As if major surgery isn’t stressful enough, now there’s another thing to worry about: what if your surgeon is a man?
An emerging medical literature based largely on Canadian data suggests female surgeons are statistically better at their jobs than their male counterparts. One recent Ontario study found that as the share of female surgeons and anaesthetists at a hospital rises, the overall risk of post-operative complications at the facility falls. This result is much stronger when female surgeons perform the actual operations. Other studies using similar Ontario data bolster these findings. One shows that women-led surgeries cost the provincial health-care system substantially less than equivalent surgeries performed by men; another that patients are statistically more likely to die within a year of surgery if their surgeon was a man.
For decades the medical profession – along with virtually every other occupation – has been under tremendous pressure to raise female participation on the basis of sexual equity. Today, claims that anything a man can do a woman can do equally well are decidedly old news. This latest evidence purports to show that women are demonstrably better at surgery than men. While there are good reasons to treat these early results with some skepticism, it remains entirely possible that further research could confirm them as valid. And if so, that will beg some awkward questions.
If it is proven that the sex-based characteristics of women make them better suited to certain jobs, including that of surgeon, then it stands to reason that the sex-based differences of men must make them better suited to other jobs. If women are more capable surgeons, then men might be statistically proven to be better suited to occupations they have habitually dominated, such as firefighter, soldier or movie director. And then what? Are we ready to upend decades of claims of gender discrimination and demands for gender equality policies and go back to “boy jobs” and “girl jobs”?
Distaff Advantage in the OR
“Association between anaesthesia-surgery team sex diversity and major morbidity” – the first study referred to above – was published in March 2024 in the British Journal of Surgery (BJS). Based on over 700,000 surgical procedures in Ontario between 2009 and 2019, it claimed to show a 3 percent decline in “major morbidity” – that is, significant post-operative complications including death – within 90 days of surgery when the share of female surgeons and anaesthetists at an individual hospital rose above 35 percent.
This potentially life-saving advantage, the researchers claim, is due to the intermingling of “different skills, knowledge, experiences, beliefs, values and leadership styles” provided by greater female representation in the workplace. As lead author Julie Hallet, a surgeon at Toronto’s Sunnybrook Health Sciences Centre, told the CBC, “It’s not only about equity and justice. It’s really about increasing performance and providing better care.” According to Hallet, this sex-based advantage begins at around one-third female representation and tops out somewhere above that. “As you increase the proportion of female physicians, eventually you’re going to hit a wall where you don’t have any more health benefits,” she added.
The CBC has greeted findings of a “diversity bonus” in the operating room with rapturous attention, given how it provides yet another data point impugning an incompetent (and mainly white) patriarchy. On CBC Radio’s The Current, Saroo Sharda, an anaesthesiologist and associate dean of equity and inclusion at the Faculty of Health Sciences at McMaster University in Hamilton, Ontario, used Hallet’s study to argue for the elimination of the traditional operating room dynamic with a “lone, usually male, white older surgeon as the expert and everybody else…deferring to him.”
Curiously enough, Hallet’s heavily-promoted but numerically small 3 percent diversity bonus is not the most striking result of her study. The much bigger effect was that at hospitals with greater than 35 percent female representation, having a female surgeon holding the scalpel produced a dramatic 17 percent reduction in major post-operative complications. For female anaesthetists, the sex advantage was somewhat smaller but still noteworthy at 8 percent. Rather than revealing a benefit from gender-balanced teams, Hallet’s results suggest there’s an advantage for women physicians over men.
Further, Hallet’s study includes a chart (reproduced below) showing that as the share of female surgeons and anaesthetists rises at a hospital, major morbidity drops at a nearly continuous rate. At around 60 percent women, it approaches zero. This is in sharp contrast to her CBC interview that talked of hitting a wall. Rather, Hallet’s projections show that majority-female surgical teams would experience almost no post-operative complications and make almost no mistakes. If true, it suggests the entire health care sector ought to be purged of men immediately.
