Women in Academic Surgery

From the 10/23/2020 newsletter

Interview

 Women in Academic Surgery

 

Eileen Peterson – Transformational Times Associate Editor

 

Surgery has historically been a male-dominated specialty, and the rewards and challenges facing women in general surgery were addressed in a recent article in Academic Medicine. Associate Editor and MCW medical student Eileen Peterson spoke to the authors and an MCW surgeon to learn more …

 

 In the October, 2020 issue of Academic Medicine, Dr. Rachel Greenup and Dr. Susan Pitt wrote about the challenges women face in academic surgery in their article, “Women in Surgery: A Double-Edged Scalpel.” As a medical student, it is eye-opening for me to take a step back from studying enzymes and drug mechanisms to consider the difficulties that might arise in my near future. That was certainly the case with this article, a quick and important read for anyone who is interested in surgery, is currently a surgeon, or who cares about female surgeons.

 In their commentary, Drs. Greenup and Pitt discussed challenges that many female surgeons face; this can include underrepresentation, mistreatment, social norms, and structural biases within surgical culture. They also discuss a call to action, which has arisen in part from social media movements such as #ILookLikeASurgeon and #NYerORCoverChallenge.

 Both authors are alumni of the Medical College of Wisconsin: Greenup and Pitt both attended medical school at MCW, and Greenup also completed her general surgery residency at MCW. When I was invited to take on this piece, I jumped at the opportunity to connect with and learn from two former-MCW-students-turned-badass-female-surgeons. I reached out to Greenup and Pitt, and they graciously agreed to an interview about their article and their personal experiences being women in surgery. Since Greenup is at Duke and Pitt is at UW-Madison, I also connected with Dr. Sabina Siddiqui, a pediatric and critical care surgeon at MCW.

 These women have been an incredible resource, and it is clear they all share a great passion for their profession. I was able to conduct two separate interviews via Zoom, the first with Drs. Greenup and Pitt and the second with Dr. Siddiqui. These calls were informative and engaging. I have shared some excerpts from both calls below.

 

 

Was it a difficult decision to choose surgery?

 Dr. Sabina Siddiqui: It was hard not to choose surgery. It doesn't matter who you are – whether you're male, white, brown, purple. If you can find anything you like half as much as you like surgery, then you should totally do it, because your life will just be easier, and your training will be shorter. What's cool about surgery and what binds us all is the fact that you really don't feel like you could do anything else. It's a passion and a love.

 Dr. Susan Pitt: I have actually been quoted more than once saying ‘If it weren't for my dad, I don't think I'd actually be a surgeon.’ My father was a tremendous surgeon and influence on my decision to become a surgeon. If I didn't have his strong influence, I am not sure I would have gone into medicine. Because of my other interests, I lean more toward the art of medicine than the science. I don't think I'd ever go back and do something differently. I love what I do.

 Dr. Rachel Greenup: The closest I got to quitting residency was as a second year on my transplant rotation. I had a 10-month-old baby at home that I had not seen in four days, and told my husband to bring him to the hospital so that I could feed him. He offered to bring me lunch and a visit from my baby, but showed up with the sub sandwich alone. I literally started crying in the middle of the Froedtert Hospital cafeteria thinking, ‘I don't want your damn sandwich, where's my baby!’ There were definitely messy, hard times. It is difficult, but rewarding work. You have to love it.

 

 Talk about the feeling of “perfectionism.”

Pitt: [During residency and fellowship], I had this need to be the best in my class. I drove myself into the ground trying to be perfect. I initially went into transplant surgery. It was something I loved, but struggled to love every last moment. I decided to change my focus to endocrine surgery and ended up getting divorced in the middle of my transplant training. It was like I was playing this Jenga game and someone pulled out one small, wooden bar and everything crumbled down on me. I started over from the beginning. My outlook on life changed a lot after that because I don't try to be perfect anymore. You have to let some of that go or you will drive yourself insane.

Greenup: Women are expected to be flawless, and when they are not it overshadows their prior accomplishments and successes. When men are imperfect, the quality of their written work, grant funding, and reputation are not forgotten.

Siddiqui: What's fascinating is the dynamic changes as you go up higher in the echelon. As a female professional, you walk a pretty fine line.  As you advance in the ranks, student to resident to fellow to attending, that power differential increases and that fine line gets finer and finer. And your ability to misstep becomes much, much more plausible.

In my fellowship, I had an African-American female attending. Amongst the trainees, there was a lot of commentary on how particular and slow she was in her decision-making. I had the opportunity to chat with her, and she pointed out that as the only Black and the only female attending, she felt that she had to avoid mistakes at all costs. That any mistake that she rendered in addition to being interpreted as a judgment error would also carry with it the connotation of, ‘Did she really belong here? Did she only get in because of her differences? Was she as skilled [as her male counterparts]?’ I don't want to make it sound like it's this monster that sits on our back, because it doesn't. Our jobs are full of joy and so very damn cool. But, it is an underlying concern that colors how you make decisions.

 

 What makes a good mentor?

Pitt: Find someone that can be a champion for you. Don't be hesitant to ask. Most of the students that I mentor closely, came and found me. It is intimidating to find a faculty member who you just cold email or walk right up to during a meeting. We've all been there, and we're all very receptive. If the potential mentor you approach is not receptive, then maybe you don't want them to be your mentor anyway.

Greenup: Your mentors should want you to be truly happy, regardless of what path you choose to go down.

 

Tell me about how you manage work/life balance.

