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Tippabhatla A, Silvestre J, Torres-Izquierdo B, Garvin L, Shea KG, Kelly JD, Hosseinzadeh P. Understanding Financial Relationships Between Orthopedic Surgeons and Industry for Research. Orthopedics 2024; 47:172-178. [PMID: 38147497 DOI: 10.3928/01477447-20231220-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE This study sought to understand trends in industry payments for research awarded to orthopedic surgeons. MATERIALS AND METHODS The Centers for Medicare & Medicaid Services Open Payments database was queried for the years 2016 to 2021 for industry payments for research. Financial analyses were performed to understand temporal trends and differences by orthopedic subspecialty and principal investigator characteristics such as sex. The threshold for statistical significance was set at .05. RESULTS A total of 2014 orthopedic surgeons were identified, among whom 542 adult reconstruction (27%) and 460 sports medicine (23%) surgeons were major beneficiaries. Seventy-one female orthopedic surgeons comprised the minority (4%). Total research payments awarded during the study period aggregated to $266,633,592, with adult reconstruction ($88,819,047; 33%) and sports medicine ($57,949,822; 22%) receiving the highest amounts. Total research payments awarded trended upward yearly except for a decline in 2020 that subsequently rebounded (P<.001). Median annual research payment per orthopedic surgeon was $13,375. Median total industry payments per orthopedic surgeon differed between specialties (P <.001), with the highest amounts for adult reconstruction ($44,063) and sports medicine ($34,567) and the lowest amounts for hand ($12,052) and foot and ankle ($19,233). Median total payments did not differ significantly when stratified by sex (P=.276) and region (P=.906). Specialties in which the respective top three companies offered the majority of the research funding were musculoskeletal oncology (90%), pediatric orthopedics (66%), and shoulder and elbow (64%). CONCLUSION These results can be used as a primer for orthopedic surgeons seeking to leverage industry relationships to fund translational research. [Orthopedics. 2024;47(3):172-178.].
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Miura M, Tanimoto T, Saito H, Yamamoto K, Yamashita E, Ozaki A. Association Between Gender and Payments Received From Pharmaceutical Companies Among Medical Professors and Associate Professors in Japan. Cureus 2024; 16:e58871. [PMID: 38800220 PMCID: PMC11126318 DOI: 10.7759/cureus.58871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction While prior research showed gender gaps in industry payments for medical professionals in the United States, there are limited data in Japan. So, this study seeks to investigate the potential gender gap in the receipt of pharmaceutical companies (PFCs) across all medical fields in Japan. Based on the results of previous studies, we developed a hypothesis that male doctors get more PFC than female doctors. Materials and methods Data from 92 pharmaceutical companies in Japan, covering 2016 to 2019, were analyzed. The analysis was conducted on professors and associate professors at all national and public medical universities in Japan, with gender as a factor variable and payments as an outcome variable, and variables that may have influenced the factor or outcome variables in previous studies, such as specialization, university type, region, rank and years since graduation, as control variables. Payments were converted to US dollars using the December 31, 2021, rate of 115 yen to the dollar for comparison purposes. Results Out of 1,825 subjects, 1,755 were males and 70 females. Males consistently received higher median payments from pharmaceutical companies (PFCs) than females across categories. In particular, among physicians specializing in internal medicine, the median PFC for men was $25 compared to $8 for women. For physicians affiliated with former imperial universities (the seven former imperial universities founded before World War II), the median PFC for men was $32 compared to $5 for women. Multivariate analysis confirmed significantly higher total benefits for males from 2016 to 2019, with the gender gap widening during this period (incidence rate ratio (IRR) for 2016: 0.51, IRR for 2019: 0.44). Conclusions Japanese male professors and associate professors received significantly higher PFCs than their female counterparts, and this gender gap expanded from 2016 to 2019, highlighting persistent gender inequality in the medical field in Japan, similar to trends observed in the United States.
