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Page 81 Capelli et al. Art Int Surg 2023;3:80-9 https://dx.doi.org/10.20517/ais.2022.40

transformed work environment could benefit surgeon and staff productivity and ultimately improve patient care.

Keywords: Work-life balance, women surgeons, gender equality, career, invisible work

INTRODUCTION
Despite a growing number of women choosing to pursue surgical specialties , surgery is still perceived as a
[1-4]
[2-5]
woman-unfriendly career by an alarmingly high number of healthcare professionals . One of the main
reasons for this lies in the difficulties of conciliating a demanding career with the requirements of both
[6-8]
personal and family life . On the one hand, women have traditionally been considered responsible for
childcare and household management, irrespective of their career choice . It is well acknowledged that
[9]
women, even working ones, often take responsibility for a number of tasks that are connected to family,
house management, and caregiving [10,11] . This has been known since the eighties; in 1987, Professor Arlene
Kaplan Daniels coined the term “invisible work” to define this set of tasks that are both unpaid and
[12]
unacknowledged. On the other hand, the choice of a surgical career should not prevent women from being
partners and mothers; career choice should not limit women or be an obstacle in their path to self-
realization [13-15] . Maternity leave policies remain highly variable across different countries and institutions,
particularly for residents, and lack of institutional support for pregnancy and childcare has been pointed out
as a possible reason for the dropout of women surgeons [16-18] .

Since the nineties, many authors have attempted to investigate the main problems women face in
conciliating their surgical career with personal and family life, with the dual aim of accessing the true extent
[19]
of the problem and proposing solutions . At first, the authors mainly focused on practical issues,
advocating for the allowance of longer maternity leaves, time off for childcare, the creation of childcare
facilities within hospitals and academic institutions, and the implementation of paternity leave [7,9,19-23] .
Recently, women surgeons have been advocating for a further change in mentality, questioning the very way
in which productivity is understood in surgical departments [24,25] . Working long hours on someone else’s
schedule does not allow for work-life integration and, more importantly, does not necessarily enhance
patient care [6,25,26] .

During the last few decades, associationism has been pivotal for women surgeons as a means to share
common problems, find solutions and support their empowerment and leadership in a male-dominated
field . In Italy, Women in Surgery Italia (WIS Italia) has promoted female leadership in surgery since its
[27]
foundation in 2015 through the implementation of many initiatives, including a mentoring program
targeting female students and surgical residents . A strong interest in surgical research, along with a
[28]
profound involvement in the #HeforShe movement, has led the association to become a partner of Artificial
Intelligence Surgery (AIS). In previous studies, the research board of WIS Italia has analyzed the potential of
AI as an equalizer for women surgeons [29,30] ; our results support the relevance of research and technology in
reducing the gender gap, which still exists in both clinical and academic medicine. In particular, it is pivotal
to create an active network of people who are passionate about promoting diversity in surgical departments,
possibly through the implementation of technologies that can mitigate the numerous disadvantages and
challenges still faced by both women and minorities pursuing a surgical career [31,32] .

In this context, the current study aimed to summarize existing evidence on the issue of work-life balance for
women surgeons, particularly focusing on possible strategies to improve it, including changes in surgical
department structures and work schedules. Artificial intelligence (AI) has also been investigated as a
possible means to close the gender gap, acting as an equalizer for women surgeons.

Women surgeons and family life