Opinion

College must act to ensure equitable health-care outcomes for women, marginalized communities

In December 2021, Christopher Wallis and colleagues published an article in JAMA Surgery with a starkly grim revelation: Between November 2020 and March 2021, women in Ontario who underwent surgery were 32 per cent more likely to die if operated on by a male surgeon rather than a female surgeon and 15 per cent more likely to suffer a negative outcome of any kind. Men operated on by female surgeons, on the other hand, were only 2 per cent more likely to have complications

Though this study’s shocking findings have been shared widely across international news outlets, the response in Ontario is chillingly silent. As Angela Jerath, a co-author on the study said to The Guardian, “This result has real-world medical consequences for female patients and manifests itself in more complications, readmissions to hospital and death for females compared with males. We have demonstrated in our paper that we are failing some female patients and that some are unnecessarily falling through the cracks with adverse, and sometimes fatal, consequences.”

The Ontario College of Physicians and Surgeons has yet to publicly acknowledge these findings, failing to speak to the ways that death is a preventable outcome for women accessing surgeries in the province. This reality not only warrants concerted action but also demonstrates that despite social and political advancements in gender equity, women continue to experience disproportionate harms in the equitable distribution of health-care and positive health outcomes. Though this research reported on people identified via the gender binary, these findings warrant further investigation into the outcomes that gender-diverse people (e.g., two-spirit, transgendered, non-binary and gender-fluid) experience during surgery, given the known barriers faced for these populations when attempting to access primary, emergency and gender-affirming care.

This is a gendered public health crisis and must be treated as such.

These findings verify what women across all social strata have testified to for decades. In fact, Wallis and colleagues’ recent work adds to some members of the study team’s previous work published in the British Medical Journal in 2017. That research found that across Ontario, between 2007-2015, “patients treated by female surgeons had a small but statistically significant decrease in 30-day mortality and similar surgical outcomes (length of stay, complications and readmission), compared with those treated by male surgeons.”

Particularly for Black women, this finding is no surprise. Though Wallis and colleagues’ groundbreaking work does not stratify women’s outcomes based on race, systemic anti-Black racism is a reality across Canada as a whole.

The findings necessitate a significant reframing of the negative health outcomes being presented passively across surgeries and demonstrates that health-care environments are providing differential quality of care, particularly in times of extreme vulnerability. What’s more, we know that “vulnerability” is a destination individuals and communities arrive at through systemic oppression, which produces and reproduces preventable illness and death.

The findings shared by Wallis and colleagues cannot be separated from the broader context of the health-care sector in Ontario. Female surgeons are “paid 24 per cent less per hour of operating time than their male counterparts.” Further, women in the medical field hold significantly less power than their male counterparts, on average, and the issue of gender inequity across medicine is well known.

We must move far beyond the performativity and currency of allyship to concerted “actionship.”

Wallis and colleagues’ work offers a crucial contribution to understanding the ways that oppression actively harms people. While women face significant barriers to practicing as surgeons, women patients suffer worse health outcomes at the hands of surgeons who are men.

And the findings cannot be separated from other inequities in health care. In the context of the COVID-19 pandemic, the inequities in working conditions as well as accessing health care have emerged with disturbing clarity. Black women working in frontline health-care positions are more likely to be employed in precarious, low-paid, unsafe working conditions. As the provincial government continues to vote down paid sick days, has largely privatized COVID-19 testing, and refuses to improve working conditions for groups such as nurses and Personal Support Workers, the devaluation of women – and Black women’s lives in particular – is clear.

The College of Physicians of Ontario has a duty to conduct investigations into surgeries that lead to complications and death. Their silence on Wallis and colleagues’ study normalizes reckless, substandard care.

The College also has a duty to investigate poorer outcomes for marginalized communities. Because oppression is a routine, deadly reality for Black and Indigenous peoples, 2SLBGTQ+ communities, working-class people, people experiencing mental illness, people who use drugs, the elderly and people living with disabilities, there is a shared interest in challenging it. We are all devastated by conditions that undermine our shared right to survive health-care procedures. Because ultimately, as COVID-19, has shown us, we are all much more “vulnerable” than we realize.

It is through solidarity and shared demands for accountability that we can stem the tides of preventable deaths being experienced by patients and health-care practitioners alike. We must move far beyond the performativity and currency of allyship to concerted “actionship.” With that, we ask: What will you do next?

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2 Comments
  • C Wong says:

    It would interesting to see what the numbers are on male surgeons on male patients. Also the breakdown on the types of surgeries performed.

  • Noel Hershfield FRCP Clin Prof U of Calgary. says:

    Where can I find the originals
    There are so many conclusions .What was the pre op health of all patients.Pre op significantly affecting outcome . Urgent,non emergent ,elective? Who did the surgery? Was there evidence of surgical mayham add autopsy if some of them died, what is there evidence of surgical Mayham in those I did not die. What is the age of the patients that died or had a bad results ? Please let me know how I can get a copy this is very worrying publication,.

Authors

Idil Abdillahi

Contributor

Idil Abdillahi is an Assistant Professor at the School of Disability Studies, cross-appointed to the School of Social Work at Ryerson University. She is an internationally recognized scholar, researcher and practitioner across the social sciences. She is the author of Black Women Under State: Surveillance, Poverty, & the Violence of Social Assistance (2022), co-author of BlackLife: Post-BLM and The Struggle For Freedom (2019), author of Blackened Madness: Medicalization, and Black Everyday Life in Canada (forthcoming), and a co-editor of the forthcoming edition of Mad Matters: A Critical Reader in Canadian Mad Studies.

Anne Rucchetto

Contributor

Anne Rucchetto is a writer and researcher interested in structural forces of power and oppression, as well as their manifestation across health-care settings. She has been published widely as a journalist and academic.

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