Take 3: Comments from a Leader and Vascular Surgeon

 From the 10/23/2020 newsletter

Take 3: Comments from a Leader and Vascular Surgeon

 

With Julie Freischlag, MD - Former MCW faculty member and President-Elect of the American College of Surgeons

Julie A. Freischlag, MD, FACS, FRCSEd(Hon), DFSVS is a former MCW faculty member. Over the course of her career, she has broken new ground by serving as Chief of the Zablocki VAMC Surgical Service, Chief of Vascular Surgery at UCLA, Chair of Surgery at Johns Hopkins, Vice Chancellor for Human Health Sciences and Dean of the School of Medicine at UC Davis, and CEO of Wake Forest Baptist Health and Dean of Wake Forest School of Medicine in Wake Forest, NC.

 She serves on the Executive Board of the Association of Academic Health Centers, the Council of Deans of the Association for American Medical Colleges, the Aga Khan University Board of Trustees, the University of Pittsburgh School of Medicine Advisory Board, the University of Illinois Health Advisory Board, and the American Hospital Association Changing Workforce Task Force.  She is the 2020–2021 President-Elect of the American College of Surgeons (ACS) and will be installed as ACS President in October 2021.

 Despite her administrative responsibilities, she still spends time in clinic and the OR, offering her expertise in the surgical management of thoracic outlet syndrome. She is also an attentive wife, mother, stepparent, and friend. She took time from her schedule to talk about mentoring, resiliency, and work-life balance.

She was interviewed by her medical school classmate and Editor-in-Chief of the Transformational Times, Bruce Campbell.

 

 

Question 1:  You have a reputation as an engaged and positive mentor for both men and women in medicine. How do you approach your role as a mentor for women who are contemplating demanding specialty careers?

 

I always tell students and residents to “Go to your passion.” As they rotate through services and specialties, I tell them to look to see if they are passionate about the disorders and diseases that the specialty treats. Mentors are great, but the student must look beyond whomever is their inspiration and see if the career holds the things that most love. Some specialties are particularly demanding of time and attention. The student should not be afraid of the demanding specialties, particularly if it is their ideal fit. If they do, they will spend years wondering if they made the right choice. 

 

Next, I tell them to “Be the best you can be, whatever it is.” I want them to understand that they will spend the early part of their careers doing whatever they can do to be great. I tell them, “Energy gets you competent. Then you get competent.” 

 

That said, I believe that COVID-19 might change how even the most demanding specialties are practiced. We are getting more accustomed to doing some of our work from home, to virtual visits, and to shared responsibilities. We might see less need for exhaustive daily rounds and face-to-face time. This type of change might be particularly valuable for dual-MD couples and people with shared childcare duties. 

 

In fact, I tell my surgical colleagues who over-engage to take it easy. If someone is sending emails at 3:00 in the morning, what does that tell trainees about our specialty? Does that sort of behavior tell trainees that we don’t trust them? Who would want to go into a field where that kind of intensity is normal?

 

Question 2: What are the opportunities for creating learning environments for students and residents that will propel learners successfully into their careers? How can we help students and trainees see the value of self-care over the long haul?

Back when I was in training, that seemed the furthest from anyone’s thoughts. Basically, it seemed liked we were engaged in the survival of the fittest and it was assumed that those of us who survived would do okay. That, clearly, was not the case.

 

We were all concentrating on self-care when COVID-19 hit. The virus has made us all rethink how we will model and practice self-care. We will all have to reacclimate to being in the same space again; our pre-clinical students were anxious about working with standardized patients and sitting together in classes.

 

I tell students that they need to “learn” their own space. I ask them, “What do you do that helps your relax, but is also easy?” For many, this includes, exercise, family time, hobbies you can continue over a lifetime, music, or writing.

 

Despite my schedule, I try to model self-care. I concentrate on what is important. I talk with them about how they find their “peaceful times.” We have an Office of Wellbeing that offers a weekly wellness newsletter, strategies, and activities. We organized virtual yoga and meditation sessions.

 

Another surgeon recently talked about how she wakes up each morning to spend a few minutes being thankful and happy about a few things. She lets go of things she can’t control. I tell trainees that it is futile to spend time beating down a door that is closed. Don’t even go in through the window. Find another door.

 

Finally, I cannot believe how quickly time has flown, but I have tried to pay attention to how I feel and to take care of myself. It’s a marathon, not a sprint. I try to help trainees see that we all are better when we work together.

