Women and Men in Plastic Surgery: How They Differ and Why It Matters

In societies where men are truly confident of their own worth, women are not merely tolerated but valued. —Daw Aung San Suu Kyi, Nobel Peace Prize winner and leader in Myanmar Women plastic surgeons face unique challenges not experienced by their male colleagues. They are underrepresented in leadership positions, both in academics and in professional societies.1 As junior faculty, they are less likely to receive promotions and more likely to abandon academic medicine altogether. In their personal lives, they are less likely to marry, to have children, or to be satisfied with their work/life balance.2,3 Despite their growing numbers, women plastic surgeons have yet to achieve parity with the men in their specialty. It is time to explore the root causes of this inequity and to generate solutions. Plastic surgery has historically been a male-dominated profession. Between 1950 and 1959, women constituted only 0.2 percent of all board-certified plastic surgeons.4 Sixty years later, that number remains low at 14 percent. Among current plastic surgical trainees, however, 37 percent are women.5 With this demographic shift, it is imperative to investigate the personal and professional challenges women experience as they embark on a career in plastic surgery. In a series of upcoming articles in the Journal with accompanying videos, we will analyze the following seven major issues: The leadership gap. Men hold most of the leadership positions across the specialty. We will explore why women are less likely to achieve the level of full professorship, department chair, and society presidency and the impact this has on our profession. After analyzing the factors that have stifled women’s ascent, we will offer possible solutions. Retirement and financial planning. With longer lifespans and greater family care responsibilities, women have unique financial needs. Financial planning is rarely addressed during training, in seminars, or at meetings. As we look at the different phases of a woman plastic surgeon’s career, we will offer practical advice on steps to achieve financial security, along with contributions from women themselves. Work/life balance. Although work/life balance has become a hot-button issue for both sexes, studies indicate that women suffer more dissatisfaction than men, potentially contributing to their greater likelihood to leave academic medicine and to shorten their plastic surgical careers altogether.1,2 After exploring the factors contributing to work/life dissatisfaction, we will suggest ways to ameliorate this imbalance so that our profession is more accommodating to the lives of both women and men. Academic versus private practice. Women are more likely to leave academic practice, but is private practice an improvement? We will dissect the challenges women plastic surgeons face both in academia and in the community. Women who have experienced the varying modes of practice will share their own stories. Finally, we will discuss how women evaluate their own needs and talents to decide how they ultimately choose to practice. Negotiation. Junior female researchers receive significantly less funding than their male counterparts,6 and they have been shown to be less assertive when negotiating for salary and benefits. There is evidence that women are less confident than men,7 but their reluctance is not just internal; unlike men, women are more likely to suffer a social cost when they do negotiate.8 By gaining insight into their intrinsic nature, we will discuss how women can learn to promote themselves. We will also discuss the importance of mentoring and nurturing our young women colleagues. Pregnancy, infertility, and parenting. Two decades ago, 26 percent of women plastic surgical residents surveyed had terminated a pregnancy without their program directors’ knowledge. Sadly, that same survey showed that one-third of women plastic surgeons struggled with infertility.9 Peak fertility years collide with training and launching a career, resulting in more women plastic surgeons being childless. We will explore the impact that plastic surgery, both training years and career, have on the personal lives of women who desire marriage and children, after which we will present concrete suggestions for making both residency and career more conducive to pregnancy, breast-feeding, and parenting. Sexism, harassment, and the benefits of diversity. Although overt comments and assaults may be less common today, women still suffer the sting of sexism and harassment. Even at its most subtle, gender bias handicaps women.10 As we explore these biases, we will offer insights on how to promote gender equality. The personal experiences of women plastic surgeons will illustrate the barriers, prejudices, and inequities that must be torn down. The lions of plastic surgery were and continue to be male-dominated. Men have built our surgical departments, our training programs, our professional societies, and our board. During our profession’s genesis, the stipulation of terms for a resident’s maternity leave would have seemed ludicrous. Now, however, women are no longer rare birds; in fact, over 50 percent of all medical students now attending U.S. medical schools are female. For decades, the women braving a career in plastic surgery have done so by attempting to shape themselves to a mold made for men, often at great personal sacrifice. Times are changing and so must plastic surgery to properly accommodate a future in which women play a major role. With each article, we will analyze the current and future issues impacting women plastic surgeons, and we will suggest potential positive and realistic changes in the design of our training programs, our institutions, and our organizations. We hope to stimulate a blueprint for a paradigm shift in plastic surgery, which will ultimately benefit all of our surgeons, and our patients. We anticipate that these topics will stimulate discussions among colleagues at all levels: from our core academic spheres, in hospitals, our major organizations, at the dinner table, and in resident journal clubs. We applaud plastic surgical training programs, institutions, and professional societies for accepting increasing numbers of women. However, we must do more than acknowledge their passion, work ethic, and talent as surgeons; we must nurture and embrace those qualities unique to women. Revolutionizing plastic surgery to make it more welcoming, challenging, and satisfying to every plastic surgeon will only enhance our specialty. If society will not admit of woman’s free development, then society must be remodeled. —Elizabeth Blackwell, M.D., first woman granted a medical degree in the United States