SICOT

Women orthopedists in Colombia

Amparo Gómez Gélvez   Bogota, Colombia

I decided to study orthopaedics in 1990 because, being a surgical field, it would allow me to offer patients an efficient and expeditious way to solve their medical problems and offer them a better quality of life. My family and medical peers were surprised and worried for me because it was a specialty “designed” only for men, which required “great physical force”.  During my admission interview I was asked what would happen if I got married and had children, if I considered myself physically strong enough, and why they should prefer me over a male candidate. When I was admitted into the Orthopaedic Programme at Universidad Javeriana, Colombia had only two female orthopaedic hand surgeons, one female paediatric orthopaedist and a female doctor training in second year of our university department; no other women were training to be orthopedists in the whole country.

Initially the staff from my area, other hospital departments and even the patients were surprised, even distrustful and skeptic, when they saw a woman as part of the orthopaedic group. Some patients wanted to be seen by a male doctor, and some even thought I was a nurse. Some colleagues thought I would never finish my studies or work as an orthopedist if I did, and I had taken away a male doctor’s chance to study. Those who thought I would achieve my degree were sure I would dedicate myself to hand surgery, a subspecialty “fit” for women. On the other hand, my peer residents accepted me as one of them without any restraint. During my four-year training programme I received no special treatment for being a woman by my peers or chiefs regarding work at ER, outpatient clinic or nightshift duties, as hard work and demand for results were equal for men and women; however, there were clear differences in opportunity for surgical training as frequently professors chose my male residency partners to perform as main surgeons in complex or “big” surgeries, assigning me as their surgical assistant. In private staff meetings my partners were referred to as “brilliant” and I was called “nice and likeable” although our academic scores were equal!

The first two years in residency were miserable: night shift every third day with no free time to rest (or study) after the shifts; the work was overwhelmingly intense with a permanent feeling of tiredness and the daily fear of failing or being unable to fulfill responsibilities; fear of having to admit this was not really a woman's area of work burdened me. I feared asking my teachers things I didn’t know so I would not seem ill-prepared - I learned everything I could from my fourth-year residency peers and they were the ones who taught me and led me through those first years. My memory of those years has been reduced to life inside a hospital: I had almost no social or family life, I was almost clueless about things happening in my country or around the globe; I even lost school friends when they saw I never had time for them.

When I finished my residency programme I began work in outpatient clinic and ER in different medical centres; a year later a post in orthopaedic major trauma was available in a high complexity level hospital. The department’s director, having been one of my teachers and knowing my previous work, had no problem accepting me when I applied; he trusted and respected my skills from the start. I worked there for five years with no limitation or difficulty because of my gender - quite the opposite, I enriched my orthopedic formation being in a different school from mine.  For the last 16 years I have worked in Bogotá at a high complexity hospital, Hospital Universitario de La Samaritana, dedicated to polytrauma, major trauma in lower extremities, and management of complications; I am the coordinator of the orthopaedic resident’s programme and participate in investigation and administration in our department. I am also a national and regional AO faculty member. I have been married for the last 20 years to a paediatric orthopedist with whom I have two children, a fact that has never limited my capacity to work at the same level as my male peers. I have always received full support from my family for my academic, work and professional activities; they have always felt proud of my work and accomplishments.

Since 1991 the number of women admitted into orthopaedic training programmes in Colombia has risen, especially in major cities. Women comprise 10 to 30% of in-training orthopedists at our major universities. Pontificia Universidad Javeriana, which was the first centre to open its doors to women in orthopedics, has graduated 29 of them from a total number of 197 graduates. Universidad Nacional, the main public centre in Colombia, has graduated 228 orthopaedic surgeons, but only 8 women: today there is only one woman among 16 residents. Universidad Industrial de Santander, a state university in the city of Bucaramanga, has graduated none – there are two women training there now, out of a total of 8 residents. Small cities still register below 10% in the number of female residents being trained.

Colombia has approximately 1,900 orthopedists; 1,380 of them are registered in the Colombian Orthopaedic Society, of which only 80 are women: 4.25%, still a very low number. This proportion is expected to rise significantly in the next years as more women than ever before are training to become orthopedists.

Nearly 3% of graduated female orthopedists are not working in their field or dedicate themselves to administrative tasks; most of the graduated women practice foot and ankle, hand, shoulder, paediatrics, or general orthopaedics. In the so called “tough” subspecialties we have two spine, four hip, four knee and only three major trauma surgeons. No training programme has a female chief, but our AO Trauma chapter director is a woman and we have 8 female AO national faculty members.

Things have changed since I started my journey in 1990: every year you see more female candidates in the admission process and they are not asked what would happen if they got married and had children, or if they are strong enough; the evaluation centres on motivation, disposition and skills to work in the field. No special considerations are assumed for women during their training programme. Conditions have become better for men and women: daily and weekly work hours are regulated by law as well as the compensatory rest hours after a night shift, which are enforced. Patients and their families are no longer taken back or express distrust at seeing a woman in charge of their medical problem and the rest of the medical team are no longer suspicious of our capabilities. Surgical opportunity is equal for men and women. There are no obstacles for a woman in her aspiration for a subspecialty, and working opportunities and salary are equal for both genders; most importantly, wishing to have a family is no special consideration in regard to being a fulfilled orthopedist.

After twenty years of practising orthopaedics I think that to be a good professional you must learn how to think clearly and efficiently, understand medical problems in context with the patient and his peculiarities, and learn how to work in a team to make the right decision at the right moment. You must plan, anticipate and operate gently to avoid harm; you must learn how to be humble and compassionate - humble to recognize failures, correct and learn from them, acknowledge limitations and ask for help if it is needed, and compassionate with patient and family. To achieve these, it makes no difference being a man or a woman. Being female orthopedists doesn't make us any different: we deserve no more or less than any man in equal conditions. If we work as hard as anyone else we will have the same opportunities of success as any other professional.

So yes, I have concluded you do need strength to be a good orthopedist, but mental, not physical. On occasion you do require that extra amount of physical force but this can be replaced by tools or a willing team partner if you don't possess it.