Why I became a… spinal surgeon

by Iona Collins

A doctor recalls striving to get into medicine in a male-dominated arena 

Location: Wales
Published: Thursday 14 April 2022
Iona small

No doctor decided to become one on a whim; the amount of effort required to qualify as a doctor takes sheer determination. 

Firstly, there’s self-motivation required to explore medicine as a career option. Secondly, we must seek guidance in applying for medical schools and how to gain the relevant desirable attributes to make us competitive at interview. If we’re successful in getting into medical school, we must commit a wealth of information to memory. If we qualify as doctors, we must then choose our generalist or specialist career. I ended up as a spinal surgeon opportunistically and, perhaps, despite what others expected me to do for a career.

When I was in school back in the ‘80s, most doctors at that time were men. I attended a typical Welsh comprehensive school with approximately 2,000 pupils and when I was around 11 or 12, a careers advisor paid us a visit.

A man in a suit turned up and spent short amounts of time with each of us, asking us what we’d like to do for a living. I replied that I would like to be a barrister and he roared with laughter. To this day, I have no idea what was so funny, but I remember feeling humiliated. My ambition to pursue law fizzled out shortly afterwards – probably not solely due to this event, but this would have certainly made me think more deeply about my potential career direction. 

I focused on the sciences after my O levels. I thought I could be a vet or work in a laboratory in some capacity. Some of my friends particularly liked the idea of healthcare and were automatically steered towards nursing vocations. 

My parents were the ones who said a career as a doctor could be a good choice for me. They bought me books, phoned around local hospitals and arranged for me to shadow hospital personnel. I developed a genuine interest in healthcare as a result.

No member of my family had been to medical school or had any social contacts with doctors, so, Mum and Dad must have invested a considerable amount of energy to this. As no-one had experience of applying to medical school, I missed closing dates for entry to certain schools. There was a more generalised application process, however, so I was able to apply, indicating my preferences.

At interviews for various medical schools, I don’t recall being asked anything specifically gender-orientated, but I was asked by one prominent London medical school whether I felt different, since I came from a school whereby only 5% of students pursued higher education. I suddenly didn’t feel so confident.

I think that I had been unintentionally marginalised by that particular interview panel. Anyway, I ultimately accepted a place at a different London medical college and off I went. 

At some point in medical school, students start thinking about what type of doctor they wish to become once qualified. Back in the early ‘90s when I was in medical school, female medical students were expected to be future GPs, along with some medical hospital doctors. the lecturer asked for a show of hands regarding who was thinking about a career in surgery. 

He then asked those who were female to lower theirs, since there was no chance that they would 'make it' and they should think of doing something else instead. Maybe the lecturer was trying to be funny, but this offhand remark had a major impact on me and another female friend who had decided to pursue surgery. We resolved that, damn it, we would prove that man wrong!

I sometimes wondered during my surgical training whether I chose surgery because of my determination to go against the grain or whether I truly wished to help people as a surgeon. My paediatric neurosurgery attachment in Vancouver, Canada, was a definite positive influence on my surgical ambitions as a medical student, but I continued to second-guess myself.

Self-doubt seeds itself subtly. I don’t think I thought that I would ever ‘belong’ to the surgical fraternity, though, with this outsider feeling persisting to this day. It’s the sort of feeling that I’ve come to terms with over the years.

When I graduated, I did my house officer job in St Helier, Jersey. My boss, an orthopaedic surgeon, was great. One day, he casually asked me if I intended pursuing surgery as a career, specifically in orthopaedics, and when I confirmed that this was my secret ambition, he said he’d make a few calls and put in a good word for me.

I felt overwhelmed with gratitude. At the time, there were hardly any female orthopaedic surgeons, although I’m glad to say the percentage has steadily increased to the current level of around 11%. 

I had a good experience in my surgical training overall. Everyone who pursued surgery and then orthopaedics had to work really hard. We all worked extra hours and got scrubbed in on our days off to make our surgical logbooks stand out. We were determined to succeed. For me, as a female, I experienced some additional challenges, which may sound trivial, but for some, may have been the straw that broke the camel’s back.

Before I sub-specialised in orthopaedics, a few of my female colleagues diverted away from a surgical career during their training. I have a sad memory of a junior doctor telling me that she was pursuing medicine instead because she ‘wasn’t loud enough’ to be a surgeon. Since when does having a loud voice influence surgical outcomes? I remained as determined as ever to succeed. 

After gaining my MRCS and completing my SHO training rotation in Oxford, I initially took a stand alone SHO job in neurosurgery in the massive Derriford hospital, Plymouth, before moving to New Zealand for a year as an orthopaedic registrar.

