Challenges to Professional Success for Women Plastic Surgeons: An International Survey

Gender Gap? A Survey among Plastic Surgeons in Germany

INTRODUCTION

There is an ongoing increase in the percentage of females in the field of Plastic Surgery in Germany. Currently, 29,1% of fellows and 46% of residents in Germany are female. Several studies have pointed out the various obstacles that female doctors, especially female plastic surgeons, are confronted with in their professional life. The aim of this study is to examine gender parity among plastic surgeons in Germany. Furthermore, we aim to evaluate the opinion of both women and men on gender-specific discrimination.

METHODS

In a nonrandomized, cross-sectional study an anonymous questionnaire covering various subjects such as education/training, career path, the compatibility of family and career, as well as the subjective perception of gender equality in Plastic Surgery was distributed among members of the German Association of Plastic, Reconstructive and Aesthetic Surgery (DGPRÄC) as well as through social media. Data was collected with Google Docs.

RESULTS

The sample group (n = 285) composition was 162 female (56,8%), 122 (42,9%) male and 1 nonbinary (0,4%). The majority of women (54.3%) and men (49.1%) rated work-life balance as "difficult". In 82.1% of women and 44.3% of men, family planning was influenced by the profession. Most of the respondents work in hospitals (62.9% of women and 50.0% of men). The main motivation of 61.4% of women to go to in private practice was family reasons, 51.8% of men gave financial reasons. 64.1% of women and 54.1% of men have a doctoral degree, whereas 6.9% of women and 13.3% of the men have a postdoctoral degree. While 33.6% of the men believe that their own gender had no influence on their respective career decision, career progress or success, only 4.9% of women had the same opinion. In addition, 43.8% of women and 22.1% of men reported having experienced sexual harassment in their professional lives.

CONCLUSION

This study reveals significant gender differences in career development in Plastic Surgery. Family planning, motivations for establishment and academic careers, as well as the experience of sexual harassment, are of primary concern. Actively helping to shape the work environment of career development opportunities in light of this study may help to reduce gender disparities in Plastic Surgery in the future.

The Representation of Wellness Programs in Plastic Surgery Residency

Background

Plastic surgery residency comprises a significant portion of early adulthood. The difficulties of residency are well documented, particularly with the impact on wellness and risk of burnout. Structured wellness programs, mentorship, social support, and autonomy can decrease residency burnout. This study looked at how plastic surgery program websites and GME websites represent wellness and support programs between both integrated and independent plastic surgery residencies.

Methods

A cross-sectional analysis of US plastic surgery residency programs was performed during the month of April 2024. The authors conducted a systematic content analysis on the available websites of these residency websites, GME websites, and associated programs' Instagram and X (formally Twitter) pages. Data points included (1) mention of wellness on the program website, (2) vacation time mentioned on the website, (3) protected time available, (4) spouse support options, (5) day care options, (6) connections with mentors, (7) images of social events on the website, and (8) images of social events on Instagram. Data were compiled and analyzed in JASP (JASP Team [2024]. JASP [version 0.18.3; computer software]) as well as Microsoft Excel. Categorical variables were compared using binomial tests and chi-squared tests. Statistical significance was defined a P value less than or equal to 0.05.

Results

The majority of plastic surgery residencies did not discuss or describe their wellness programs on their official website, regardless of program size. Similar results were displayed when searching for spousal support and daycare. GME websites were more comprehensive than the program websites but still showed significant discrepancies with vacation policies and day care. Mentorship was mentioned in under half of all plastic surgery residencies. Integrated programs were more likely to display social events on Instagram when compared with independent programs.

Conclusions

Plastic surgery residencies do not provide evidence of existing wellness programs on their program websites. Although a lack of public information on wellness programs does not mean they do not exist, this could easily be mitigated by providing more comprehensive information on both GME and program websites.

Diversity, Equity, and Inclusion in Plastic Surgery: A Systematic Review

BACKGROUND

The number of publications on the subject of diversity, equity, and inclusion has surged in the last 5 years. However, a systematic review of this topic has not been published.

METHOD

Six top plastic surgery journals were queried from 2018 to 2023 using the search term "diversity." Methods, conclusions, and recommendations were tabulated.

