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The unseen work of women surgeons

I always said yes, taking on numerous tasks and roles, but now I question the value of unpaid work in my career trajectory as a colorectal surgeon. I always said yes. That’s what you’re supposed to do, right? Always say yes because you don’t know which opportunity will be “the one” that launches your career into orbit. So I said yes to organizing the lunch orders when the drug reps came; I said yes to an extra teaching session about bowel obstructions for the PAs; I said yes to Saturday morning medical school interviews, Friday afternoon laparoscopic workshops, and joining XYZ committees on which I was the token Asian lesbian. I thought, someday, all this hard work and extra time I’m putting in will get recognized. Little did I know that none of these things counted toward the most important benchmarks of productivity and publication. When the hospital administrators have you justify your bonus at the end of the year, they ask you what your relative value units are and how many papers you wrote, not how many committees you were on.

Not to say that I didn’t do a lot of surgery cases and also write a bunch of abstracts, and this isn’t to say that I don’t enjoy all of the other stuff that I do because I love teaching and writing and being a voice for the people. But I had been thinking a lot about everything I do for free, both at work and outside of it. We pay to go to medical school, and then we are paid when we become physicians. But then, we end up paying to be part of a society or association to serve on their committees and do some work for free. Some of us also volunteer as ambassadors and mentors, do virtual shadowing, write recommendation letters, edit personal statements, write guest blog posts, edit and present abstracts, review journal articles, and more. What is it all for? Perhaps some extracurriculars count as stepping stones toward a bigger goal, such as a promotion or national committee chair. But does ordering lunch really make that much of an impact? Or is it that “getting the food” is considered womanly work, or is it that I’m too nice and people always think, “Carmen will do it!”? However, studies have also shown that women tend to do more of this “free” work than their male colleagues. The authors of “The No Club” wrote in this Harvard Business Review article that women were found to do 200 more hours of non-promotable work than their male counterparts. These hours include sitting on committees, planning birthday parties, ordering coffee, and working with trainees.

At a recent Zoom meeting where a dozen or so early career surgeons were “chosen” to be part of a journal article reviewer academy, we were sold and told to apply because it gave us the “chance” to work with seasoned article reviewers and potentially join the group of reviewers one day, or even rise to be an editor. I jumped at the opportunity and was extremely honored that my application was accepted. I learned a lot at each session and valued the feedback I received for my article reviews. However, as I looked around the virtual room at my fellow reviewers, I saw many women, especially many women of color. I couldn’t help but think, were we enticed into doing free, non-promotable work by showing us the carrot of a prestigious career path that only white cis-men have taken? One example in this article is “tending to high-touch clients.” I can’t help but think how women colorectal surgeons bear the brunt of pelvic floor dysfunction patients, which tend to be more time-consuming and require more extensive workup and psychosocial evaluation, generally without the “payoff” of a large operation.

We do a lot for free. Should we stop doing the free stuff, demand fair pay, or count it all as stepping stones toward higher-paying, more prestigious positions? Evidence says maybe all of the above, but most importantly, institutions must consciously distribute these “housekeeping” jobs or ask the most qualified person, regardless of gender. Women find it hard to say no. “A big contributor to women doing this work is that we expect them to do it,” one of the authors of the Harvard Business Review article says. When considering my own culpability in this systemic injustice, I realize that sometimes I take on these roles because I feel that I could do a better job than anyone else, and sometimes if you want something done right, you have to do it yourself! I am sure many of you reading this feel this way. Doing it yourself nurtures some sense of control. But sometimes, it’s OK to delegate. For whatever reason, or no reason at all, consider this your permission to say no.

The thing is, maybe I like doing all these other things. While a man only has to be good at one thing at a time, women must be good at at least three things simultaneously. But is there a better feeling than being able to say, I swung by the bakery on the way to work, picked up this cake, and had everyone sign this card before your surprise birthday party? Or throwing a Secret Santa for all your colleagues as a minute speck of light in all the darkness that is residency training? One afternoon, my wife told me she had to make a list of all the things she’s done in the past year as a part of her annual performance evaluation, and she was surprised at how long her list was, even though she didn’t feel like she was doing much at the time. She said I should make a list of all the things I’ve done. Looking back, I have done a lot in my short career. And while most of it did not count toward the productivity and publication standards we’re often judged by, I feel like I can count my successes on the people I’ve helped. And that counts for something.

Carmen Fong is a colorectal surgeon.


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