Commentary on: A Work in Progress: Women's Status in the Plastic Surgery Workforce and Recommendations for Success

See the Original Article here.

I am pleased to have been invited to provide a Commentary for this timely article. The authors conducted a survey of US female plastic surgeons and achieved a response rate of 53% (707 of 1342 board-certified female plastic surgeons based in the United States). I want to thank the authors for this timely update on information about the status of female plastic surgeons in the United States, who comprise 20% of the plastic surgeon workforce. There has been a tsunami of women entering plastic surgery training: this paper quotes a 55% female plastic surgery match in 2022 and a 59.9% match in 2023,¹ so it’s safe to say that the percentage of practicing female plastic surgeons will certainly continue to rise at a faster rate in the future. We do need to reassess how to continue to foster success for all plastic surgeons and to recognize the different barriers faced by women and men in achieving such success. Although this paper specifically addresses the challenges faced by women, we are all dependent on the success of each other. Much like how any aesthetic procedure complication reflects poorly on plastic surgery, whether it was performed by a plastic surgeon or not, failure to support young plastic surgeons adversely affects all our futures. During my year as president of The Aesthetic Society, my repeated mantra was: “We are stronger together.” The success of women plastic surgeons affects all of us and our strength as a specialty, especially as women currently represent over 40% of those in training. Excluding Obstetrics and Gynecology, ours is the first surgical specialty to approach gender parity. We can lead all surgical specialties, and potentially all of medicine, but that requires change. The first step is to assess where we are and what are the barriers to success in our changing workforce. These authors have identified the most significant barriers to success, namely, personal or family demands, lack of mentorship, gender discrimination, and lack of networking.

The authors discuss three models of practice: private practice, employed practice, and academic practice. Although all respondents were satisfied with their career, satisfaction was highest in the private practice model. The authors report that the proportion of women in academic practice amounts to only 12.3%, raising questions as to what the barriers are there. Why are women plastic surgeons so much happier in private practice? Our future plastic surgeons see these academic surgeons first while in training. As a student, it is easier to imagine yourself in any position if you can identify with the role models already there. And does females’ lesser satisfaction with academics and their reasons for this translate to the male plastic surgeons? Is this a harbinger of a migration of our best and brightest away from academics? What can be done to improve the quality of life in academics to attract more women, because there is discordance here between not just our percentage of female residents but our percentage of female practicing plastic surgeons? Can we look at this survey at what these women perceive as their barriers and apply these to academics, as well as across the board?

The challenges to success of the women plastic surgeons polled varied but most quoted personal and family obligations as a significant barrier, regardless of their current practice type. The authors state that “female surgeons face the unique challenge of balancing their career with pregnancy, fertility treatments, breastfeeding, and serving as caregivers.” I would argue that these challenges are not unique to women plastic surgeons but are the same challenges facing most women in the workforce, despite most households having two working parents. According to the New York Times, “Men between ages 18 and 34 in opposite-sex relationships are no more likely than older couples to divide household labor equitably. And while it's true that men have picked up some of the household labor, a significant gap remains.” In the United States, women spend about 4 hours a day on unpaid work,² compared with about 2.5 hours for men, according to data from the Organisation for Economic Cooperation and Development.^3,4 The needs of women plastic surgeons mirror that of all women in the workforce. We can do better for everyone.

While this paper rightfully focuses on women, I believe focusing on women and barriers to their success can lead to more success for everyone in our field. For example, over 53% of women respondents surveyed reported still taking emergency room calls. For those with young children, drop-off hospital childcare would alleviate an incredible amount of stress. Although still a minority, there are male plastic surgeons who would also benefit from in-house childcare. As a single mom, having to have my mother spend the entire week with me anytime I had hospital call duty or calling upon a friend if a patient had a late-night emergency added unnecessary stress.

I think it is also important to compare progress of women plastic surgeons to women in business. According to the authors, women comprise 12% of program directors and 8.7% of department chairs in plastic surgery. Interestingly, according to Fortune,⁵ as of June 4, 2024, only 10.4% of Fortune 500 companies have women CEOs. In fact, 2023 was the first year that women CEOs outnumbered the number of male CEOs with the first name “John.”⁶ Women in business also quote the difficulties of lack of sponsorship and mentoring as barriers to success and advancement, mirroring the findings of the authors here. I have enjoyed my time in leadership but am continually stunned by the number of women plastic surgeons worldwide who have asked for my guidance. Lack of mentorship is not because women aren’t asking, and they aren’t just asking other women. We need to encourage and foster the asking, and sponsor and mentor those who ask. Forums to encourage this can be found formally in both of our large societies such as Women Plastic Surgeons started by Dr Jane Weston and others, as well as private forums. These private forums include personally funded dinners and gatherings both at meetings such as those organized by Dr Angela Cheng at the American Society of Plastic Surgeons and by women in our communities such the Nashville Middle Tennessee Women's get togethers organized by Dr Lauren Connor, which includes all Vanderbilt residents as well as all the women plastic surgeons in the community. There are groups of male and female plastic surgeons who have done this on a smaller scale for years; we need to be more intentional.

Combined with all our surgical advances and our specialty taking the lead on regenerative medicine, I think this is an incredibly exciting time to be a plastic surgeon. As this amazing young group of women plastic surgeons emerges, it was an incredible time for me to be The Aesthetic Society president. I can attest that there are opportunities for each of us to mentor and sponsor no matter what position we are in.

I want to congratulate the authors on an incredible survey response rate. Clearly this is a topic that is meaningful to many on a personal level. And as most great surveys do, it raises more questions that I hope may be answered in future surveys. Although this paper focuses on women, it is also an indication as to the health of our specialty and offers guidelines for our future. How do we address these barriers to success, the highest of which quoted were personal or family demands, lack of mentorship, gender discrimination, and lack of networking? And if they surveyed an age-matched cohort of male plastic surgeons, how would their answers differ, if at all? Times are changing and plastic surgery needs to change with the times.

Disclosures

The author declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

Funding

The author received no financial support for the research, authorship, and publication of this article.

REFERENCES

Author notes