In a field where the patient demographic is dominated by women, why are most plastic surgeons men?

Often when we are young, we are told we can do anything we set our minds to. Our family members and teachers tell us we can be astronauts, business owners, mothers and surgeons. But at what point does that message get lost in translation when young women go out into the world?

Women make up nearly half of medical school graduates. However, according to a 2017 study in Plastic and Reconstructive Surgery – Global Open, they remain underrepresented among surgical residents and surgeons. And with the majority of cosmetic procedures being performed on women (nearly 87 percent of all cosmetic procedures according to the most recent procedural statistics from ASPS), the question remains: Why are there comparatively fewer women than men in a field where the patient demographic is the opposite? What are plastic surgeons doing to address the need for gender parity in their specialty?

"Women and marginalized minorities continue to face inequity with regard to compensation, advancement and opportunities within the field of medicine," said Katerina Gallus, MD, FACS, a board-certified plastic surgeon and former chair of the Women Plastic Surgeons (WPS) Forum. "This continues to bear out in numerous studies that highlight the need for education, transparency and a change in leadership to foster the much-needed parity."

According to a 2022 report from the International Labor Organization on women in the health and care industries, women are discriminated against based on anything from age and race to religion, sexual orientation and more. And during crises like the COVID-19 pandemic, the disparities grew as women were more frequently relegated to the lowest-paying and riskiest job roles.

Unequal pay and having a family may be a deterrent for women in plastic surgery

Women have practiced the art and science of medicine since ancient times. Even before the advent of more modern techniques, they appear throughout history as midwives, medicine makers, healers and more. Though both genders have contributed to medicine, there is one thing cis men in the field will never experience in the same way as their female counterparts: pregnancy. The desire to start or have a family while following your dreams can deter many young women from entering the field of medicine. A report from the American Medical Association showed 90 percent of women physicians reported gender-related bias specific to pregnancy or maternity leave. Further, one-third of female physicians in the same report stated that they faced workplace discrimination "related to their role as a mom."

Years ago, when Ashley Amalfi, MD, was in her residency, she was juggling her plastic surgery training with pregnancy complications. "There was little flexibility in our training model to support my needs," said Amalfi. "I was forced to take a leave of absence – and ultimately, my graduation was extended as I cared for a newborn who required open-heart surgery."

"Many women still postpone starting a family to accommodate the timeline of their training and board examinations," said Amalfi, adding that this reality disproportionately affects women in our specialty. "Women surgeons experience higher levels of pregnancy complications, fertility issues and inability to conceive due to advanced maternal age at rates that are unacceptable when compared to the general population."

While times are changing, Amalfi also said there are new allowances that are much more accommodating for female and male trainees to adapt to the medical needs of themselves or a family member throughout training.

"This is a giant step forward, but there is still much work to be done."

The lack of supportive parental leave policies for surgical residents and practicing surgeons isn't the only barrier women face in the field. Women physicians make $.64 to $.75 for every dollar earned by male doctors in the same roles. From primary care to specialties, a gender pay gap covering a range of 25 percent to 36 percent respectively continues to hinder the earning potential of women physicians comparative to their male colleagues, according to a report from the Harvard Business Review. Complicating the issue of pay disparity further are the different reasons patients consult a female physician versus male, the length of those appointments and the complexities of the care given. While many women and their male allies in medicine believe that the pay gap is meant to be closing, data such as this shows it remains very much intact.

WPS connects women in a field still dominated by men

Plastic surgery aims to revolutionize its practices and protocols, and women in the field are taking a stand to make that happen with concentrated DEI efforts like WPS and more.

"WPS will continue to advocate for the needs of our members until full equality is reached," said Paige Myers, MD. "The sisterhood of WPS is a powerful force[...] WPS provides a valuable network for surgeons to lean on each other through difficult situations while also praising and promoting successes. There are challenges unique to female surgeons, and WPS provides that space for overcoming them together."

Given the significant disparity between men versus women in the field, it's seemingly uncommon to have a female mentor in plastic surgery training, but organizations like WPS make that possible. It provides women with a familiar shoulder to lean on in a field that is dominated by men.

"WPS provides a safe space for women to share, remain vulnerable and build each other up in an effort to accomplish change," said Amalfi. "There is something magical that happens at the WPS meetings. We let our guards down, we tell our stories and we allow ourselves to be vulnerable. In turn, lifelong friendships and mentorships are made, critical networking happens, we influence the women coming into our specialty and leave a lasting legacy in our wake. The WPS meetings and initiatives are integral to the success of diversity in our specialty – and the driving force for change and progress in plastic surgery."

Gallus agreed, stating, "It is well known that participation in a woman-focused professional organization enhances members' career retention and advancement. By creating opportunities to facilitate leadership, research and advancement in our field by those who have previously and continue to face inequity and discrimination, all surgeons will be contributing to the health and growth of plastic surgery as a whole." Indeed, support of both current and future generations of women in the specialty can mitigate physician burnout and foster a culture of equality and inclusion.

Wolters Kluwer notes efforts like WPS speak to a greater sense of ethics and also that "supporting the well-being of women in healthcare with equal pay, opportunities and cultural value is likely to improve job satisfaction, performance and retention."

This recognition, supported by the efforts of many women surgeons and allies, are indicators of a more promising future for the generations of women in plastic surgery. While the work is not yet done, the promise of more women entering into and being supported throughout their careers in medicine (like the 12 out of 13 Stanford residents making news in recent weeks) is becoming greater every day.

To find a qualified plastic surgeon for any cosmetic or reconstructive procedure, consult a member of the American Society of Plastic Surgeons. All ASPS members are board certified by the American Board of Plastic Surgery, have completed an accredited plastic surgery training program, practice in accredited facilities and follow strict standards of safety and ethics. Find an ASPS member in your area.