Why did you choose to become a surgeon?
Tseten: Surgery was my only choice. I have never wanted to be anyone else. I have always loved the creative aspect of surgery. I have admired how one can neatly remove an ailing and failing organ (or a part of it) and reconstruct it as needed. I have always been mesmerised by how the knowledge of the anatomy and physiology of the human body has allowed us surgeons to think about it to improve health and prolong life. With advancing technology, surgeons have developed the ability to improve our precision like never before. The results are far better. With good use of AI, there is much more to look forward to in surgery. With all this fascination, why wouldn’t I become a surgeon?
Banira: The surgical field is very demanding, and the work is never boring with its challenges. It prepares you to perform well under pressure. Since my surgical posting at medical school, I could sense my growing enthusiasm for surgery, following which I proceeded with six months of internship in surgery at a very high-volume centre at Lahore Hospital. I was so intrigued by the work done by the surgical team and the thrill of performing complicated procedures to help patients and make rapid and life-changing differences in patients’ lives. This had a lasting impression on me and I was drawn to the field of surgery.
Sarina: I do not have any inspiring story about why I wanted to become an ENT surgeon. During my medical practice, I deliberately chose to become a facial plastic surgeon as it is quite appealing to me. Rhinoplasty and facial aesthetic surgery are an emerging field and are becoming widely popular. I also have a personal interest in this field and it has helped me become more innovative and has kept me on my toes.
Nisha: I have always aspired to be a surgeon. This skill has always been one of my favourites; the intricacies and the delicate hand required in this field are some things I have always strived to achieve.
Upama: Since my childhood, I wanted to be a doctor and surprisingly longed to become a cardiac surgeon. My parents tried to talk to me out of it at first but I was adamant about being a doctor. Later during my MBBS days, I got a glimpse of working in an operating theatre. As I got exposed to various other departments during my undergraduate training days, the choice of specialisation solidified even more.
Tulika: I choose to become a surgeon because surgery poses intellectual challenges and it has quick results. You see someone improved almost immediately which is very satisfying. Surgery is the driving force in my life.
The world was going to see me for my skills and not my gender. I was going to give the world a happy surprise.
Dr Tseten Yonjen Tamang
Consultant Liver, Pancreas & Biliary System Surgeon
Surgery has been a male-dominated profession for a long, what holds women back from pursuing this career? What are the prejudices against women wanting to become specialised surgeons?
Tseten: We are all a part of the society. What society thinks and advocates influences naive minds deterring them from surgery. Besides working with prejudiced men isn’t easy, let alone venturing into what has predominantly been their job. Eventually, what seems to deter youngsters these days is the long and odd working hours which sometimes collide with the unduly pressure of bearing and rearing children and family on the girls. Truthfully, there isn’t a successful career that does not demand every ounce of your life. Passion for the work drives you through the hard times.
Banira: The foremost reason that holds women back is our general thinking that surgery is ‘MEN ONLY ZONE’. Surgical training is not just a physically demanding speciality, but mentally draining and challenging too. This holds for both men and women, but the immense pressure of getting married, starting a family, and also pursuing a carrer in surgery at the same time with added responsibility and commitment makes it difficult for work-life balance. It is further strained by unsupportive workplace or family members. Even my parents were insecure about my decision to be a surgeon but I was immovable, that nothing could hold me back.
Sarina: It is a well-known fact that a male-centric culture has been prevailing in our society for a long time. But, of late, I do think that women are becoming more involved in their professional lives, as even males nowadays tend to lend a helping hand in household chores (I hope!). It is still challenging for females to attain recognition due to the under representation of women in leadership positions.
Gender bias and stereotyping among both medical practitioners and patients, assuming women to be the “weaker” gender, physically and emotionally, and fulfilling family responsibilities are some factors that hold women back from pursuing their dreams or training further.
Nisha: In Nepal, the perception that surgery is a male-dominated field has discouraged many women from perusing this career. Traditional gender roles often dictate. Still, there are doubts regarding their ability to handle the physical and emotional demands of the profession as well as concern about their dedication and commitment compared to their male counterparts. Overcoming these prejudices requires challenging traditional norms, providing a support system to aspiring female surgeons, and promoting gender equality in the medical field.
Upama: Relatively speaking, women medical students often face disinterest in pursuing surgical careers. Also, this career choice needs rigorous training and a significant amount of time but as a female, there is a social pressure of maintaining a balance between family and her career. Another reason is the patriarchal system in the surgical field. The lack of trust from the general public that a woman can also become a good surgeon can be another factor.
