I always thought I was quite well-informed and aware of workplace discrimination, especially being a female surgeon in a male dominated field. However, I recently learnt that I clearly had no idea how bad things really were!

I was invited onto the review panel, reporting on the Royal College of Surgeons of England’s diversity within professional leadership, and it was the most eye opening and humbling experience of my life so far. I got to hear first-hand accounts from people who had witnessed or been subjected to life-long, or career-long, discrimination.

What struck me most was how subtle some of it appeared to be to outsiders or those not in the firing line, when actually it wasn’t subtle at all to those on the receiving end. The constant micro-aggressions that some people have had to endure on a daily basis were hard to hear. Listening to the responses from those in positions of power, that ‘getting to the top should be about meritocracy’ and ‘surgery is just about working hard’, was even harder to hear. Many felt that we should not have quotas or give certain people a helping hand and that it should all be based on skill and merit. But I have realised that there is no such thing as meritocracy if the playing field that we are all starting on isn’t level in the first place.

While carrying out the review we, as a panel, quickly realised that a lack of diversity when it came to leadership positions, across all sections of surgery, was having a huge impact. If individuals could not actually see themselves, or people like themselves, in leadership roles, then the vast majority assumed ‘it’s not a role for us’.

Females are still vastly outnumbered by males in surgery and the gender pay gap report (by Dame Dacre and Prof Woodham) has shown that even if women take no time out, work full time, don’t have children and are matched like for like exactly with a male, they still earn significantly less than their male counter parts. The report also highlighted that Black and Indian doctors earn far less and progress less quickly than their White peers. This is irrefutable evidence that the playing field is most definitely not level.

Another finding from the panel was that the problems started before even embarking on a surgical career. Students don’t even apply to medical school if they don’t think their socio-economic background fits the picture they see of the surgeons that they might have wanted to emulate. This was something I personally struggled with, as I come from a single-parent, low-income background and I was in the minority applying for medical school, let alone surgery. In 2019, the Sutton Trust found that only 6% of UK doctors were from working class backgrounds. Students and trainees don’t apply if they think they are the ‘wrong’ gender, race, sexual preference, background or even have the ‘wrong’ accent. None of those factors should stand in the way of becoming a surgeon. Again, where is the level playing field so that we can all talk about meritocracy?

I’ve realised, thanks to the people willing to talk openly to the panel, that it is incredibly unfair to say ‘one just needs to work hard to get into med school, surgical training and consultancy’. There are so many extra hurdles that some individuals will have to jump that it must seem impossible at times.

Gathering evidence with this panel really helped me to see that just because we don’t always hear or see first-hand direct racism, sexism or discrimination in some form, doesn’t mean it’s not happening. And to respond with ‘well I’ve never seen that,’ or ‘it doesn’t happen where I work,’ or ‘my hospital/institution/organisation is not discriminatory,’ is just not acceptable. It belittles and negates the experiences faced by those individuals who are suffering on a daily basis. If this is or has been your response, I would argue that it is more likely you are simply not in the minority demographic so are not truly aware of the situation or micro-aggressions that go on around you.

However, it’s not all doom and gloom. I feel really positive about the fact that the report was commissioned in the first place; it was a brave move by the President of the RCS of England as it opened up the college and surgeons in the UK to huge criticism and put them under great scrutiny. The fact that the report was called for by a few of us college council members and the college listened and paid for an independent report to be carried out, means that there is an appetite for change, even at the top level.


Miss Victoria Pegna MBBS MSc MRCS
ST7 Colorectal & General Surgery, KSS Deanery
Member of Council; RCSEng
Co-founder of sustainability in surgery (SiS) committee RCSEng
WinS Committee Member


Links to articles and reports:

The Gender Pay Gap Report https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/944246/Gender_pay_gap_in_medicine_review.pdf


RCS Eng Professional Leadership Diversity Report



Women in Surgery