On the eve of International Women’s day, we ask: why are cosmetic surgeons mostly men and why does this matter?

This year’s International Women’s Day campaign, #PressforProgress, highlights the fact that now, more than ever, there is a strong call to action to press forward and progress gender parity in all walks of life.

So, how well represented are women in the field of cosmetic surgery? Shockingly, figures from the Royal College of Surgeons reveal a stark gender gap in surgery generally, with women making up just 11% of all surgeons (rising to 30% of trainees). Furthermore there has only been a meagre 8% increase in female surgeons in the past 15 years. This is despite surgery being one of the most important medical procedures offered worldwide.

While the disparity between male and female cosmetic surgeons is also true of surgery overall, it is all the more poignant in the field of cosmetic surgery. In her article, ‘Plastic surgeons are mostly men, but their patients are mostly women’ Nina Wolpow points out that while 92% of cosmetic surgeries in the US are performed on women, they only make up 15% of the doctors available to patients (4% more than for surgery generally).

Meanwhile, Tatler’s latest definitive guide to the very best cosmetic surgeons and doctors in the UK contains twice the number of male doctors compared to female doctors. Despite the care that Tatler presumably take to limit gender bias as much as possible, this split is still far from a representation of gender parity, no doubt reflecting the reality of the cosmetic surgery sector. Interestingly, when it comes to the very best botulinum toxin and fillers doctors the split is 50/50, but for the more expensive surgeries such as face lifts, all the top surgeons featured are men.

In her January 2017 article (published on the Royal College of Surgeons website), ‘The gender pay gap in surgery’, Erin Dean asks why the glass ceiling has yet to be cracked, even for women in such a highly paid profession.

She notes that although the number of women in surgery generally is increasing (albeit slowly), this does not seem to be the case for those in the best paid surgical positions. There are more women in specialities that are less well paid. And this gap, instead of narrowing, appears to be getting worse. According to the Office for National Statistics, in 2004 male doctors earned 21% more than their female colleagues, but by 2015 they earned 41% more.

Plastic surgery is one of the best paid specialities, while paediatrics, which has the highest percentage of female consultants (according to information from the HSCIC in 2014), is amongst the lowest. While the second-highest proportion of female consultants can be found in plastics, they still only make up 17% of this consultant workforce.

Whether women choose specialities that don’t tend to come with higher earnings, or whether they are encouraged away is not clear.

Wolpow notes that the underrepresentation of female surgeons is generally attributed to one of two connected beliefs: that surgery is and has always been an old boys club, and that women’s domestic responsibilities interfere with the practice’s long hours and physical demands.

Dr Umarah Muhammad (Academic lead for Liverpool University ENT Society) says of the lack of women in surgery generally: “I do think it is a blend of things, of course it is a male-dominated field but one of the most commonly cited reasons is due to lack of female role models.”

While UCAS figures from the Royal College of Surgeons show that women outnumber men when applying for medicine and dentistry degrees, with 58% of students being female in 2016, this does not translate to careers in surgery.

So, while there is not a great shortage of women embarking upon careers that could lead to surgery, few of them make it that far and of those who do they are often not earning as much as their male counterparts. Consequently, young girls lack female role models in the field, which fuels the perception that surgery is a man’s world.

But when it comes to cosmetic surgery, does it really matter that cosmetic surgeons are mostly men while their patients are most often women? In the specialism of cosmetic surgery this ‘double gender gap’ matters for other, perhaps more surprising reasons.

For example, one recent study revealed that more than a quarter of those considering a cosmetic surgical procedure have a gender preference for a female surgeon, while only 1% of those in the study requested a male surgeon.

In response to this demand for female surgeons and the corresponding lack of supply, Dr Muhammad echoes Wolpow, noting “It’s surprising that that in itself isn’t a reason to drive more females into the surgical workforce. If you look at cosmetic and reconstructive surgery, the majority of patients are female, but there are more male surgeons.”

Perhaps most pertinent to the issue of the gender gap in surgery generally is the recent discovery that women surgeons actually have lower death rates than men. In a study carried out at a hospital in Ontario, Canada, between 2007 and 2015, involving 104,630 patients and 3,314 surgeons, female surgeons were thought to be more skilled, better at following guidelines and superior at communicating with other staff, researchers said. The study compared outcomes for patients undergoing one of 25 surgical procedures by a female surgeon with those having the same operation from a man.

The results showed that patients operated on by women had slightly lower death rates than men, with their patients being 12% less likely to die. This difference was very small, with only one extra death for every 230 procedures at the hands of male surgeons compared with women. And patients treated by men were no more likely to suffer further complications or need to be admitted back to hospital. Nonetheless, the findings do back up previous studies which have found that women doctors are far less likely to be struck off than male colleagues.  The authors from the University of Toronto speculated that the care of female surgeons was more ‘patient centred’, in line with guidelines’ and involves ‘superior communication’.

There is also evidence that they take fewer risks than men and are more inclined to ask for help from colleagues if things go wrong.

In a Daily Mail article citing the study, Professor Clare Marx, the former president of the Royal College of Surgeons and Professor Derek Alderson, the current president, said the findings would help dispel ‘an unconscious bias’ among patients – and staff – against women doctors.

‘This study helps to combat these lingering biases by confirming the safety, skill, and expertise of women surgeons relative to their male colleagues,’ they wrote in an editorial accompanying the study in the BMJ.

With the evidence showing a strong demand for female cosmetic surgeons and attitudes towards women in surgery gradually beginning to change, there is a glimmer of hope that the double gender gap in cosmetic surgery could start to narrow. However with the World Economic Forum’s 2017 Global Gender Gap Report findings telling us that gender parity is over 200 years away, this year’s International Women’s Day theme, #PressforProgress, seems more timely than ever.

 

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