Intended for healthcare professionals

Opinion Dissecting Health

Scarlett McNally: Changing surgery to support women surgeons

BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1616 (Published 18 July 2023) Cite this as: BMJ 2023;382:p1616
  1. Scarlett McNally, professor
  1. Eastbourne
  1. scarlettmcnally{at}cantab.net
    Follow Scarlett on Twitter @scarlettmcnally

I sometimes worry that I’ve made things worse for the women surgeons of the future. I went through surgical training when things were very different. We operated all night if there were operations to do, but this meant that patients, staff, and organisations had to accept me as a surgeon—otherwise, operations wouldn’t happen. It’s frustrating when doctors today are taken out of theatre to complete administrative tasks when they could be operating. My weekend shifts used to be Friday morning to Monday evening, but I was given a bed on site, whereas registrars today have to work punishing consecutive 12.5 hour shifts, with long commutes, causing damaging fatigue.1

In my first orthopaedic job in the early 1990s, I remember being mortified when my consultant assumed that I was discussing my menstrual cycle when I’d been explaining that our firm’s rota of “1 in 4” meant that we had lots of inpatients from our busy monthly weekend on-call. When I returned to work after my first miscarriage, a fellow registrar sneered that he’d never taken two days off for the flu. No one talked about periods then, nor sexism, sexual harassment, menopause, pregnancy, breastfeeding, or the gender pay gap. At the time it seemed that the best way to get on was to stay calm, study and work hard, and be grateful for that coveted training post.

Yet more accounts of sexual harassment of women surgeons have recently been published in the Mail and the Times.23 We must confront the perpetrators of harassment lest they cause further harm to others. Disciplinary processes around sexual harassment are often too lengthy, adversarial, and confidential for the necessary learning to happen.

It’s important to change the culture. This includes behaviours of people who don’t realise how they’re perceived or the impact of their actions. There should be an atmosphere of respect. Everyone should be an ally or an active bystander and take responsibility for calling out poor behaviour. The 2021 Kennedy review into diversity and inclusion in surgery highlighted the issue of “microaggressions”—instances of indirect, subtle, or unintentional discrimination that undermine someone’s position.4 To counter this, I make an effort to listen and offer opportunities to colleagues who may have had negative experiences.

Surgical training often coincides with the years of childrearing, and if we support surgeons during this time it helps with retention. Many women surgeons leave who could have been supported and helped to stay.5 We must challenge the hurdles: each person should be given the opportunity to achieve, irrespective of how they look or any gender stereotypes. Yet, in general, women doctors and ethnic minority doctors have worse experiences of working in medicine. Unconscious bias is everywhere—patients expect different things if their doctor’s a woman. Diverse teams can liberate thinking, and women surgeons sometimes have better outcomes.6

Colleges and societies have improved some aspects of their culture,7 such as providing information about pregnancy and parenthood for surgical trainers.8 But further work needs funding and political will. If £2.4bn is newly available for the NHS workforce, we should start by improving training in surgical or craft specialties for all, with better support.

Funding would help in some parts by reducing the burden of service provision, providing doctors’ assistants or administrative help, reducing the size of rotations and commuting distances, having supernumerary training slots to gain experience, encouraging men to take parental leave, and supporting the return to work after a break.

To get the best future surgeons, we must overhaul surgical training.

Footnotes

  • Scarlett McNally is a consultant orthopaedic surgeon. She is president of the Medical Women’s Federation and was an elected council member of the Royal College of Surgeons of England from 2011 to 2021.

  • Provenance and peer review: Commissioned, not externally peer reviewed.

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