Tulika: The prejudices often arise from outdated gender stereotypes and biases. Some people, even male and female seniors or colleagues feel surgery is physically demanding or they may question a female’s ability to balance a demanding career with family plus it’s the general male mechanism in our subcontinent where males in general are considered as superior race and hence men and women tend to trust men more than women with critical and sensitive issues which are all so wrong.
A recent global report stated that patients operated by female surgeons recover faster? Do women make safer surgeons?
Tseten: I think an excellent surgeon loves the art and is dedicated to the discipline. An astounding safe surgeon is one who seeks to heal the patient rather than just do an excellent technical job in surgery. Healing could be related to patient hearing, long discussions, and counselling with the patient and his/her loved ones. I believe these characters build a safe surgeon. Inherently, women surgeons are all of this. Probably this is reflected in the results. Furthermore, the need for women surgeons to prove oneself repeatedly at every ground forces us to keep updated and upgraded at all times.
Banira: It’s like “The Tortoise and the Hare” story where slow and steady wins the race as doing something passionately becomes your strength. Besides I don’t believe gender plays a role in becoming a safer surgeon. Whether male or female, it’s your dedication, perseverance, better communication, understanding, decision-making, surgical skills, and confidence that makes you a safe surgeon.
Sarina: I am not aware of such a study, but I am not surprised to hear that either. I don’t think us being safer surgeons would be the best way to put it. I assume it is the TLC (tender loving care) and the compassion that we females tend to put into our work that yields the results. Everyone appreciates a soothing touch and affection during their treatment and recovery, and women are more involved in the caring culture even in day-to-day settings.
Nisha: That’s an interesting new thing to know. It’s observed that females, whichever field they are in or whatever task they are carrying out, often do it diligently. They put their mind and heart to it, and the same principle may apply to surgeons. This may bring out the difference. Female surgeons bring a similar level of diligence and precision to their practice, potentially resulting in better outcomes for the patients.
Upama: Great but in my opinion, this is a skill-based field so the speed of patient recovery is not affected by the gender of the surgeon involved. However, it is said that women are more caring than men, so it might be true. You need to ask my patients.
Tulika: I have no doubt whatsoever that women are more alert, sensitive, and gentle when it comes to surgeries. They have also been research claiming women surgeons have better surgical outcomes and fewer complications.
We, the female surgeons of Nepal, have created a common platform (Women in Surgery – Nepal) where we discuss our issues, celebrate our success, and motivate each other.
Dr Banira Karki
Consultant Breast Onco Surgeon and First Female Breast Cancer Surgeon of Nepal
A lot of highly professional surgeons talk about patients treating them differently or not taking them seriously, often to the point of mistaking them for nurses or interns. Have you faced this? How do you view this discrimination and react to it?
Tseten: Oh yes! Multiple times. Not limited to just patients but by other medical colleagues too. In my initial days, it hurt my feelings. Nurses are respectable medical professionals too. But, the title of a doctor had been achieved with much hard work often adorned with medals and certificates of excellence. It felt like the non-recognition belittled the work. It belittled me. Men with white coats, albeit without a medical degree were given the undue respect we longed for. I often reacted to them, sometimes politely and sometimes not. Soon, I realised my response was only regarded as arrogant and disrespectful. Then, the remarks generated no response from me. The world was going to see me for my skills and not my gender. I was going to give the world a happy surprise. Luckily, days have changed for me. Though finding a lady in the chair of a surgeon still startles some, I am recognised for who I am today. Additionally, my gender-neutral name does confuse people as to which gender to expect on the chair too. So, I happily amaze them from my chair.
Banira: Yes, in fact, every female doctor worldwide must have come across this situation where they are addressed as nurses at one point in life and being treated differently. It always got on my nerves whenever I came across this situation and once I was so furious with one of the senior anaesthesiologists for the same that once the surgery was over, I confronted him saying “if educated people like you behave this way then what would we expect from the rest”. He was sorry about it but yes, people need to change their mindset. Nowadays I don’t bother or react much, rather I teach them to address as doctors as I feel it’s due to a lack of education and awareness.
Sarina: I am not surprised. I am sure all female doctors have been called or regarded as a nurse/ sister, or being told that we look too young to be a surgeon. I do not mind being called a nurse, giving them (the patients) the benefit of the doubt, and assuming that they have made a genuine mistake. But some patients tend to be rather dubious even after being told that we are their surgeons. Maybe it is the perceived lack of commitment that patients deduce female surgeons have due to family responsibilities, or just plain gender bias. Here’s an example. I have had clients come to me for consultation for surgery but decide to get their surgery done by male surgeons instead. Then again, I get called by those male surgeons for the required surgeries. It sounds twisted and hilarious, but that is what it is.
