Surgical Sexism

Indian Journal of Surgery https://doi.org/10.1007/s12262-023-03994-8

OTHERS

Surgical Sexism—a New Word in the Surgical Arena

Surajit Bhattacharya1 · Kaushik Bhattacharya2 · Sandeep Kumar3

Received: 5 September 2023 / Accepted: 18 November 2023 © Association of Surgeons of India 2023

Abstract

“Surgical sexism” is the latest addition to the medical vocabulary where studies revealed surgical specialists treating women are reimbursed at a lower rate than surgical specialists treating men. While in India, this ethical issue has still not been reported, it is an issue to watch for in future as a part of gender discrimination.

Keywords Sexual sexism · Gender discrimination · Gender politics

As part of the study, which was published in the Canadian Journal of Surgery on July 4, 2023 [1], researchers looked at similar procedures done on both male and female reproductive organs. For example, surgeons get paid more for doing a biopsy of male genitalia versus female genitalia, even though it is essentially the same procedure. To untwist an ovary, you have to go into the abdominal cavity, so it is a much more risky surgery and more complex surgery, and it is paid at 50% less than what untwisting a testicle will pay.

Doctors in eight provinces of Canada, who perform genitourinary (reproductive and urologic) procedures on female patients are paid 28% less on an average than those who do similar surgeries on male patients. Saskatchewan has the largest discrepancy of the eight provinces, at 67%, followed by B.C. at 61% and Yukon at 41%. It sends a message that perhaps women’s health is not as valued as the health of men folk. In Canada not only are women surgeons paid less on average, but surgeons who look after women are also paid less. This reflects double discrimination

* Surajit Bhattacharya surajitbh@yahoo.co.in

Kaushik Bhattacharya kbhattacharya10@yahoo.com

Sandeep Kumar profsandeepsurgeon@gmail.com

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both against the care providers who manage the care of female patients and against female patients. While female physicians are devalued by provincial fee schedules, those who care for female patients are even further devalued. As female providers predominate in obstetrics and gynecology, this may reflect one form of structural sexism leading to decreased compensation for female surgeons.

In a 2007 Norwegian survey, medical trainees were asked to rank different medical conditions according to the relative prestige of treating them and found that ovarian cancer was considered a less prestigious disease than testicular cancer [2]. The American literature too has demonstrated a substantial difference in the relative value units (RVUs) assigned to procedures specific to female versus male patients [3].

In the USA, there is a strong negative relationship between the proportion of female physicians in a specialty and the mean salary in that specialty, with gender composition correlated with 64% of the variation in salaries among the medical specialties in the USA [4]. A similar trend in Canada, female specialists earn 40% less than their male counterparts [5]. Fortunately, in India, both in the government and in the corporate sector this malady does not exist. When the government advertises for both teaching and non-teaching jobs, the salaries to be paid are announced beforehand, along with all the perks and gratuity benefits and this does not change whether a male or a female doctor is appointed for the post. Corporate hospitals negotiate with individual doctors, but their salaries are decided not by their sex but by their demand and the hospital’s requirements. Thus, a radiologist often demands and gets the highest salary, and a general surgeon may have to settle for a lesser

Plastic Reconstructive & Aesthetic Surgery, Sahara Hospital, Lucknow 226010, India

Department of Surgery, MGM Medical College and LSK Hospital, Kishanganj 855107, India

AIIMS Bhopal, HIG 111, Sector E, Aliganj, Lucknow 226024, India

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sum. Both the central Government Health Scheme (CGHS) and the state governments and the insurance companies have a list of item numbers representing every surgical procedure and the same amount is paid to the surgeon irrespective of his/her sex.

Another important factor, particularly in those parts of India in which the Muslim population is substantial, is the most obstetrician and gynecologists specialists are women. The cultural hitch which the Muslim women feel approaching a male surgeon for their most intimate problems put our female surgeons in a far more advantageous position than their male counterparts and that allows them to charge a higher fee in the private set-up. It is recommended that the pay should essentially be independent of gender and be decided by other attributes like qualifications, seniority, level of expertise, and work volumes.

However, there is no doubt that females in surgery lack support, particularly during pregnancy, face harassment, and have unequal opportunities, which were often exacerbated by sex blindness by their male counterparts. In a study to explore the personal and professional challenges, practice barriers, and level of satisfaction among female urologists/ urology trainees in India, it was concluded that the reason why females were reluctant to choose urology as career was due to gender discrimination in training and work, lack of mentorship, pregnancy-related compilations, and compromised career due to family responsibilities [6]. Mothers are especially affected, struggling to achieve a work-life balance while facing strong criticism. However, with increasing recognition of the unique professional traits of female surgeons, there is progress toward gender equality. In all specialties, structures should be improved to make it easier for women and men—or the second parent—to take shared parental leave or less-than-full-time training. This would not only improve life for these doctors but also show future cohorts that this is possible.

Gender-based discrimination in India however plays at a different level and starts even before a female child is born and continues until death. Government has been trying to address the scourge of female feticide and dowry atrocities by strict laws and extensive socio-cultural efforts and education. The hierarchical caste system, which had assigned a second-class status to women resulting in a neglect of their education and health, is fast waning and laws are being amended to help them be counted as equal citizens. But still if a woman in not self-sustaining her health gets a lower priority and, in all ages, we see female patients reaching the hospital in a far more advanced stage of the diseases, whether it is congenital, inflammatory, or neoplastic.

Although we may say that the form of surgical sexism that’s mentioned in the Canadian paper is not seen in India, we also need to acknowledge lack of reporting and paucity of such studies from India. Articles related to non-clinical aspects of healthcare such as training-related issues, gender disparity, physician health, burn out, patient billing, health care costs, etc., are highly under reported from India [7]. Therefore, it may be possible that we are not aware of existence of such disparities just because of lack of published evidence.

There is a difference in the way that sexual/gender politics plays out in the case of a female doctor and a female patient, but the glass partition demarcating genders has been showing some cracks in India. Every part of a woman’s body has today become a site of medical interventions. In surrogacy, the uterus has been reduced to an object of research, study, and trade. Women’s genital mutilation surgery is a common practice in many Muslim countries around the world. Their genitals are cut off during circumcision and sewed into a hole. It is a practice based on the belief that the virginity of a woman must be protected until her marriage.

Declarations

Conflict of Interest The authors declare no competing interests. References

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2. Album D, Westin S (2008) Do diseases have a prestige hierarchy? A survey among physicians and medical students. Soc Sci Med 66:182–188

3. Benoit MF, Ma JF, Upperman BA (2017) Comparison of 2015 Medicare relative value units for gender-specific procedures: cynecologic and gynecologic-oncologic versus urologic CPT coding. Has time healed gender-worth? Gynecol Oncol 144:336–342

4. Pelley E, Carnes M (2020) When a specialty becomes “women’s work”: trends in and implications of specialty gender segregation in medicine. Acad Med 95:1499–1506

5. Cohen M, Kiran T (2020) Closing the gender pay gap in Canadian medicine. CMAJ 192:E1011–E1017

6. Pandit SR, Venugopal P, Keshavamurthy R, Chawla A (2022) Challenges and gender-based differences for women in the Indian urological workforce: results of a survey. Indian J Urol 38(4):282– 286. https://doi.org/10.4103/iju.iju_143_22 Epub 2022 Oct 1

7. Bhattacharya K, Bhattacharya S (2023) How can we prevent sexual harassment of woman surgeons? J Med Evid 4(2):166–169. https://doi.org/10.4103/JME.JME_10_23

Indian Journal of Surgery

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