Australasian College of Podiatric Surgeons

Women in surgery: the story so far

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15 min. reading time

Leah Cook graduated from QUT with a Bachelor of Applied Science (Podiatry) with Distinction in 1995. Following graduation, Leah moved into private practice in Tasmania. In 1996 Leah moved to Northern NSW where she established the first of her clinics, Rightfoot Podiatry.

Simon Smith is a podiatric surgeon and fellow of the Australasian College of Podiatric Surgeons (ACPS). He is an endorsed prescriber and mentor for scheduled medicines endorsement. Simon is also chair of the Selection Committee for the ACPS and sits on the college council. He has published scientific and surgical technique papers in international podiatric and foot and ankle surgery journals and has frequently presented to his peers over zoom, and at state and national conferences. Simon is dedicated to student and peer education. Simon’s major interests are in surgical reconstruction of forefoot pathology. Simon practices in Melbourne and Geelong, Victoria.

Emilia graduated from QUT in 2002 with a Bachelor of Health Science (Podiatry) and commenced her working life in the private sector. In 2009 Emilia started her own private practice and also accepted a part-time role working in the public sector as a Senior podiatrist in the area of high-risk foot management.

The Royal College of Surgeons and Royal Australasian College of Surgeons have created a mentoring program as part of a Women in Surgery initiative. The ACPS is also set to formalise a broader initiative to attract more women to podiatric surgery. To understand why this issue is so very important today…

“Through the middle ages and the Victorian era, women were banned from the study of medicine and surgery.”

Above - Figure 1. Ms Emilia Bran Hernandez (centre) assists podiatric surgeon and fellow of the ACPS, Dr Leah Cook (left)

Throughout history, women have been engaged in surgical practice. The earliest record of a woman involved in surgery dates back 5000 years, where Queen Shubad of Ur was buried with her surgical instruments so that she would go on and continue surgical practice in the afterlife. However, through the middle ages and the Victorian era, women were banned from the study of medicine and surgery.

Women banned from surgery

Social attitudes towards women as the inferior gender and unable to perform surgery persisted until the early twentieth century. In fact, during this time women were known to dress up as men in order to practice surgery. A notable case of this was Dr James Barry, a distinguished military surgeon, who performed one of the first successful caesarean sections. Dr Barry was found to be a woman only after her death in 1865.

Misconceptions that continue until challenged

Only forty years ago, a perception still persisted amongst some patients that women were unable to perform surgery. For example, early in the career of podiatric surgeon Dr Lee Gray, she recalls an elderly female patient challenging her abilities.

When discussing the details of the planned surgical correction, which involved the insertion of a screw into the first metatarsal, Dr Gray recalls the patient exclaimed, “My dear! But you are only a female, surely that is a man’s job to be dealing with screws…”

That comment was quite impactful on Dr Gray, and while she felt that being a young female surgeon in the 1980s was “awkward and scary at times”, these experiences only made her more determined to be a leader in the profession – something which she has indeed gone on to become. Dr Gray holds positions on the Australasian College of Podiatric Surgeons (ACPS) Training and Selection committees and is a busy podiatric surgeon, a mentor, a teaching fellow, and a past college council member.

Where we are at today

Women now make up more than 50% of all medical residents. However, this increased proportion of women in medicine is not reflected in the proportion of women in surgery, where women make up less than one third of surgeons around the world.

A similar trend is also observed in the proportion of women in podiatric surgery in Australia. According to the most recent statistics reported by the Podiatry Board of Australia, women comprise 59.3% of all registered general podiatrists but represent only 25% of registered specialist podiatric surgeons.

Despite this, women have played an integral, even foundational, role in podiatric surgery in Australia.

Doctors Valerie Dobie and Pauline Barry were part of the original trailblazing fellows of the Australian College of Surgical Podiatrists that formed in 1978 (and would go onto become the ACPS). Through the decades, women have continued to forge a career in podiatric surgery in Australia. Drs Lee Gray, Elizabeth Jordan and Jenny Bryant joined the college in the mid 1980s and Drs Julie Taranto and Leah Cook in the early 2000s. More recently, Dr Maree Marks, Mina Azarian and Hannah Chun have gone on to become registered podiatric surgeons in Australia.

Yet the question remains – why are women under-represented in podiatric surgical practice?

"Social attitudes towards women as the inferior gender and unable to perform surgery persisted until the early twentieth century. In fact, during this time women were known to dress up as men in order to practice surgery."

(Above) Figure 2. Podiatric surgeon and fellow of the ACPS, Dr Lee Gray (right) performing foot surgery.

The current challenges

Several barriers are reported in influencing a woman's participation in surgical practice; including recruitment, career development and impact on life. Research has identified a key challenge is the relatively poor exposure to surgery at an undergraduate level and minimal representation or visibility of women surgeons.

Possible solutions

What is the solution? One suggestion is for a more widespread positive mentorship experience for undergraduate students and practicing general podiatrists. If this were facilitated by women podiatric surgeons, it might help overcome the low number of women seeking a career in podiatric surgery.

In fact, in the broader context of all surgical sub-specialties, mentoring of surgical registrars and young female surgeons by female – and male – surgeons has been proposed to help facilitate a more positive environment, create leadership roles and demystify other barriers, such as the so called “boys club” reputation.