RESULTS

A total of 138 publications were identified; 68 studies presented data suitable for analysis. All studies were retrospective. Currently, over 40% of plastic surgery residency applicants are women. The proportion of women in integrated plastic surgery residents is now 43%. In 2021 and 2022, the percentage of female first-year residents exceeded men. The percentage of female presenters at meetings (34%) is double the number in the workforce (17%). Twenty-five percent of academic faculty positions and 22% of program director positions are now held by women. Underrepresented minorities account for fewer than 10% of applicants to integrated plastic surgery residencies.

DISCUSSION

The proportion of Black and Hispanic applicants to integrated plastic surgery residencies (6% and 8%, respectively) mirrors the proportion of Black and Hispanic medical students (7% and 6%, respectively). Numerous recommendations have been made to increase the proportion of underrepresented minorities in plastic surgery programs.

CONCLUSIONS

The representation of women in plastic surgery has increased dramatically. A lack of Hispanics and Blacks reflects a small pool of applicants, as opposed to a "leaky pipeline."

The Importance of Perceived Barriers to Women Entering and Advancing in Orthopaedic Surgery in the US and Beyond

BACKGROUND

Global perceptions of barriers to women in orthopaedics have not been assessed. The purpose of this study was to determine the importance of international barriers to women entering and advancing within orthopaedic surgery.

METHODS

An anonymous, online survey was distributed to women medical students, trainees, and practicing surgeons via Women in Orthopaedics Worldwide, the "Women in Ortho" Facebook page, and individual programmes. Participants were asked to rate perceived barriers to (1) pursuing training and (2) career advancement on a scale of 1-5, with 5 being the most important and relative to other barriers. Descriptive statistics and univariate analyses were employed.

RESULTS

The survey yielded 237 US (84.0%) and 45 international (16.0%) respondents. Per entering orthopaedic surgery, the most important barriers were male-dominated culture, lack of a strong women mentor, and lack of female representation at home institution. Compared with the US surgeons/trainees, international respondents cited greater societal disapproval (2.8 ± 1.2 vs. 3.4 ± 1.3, P = 0.01). Medical students assigned less importance to lack of exposure, more to lack of resources for creating competitive applications (P < 0.05). Regarding career advancement, lack of women leadership, family responsibilities, and gender-biased selection for promotion were the most important. International surgeons/trainees noted greater concern for societal disapproval (3.5 ± 1.5 vs. 2.6 ± 1.3, P = 0.003) and were more likely to rank sexual harassment in their top three (17.6 vs. 4.2%, P = 0.02).

CONCLUSION

While notable differences exist, there is striking similarity across countries and position levels in perceived barriers to women entering and advancing in orthopaedic surgery.

LEVEL OF EVIDENCE

III.

Understanding Gender Differences in Research Productivity of Canadian Otolaryngologists-A Comprehensive National Audit

Objective: To understand the factors contributing to gender disparities in the research productivity of Canadian academic otolaryngologist-head and neck surgeons. Methods: Publicly available sources including departmental websites, SCOPUS, and the Royal College of Physicians and Surgeons of Canada were accessed between February and April 2022 to analyze gender differences in the academic productivity of otolaryngologist-head and neck surgeons across Canada. Gender differences in research productivity metrics, including h-index, i10-index, publication number, and number of first and senior authorships were assessed. Demographic data, including gender, institution, years in practice, and leadership roles were assessed for correlation with increased research productivity. Subgroup analyses were used to evaluate gender differences in productivity metrics, and univariable and multivariable regression analyses were used to evaluate predictors of research productivity. Results: Data were collected for 316 academic otolaryngologists (252 men, 64 women, P < .001). Men had significantly more years of publishing [mean (standard deviation, SD), 15.64 (9.45) vs 12.44 (8.28), P = .014], higher h-indices [12.22 (11.47) vs 7.33 (5.36), P < .001], i10-indices [22.61 (37.88) vs 8.17 (9.14), P > .001], publication numbers [46.63 (65.18) vs 19.59 (23.40), P < .001], and first [8.18 (9.95) vs 4.89 (6.18), P = .001] and senior authorships [12.98 (22.72) vs 3.83 (6.89), P < .001]. Gender differences were most pronounced in head and neck oncology, pediatrics, and the late career stage. Gender disparities in productivity were absent in the early career stage. Multivariate analysis identified only the number publications and number of senior author publications as being significantly influenced by gender. Conclusion: Canadian female otolaryngologist-head and neck surgeons appear to have equivalent research productivity to their male counterparts in the early career stage. This mirrors the recent findings in the United States, and demonstrates progress compared to earlier studies that found women to have lower research productivity in the early career stage.