While writing about barriers to career development for the Council on Women in Surgery, I came across the conundrum of how to refer to the surgeon’s gender. Most of the existing literature refers to surgeons who are women as “female surgeons”, and this terminology is pervasive in casual conversation, social media, and news stories.
This observation led me to reflect on how our language influences our attitudes and culture. Language mirrors the values of the culture using it. The historical exclusion of women from many professions has led to associations based on the predominance of men. While the number of women increased within various professions, the referral to gender within a profession is still assumed to male unless otherwise noted as female. Thus, the modern-day surgeon is presumed to be male.
I argue that using the qualifier “female” for a woman who is a surgeon reduces her status. None of my male colleagues aspire to be a male surgeon—everyone simply aspires to be a surgeon. If you are not convinced that using the word “female” before “surgeon” connotes “less than,” consider how language shapes our gender biases. When we refer to a surgeon as a “female surgeon”, we are not equating her to “surgeon” — even if only on a subconscious level. Rather, the implication is that she is inferior to other surgeons, who are by default men.
There is abundant evidence regarding the societal attitude that devalues work done by females. Employers place a lower value on work done by women even when controlling for education and skill. Moreover, skilled work is perceived to be men’s work, while unskilled work is perceived to be men and women’s work. This attitude is pervasive and is clearly seen in the phenomenon of devaluating the occupations that have experienced an increase in the number of employees who are women.
It is time to shift our narrative. Women have accounted for 50% of medical school graduates for decades, yet this is not reflected in our leadership. For over two decades, the phenomena of “glass ceilings”, “sticky floors” and the “broken pipeline” have all been well documented. It is 2018 and in the academic surgical world, women are less likely to be promoted, earn less, publish less, receive less mentorship, receive less mentored research funding, and receive less independent research funding compared to men.
The interplay between these observations and the underlying causes is complex, but the reasons for the disparities are frequently attributed to individual choices by women, difficult personalities of women, or poor negotiations by women. Or, as we recently experienced with the recent article by the Dallas Medical Journal that made national news, being “female” is the reason for the pay gap since “female” physicians do not work as hard as “male” physicians.
Another proposed explanation is that women are less capable. The latter bias manifests in the differential response among referring providers when a patient suffers a complication, which translates to fewer referrals to women but not to men.
These biases find their way into our language. The language we speak and hear physically alters our neural connections including the areas related to how we experience reality and link words to ideas. As such, our language not only expresses our view of the world, it also influences our perception of the world.
This is important to understand, as bias is not the prevue of men alone. Women too can display misogynistic behavior towards other women—a phenomenon called internalized misogyny—while holding other women to a double standard. An obvious form of bias manifests as the backlash effect to women stepping outside the proscribed gender norms and take on leadership positions (status incongruity). This gender discrimination further leads to isolation as others (including women) mostly deny that such experiences exist or simply distance themselves from women who have experienced discrimination based on gender.
Because culture is rooted in language, changing our language can change our culture. Today, we celebrate empathy in medicine, narrative medicine is a specialty, and research outcomes are “patient-centered.” These were novel concepts when first introduced into our language and are now pervasive in our culture. I argue that it is time to promote women to “full human” status and no longer reduce their complex identity to their biologic sex. It is possible to speak in gender-neutral language that is inclusive and respectful of one’s humanity without conjuring up deep biases. This is a call to exercise precision in the way we command our language.
It is time to shift our inner dialogue and the way we perceive the world we live in. Although the issues surrounding the advancement of women in surgery are multifaceted, we can at least begin with a small change in language shaping our attitude toward women who are surgeons. Let’s call a surgeon a surgeon and if you must invoke gender, then simply say “surgeons who are women”.
Dr. Sherene Shalhub is a vascular surgeon, translational researcher, and an educator. Her overarching research goal is to personalize healthcare for patients suffering from genetically triggered vascular conditions associated with aortic/arterial dissections and aneurysms, and improve the success of surgical repair and long-term survival for these patients. Currently, she is investigating the effect of gene mutations on vascular disease by utilizing a collaborative multidisciplinary approach combining genetics and surgical outcomes. She is passionate about mentoring the next generation of young surgeons and scientists.