Feminine perfection? Hallet’s study purports to show a nearly continuous decline in major post-surgical morbidity as the share of female surgeons and anaesthetists rises, miraculously approaching zero when women comprise close to 60 percent of a hospital’s surgical staff. (Source of graph: British Medical Journal, Vol. 111, Issue 5, May 2024)
The same implication can be found embedded in two similar Ontario studies produced by a different research team and published by JAMA Surgery. The first, published in August 2023, examined nearly 1.2 million operations performed from 2007 through 2019. It found that patients with male surgeons had significantly higher rates of post-operative complications than those with female surgeons. Patient mortality after one year appeared to be 50 percent higher if a man had performed the procedure. The other study, published in November, revealed an equally striking gap of over $6,000 in average total health care costs. Patients with a male surgeon cost the provincial health care system an average of $24,882 compared to only $18,517 for female surgeons performing similar operations.
As for the reasons behind these large gender gaps, the authors observed that female surgeons take an average of 15 minutes longer to complete comparable surgeries than do men. This suggests they may be more careful and better at following rules, traits that might reasonably lead to fewer mistakes in the OR. That logic complements other earlier research suggesting women doctors spend more time communicating with their patients and hence may be more aware of possible complications and concerns.
At first blush, the evidence in favour of female surgeons appears strong, based as it is on large, high-quality datasets using sophisticated statistical methods and having been published in reputable, peer-reviewed academic journals. As a result, many observers find the argument of a female advantage wholly convincing. The Toronto Globe & Mail last week touted the great benefits of the “‘feminization’ of medicine”, referencing the above research as well as similar data from the U.S. Based on the same information, the UK-based newsmagazine The Economist recently asked rhetorically, “Do women make better doctors than men? Research suggests yes.”
The claim that female surgeons are superior to men is winning over many observers, including The Economist newsmagazine.
Brain Surgery for Beginners
There are, however, a few caveats to note before men are ushered out of the OR for good. First, despite the clamorous media focus, not all the available evidence backs a clear – or any – distaff advantage. A recent study of nearly 300,000 gastro-intestinal procedures over a five-year period in Japan, for example, found no statistical difference in results for male versus female surgeons. Null outcomes such as this tend to get much less attention in academic journals and the popular press since they don’t demolish any shibboleths; but that doesn’t make them any less important.
It also needs to be firmly established that in asserting a gender advantage the studies are not comparing surgical apples to surgical oranges. For example, a deeper look into the underlying data reveals many significant variances in the types of procedures male and female surgeons perform. As one of the JAMA Surgery studies explains, “Patients treated by female surgeons were more likely to have undergone general, obstetric or gynecologic, or plastic surgeries, while those treated by male surgeons were more likely to have undergone cardiac, neurosurgical, orthopedic or urologic procedures.” These differences can be very dramatic. Of 58,912 neurosurgeries in the study, 56,049 – or 95 percent – were performed by men. Cardiothoracic and orthopedic procedures had the same relative shares.
A similar imbalance can be found in the BJS study. Surgical teams at hospitals blessed with greater than 35 percent female representation accounted for a mere 1.7 percent of cardiac operations in Ontario from 2009-2019. For neurosurgery, it was 10.3 percent. In other words, the very riskiest operations – those involving brains and hearts in particular – are overwhelmingly handled by men at hospitals with mostly male surgical teams.
Every surgical procedure obviously entails some degree of risk, but a neurosurgeon is clearly exposed to a far greater possibility of post-operative complications, including a patient’s death, and higher overall costs than colleagues doing routine gall bladder work. The same goes for heart surgery and orthopedic procedures. This raises an obvious statistical problem and calls into question any sweeping conclusions the authors derive.
A further issue is the extremely low share of female surgeons overall. Women accounted for fewer than 7 percent of all surgeries in the BJS study and 13 percent in the two JAMA Surgery studies. Both these facts must be accounted for in the calculations. While all authors claim their statistical work corrects for any differences in surgical complexity across sexes, as well as the smaller number of female data points, the implications here seem so great that an expert second – and perhaps third – opinion seems warranted. There is an obvious need for replication studies to put these concerns to rest.
As for the notion that diverse teams always produce better results – and that there’s a sweet spot where these benefits are maximized – the overall body of evidence suggests opposite or null effects are just as likely. A U.S. study on racial diversity in nursing teams, for example, found that bringing together divergent world views in the workplace led to frequent breakdowns in cohesion. “Alternative realities encourage participants to attribute causation differently which…fuels team conflict and miscommunication,” the authors reported.
