Three years ago, I was applying for a fellowship in head and neck surgical oncology and microvascular reconstruction. I flew around the country, visited different academic departments, and interviewed with esteemed academic surgeons -- all the while hoping I would be judged worthy of their mentorship. It was a tough but exciting time.
Though I had gravitated toward specializing in head and neck cancer surgery since my intern year in otolaryngology, I worried whether I was cut out for the emotional burden of caring for patients with such dehumanizing illnesses. The prospect of entering a specialty in which any mistakes could significantly impact a patient's survival and functional outcome was also acutely daunting. I had been dealing with my own for years, and had found the reassurance from my program director and faculty mentors -- all of whom supported my decision to pursue fellowship training -- only transiently soothing.
During one interview, the chair of a particularly prestigious department looked across his desk at me and said something I'd been unconsciously worrying about for years.
"I'm going to give it to you straight," he said. "Do you realize you're going to need to be three times as good of a surgeon as your peers?" I stayed quiet, and he went on: "You're a woman, so you need to be twice as good; and you do this writing stuff instead of research, so you need to be three times as good. You need to be beyond reproach."
Though this was the first time anyone had acknowledged this truth so bluntly, the concept that women have more to prove in surgery is not new, and the wincing smile with which I responded to him wasn't either. When the department chair gave a voice to the gaslighting I'd been doing to myself for years, I felt, perhaps paradoxically, gratitude toward him. He acknowledged that there is an imperfect system in place that not only makes it more difficult for women to succeed in surgery, but asks them to be better than their male peers if they want the same opportunities. While I appreciated that he recognized that truth, I only wish this had led us to a conversation about how to change the status quo.
When I eventually wrapped up my interviews and began my fellowship, this "status quo" was all too prevalent. Not infrequently, I encounter disbelief from patients or staff when they find out I'm the attending surgeon. There are countless examples, but a particularly egregious one sticks out in my mind. During fellowship, I was preparing to perform a total laryngectomy with bilateral neck dissections -- an all-day case. As I opened a cabinet to get my surgical gloves, a staff member in the room asked whether I was the new medical student on service and warned me not to touch the sterile table. She doubled down when I gently told her I was the attending, and said, "Well, you don't look old enough to be out of medical school!" I usually dismiss these types of comments with a self-deprecating, "Oh, you just can't see my gray hair under this cap -- I'm older than I look!" But in this case, her words stung. I was already feeling anxious about the case, already wondering whether I was good enough to do it. (Spoiler alert: the case went fine, and the patient did well).
In those first-impression moments, what people are really saying is that I don't look like what they think an attending surgeon should look like.
This bias has significant implications. Earlier this month, JAMA published of nearly 40 million referrals to American surgeons, finding that male physicians referred their patients preferentially to male surgeons, and that female surgeons received non-operative referrals more often than their male counterparts. When female surgeons aren't given the same level of professional courtesy as their male peers, they don't operate as much and the feeling of not being as busy as their peers can become a self-fulfilling prophecy. This has implications for female surgeons' surgical skill development as well as their ability to advance in academic departments. In my specialty, women are paid only compared to their male counterparts. Although gender parity is getting better within otolaryngology on the whole, head and neck surgical oncology and microvascular reconstruction .
A life in surgery is a difficult one -- full of long days, weighty decisions, and serious implications for mistakes. It's hard enough for anyone to do without worrying that, by virtue of their sex, they have something additional to prove. It's time to change the status quo.
is a writer and an otolaryngologist-head and neck surgeon at Oregon Health and Science University who specializes in the treatment of patients with head and neck cancer.