Unequal representation of women in the health sector starts from the field of education itself. Ever since the right to education became a fundamental right, several barriers that were present in the past have been removed but however a few barriers still exist for women through academic institutions. These barriers could be understood through the phenomena of the leaky pipeline. Though a lot of women are educated, sever of the candidates gradually leak out of the educational system due to the flaws in the channel and only a few attain the intended goal. For example, in the UK, 50% of enrolment in medical schools are women, but only 21% of them end up becoming surgeons, and even fewer women enter into specialties (Park, 2005).
One of the reasons for the working of the leaky pipeline in the field of medical education could be the structural barriers that exist. One of the recent investigations in 2018 found that a few medical schools in Tokyo manipulate the entrance exam scores of female candidates. The scores of the female candidates were lowered by 20%, and the scores of the male participants were increased. It was reported that the school did not want female doctors, since it was anticipated that they would shorten their career after having children. Nevertheless, the authorities of the institution denied having any prior knowledge about the incident. Similarly, a few medical colleges in Andhra Pradesh reserve around 120 seats for women in fields like gynecology and dermatology, but only 12-20 seats in specialties like neurosurgery and orthopedics. However, now, most of the medical schools have removed gender-based reservations. During clinical internships, surgeons prefer male interns for assisting and suturing. Since female interns get lesser opportunities to work, they have limited scope for developing skills.
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Every society has a sexual division of labor based on the perceived characteristics of a gender. We can understand the sexual division of labor through Sandra Bem’s gender schema theory. According to this theory, there are certain schemas or mental frameworks which describe the characteristics of male and female. Surgeons describe themselves as active, strong, decisive, brave, detached and aggressive. All these characteristics come as a part of natural and embodied knowledge for men, but not for women. Women tend to be more nurturing, caring and cooperative, so they are believed to be more fitted to be nurses rather than surgeons. This could also be one of the major reasons for male surgeons to have a profound distrust on the performance of women, and this attitude is carried by patients as well.
Joan Cassell conducted a study on female surgeons in 1996. She conducted an elaborate survey on the attitude of female surgeons towards relationship with male surgeons and patients. A few of the findings from the study was that, women surgeons were not allowed to engage in ‘doctor fits’, whereas male surgeons who threw tantrums were let go as being under pressure or high strung. Women in the medical sector were also more likely to face stronger consequences from the authorities if something went wrong in the surgeries. While on one side female surgeons are treated harshly and disrespected in the work space, there exists the other side of the spectrum as well, wherein the male surgeons sometimes adopt female surgeons as daughters or sisters and keep them away from challenging tasks - this is problematic as it undermines the abilities of women. Female surgeons also face a variety of issues while dealing with patients. The term ‘doctor’ is almost always associated with men. In the mass media, men are always portrayed as mental health professionals and women as assistants or nurses. So, when a patient walks into a hospital they do not expect a woman to be a doctor or surgeon. Female surgeons are usually mistaken as nurses. In the study conducted by Cassell, a few of the surgeons shared their experiences of instances when patients have denied treatment from a surgeon because she was a woman. Patients prefer to hear about their surgeries from male surgeons, even if they are just interns or junior residents.
“The wrong body in the wrong place”. This is a phrase that Joan Cassell keeps reinforcing throughout her book ‘The Woman in the Surgeon's Body’ (1996). She uses the idea of hegemonic masculinity to understand why women are underrepresented in the field of surgery. A woman's body is considered to be a misfit to the idea of masculinity. According to her, the major characteristics of masculinity include dominance, assertiveness, aggressiveness, etc. During surgery the body of a surgeon dominates the body of the patient; the surgeon dominates the body by piercing and cutting through the body, making irreversible changes in it (Cassell, 1996). This is considered to be a power that is held by the epitome of masculinity but when a woman performs surgery it disrupts the power structure. Men are also considered to be life givers; semen is considered as a source of life, as it has the power to impregnate or not. A surgeon also holds this supreme power of giving life or taking away life. When a woman performs surgery, she also holds this power. The idea of a male patient being vulnerable at the hands of a female, even if she is a surgeon is unfathomable. According to Cassell, this is the reason for the patriarchal system to limit surgery only to males.
Work-life balance is also important. A surgeon must always be on the go because they will be immediately called if something goes wrong in their patients, no matter what they are doing. Since women also take family responsibilities, it becomes very difficult to maintain a work life balance. Studies suggests that, female surgeons have decreased levels of relationship and parenting satisfaction compared to job satisfaction (Hebbard, 2009). Job satisfaction of women surgeons reduced after they had family and children (Incorvaia, 2005). Female surgeons say that residency, which is the most important face of a medical career, is the most difficult phase of the medical training because it is around this time that women give birth and take up other family responsibilities. Female surgeons who have children are less likely to pursue surgical specialties; they have fewer publications and slower career growth (Sood, 2010). Crucial years of personal life collides with the crucial work years of professional life, forcing women to choose between the two.
Within surgery the highly paying specialties are dominated by men. For example, orthopedic surgery has 80 4.6% men, neurosurgery has 82.5% men, cardiology has 80.8% men whereas other fields like gynecology, pediatrics and dermatology is dominated by women. This again reinforces the gender stereotypes. Aspiring female surgeons do not find female role models in fields like orthopedics and cardiology, so they also pursue the female dominated surgical fields, continuing the cycle.
In recent times the number of female surgeons is slowly increasing however, the power positions are still held by men. Surgery to this day remains a ‘male sport’. There is a long way for women and men to attain equality in the surgical field.
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