There have been numerous campaigns aimed at boosting the share of female surgeons. Despite all the effort, however, their share remains perishingly small.
And in the business world, claims that adding women to corporate boards will improve the performance of publicly-traded companies has been conclusively demolished by Wharton School of Business professor Katherine Klein. “There is no evidence available to suggest that the addition, or presence, of women on the board actually causes a change in company performance,” Klein wrote in 2017, summarizing the available data. “In sum, the research results suggest that there is no business case for – or against – appointing women to corporate boards.” Demands for greater female representation made on the basis of equity alone should be recognized as being politically motivated, and devoid of any practical benefit.
Sex Matters. Now What?
Despite these notes of caution, however, the possibility remains that women actually are better at surgery than men. If the studies noted above have properly accounted for the striking gaps in surgical risk between male and female surgeons, along with other potentially confounding factors, then it’s conceivable there is a distinct and measurable benefit attributable to women. This could even be due to immutable, sex-based characteristics such as emotional intelligence, rule-following, communications skills and so on. But then what? If we accept these findings as valid, they lead to many other uncomfortable questions.
The first issue is one of practicality. If women are better surgeons, then it stands to reason we should want more of them. And in some ways, this is already happening. Women have formed the majority of students at Canadian medical schools since the 1990s, and there have been numerous campaigns aimed at boosting the share of female surgeons during this time. Despite all the effort, however, the share of female surgeons remains perishingly small. The preferred CBC/Globe explanation for this situation, as articulated by Hallett and Shardo, involves systemic discrimination, toxic male behaviour and unfair wage gaps.
Yet ample anecdotal evidence suggests the biggest determinant remains the freely made choices of female physicians themselves. Compared to other medical pursuits, surgical work is extremely time-consuming, arduous and stressful. In 2000, when the JAMA Network asked Mary Ann Hopkins, an attending general surgeon at the New York University Medical Center, why there aren’t more women surgeons, she replied, “It’s probably because of the long hours and the family sacrifices that you have to make.” Evidence also points to a strong preference among female doctors for part-time work, which is typically incompatible with a surgical specialty.
Women have comprised the majority of students at Canadian medical schools since the 1990s, yet the share of female surgeons in the higher-risk specializations remains low. (Source of graph: BMC Medical Education, Vol. 24, Issue 100, January 2024)
Nearly a quarter-century later, a retired Toronto-based female anaesthesiologist who provided comments on a not-for-attribution basis backs Hopkins’ assertion. “Generally speaking, surgery and anaesthesia seem to be under-represented by females due to choice,” she says. “Female surgeons are few because of the demanding residency and then demanding lifestyle upon graduation. Surgery equates with potentially long working hours, on-call commitments, stressful situations and a lot of responsibility.” All this makes general practice or other less-demanding specialities such as radiology and dermatology far more attractive to a female doctor who wishes to raise a family. While everyone is obviously free to make their own decisions about how much to work, it presents an obvious roadblock to increasing the number of female surgeons. Women, it seems, are just not particularly interested in the job.
This in turn means that male surgeons, whatever their flaws may be, remain absolutely critical to patient care in Canada. They alone are prepared to put up with the demands of the job, and thus deserve our gratitude as well as respect.
For patients, any evidence that they might live longer or experience less pain following surgery if only there were more female surgeons amounts to intriguing information they cannot use. Thanks to Canada’s rigid and monopolistic public health care system, most Canadians have no way of choosing their own surgeon and, even if they could, the waiting lists for those magically talented female surgeons would soon grow endless.
There is no centralized dataset available to examine the efficacy of male versus female firefighters when putting out blazes, prying open mangled automobiles or rescuing cats from trees. There is, however, ample evidence on how the two sexes bear up to the occupation’s physical challenges.
There is, however, one area in which this information could prove immediately useful. Accepting the presence of sex-based differences in job performance for surgeons (if eventually proven via replication studies) opens the door for numerous other revelations. In particular, if women make better surgeons because of certain sex-based characteristics, then it stands to reason that men are likely better-suited to doing other jobs that take advantage of their unique traits and strengths. Male dominance in certain sectors or occupations thus might not be evidence of systemic discrimination, but rather an efficient sorting of tasks. While such an argument is not likely to feature on the CBC anytime soon, it holds the promise of inserting a welcome dose of common sense and logic into the modern, woke-addled workplace.
