Level 4, 18 North Tce, Adelaide SA

Purpose

  • Following the cessation of the use of gendered titles for surgeons by the WCH, there is a compelling case for the AMA to support phasing out gendered title throughout Australia

Recommendation

It is recommended that the use of gendered titles by surgeons working in Australia cease.

A non-gendered approach to surgeon’s titles would not only be less confusing to patients but would provide a powerful message of inclusiveness to staff, patients and the community it serves.

Discussion

  1. Background

The use of the term ‘Mister’ for surgeons’ dates to the 16th Century when ‘barber surgeons’ performed operations at the direction of physicians. The pre-nominal Mister distinguished the barber from the university-trained physician ‘Doctor’ (Loudon 2014). This tradition was retained and championed as a label of status by the Royal College of Surgeons of London when established in 1800 and perpetuated by its members in the UK and Australia.

Surgery is the only profession that continues to use these confusing gendered titles. State and Australian police forces have moved to ‘police officer’ and the Australian Defence Force no longer uses gendered titles. In business, standard boardroom use the gender-neutral Chair or Chairperson (Neuhaus 2018).

There has been increasing recognition amongst surgeons that gendered titles are discriminatory and divisive (Neuhaus 2018). While many prominent surgeons, including the last two Presidents of the RACS, have called for all surgeons to be referred to as Doctor, progress on the issue has been slow.

Approximately 12% of surgeons in Australia are female. This proportion is highest among paediatric surgeons and lowest among orthopaedic surgeons. Women outnumber men in the medical student population and around a third of RACS surgical trainees are female (McDonald 2013).

All female surgeons in South Australia are referred to as ‘Doctor’, while male surgeons are referred to as ‘Mister’ in two-thirds of cases, and ‘Doctor’ in one-third of cases (WCHN excepted from February 2021).

There is variability amongst the Australian states on the matter; ‘Mister’ is very common in Victoria/Tasmania, with over three quarters of male surgeons electing the title, and much less common in Queensland with less than half male surgeons electing the title. In Victoria, many female surgeons us the title Miss or Ms (Neuhaus 2018).

  • Current status risks

Gendered titles are confusing for patients, referrers and the community as they create the perception that Dr X and Mr Y have different qualifications despite both being surgeons in the same department (Truskett 2015). This is compounded by the reality that many patients still question the qualifications of female surgeons (Bruce et al 2015).

While overt discrimination is no longer legally tolerated, this more subtle implicit bias is somewhat surprisingly still practiced and upheld. The obvious and inherent gender perception bias persists despite current gender discrimination legislation (Chapman 2015, Kaatz 2014).

It is well-recognised that gendered language has an effect on attitudes (Harris 2017). Societies that use gendered language display greater gender inequality than those with gender neutral language. Language especially plays an important role in moulding attitudes toward gender and occupation. Women are significantly less likely to apply for a job advertised with a male suffix (-man vs –person) (Bem, 1973).

Gendered language is not benign. Language bias has real and measurable consequences for individuals and society (Vigliocco 2005).

  • Opportunity

As a result of the recent Parkinson Report (WCHN, 2020), into a governance issues at the WCH, a recommendation was made that the use of gendered titles should be phased out at the WCHN. “A non-gendered approach to surgeon’s titles would not only be less confusing to patients but would send a powerful message of inclusion which would be more than symbolic.”

This recommendation was accepted and the phasing out of surgeon’s use of ‘Mister’ is being achieved by no longer using gendered titles in WCH correspondence, on the WCH website or on nameplates and name-badges.  Furthermore, all new WCH surgeons are welcomed as ‘Dr’. It is worth noting that this reform has been a simple, easy deliverable, at negligible cost. The undebatable long-term benefits dramatically outweigh any possible downside.

Conclusion

In South Australia, approximately two-thirds of male surgeons elect to use the title ‘Mister’ over ‘Doctor’ while all female surgeons are titled ‘Doctor’. These gendered titles are inequitable, divisive and confusing for patients, and not in keeping with modern standards to encourage diversity and respect (Neuhaus 2018). We propose that the AMA support the cessation of the use of gendered titles.

Authors

Anthony Porter (Adelaide Plastic Surgery)

Amy Jeeves (WCH Plastic Surgery Unit)

Claire Parkinson (Opportunity Knocks)

References

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Chapman EN, Kaatz A, Carnes M, ‘Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities’, J Gen Intern Med. 2013;28(11):1504-1510.

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