The researchers note that women are still underrepresented in the surgical profession internationally and call for more opportunities for female surgeons to help lessen gender-based inequity. Despite the fact that the number of female doctors has increased globally in recent years, women continue to be a minority in the surgical field. For instance, in Canada, the US, and the UK, female general surgeons made up 28% (2019), 22% (2019), and 33% (2017), respectively, of all surgeons. In Japan, the percentage of female doctors is 22%, while the number of female surgeons is significantly lower, at 5.9%. However, earlier research from the US and Canada revealed that the proficiency of female doctors and surgeons was on par with or superior to that of their male colleagues. In order to explore this further, researchers compared the surgical results of male and female surgeons from 2013 to 2017 using the Japanese National Clinical Database (NCD), which contains data on over 95% of operations carried out in Japan. They also examined the relationship between postoperative mortality (within 90 days of surgery) and surgical complication rates (within 30 days of surgery) and the surgeon’s licensing terms. They focused on three common procedures for stomach and rectal cancer (distal gastrectomy, total gastrectomy, and low anterior resection). These were chosen because the number of female surgeons who did these surgeries was sufficient for analysis without the individual surgeon being identified. Their analysis included 149,193 distal gastrectomy surgeries, 63,417 gastrectomy surgeries, and 81,593 low anterior resection procedures. The researchers found that female surgeons performed only 5% of these procedures and those female surgeons were less likely than male surgeons to work in high-volume centers. Female surgeons were more likely than male surgeons to be assigned high-risk patients (those who were malnourished, on long-term steroids, or with higher-stage disease). But despite this, the researchers found no overall differences in the rates of death or surgical complications between male and female surgeons, after taking into account other patient-related factors. On average, female surgeons also had fewer post-registration years and did fewer minimally invasive (keyhole) surgeries than male surgeons. The researchers suggest this could be due to reduced training opportunities linked to preferential treatment of male trainees and the competing demands of women’s traditional societal roles, including raising a family. This is an observational study, so no firm conclusions can be drawn about cause and effect, and the researchers cannot rule out the possibility that the results may be due to other unmeasured factors. They also point to a lack of details on surgeons’ work and personal life conditions and say the results may not apply to other types of surgical procedures or those performed by surgeons with other specialties. However, study strengths included the use of a highly accurate clinical database in terms of patients’ preoperative condition and surgical outcomes, and accounting for important patient-related factors for the individual procedures selected. “Many aspects can impair the successful development of female surgeons,” say the researchers. “Nevertheless, in this analysis, no significant difference existed in the mortality or complication rates of surgeries done by female and male surgeons, suggesting that they are equally successful in developing their surgical skills.” They add: “More appropriate and effective surgical training for female surgeons could further improve surgical outcomes.” The challenges faced by female surgeons in Japan are not unique, and many female surgeons elsewhere have had similar experiences, notes Cherry Koh, a colorectal surgeon based in Australia, in a linked editorial. Change at work, at home, and at a societal level is necessary to support women in the workforce, she says, while leadership at all levels is crucial to driving change, including commitment from government ministers, professional surgical societies, hospital managers, and departmental leads. Only through broad engagement can national regulations (such as targets or quotas supporting gender equity in recruitment, training, and retention) be combined with local measures (such as codes of conduct, safer workplace practices, and mentoring opportunities),” she writes. “Rapid change is needed, in the interest of both clinicians and patients.” Reference: “Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study” by Kae Okoshi, Hideki Endo, Sachiyo Nomura, Emiko Kono, Yusuke Fujita, Itaru Yasufuku, Koya Hida, Hiroyuki Yamamoto, Hiroaki Miyata, Kazuhiro Yoshida, Yoshihiro Kakeji and Yuko Kitagawa, 28 September 2022, The BMJ.DOI: 10.1136/bmj-2022-070568
