Why ARE there so few female surgeons?
All her life,Mayoni wanted to be an NHS consultant Now, at 41, she’s quit. Her story and those of others like her highlights a deeply troubling question...
Going into the family business is a tried-and-tested career path for many young people. When you grow up watching your mum and dad devote themselves to medicine it is hardly surprising you would want to follow in their footsteps.
And so it was for little Mayoni gooneratne, reading the medical journals her father brought home when she was just seven years old. Saving lives is ‘pretty much in the DnA’, she says.
Her mother was a gP. Her father still is. At 76 years of age, Henry gooneratne is the oldest practising family doctor in Croydon, South London, and received a letter from the Queen recently congratulating him on his services to the medical profession. Mayoni’s younger brother is an anaesthetist at one of London’s busiest hospitals.
For as long as she can remember, Mayoni has wanted to be an nHS doctor and by this point — she is 41 — she fully expected to be continuing the family tradition. She started medical school in 1994 and in 2002 was admitted to the Royal College of Surgeons.
From there the route to becoming a consultant — at the top of the medical tree — is long and gruelling, taking around ten years. She was on track, though.
Yet she was just one year away from becoming a consultant when she ‘did the unthinkable’ — and quit the nHS, walking away from the career to which she had devoted her life.
now, she still uses her medical skills, but in a very different arena. She runs an aesthetic clinic, dispensing Botox and fillers, and organising manicures. A laudable business venture, but a far cry from saving lives on the front line. She’s the first to admit that this was very much an unwanted Plan B.
‘i wanted to save lives,’ she says. ‘i was what you would have described as a hardcore surgical trainee. i was passionate about the job, passionate about the nHS. it’s all i wanted to do. Leaving was the most devastating thing i’ve ever done.
‘i had to have counselling because i was in such turmoil. i felt i’d let everyone down — my parents, myself. i dreaded telling my father.
‘it was a terrible time. i’m not by nature a quitter. i was in pieces. For an awfully long time afterwards i couldn’t even talk about what i had done without getting emotional. it was a devastating loss, and one i never ever expected to have to go through.’
it was perhaps a more devastating loss for the rest of us. it takes 15 to 20 years to train an nHS consultant, at huge expense. it’s hard to put a figure on the cost, but when you consider that we are talking £610,000 per doctor for basic medical training, the sums are stratospheric.
ToHAve that doctor quit at any stage is a slap in the face for the taxpayer. But to see them bow out, taking so much high-level experience with them is heartbreaking.
So why did Mayoni go? She says she reached the ‘start of the end’ as she walked to work at Lewisham Hospital and found herself weeping openly before she reached the front doors.
Disillusion with the ‘system’ was part of her anguish. ‘i’d already been brought down by the bureaucracy and the great sense of apathy in the nHS. every day i’d feel that i wasn’t able to do the job i’d trained to do.’
But there was an added complication: her children.
‘i’d had two children by this point, in quick succession, but i’d always believed that women nowadays could have children and a rewarding medical career. But i was worn down.
‘The hours were punishing, and i’d go home and find i had nothing left to give them. i was expending too much energy fire-fighting on the job to actually be a mum. it tore me apart.
‘When i’d started to actually burst into tears on the way to work, i knew i had to get help. i went for counselling.
‘When my counsellor suggested i should see a medical careers service, to look at alternative careers, i was horrified. give up this job that was everything to me? But eventually i had no choice. i had to put my children, my family and my own health first.
‘it was still the hardest thing i’ve ever had to do.’
Alas, Mayoni, who is married with three children now aged five, four and two, isn’t the first woman to bow out of surgical training, citing it as incompatible with family life. And she won’t be the last.
The thorny issue of why there are still so few women surgeons in the UK was recently highlighted in the brilliant Channel 4 series Confessions of A Junior Doctor.
The first three episodes of the programme, which is filmed on the wards of northampton general Hospital and traces the progress of junior medics, were filled with women — reflecting the fact that more women than men are accepted to medical school these days.
However, the fourth episode — which focused on the brutal surgical training programme — was startling. Where had all the women gone, and why did the place seem so awash with testosterone? There’s no denying that surgery is still male- dominated. Despite a 55 per cent female intake to medical school, only 33 per cent of surgical trainees are women.
The cameras in northampton found only one female who wearily observed that she had been hurled into a world of ‘egomaniac men’.
‘every day, every minute, you have to dress like a man, think like a man, talk like a man,’ said 32year- old Kayla. it wasn’t the macho culture that forced her to quit her training by the end of the programme, though, but her own family responsibilities.
She had a three-year- old son, whom she hadn’t seen for months because she had sent him to live with her parents in China.