Boy Jobs
As Lynne Cohen explains in Part I of this three-part series, ample scientific evidence demonstrates key differences in the embedded behavioural traits of men and women. Men take more risks and are more adventurous, more competitive and more likely to push boundaries and explore frontiers than are women. They also display a two-tailed IQ distribution, with more men than women at either end of the scale (that is, both very smart and terminally dull). This explains why men tend to dominate the upper echelon of non-physical competitive pursuits such as chess, bridge and Scrabble. And, of course, men are typically bigger and stronger than women, and hence better-suited to tasks requiring sheer physical strength.
While there’s a paucity of current academic literature studying possible areas of male occupational superiority, there are plenty of indicators if you know where to look. Firefighting, for example, was once the exclusive domain of men; Canada did not have a professional female firefighter until 1983, when Karen Morrison was hired by the Windsor Fire Department in Ontario. That is why this occupation was once accurately known as “fireman”. Today, women comprise approximately 11 percent of firefighters nationwide, both volunteer and professional.
Unlike for surgery, there is no centralized dataset available to examine the efficacy of male versus female firefighters when putting out blazes, prying open mangled automobiles or rescuing cats from trees. There is, however, ample evidence on how the two sexes bear up to the occupation’s physical challenges. As a job that requires plenty of lifting and carrying, it seems plausible that men, with their bigger frames and larger muscles, will be better-suited to the tasks firefighting requires. Evidence appears to bear this out. According to research on Canadian firefighters published in the academic journal Work, “Women experienced a 1.4-1.6 times greater likelihood of sustaining musculoskeletal” injuries than men.
Another study by several of the same authors from Western University in London, Ontario found that while male firefighters have a tendency to suffer shoulder and knee-related disorders, female firefighters face a much longer list of other ailments, including injuries to the head, neck, arm, elbow, hand, back and upper thigh, and generally at a higher rate of occurrence. “Fitness profiles of female firefighters consistently differ in comparison to their male counterparts, in terms of cardiovascular levels, muscle strength and endurance,” the study reports, noting that while a male firefighter can use his upper body strength alone to hoist himself through an open window, women doing the same task often need to take a running jump.
None of this should be seen as evidence that women cannot or should not be firefighters. But if efficiency and effectiveness are our measures, it appears men hold an edge over women when doing the job because their bodies are better-suited to the tasks involved. If women make better surgeons for reasons of carefulness and emotional intelligence, then men appear to make better firefighters for reasons of brawniness and size. Nonetheless, it has become an accepted truth that Canadian fire departments need more women. And that the physical requirements for the job must be lowered to make this happen.
GI Joe and GI Jane
Similar indirect evidence of a male advantage can be found in other traditionally masculine occupations. The U.S. military, for example, has been fully integrated since 1994, with all tasks – including combat roles – open to both men and women. Among the many changes made to facilitate this shift, boot-camp entrance standards are now differentiated by gender. U.S. Air Force requirements, for example, state that new male recruits must run 1.5 miles in under 12 minutes and do 33 push-ups and 42 sit-ups in one minute each. Female recruits, on the other hand, have 14:26 to complete the same run and need to do only 18 push-ups and 38 sit-ups. The male-female gap in physical requirements is substantial and speaks to the bodily limitations of female soldiers.
Other differences are less clear-cut. A comprehensive review of gender statistics arising from the U.S. military’s experiences with Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq was conducted in 2013 by U.S. Army Major Seneca Peña-Collazo as part of his Master’s degree in Military Operational Art and Science. While the bulk of his data suggest a distinct male advantage, the one aspect of his report to receive national press was that no U.S. military AH-64 Apache attack helicopter had ever crashed with a woman at the controls.
‘As more women enter them, the armed forces in question will become both less willing to fight and less capable of doing so,’ van Creveld wrote.
