Excuse me Doctor, are you my surgeon?

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Australia ended 2019 with the news that it had continued its almost uninterrupted backwards slide in the World Economic Forum’s Global Gender Gap Report, slipping to #44 out of 153 countries. In 2006, Australia sat at #15. Gaps in political participation and economic empowerment, in particular, are fuelling the downward trajectory[1].

Sure, we’ve come a long way since the 1500’s. But even against the harrowing backdrop of surgery before anaesthesia, we still have much to do in how we level workplace equality…

If you need to have surgery, who would you rather see? The ‘Doctor’ or the ‘Mister’ or the ‘Miss’?

Dating back to the 16th century, referring to surgeons as ‘Mister’ came about when the Company of Barbers united with the various guilds of surgeons. Unlike physicians, who were ‘gentlemen’ with a university education, surgeons had few, if any, formal qualifications and therefore not eligible to be called ‘Doctor’.

When the Royal College of Surgeons of London was established in 1800, the title ‘Mister’ was retained and it remains in use with male surgeons titled ‘Mr’ and women entitled to use the title ‘Ms’, ‘Mrs’ or more commonly ‘Miss’; a tradition that has persisted in varying degrees across Australia and New Zealand.

Currently, just under 12% of surgeons, across all speciality groups, in Australia and New Zealand are women. The majority (>86%) of female surgeons use the term ‘Doctor’ but the use of the title ‘Mister’ is used by many of their male colleagues and continues to rise, predominantly amongst younger cohorts, and within particular geographic jurisdictions.

There have been calls for this historically archaic practice, which arguably constitutes a form of ‘inverted snobbery’, to be phased out[2],[3].Yet, despite its incongruity, the tradition persists.

In all other walks of life, gender neutral words have replaced masculine and feminine job titles. This not only limits discrimination but encourages those with suitable qualifications, rather than gender attributes, to pursue a career path or apply for a role.

The Australian police forces (Commonwealth and State) and Australian Defence Force, which now has opened all roles, including combat roles, to women no longer use gendered titles or gender identification systems. Presumptions of gender have been removed from the term ‘nurse’, ‘engineer’, ‘pilot’ and ‘paramedic.’

Within the Australian business community, the use of the term ‘Chair’ or ‘Chairperson’ is common, although the Latin derivation, from ‘manus’ referring to the role of ‘guiding hand’, is arguably not gender based.

So why is it that surgery is the only profession that continues to use gendered titles? Particularly as the practice is confusing for patients, referrers and the community and risks an impression that the female surgeon’s qualifications differ from those of her male colleagues? 

Traditions are important. But as we strive towards greater equity and inclusion, not just in medicine, but in society, we must be willing to reassess whether certain traditions bind only to the past, rather than providing a bridge to the future. And if traditions are to the detriment of one or other gender, they should cease to be traditions and be ruled unlawful.

Against this setting, and despite significant progress, barriers to women in the medical professions still exist. In March 2020, the Australian Medical Association (AMA) called on governments, medical administrators, medical schools, colleges and the profession to take urgent action to address barriers to gender equity in medicine.

Female doctors still earn, on average, 25 per cent less than their male counterparts, across all specialities and wage groups[4]. Women in health care are under-represented in leadership positions. In 2019, fewer than one in three medical college deans and government chief medical officers, and just over one in ten CEOs in large hospitals were female. Astonishingly, not only do general practice trainees take a significant cut in pay when they leave the public hospital system, they lose accrued entitlements such as parental and carer’s leave, making it much more difficult to juggle work and family.[5]

Some may argue that a change away from gendered titles in surgery is unlikely to have significant impact. But in a world defined by symbols, branding and language, words have power. A non-gendered approach to surgeons’ titles would send a powerful message of inclusion. It would be more than symbolic. It would be an act of leadership.

Australia has historically been a leader in gender equality, beginning with South Australia legislating women’s suffrage in 1894. There is an opportunity for SA to lead again and drive for the abolition of gendered terms within our health care system. Whilst the Royal Australasian College of Surgeons has the ability to encourage universal use of the gender neutral term ‘Doctor’ for all surgeons, regardless of geography or discipline, it is the leadership within the hospital system that can lever that change. It is not complicated to no longer use gendered titles (Mr/Miss/Ms/Mrs) for surgeons in correspondence, notice boards and name tags. It is not complicated to issue all contracts to surgeons as ‘Doctor.’

And for a new generation, “Excuse me Doctor, are you my surgeon?” – becomes a question of innocence, not bias.

Guest Blog by Susan Neuhaus and Claire Parkinson

[1] Sydney Morning Herald,Jan 30, 2020. Kristine Ziwica, ‘It's a matter of holding ground': where to for gender equality in 2020

[2] Neuhaus SJ. The Ties that Bind: What’s in a Title? ANZ J Surg 88 (2018) 136-139

[3] Truskett P. What’s in a title: does it really matter? ANZ J Surg 88 (2018) 126

[4] Research by Medicine in Australia: Balancing Employment and Life [MABEL] Available at: https://melbourneinstitute.unimelb.edu.au/mabel/home

[5] The 2019 AMA Gender Equity Summit Report available at: https://ama.com.au/media/action-needed-achieve-gender-equity-medical-leadership-and-medical-profession

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