Is surgery losing its allure?

Cropped image of surgeon using scissors during surgery in operating room. Horizontal shot.

I knew from fairly early on in my medical student career that I wanted to be a surgeon. Inspired by enthusiastic and passionate teachers in my third year surgical attachment, there was no question that I was going to do anything else. I loved the mix of patient contact, challenging cases and the ability to do something very practical to impact on a patient’s health and wellbeing.

Therefore I was disheartened to see a recent BMJ Careers article about how surgery is becoming a less attractive career option. Historically surgery has been a popular specialty and is usually oversubscribed. Although the ratio of applicants to jobs has remained fairly static, the fill rate of posts after the first round of interviews is decreasing. In Northern Ireland, only 45% of core surgical training posts have been filled after the first round of recruitment. This is leading to problems with CT rotas and means that we are becoming ever more reliant on employing locums.

So, why is surgery not seen as attractive option any more? One reason may be the higher proportion of female medical graduates. Women now make up almost 60% of graduates but only 30% of core surgical trainees and 11% of general surgical consultants in the UK. A paper published in 2013 by Dr Ed Fitzgerald found that 59% of male and 68% of female medical graduates believe that surgery is not a career that welcomes women. This is partly due to the perception that there are still negative attitudes towards women in surgery. Indeed, a survey published in the The Bulletin (RCSEng) found that many students cited poor work/life balance as a reason for not choosing a surgical career. Two female respondents said that they had been directly dissuaded from a surgical career by their consultant, told that being female and wishing to have a family would only be a hindrance to their training. Poor anatomy training was the second most common reason.

There is a general dissatisfaction with surgical training as documented by the 2014 GMC trainee survey. Satisfaction ranges from 72.1% for foundation trainees to 82.5% for ST4 and upwards. These are the lowest average scores of all specialties. If foundation trainees have a poor experience then they may not pursue a surgical career.

There are obviously still many issues that need to be addressed. The first is to get rid of the perceptions of a male dominated specialty. We continue to have an image problem with the continuing stereotype of the arrogant, aggressive & misogynistic surgeon. The #ILookLikeASurgeon campaign started by Heather Logghe  on Twitter is an important step to challenging this stereotype and continues to gather momentum.

Looking at a change in working patterns to include more flexible working hours will go a long way to making surgery more accessible. Both men and women would like more balance with more than 30% consultant surgeons in the UK expressing a desire to work part-time at some point in their career (RCSEng workforce census 2011).

Those of us who already have a career in surgery have a responsibility to encourage younger generations to apply. We need to engage and support our trainees, especially those at foundation level. If we don’t do this then we will fail to recruit the best candidates for the jobs as we will be recruiting from an ever smaller pool of suitable applicants.

We also need more visible and positive role models (of both genders) to engage and inspire those considering a career in surgery. We need to positively influence attitudes of colleagues and junior staff to encourage diversity within the profession and to continue to dispel the myths and stereotypes about gender, personality & work-life balance.

Be part of the change. #challengestereotypes #ILookLikeaSurgeon

The privilege of caring

Never underestimate the impact we have on patients and their lives. Life can change immeasurably in the blink of an eye and after that moment nothing will ever be the same again. As a colorectal surgeon I spend a lot of my time telling patients they have cancer, and it still doesn’t get any easier. It is a life-changing diagnosis and the way the news is delivered will have a lasting impact on the patient and may have an impact on the doctor-patient relationship. Although some may have been expecting the diagnosis, they still hold onto hope that they are wrong, that you are going to tell them that everything is going to be ok.  To hear the word “cancer” spoken out loud makes it frighteningly real.

My job is to help them understand, to make treatment plans and to answer their questions to the best of my abilities. Being honest and specific with information allows the patient to start making sense of things and can provide a sense of relief as the detail can create boundaries to contain the patient’s fears as it is all too easy to imagine the worst case scenario. But there are some questions that I don’t have the answer to and, although my patients ask them, I’m not sure they really want to hear the answers. We can only make generalisations and we all have patients who have defied the odds and are still alive several years down the line despite widespread disease. I feel we walk a very fine line between not giving false hope but not dashing hopes completely.

