Gender trends in Canadian medicine and surgery: the past 30 years

Abstract

Background: While the number of women entering medicine has steadily increased since the 1970s in Canada, the gender composition along each stage of the medical training pathway has not been comprehensively reported. We therefore sought to systematically examine the gender composition of students, residents, and practicing physicians over the past 30 years in Canada.

Results: In this cross-sectional analysis of Canadian medical trainees including MD applicants (137,096 male, 169,099 female), MD students (126,422 male, 152, 967 female), MD graduates (29,413 male, 34,173 female), residents by the decade (24,425 male, 28,506 female) and practicing surgeons (total 7,457 male, 3,457 female), we find that increased female representation in medicine is not matched by representation in surgery, with the key being the specialty choice process. The likelihood of female applicants matriculating to medical school was less than male applicants in the 90s (OR 0.92, 95% CI 0.92-0.93), greater in the early 2000s (OR 1.03, 95% CI 1.03-1.04), and has since balanced out (OR 1.00, 95% CI 1.00-1.01), with medical school classes being nearly 60% female for the past two decades. Despite this, females have remained underrepresented in most surgical residency programs, with odds of female medical students entering surgical residency other than Ob/Gyn being about half that of male students (OR 0.56, 95% CI 0.44-0.71), resulting in a slow increase in practicing female surgeons of less than 0.5% per year in many surgical disciplines and projected parity decades or centuries in the future.

Conclusions: While undergraduate medical education has been majority female in Canada for nearly three decades, females remain greatly underrepresented in the physician workforce within surgical specialties. To build a representative medical workforce equipped to care for diverse patient populations, factors influencing the specialty choices of early career physicians will need to be examined and addressed.

Keywords: Canada; Gender; History; Medical education; Medicine; Surgery; Women.

Fig. 1

Proportion of female graduating medical doctors every 5 years since 1940 (A) and yearly since 1990 (B), demonstrating convergence in 1996. (C) Proportion of female applicants to Canadian MD programs. Note MD applicant gender was not reported by some Ontario universities beginning in 2014. (D) Proportion female first year MD program students. Odds ratio (OR) and 95% confidence interval (CI) indicate relative likelihood of female vs. male applicants matriculating, pooled by decade

Fig. 2

(A) Percent female first-year residents in non-surgical and surgical specialties. (B) Odds of female vs. male graduating medical students entering first-year residency in a surgical discipline. (C) Percent female first year residents in each surgical specialty. Grouped bars represent years 1990, 2000, 2010, and 2020 respectively for each specialty or group of specialties. Data from CAPER.

Fig. 3

Percent female practicing physicians across surgical subspecialties, rate of increase in female representation since 1990, and projected year of gender parity based on this trend. Data from CIHI.

Fig. 4

Summary of gender balance in the surgeon training pathway in Canada, illustrated as a pipeline from medical degree to surgical residency to practicing surgeon. Data from AFMC and CAPER 2020/21. *Ob/Gyn not included