Female plastic surgeons need more equitable representation in leadership roles, according to an op-ed in Plastic and Reconstructive Surgery.

"Women bring unique qualities to leadership, yet there remain barriers to gender equality," according to the article by five leading women plastic surgeons. "Our failure to attract, nurture, and sustain women for leadership positions significantly reduces the talent pool of capable leaders in plastic surgery," writes Debra J. Johnson, MD, of The Plastic Surgery Center in Sacramento and colleagues.

What has gone wrong? It isn't sexism now, but in the past there were a lot more men. They weren't all fired to make room for women, that would be equality doublethink, and even today only 14 percent of plastic surgeons are female. Advocates insist women are somehow less mentally strong than men so if they don't have equal numbers in surgery, women will be intimidated and drop out. Currently 32 percent of plastic surgery residents are female so reality does not match up to beliefs about the emotional fortitude of women. And 25 percent of  the ASPS Executive Committee is female, so women are over-represented there. Unless competence and willingness to participate matters more than gender, in which case the gender percentage is no big deal.

The authors argue that there are both intrinsic and extrinsic barriers to leadership positions for women plastic surgeons. Intrinsic factors include differences in career aspirations and a confidence gap - women are hesitant to seek promotion. Extrinsic factors are more legitimate, because those include women's continuing disproportionate responsibility for family and home duties. They speculate about "role incongruity," where women in leadership roles may be viewed as less competent due to gender-role stereotypes, but provide no evidence it exists in 2016.

"While women leaders may not be as popular as their male counterparts, there is actually no difference in their effectiveness as leaders," Dr. Johnson and coauthors write, despite showing evidence for it, and then, "In fact, women more often exhibit leadership styles that are associated with greater effectiveness," also without evidence.

The authors call for increased mentorship opportunities for women, education on promotion criteria and equal pay for equal work, and institutional support to ease conflict with family responsibilities. They also encourage women surgeons to take active steps to prepare themselves for leadership roles, such as seeking mentors and regularly discussing their career progress with supervisors.