Practice patterns and work environments that influence gender inequality among academic surgeons - 31/10/19

Doi : 10.1016/j.amjsurg.2019.10.029

Biqi Zhang ^a, Maggie L. Westfal ^b,^c, Cornelia L. Griggs ^d, Ya-Ching Hung ^e, David C. Chang ^b, Cassandra M. Kelleher ^b,^c,^⁎
^a Department of Surgery, Brigham and Women’s Hospital/Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
^b Department of Surgery, Massachusetts General Hospital/Harvard Medical School, 165 Cambridge Street, Suite 403, Boston, MA, USA
^c Department of Pediatric Surgery, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA, USA
^d Department of Pediatric Surgery, Columbia University College of Physicians & Surgeons, New York, NY, USA
^e Department of Surgery, Sinai Hospital of Baltimore, Baltimore, MD, 21215, USA

^∗Corresponding author. Pediatric Surgical Services, Massachusetts General Hospital for Children Boston, MA, 02114-2696, USA.Pediatric Surgical ServicesMassachusetts General Hospital for Children BostonMA02114-2696USA

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 31 October 2019

Abstract

Background

Practice pattern and work environment differences may impact career advancement opportunities and contribute to the gender gap within highly competitive surgical specialties.

Methods

Using a 2000–2015 New York statewide dataset, we compared board-certified pediatric surgeons by specialist case volume and Herfindahl-Hirschman Index (HHI), which quantifies surgeon focus within specialist case mix.

Results

51 pediatric surgeons were analyzed for 461 surgeon-years. Female surgeons had lower case volume (159 cases/year versus 214, p < 0.01), lower shares of specialist cases (14.1% versus 16.7%, p = 0.04), and less focused practices (HHI 0.16 versus 0.20, p = 0.03). Female surgeons’ networks had fewer colleagues (7.2 versus 12.1, p < 0.01), and lower annual total (388 versus 726, p < 0.01) and specialist case volume (83 versus 159, p < 0.01), even after accounting for career length. However, female surgeons performed more cases within their networks (49% versus 36%, p = 0.04) and worked at major teaching hospitals as often as men (76% versus 76%, p = 0.97).

Conclusion

The challenges that female surgeons face may be reflective of organizational inequities that necessitate intentional scrutiny and change.

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Highlights

•	Female pediatric surgeons operate in smaller clinical networks with fewer expertise-building cases than male pediatric surgeons.
•	Female surgeons have less specialized and less focused clinical practices than their male counterparts.
•	However, female surgeons perform an equal share of all available work.
•	Uneven access to expertise-building cases and large physician networks may contribute to the career advancement gap in surgery.

Le texte complet de cet article est disponible en PDF.

Keywords : Gender disparity, Pediatric surgery, Practice patterns