Women surgeons fighting for work-life balance: how technology might help close the gender gap

Abstract

Despite a growing number of women choosing to pursue surgical specialties, surgery is still perceived as a woman-unfriendly career. The difficulties of conciliating a demanding career with the requirements of both personal and family life for women surgeons have been investigated by several authors. The current study aims to summarize existing evidence on the issue of work-life balance for women surgeons, particularly focusing on possible strategies to improve it. Artificial intelligence (AI) has been investigated as a possible means to close the gender gap, acting as an equalizer for women surgeons. Female surgeons have been reported to be unmarried or to have married later in life at a higher rate than their male colleagues; many of them also choose not to have children or to have fewer and to have them later in life. These disparities are partly due to the issues connected to invisible work (e.g. household management), the difficulties of managing pregnancy during surgical residency, the challenges women face when returning to work following maternity leave, and the lack of a supportive environment. Flexible work schedules, implementation of childcare facilities, introduction and encouragement of paternity leave for surgeons, and enforcement of mentorship and sponsorship for female surgeons are some of the proposed solutions for building a fair and equitable work culture for all surgeons and overthrowing old, conventional ideas concerning gender roles. Moreover, technology has been advocated as a possible solution to gender discrimination in surgical departments; technology could facilitate an objective assessment of surgical performances and advanced training for surgeons unable to attend in-person education. A healthy, thriving, organized, supportive, and culturally transformed work environment could benefit surgeon and staff productivity and ultimately improve patient care.

Keywords

Work-life balance / women surgeons / gender equality / career / invisible work

References

[1] Burrow GN.The evolution of women as physicians and surgeons.Ann Thorac Surg2001;71:S27-9

[2] Brown MA,Munger AM.Despite growing number of women surgeons, authorship gender disparity in orthopaedic literature persists over 30 years.Clin Orthop Relat Res2020;478:1542-52 PMCID:PMC7310313

[3] Pflibsen LR,Bernard RW.Representation of women on plastic surgery journal editorial boards in the United States.Aesthet Surg J2021;41:NP914-20

[4] La Peña NM, Richter KR, Haglin JM, Pollock JR, Richter RA, Kouloumberis PE. Differences by practice year in numbers of U.S. female neurosurgeons.World Neurosurg2021;145:363-7

[5] Hutchison K.Four types of gender bias affecting women surgeons and their cumulative impact.J Med Ethics2020;46:236-41

[6] Fahlén M.The attitude and perceptions of work-life balance: a comparison among women surgeons in Japan, USA, and Hong Kong China.World J Surg2013;37:12-3

[7] Kawase K,Yorozuya K,Numann PJ.The attitude and perceptions of work-life balance: a comparison among women surgeons in Japan, USA, and Hong Kong China.World J Surg2013;37:2-11

[8] Shaikh S.Women trauma surgeons penetrating the glass ceiling.Am J Surg2020;220:1358-60

[9] Kwong A,Kawase K.Work-life balance of female versus male surgeons in Hong Kong based on findings of a questionnaire designed by a Japanese surgeon.Surg Today2014;44:62-72

[10] Rogers AC,McNamara DA.Gender and specialty influences on personal and professional life among trainees.Ann Surg2019;269:383-7

[11] Ponzio DY,Stavrakis A.Discrepancies in work-family integration between female and male orthopaedic surgeons.J Bone Joint Surg Am2022;104:465-72

[12] Daniels AK.Invisible work.Social Problems1987;34:403-15

[13] Ross SB,Spence J,Sucandy I.Men surgeons’ perceptions of women surgeons: is there a bias against women in surgery?.Surg Endosc2020;34:5122-31

[14] Naidu NS,Bregman D.Challenges to professional success for women plastic surgeons: an international survey.Aesthetic Plast Surg2021;45:2464-72

[15] Straehley CJ.Family issues affecting women in medicine, particularly women surgeons.Am J Surg2006;192:695-8

[16] Sauder M,Zagales R.Comprehensive assessment of burnout among surgical trainees and practicing surgeons: a systematic review.J Surg Educ2022;79:1188-205

[17] Rasmussen JM,Ties JS,Kallies KJ.Career Satisfaction, gender bias, and work-life balance: a contemporary assessment of general surgeons.J Surg Educ2021;78:119-25

[18] Hu YY,Hewitt DB.Discrimination, abuse, harassment, and burnout in surgical residency training.N Engl J Med2019;381:1741-52 PMCID:PMC6907686