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Affiliation(s)
- Motoi Miura
- Graduate School of Public Health, Teikyo University, Tokyo, JPN
| | - Tetsuya Tanimoto
- Internal Medicine, Navitas Clinic Kawasaki, Kawasaki, JPN
- Health Care, Medical Governance Research Institute, Tokyo, JPN
| | - Hiroaki Saito
- Gastroenterology, Soma Central Hospital, Soma, JPN
- Health Care, Medical Governance Research Institute, Tokyo, JPN
| | - Kana Yamamoto
- Health Care, Medical Governance Research Institute, Tokyo, JPN
- Medicine, Fukushima Medical University, Fukushima, JPN
| | - Erika Yamashita
- Health Care, Medical Governance Research Institute, Tokyo, JPN
| | - Akihiko Ozaki
- Medicine, Fukushima Medical University, Fukushima, JPN
- Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, JPN
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Park YH, O'Rourke P, Gabrielson A, Hogan SO, Holmboe E, Jing Y, Yamazaki K, Trock BJ, Han M. The Association of Subspecialty and Sex with Industry Payments to Internal Medicine Physicians Who Recently Completed Training. J Gen Intern Med 2024; 39:45-51. [PMID: 37550442 PMCID: PMC10817869 DOI: 10.1007/s11606-023-08351-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Financial relationships with drug and medical device companies may impact quality of care and academic research. However, little is known when and how these financial relationships develop among newly independent physicians who recently completed from residency or fellowship programs in internal medicine (IM). OBJECTIVE To compare patterns of industry payments among IM graduates. DESIGN Retrospective, observational cohort study. SUBJECTS IM graduates from residency or fellowship programs between January 2015 and December 2019. MAIN MEASURES We analyzed Open Payments reports made between July 2015 and June 2021 to recent graduates of U.S. Accreditation Council for Graduate Medical Education (ACGME)-accredited residency and fellowship programs in IM. The primary outcome was general payments accepted by these physicians, stratified by procedural (i.e., critical care medicine/pulmonary medicine, cardiac/cardiovascular disease, and gastroenterology) and non-procedural (i.e., infectious disease, general internal medicine, and other specialties) subspecialties. The secondary outcomes included general payments stratified by sex and age at residency or fellowship training completion. KEY RESULTS There were 41,669 IM physicians with a median age of 33.0 years. In the first 3 years after completion, the proportion of physicians accepting any general payments was 72.6%, 91.9%, and 86.8% in Critical Care Medicine/Pulmonary Medicine, Cardiac/Cardiovascular Disease, and Gastroenterology, compared to 56.1%, 52.6%, and 52.3% in Infectious Disease, General Internal Medicine, and Other Specialties (p<0.0001). After adjusting for confounding variables, the procedural group showed an increased hazard ratio (HR) for accepting any general payments and at least $5000 of general payments compared to the non-procedural group. The HRs of accepting any general payments in the procedural subspecialty were 2.26 (95% CI, 2.11-2.42) and 2.83 (95% CI, 2.70-2.97) in female and male physicians, respectively (p-value < 0.0001). CONCLUSION Industry financial relationships among newly independent physicians in IM exist immediately after completion of training and are influenced by subspecialty, sex, and age.
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Affiliation(s)
- Yong Hyun Park
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
| | - Paul O'Rourke
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Andrew Gabrielson
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sean O Hogan
- Accreditation Council for Graduate Medical Education (ACGME), Chicago, IL, USA
| | - Eric Holmboe
- Accreditation Council for Graduate Medical Education (ACGME), Chicago, IL, USA
| | - Yuezhou Jing
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kenji Yamazaki
- Accreditation Council for Graduate Medical Education (ACGME), Chicago, IL, USA
| | - Bruce J Trock
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Misop Han
- James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Watane A, Patel M, Yannuzzi NA, Kombo N, Sridhar J. Trends in Immunosuppressive Agent Use for Non-Infectious Uveitis by US Ophthalmologists in Medicare Beneficiaries and Association with Physician-Industry Interactions. Ocul Immunol Inflamm 2023:1-7. [PMID: 37917798 DOI: 10.1080/09273948.2023.2272171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To report the trends of immunosuppressive drug use for non-infectious uveitis and explore their relationship with industry payments. METHODS A retrospective review of ophthalmologists reimbursed by Medicare for the administration of adalimumab (ADA), repository corticotropin (RCI), methotrexate (MTX), and mycophenolate mofetil (MMF) between 2014 and 2018. RESULTS A total of 316 ophthalmologists were reimbursed by Medicare for 1567 ADA, 465 RCI, 1752 MTX, and 12 333 MMF administrations. The number and dollar amount of industry payments were positively associated with ADA and RCI use (P < 0.001). From 2014 to 2018, there was a positive trend in the proportion of ADA (P = 0.007) and RCI (P = 0.007) used and negative trend in the proportion of MMF (P = 0.025) used. CONCLUSION From 2014 to 2018, the use of ADA and RCI increased while MMF decreased and MTX remained stable. There was a positive association between ADA and RCI use and physician-industry interactions. A causal relationship is not determined.
