When Representation Is Not Enough: Persistent Gender Discrimination in a Majority-Women Surgical Workforce

Background Gender-based discrimination affects up to 50% of early-career surgeons in high-income countries. We carried out this study to examine gender-based discrimination in surgical fraternities within the Commonwealth Caribbean. Methodology Researchers interviewed active physician members of the surgical fraternity who were registered with the medical councils in 17 nations in the Commonwealth Caribbean. A validated questionnaire was used to collect data on gender-based discrimination and unprofessional behavior in the workplace. Results Data were collected from 190 participants, composed of 76 (40%) men and 114 (60%) women. There were 67/190 (35%) respondents who experienced gender-based discrimination. After multivariate logistic regression analysis, gender (adjusted odds ratio: 5.59; CI: 2.55-12.26; P < 0.001) and training level (adjusted odds ratio: 1.94; CI: 1.01-3.74; P 0.048) were independent predictors of experiencing gender-based discrimination. Seventy-one (37%) participants declined to answer questions about unprofessional behavior, and women were over-represented in non-responders (49% vs 20%; P < 0.001), creating the potential for selection bias in unknown directions, and potentially altering prevalence and associations in 119 respondents. Firth penalized likelihood logistic regression models were used to compensate for data sparsity and quasi-complete separation as only 4/61 (6.6%) males experienced unprofessional behavior. This revealed that gender (adjusted odds ratio: 24.70; CI: 8.72-69-.96; P < 0.001), but not training levels, remained a significant predictor of unprofessional behavior. Conclusion This study demonstrates that respondents within the surveyed surgical fraternity continued to experience discrimination and unprofessional behavior, despite women surgeons accounting for the numerical majority. An important contextual consideration is that the surgical discipline does not change based on the surgeon’s gender. These observations led to our hypothesis that demographic change alone may be insufficient to achieve workplace equity. This may require cultural change in addition to better representation.