Looking forward – July 2015

David B. Hoyt

David B. Hoyt, MD, FACS

Women have practiced surgery since the profession’s inception and have played a role in the American College of Surgeons (ACS) since its founding. Nonetheless, women have been and continue to be underrepresented in surgery, and, unfortunately, there are signs that fewer women will be entering the surgical workforce in the coming years as the number of women medical school graduates slowly declines. In 2005, 49.5 percent of medical school graduates were women,* but in 2014, less than 47.5 percent of medical school graduates were women. Furthermore, only 21.3 percent of all surgeons in the U.S. are women.

The reasons women have traditionally chosen to work in health care professions other than surgery are myriad. The personal experiences of women surgeons of all ages, specialties, and backgrounds are presented in a new book, Being a Woman Surgeon, edited by Preeti R. John, MB, BS, MPH, FACS, acting director, surgical intensive care unit, Baltimore VA (Veterans Affairs) Medical Center, and clinical assistant professor, University of Maryland Medical Center, Baltimore. In all, 60 women surgeons describe in essays, poems, and interviews how they have dealt with the challenges, joys, frustrations, and rewards of being a woman in surgery. Their stories range from the humorous to the heartbreaking and make for inspiring reading.

Being a Woman SurgeonBlazing the trails

Many women leaders of the ACS have contributed to this book, including Kathryn D. Anderson, MD, FACS, our first woman President; Patricia J. Numann, MD, FACS, the second woman ACS President and the founder of the Association of Women Surgeons; Barbara Lee Bass, MD, FACS, Past-Regent and recipient of the College’s highest honor, the Distinguished Service Award (DSA); and Julie Ann Freischlag, MD, FACS, the first woman to chair the ACS Board of Regents.

Other surgeons who contributed to this compendium also were the first women to assume leadership positions within their institutions. Dr. Freischlag, for example, was the first woman to head the department of surgery at The Johns Hopkins Hospital, Baltimore, and Mary Maniscalco-Theberge, MD, FACS, is the first and only woman to have served as chief of the department of surgery at Walter Reed Army Medical Center, Washington, DC.

Challenges

As the authors note, surgical training and practice are challenging for all of us, but some of these difficulties are compounded by gender. Starting a family, for instance, creates specific obstacles for women in surgery simply because of the fact that they are the child bearers. As a result, women surgeons have had to give more thought to whether and when to have children. Indeed, some authors indicate that they were asked why they should be accepted into a residency program or on staff at a hospital when they would probably leave to have children and thereby deny those opportunities to a man who, it was presumed, would be more likely to continue working regardless of whether he chose to have children.

Several authors opted not to have children. Many of the women who did decide to raise a family continued to operate until moments before their babies were born, both due to their dedication to their patients and in an effort to overcome any misconceptions about their commitment to balancing their professional and personal lives. They tell stories of reaching over their bellies to operate and going directly from the operating room to the labor room.

Once the babies arrive, new challenges emerge. Even since the American Board of Surgery passed rules that residents were required to work only 48 clinical weeks per year—46 in instances involving maternity leave—surgical residency during a child’s infancy can be grueling. On the other hand, it can also make for some rather memorable anecdotes. For example, one author describes using her breast pump when the intercom went off announcing a code blue on the surgical floor.

Many women in the book also recount their encounters with sexism, ranging from the subtle to the blatant. One woman tells of the time a male surgeon refused to shake hands with her at a surgical meeting. Others recall hearing male colleagues make sexist remarks in the hallways or hanging pictures of naked women in the rooms where residents would rest when on call in the hospital. More recent examples are subtler, such as physicians who only refer women patients to women surgeons, exclusion from certain meetings or events, being passed over for promotions, and so on.

Some gender stereotypes, on the other hand, actually seem to have worked in favor of these women surgeons. Many of their patients say that women surgeons are better communicators and more empathetic than their male counterparts.

Mentors and role models

In any event, most of the authors gladly note that the days of overt gender bias in surgery are largely over, and even those surgeons who have faced discrimination or harassment in the workforce prefer to focus on the positive aspects of their careers. In fact, most of the authors point to many men surgeons who were willing to give women an opportunity to train at their institutions and who fostered the professional development of all of their trainees—regardless of gender. Some of the men surgeons cited for their willingness to help women surgeons pursue a surgical career include ACS DSA recipient John R. Davis, MD, FACS, at the University of Vermont, Burlington; Philip Donahue, MD, FACS, at Cook County Hospital, Chicago, IL; Ralph DePalma, MD, FACS, at the VA in Reno, NV; ACS Past-President Claude H. Organ, Jr., MD, FACS, at the University of California-East Bay; ACS Past-President C. Barber Mueller, at State University of New York, Upstate Medical University, Syracuse; Keith D. Lillemoe, MD, FACS, at Johns Hopkins and Massachusetts General Hospital, Boston; and ACS Past-Secretary Courtney Townsend, Jr., at University of Texas Medical Branch, Galveston.

All of us, men and women alike, would attribute at least some of our success in this demanding profession to these and other surgeons who mentored us—who saw something in us as medical students or residents that indicated we had the potential to provide quality care to surgical patients. One author recalls with great enthusiasm the time when, as a medical student doing her surgical rotation, her mentor, Karen Deveney, MD, FACS, Past-Secretary, ACS Board of Governors, allowed the student to sew in the mesh during an inguinal hernia repair. That, of course, was the moment she got hooked on surgery.

A calling and a passion

Most surgeons, including the women who share their stories in this collection, say that they didn’t choose surgery so much as it chose them. They knew from the first time they witnessed an operation that they wanted to be surgeons. They got a rush from being in the OR, from the intensity of the work, from being able to bring almost immediate relief to critically ill and injured patients. As one author writes, “There is only one requirement to be a truly great surgeon—passion. You have to love it with your heart and soul.”

Anyone who agrees with that statement—male or female—will surely enjoy reading Being a Woman Surgeon, and hopefully, this book will make its way into the hands of medical students and encourage more women to pursue a surgical career. We need them now more than ever.


*Association of American Medical Colleges. The changing gender composition of U.S. medical school applicants and matriculants. Analysis in Brief. 2012;12(1):1-2.

Association of American Medical Colleges. Total graduates by U.S. medical school and sex, 2010–2014. Available at https://www.aamc.org/download/321532/data/factstable27-2.pdf. Accessed May 28, 2015.

American College of Surgeons Health Policy Research Institute. The Surgical Workforce in the United States: Profile and recent trends. April 2010. Available at http://www.acshpri.org/documents/ACSHPRI_Surgical_Workforce_in
_US_apr2010.pdf
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