Greenup: I have a little sticky note on my bulletin board that says, “Family, patient care, mentoring, research.” I often look at it to remind myself what really matters. Our patients want us to take incredible care of them, but they also really want us to be human. You have to continue to find ways to center yourself.

 

What difficulties did you face along the way during your training? Do you face the same difficulties now as you did then?

Pitt: I think difficulties change a little bit. Particularly for women, age bias gets coupled with gender bias. Some older patients will say, “I don't think you were born when this happened.” And I'm like, “Maybe I wasn't, but I'm plenty well trained to do your operation.”

Greenup: Surgical culture has a difficult time reconciling kind, strong, vulnerable women with what they think of as surgical leaders…they don't know where to put you.

Siddiqui: I was one of two females in my residency class. There was a super cool fourth year female surgery resident and one female surgical attending where I trained. So, was that difficult? It wasn't until recently that I started thinking about it [surgical residency] as being any more or less difficult than anyone else who was doing surgery, mostly because it [women and their challenges in their field] wasn't part of the conversation.

 

Do you have any comments on the attrition of women from surgery?

Greenup: It is hard to know what to expect from surgical training until you get there. If you actually step back a little, it is not surprising that surgery has a high attrition rate when people are asked to work long hours, make significantly less money than their peers, not see the outside world or their families, and continue to perform in a highly critical environment.

Pitt: I think everybody sees [surgery] as a step-wise training paradigm that has to happen or else you're out. It's a very messy game. We have these unrealistic ideals in the past – if you want to be a chairman, you have to [follow] all these perfect steps. It's just not true. There are extremely talented surgeons out there who didn’t match because of their ponytails or tattoos. Luckily, the culture is changing, but it's just a slow change.

 

What has changed over the years?

Pitt: A lot of things have changed quickly in the last few years. We now have a maternity leave policy and have identified lactation rooms for our residents. Previously, it was like, “Oh, you need a refrigerator for your breast milk? Wait, you need your own room to breastfeed?” Those “luxuries” weren't available to a lot of women in the hospital. It took a lot of changes at many levels and at many institutions around the country to make breastfeeding easier for trainees and faculty.

At UW, within the divisions that make up General Surgery, the gender composition is over 50% women. That's very unusual in surgery where women are actually the majority. Eventually, I think there will be more gender parity particularly with who goes into different specialties. However, some of that change will be slower to actually realize, because people have to go through the many year training process.

 

What techniques or strategies have you learned along the way to deal with gender bias?

Pitt: I reply to people who make biased statements with inquisition like, “Oh what makes you say that?” It gives them an opportunity to explain.

Greenup: I have outlets that are non-medical; I read a lot. I am a runner. I spend a lot of time in nature. I have a wonderful family, great friends, and colleagues who I can candidly talk to about the challenges of being a surgeon, mother, and human being. You have to be really aware of who you are and what you need to be happy in this career.

 

What recommendations do you have for medical students, current residents, and other female surgeons?

Greenup: We ask medical students to choose their life’s work based on a single rotation – almost like asking you to marry someone you dated for a month. So, I encourage students to talk to faculty early and often to really get a sense of what your life will be like when you finish surgical training. If you work hard and are good at what you do, you can create the professional life that you want. For example, there are surgeons that do global surgery work and spend six months a year abroad. Rural surgeons. Locum surgeons, Academic surgeons and private practice surgeons. Contemporary surgical practices are different than they have been in the past.

Pitt: Be yourself. For a long time, I tried to be who everybody else wanted me to be. That led to my unhappiness. I am finally comfortable with who I am and my personality being a little different. There is no one way to become a successful academic surgeon. Everybody used to think you had to do step A, then B, then C, then D, but actually there are many different pathways to success and many different definitions of success.

Siddiqui: There will be moments that people will, even unintentionally, tell you things that are discouraging, like, "Oh well, surgeons can't have good family-life balance," or, "You'll never be able to be a mother." Surgery can be a source of joy, and the women surgeons I know who are mothers say they're better mothers for it. So, not taking those statements at face-value is A: the most important thing. But then B: be strategic.

You need a tribe. These are the people you can go to and say, "Oh my god, you won't believe what he said to me about women and PMS today." Or you can say, "Ugh, I got called a nurse again." Your tribe that you can vent to and release some of the angst that builds up.

You also need your allies. If I have something that I feel really strongly about and I don't feel like I'm being heard, I reach out to these allies to amplify my voice.  These are usually older, White, male colleagues that I reach out to. I've even had them come into the OR to validate what I'm doing. I don't get angry about it per se. I just need to be able to take care of my patients in the best way possible, and this is a strategy that works. These gentlemen validate what I'm saying, what I'm doing, to people who need to see it come from someone who looks like them.

The third is your mentors. Your mentors are the ones who are going to help you build your strategy and build your success. And that mentoring group is going to change as you change through your levels. So, it's very important to kind of keep your eye on who those people can be and what they can bring you.

 

Other resources to check out:

· #MedTwitter

·  “Sticky Floors and Glass Ceilings” – Caprice Greenberg’s 2017 presidential address at the Association for Academic Surgery

·  “Harvard Business Review: Women at Work” Podcast

·         Read

o   “Untamed” – Glennon Doyle

o   “Gifts of Imperfection” – Brené Brown

o   “What Got You Here Won’t Get You There” – Marshall Goldsmith

·         Research

o   “The State of Diversity in American Surgery”

 

 

Eileen Peterson is a medical student in the MCW-Milwaukee class of 2023 with interests in diversity and inclusion, medical humanities and student wellness. She is an Associate Editor Kern Transformational Times newsletter.