Where are the female surgeons?

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Eric Garcia

Washington Bureau Chief

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WHEN A woman is diagnosed with breast cancer, she is usually called into a male consultant's office for a painful exposition of her chances of survival. Minutes later, she's back out in the world, bewildered, probably alone, feeling like a death sentence has been passed.

Briony Ackroyd's patients are luckier. "I like to visit them in the comfort of their homes. The news can be such a shock," she says. "It is time-consuming. Some people are outraged that I do it. But I think it is important. I don't know any other surgeon who does it."

That may be because about 95 per cent of breast surgeons are men, no doubt caring, but perhaps not as empathetic. Miss Ackroyd a consultant at Walsgrave hospital in Coventry is one of only about 20 women doing the job in Britain. "In most places in this country," she says, "a woman with breast cancer has no chance of seeing a female consultant, unless she is prepared to go out of area. One of my patients travelled from as far away as Bradford to see me."

These are extraordinary figures, given that for 15 years nearly half of medical graduates have been female. The situation is worst in surgery: just four per cent of consultants are women. But across all disciplines, less than one in five consultants is female.

So, why are they still finding it so hard to get to the top? After all, they succeed well in other parts of the medical profession: more than half of all new GPs are now female. If sexual discrimination really is still rife in hospital medicine, we should all be worried. The best surgeons are drawn from the largest pools. If they are mainly being recruited only from half of all graduates - the men - skill will suffer.

You can see why women are put off. Most people still think you need balls to slice someone open. Of fresh graduates naming surgery as their preferred hospital discipline, less than 20 per cent are women, compared with 75 per cent of those who aim to be gynaecologists. Long hours and the locker -room attitudes put them off.

"Surgery seems to attract a certain macho personality, although it is changing," says Dr Elisabeth Paice, post-graduate dean in the North Thames region. "People still imagine there are a few Sir Lancelot Spratt types.

"Certainly, it is true that some surgeons, who may be terribly effective, are not that sensitive to the human side. The sort of surgeon who will stand at the end of the bed and say: 'Don't worry, I've done it a hundred times before and I'll be very quick.' Women look at surgery and see a whole lot of male role models and think, 'I'm not that sort of person'. They tend to be attracted to the caring side of medicine, so they don't choose surgery."

Another female surgeon, of above average ability, who inexplicably missed out on becoming a consultant, blames sexism. She says: "The view is that any woman who goes into surgery has got to be a tough cookie, a bit odd, and if you do something not quite right you are marked as unsound. Or you are regarded as too nice.

"One consultant said to me, it was good to have me on the team because I was so nice to the relatives. My role was to make the coffee." After one job interview, a male consultant surgeon suggested to her that she "wear a bit of make-up next time".

Recently, Dr Janey Huber, who did her clinical training at Addenbrooke's hospital in Cambridge, spoke about how she returned to work after having children but finally resigned her surgical post. The reason, she said, was that she felt so mistreated by male colleagues.

But a few women do succeed, although there are many obstacles to overcome. Appointed a consultant in 1995, Briony Ackroyd, 48, was the first woman to train successfully under a four-year flexible training scheme for senior registrars in general surgery. The deal had been available since 1979. Eleven women before her had tried and failed to make it work.

"I started in 1990 after my daughter was born. I was on what was called a part-time scheme, even though it actually involved working 72 hours a week. Full-time would have been over 100 hours. It meant that, in the end, it took me four years instead of the usual two years to complete my training."

She nearly did not get that far. "In an earlier job, after two years, there was the usual review to consider whether to renew my contract. Everybody always got through, but I was told that my contract would not be renewed.

"They said they felt that because I was a woman and older than my fellow trainees, I would be unable to achieve a consultancy, so there was no point in finishing the training. I was devastated, pointing out that I had not changed my sex since they first appointed me two years before and I had aged at the expected rate. Eventually, after I confronted them, they changed their minds."

Like many female surgeons, Miss Ackroyd also had trouble with nursing staff. "Many want their surgeons to be male. A particular ward sister had never had a female registrar. She really took against me and started complaining about me. So there had to be an inquiry into my competence. I survived but, once again, it was unpleasant."

These days, the flexible training contract that Miss Ackroyd used is much more commonplace. Dr Paice, at north Thames has struggled hard with strong Government support to meet a 30 per cent annual expansion in demand for several years. But there is still debate, even among top female surgeons, about whether women can really be as good as men, if they take time out for example to have children.

This is an attitude Miss Ackroyd dismisses. "It's a myth. A man will go off and do a research job, perhaps of one or two years, and no one questions whether he can carry on being a surgeon. Women go on maternity leave and they should not find it difficult to regain their skills.

"I could take an appendix out blind-folded because I have been taking them out for 20 years. You might need a week or so to brush up your skills, but men and women who have taken one or two years off should not have problems."

And by the way, Miss Ackroyd may have difficulties staying in a good mood but none keeping a steady hand during PMT.

Miss Ackroyd has finally made it but life is still hard. In the mornings, she has her "quality time" with her nine-year-old daughter: shared breakfast in bed, time when they practice the violin together for their Suzuki lesson and then the journey to school. After that, she might not be back home again until 10pm or 11pm. If her daughter wants to catch her in the evening, she will need to use the mobile phone. Her father, a businessman, is more likely to be at home.

Nevertheless, Miss Ackroyd is optimistic. The time it takes to become a consultant has halved in recent years. She, along with her fellow pioneers are planning to establish a mentoring system for would-be female surgeons. The future, she says, in spite of everything, is bright for women who want to wield the knife. Just don't expect it to be easy.