[19] Troppmann KM,Goodnight JE Jr,Troppmann C.Women surgeons in the new millennium.Arch Surg2009;144:635-42

[20] Rusch VW.Women leaders in (colorectal) surgery: can the extraordinary become ordinary?.Surgery2020;168:363-4

[21] Castillo-Angeles M,Rangel EL.Perspectives of general surgery program directors on paternity leave during surgical training.JAMA Surg2022;157:105-11 PMCID:PMC8637392

[22] Compton J,Pugely AJ.Pregnancy and parental leave during orthopaedic surgery residency.Iowa Orthop J2021;41:19-23 PMCID:PMC8259193

[23] Altieri MS,Bevilacqua LA.Perceptions of surgery residents about parental leave during training.JAMA Surg2019;154:952-8 PMCID:PMC6686777

[24] Feliu-Dominguez R,Cruz-Correa M.Women gastroenterologists in academic medicine: tradition versus transition.Dig Dis Sci2017;62:13-5

[25] Rouse LP,Gebhard RE.Women physicians: gender and the medical workplace.J Womens Health2020;29:297-309

[26] Senturk JC.Surgeon burnout: defining, identifying, and addressing the new reality.Clin Colon Rectal Surg2019;32:407-14 PMCID:PMC6901360

[27] Verdi D,Capelli G.Women surgeons: how can we shape the future of new leaders?.Surgery2022;172:633-8

[28] Women in surgery Italia. Available from: https://womeninsurgeryitalia.it/ [Last accessed on 6 May 2023]

[29] Mari V,Ferrari L.The potential of artificial intelligence as an equalizer of gender disparity in surgical training and education.Art Int Surg2022;2:122-31

[30] Spolverato G,Majidi D.Statement on artificial intelligence surgery by women-in-surgery - Italia: can artificial intelligence be the great equalizer in surgery?.Art Int Surg2021;1:18-21

[31] Myers SP,Brown JB.Effects of gender bias and stereotypes in surgical training: a randomized clinical trial.JAMA Surg2020;155:552-60 PMCID:PMC7240638

[32] Yuce TK,Glass C.National evaluation of racial/ethnic discrimination in US surgical residency programs.JAMA Surg2020;155:526-8 PMCID:PMC7160741

[33] Halperin TJ,Mulliken JB.Gender differences in the professional and private lives of plastic surgeons.Ann Plast Surg2010;64:775-9

[34] Ridgway EB,Chiou AP,Mulliken JB.Reflections on the mating pool for women in plastic surgery.Plast Reconstr Surg2014;133:187-94

[35] Sangji NF,Donelan K,King D.Gender disparity in trauma surgery: compensation, practice patterns, personal life, and wellness.J Surg Res2020;250:179-87

[36] Tulunay-Ugur OE,Chen AY.Assessment of gender differences in perceptions of work-life integration among head and neck surgeons.JAMA Otolaryngol Head Neck Surg2019;145:453-8 PMCID:PMC6537789

[37] Lafer MP,Zhang Y,Lee JW.Gender differences in compensation, mentorship, and work-life balance within facial plastic surgery.Laryngoscope2021;131:E787-91

[38] Baptiste D,Dolejs SC.Gender differences in academic surgery, work-life balance, and satisfaction.J Surg Res2017;218:99-107

[39] Johnson HM,Strassle PD.Associations between career satisfaction, personal life factors, and work-life integration practices among us surgeons by gender.JAMA Surg2020;155:742-50 PMCID:PMC7315384

[40] Kawase K,Tominaga R.Analysis of gender-based differences among surgeons in Japan: results of a survey conducted by the Japan Surgical Society. Part. 2: personal life.Surg Today2018;48:308-19

[41] Kawase K,Nomura S.How pregnancy and childbirth affect the working conditions and careers of women surgeons in Japan: findings of a nationwide survey conducted by the Japan Surgical Society.Surg Today2021;51:309-21

[42] Rangel EL,Castillo-Angeles M.Pregnancy and motherhood during surgical training.JAMA Surg2018;153:644-52 PMCID:PMC5875346

[43] Theodosiou AA.Cassandra’s prophecy: medic or mother?.Reprod Biomed Online2013;27:25-8

[44] Maloni K,Reed A,Dougherty M.Attitudes regarding pregnancy among vascular surgery trainees and program directors based on a survey of vascular residents, vascular fellows, and the association of program directors in vascular surgery.Vasc Endovascular Surg2022;56:561-5

