By Monique Hassan
On August 31st, the Association of Women Surgeons co-hosted a tweetchat with @SAGES_Updates to discuss inclusiveness in the operating room and in the surgical field. The tweetchat was moderated by myself, Dr. Rebecca Snyder (@RSnyder_MD), Assistant Professor, Division of Surgical Oncology, Department of Surgery at East Carolina University, Dr. Kellie McFarlin (@McFarlinKellie), Assistant Professor of Surgery and Senior Staff Surgeon, Wayne State University School of Medicine, and Dr. Jenny M. Shao (@JennyShaoMD), Graduating Advanced GI MIS Fellow, Carolinas Medical Center, incoming Assistant Professor of Clinical Surgery, MIS, University of Pennsylvania.
This is an issue that might often frustrate women in surgery but is rarely discussed. Therefore, having the opportunity to offer my unique perspective about this important topic pertaining to women surgeons was a great experience.
Surgical disciplines are disproportionately male despite increasing numbers of female medical students. Even though women now comprise more than half of medical school enrollees and 35.2% of all active physicians, they are often scarce in the surgical field. According to 2017 data from the AAMC, women make up less than one-quarter of 10 surgical specialties and are the least represented in orthopedic surgery, at 5.3%. The inclusion of women in surgery should not be understated. Women surgeons are just as skilled as their male counterparts. A recent study revealed that the more women in the operating room, the better it is, not only for patients but for physicians as well. Patients treated by female surgeons were found to have a statistically significant decrease in 30-day mortality when compared with those treated by male surgeons. Female physicians are more likely to follow medical guidelines, collaborate with colleagues, communicate better with their patients, and adopt a patient-centered approach to care which led to improved patient outcomes. Gender inequity in the surgical profession, including disparities in compensation and promotion, is alarming. Hospitals need to focus not only on increasing the number but specifically, retention of female surgeons.
Several ways retention within an organization could be improved:
- Pay Transparency: open conversations about pay allows for better collaborations and decreases discrimination
- Mentorship: providing allyship and mentorship to ensure that women become leaders
- Healthy Work Culture: creating a culture so women are not made to feel guilty wanting a healthy work-life balance
While changing the culture of the surgery may not be easy, it is essential to retaining excellent surgeons, male or female.
As a minimally invasive surgeon, there are several ergonomic challenges that I face on a day to day basis – the design of instrument handles, operating rooms not built to optimize table height, and inadequate monitor placement. The traditional operating room design has favored the taller male surgeon, not women, who on average are shorter and wear a smaller glove size. Laparoscopic surgical instruments have been reported to cause hand and upper extremity discomfort. In a survey of 726 laparoscopic surgeons, females found that the scissors and staplers were more difficult to use for the small and medium glove size. Specifically, individuals using glove sizes 6.5 or smaller experience significantly more difficulty using common laparoscopic instruments, and in particular laparoscopic staplers. Compared with surgeons performing open surgery, surgeons performing minimally invasive surgery (MIS) were significantly more likely to experience pain in the neck. As women are entering the field of surgery more frequently, an initial step in solving these problems is the recognition that the dimensions of optimal ergonomics may differ widely for male and female surgeons. Manufacturers of surgical hand tools should consider hand size when designing future surgical instruments.
Organizations such as AWS and SAGES can help lead the way for changes, so we do not have to make accommodations to the detriment of our bodies. Advocacy for input regarding future changes regarding the design of surgical instruments is critical from hospital leadership. Having women surgeons within hospital leadership can drive operating room changes such as equity in locker room spaces and operating room equipment such as tables and monitors. I think it’s important for female trainees who are interested in surgery to have patience and not give up! Practicing by using simulation or via laparoscopic trainer will allow more familiarity with the instruments and how best to make the environment work for you. In addition, it’s natural to feel frustrated with the instruments and environment of the operating room especially during a long and complicated case, but we must remember that our patients need to get the benefit of our efficiency despite the ill-fitted surroundings.
Dr. Hassan is a fellowship-trained minimally invasive Bariatric Surgeon. She was an Army surgeon and the Medical Director of the Bariatric Surgery Program at Fort Sill, OK, from 2013-2017. Dr. Hassan holds a Doctor of Medicine degree from The George Washington University School of Medicine and Health Sciences and a Master’s Degree in Biological Sciences from Drexel University. She completed her residency in General Surgery at Madigan Army Medical Center in Tacoma, WA, in 2012 and completed a Minimally Invasive and Bariatric Surgery fellowship at The Cleveland Clinic Foundation. Her clinical areas of expertise are laparoscopic bariatric surgery and revisional bariatric surgery. She specializes in laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy, and she has experience with the management of duodenal switch, upper endoscopy, and intragastric balloon placements surgeries. Dr. Hassan has been published in multiple peer-reviewed surgical journals and has presented her work at national meetings. She is board-certified by the American Board of Surgery and is a Fellow of the American College of Surgeons. Dr. Hassan is married and enjoys spending time with her family traveling the world and participating in CrossFit. You can find her on twitter @drmoniquehassan.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.