Gender Disparity in Surgery in Ukraine: A Nationwide Survey
Authors:
- Marta Antoniv, MD — surgeon, research fellow, Department of Surgery, Brigham and Women’s Hospital, Boston, USA.
- Inesa Huivaniuk, MD — surgical oncologist, Kyiv Regional Oncology Center; editor in chief, GMKA Ukraine.
- Anna Malovanna, MD — surgical oncologist, private institution, a participant in the annual mentorship program of the American College of Surgeons (ACS).
- Anastasiia Prystaia, MD — colorectal surgeon, Feofaniya Clinical Hospital, Kyiv, Ukraine; director of public relations and communications, GMKA.
- Yulia Novosad — medical student at the University of Warmia and Mazury in Olsztyn, Poland.
- Anastasiia Volkova — medical student at Lviv National Medical University; local president of the Ukrainian Medical Students’ Association in Lviv, Ukraine.
- Galyna Shabat, MD, PhD — surgeon, endoscopic surgeon, Policlinico San Donato Research Hospital, Milan, Italy; director of patient education, GMKA.
- Solomiia Semeniv, MD — general surgery resident, University Clinic in Krakow, research associate, Jagiellonian University, Krakow, Poland; director of the educational program for surgeons, GMKA.
- Lesia Strylka, MD — burn and plastic surgeon, First Medical Union in Lviv, Ukraine.
- Olena Tytarenko — medical student, Vinnytsia National Medical University Vinnytsia, Ukraine.
- Nelya Melnitchouk, MD, MSc, FACS — colorectal surgeon, Massachusetts General Brigham, Dana Farber Cancer Center, Professor at Harvard Medical School, Boston, USA; CEO/President of GMKA.
Background
Gender discrimination and stereotypes regarding women’s professional choices are globally pervasive issues. 80% of female doctors have been told they cannot be surgeons due to perceived difficulties balancing work and family life. Despite societal claims that gender inequality is no longer an issue, this study seeks to assess the true state of gender discrimination in the surgical field in Ukraine.
“In 2024, female surgeons continue to face sexual objectification, gender discrimination, and harassment in the workplace. We discuss these issues privately among other female surgeons, while the male community often denies their existence,” says Inesa Huivanyuk, a surgical oncologist at the Kyiv Regional Oncology Center and head of the “SurgFem: Women in Surgery” project.
Study Design
A study was conducted by the “SurgFem: Women in Surgery” project team to examine gender discrimination in the surgical field in Ukraine. A web-based survey was distributed via social media from January 23 to February 24, 2024, targeting female attending surgeons and surgical residents across various specialties. The survey received 340 responses and featured demographic, work-, and gender-specific questions (quantitative) and solicited suggestions for establishing gender equality (qualitative).
Objective
The study aimed to identify the gender-specific challenges that female surgeons face in Ukraine, including discrimination, sexual objectification, and harassment throughout their education, residency, and professional careers.
Preparation
The research team conducted a literature review on gender issues, selected key questions, and conducted a pretest among Ukrainian female surgeons and residents to ensure the survey’s relevance and clarity.
Participants and Key Findings: The survey included 340 respondents.
Demographic breakdown
Marital Status:
- Unmarried: 39.1%
- Married: 41.2%
- Civil marriage: 12.9%
A significant number of the respondents (32.4%) graduated from medical university between 2016 and 2020, while 38.2% graduated after 2020. This trend continued in residency, with 61.8% finishing their residency after 2020.
Professional Status:
- Attending surgeons: 64%
- Residents: 36%
Marital Status:
- 39.1% – single
- 41.2% – married
- 12.9% – in civil marriage
Children:
- No children: 68.2%
- One child: 19.4%
- Two children: 8.8%
Place of work:
- 38.8% work in state urban hospitals
- 29.1% – in private hospitals
- 25% – in state regional hospitals
- 0.3% – in rural hospitals
The most represented specialties were:
- General Surgery: 40.6%
- Obstetrics and Gynecology: 17.9%
The least represented specialties were Transplantology and Neurosurgery, each accounting for less than 2% of respondents. Pediatric Neurosurgery was not represented by any of the female surgeons.
Distribution of female surgeons at the hospital
40.3% of the respondents reported that there were between 2 and 4 female residents in their department. Most (34.4%) also reported that there is only one female attending in their hospital.
Administrative Positions
- 49.1% of respondents said that there are no female surgeons in administrative positions at the hospitals
- 30.3% said there are 1-2 female surgeons in administrative positions
- 12.1% said there are 3-5 female surgeons in administrative positions
- 1.8% said there are 6-10 female surgeons in administrative positions
- 1.8% said there are more than ten female surgeons in administrative positions
Professional Roles and Opportunities
The study also explored the common roles that female surgeons obtained in the operating room.
Only 32% of the attending surgeons reported having equal opportunities to operate as their male colleagues. Half of the female surgeons (51.8%) stated that they worked as assisting surgeons during surgical procedures.
A few respondents (0.9%) reported being heads of departments, and 1.8% were hospital administrators.
51.9% of female surgeons perform 1-2 surgeries per week, whereas assistant roles are more common, with 40.9% assisting in 3-4 surgeries and 20.9% assisting in 5-7 surgeries per week.
The survey also showed that 37.1% of female surgeons experienced gaps in their surgical practice. The primary reasons for these were pregnancy and maternity leave (50.1%), followed by changing jobs or relocating (26.2%), burnout or stress (20.6%), changing specialties (8.7%), pursuing further education or research (5.6%), and health issues (3.2%).
Professional Challenges
Women in surgery face numerous obstacles throughout their education, job search, and professional practice.
The most common challenges during the search for an internship position include:
- Gender stereotypes in society (65.6%)
- Lack of support in choosing a surgical specialty (53.5%)
- High competition in surgical specialties (47.9%)
- Preference for men over women in residency (41.2%)
- Corruption in candidate selection (32.4%)
During their residency, 51.5% of female surgeons reported no impact of their gender on the quality of their training, while 28.8% experienced a moderate negative impact, and 6.5% experienced a significant negative impact.
The most common challenges during the job search after completing residency include:
- Gender stereotypes (60.8%)
- Lack of vacancies in surgical specialties (57.4%)
- Financial corruption in candidate selection (47.7%)
- High competition (44.3%)
- Lack of network connections (40.4%)
The most prevalent challenges in professional development are:
- Professional burnout (50.0%)
- Gender stereotypes or discrimination at work (48.5%)
- Lack of support from the head of the department (41.5%)
- Insufficient resources or funding for projects or ideas (39.1%)
- Limited access to mentorship (35.3%)
Despite these challenges and gender disparities, the survey results indicate a generally positive attitude among female surgeons toward their profession and career choice.
85% of respondents reported being satisfied with their profession:
- 44.4% were completely satisfied
- 40.6% were mostly satisfied with their choice of specialization
78.5% would choose surgery again if given the chance:
- 54.4% would choose this path
- 24.1% would likely choose it
Mentorship in the Professional Lives of Female Surgeons
Mentorship is crucial for professional development and motivation in the surgical career path, a point emphasized by SurgFem.
The study demonstrated that only half (56.2%) of female surgeons have mentors supporting their professional journey in surgery.
Many respondents report having role models in surgery, with 44.2% of these role models being male surgeons and 38.8% being female surgeons in Ukraine. Additionally, some respondents find role models among foreign male and female surgeons (11.2% and 12.9%, respectively).
Gender Discrimination
Female surgeons face gender stereotypes, sexual harassment, objectification, and gender bias, as demonstrated by this study:
- A significant majority of respondents (80%) reported that colleagues have said that surgery is not suitable for them because of their gender.
- Nearly all respondents (92.1%) mentioned that patients have perceived them as nurses and 68.2% noted similar perceptions from other medical professionals.
- A substantial number of female surgeons (38.3%) felt that their gender negatively impacted their relationships with colleagues.
- Nursing staff perceived female surgeons more positively (23.8% reported a somewhat positive impact, and 17.3% reported a significantly positive impact).
- More than half of the female surgeons (54.4%) heard derogatory remarks or experienced disrespectful attitudes from colleagues due to their gender.
- Half of female surgeons (54.4%) faced doubts about their skills from patients due to their gender, while some (5.3%) frequently felt that their skills were mistrusted by patients because of gender stereotypes.
- Over half of the respondents (54.7%) had experienced sexual objectification or harassment from colleagues, and 30.3% had faced such issues from patients.
Impact of Career on Personal Life
The demands of a surgical career significantly affect the personal lives of female surgeons.
A significant number of respondents (59.1%) indicated that they postpone having children due to the intensity of their work.
Among those who have children, 60.8% had their first child between the ages of 25 and 30.
56.9% of respondents continued to practice during their pregnancy or childcare period.
Regarding maternity leave, 31.4% of female surgeons took a break of more than 1.5 years.
Shorter leave periods were also common: 14.7% took up to 3 months, and 16.7% took between 3 and 6 months.
A significant number of respondents (21.6%) reported that their surgical activity returned to the level before break within less than 2 months after returning from maternity leave. However, 11.8% indicated that their activity never fully recovered.
The most common challenges faced by female surgeons when returning to work or seeking a new job position after childbirth include the following:
- 51.0% felt unsure about their professional skills after a break
- 35.3% experienced a decline in competitiveness
- 47.1% reported that their career development was limited due to their status as a mother
- 41.2% had difficulties finding a nanny or daycare
- 42.3% did not expect to receive adequate support from their institution, and 25.9% anticipated only partial support
The survey also highlighted that female surgeons contribute various percentages of family income: 31.2% of respondents contribute less than 25%, while 11.5% provide 76% or more of the family income.
Despite their demanding careers, female surgeons often take on primary responsibilities at home:
- 56.2% manage daily childcare planning
- 47.2% handle unexpected situations related to childcare
- 50.5% are responsible for cooking
- 50.3% take care of buying clothes
Addressing Gender Inequality in Surgery
Female surgeons who responded to the survey recognize the real problem of gender discrimination and have proposed various solutions to overcome it:
- Equal selection criteria: “Selection of residents should be based on the student’s knowledge and motivation, not their gender. A fair system for role assignments should be established in the department and the operating room. Professional growth should be encouraged, along with financial stability and independence. Leadership positions should be granted based on a transparent selection process. Depending on the number of female surgeons, daycare provisions at the workplace should be organized for children.”
- Reduction of judgment: “Reducing judgment based on gender from colleagues and university teachers.”
- Dealing with gender stereotypes: “We should spread information about successful female surgeons and break the stereotype that surgery is a ‘male’ profession. Create policies and procedures against sexual harassment and gender discrimination in the surgical field. Encourage surgical teams to include members of different genders to ensure diversity of thought and experiences.”
- Social projects: “Increasing social projects to popularize women in various professions with explanations of rights and opportunities will eventually lead to society becoming accustomed to and accepting of women in all professions as the norm.”
- Equal parental leave: “Equality in parental leave for childcare, eradicating outdated stereotypes from the minds of older hospital administrators.”
- Opportunities for learning and mentorship: “Provide learning opportunities and organize events to acquire new skills and knowledge. Mentorship is crucial.”
- Changing perceptions: “Male surgeons need to understand that a female surgeon can be just as professional as they are, if not more. Establishing mentorship for female surgeons, especially during and after maternity leave, is essential.”
- Role models and trust: “The more successful female colleagues there are, the faster sexism will disappear. Unfortunately, simply talking about it isn’t enough. Surgery is a demanding specialty, and only through the example of successful female surgeons can we demonstrate our intelligence, skills, character, and advantages over some male colleagues. Additionally, it is important for female colleagues to trust female surgeons more.”
However, some women doubt that immediate change is possible and believe that gender bias is too deeply entrenched in the system. They hope for change with the new generation of doctors:
- “Everything will come in time; our generation will end gender inequality.”
- “The thing is all the problems I face are only with older colleagues. My peers and slightly older colleagues treat me with respect. It’s difficult to break stereotypes and the system we work in.”
- “It’s hard to answer because there is a certain disbelief that something can change in the minds of the older generation of doctors. Perhaps greater popularization and highlighting of the work of female surgeons are needed. Creating a strong community with legal support is necessary to feel protected.”
- “I don’t believe in it, and I simply don’t see the prospect of a change in mentality in that direction during my life.”
Conversely, some responses deny the existence and relevance of the problem:
- “There is gender equality in Ukraine! There are no problems.”
- “Gender equality cannot exist ‘by definition’ because men do not menstruate, give birth, breastfeed, or go through menopause. Men have stronger muscles.”
- “Everything is fine as it is.”
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