KYOTO, Japan — It makes no difference if your surgeon is a man or a woman, according to new research out of Japan. Scientists report male and female surgeons had the same rates of death or surgical complications, despite female surgeons often taking on more challenging procedures and high-risk patients.
Study authors are advocating for more opportunities for female surgeons. They note that on a global scale, women are still a minority in the surgical field. On a more positive note, the number of female physicians has increased in recent years.
More specifically, female general surgeons accounted for just 28 percent of Canadian surgeons in 2019, only 22 percent of U.S. surgeons in 2019, and 33 percent of U.K. surgeons in 2017. Meanwhile, women only account for 22 percent of physicians in Japan, and a meager 5.9 percent of surgeons. Still, prior studies in the United States and Canada reveal that the proficiency of female physicians and surgeons is actually equal to or greater than that of their male peers.
Women are more likely to take on high-risk patients
To research this topic further, researchers made use of the Japanese National Clinical Database (NCD), which features data pertaining to 95 percent of all surgeries performed in Japan. Study authors compared that data to surgical outcomes among female and male surgeons between 2013 and 2017. Additionally, they examined the relation between postoperative mortality (within 90 days of surgery) and surgical complication rates (within 30 days of surgery), and the surgeon’s licensing terms.
The team placed particular emphasis on three common procedures for stomach and rectal cancer: distal gastrectomy, total gastrectomy, and low anterior resection. They chose those three because enough female surgeons have performed these surgeries to facilitate an analysis while keeping the surgeons anonymous. The complete analysis featured 149,193 distal gastrectomy surgeries, 63,417 gastrectomy surgeries, and 81,593 low anterior resection procedures.
Study authors found that female surgeons performed only five percent of these procedures and were much less likely than their male counterparts to work in high-volume medical facilities. Yet, hospitals were more likely to assign female surgeons to high-risk patients, defined as patients who were either malnourished, on long-term steroids, or with more severe disease.
Despite all that, there were no overall differences in the rates of death or surgical complications between male and female surgeons. Study authors were sure to account for other patient-related factors as well.
Female surgeons face many obstacles
Female surgeons, on average, had fewer post-registration years, and performed fewer minimally invasive (keyhole) surgeries than male surgeons. The research team speculates this could be the result of fewer training opportunities linked to preferential treatment toward male trainees, or the competing demands of women’s traditional societal roles, such as raising a family.
Ultimately, the team notes that this project was observational in nature, meaning they can’t make a firm conclusion about cause and effect. Study authors admit that at this time, they cannot rule out the possibility that their results are the result of other factors they did not measure. This project also failed to consider all the details on surgeons’ work and personal life conditions, and it may not apply to other types of surgeries or procedures performed by surgeons with other specialties.
However, study authors still argue their findings hold scientific merit and warrant further research. This project featured the use of a highly accurate clinical database in terms of patients’ preoperative condition and surgical outcomes and accounted for important patient related factors tied to the individual procedures selected.
“Many aspects can impair the successful development of female surgeons,” researchers write in a media release. “Nevertheless, in this analysis, no significant difference existed in the mortality or complication rates of surgeries done by female and male surgeons, suggesting that they are equally successful in developing their surgical skills.”
“More appropriate and effective surgical training for female surgeons could further improve surgical outcomes,” they add.
Does the medical community need ‘rapid change’?
Cherry Koh, a colorectal surgeon based in Australia, adds that these findings don’t only apply to Japan; female surgeons all over the world have had similar experiences. She believes that changes across virtually all facets of society are necessary to better support women in the workforce. Leadership at all levels — government ministers, professional surgical societies, hospital managers, and departmental leads — also need to commit to change.
“Only through broad engagement can national regulations (such as targets or quotas supporting gender equity in recruitment, training, and retention) be combined with local measures (such as codes of conduct, safer workplace practices, and mentoring opportunities),” Koh concludes. “Rapid change is needed, in the interest of both clinicians and patients.”
The study is published in The BMJ.