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

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