1. WOMEN IN SURGERY Past, Present and Future Dixie Mills, M.D., FACS Department of Surgery Maine Medical Center September 19, 2003

2. Women in Surgery v Brief history of Women in Surgery v Rise of Women in Medicine v Characteristics of Women in Surgery v Association of Women Surgeons v Future

3. Women in Surgery - History v Ancient History – Egyptian and BC evidence v Middle Ages – Women of Salerno and the Crusades – Tortula’s Gynecological Text v The 1400’s to 1800’s - The “Surgeoness”

4. The “Beardless Lad” Dr. James Barry - 1795-1865 v Attended Edinburg Medical School v During the Napoleonic Wars was an Army Surgeon v Performed one of the first successful C/Ss v At burial was found to be a woman

5. Dr. Elizabeth Blackwell 1821-1910 v 1st woman medical graduate in the US - 1849

6. Women’s Medical College of Pennsylvania - 1903

7. Women in Surgery - History v Turn of the Century- 6% of physicians were women - the number never went higher until 1970 v The ACS admitted one woman in 1913 and from 0 to 5 (<2%) each year until 1975 v 1st woman governor-Lillian Farrar 1925-1947 v Army Hospitals and WWW II

8. Women in Surgery v History of Women in Surgery v Recent rise in Women in Medicine

9. Women in Medicine v A rise in women applying to medical school began in the 1970’s due to - Increase in medical schools and slots –The “Women’s Movement” –The Equal Opportunity Act was passed –Growing number of “baby boomer girls” were finishing college

10. Medical School Graduates 0 2 4 6 8 10 12 14 16 1960197019801990 Women All

11. Percent Distribution of Total US Physicians by Age and Sex, 2001

12. U.S. Physicians 1970-2001

13. Women in Surgery v History of Women in Surgery v Recent rise in Women in Medicine v Women in Surgery today

14. Surgeons – 2001* N = 157,669 *AMA Physician Characteristics 2003

15. Surgeons - 2001 N = 157,669

16. Surgeons – 2001 N = 157,669

17. Other Surgical Specialties - 2001

18. General Surgeons over Time

19. ACS Membership by Gender

20. Women Surgeons in Illinois-2001 N= 1,285/6,398

21. Characteristics of Women Surgeons v Published in the American Journal of Surgery - September 1998 v Erica Frank, MD, Michelle Brownstein, MD, Kimberly Ephgrave, MD, Leigh N eumayer, MD v 4,501 US women physicians from the Women Physicians Health Study were studied v 134 surgeons or 4% of total

22. Characteristics of Women Surgeons 1994 v Worked more clinical hours and call nights v Personal health habits were similar, however exercised more v Did not feel they worked too much, nor had too much stress v Satisfaction in their specialty was greater v Higher personal and family income v Younger, white, single and childless than other women physicians

23. Women in Surgery v WHY WOMEN CHOOSE SURGERY –ROLE MODELS –LIKE THE INTELLECTUAL CHALLENGE, TECHNICAL ASPECTS, DECISIVENESS –MUCH THE SAME REASONS AS MEN –“SURGICAL PERSONALITY”

24. Women in Surgery v WHY WOMEN DON’T CHOOSE SURGERY –PERCEIVED AS TOO “DIFFICULT” “MALE” –NOT ENCOURAGED –TOO TIME CONSUMING –NOT FAMILY FRIENDLY –LIFESTYLE NOT CONTROLLABLE –NO ROLE MODELS

26. Residents - 2001 N = 93,674 Residents - 2001 N = 93,674

27. Surgical Residents- 2001 N= 20,839

28. Other Specialties - 2001 Residents/Fellows

29. Surgical Residents - 2001 N=20,839

30. Women in Surgery v History of Women in Surgery v Recent rise in Women in Medicine v Characteristics of Women in Surgery v Association of Women Surgeons

31. Association of Women Surgeons v Founded in 1981 v Membership grew to over 1200 by 1990 v Seat on the ACS Board of Governors in 1995 v Increasing numbers on committees, boards and as speakers v Members serve on over half of ACS State Chapters

32. Association of Women Surgeons k Mission Statement - To inspire, encourage and enable women in surgery to realize their professional and personal goals

33. Association of Women Surgeons - Goals v To promote professional growth and advancement v To enhance and facilitate interaction among female surgeons throughout the world v To foster an environment supportive of personal values and individual diversity v To advocate the highest standards of competence and ethical behavior

34. AWS - Membership 2003 v 1614 members v 63% are board certified v 61% are fellows of the college v 60% are general surgeons v 30% are academic officers v 23% are students or residents v Member is each state and many international

35. AWS v Membership Directory v Quarterly Newsletter v Website, E-zine, listservs v Pocket Mentor v Fall Conferences v Networking Meetings at other conferences

36. Women are Surgeons Video

37. AWS v AWS-Ethicon Endoscopic Fellowship Award v AWS Outstanding Woman Resident Award v AWS Visiting Professor v Code of Conduct approved by ACS v Family Leave Policy

38. Surgical Leadership -2003 v ACS Officers - 1/8 women v ACS Board of Regents - 3/19 women v ACS Officers of the Board of Governors -1/3 v 250 residency program - 4 women directors v Editorial Boards - 12/223 (5%) for 5 journals v RRC - 1/12 v Two Chairs of Department of Surgery

39. Women in Academics NEJM - 2/00 - Associate Profs 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% SurgeryObGynRadiologyAnesthesiaPeds Men Women

40. Academic Medicine v Women join academic ranks post graduation at higher rates than men v However they advance to senior ranks less v Leave academic ranks at higher rates v Perceived reasons why- micro-inequities less mentoring, publish less, less support and resources lack of visibility and isolation, failure of support more attractive alternatives

41. Issues in the recruitment and success of women in academic surgery - Colletti Surgery 8/2002 v Presented at the Society of University Surgeons v Nat’l survey completed by 386 W, 338 M v Women report similar objective experiences, but very different perceptions of issues v Women perceived that opportunities for collaboration, networking and support are missed v A quarter of respondents were considering leaving academic surgery

42. The Future v Is there a problem? v Can it be fixed? v Where to “attack” it v Where in the pipeline to start?

43. Medical Students v Applicants to general surgery programs have been dropping over the last 10 years v Women medical students (almost 50% of total) exhibit less interest in surgery from entrance, through and in graduating medical school v There are 1000+ categorical slots (75%men, 25%women)- this means we are recruiting only 3% of women and 10% of men senior students

44. Women in Surgery- Trends Medical Students to Surgical Residents

45. Women General Surgical Residents

46. Top Specialties - 2001 v MEN - Internal Medicine - Family Practice –Pediatrics –OB/GYN –Psychiatry –General Surgery v WOMEN –Internal Medicine –Pediatrics –Family Practice –OB/GYN –Psychiatry –…10th - General Surgery

47. Possible Solutions v Enhance the surgical environment for both men and women – in the hospital and office v Reduce gender discrimination/sexual harassment v Increase the number of women in leadership positions – Woman president of ACS???? v Increase the visibility of women surgeons v Changes in surgical training – hours, length, programs – look at the GYN/OB residency programs

48. The Future Much can be done to encourage women to pursue surgery. Surgery cannot remain competitive, attracting the best and the brightest if the selection pool is reduced by half. Promoting a surgical lifestyle that allows individuals to balance family and work, enabling both male and females to fulfill parenting and life roles is essential.