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Affiliation(s)
- Arjun Watane
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marissa Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ninani Kombo
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, Florida, USA
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Haimowitz S, Veliky J, Forrester LA, Ippolito J, Beebe K, Chu A. Subspecialty Selection Impacts Research Productivity and Faculty Rank of Academic Orthopaedic Surgeons. J Bone Joint Surg Am 2022; 104:e31. [PMID: 34793371 DOI: 10.2106/jbjs.21.00443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Faculty promotion and research productivity are important for the overall career trajectory of academic orthopaedic surgeons. The purpose of this study was to investigate the role that subspecialty and demographic factors play in research productivity and academic advancement among orthopaedic surgeons. METHODS We conducted a retrospective cross-sectional analysis of academic rank among orthopaedic surgeons in 2018. We identified academic orthopaedic programs in the United States from the Fellowship and Residency Electronic Interactive Database (FREIDA) and collected publicly available data for surgeons, including fellowship training, gender, faculty rank, geographic region, and years since residency, from institutional websites. Research productivity was defined with the Hirsch index (h-index) from Scopus, and the m-index was calculated from the surgeon's h-index and the date of the first publication. Multivariate regression analyses were performed to determine the variables that are associated with associate professorship, full professorship, and the h-index. RESULTS In this study, we identified and included 2,879 academic orthopaedic surgeons. Completion of a fellowship in foot and ankle (odds ratio [95% confidence interval]: 2.45 [1.17 to 5.15]), sports medicine (2.15 [1.12 to 4.15]), trauma (2.83 [1.42 to 5.66]), hand and upper extremity (2.20 [1.13 to 4.28]), musculoskeletal oncology (3.28 [1.49 to 7.21]), or upper-extremity reconstruction (3.20 [1.31 to 7.81]) was associated with associate professorship. Completion of a trauma fellowship was associated with full professorship (2.93 [1.27 to 6.77]). Completion of a fellowship in adult reconstruction (difference in least-squares means [95% confidence interval]: 5.01 [1.22 to 8.81]), sports medicine (4.52 [1.00 to 8.04]), spine (5.40 [1.63 to 9.18]), or upper-extremity reconstruction (10.64 [6.15 to 15.12]) or the completion of multiple fellowships (5.12 [1.27 to 8.94]) were independently associated with a higher h-index. Women had significantly lower h-indices than men at the assistant (median [interquartile range]: 3 [1 to 6] versus 4 [2 to 8]) and full professor (17 [12 to 26] versus 22 [13 to 34]) levels. There were no differences in the m-index between men and women at any academic rank. CONCLUSIONS Orthopaedic subspecialty selection is independently associated with research productivity and academic rank. The differences in research productivity may be important to consider when evaluating orthopaedic surgeons for promotion. While female surgeons had lower h-indices than their male counterparts, this difference was not seen when using the m-index.
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Affiliation(s)
- Sean Haimowitz
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jacob Veliky
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Lynn Ann Forrester
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Joseph Ippolito
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Kathleen Beebe
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Alice Chu
- Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey
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Watane A, Kalavar M, Yannuzzi NA, Kuriyan AE, Sridhar J. TRENDS IN INTRAVITREAL CORTICOSTEROID AGENT USE BY US OPHTHALMOLOGISTS IN MEDICARE BENEFICIARIES AND ASSOCIATION WITH PHYSICIAN-INDUSTRY INTERACTIONS. Retina 2021; 41:1754-1761. [PMID: 33315816 PMCID: PMC8190160 DOI: 10.1097/iae.0000000000003081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report trends of intravitreal corticosteroid use and explore the relationship between career experience, reported industry payments, and prescribing habits. METHODS A retrospective review of ophthalmologists who administered intravitreal dexamethasone implants (DEX) and triamcinolone acetonide (TA) injections between August 2013 and December 2017. RESULTS A total of 1,070 US ophthalmologists were reimbursed by Medicare for 522,804 DEX injections and 2.6 million TA injections. There was a significant positive trend in the number of DEX (P = 0.01), but not TA, injections per year. Mid-career and late-career physicians performed significantly greater total injections on average compared with early-career physicians (both P < 0.001). Early-career physicians performed a greater proportion of DEX injections than late-career physicians (P = 0.006). Industry payments were positively associated with the proportion of DEX used and inversely correlated with the proportion of TA administered (P < 0.001). On multivariate analysis, years in practice, number of payments, and total value of payments were significantly associated with the number of DEX injections administered (all P < 0.001). CONCLUSION From 2013 to 2017, the use of DEX increased, whereas TA use remained stable. There was a positive association between DEX use and physician-industry interactions, which may be explained by seniority and experience. This study does not define a causal relationship.
