On October 15, 2020, the article, "STS 2019 Workforce Report: Ad Hoc Analysis of Women in Cardiothoracic Surgery" (DuyKhanh P. Ceppa, John S. Ikonomidis, Lava R. Timsina, et al.), was published in The Annals of Thoracic Surgery.
Dr. HelenMari Merritt-Genore describes the article, what it means for cardiothoracic surgery, and her view on the topic of women in the specialty.
The workforce survey did not evaluate or compare factors that may be tied to compensation, including relative value units, rank, or geographic locations. However, studies previously have demonstrated that women physicians report lower compensation, even after accounting for age, experience, specialty, faculty rank, research productivity, and clinical revenue.
It is true that women physicians and surgeons are less likely to hold advanced academic ranks and titles. For all subspecialties, approximately 85% of all dean and department chair positions are held by men, and only 21% of full professor faculty positions are held by women.
In terms of clinical abilities and outcomes, women surgeons perform equally well as men. A 2017 study that compared approximately100,000 matched patients concluded that patients treated by female surgeons had a statistically significant decrease in 30-day mortality, with similar length of stay, complications, and readmissions.
What can we do to address these issues that are contributing to the gender wage gap and difficulty recruiting women to our specialty?
This analysis also examined job satisfaction. Encouragingly, both male and female surgeons were generally satisfied in cardiothoracic surgery, yet female surgeons were less likely to report being “extremely satisfied,” and more likely to report burnout. We should passionately explore this outcome, especially considering that the female survey respondents were younger and earlier in their career than the male surgeons. Ask yourself if women physicians in your practice more commonly perform duties not directly tied to compensation or advancement like writing schedules for call, serving on committees, arranging conferences, or coordinating guest speakers. These uncompensated duties, in addition to a disproportionate amount of domestic tasks, may contribute to burnout and have been described as the “sticky floor” rather than the glass ceiling for advancement. This is according to several studies that have examined citizenship tasks within practices and the gender differences which may exist. Additionally, approximately 1-in-3 women in academic medicine have reported experiencing sexual harassment. Our own subspecialty data suggest that >80% of women in thoracic surgery have experienced some form of sexual harassment, which has previously been linked to physician burnout.
What can we do to address these issues that are contributing to the gender wage gap and difficulty recruiting women to our specialty? Number one is transparency, and for this, I applaud the authors for publishing these data. This type of direct discussion must occur at national as well as institutional levels.
Also critical is the sponsorship for leadership positions and promotion. Our society has been on the front line of leadership in this regard, increasing women in society meetings and leadership positions, involving male surgeons in #heforshe, and utilizing STS presidential addresses to focus on the benefits of inclusion and the advancement of women in our field. This should be commended and continued on national and local levels.
In addition, the intolerance of sexual harassment, which should need no further explanation, is important. Read Dr. David Tom Cooke’s thoughts on sexual harassment within cardiothoracic surgery in “No Such Thing as an Innocent Bystander.”
Other action items include the implementation and funding of strategies to address disparities, as well as the investigation and critical examination of pay structures. Lastly, tracking and reporting outcomes are imperative.
While the 2019 STS Workforce Survey was not specifically designed for a complete and thorough comparison of female and male cardiothoracic surgeons, the ad hoc analysis helped identify serious issues within the specialty that require attention, dedicated conversations, and important action.
HelenMari Merritt-Genore, DO, is an adult cardiothoracic surgeon at Methodist Physicians Clinic in Omaha, Nebraska. She completed an integrated residency from The University of Texas Health Science Center in San Antonio, Texas. Dr Merritt-Genore has clinical interests in minimally invasive CT surgery and surgical ablation, as well as a passion for surgical education. She holds several leadership roles in STS and Women in Thoracic Surgery.