Gender inequity in the surgical workforce

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Presentation transcript:

Gender inequity in the surgical workforce Does it predispose to bullying and harassment ? A / Prof David Hillis, DEd, MHA, FRACMA, FRACGP, FRACS (Hon) Chief Executive Officer, RACS Principal Fellow, Medical Education Unit, Melbourne University,

Abstract Surgery has traditionally been a ‘male dominated’ workforce. Currently only 11% of the surgical workforce is female although over 30% of current trainees are female.   Procedural based specialties appear to be at a higher risk of discrimination, bullying and sexual harassment. Factors in this include the hierarchical structure of the workforce, stressful healthcare environment including pressures to meet administrative deadlines, lack of support for victims, lack of leadership as well as substantial gender imbalance. Initiatives from the Royal Australasian College of Surgeons (RACS) will be discussed.

Gender Equality All human beings, both women and men, are free to develop their personal abilities and make choices without the limitations set by stereotypes, rigid gender roles, or prejudices. Source: UN Women

Gender Equity Gender equity means that women and men are treated fairly according to their respective needs. This may include equal treatment or treatment that is different but considered equivalent in terms of rights, benefits, obligations and opportunities. A gender equity goal often requires the implementation of special measures to correct historical and social disadvantage: quotas, affirmative action, etc   Source: UN Women

The Numbers 1 – MBA Registration by Gender Registration Type (August 2015) Female Male Total Percentage General 17640 17169 34809 51% General and Specialist 16870 32329 49199 34% Specialist Only 2737 5573 8310 33% Other 4943 5872 10815 46% 42190 60943 103133 41%

Profile of surgeons. Total Active surgeons. Australasian figures Specialty Female Male Total Percentage Cardiothoracic 12 209 221 5% General 278 1676 1954 14% Neurosurgery 32 234 266 12% Orthopaedic 58 1477 1535 4% Otolaryngology 75 476 551 Paediatric 98 130 25% Plastic 66 427 493 13% Urology 44 432 474 9% Vascular 21 186 207 10% 618 5215 5833 11%

SET intake

Trainee age at selection 2007 - 2013 Specialty 24-27 28-29 30-31 32-34 35-40 41+ Total Total Age% 12.4% 26.8% 24.7% 21.7% 12.2% 2.2% 100% Female% 36.4% 28.7% 27.4% 24.0% 18.4% 17.1% CAR 17.7% 24.4% 28.8% 8.8% GEN 15.0% 27.7% 17.9% 12.5% 2.0% NEU 7.0% 29.6% 26.7% 19.7% 15.4% 1.4% ORT 5.2% 25.9% 23.7% 29.2% 13.4% 2.3% OHN 10.7% 29.5% 25.5% 23.4% 9.3% 1.3% PAE 18.2% 21.1% 31.5% 10.5% 0.0% PLA 6.5% 27.6% 24.3% 19.1% 2.6% URO 19.4% 30.0% 22.2% 7.2% 1.6% VAS 29.9% 20.2% 18.9% 10.8% 2.7%

Female proportion of PGY/specialty cohorts

Key Gender Indicators: Ratio of Female to Males Specialty 2014 Appointed Active trainees Active Fellows < 44yo Active Fellows Cardiothoracic 0.40 0.23 0.10 0.06 General 0.57 0.55 0.36 0.17 Neurosurgery 0.67 0.28 0.25 0.15 Orthopaedic 0.12 0.07 0.04 Otolaryngology Head and Neck 1.00 0.56 0.38 0.16 Paediatric 0.50 1.23 0.71 0.37 Plastic and Reconstructive 0.45 0.62 Urology N/A 0.30 0.21 Vascular 0.18 0.27 0.11 All Specialties 0.41

Trainee attrition (290) – gender %  

Exit reasons across gender Female Male Female / male ratio Totals   Number % of all female trainees % of all male trainees Misconduct  0 2 0.13% Unpaid fees 0.32% 3 0.2% 1.62 5 Maximum exam attempts 0.8% 8 0.5% 1.6 13 Time expired 49 7.8% 72 4.7% 1.66** 121 Unsat. performance 4 0.6% 12 0.7% 0.86 16 Withdrawn 90 14.4% 87 5.7% 2.5*** 177 Death All exits 150 24% 187 12.3% 1.95*** 337

Profile of leadership Councillors Training Board Chairs Profile of examiners Gender balance reflects percentage of more senior surgeons: low

So lets consider… Are female doctors making a choice not to apply to surgery, or is there something about surgery that is making the choice for them? Why do some specialty programs receive significantly more interest from female doctors than others? Is there a single surgical culture, or are there nine (or more) surgical specialty cultures?

So lets consider… Is our selection process free of gender bias? Are the prerequisites for applying equally achievable by females and males? Is there more the College could do to promote gender equity? Is there more that Fellows as individuals can do to promote gender equity?

Key messages from DBSH Issues paper: Predisposing factors Unhealthy work practices and training arrangements Facilitates bad behaviour Precludes work-life balance for men and women Culturally embedded in practice of surgery, particularly hospitals Excessive unpaid work hours are used as a form of bullying Lack of diversity, gender inequity and strong hierarchies in the surgical profession are linked to increased prevalence of discrimination, bullying and sexual harassment

Finding from RACS surveys 49% of surgeons report being subjected to discrimination, bullying and sexual harassment (DBSH) 63% of trainees 71% of hospitals reported DBSH in last five years with bullying the most frequently reported issue Senior surgeons and surgical consultants are reported the principal source of the problem

Recommendations Cultural change and leadership Education About educating About DBSH About coping with stress About ‘calling out’ DBSH and bad behaviour Complaints management Gender Equity Reviewing issues like flexibility that will increase the appeal of surgery to a more diverse group Setting targets, monitoring Identifying champions and role models

Summary DBSH is endemic. There is no workplace, no hospital that is not affected. Gender equity is one of the many things that must be addressed RACS has now formally apologised publically for the prevalence of DBSH within surgery and its negative impact We must all do more to ‘call it out’, act on it locally, with our peers and across the health sector