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Affiliation(s)
- Arjun Watane
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine. 900 NW 17 Street. Miami, FL 33136
| | - Meghana Kalavar
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine. 900 NW 17 Street. Miami, FL 33136
| | - Nicolas A. Yannuzzi
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine. 900 NW 17 Street. Miami, FL 33136
| | - Ajay E. Kuriyan
- Mid Atlantic Retina, Retina Service for Wills Eye Hospital, 840 Walnut Street Suite 1020, Philadelphia, PA 19107
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine. 900 NW 17 Street. Miami, FL 33136
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Watane A, Kalavar M, Patel M, Yannuzzi N, Vanner EA, Kuriyan AE, Sridhar J. A 5-Year Analysis of Physician-Industry Interactions, Physician Gender, and Anti-VEGF Use in US Ophthalmologists. Semin Ophthalmol 2021; 36:804-811. [PMID: 34024227 DOI: 10.1080/08820538.2021.1922710] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose: To explore physician gender, industry payments, and prescribing habits of anti-vascular endothelial growth factor (VEGF) agents.Methods: Retrospective review of U.S. ophthalmologists prescribing and receiving industry payments for aflibercept and/or ranibizumab (brand anti-VEGF injections) between August 2013 to December 2017.Results: Men receiving industry payments were older and had longer post-residency experience than women (both P < .001). Men were more likely to receive industry payments (P = .01), receive >5 payments (P = .003), and receive payments totaling >$1000 (P = .008). Men administered more injections on average than women when receiving >3 industry payments (P < .001) or when receiving >$100 (P < .01). On multivariate analysis, years in practice, male gender, number of payments, and total value of payments were independent factors associated with the number of brand injections administered (all P < .001).Conclusions: A positive association between industry payments and brand anti-VEGF use was identified, however, causality was not determined. Gender bias may be present in physician-industry relationships.
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Affiliation(s)
- Arjun Watane
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
| | - Meghana Kalavar
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
| | - Marissa Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
| | - Nicolas Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
| | - Elizabeth A Vanner
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
| | - Ajay E Kuriyan
- Mid Atlantic Retina, Retina Service for Wills Eye Hospital, Philadelphia, PA
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, FL
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Thomas KA, Cabell A, Hu SS. Relationship between industry royalty and licensing payments and patent authorship among orthopedic spine surgeons. Spine J 2021; 21:541-547. [PMID: 33347971 DOI: 10.1016/j.spinee.2020.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/09/2020] [Accepted: 12/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The Physician Payments Sunshine Act requires manufacturers of drugs, medical devices, medical supplies, and biologics to record all financial relationships with physicians in the Open Payments database with the goal of increasing transparency for patients and the general public. The majority of total money going to orthopedic surgeons has been found to go to a small number of surgeons in the form of royalties and licensing payments. This category of payment is intended to compensate physicians for use of their intellectual property. However, little research has been done to investigate the degree to which these physicians own intellectual property. PURPOSE To the authors' knowledge, the association between patents and industry payments to orthopedic surgeons has not been explored. We quantify the association between the patents and academic productivity of orthopedic spine surgeons and the amount of royalty and licensing fees they receive. We then compared this with the associations observed for other categories of payments. STUDY DESIGN Cross-sectional study METHODS: Top royalty and licensing earners, defined as those who collectively earned 50% of all royalty and licensing payments over the period August 2013-December 2018, were identified. The h-index, publication count, and patent count of this group were compared with top earners of other payment categories using the Mann-Whitney U test. The association between (1) earnings and patent counts, (2) earnings and manuscript counts, and (3) earnings and h-index among the top royalty and licensing earners was assessed using Spearman correlation. RESULTS Top royalty and licensing earners had significantly more patents than every comparison group except the top earners of money derived from ownership in a biomedical company. For this one exception, there was a trend toward the top eight royalty and licensing earners having more patents (p=.054). The top royalty and licensing earners had significantly more manuscripts than three of the five comparison groups and significantly higher h-indices than four of the five comparison groups. Among the top royalty and licensing earners, receiving more royalty and licensing payments was associated with holding more patents, but not with publishing more papers or having higher h-indices. CONCLUSIONS There is a strong association between the number of patents authored by individual orthopedic spine surgeons and the amount of royalty and licensing fees they receive from industry. This supports the hypothesis that these payments serve as compensation to inventor-surgeons for their intellectual property. CLINICAL SIGNIFICANCE Our findings provide new, important context for the largest category of industry payments to orthopedic spine surgeons and suggests that physicians' patents should be considered when evaluating financial transactions between industry and physicians.
