“When is the doctor coming?” or “Are you the nurse?” – most doctors have heard such questions from patients in their day-to-day work. Sexism, not only on the part of patients but also on the part of male colleagues or superiors, is still a big problem in clinics and practices. Surgery in particular is a male domain: in Germany, more than 60 percent of medical students in their first semester are female. According to the 2021 physician statistics from the German Medical Association, only 9,162 of the 40,194 fully trained surgeons were female, i.e. there were more than three male surgeons for one female surgeon. In other countries, the situation is not much better: in the US, 22 percent of surgeons were women in 2019, in the UK it was 32.5 percent in 2017.
In Japan, the proportion of women in surgery is only 5.9 percent. A current evaluation in the British Medical Journal shows that this inequality is not due to the skills of female doctors. Researchers from Kyoto University in Kyoto analyzed data from the Japanese National Clinical Database on nearly 300,000 surgeries performed across the country between 2013 and 2017. These were resections of sections of the stomach or intestines. The mortality rate of the patients and whether complications had occurred were compared, depending on the sex of the surgeon.
Mortality was counted as deaths occurring 90 days after surgery or 30 days after discharge. Postoperative complications were, for example, the formation of fistulas or leaking anastomoses, which is what the newly created connections of intestinal sections are called after a part has been removed.
The result of the study is unequivocal: For patients, it makes no difference whether a woman or a man is standing at the operating table during the procedure. No statistically significant difference between the sexes could be found with regard to complications or mortality. What is remarkable, however, is that the doctors had on average less experience than their colleagues. Only physicians who were registered with the Japanese Society of Gastroenterological Surgery, i.e. surgeons who had specialized in the field of gastroenterology, were included. In addition, women were more likely to look after the more complicated risk patients than men.
Studies from Canada and the USA had already suggested that female doctors and surgeons were sometimes even more competent and achieved the same or better results with their patients than male colleagues. In America, for example, a 2017 study analyzed more than 1.5 million cases of elderly patients who were hospitalized with internal diseases as part of the state Medicare program. Regardless of the severity of the disease or the age of the patients, mortality was slightly lower when they were treated by a female doctor. In addition, they rarely had to be treated again in the hospital promptly after discharge.
There are various reasons why few women work in surgery. One possible factor is that working at the operating table is often physically demanding, with standing for hours. This is hardly possible during pregnancy. Surveys have shown that particularly rigid working hours are a problem for women. The working day of surgeons starts early, sometimes before 7 a.m., and when it ends often depends on the course of the operation. This is particularly difficult for mothers – because women often take care of family chores, for example they have to pick up children from daycare. That’s why they work part-time. Many female surgeons also report sexist insults from their colleagues and a “glass ceiling”, i.e. a lack of opportunities for advancement due to their gender.