There was a lot to learn, and we had regular teaching sessions, however, since I was the first female orthopaedic registrar to attend this hospital (apparently, the consultant who approved my appointment simply said 'hire the chick'), it just so happened that all the surgical approaches and anatomy books were stored in the theatre male changing room.

I had no option but to buy the necessary books again. I thought nothing of it at the time, beyond the situation being a nuisance. I also didn’t reflect on the fact that the surgeon-specific theatre scrubs were way too big for me. I didn’t take it personally.

At a social function, one of the surgeons’ wives told me she assumed I’d chosen not to have children, since being a surgeon and a mother simultaneously was an inconceivable concept (pardon the pun). 

Upon my return to the UK, I was lucky enough to work between Dundee and Perth, Scotland, learning from truly inspirational orthopaedic consultants before returning to Oxford for my orthopaedic specialist registrar training.  The occasional additional challenges due to my 50:50 random outcome of being born female, however, kept coming.

One day, for example, I was in theatre and the trauma consultant embarked on what he must have thought was an open discussion about why surgery was such a poor career choice for women. I had a female medical student shadowing me at the time. I don’t know why he thought this discussion was more valid than teaching us surgery.

I kept defending my position as a female surgical trainee, explaining that orthopaedics was about brains not brawn, that current theatre equipment negated the perceived advantage of being an ex-rugby player and in the end, he asked me what advice I would give my hypothetical younger sister, if she told me that she was pursuing a career in surgery. I remember replying along the lines of ‘it was essential to have a thick skin’, which ended that debate.

I completed my certificate of training and three spinal surgery fellowships in total over two years, between Oxford, Nottingham and Sydney. One of my prospective consultant supervisors said I should consider getting hired quickly before I got pregnant. I was unmarried at this point and hadn’t contemplated starting a family, but others were clearly family planning on my behalf. 

When I gained my first consultant post in Nottingham, I can’t explain to you how guilty I felt when I informed my colleagues that, despite my relatively advanced age, I was going to try for a baby. I had no idea whether I would conceive, but I truly felt I was letting my colleagues down. I have no idea how my colleagues felt about this, but I didn’t witness any negativity.

On the contrary, one of my consultant colleagues double-scrubbed with me for the longer scoliosis cases during my third trimester. I worked up until two weeks of my expected delivery date without any issues and my colleagues were great. 

My next consultant post was a consequence of finally returning home to South Wales. I have a large family and most of my relatives live in one area along the Neath Valley. So, when Swansea’s Morriston hospital announced it was going to have a brand-new spinal unit, I applied to be one of its founders. 

I’ve settled into my consultant role and since had another child. I’m happily married to a non-medical and massively supportive husband. I sometimes receive invites to deliver talks as an invited guest at meetings, with most of them being in relation to the fact that I’m female.

I’ve delivered lectures about imposter syndrome (yes, everybody has this to a greater or lesser extent), psychopaths, the paradox of empathy on the one hand and cutting people open on the other, along with potted histories of my journey to becoming a surgeon. More recently, I’ve taken an active role with the BMA, where I’ve been welcomed with open arms. If you ever think about engaging with the BMA as a representative, just do it. I promise that you won’t regret the decision.

Today, after all these years, you’d think that I’ve earned my stripes. As a consultant, when I do my on-call ward round, patients who haven’t previously met me, automatically talk with my male trainees.

I will often do odd jobs for patients on the wards who call to me “nurse! nurse!” I’ll wash my own cup after making my own coffee, sometimes along with those that my male colleagues have automatically left for me too. Sometimes, when I’m on call and I introduce myself, with my name and job title clearly marked on my scrubs, I’m still asked by patients when they are likely to meet the surgeon.

I get it, honestly. They’re often terrified, in an alien environment, with a small percentage of verbal communication being absorbed. The last thing I want to do is make them feel embarrassed or awkward in addition, so I apologise for not introducing myself more clearly. I also routinely give a potted history of my experience as a spinal surgical consultant.

Everybody who trains to be a surgeon must have a bucket full of determination to achieve. I wonder, though, whether women who decide to train as surgeons need slightly larger buckets of determination.

All I can say to women who think that surgery is an attractive career choice is that gender does not influence surgical outcomes. One day in the future, I have no doubt that there will be a relatively even spilt between male and female surgeons and when that time comes, I believe that we will have normalised surgery as a career option for both men and women. I hope I’ll still be around to witness this.

Iona Collins is a consultant orthopaedic spinal surgeon at Morriston Hospital, Swansea