The plan had been that little Zak would join her in the UK, but the demands of the job made it impossible, and she was filmed chatting to him on Skype, racked with guilt and describing herself as a ‘horrible mother’.
it came as no surprise that she bowed out, devastated that she couldn’t see a future where she could be a mum and a surgeon. ‘i know i am not going to be a good surgeon if i have a son at home,’ said Kayla. ‘You can’t be a good mum and be a surgeon. You have to sacrifice one.’
That thinking wasn’t exactly challenged by Claire Brown, the lone female general surgeon at northampton general, herself a single mum to a five-year-old.
MiSSBrown has seen many talented women quit — some from near the top of the tree, others as soon as they have realised how difficult the lifestyle is.
There are no official ‘ drop- out’ figures, making it impossible to assess the scale of the problem, but, anecdotally, we seem to be facing a crisis.
‘There are fewer women at the top,’ says Miss Brown. ‘i’ve seen many female surgeons become disillusioned. Surgery involves unsociable hours and trying to find childcare for those unsociable hours is almost impossible.
‘i couldn’t manage without a
complete network k of people who go o out of their way to o help me.’
Interestingly, Mayoni agrees with ith the sentiments in the programme. programme ‘I think it’s very different when you don’t have children. It’s a brutal environment but if you are able to act like a man — or the traditional image of the man — then you can do it. But a lot of women are conflicted when they have children.
‘You want, need, to be there for your kids. Personally, I don’t think you can be a good surgeon and a good mother. There’s an old adage in surgery of “knife, life, wife” — meaning the order of importance surgeons attach to things. I still think it holds true. I thought I could fight it, and prove them all wrong. I couldn’t.’
A devastating portrayal of a profession, then, that was supposed to have embraced equality by now. And while something approaching a third of surgical trainees are now women, this is not yet translating into more surgical consultants. Across the UK, still only 12 per cent of consultants are female, reinforcing the idea that surgery is one of the last male bastions in the NHS.
There have been myriad attempts to overhaul the training. It is now possible to complete surgical training on a part-time basis, supposedly opening the doors to those women (and men) who have young families.
However, the Channel 4 programme reinforced the notion that you have to be a man — and a certain type of man, too — to reach the top.
Consider these comments from Peter Kang, one of Northampton General’s senior consultants.
‘Surgery is an art, as much as it is science, but there are very few Mozarts and Beethovens. Surgery is hard. It is not easy. Not everyone can be a surgeon. We are like Top Gun. Surgeons inherently are very competitive. In order to get ahead in surgery you have to be very domineering, to some extent. The fact is that surgeons tend to be Alphas.’
It’s a view that has Sussexbased orthopaedic consultant surgeon Scarlett McNally — who has long campaigned to get more women to the top — putting her head in her hands.
‘The Alpha people are the ones who get noticed. They are the ones who talk. But there are lots of surgeons doing really good work who aren’t Alpha, Top Gun type of people.’
It’s that idea, though, that puts women off applying to be surgeons in the first place. ‘The competition has always been fierce, but I did a paper in 2008 looking at the figures and it actually showed that the women who applied were statistically more likely to be accepted. The trouble was that fewer women were actually applying. Only the best women would put themselves forward.
‘ There is no reason women should be under-represented. It’s act actually a wonderful career and mo more conducive to a family life th than it was when I started out.
‘And so many of the assumpti tions are just wrong. You don’t n need to be tall to be a surgeon. Y You can stand on a step. I am 5f 5ft and half an inch.
‘ ‘You don’t have to be strong to be an orthopedic surgeon, for instance, in as people seem to think. th I am quite strong, but you don’t do have to be strong. There are tools. You don’t have to do th these things in a macho way.’
Mrs McNally has four children, and strongly believes that you
can be a good mother and a good goo surgeon.
YeTshe admits her own career progression was made easier by the fact that her husban band, a nurse, was a stay-at-home dad for at least one crucial period dur during her training. ‘Had I been a sing single mother, it would have been an awful a lot harder,’ she says.
Bu But with women making up just 12 per p cent of consultant surgeons in the t NHS, the chances are many of us u could go through our whole lives live still thinking surgeons are always alw men. It’s the bane of the female fem surgeon’s life.
every ev woman surgeon has a story sto of being mistaken for a nurse, or a secretary.
Mrs McNally says she gets it on a daily basis. ‘I go onto a ward with a handsome junior doctor and he is the one the patient assumes is the consultant. Or a patient will say to me, even after we have been speaking for a while: “Oh, are you doing the surgery, too?” They assume I am there in an administrative capacity.’
The fact is that the NHS needs to push the female trainees through the ranks, not waving them off into the perceived ‘easier’ branches of medicine, or seeing them leave the NHS entirely.
But won’t the current exodus be seen as evidence that women can’t ‘hack it’ at the top?
Mayoni says nothing is further from the truth. ‘ The problem is that women like me just aren’t prepared to sacrifice everything for the job, and kill themselves in the process. And there is something wrong with a system that expects you to do it.’