A comprehensive study published in early 2022 highlighted a concerning disparity in surgical outcomes: women are 32% more likely to die when operated on by male surgeons compared to female surgeons.
This research, led by Dr. Christopher Wallis and Dr. Angela Jerath from the University of Toronto, analysed over 1.3 million surgeries performed between 2007 and 2019 in Ontario, Canada.
The results are not only alarming but also shine a light on the broader issue of gender disparities in healthcare, which have far-reaching implications for patient safety and equality.
Key Findings of the Study
The study, published in JAMA Surgery, examined the outcomes of 21 types of surgical procedures, ranging from general surgeries to more specialised operations like brain and heart surgeries.
One of the key takeaways was that female patients had worse outcomes, including a higher risk of death, when their surgeries were performed by male surgeons. Specifically, the risk of death for female patients increased by 32%, and the likelihood of complications and readmission to the hospital was also significantly higher.
One of the key takeaways was that female patients had worse outcomes, including a higher risk of death, when their surgeries were performed by male surgeons.
In contrast, male patients experienced similar outcomes regardless of whether their surgeon was male or female. This suggests that the disparity is specific to female patients, making it a gendered issue that requires urgent attention.
For example, in cardiothoracic surgery, the mortality rate for women operated on by male surgeons was 1.4%, while it dropped to 1% for those treated by female surgeons.
Possible Explanations for the Disparity
Several theories have been proposed to explain this stark difference in outcomes between male and female surgeons. One prominent explanation is the potential for implicit gender biases in medical practice.
While both male and female surgeons undergo the same technical training, there may be subconscious attitudes and stereotypes that influence how male surgeons approach female patients. These biases could affect everything from the initial surgical decision-making to post-operative care.
While both male and female surgeons undergo the same technical training, there may be subconscious attitudes and stereotypes that influence how male surgeons approach female patients.
Dr. Jerath, one of the co-authors of the study, has suggested that communication differences between male and female surgeons may play a role. Female surgeons might engage more in pre- and post-operative discussions with their patients, picking up on subtle symptoms or complications that could otherwise go unnoticed. This more collaborative and communicative approach might lead to better overall patient care and outcomes.
Another potential factor is the difference in how male and female surgeons manage their surgical teams and workflows. Female surgeons may take a more meticulous, slower approach to procedures, ensuring that every detail is considered, which could lead to fewer complications.
The Broader Context: Gender Disparities in Healthcare
This study's findings are part of a larger body of research that shows gender disparities in healthcare are not limited to surgery. Women are frequently at a disadvantage when it comes to medical care, whether through misdiagnoses, delays in treatment, or the dismissal of their symptoms.
For example, heart attack symptoms in women often present differently than in men, and because medical education has historically focused on male symptoms, women’s heart attacks are more likely to be missed or misdiagnosed.
Because medical education has historically focused on male symptoms, women’s heart attacks are more likely to be missed or misdiagnosed.
Similarly, conditions such as endometriosis and polycystic ovary syndrome (PCOS) are often under-diagnosed or treated inadequately, leaving many women to suffer for years before receiving proper care. This pattern of inequity is reflective of a healthcare system that, for too long, has been designed with a male patient as the default.
Surgery and Gender: A Male-Dominated Field
Surgery, in particular, has long been a male-dominated field. In Britain, for example, nearly 90% of senior surgeons are men. The gender imbalance in surgery may be contributing to the disparities in outcomes for female patients.
Dr. Scarlett McNally, a consultant orthopaedic surgeon, has noted that more women are deterred from entering surgical fields due to structural barriers like inflexible working hours and a lack of support for part-time training. Additionally, many female surgeons report experiencing micro-aggressions or subtle biases that make their working environment less welcoming.
In Britain, for example, nearly 90% of senior surgeons are men.
This underrepresentation of women in surgery may have a direct impact on the quality of care female patients receive. As Dr. Jerath explained, “Patients want to see themselves reflected across the table.” Women may feel more comfortable and understood by female surgeons, who may be better equipped to anticipate their specific needs.
Implications for Healthcare Policy and Practice
The findings of this study raise important questions about how healthcare systems can address these disparities. One immediate recommendation is to ensure that all healthcare professionals, regardless of gender, undergo comprehensive training in gender sensitivity. This training should include understanding how gender biases can affect patient care and learning strategies to overcome these biases in practice.
Furthermore, increasing the number of women in surgical fields is a critical step toward achieving more equitable healthcare. Diversifying the workforce can improve patient outcomes by ensuring that more perspectives and experiences are represented in the decision-making process. Dr. Wallis, one of the study's authors, highlighted the importance of fostering a sense of belonging for all surgeons, regardless of gender, to ensure that every patient receives the best possible care.
Diversifying the workforce can improve patient outcomes by ensuring that more perspectives and experiences are represented in the decision-making process.
Finally, the study underscores the importance of encouraging patients - especially women - to advocate for themselves in healthcare settings. Women should feel empowered to ask questions, seek second opinions, and choose healthcare providers they feel comfortable with. Building a trusting relationship with a surgeon is crucial to ensuring better outcomes, and patients should not hesitate to speak up if they have concerns about their care.
Moving Forward: A Call for Further Research
While this study has provided valuable insights into the gender disparities in surgical outcomes, there is still much that remains unknown. For instance, the specific mechanisms driving these disparities are not yet fully understood. Are there particular types of surgeries where the gap is wider? How do different healthcare systems around the world compare in terms of these outcomes?
Dr. Jerath and her team have expressed their intention to explore these questions in future research. By continuing to investigate the root causes of gender disparities in healthcare, researchers hope to develop more targeted interventions that can improve outcomes for all patients.
Conclusion
The 2022 study on surgical outcomes is a stark reminder of the ongoing gender disparities in healthcare. Women are 32% more likely to die when operated on by male surgeons, a statistic that highlights the urgent need for systemic changes. Addressing these disparities will require a multi-faceted approach, including better gender sensitivity training for healthcare providers, increasing diversity in surgical fields, and empowering patients to advocate for their care.
While this research has provided important answers, it has also raised new questions that must be explored. Ultimately, by addressing these issues, the medical community can move closer to providing truly equitable care for all patients, regardless of gender.
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