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Fostering Gender Equity and Inclusion in Surgery for Women Surgeons

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One sweltering afternoon during the hot summer in South India, I walked into a surgical professor's office, desperate for her help to expand my survey on women surgeons for one of my gender equity studies. As soon as I shared my nervous elevator pitch, I saw immediate rejection on her face. She looked over at me and firmly said, “I find your study insulting, and I do not want to participate. I view women surgeons as the same as male surgeons and do not choose to look at them in a different light.” 

Though we eventually ended up having a fruitful discussion about how women physicians are at a larger risk for burnout, depressive symptoms, and lesser career satisfaction, I was struck that this amazing women surgeon had believed in an insidiously prevalent misconception: That inspecting gender-specific differences promotes discrimination.

I noticed during my review of literature that many burnout and career satisfaction studies do not track gender effects — though many that do find significant differences. But gender equity among physicians is still a highly taboo subject: there is very little public awareness of the impending need for expansion in the literature of studies on gender bias and inequitable gender gap, especially in lower-income countries. Having gotten the opportunity to be a lead researcher on a study about this, I was made aware of a sad truth: Living in systemic oppression for centuries has taught many women surgeons they need to camouflage themselves. 

What do I mean by camouflaging? Women not wanting to be seen as a separate group requiring separate needs, due to fear of retaliation. Forms of retaliation can be harsh treatment at work, like being deprived of training opportunities for seeming “too bold,” “too outspoken,” or “too dramatic” for wanting to improve gender inequity. In essence, this fear of being afraid to come forward and talk about our needs is a milder version of historic camouflaging.

In the 18th century, Englishwoman Hannah Snell used the identity of her brother-in-law in order to serve in the British Royal Marines, and went to the extent of operating on herself to remove a musket ball to conceal her gender identity. In the 19th century, Dr. James Barry, born to the name Margaret Ann Bulkley, disguised herself as a man to receive medical education and was the first surgeon to perform a successful C-section in South Africa. In the 1990s, Dr. Elizabeth Shaughnessy, the president of the Association of Women Surgeons, was asked as a surgical resident, “Why can’t you be more like [a male colleague]?” She proceeded to say during her presidential address, “To fit in, I changed my style of dressing, my hair, and lowered my vocal tone to be more authoritative. I denied my authentic self trying to survive residency.” 

It is 2022, and while we may not disguise ourselves as men to gain educational opportunities anymore, many women continue to change the way they express themselves and fear addressing female gender-specific needs during surgical training. It is high time we stop camouflaging and begin aggressively addressing gender inequity as something that, if we can’t change for ourselves, we can at least give to the generation after us.  

However, I have directly heard of schools of thought from senior woman surgeons who weren’t too supportive of conversation on gender equity because they personally went through a more hostile atmosphere during their surgical training. Hence, they have a “tough coach” mentality, in which they consider a young woman surgeon emotionally weak or just not a competent surgeon when they talk about their issues of work-life balance, their need for maternity leave, their need of support from colleagues during the postpartum period, or other gender-specific requirements.

Dr. Arianna Gianakos is actively fighting this by asking women to speak up about what they are enduring during training. “During my orthopaedic surgery training I was introduced to a culture of hostility, experiencing bullying and sexual harassment,” said Dr. Gianakos at the Women in Medicine Summit. “When I tried to stand up for myself, I faced severe retaliation. I realized that this was a systemic problem affecting many across the world.” She has co-authored many peer reviewed manuscripts to provide solutions to the widespread problem of gender inequity in surgical training. 

Surgical training is a sensitive time in a young physician’s life. It is important that young woman physicians are able to look up to the trailblazers of women in medicine, especially in surgery. It’s vital that young women physicians understand that surgery can be a place for them, though so many believe it isn’t. One Chinese medical student survey conducted this year revealed that 53.19% of medical student respondents believed that surgery was not suitable for women. In India, women surgeons represent only 2.4-2.8% of all surgeons, despite approximately 50% of graduating medical students being women. If surgical specialties are to undergo major development in the future, women medical students must perceive it to be a professionally satisfying career path.

Although there has been a steep increase in the proportion of women in surgery in the past thirty years, this does not instantly put everyone on an equal playing ground.

Dyrbye et al., concluded that women surgeons, in comparison to men, were more likely to have experienced conflict with their spouse’s career, and more likely to have undergone work-home conflict. It is essential for us to establish a culture in surgery to allow women surgeons to be their authentic selves, speaking up about issues and asking for gender-specific assistance when necessary.

Gender equity in surgical training can be improved by taking into account gender-specific needs of women, and by providing gender-specific surgical mentorship focus to women pre-medical school, as well as while they are medical students. A gender spotlight should not be seen as an insult or a condescending approach. Identifying the unleveled areas will point to us the areas of needed repair, and we can heal the consequences of gender camouflage from the ground up.

How do you combat camouflage? Stand out in the comments.

Oviya Anjali Giri is a final year medical student at P.S.G. Institute of Medical Sciences and Research, India. Her research interests include minimally invasive surgical outcomes research and women in surgery research. She is a budding physician writer and aspires to train in general surgery in the United States in the upcoming years.

Illustration by Jennifer Bogartz

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