Strengths and Barriers for Women in Vascular Surgery: The Brazilian Perspective

Women's participation in the medical workforce has increased substantially in recent years. However, compared with men, women pursuing surgical specialties remain under represented because they are less likely to choose surgical careers, and the rate of withdrawal during training is higher. Many researchers posit that the main contributing factor is the preference for a career that offers a more accommodating balance between work and personal life.1Crompton R. Lyonette C. Women's career success and work–life adaptations in the accountancy and medical professions in Britain.Gend Work Org. 2011; 18: 231-254Crossref Scopus (85) Google Scholar Another factor that cannot be overlooked is the shortage of women surgeons in leadership positions to serve as role models and mentors.1Crompton R. Lyonette C. Women's career success and work–life adaptations in the accountancy and medical professions in Britain.Gend Work Org. 2011; 18: 231-254Crossref Scopus (85) Google Scholar A partial explanation as to why there are fewer women among the most experienced surgical professionals and, consequently, in leadership, is that only recently has there been an increase in the number of women interested in pursuing a surgical career. This is evidenced by the higher percentage of women surgeons in the younger generation of specialists. Nevertheless, although the number of female surgeons is rising, their involvement in management positions has not increased at the same rate. For example, among Brazilian vascular surgeons, women increased their participation from 13% in 2004 to 22.9% in 2018.2Scheffer M. Cassenote A. Guilloux A.G.A. Biancarelli A. Miotto B.A. Mainardi G.M. et al.Demografia Médica No Brasil 2018. São Paulo: FMUSP, CFM, Cremesp2018: 1-286Google Scholar However, from 1952 to 2020, only two women have served as presidents of the Brazilian Society of Angiology and Vascular Surgery (Sociedade Brasileira de Angiologia e de Cirurgia Vascular [SBACV]), which represents the specialty in the country, with 3209 associate surgeons.3Silva F.C.S. Cerqueira M.M.B.F. Ruivo B.B.C. Rautenfeld M. Women in vascular surgery: a brief analysis of the Brazilian profile.J Vasc Bras. 2018; 17: 128-135Crossref PubMed Scopus (5) Google Scholar To identify recruiting and retaining strategies specific to women, several studies have been conducted to explore the reasons for choosing and staying in the surgical profession.4Ali A.M. McVay C.L. Women in surgery: a history of adversity, resilience, and accomplishment.J Am Coll Surgeons. 2016; 223: 670-673Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar With this in mind, we conducted a cross sectional survey study aimed at describing the professional profile of women vascular surgeons in Brazil. Although this is a very specific demographic segment, our results provide a basis for recommendations and a much broader discussion on the subject. After the publication of a pilot study in the Jornal Vascular Brasileiro3Silva F.C.S. Cerqueira M.M.B.F. Ruivo B.B.C. Rautenfeld M. Women in vascular surgery: a brief analysis of the Brazilian profile.J Vasc Bras. 2018; 17: 128-135Crossref PubMed Scopus (5) Google Scholar in June 2018, a survey link was made available through survio.com for 60 days. The invitation to participate was distributed by the SBACV institutional email account to the 810 associated women vascular surgeons. Data on demographics, the extent of specialised training, economic aspects of professional practice, scientific engagement, and experience in management positions were collected. The study was registered under the name “WoVaS”, an abbreviation for “women in vascular surgery”, and approved by the Research Ethics Committee of Hospital da Bahia, Salvador, Brazil. A total of 281 valid questionnaires were completed. The highest percentage of women surgeons were from the South East region (54.8%), which corresponds to the high concentration of medical schools in this location. In total, 81.5% (n = 229) of the respondents were aged < 45 years and almost two thirds had worked in their specialty for ≤ 10 years, indicating an upward trend of women pursuing vascular surgery as a profession in the last decade.5Mueller C.M. Gaudilliere D.K. Kin C. Menorca R. Girod S. Gender disparities in scholarly productivity of US academic surgeons.J Surg Res. 2016; 203: 28-33Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar In Brazil, there are two options for becoming licensed in vascular surgery. The accredited programmes comprise two years of general surgery training, followed by two years of residency or internship in vascular surgery recognised by the SBACV, with an optional year for endovascular surgery certification. However, the Federal Council of Medicine allows physicians to work in any specialty, regardless of specific training, and undergo a licensing examination after eight years of practice. Despite the rigour of accredited training programmes, only 2.5% of the study respondents opted for the non-accredited route. The majority (77.6%, n = 218) attended a residency programme in vascular surgery, representing a high level of qualification. In addition to the accredited training, passing the SBACV licensing examination is mandatory to obtain the title of specialist and is needed to serve in executive positions and professional committees. Among the 281 respondents, 192 reportedly have one or more titles offered by SBACV. This suggests that two thirds of the participants have the minimum criteria necessary to participate in professional leadership, although only 10.7% reported that they have held a management position with the specialty society. This follows the global trend documented in several specialties,2Scheffer M. Cassenote A. Guilloux A.G.A. Biancarelli A. Miotto B.A. Mainardi G.M. et al.Demografia Médica No Brasil 2018. São Paulo: FMUSP, CFM, Cremesp2018: 1-286Google Scholar highlighting the need for professional associations to act proactively so that women are fairly represented in leadership roles. Regarding their position in the workforce, 64.4% (n = 181) of the interviewees reported that they prefer to work more hours in the clinic than in the hospital. Among the respondents, more experience in the specialty corresponded with an emphasis on outpatient care (p = .002). Moreover, 55.5% (n = 156) indicated venous surgery as their main activity and 37% reported owning their clinic, which indicates that there are opportunities for self-employment in the field. Nevertheless, men's hegemony in arterial surgery groups is a cultural barrier to be overcome, as this type of obstacle may be limiting women's talents in this area and contributing to the fragmentation of vascular surgery into subspecialties. The scientific engagement among the respondents was impressive, with about 70% reporting involvement in the congresses of the specialty or publication of scientific work. A US based literature review shows that the participation of women as first authors of original articles has increased over the last few decades; however, men retain first authorship in most surgical publications.5Mueller C.M. Gaudilliere D.K. Kin C. Menorca R. Girod S. Gender disparities in scholarly productivity of US academic surgeons.J Surg Res. 2016; 203: 28-33Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar Finally, the study assessed the respondents’ perception of the impact of gender on their careers. Despite some advances, women still struggle to be treated as equals, as reflected by > 60% of the respondents, who reported feeling disadvantaged because of their sex. Although the results cannot be generalised, the work presented here is intended to foster discussion about women's performance within a specialty still led by men. Encouraging women's leadership through institutional support from professional societies is one way to reduce barriers for women in the surgical field. We believe that this will promote mentorship of more young women as engaged professionals in vascular surgery.