Abstract
The stereotype of the privileged white male surgeon is a strong, and almost unshakable one. The problem is less that privileged white men choose to become surgeons and more that opportunities are denied to people who don’t fit neatly into that category. The data speak for themselves, certain groups are underrepresented. But data on how that happens can be hard to accumulate. In fairness, the Royal College of Surgeons has openly discussed the problems in surgery and the need for greater diversity. The question now, though, is whether the college can transform its record on representation.
One area of focus needs to be the MRCS examination. Recent data suggest that, after adjusting for academic attainment, being male and from a fee-paying school are independent factors for success. 1 Being black or Asian means trainees are less likely to pass MRCS than white trainees. The data are clear and the responsibility now rests with leaders in surgery and professional societies and associations to eliminate the bias that is damaging to staff and to patient care.
New issues of prejudice and discrimination in medicine and health are raised almost every week. The same applies to the pressures in primary care. With rising demand and fewer staff to meet it, consultation times are increasingly squeezed. Any new model of primary care must consider what the optimal consultation time should be since covid-19, 2 multimorbidities, and increasing administrative demands mean that more needs to be done at each appointment. 3 The stereotype of a general practitioner coasting through surgery and day visits, enjoying optimal work life balance, may never have been true but couldn’t be further from the truth now.
The Royal College of General Practitioners is vocal in its call for reform of primary care. Professional societies and colleges can be relied upon to speak up for their members, just as readily as they can be expected to produce clinical guidelines. While they can be trusted to argue for the best deal for their members, medical associations are less reliable in the quality of their clinical guidance. The main reason is the entanglement of financial interests. One solution would be to ensure that all members of guidelines committees are free of conflicts of interest, but that might be impractical, ignore people with expertise, and miss the experience of industry. As hard as it might be, though, addressing conflicts of interest is central to making guidelines trustworthy and a way forward is possible. 4
The stereotype of a medical association, demanding better rights for its members while benefiting from industry sponsorship of its outputs, is one that medical associations themselves must change.