“As it pertains to just AH-64 aircraft, 100% of all accidents, both in garrison and in theater, involve all-male crews, at least suggesting that female attack pilots may be even more safe in the performance of flight duties,” newsmagazine Time quoted from the study. Only 3 percent of all Apache pilots are women, however, creating the same small-sample-size problem as with studies of female surgeons. The Time article, to its credit, also noted that Peña-Collazo’s study did not attempt to assess whether female pilots were as effective at accomplishing their missions, as aggressive in hunting and destroying the enemy or as willing to take life-threatening risks in providing air cover or combat rescue for ground troops.
More broadly, Peña-Collazo’s statistical work showed that female soldiers in Afghanistan and Iraq suffered 17 percent of all injuries (both combat and non-combat, requiring up to 30 days loss of duty) despite accounting for only 11 percent of combat troops over this time. Conversely, women comprised just 1.6 percent of all U.S. Army deaths in Afghanistan and 2 percent in Iraq. This suggests distinctly asynchronous experiences for men and women in war. Women tend to get injured more often but, it seems, are rarely placed in the direct line of fire. A modern army assembled along strict efficiency grounds would, accordingly, almost certainly be all-male. As armies have been since the dawn of warfare.
Widely-respected military historian Martin van Creveld, professor emeritus at Jerusalem University, is a vocal critic of women in the military. His 2001 book Men, Women & War: Do Women Belong on the Front Lines? answers the titular question with a definitive “No.” Van Creveld argues that the introduction of physically-inferior women into combat units erodes their effectiveness and preparedness. “As more women enter them, the armed forces in question will become both less willing to fight and less capable of doing so,” he wrote. Our era’s fixation with increasing female representation, van Creveld stated, is political rather than operational. Because of this, he predicted that elite organizations such as the U.S. Marine Corps and special forces units that are exclusively or nearly-exclusively male would become increasingly more significant as the last bastions of “true warriors”.
“Less willing to fight”: In his 2001 book Men, Women & War: Do Women Belong on the Front Lines? military historian Martin van Creveld made the case against putting women at the sharp end of the spear, arguing their lack of physical strength erodes the fighting capabilities of military units.Despite such concerns, boosting female representation in the military remains a clear objective throughout the U.S. (and Canadian) armed forces. “While the U.S. military today has never had a higher fraction of women, they remain just 16 percent of the total force,” lamented U.S. Air Force General (ret.) Lori J. Robinson in 2020. “In senior leadership, the numbers are worse and reflect the work that needs to be done to help integrate women into the military.” The Canadian Armed Forces are burdened with the similar – if equally unrealistic – goal of raising female enlistment to 25 percent by 2026. With these explicitly political objectives at work, official evidence contradicting the argument that men and women are equally suited to combat is unlikely to see the light of day.
Lights, Camera…No, Wait a Second
Directing movies is another male-dominated occupation that faces similar pressure to enlist more women. While the job clearly has nothing to do with physical strength, nearly every famous film director from the silent era to today has been a man – from Cecil B. De Mille to Alfred Hitchcock to Steven Spielberg to Christopher Nolan. Women may collect Best Actress and Best Supporting Actress Oscars annually, but in the Academy Awards’ 96-year history only three women have ever been named Best Director; the first was Kathryn Bigelow for her male-centric war movie The Hurt Locker in 2008. This factoid is frequently cited as prima facie evidence of rampant gender discrimination in Hollywood. But could there be a distinct sex-based advantage to directing movies similar to that for female surgeons and male firefighters?
Two years ago, provocative Hollywood blogger Sasha Stone claimed that men are simply better-suited to commanding a set and crafting a coherent visual message. “Men are uniquely built to be great directors because they are more visual/spatial than women,” she wrote on her much-read website AwardsDaily. “This is an evolved trait over millions of years because men have built-in predatory eyes, both in hunting and in terms of sexuality/mating. That doesn’t make them predators; it just means they’re great at the visual stuff, which is why they make great movies.” As might be expected, Stone’s observations set off an explosion of social media outrage.
