Women cut apart by surgical culture
In Australia, only nine per cent of surgeons are female.
When I decided to have my entire vagina reconstructed, it wasn't just the fear of the operation that held me back.
Yes, I was frightened, despite the fact I felt like my entire insides were about to fall out at any given time. But I also had a strong, strong urge to find someone who would understand exactly what it meant to me to have this most primal part of my anatomy remade.
I can imagine there are men who may display great empathy for this but that wasn't exactly the quality I was looking for. I wanted to make sure that whoever did the doing - a highly complex procedure which can end badly for some women - would not only have empathy but ownership expertise. I definitely wanted someone operating on my vagina who had one herself.
Turns out I was lucky. There are plenty of women obstetricians and gynaecologists who specialise in this kind of surgery so I had no trouble finding someone who'd done heaps of these operations and who offered to let me speak to previous patients.
When I've recounted this feeling to others, the response has been mixed. From, well, yes, of course, you want a woman looking up your fanny. To, don't you just want the best person for the job? Well, yes, I did want the best person for the job and I definitely did not want a bloke doing it.
But if you had a strong urge to have a female surgeon operate on any other part of you, you would be in big, big trouble. Not only are there very few female surgeons in Australia, but the combination of the closed-shop of surgical training and the narrow attitudes of hospitals who employ those surgeons make it bloody difficult for women to become surgeons.
A friend of mine, Jill Tomlinson, deputy chair of the Women in Surgery (WIS) section of the Royal Australasian College of Surgeons (RACS), is now a qualified plastic surgeon. She specialises in hands, so I know I'll be well looked after if I ever want to get rid of the webbing, an occupational hazard of being a dragon. Joke. Anyhow, she and her colleagues at WIS just published a paper in the December issue of the Australian and New Zealand Journal of Surgery on flexible surgical training positions for Australian doctors, examining the evidence on whether flexible and/or part-time training had negative effects in other areas of medicine where that kind of training was possible.
The answer is no, according to Tomlinson. The specialities that offer flexible training - that is, every speciality in Australia except surgery - have no decline in quality of trainee. Happy trainees, happy professionals.
Turns out that out of all the specialities available for doctors in Australia, surgery is the only one that won't offer flexible training. The statistics are clear: just won't do it. The policy says the RACS says it will but the flexibility doesn't happen. So there you are, a very bright young parent with childcare responsibilities and here is this training program that just won't budge from utterly antiquated attitudes.
So it is completely expected that out of all the specialities, surgery has the lowest percentage of women, just shy of nine per cent. Which is weird since women make up 55 per cent of medical students. That's right. More than half.
As the Tomlinson et al paper says: ''Barriers exist at the trainee, college, specialty board, hospital administration and medical organisational levels.'' Yet both men and women who want to be surgeons say they want to have flexibility and/or part-time training.
Another article by Mary Rogers and others published this year in the Australian Health Review tried to determine why doctors won't choose surgery as a specialisation. The news for anyone interested is brutal. Nearly three-quarters of those surveyed said they absolutely would not choose surgery because of the training expectations, the lifestyle and the culture of those who already practice surgery. In addition, women interviewed said they rejected the speciality because of the way in which men dominated it.
And people, we are short of surgeons. It's not like there is a long queue of people desperate to sign up for a minimum 60-hour week and an alienating culture.
Here is what some of those interviewed for the Rogers paper said: ''The amount of hours that the registrars do, I find absolutely ludicrous. It's very difficult to get a proper life balance. You need to be single because your first commitment has to be to the job.''
Or: ''[What] puts me off is that often surgeons have a poor reputation with their other medical colleagues … they might behave and speak to other members of staff in ways that would be completely unacceptable if they were working in public service. It would be considered harassment or bullying in other publicly funded work places. And there doesn't seem to be anything being done about that by the college as a whole.''
When the federal Sex Discrimination commissioner, Elizabeth Broderick, completed her report on the treatment of women in the Australian Defence Force, she made 31 recommendations. My view is that Australians are more at risk from a professional medical culture that degrades and discriminates against women. Maybe Broderick needs to put the RACS next on the list for her special brand of advice.