Countercurrents in Cardiothoracic Surgery

By Megan Mayerle, PhD

Gender diversity impacts the operations and services rendered in many industries, including academic science and medicine. In clinical specialties such as cardiothoracic surgery, the consequences of inequality and cognitive biases can directly affect patient safety and outcomes. Stanford Cardiovascular Institute member Leah Backhus, MD, MPH, and colleagues explore how an institution's culture as related to safety and gender inclusion impact surgical training and physician well-being in a recently-published article published in the Annals of Thoracic Surgery.

Currently only 6.6% of US thoracic surgery academic faculty members are women, and estimates indicate that without significant policy changes, it will take at least 100 years to achieve gender parity in thoracic surgery at the full professor level. This disparity is quite striking, particularly in light of the fact that women present at as many scientific conferences as their male counterparts, and that the quality of their scientific investigations is either on par or superior to their male colleagues.

It's an issue of equality—women's contributions are systematically undervalued. Backhus and colleagues emphasize that much of the disparity arises from subtle issues that, when combined, create a countercurrent that hinders women's advancement.

The authors are careful to debunk the off-cited "work/life balance" explanation for the absence of women cardiothoracic surgeons, pointing out that male surgeons are much more likely to be parents, and that studies indicate that both women and men seek balance.

Female surgeons are also more likely than their male counterparts to teach in the clinic and pursue advanced training in educational scholarship. This emphasis is undervalued compared to more research-focused scholarship, contributing to the dearth of women in top leadership positions and a lack of female mentors and role models.

Backhus also points out how pervasive sexual harassment and gender-based microaggressions are. Harassment, condescending remarks, and rudeness undermine patient care team cohesion, interprofessional interactions, and negatively impact patient care. The authors note that even very resilient women can become disenchanted as their careers progress.

The authors close by recommending that health care organizations acknowledge the presence of bias and its influence on the gender gap. They advise that universities and health care centers prioritize diversity efforts and train their personnel to recognize mitigate the effects of bias. Such efforts are necessary to ensure the health and wellbeing of patients as well as their doctors.

Dr. Leah Backhus