This article appears as part of the Inside the NHS newsletter.
If the television industry is about to undergo its 'MeToo' moment in the wake of the Russell Brand allegations, then another area where it is long overdue is surgery in the NHS.
A report published in the British Journal of Surgery (BJS) on September 12 highlighted widespread experiences of sexual harassment in the workplace toward female surgeons, extending as far as assault and even rape in some cases.
What were the findings?
The research was based on an online survey carried out between September and December 2022. It was circulated to doctors across the UK working at all grades – from trainee to consultant – in various surgical specialties.
A total of 1,434 respondents provided enough feedback for an "unweighted" analysis. This included medics working in Scotland. A "weighted" picture – adjusting for male/female representation in the workforce to illustrate the scale of sexual misconduct most accurately – focused on 756 surgeons employed within NHS England only.
Based on the weighted results, 71.3% of female surgeons had personally experienced sexual harassment from a colleague at some point in the previous five years compared to 29% of males. One in three (34%) had been the target of a sexual assault versus 10.3% of male surgeons, and 1.4% had been raped by a colleague – something no male respondent to the survey reported.
In the context of the survey, sexual harassment ranged from being exposed in the workplace to sexualised pictures or jokes – the most common complaints – to being asked out on a date by a colleague having previously refused. According to the unweighted analysis from all 1,434 respondents, 5% of female surgeons had been "offered career opportunities for sex" compared to 0.7% of male surgeons.
In the sexual assault category, 5.4% of women in the unweighted analysis said a colleague had groped their breasts or genitals compared to 0.6% of males.
Female surgeons were also much more likely to have witnessed sexual misconduct at work.
Researchers said it was clear from the responses that "women and men in the surgical workforce are living different realities".
Where female surgeons reported having been raped by a colleague, this was twice as likely to have occurred in settings such as after-work parties, nights out, or conferences when "boundaries may be more easily transgressed by a perpetrator".
The study notes that both male and female surgeons described "banter cultures" in their workforce, but the researchers caution that rather than being "innocuous" these types of jokes provide perpetrators of sexual misconduct to "test the boundaries of their activities" which over time "can become bolder, increasing the risks they pose to staff members and patients in their care".
Yet the normalisation of this kind of innuendo, they added, means that for young surgeons coming into the profession "an implicit aspect of becoming part of surgical culture is to not draw attention to sexual misconduct".
Male dominant culture
Since 1996, females have outnumbered males in UK medical schools and there are now more women in higher surgical training than at any point previously, but the gender imbalance endures.
Across all grades, women account for fewer than one in three (28%) surgeons. At a consultant level the disparity is even more stark.
A detailed workforce breakdown for NHS Scotland shows that, as of March 2019, there were 735 consultant surgeons by headcount – but just 109 (15%) were female.
Narrowed down by specialty, women made up nearly a third (29.1%) of the paediatric surgery workforce in Scotland, but as little as 6.5% and 10.5% of those working in oral & maxillofacial and trauma & orthopaedic surgery respectively.
Read more:
- Inside the NHS | Brain drain: Staff retention and the NHS
- More than half of female surgeons encountering sexism in the workplace
- Exclusive: Argyll sex health medic Christopher Valentine investigated
- BMA Scotland's Lailah Peel on sexism in the NHS
Progress has been made, however. Back in 1993, just 1% of general surgeons in Scotland were female; now the figure is more than 18%.
Previous research has pointed to "inflexibility in surgery and surgical training" for deterring female recruits who want to take maternity leave or work part-time while children are young.
A lack of female role models has also been blamed. A poll in 2019 also found that more than half of female surgeons in the UK had witnessed or encountered sexist discrimination.
If an example were needed, take a 71-year-old retired anaesthetist Peter Hilton who responded to the BJS research by telling female doctors to "toughen up" in a letter printed in a national newspaper.
Elaborating on his point, Dr Hilton added: "If these girls want to be a surgeon, they are going to have to deal with much more difficult things than another surgeon saying something inappropriate."
Or, as Professor Rosalind Searle – a Glasgow University academic and co-author on the BJS study – put it: “Ultimately, you can choose to either be part of the solution – or be part of the problem.”
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