My job as a surgeon is both an honour and a privilege. I see people at their most vulnerable and they have to trust that I will do my best to treat them. Patients often comment that I look awfully young to be a surgeon and I sometimes wonder if they find it harder to put their trust in me and what I can do to help.

I was reminded of this impact that we have by one of my patients who I treated for a rectal cancer last year. He wrote a poem about his experience of diagnosis and dedicated it to me (it has been reproduced below with his permission). I was so humbled and moved by this. It’s easy to get caught up in the routine and go through the motions but we should never forget, that for our patients, their appointment will change their life forever.

The Surgeon

We waited outside the consultant’s room

Waited to be called, pale & expectant

When the call came we entered the room

The surgeon, a focal point

The essence of her filled the space

Surrounded by assistance

The number in the room

Compounded the gravity

She seemed young, younger than us

But essential, assured, unhurried and prepared

A thousand years visible in her eyes

She was older than all of us

Behind her, a nurse sat and watched patiently

One of a kind devoted to stemming

The endless stream of cance

Acknowledging the inevitable

A dispenser of hope

‘You’ve seen the scans?’

I stared at the snapshot in her hand

The tumour, round, white and red

Like a moon round Saturn

Alien and deadly

Stared back at me

‘It has blocked the bowel here and there

We will cut that bit out and then with care

Join what’s left, careful to keep a blood flow.’

I assented, white as the tumour

With a nervous smile bereft of humour

I stared at the snapshot in her hand

The same hand that held the knife

The same hand that held my life

Surgery is women’s work

So, it’s 2015 and I still get asked if i’m sure I’m a surgeon! It probably doesn’t help that I am the first female general surgeon in my hospital but surely in this day & age people realise women can be surgeons?

Some of you may have noticed the Twitter campaign #ILookLikeaSurgeon over the last few days. This has led on from the very successful #ILookLikeAnEngineer campaign started by Isis Wenger (@isisAnchalee) after her image, used as part of a recruiting campaign for engineers, sparked unexpected controversy. The reason for the controversy?…..she didn’t “look like an engineer” (too pretty, too sexy etc). I’m pretty sure that no man has ever been told that he is too handsome to do his job! These 2 hashtag campaigns are part of a larger movement  #ThisIsWhatWeLookLike – started by a philosopher and anaesthetist to change the way we think about women and work.

Those of us in surgery have been mistaken for nurses, physiotherapists, secretaries etc – all very admirable & important jobs but it would be nice if it didn’t come as such a surprise that we are surgeons, an issue highlighted by @rhiharries in a recent Guardian article. Comments such as “you don’t look like a surgeon”, “isn’t that a man’s job?” or (my personal favourite about a hernia repair) “are you sure you know how to do my operation?” are still fairly commonplace.

While we are by no means oppressed as women can be in other countries, there are still issues with the way our society views and treats professional women. It’s been amazing to see so many inspirational women pulling together & supporting this campaign & each other. I am so happy to be a part of this, promoting positive role models and changing perceptions of women in male-dominated professions.

I hope that this might encourage more women to join a career path that I love and feel privileged to do. Defy the stereotype & be part of the solution! #ILookLikeaSurgeon because I am a surgeon.

Just to say hello

So this is my first ever blog post! Seems like everyone is doing it so thought I’d join in 🙂 I’m a locum consultant surgeon in NI – one of only 2 female surgeons with a colorectal interest! I’m passionate about encouraging more women into surgery and defying the stereotype. This has been prompted by a Twitter campaign challenging gender stereotypes in professions that are traditionally thought of as male – it all started with #ILookLikeanEngineer and has progressed on to #ILookLikeaSurgeon. It’s great to see so many amazing women challenging stereotypes!