Outstanding in her field: The pantheon of famous movie directors is almost entirely male, including (clockwise from top left) Cecil B. DeMille, Alfred Hitchcock and Steven Spielberg. Kathryn Bigelow (bottom left) was the first woman to win a Best Director Oscar for her 2008 war movie The Hurt Locker. (Sources of photos (clockwise starting top-left): Running Press; Il Fatto Quotidiano, licensed under CC BY-NC-SA 2.0; The Playlist; Pulicciano, licensed under CC BY-SA 2.0)The predictable responses to any research or opinion suggesting a male advantage anywhere in the workplace – shock, horror and condemnation among them – are clearly obstacles to greater clarity on the issue of whether occupational suitability diverges along sex lines. This phenomenon is front and centre in the fate of an otherwise innocuous academic paper that had the misfortune to discover men are better at something than women.
The Advantage that Dare Not Speak its Name
In 2020 a trio of researchers at New York University in Abu Dhabi set out to examine the benefits of academic mentors. The authors sifted through millions of academic papers to identify those co-written by both senior and junior scientists. This yielded 3 million mentor-protégé pairings which the authors then used to conduct further research in an attempt to discern the impact a well-connected mentor can have on a protégé’s career. They also conducted a survey of participating academics. The resulting peer-reviewed paper, published in the prestigious journal Nature Communications, pointed to a clear benefit arising from mentors who are regarded as being a “big-shot” – that is, much-published and famous among their peers – over mentors who were simply well-established but lacked a high profile. It seems an interesting, if somewhat inconsequential finding.
What stirred the hornet’s nest of social media, however, was the ancillary result showing female mentors had little apparent impact on the career advancement of other females. Having a male mentor, on the other hand, seemed to matter quite a bit. “Female proteges…reap more benefits when mentored by males rather than equally-impactful females,” the authors reported. They also found benefits for female mentors when their protégés were male.
Current research suggests the varied abilities and traits of men and women may lead to divergent outcomes across occupations – which could offer significant benefits to society-at-large by improving outcomes and better matching workers with jobs.
Such evidence of a manly advantage in the academic workplace again caused the internet to go berserk. Some claimed the findings themselves were distorted by misogyny, others that they proved the existence of deep-seated misogyny throughout academia. Despite the paper having been peer-reviewed, the publisher demanded it be retracted “in response to criticisms about the assumptions underpinning the Article.” The authors, suitably cowed by the reaction on social media, went along with the punishment, if only grudgingly. In their retraction statement they strangely claimed that, “We believe that all the key findings of the paper…are still valid” while also agreeing that “the most appropriate course of action is to retract the Article.” In other words, the paper was simultaneously correct and unsuitable for public consumption.
There is ample room to quibble with the approach and methodology of this study. But, as defenders of the scientific method have pointed out, the proper course of action for anyone who disagrees with a paper’s findings or its authors’ methodology is to conduct verification research on the same topic and publish any contradictory results, if they exist. Retractions are meant to correct fraud or grotesque errors, not to punish researchers whose work promotes unpopular points of view. Curiously, two of the same researchers used a similar methodology to examine the role of ethnic diversity in academic success, with the resulting paper published by the same journal in 2018. This earlier effort, however, claimed to show that greater ethnic diversity benefits its participants; this “proper” outcome thus excited no social media campaigns and no demands that the work be retracted.
You can’t say that: A large-scale, peer-reviewed 2020 study published in Nature Communications concluding that “female protégés…reap more benefits when mentored by males” caused widespread outrage and prompted the publisher to retract the paper. (Source of photo: Freepik)The lessons arising from this review of potential masculine work advantages seem both obvious and alarming. Setting skepticism aside, current research suggests the varied abilities and traits of men and women may lead to divergent outcomes across occupations – which could offer significant benefits to society-at-large by improving outcomes and better matching workers with jobs. However, this logic apparently only works one way. Evidence that women might bring intrinsic advantages to some occupations, such as surgery, is generally greeted with great applause and acclaim among elite opinion-makers. On the other hand, evidence pointing in the opposite direction – that men may be innately suited to other jobs for analogous reasons – is always and everywhere a trigger for revulsion, condemnation or even dismissal. This undoubtedly suppresses further work in the area and obscures the interests of science.
In short, women are allowed to outperform men, but not the other way around. If society is to benefit from identifying and taking advantage of sex-based differences in occupational performance, this is the wrong way to go about it.
Peter Shawn Taylor is senior features editor at C2C Journal. He lives in Waterloo, Ontario.
Source of images in main montage: Shutterstock.
