‘The Unwritten Rules of Being a Woman Surgeon’: Women in Surgery Share Their Experiences with Workplace Conflict

Despite efforts to increase gender diversity in medicine, women remain widely underrepresented in the field—notably in surgery, be it general surgery, where women comprise less than 21% of the field, or in subspecialties, such as orthopedics, where they only make up 5.3% of the field. Recently, women surgeons were interviewed about their experiences with interprofessional conflict. The researchers questioned how this may affect personal, professional, and patient outcomes, as well as potential ways to navigate such conflict. They recruited and recorded interviews with 30 women surgeons aged between 25 and 34 years (27%), 35 and 44 years (53%), 45 and 54 years (17%), and 55 and 64 years (3%). A variety of specialties were represented:
  • Bariatric (3%)
  • Breast (10%)
  • Cardiac (3%)
  • Colorectal (7%)
  • General (33%)
  • Hepatobiliary (3%)
  • Otolaryngology (3%)
  • Pediatric (7%)
  • Plastics (13%)
  • Surgical oncology (3%)
  • Trauma (7%)
  • Urogynecology (3%)
  • Vascular (3%)
The recorded interviews yielded three major themes in terms of circumstances surrounding interprofessional workplace conflict: (1) circumstances of reported conflicts, (2) implications of conflict, and (3) strategies for navigating conflict. Circumstances of Reported Conflicts The four circumstances surrounding the reported conflicts were identified by the study authors as (1) the surgeon’s response to perceived performance-related issues on behalf of the staff member, (2) the interprofessional staff perceiving the women surgeons as unprofessional, (3) breaches of protocols, or (4) a combination of these circumstances. Several surgeons reported that women seemed to have a hard time taking orders from other women, but not from a man. Double standards were also observed—and, in at least one instance, acknowledged: “And then I was stunned at the end of the meeting when he told me he understood that, yes, sometimes men and women who may say the exact same thing in the exact same tone, we may be perceived differently. And I was very happy to hear him acknowledge that. But in the very next breath, he said, ‘Maybe you would like to pursue some coaching to help with the way people perceive you?’” Implications of Conflict The surgeons confirmed that interprofessional workplace conflicts affected personal, professional, and patient outcomes. On a personal level, the ramifications were twofold: emotional and, less often, physical. Implications were described as “really stressful,” “draining,” and “demoralizing.” Several women said their career trajectory suffered, from low satisfaction at work to delayed promotions. Another woman dropped out of a leadership entirely, saying, “I couldn’t advocate for my fellow residents while not seeming overconfident … I avoided any interaction even with my fellow residents and particularly with attendings that [sic] were not necessary.” One surgeon said that she was told in the OR by a nurse to “calm down your hormones” while trying to follow policy. Strategies for Navigating Conflict The surgeons discussed the following ways of navigating conflict: relationship management, rapport building, and building social capital. According to the researchers, their responses “could be collectively considered the unwritten rules of being a woman surgeon.” One of the women said: “I’ve had conversations with my female counterparts, and it’s always the same conversation. If you want something done, bring cookies. If you get mad, don’t show it. If you have conflict, address it head on, apologize. Even if you don’t think you’ve done anything wrong you’re still at fault. It’s just kind of a theme.” Women also described formal and informal support settings, where groups of female surgeons get together and discuss similar experiences as well as share advice on how they’ve managed conflict. The study was published in JAMA Network Open. “Further research to elucidate drivers and outcomes of interprofessional conflict, including the role of gender, is necessary to inform policy and practice. Only by evidence-based intervention can patient care and professional wellness be optimized,” the study authors concluded.