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graduates.7 Of these female graduates, the majority still enter fields outside of surgical subspecialties.15,16 In comparison to other surgical subspecialties, women are most represented in plastic surgery, and their representation has increased from 14% in 1990 to 40% in integrated plastic surgery programs in 2015.15 Despite this substantial increase in female presence within plastic surgery training, significant gender discrepancies remain within academic postgraduate practice. Overall, 27% of plastic surgery graduates enter academic practice, and, according to the American Medical Association, women comprise only 12.3% of those within academic plastic surgery.15-17 Multiple studies have demonstrated that women in academic surgery are less likely to gain tenure, hold leadership positions, or participate in research despite holding equal qualifications to their male colleagues.15-18 Similarly, female representation among national plastic surgery associations remains low, with women constituting only 10.8% of American Board of Plastic Surgery diplomates, 10% of the American Council of Academic Plastic Surgeons, 16% of American Society of Plastic Surgeons (ASPS) members, and 14% of the American Society for Aesthetic Plastic Surgery (ASAPS) (M Simpson, email communication, June 2019).15,16,19 In addition, women constitute a minority of invited speakers at academic plastic surgery meetings despite the impact of their published work being no different to that of men.19 Further, recent studies have demonstrated that, when introducing academic speakers, Downloaded from https://academic.oup.com/asj/advance-article-abstract/doi/10.1093/asj/sjz299/5609346 by guest on 14 February 2020 Moak et al 3 male introducers are less likely to use formal titles in the first form of address with an even greater discrepancy of formal title use between female (49.2%) and male (72.4%) introductions, a practice that may create the perception that women are of lower status than men, despite having the same professional rank.20 Barriers to Females in Plastic Surgery We currently live in an era where women become CEOs in the technological sector, presidents and founders of their own corporations, and leaders in global business. Unfortunately, although women account for 47% of the US workforce and hold almost 52% of management-level jobs, gender disparity remains present even in the business sector.21-23 For example, on the 2019 Fortune 500 list, women held only 6.6% of CEO roles in all companies listed.24 In the legal profession, women make up 45% of legal associates but only 22.7% of firm partners.23,25 They constitute 61% of accountants and auditors, 53% of financial managers, and 37% of financial analysts, but represent only 12.5% of CFOs on the Fortune 500 list.23,24,26 Within the US government, females now comprise a historic high of 25% of the US Senate and 23.4% of House members.27 Interestingly, many of these women who do rise to the top of their respective professions do so by beginning in entry-level jobs within the companies they later run. Over 70% of female CEOs within Fortune 500 companies spend more than 10 years, with a median of 23 years, at that company prior to becoming CEO.28 By comparison, the same promotional ladder for men in Fortune 500 CEO companies spans a median of 15 years prior to reaching CEO.28 Despite these disparities, female presence in all of these professions continues to grow. How it is possible that, in this modern age, women continue to make up less than 20% of the US plastic surgery community, a community that places a great emphasis on female beauty, no less? A career in plastic surgery requires at least a decade of training and education following undergraduate studies. Not only must one make a long-term decision at, usually, a very young age, but this decision inherently entails long hours of work and study with the perception of little time for personal or social activities. For many young women in college, this path may seem daunting, especially when there remains a paucity of female role models and mentors to encourage their interests and demonstrate that a worklife balance within plastic surgery is possible.14 Plastic surgery professional advancement during residency training and early practice years can be rigorous and grueling at a time in life when many women also seek to progress personally. Demands of work pose significant challenges should a woman wish to find a partner or spouse, and have been shown specifically to contribute to divorce amongst female surgeons.15,18 Further, desire to start a family during biologically optimal reproductive years is not only difficult with regard to work-life balance from a practical standpoint, but also from a medical standpoint.29,30 Specifically, the Accreditation Council for Graduate Medical Education and the American Board of Plastic Surgery offer only a 4-week maximum for maternity leave during medical training with the option for an additional 2 weeks of maternity leave that are effectively borrowed from another training year’s vacation time to maintain the mandated 48 clinical weeks per year residency training requirement. This often poses difficulty for plastic surgery training programs regarding the logistics of arranging reasonable leave for new mothers and allows for
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