[45] Mizgala CL,Walters BC,McNeill IY.Women surgeons. Results of the Canadian population study.Ann Surg1993;218:37-46 PMCID:PMC1242898

[46] Offiah G,Rees CE.Gender matters: understanding transitions in surgical education.Front Med2022;9:884452 PMCID:PMC9127800

[47] Dyrbye LN,Balch CM,Sloan J.Relationship between work-home conflicts and burnout among American surgeons: a comparison by sex.Arch Surg2011;146:211-7

[48] Shanafelt TD.Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout.Mayo Clin Proc2017;92:129-46

[49] Lim WH,Jain SR.The unspoken reality of gender bias in surgery: a qualitative systematic review.PLoS One2021;16:e0246420 PMCID:PMC7853521

[50] Wu D,Rittenhouse K,Mooney C.A preliminary analysis of compassion fatigue in a surgeon population: are female surgeons at heightened risk?.Am Surg2017;83:1302-7

[51] Cil TD.The role of gender in patient preference for breast surgical care - a comment on equality.Isr J Health Policy Res2018;7:37 PMCID:PMC6036689

[52] Wallis CJ,Coburn N,Detsky AS.Comparison of postoperative outcomes among patients treated by male and female surgeons: a population based matched cohort study.BMJ2017;359:j4366 PMCID:PMC6284261

[53] HeForShe. Available from: https://www.heforshe.org/en/champions [Last accessed on 6 May 2023]

[54] Wood DE.How can men be good allies for women in surgery?.J Thorac Dis2021;13:492-501 PMCID:PMC7867856

[55] Hashimoto DA,Rus D.Artificial intelligence in surgery: promises and perils.Ann Surg2018;268:70-6

[56] De Simone B,Gumbs AA.Knowledge, attitude, and practice of artificial intelligence in emergency and trauma surgery, the ARIES project: an international web-based survey.World J Emerg Surg2022;17:10 PMCID:PMC8832812

[57] Solanki SL,Nayak A,Ambulkar RP.Artificial intelligence in perioperative management of major gastrointestinal surgeries.World J Gastroenterol2021;27:2758-70 PMCID:PMC8173379

[58] Humm G,Stoyanov D.Supporting laparoscopic general surgery training with digital technology: the United Kingdom and Ireland paradigm.BMC Surg2021;21:123 PMCID:PMC7941971

[59] Greenfield MJ,Billingsley ML.Demonstration of the effectiveness of augmented reality telesurgery in complex hand reconstruction in Gaza.Plast Reconstr Surg Glob Open2018;6:e1708 PMCID:PMC5908501

[60] Lin CC,Chiang CC,Lee OK.Real-time streaming of surgery performance and intraoperative imaging data in the hybrid operating room: development and usability study.JMIR Med Inform2020;8:e18094 PMCID:PMC7316181

[61] Vera AM,Mohsin A.Augmented reality telementoring (ART) platform: a randomized controlled trial to assess the efficacy of a new surgical education technology.Surg Endosc2014;28:3467-72

[62] Anvari M,Barlow K.From telementorship to automation.J Surg Oncol2021;124:246-9

[63] Mirchi N,Yilmaz R,Winkler-Schwartz A.The virtual operative assistant: an explainable artificial intelligence tool for simulation-based training in surgery and medicine.PLoS One2020;15:e0229596 PMCID:PMC7046231

[64] Bissonnette V,Ledwos N,Winkler-Schwartz A.neurosurgical simulation & artificial intelligence learning centreartificial intelligence distinguishes surgical training levels in a virtual reality spinal task.J Bone Joint Surg Am2019;101:e127 PMCID:PMC7406145

[65] Reiley CE,Yuh DD.Review of methods for objective surgical skill evaluation.Surg Endosc2011;25:356-66

[66] Cole SJ,Ha J,Miskovic D.Randomized controlled trial on the effect of coaching in simulated laparoscopic training.Surg Endosc2014;28:979-86

[67] Kowalewski KF,Schmidt MW.Validation of the mobile serious game application Touch Surgery™ for cognitive training and assessment of laparoscopic cholecystectomy.Surg Endosc2017;31:4058-66

[68] Chidambaram S,Leff D.A randomized controlled trial of skills transfer: from touch surgery to laparoscopic cholecystectomy.J Surg Res2019;234:217-23

[69] De'Ath HD,Mehta C,Qureshi T.Mentored trainees have similar short-term outcomes to a consultant trainer following laparoscopic colorectal resection.World J Surg2017;41:1896-902