Nisha: It’s very common in Nepal for a female doctor to be addressed as a nurse due to prevailing gender norms and I have encountered patients and their relatives making this assumption a lot. This reflects the outdated stereotypes about women in medicine. In response, I assert my expertise and professional identity as a doctor/surgeon.
Upama: Yes, of course. I think almost everybody in this part of the world has faced this problem of mistaken identity. At first, I used to get angry after all I had become a doctor with so much hard work just like men, and talking about the opposite sex they are called doctors even if they are not one. Now, as I have become mature enough and understand that it is not their fault. It does not matter what I am being called as long as I don’t forget who I am.
Tulika: Yes. I have faced it in the past and still face it day in and day out. There have been patients who are referred to me by colleagues because of my speciality in head and neck oncology and still choose to go get operated on by male colleagues who are not trained at all. This is sad but female surgeons face this all over the world. Gender biases macroaggressions in the form of subtle but harmful comments. Lack of mentorship and networking opportunities pay in equity.
The question of career-life balance is often posed to women professionals only, does this offend you? What are your thoughts?
Tseten: Career-life balance is a real struggle for us. This discussion must be had. It must ease now. Our career and the responsibilities of a family seem to follow a similar trajectory. It peaks and dips at similar times. Both deserve and demand our undivided mental, emotional, and financial focus and effort. However, times spent learning surgery (or any other skill set) do deviate us from preparing much to raise a family. Women in a profession are as naive to career-life balance as their spouses. Nevertheless, the responsibility to raise children and family is lopsided on us, creating an imbalance. Guilt becomes a significant company. Guilt from stealing away some time from the family for the profession and vice versa. Many times, society seems to impose the feeling that the freedom to work has been granted and the achievements have been allowed rather than earned together with much diligence. Understanding and support from family is crucial to creating some sort of balance.
More opportunities should be created, equality based on skill should be established, and pay discrimination should be discouraged.”
Dr Upama Sharma
Neurosurgeon
Banira: Not at all, I would rather take it as a compliment and in fact this is an art, a quality of multi-tasking which women probably inherits. Having said so, at times it can be an overwhelming experience which has to be steered through patiently. “Support”, be it at workplace or at home is very essential. Finally, “Ask for help”, one cannot do everything by themselves, and you don’t have to, either. Asking for help might feel uncomfortable to many but talking to your closed ones will make you feel supported and improve your resilience.
Sarina: Is it true that women face more issues with career-life balance? Yes. Does the question offend me? Not really. People asking me this question amuses me. It’s a way of them expressing that we’ve figured out a way to balance and harmonise family, life and work. If married, we also learn to include our significant others in this harmony. If this question bothers anyone, the best way to escape it is by not making a big deal out of it.
Nisha: The question regarding career-life balance being directed solely at female professionals can be frustrating sometimes. It’s a universal concern, for all professionals, regardless of gender. Singling out women implies that they must navigate this balance differently or prioritise family over career.
Upama: Not at all, to be honest sometimes. However, it is only possible for us women to create a human life which tops everything else for me. So, balance is needed after all family is also important as they are your support system. It’s difficult for an individual to persist without emotional support and that goes for the gentlemen too. If women are given freedom from society, I think they don’t mind balancing career and life.
Tulika: Well, I think females are naturally wired in a way where we do things like, cooking, cleaning, and caring better but that does not mean that we are the only ones responsible. So yes, it does offend me when only I am expected to balance things but luckily, I have a very supportive family to help me with that.
What can be done to empower women in medicine?
Tseten: I think we are witnessing an evolutionary change in the number of female recruits in the medical field. The number of female surgeons is increasing dramatically. This, I think is the result of our seniors (medical and non-medical) who have paved the path for us. Their work and results have established the excellence one can expect from our work. Thus, there are ideals and idols for our young girls to look up to. Young girls can certainly aspire to become what they desire to irrespective of the beliefs and expectations of society.
Banira: Supporting work-life balance by both family and workplace, acknowledging the obstacles should be prioritised. Furthermore, giving respect, and equal opportunities and promoting leadership would help empower woman
Sarina: Women supporting and encouraging other women.
