B. Zhang1,2, M. L. Westfal1,2,3, C. L. Griggs1,2,3, Y. Hung2, D. C. Chang1,2, C. M. Kelleher1,2,3 1Harvard Medical School,Boston, MA, USA 2Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 3Massachusetts General Hospital,Department Of Pediatric Surgery,Boston, MA, USA
Introduction:
Anecdotally in surgery, female surgeons have less robust practices and perform less advanced or less sub-specialized surgical cases than their male colleagues. It is unclear whether these anecdotes are isolated incidents or are true of surgeons throughout the system.
Methods:
Analysis of inpatient and ambulatory cases of board-certified pediatric surgeons in the New York Statewide Planning and Research Cooperative System dataset from 2000-2015 was performed. Two measures of surgeon practice patterns were compared by surgeon gender: (1) percent of case volume that is pediatric surgery-specific (% peds) and (2) Herfindahl-Hirschman Index (HHI), a measure of case mix that quantifies each surgeon’s degree of focus within pediatric surgery. Additionally, surgeons’ work environments were assessed in five ways as based on "network" – the group of colleagues who operated at all hospitals in which the surgeon worked that year: (1) total network case volume (2) network pediatric surgery-specific case volume (3) number of surgeon colleagues (4) proportion of network case volume that each surgeon performed and (5) type of hospital at which each surgeon performed the majority of their cases each year, academic or non-academic.
Results:
51 surgeons were analyzed (10 female, 19.6%) for 461 surgeon-years (64 female, 13.9%), and 94,979 cases (10,151 female, 10.7%). Case mix of female surgeons had significantly fewer pediatric-specific cases (14.1% peds vs 16.7% peds, respectively, p=0.04) and was less focused than that of male surgeons (HHI 0.16 vs 0.20, p=0.03). Female surgeons worked in networks with fewer surgeon colleagues (7.2 vs 12.1, p<0.01) and with lower total case volumes (388 vs 734, p<0.01) and lower pediatric surgery-specific case volumes (83 vs 159, p<0.01) (Fig. 1). In addition, female surgeons performed a greater proportion of all available work within their networks than male surgeons (49% vs 36%, p=0.04), and the percentage of female surgeons operating at academic surgical centers was not different from that of the male cohort (74.2% vs 72.3%, p=0.99).
Conclusion:
Despite achieving the same levels of sub-specialty training as their male peers and maintaining competitive appointments at academic surgical centers in equal proportion, female pediatric surgeons operate in smaller networks with fewer cases and fewer colleagues. Even though female surgeons perform a greater share of all work that is available to them, they have less sub-specialized practices and caseloads with fewer expertise-building, pediatric surgery-specific cases. Gender disparity in professional achievement may be due to lack of sponsorship and access to large physician networks rather than lower female surgeon productivity.
