialty (1) and we have significant concerns about its accuracy. For example, it says that there are 209 Full Time Equivalent (FTE) Specialty Trainees in Oral and Maxillofacial Surgery (OMFS). There are only approximately 150 National Training Number (NTN) posts in OMFS, some of whom work less than full time. Even allowing for some trainees working in core surgery in 'run-through' specialty training posts or working their grace period, the figure within the NHS Digital February 2018 spreadsheet is out by more than one third. This is worrying as these data may be used for workforce planning purposes.
The quoted numbers for OMFS consultants (351) and non-consultant grades (210) feel closer to the mark. It is the proportion of females in the SAS group which makes the total females in the specialty OMFS 35% quoted in the text of the BMJ Careers article (2). Almost all SASs in OMFS are solely dentally qualified rather being medical doctors or having the dual medical and dental qualifications needed to be a consultant or specialty trainee. Clinicians who enjoy working in OMFS but who decide against studying for a second degree and completing surgical training, can only work in a non-consultant grade. The majority of OMFS SASs may be female because they are more likely to take this decision.
SASs are an essential and very active part of the OMFS workforce. Holding solely a dental qualification means there is no CESR route for them to get on the OMFS specialist list but the specialty - through our specialty association (British Association of Oral and Maxillofacial Surgeons - BAOMS) - strongly supports OMFS SASs applying for entry to the Oral Surgery specialist list held by the General Dental Council.
Consultant OMFS Surgeon
1. NHS Workforce Statistics - February 2018
2. A fifth of surgeons in England are female
BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4530 (Published 30 October 2018) Cite this as: BMJ 2018;363:k4530
Competing interests: No competing interests
I appreciate the transparency on the percentage of male and female physicians in various specialties in the two recent BMJ articles.<1><2> However, as some readers pointed out in the rapid responses, men are also outnumbered by women in some specialties, such as dermatology, palliative medicine, and obstetrics and gynaecology. Surprisingly, the data on percentage of male and female physicians in obstetrics and gynaecology was left out in both BMJ articles. Moreover, these articles do not take into consideration that some specialties have less female than male applicants; some applicants are offered training positions but voluntarily decline them. These data can potentially mislead readers to believe there is gender inequality in selection of speciality training candidates.
Perhaps, it would be more insightful to report the rejection percentage of male and female applicants in various specialities. A study showed that, during the decade 1995–2004, men were about 1.6 times more likely than women to be rejected in their applications to Canadian residency training programs.<3> Men were almost 2 times more likely to be rejected in applications to family medicine, psychiatry, and emergency medicine. The authors suggested that selection committees might consciously or subconsciously over-select female applicants to “correct” for the predominance of men. Similarly, if we carelessly interpret the data presented by these two BMJ articles, we would be prone to make the same mistake in the UK. We may correct gender imbalance, but also create gender inequality by intentionally selecting against male applicants to speciality training positions.
1. Moberly T. Men outnumber women three to one in some specialties. BMJ. 2018;363:k4098.
2. Moberly T. A fifth of surgeons in England are female. BMJ. 2018;363:k4530.
3. Baerlocher MO, Detsky AS. Are applicants to Canadian residency programs rejected because of their sex? CMAJ. 2005;173(12):1439-1440.
Competing interests: I have been paid for working as a physician, but not for writing this letter.
Oral & Maxillofacial Surgery (OMFS) not included in important paper - 15% Female STs and consultants currently in OMFS
Disappointing that oral and maxillofacial surgery (OMFS) is not mentioned in this paper. We are one of the 10 surgical specialties recognised by the General Medical Council and as such our specialist list and curriculum are held by the GMC(1) . It seems our medical colleagues forget we are part of the surgical community perhaps because we are a dual degree specialty with all OMFS STs completing dental and medical degrees and surgical training prior to entering specialty training.
If the authors had contacted the British Association of Oral and Maxillofacial Surgeons (BAOMS) for gender information on our specialty, we would have told them that there are currently 33 female specialty trainees in OMFS which is roughly 22-24% (depending on whether you consider the denominator as all trainees i.e. run-through and completed trainees or just ST3-ST7).
Regarding consultant OMFS surgeons over the 18 years since the year 2000 female consultants in OMFS have increased from less than a handful to 42 in 2018. This is roughly 12% of Whole Time Equivalents (WTEs).
Combining both numbers, there are 75 female consultant and trainees making 15% of an OMFS community of surgeons numbering approximately 500.
Although this compares favourably against other surgical specialties we continue to seek new colleagues independent of gender or first degree. OMFS consultant practice is fun, fascinating and family friendly. So if you are a dentist or a doctor, think about a career in OMFS
Competing interests: No competing interests