Nisha: Increasing representation in leadership roles, providing mentorship and support networks, addressing gender bias in hiring and promotion, and challenging stereotypes and cultural norms can be some of the steps in achieving this goal. Long and tough way to go.
Upama: First of all, they should not think any less of themselves. Secondly, women already in higher positions should encourage and make policies for gender equality in the workplace.
Tulika: Empowerment is a multifaceted approach but should always start at home. A supportive partner, family, and society is the first step towards empowering women in medicine. Apart from these, equal opportunities, pay parity, recognition, and working as a team with us rather than working against us.
Is there a disparity for women in surgical leadership?
Tseten: Yes. There are only a few women surgeons in surgical leadership. Few female surgeons compared to their male counterparts may have caused this. But it is also true that the options for surgical leadership rarely include a women surgeon, let alone select one. I am certain this will change in times to come. And when it shall happen, the surgical field shall grow better and bigger.
Banira: Yes, to some extent but it all depends on how you extend yourself. You really need to be strong and bring the best out in you and cross all the difficult hurdles to stand out amongst the male surgeons.
Sarina: There has always been a significant gender disparity in surgical leadership positions. We often hear quotes like – “A male ambitious leader is thought to be great and driven, whereas a female leader is often viewed as mean, attention-seeking and illogical at times.” But I do have to applaud my seniors, who, against all odds have managed to become department heads of Otolaryngology in their respective medical colleges. They are an inspiration to younger female surgeons, who have recently stepped into this field.
Nisha: Yes, there is a significant disparity for women in surgical leadership. Despite advancements in gender equality, women remain underrepresented in leadership positions within surgical specialties. Factors such as unconscious bias, lack of mentorship opportunities, and traditional gender roles contribute to this disparity. But as I said, women have come a long way and many positive changes can be seen in the field these days. I have been lucky to be a specialist (ophthalmology) where women surgeons have been able to strive, challenge the system, and be an inspiration to the juniors to follow.
Upama: Definitely. Not in the sense that they are not given an opportunity but the surgical field is male-dominated but women are slowly increasing and recently I read somewhere in Nepal that there is a team of female surgeons.
Tulika: Sadly yes, as we see it the new generation male counterparts are more tolerant and accepting. But because of the disparity, very able female surgeons still have to be shadow surgeons to their male counterparts.
The question regarding career-life balance being directed solely at female professionals can be frustrating sometimes. It’s a universal concern, for all professionals, regardless of gender. Singling out women implies that they must navigate this balance differently or prioritise family over career. ”
Dr Nisha Shrestha
Oculoplastic Surgeon
How can hospitals and government encourage women surgeons to rise to leadership positions?
Tseten: Leadership should be based on quality. A person blessed with the quality to lead an institution to growth should become the leader. If this is the criteria to select for a leadership position, numerous women will be a strong contender.
Banira: Equal treatment and opportunities of men and women alike Recruitment and retention policies for women in healthcare by addressing structural issues and changing workplace norms. Creating a woman support network system where women from different fields of surgery can come together and share their experiences and support each other to create change. With the same concept, we the female surgeons of Nepal have created a common platform (Women in Surgery – Nepal) where we discuss our issues, celebrate our success, and motivate each other.
I have no doubt whatsoever that women are more alert, sensitive, and gentle when it comes to surgeries. They have also been research claiming women surgeons have better surgical outcomes and fewer complications.
Dr Tulika Dubey
ENT – Head and Neck Onco Surgeon
Sarina: This can be done by taking proactive measures to address unconscious bias, gender stereotypes, and discrimination within the workplace. Not questioning a woman’s ability to communicate, guide, perform, and make decisions would also help encourage us to give our best. The government has allocated “mahila/ female” slots, which should be appreciated. It all comes down to how women are treated or regarded at their workplaces – by providing us with equal opportunities, trainings, salaries, and respect.
Nisha: To encourage women surgeons to rise to leadership positions, hospitals, and government can implement a range of initiatives. This includes establishing a diversity program to actively recruit and support gender equality, providing mentorship and leadership training, addressing unconscious bias, and recognising and celebrating the achievements of female surgeons.
Upama: Most importantly more opportunities should be created, equality based on skill should be established, and pay discrimination should be discouraged.
Tulika: A lot should and can be done by the hospitals and in particular by the government. We are blessed in recent times to have young women as leaders so people should stop doubting us and try to get rid of the outdated gender bias and discrimination. Recognition and celebration of the achievements of female surgeons providing equal opportunities for networking and collaboration.
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