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Send to a FriendThere is no doubt that actions of past generations allow us to shape our own destinies. Women who took on new and unconventional jobs during World War II and the women's liberation movement of the 1960's and 1970's helped to make possible the attitude that a woman "could be what she wanted to be." It never occurred to me sitting in a medical school classroom in the mid-1970's comprised of only 10% women that I was unusual. Luckily, I had never read William Osler's declaration that "humanity is divided into three classes: men, women, and women physicians [1]." I did not foresee that I was at the beginning of a steep curve that would today see 50% females filling medical classrooms. I believe that I proceeded to choose surgery for exactly the same reasons men do. I am a "take-charge" person, and I liked the technical challenges and decisiveness required to make a profound difference in a person's life within a short time frame.
When I think back on my medical school experiences and intern, residency and fellowship training, several key reflections come to mind. Challenges and opportunities, some small and some momentous, occur more frequently than realized. Most surgeons thrive on challenges. However, one must recognize opportunity, be willing to act, and grow from one's experiences. The path may not be easy. Since I am a New Englander, Robert Frost has always been a favorite poet, and he says it best [2]:
Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth…I shall be telling this with a sigh
Somewhere ages and ages hence;
Two roads diverged in a wood, and I –
I took the one less traveled by;
And that has made all the difference.
Never let the little things get you down. I once heard one of the most revered surgical teachers at New York Hospital say that "a woman best belongs in the bedroom and the kitchen." Although I could have been deeply offended by that comment, it only made me work harder and eventually prove him wrong. Humor is an important part of residency and life in general, and anger is a self-defeating emotion.
Always remember that you can learn from everyone; it may be a clerk, a nurse, the janitor, or often a patient. My mother gave me that advice when I became a third-year medical student beginning clinical rotations, and I have never forgotten it and never doubted its wisdom. Surgeons should be self-confident, but humility is always around the corner to prevent arrogance.
Mentorship is important to career development, and almost all of my mentors have been men. Mutuality of respect, interest, and goals is key. I think perhaps it is much easier for a scientist and postdoctoral fellow to achieve a mentor-mentoree relationship because of very focused goals.
Physicians have varied tasks and commitments of time that hinder establishment and maintenance of mentorship. Both individuals have to work at the activity, accept limitations, share the rewards, and be honest when things are not working. Mentors will change with time and as aspirations change. Although it is often not mentioned, one can learn a lot about how not to act or lead from a negative relationship.
Once residency is over, you begin to realize that you will never be quite as smart ever again. You need to accept that fact and realize that experience becomes important. Your career becomes more focused, personal and professional commitments expand, and you suddenly realize you are in a position to be a mentor!
My present advice to women entering cardiothoracic surgery is based on twenty years of experience. First and foremost, it’s been a great career full of rewards, exhilarating challenges, some heartaches, and always changes that allow continual renewal of knowledge, skills, and self. I chose to subspecialize and enter a career of academic medicine, and therefore some of my advice is tainted by that career decision.
I remain concerned that although gender equity has been reached in medical school graduates, the "glass ceiling" in academic medicine has not been broken. Progress is incomplete, a critical mass of women leaders in medical schools, hospitals and professional societies has not been reached, and the pool of women from which to recruit academic leaders remains small. In 1985, 9.9% of full professors were women, and in 2005 that number had barely increased to 12% [3]. The future pool of women leadership in cardiothoracic surgery will remain small for the foreseeable future. Women CT residents as a percentage of all residents in the specialty has increased from 4.7% in 1994 to 7.4% in 2004 (representing only 0.1% of women residents training in the specialty) [3]. The good news is that in 2004, 26.7% of residents in surgery were women, and this is our pool of future applicants.
There may be many reasons other than numbers for the lack of women leaders in medicine. Some of the challenges faced by women include lack of recognition and, conversely, inappropriate attention; resistance in reporting to them, and constraints on their leadership and decision making styles. I believe in this day of multidisciplinary disease management, attention to outcomes and patient safety, and competitive attainment of high patient satisfaction, women offer leadership styles that will be particularly beneficial to hospitals and institutions. Women, in general, are consensus-builders, have a more collaborative decision-making process, and can manage the interpersonal dimension of a problem in meaningful ways. The corporate world is certainly ahead of medicine in this regard, where diversity has been shown to be key to performance, market share, and employee retention. But women may purposely choose not to be leaders. Women prioritize issues of importance differently than men, including time for self, family duties, money, etc. Leadership has to be attractive!
So, what would be my advice to women seeking a leadership role in academic medicine? Here is a short list:
- Be willing to widen your horizons. You have to be willing to constantly grow and realize change is essential to self-renewal.
- Be willing to stand out.
- Learn how to play the game. That does not mean you have to be subsumed. (In fact, it is quite educational and fun to step back and analyze the playing field and players.)
- Be careful about being the token woman. (If you find yourself in that position, turn it to your advantage.)
- Balance career and personal life.
- Remember you are a woman first and a surgeon second.
What does the future of CT surgery hold? We are certainly at a major crossroad with several concerning signs: 1) lack of jobs for finishing CT residents, 2) changes in technology that threaten traditional procedures, 3) a shortfall of CT resident applicants, 4) major changes in training, and 5) intense government pressures that threaten economic viability. Yet I would not discourage anybody from entering this field. If calculations are correct the job market will expand, in the next 15 years there will be an 11% to 24% reduction in the supply of cardiothoracic surgeons and a 13 million increase in the population over age 65. Training programs that do not meet requirements will be closed. Other programs will become more flexible and innovative. Although not soon enough, I believe the American Board of Surgery will in the future initiate a 3-year core surgical curriculum with the subspecialties branching off. Of most concern is governmental pressure to cut medical care costs without appropriate physician input, perhaps leading to a crisis that risks lives. As residents in training, we live in a cocoon with demands on our time and energy that leave little room for politics. This insulation often carries over into our professional lives. I have been guilty and have pledged to increase my knowledge and activity in "medical politics." The profession and particularly patients will suffer from unguided governmental decisions.
With 50% or more of medical school graduates being female, there is no doubt in my mind that women will be "movers and shakers" in medicine in the decades ahead. CT surgery will feel and benefit from this effect.