Re: Nearly a third of female surgeons have been sexually assaulted by a colleague, survey finds
Dear Editor,
Survey evidence published recently (reported by Rimmer on September 12 (1)) revealed staggering levels of sexual harassment – and worse – within surgery: 3 in 10 female surgeons reported they had been sexually assaulted, with 1 in 10 stating unwanted physical advances were tied to career opportunities (2).
Our recent evidence suggests that surgery is also an environment where it is harder to combine motherhood with a career in medicine than in other specialties. Women in male-dominated medical specialties, including surgery, tend to have fewer children and take shorter periods of maternity leave when they do have children than women in non-male dominated medical specialties (3, 4). After returning to paid work following parental leave, mothers in surgery work tend to work more hours than mothers in other specialties: when specialties are ranked by women’s average contracted hours as a share of full time equivalent, 1 to 3 years after returning from maternity leave, the top 5 are all surgical specialties (3).
There is no way of telling precisely how much of these differences reflect choices imposed on women by the structure of surgical training or the working culture. Women who choose to become surgeons may have made similar decisions about motherhood had they gone into another specialty. However, they do contribute to a picture of an environment that is unwelcoming to many women and not sufficiently supportive of their needs.
Given that female surgeons take shorter periods of maternity leave and relatively few work part time, one might expect their career progression to be less harmed by parenthood than mothers in other specialties. Our analysis suggests the opposite is true. Across all specialties, rates of progression from core to higher specialty training are lower for women returning from maternity leave than childless men (4). However, the relative falls in progression rates for mothers in surgery is more than double those in non-surgical specialties. Moreover, while adjusting for lower levels of accumulated experience - through maternity leave and part time working - explains all of slowdown for all mothers in non-surgical specialties, it explains very little of the gap for surgeons. This is because mothers in surgery tend to take shorter periods of maternity leave and work close to full time hours.
There is no evidence that parenthood has any impact on the progression of new fathers, relative to their childless male colleagues. This is therefore another area where men and women are living different realities. Women without children in surgery also have lower progression rates than childless men but the differences are much smaller.
An environment that allows women to enter surgery and progress in their careers is both the right thing to do and essential if the NHS is to make the best use of available talents. It may be that there are some features necessary to the delivery of surgery which are harder to balance with motherhood. However, at present, this seems like far from the only factor explaining why rates of women specialising and progressing in surgery remain low.
(1) Rimmer, Abi (2023) “News: Nearly a third of female surgeons have been sexually assaulted by a colleague, survey finds” BMJ 2023;382:p2090: https://doi.org/10.1136/bmj.p2090 (Published 12 September 2023)
(2) Christopher T Begeny, Homa Arshad, Tamzin Cuming, Daljit K Dhariwal, Rebecca A Fisher, Marieta D Franklin, Philippa M Jackson, Greta M McLachlan, Rosalind H Searle, Carrie Newlands (2023), “Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights, British Journal of Surgery”; https://doi.org/10.1093/bjs/znad242
(3) Kelly, E and Stockton, I. (2022). Maternity and the labour supply of NHS doctors and nurses. London: Institute for Fiscal Studies/NIHR Policy Research Unit in Health and Care Workforce. Available at: https://ifs.org.uk/publications/maternity-and-labour-supply-nhs-doctors-... (accessed: 26 September 2023).
(4) Kelly, E and Stockton, I. (2023). Progression of parents in NHS medical and nursing careers. London: Institute for Fiscal Studies/NIHR Policy Research Unit in Health and Care Workforce. Available at: https://ifs.org.uk/publications/progression-parents-nhs-medical-and-nurs... (accessed: 26 September 2023).
Competing interests:
No competing interests
27 September 2023
Elaine J Kelly
Economist
Institute for Fiscal Studies and the Health Foundation
Rapid Response:
Re: Nearly a third of female surgeons have been sexually assaulted by a colleague, survey finds
Dear Editor,
Survey evidence published recently (reported by Rimmer on September 12 (1)) revealed staggering levels of sexual harassment – and worse – within surgery: 3 in 10 female surgeons reported they had been sexually assaulted, with 1 in 10 stating unwanted physical advances were tied to career opportunities (2).
Our recent evidence suggests that surgery is also an environment where it is harder to combine motherhood with a career in medicine than in other specialties. Women in male-dominated medical specialties, including surgery, tend to have fewer children and take shorter periods of maternity leave when they do have children than women in non-male dominated medical specialties (3, 4). After returning to paid work following parental leave, mothers in surgery work tend to work more hours than mothers in other specialties: when specialties are ranked by women’s average contracted hours as a share of full time equivalent, 1 to 3 years after returning from maternity leave, the top 5 are all surgical specialties (3).
There is no way of telling precisely how much of these differences reflect choices imposed on women by the structure of surgical training or the working culture. Women who choose to become surgeons may have made similar decisions about motherhood had they gone into another specialty. However, they do contribute to a picture of an environment that is unwelcoming to many women and not sufficiently supportive of their needs.
Given that female surgeons take shorter periods of maternity leave and relatively few work part time, one might expect their career progression to be less harmed by parenthood than mothers in other specialties. Our analysis suggests the opposite is true. Across all specialties, rates of progression from core to higher specialty training are lower for women returning from maternity leave than childless men (4). However, the relative falls in progression rates for mothers in surgery is more than double those in non-surgical specialties. Moreover, while adjusting for lower levels of accumulated experience - through maternity leave and part time working - explains all of slowdown for all mothers in non-surgical specialties, it explains very little of the gap for surgeons. This is because mothers in surgery tend to take shorter periods of maternity leave and work close to full time hours.
There is no evidence that parenthood has any impact on the progression of new fathers, relative to their childless male colleagues. This is therefore another area where men and women are living different realities. Women without children in surgery also have lower progression rates than childless men but the differences are much smaller.
An environment that allows women to enter surgery and progress in their careers is both the right thing to do and essential if the NHS is to make the best use of available talents. It may be that there are some features necessary to the delivery of surgery which are harder to balance with motherhood. However, at present, this seems like far from the only factor explaining why rates of women specialising and progressing in surgery remain low.
(1) Rimmer, Abi (2023) “News: Nearly a third of female surgeons have been sexually assaulted by a colleague, survey finds” BMJ 2023;382:p2090: https://doi.org/10.1136/bmj.p2090 (Published 12 September 2023)
(2) Christopher T Begeny, Homa Arshad, Tamzin Cuming, Daljit K Dhariwal, Rebecca A Fisher, Marieta D Franklin, Philippa M Jackson, Greta M McLachlan, Rosalind H Searle, Carrie Newlands (2023), “Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights, British Journal of Surgery”; https://doi.org/10.1093/bjs/znad242
(3) Kelly, E and Stockton, I. (2022). Maternity and the labour supply of NHS doctors and nurses. London: Institute for Fiscal Studies/NIHR Policy Research Unit in Health and Care Workforce. Available at: https://ifs.org.uk/publications/maternity-and-labour-supply-nhs-doctors-... (accessed: 26 September 2023).
(4) Kelly, E and Stockton, I. (2023). Progression of parents in NHS medical and nursing careers. London: Institute for Fiscal Studies/NIHR Policy Research Unit in Health and Care Workforce. Available at: https://ifs.org.uk/publications/progression-parents-nhs-medical-and-nurs... (accessed: 26 September 2023).
Competing interests: No competing interests