 

 

Question 3: You have worked as a faculty member, department chair, dean, provost, and medical system CEO while maintaining your surgical career and raising a family. What do you tell others who are considering leadership trajectories about handling multiple roles?

 

Handling the challenges of work-life balance differs depending on your phase of life whether you are in a leadership role or not. I remember back at MCW, I was deep into a complex vascular case when my son’s childcare center called and said he was sick. I reached out to one of my partners who graciously came and finished the case. I told the family what had happened. When I stopped by to see the patient the next day, his first question was, “Is your son okay?” You see, people will understand if you tell them what is happening.

 

As he grew, I build my schedule around his whenever possible. I was a timer for his middle school basketball team. I went to his games. I took time out for family. As one of my MCW mentors told me, “Taking the kids to the swim party isn’t as good as staying to watch them.” I never forgot that.

 

I’m not saying it is easy. I actively managed my schedule. I took time to be organized.

I learned to say, “no.” It has been very rewarding and great fun.

 

Kaleidoscope is Partnering with the Milwaukee Bucks to Offer a Virtual Session

From the 10/23/2020 newsletter

 

MCW Kaleidoscope Announcement

 

Kaleidoscope is Partnering with the Milwaukee Bucks to Offer a Virtual Session

Adrienne German

REGISTER HERE 

 

Kaleidoscope is back!  After an eight-month COVID-induced hiatus, this first program back looks to be terrific.  While Kaleidoscope events have typically used film as a mechanism to explore diversity, the virtual world allows for new ways to connect and reach a broader audience across all schools and campuses.

Tune in on Thursday, October 29, 2020 from noon – 1:00 p.m. CT for “Confronting Racial Injustice: The Change Begins with You.”  In this virtual session, members of the Bucks organization will discuss the bold decision that the Bucks players made to boycott their play-off game against the Orlando Magic this past summer to demand justice for Jacob Blake and action from the state legislature regarding police accountability. The discussion will be led by Arvind Gopalratnam, Vice President, Corporate Social Responsibility and Kareeda Chones-Aguam, Vice President, Partner Strategy and Management.  

Although not everyone has as large a platform as the Milwaukee Bucks, everyone can still have an impact.  The October 29^th session will align with MCW's mission to becoming an ant-racist institution and teach people how to become an ally/accomplice against racial and social injustice.

 

Adrienne German is the High School Outreach Coordinator for the MCW Office of Academic Affairs.

 

Editor:

Kathlyn E. Fletcher, MD MA is a Professor and Residency Program Director in the Department of Medicine at the Medical College of Wisconsin. She is a member of the Curriculum Pillar of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

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.

What to do when it is your turn [and it is always your turn]

From the 10/23/2020 newsletter

Director’s Corner

 

What to do when it is your turn [and it is always your turn]

 

 Adina Kalet, MD MPH

 

 This week Dr. Kalet celebrates our focus on women in medicine by reflecting on what it has meant to be an underrepresented “minority” in medicine and what to do when it is your turn …

  

 "Women belong in all places where decisions are being made. It shouldn't be that women are the exception."

-Justice Ruth Bader Ginsburg

"There's a special place in hell for women who don't help each other!

-Former Secretary of State Madeleine Albright

 

One of my favorite things to do at MCW is study the class pictures lining the hallways of the ground floor of the medical school building. From the earliest days of the 20^th Century, MCW and its predecessor institutions created photographs of graduating classes – not surprisingly, all white men for decades – year after year – generation after generation. Starting about a quarter of the way along the length of the hallway, a few clusters of white women begin to appear, often wearing the habits of religious orders. Further down the hall, the first Black face, a man, in a sea of white male faces with a smattering of white women. Eventually there are Black female faces. And so, it goes, making starkly obvious that acceptance for women and people of color into the ranks of physicians is a very recent, evolving, and slow phenomenon.

I care deeply about our continued progress, which makes me ask: What was it like for those first women pioneers? How much better did they need to be? How fiercely defiant were they of low expectations for academic achievement? How much effort did it take to resist the pressure to conform to gender role expectations – to be considered “good enough”?

 

Being a pioneer

Over the course of my career, I have learned a great deal about being the “only one.” Early on, I ran the gauntlet daily. I regularly dodged being backed up against the wall while on rounds or touched inappropriately in the OR by male residents and attendings – all in “good fun.” I knew I risked being dismissed as the “bitch” when I insisted that junior teammates be accountable to me as they discharged their patient care duties. Being the “only one,” meant remaining appropriately humble as I informed patients, family members, and colleagues that I “was the doctor” and I “was in charge,” not the very tall, much older (he was an MD/PhD) intern standing behind me. To his credit, he regularly reinforced my leadership!