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Affiliation(s)
- Kevin A Thomas
- Department of Orthopaedic Surgery, Stanford University, 430 Broadway Street, MC: 6342, Pavilion C, 4th Floor, Redwood City, CA 94063-6342; Department of Biomedical Data Science, Stanford University, 1265 Welch Road, Stanford, CA 94305.
| | - Akaila Cabell
- Department of Orthopaedic Surgery, Stanford University, 430 Broadway Street, MC: 6342, Pavilion C, 4th Floor, Redwood City, CA 94063-6342
| | - Serena S Hu
- Department of Orthopaedic Surgery, Stanford University, 430 Broadway Street, MC: 6342, Pavilion C, 4th Floor, Redwood City, CA 94063-6342
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Xepoleas MD, Munabi NCO, Auslander A, Magee WP, Yao CA. The experiences of female surgeons around the world: a scoping review. HUMAN RESOURCES FOR HEALTH 2020; 18:80. [PMID: 33115509 PMCID: PMC7594298 DOI: 10.1186/s12960-020-00526-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/15/2020] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The Lancet Commission for Global Surgery identified an adequate surgical workforce as one indicator of surgical care accessibility. Many countries where women in surgery are underrepresented struggle to meet the recommended 20 surgeons per 100,000 population. We evaluated female surgeons' experiences globally to identify strategies to increase surgical capacity through women. METHODS Three database searches identified original studies examining female surgeon experiences. Countries were grouped using the World Bank income level and Global Gender Gap Index (GGGI). RESULTS Of 12,914 studies meeting search criteria, 139 studies were included and examined populations from 26 countries. Of the accepted studies, 132 (95%) included populations from high-income countries (HICs) and 125 (90%) exclusively examined populations from the upper 50% of GGGI ranked countries. Country income and GGGI ranking did not independently predict gender equity in surgery. Female surgeons in low GGGI HIC (Japan) were limited by familial support, while those in low income, but high GGGI countries (Rwanda) were constrained by cultural attitudes about female education. Across all populations, lack of mentorship was seen as a career barrier. HIC studies demonstrate that establishing a critical mass of women in surgery encourages female students to enter surgery. In HICs, trainee abilities are reported as equal between genders. Yet, HIC women experience discrimination from male co-workers, strain from pregnancy and childcare commitments, and may suffer more negative health consequences. Female surgeon abilities were seen as inferior in lower income countries, but more child rearing support led to fewer women delaying childbearing during training compared to North Americans and Europeans. CONCLUSION The relationship between country income and GGGI is complex and neither independently predict gender equity. Cultural norms between geographic regions influence the variability of female surgeons' experiences. More research is needed in lower income and low GGGI ranked countries to understand female surgeons' experiences and promote gender equity in increasing the number of surgical providers.
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Affiliation(s)
- Meredith D. Xepoleas
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
| | - Naikhoba C. O. Munabi
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, 1510 San Pablo St, Suite 415, Los Angeles, CA USA
| | - Allyn Auslander
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
| | - William P. Magee
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA USA
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, 1510 San Pablo St, Suite 415, Los Angeles, CA USA
- Division of Plastic Surgery, Shriners Hospital for Children, Los Angeles, CA USA
| | - Caroline A. Yao
- Operation Smile Inc, Virginia Beach, Virginia Beach, VA USA
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, 1510 San Pablo St, Suite 415, Los Angeles, CA USA
- Division of Plastic Surgery, Shriners Hospital for Children, Los Angeles, CA USA
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