Shortages in the global surgical workforce exacerbated by gender inequity

Hilary A. Sanfey, MB, BCh, FACS,
Hilary A. Sanfey, MB, BCh, FACS,

There is a substantial deficit in the global surgical workforce, leaving an estimated 5 billion people without access to surgical care. Data suggest that the workforce must double within the next 
15 years to address this gap—a goal that is currently unreachable, in part because of gender disparities in education and societal expectations that often prevent or discourage women from entering the surgical workforce.

An international panel of experts discussed strategies to address and improve gender equity worldwide and, thereby, the pipeline for women into surgical fields during the Tuesday morning session, No Woman No Care: The Case to Incorporate Women into the Global Surgery Workforce.

Although the numbers of women enrolled in medical schools continues to increase worldwide, women still make up less than 10 percent of the surgical workforce in countries such as the U.S., the U.K., and Japan. The percentages are even lower in many low- and middle-income countries (LMICs), according to Hilary A. Sanfey, MB, BCh, FACS, professor of surgery, Southern Illinois University, Springfield.

“On average, there is just one surgeon per 200,000 people in LMICs, with most of the surgical care provided by nonsurgical and often nonmedical specialists. And where qualified surgeons do exist, they tend to practice predominantly in urban areas,” Dr. Sanfey said. “To reach the surgical workforce density needed, it’s estimated that we must double the workforce by the year 2030 at a total cost of more than $45 billion, a target that is just not possible for most LMICs.”

But if a significant number of surgeons aren’t added to the global workforce by 2030, Dr. Sanfey said the result will be an estimated $20.7 trillion in losses to the global economy.

“So, while the cost of surgery expansion is significant, the cost of doing nothing is even greater,” she said. “It’s also important to understand that women’s health and women’s roles as consumers and providers of health care are intertwined, making gender diversity in the surgical workforce especially vital in parts of the world where women might be more comfortable seeking their health care from a woman due to cultural norms.”

Although progress has been made over the past several decades in removing some of the barriers and challenges to achieving gender equity in surgery, much more needs to be done, said American College of Surgeons (ACS) Governor Hiba Abdel Aziz, MBBCh, FACS, senior consultant, surgery, trauma surgery, and critical care, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.

“Among the barriers women face in the surgical workforce are those related to traditional gender roles that still exist in many parts of the world,” Dr. Aziz said. “Overt sexism and more subtle gender discrimination, as well as a lack of female mentors and role models for women, contribute to the challenge.”

Raising awareness and increasing educational opportunities are key to overcoming these challenges, according to April Camilla Roslani, MBBCh, MS, FRCS, FAMM, professor, head of general and colorectal surgery, University of Malaya Medical Center, Pantai Dalam, Kuala Lumpur, Malaysia, who discussed initiatives to create change in her country.

“The lack of trained human resources prevents access to surgical health care in Malaysia,” she said. “We are working to address that by increasing the number of women surgeons in leadership roles to mentor, sponsor, and be role models for other women in order to create an improved surgical environment that will benefit everyone.”

Abebe Bekele, MD, FACS, professor of surgery, dean of health sciences, University of Global Health Equity, Butaro, Rwanda, discussed the steps being taken in sub-Saharan Africa to address gender inequality and increase the number of women surgeons.

“The College of Surgeons of East, Central, and Southern Africa has implemented a ‘college without walls’ training model that utilizes existing human and capital resources rather than building new infrastructure,” Dr. Bekele said. “We’ve demonstrated that we can scale up surgical training rapidly and cost-effectively, and active recruitment of women trainees is one of our strategy pillars.”

In the final presentation of the session, Deborah A. McNamara, MD, FRCSI, professor, consultant general and colorectal surgeon, Beaumont Hospital, Dublin, Ireland, discussed ongoing initiatives in Ireland by the Royal College of Surgeons to implement successful gender policies.

“We have made good progress and continue to work to build a culture of support for female surgical trainees by reducing perceived barriers through educational resources, role models, career advice, and ensuring equal opportunities,” she said.