Practice Patterns and Work Environments That Influence Gender Inequality Among Pediatric Surgeons

Abstract

Purpose Gender disparity in career advancement has been attributed to shortcomings at the level of the individual. The goal of this study was to test the hypothesis that female physicians face organizational barriers in practice environment that hinder advancement, even after attaining advanced specialty training. Methods Using a 2000-2015 New York statewide dataset, we compared board-certified pediatric surgeons by their specialist case volume as a percentage of total caseload and by Herfindahl-Hirschman Index (HHI), a quantitative representation of surgeon focus within their specialist case mix. Surgeon’s networks, defined annually and as the group of hospitals where each surgeon practiced, were also compared. Results Fifty-one surgeons were analyzed for 461 surgeon-years and 94,979 cases. Female surgeons had lower case volume (159 cases/year versus 214, p<0.01), lower shares of specialist cases (14.1% versus 16.7%, p=0.04), and less focused practices (HHI 0.16 versus 0.20, p=0.03). Female surgeons’ networks had fewer colleagues (7.2 versus 12.1, p<0.01), lower total case volume (388 cases/year versus 726, p<0.01), and lower specialist case volume (83 cases/year versus 159, p<0.01), even after accounting for career length. However, female surgeons performed more cases within their networks (49% versus 36%, p=0.04) and worked at major teaching hospitals as often as men (76% versus 76%, p=0.97). Conclusions Substantial differences in practice patterns and work environment may contribute to the gender gap in career advancement even within a highly competitive surgical specialty. Our study establishes that the career challenges faced by female surgeons unlikely reflect personal shortcomings but rather represent system failures that require intentional scrutiny and deliberate change.