Once patients accepted that I was the doctor they, as often as not, expressed relief and delight. I had many experiences where men from religious traditions with strict rules against being in a room alone with a non-family member woman came to accept and respect me, allowing me special status as a “healer.” It was remarkable how much being a woman in medicine was a “superpower” my male peers didn’t have.  I thrived in the environments where I could work at my full capacity, and benefited from many “affirmative action” programs, aimed at correcting gender inequities,  focused on giving me – based on my gender – a “leg up”; for example, opportunities such as the Hedwig van Ameringen Executive Leadership in Academic Medicine® (ELAM®) program. I have worked my whole career to be surrounded by respectful, kind, and loving peers and mentors of all gender and racial identities. 

 

Being a pioneer, again

Daily experiences of frank gender-based discrimination and micro- and macro-aggressions faded into the background until I first joined institutional leadership in mid-career.

When I finally had the privilege of being invited into the “C-suite Boardroom” of a private academic health center, it became clear to me who was in charge. The decision-making tables with opportunities for real change were surrounded by men in gray suits and ties. After years of working collaboratively with women and men, I was again the only one. What I was wearing, how my hair looked, and the age of my then young children were considered acceptable small talk at the beginning of each meeting. I was made to feel self-conscious of my gender and relative youth. In the guise of “complements,” I felt “put in my place,” even by those I had considered role models. This could occur immediately before we were to talk about important issues of educational policy and practice in our department or medical school. After the meetings, my assignments might be stereotyped. For example, when a top performing women medical student (whom I did not know personally) had a body piercing that everyone else (not I) agreed could “upset” patients, the task of calling her in for a conversation fell to me.

I recovered my “voice” and, in relatively short order, there were a few other women invited to these tables. And it has made all the difference. As we diversified, discussions were more substantive, less contentious and less autocratic, more pragmatic, and more creative. Not because women uniquely possess different “ways of being” (although some of us do), but purely as an impact of diversity of points of view and life experience. Diverse leadership in institutions is better. Period. Not just right, but good for us all.  

 

How do we make progress?

Progress has been slow in academic medicine. At MCW, as it is at most other medical schools in the US, there is a problem.  While women have been 50+% of the medical students since 2019 and 43% of MCW faculty are women only 29% of full professors and 17% of chairs identify as female.  Of the traditionally impactful leadership positions (chairs, deans, and other executives), the large majority are men.

Nationally, there have been calls to impose medical school department chair term limits to open up leadership roles to more diverse pools of candidates. While the pipeline is hardy and full of talent, we are not, as of yet, experiencing the value of a fully diversified leadership roster.

Having women leaders, is more important now than ever. I am a fan-girl  of the young Prime Ministers Jacinda Ardern of New Zealand and Sanna Marin of Finland, each of whom has demonstrated leadership leading to lower COVID-19 case and death rates in their countries. They are known to encourage and listen to both dissenting and expert voices. Although each situation is unique and complicated, I say having women and other underrepresented groups at the table is a good thing and accelerates transformation.

 

Linking gender and racial equity

White women, as members of a gender minority with life experiences of bias and discrimination, but also as part of the racial/ethnic majority, are finally in the position to exercise some power. As a result, white women are now over-represented in efforts to address injustices, inequities, and the care of the vulnerable. For example, the leadership of a large, multi-institutional, foundation-funded program to mentor women and URiM early career scientists is overwhelmingly white (79%) and female (87%). This is typical of many such activities. I am not naïve; clearly, some white women (like their male counterparts) have demonstrated shameless entitlement, privilege, and racism.  We are not a monolith, but we do have collective power which we can use for good.

Change is coming. Through the efforts of MCW’s Center for the Advancement of Women in Science and Medicine (AWSM) under the leadership of Libby Ellinas, MD and the Council for Women’s Advocacy (CWA), much has been accomplished and much more needs to be done to achieve and cultivate a diverse and vibrant culture at MCW and elsewhere.

As I walk down the hallway of class pictures, I always say out loud to those pioneers “Thanks, sisters!” They helped to change the “face” of the profession. We must reflect on what they did – and what we must do – to continue the progress. We must be at the forefront, increasing the diversity and inclusiveness of our profession and institution. We must enlist everyone to assume responsibility and play a role to ensure continued transformation.

Our work is not yet done.

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin