When Kerin Fielding qualified as an orthopaedic surgeon, she created history as the first woman in NSW – and only the third in Australia – to do it.
She qualified in 1992 and orthopaedics was one of the most male-dominated specialties in the broader surgical field, which was already heavily skewed towards men.
Given that more than 25 years has passed since the now-Associate Professor Fielding earned her stripes, it would be reasonable to assume that there had been improvement, but a new report shows there is still a substantial gender imbalance in the medical profession.
The report, by Sarah McLain, a former hospital pharmacist and final year medical student at the University of Sydney, found that while females make up 50 per cent of all medical graduates in Australia, only 34 per cent of specialists and 12 per cent of surgeons are women.
The Royal Australasian College of Surgeons wants 40 per cent of doctors undertaking surgical training to be female by 2021. Currently 29 per cent of surgical trainees are women.
The Barriers to Women's Participation in Surgery paper examined factors preventing equal participation in the surgical workforce and recent strategies to recruit and retain females in surgery.
Ms McLain’s study found women are less likely than men to apply for surgical training and in recent years, female applicants have been less likely to be successful than their male colleagues.
The research revealed 27 per cent of paediatric surgeons, 16 per cent of plastic surgeons and 11 per cent of vascular surgeons are female.
A mere 4 per cent of orthopaedic surgeons are women, a figure which Professor Fielding also quotes.
In fact, in those days they used to ask you questions about whether you were going to get pregnant.Associate Professor Kerin Fielding
Professor Fielding said that, as a woman, orthopaedics was not a specialty she had considered and she was actually looking at something else.
“I sort of fell into it really because I wanted to do plastic surgery and I did quite a lot of plastic surgery as an unaccredited – so not on a program – person at St Vincent’s and a senior person said to me ‘You need to go and get a lot more experience before we will consider your application’,” she said.
“I was heading towards 30, we were thinking that we might like to have a family – and in those days you would never have a family before you did your training. It really was rare because you couldn't have interrupted training once you got on a program. You couldn't stop for maternity. There was no option. They wouldn't have you.
“In fact, in those days they used to ask you questions about whether you were going to get pregnant.
“So, this friend of mine who was an orthopaedic surgeon in Sydney said to me – I was not sure what to do, I’d been down here as a junior registrar and had been doing orthopaedics with the senior surgeons in Wagga and they had been incredibly fantastic to work for – ‘Why don’t you do orthopaedics?’.
“He said ‘You could do hands, and reconstructive stuff that way’.
“I said ‘Well, don't be ridiculous, there’s never been a woman in NSW’, but he said ‘Oh yes, buy you’ve got a good CV’, so I applied and I got on. It just wasn’t something on your horizon at the time, because no one else had done it.”
One of the issues Ms McLain’s study discovered was a lack of women in leadership roles at medical schools.
In Australia, women make up 26 per cent of deans and only 5 per cent of heads of surgery at medical schools. At one medical school, she found, only 14 per cent of surgical lectures were delivered by a female in the first two years.
Ms McLain said the research highlighted the importance of visible female role models in surgery, consistent with previous research that has found women students are more likely to choose surgery as a career if they attended a medical school with a higher proportion of women surgeons on faculty.
"You can't underestimate the importance of positive female faculty surgical role models," she said.
"They inspire and recruit female medical students and encourage them to become surgeons.”
Professor Fielding, who is regularly on call for emergencies at Wagga Base Hospital as well as working in her practice, is working to encourage more women into surgery.
She is an associate professor with the University of Notre Dame and a Royal Australasian College of Surgeons councillor who co-ordinates the pre-vocational surgical training for the whole of NSW.
Recently appointed Griffith surgeon Kate FitzGerald would like to see efforts to inspire young women into surgical careers start well before university.
Dr FitzGerald thinks these efforts should start in secondary school.
Originally from Limerick, Dr FitzGerald graduated from the Royal College of Surgeons in Ireland Medical School in Dublin in 2000 and undertook basic surgical training. She later moved to Glasgow, Scotland, to complete higher surgical training.
For the past six years, Dr FitzGerald has worked in Glasgow as a staff surgeon in general and oncoplastic breast surgery. Her subspecialist interest is the management of breast disease and, in particular, people with breast cancer.
During her time in Glasgow, Dr FitzGerald was instrumental in developing new surgical techniques for the management of breast cancer.
Both Dr FitzGerald and Professor Fielding said they have both been fascinated with the idea of medicine – and surgery – since childhood.
Intriguingly, both describe themselves as people who have, since childhood, liked working with their hands.
But, they say, interesting girls in careers as surgeons is just one step.
Both Professor Fielding and Dr FitzGerald say changes also need to be made to accommodate women’s role as mothers, with more flexible work practices.
It could be as simple as providing somewhere appropriate for a mother to express and store breast milk, or the provision of childcare facilities close to the hospital setting and acknowledging a need for maternity leave.
“I left having kids until the very end of my training because I just couldn’t see how it would work. We move from hospital to hospital every year in the UK,” Dr FitzGerald said.
Professor Fielding is a mother of four and Dr FitzGerald has three young children.
But both say some long-held views need to change to encourage more women to succeed in a career which requires years of study and long working hours.
Professor Fielding has had to overcome the view that orthopaedics is the “blokeiest” of specialties because of the physical requirements of the surgical procedures.
But the solution as such, according to Professor Fielding, is remarkably simple: A combination of excellent modern equipment and a good surgical team.
Dr FitzGerald said many of the traditional practices in medicine – including the need for a surgeon to “stay until the bitter end, whether needed or not” were changing as new generations of doctors – regardless of their gender – were training.
“In Glasgow, there were quite a few female consultant surgeons, well established, with at least five years as a consultant and even when I training, close to 50 per cent of the female surgical trainees with me were female, in the west of Scotland,” she said.
“I’ve realised that was very unusual, even in the rest of the UK, and in hindsight it is probably driven by the fact that there were so many consultant female surgeons.”