Putting it into context

Emilia Bran Hernandez is a female surgical registrar with the ACPS and she shares her experiences on this issue.

Applying for the surgical training program was a decision that she did not make overnight. In considering a career in surgery, Ms Bran Hernandez sought advice and mentorship from podiatric surgeon Dr Leah Cook who is also a teaching fellow and sits on the ACPS council.

“I have a great mentor in Dr Cook, and having that level of support and such a strong role model made the decision to apply to the podiatric surgical training program much easier,” Ms Bran Hernandez says. “I feel very fortunate to have entered the program, and I have the full support of the college.”

Dr Cook is often asked by aspiring women podiatric surgeons how she ended up in surgery, particularly as there are not as many female podiatric surgeons in Australia. She says it also came down to well-timed mentorship which inspired her onwards.

In fact, while undertaking her undergraduate studies, Dr Cook recounts the good fortune of having early mentorship from podiatric surgeon Dr Phil Perlman, with whom she ended up spending many hours observing foot surgery. She was impressed by what surgery could achieve for patients and how surgery could restore function and improve quality of life. Through the mentoring of Dr Perlman and early exposure to foot and ankle surgery, Dr Cook developed a desire to pursue a career in surgery.

During her surgical fellowship training, both in Australia and within training programs in the United Kingdom and United States, Dr Cook did note that most of the surgeons and registrars she trained with were male. However, rather than be discouraged by the lack of women in surgery, her determination to succeed became stronger.

Dr Cook says that she overcame many challenges pursuing a career in podiatric surgery, but at no point in time did she see her gender as an impediment and she was never discouraged from pursuing this path to the operating theatre. She credits the flexibility of the ACPS training program and fraternal support of college members throughout her studies in enabling her to flourish as a successful podiatric surgeon.

"women now make up more than 50% of all medical residents. However, this increased proportion of women in medicine is not reflected in the proportion of women in surgery, where women make up less than one third of surgeons around the world . . . A similar trend is also observed in the proportion of women in podiatric surgery in Australia."

(Above) Figure 3. Podiatric surgeon and fellow of the ACPS, Dr Valerie Dobie, at the inaugural Australasian College of Surgical Podiatrists seminar in 1990. Dr Dobie is one of the original fellows of the ACPS and currently sits on the ACPS Clinical Audit Committee.

A global perspective

Around the world, more flexibility in surgical training programs has been proposed to facilitate more women entering the surgical field. Not surprisingly, the overlap of surgical training and child bearing years have been identified as a barrier to women seeking a career in surgery and one that requires accommodation. Previous studies have shown that women in surgical residencies felt that marriage and pregnancy had the perception of being a burden to a successful career in surgery and these perceptions can discourage women seeking a career in surgery, where it would also seem impossible to balance training with starting, or raising, a family.

This is despite the fact that there is no evidence to suggest that starting a family detracts from surgical training performance. Notwithstanding, surgical programs need to recognise that women identify the value of quality of life with work-life balance and that starting a family is equally a priority as beginning surgical training.

The impact of the childbearing and career years

The impact of surgical training on family life – and family life on surgical training – was a concern of Bran Hernandez, who has two young children.

“I have great family support, which helps”, she notes. “However, the early mentorship from Dr Cook and seeing how a woman can be a mother, run a busy podiatry practice and become a successful podiatric surgeon was a real motivator. It can be done. And I am doing it.”

Two years on, she continues her pathway into surgery part time and actively encourages women to consider the surgical pathway. Like Dr Cook, she also highlights the flexibility of the ACPS training program and educational support from the college which enables her to continue her surgical training while working and enjoying her family life.

What the ACPS is doing

The ACPS is working toward finalising its own formal initiative for women in surgery and seeks to promote role modelling, refining flexible training models, advocacy and leadership for female surgeons. The college actively encourages female podiatric surgeons to seek leadership roles, like Drs Lee Gray and Leah Cook, on its boards and committees and will continue to boast female podiatric surgeons in positions on council, selection, training and education boards and committees.

The ACPS supports the commitment to expanding the number of women in podiatric surgical training and, like other surgical colleges and training bodies around the world, seeks to ensure that the training program does not disadvantage surgical training for women.

The college is actively pursuing female podiatrists to consider the ACPS training program and improve the ratio of female to male podiatric surgeons. Dr Cook and Bran Hernandez cite the part-time flexible training capacities that the ACPS offers as a key factor in their surgical training. The ACPS recognises the specific need to consider flexible training models for women in podiatric surgery as it relates to work and home life demands. It is committed to continuing to effectively engage in dialogue with regional training positions to ensure the availability and promotion of flexible training for all registrars and specifically for women in training.

More on the training program

The objective of the ACPS Training Program is to produce a skilled and highly competent podiatric surgeon. With approximately 60% of the podiatry profession being women and yet only representing 25% of podiatric surgeons; there is the potential that women podiatrists with the abilities, qualifications, experience and emotional intelligence to become a successful podiatric surgeon are being missed.

There is a great opportunity for the profession to increase the number of women entering the podiatric surgery field and the ACPS encourages women podiatrists with an interest in pursuing a career in podiatric surgery to contact the college office.

The authors would like to thank Dr Lee Gray for her input into this article.