Thursday, August 21, 2014

Self Care and Meditation

by: Betsy Tuttle-Newhall, MD, FACS

When one mentions the word “meditation”, images of saffron robed monks and lotus flowers come to mind for many; however, meditation is simply the act of quieting the mind and focusing the attention.  Meditation is a practice, no one starts the practice being perfect and “doing it right, (which is an important concept for surgeons!). It is by doing and making space for attention that one learns.  For those of us who work all hours of the day or night, and are constantly bombarded by phone calls, texts, pages, and other people’s needs, a moment of calm is invaluable to our own health and well-being.  Meditation is about training your mind to be in the moment either for that purpose alone, or for the other benefits of well-being- calm, relief of anxiety, cooling your anger and frustration, opening our own heart and preventing compassion fatigue.  It is about being in the moment- not worrying about the past, or planning the future- is it about being mindful of the present; it is about focused living. It is ironic that we all can “do this “ practice in the operating room. For many of us, we are “in the moment” with the gunshot wound to the abdomen, or the breast cancer in the breast or whatever our focus in the operating room. Where we are often not focused however, is on ourselves. Meditation has many benefits including promoting internal energy (or “prana” the life force), compassion, forgiveness, courage and patience with others, and most importantly, ourselves. Meditation comes in many forms and is often tied to the religious discipline with which it is associated although it doesn’t have to be religious in nature. There is active or walking meditation or sitting meditation, or even what I call the “office meditation” where you can sit in your chair and take 5 minutes to clear your head and re-orient. You can take advantage of any moment in which you can calm the mind and be “aware”. The practice is about being in the moment.

Meditation has been practiced by Christians, Doaists Buddhists, Hindus, Islamists and many other religious disciplines. One of the earliest references to meditation as a practice comes from the Hindu Vedas, the ancient Indian texts. It is here that one of the oldest mantras was written, the Gayatri mantra. “ Mantra” simply refers to a sound or phrase used during prayer or meditation.  The Buddha described meditation as a way to relieve oneself of suffering. A disclaimer- I am not Buddhist, and struggle with my relationship to the Divine either in the traditional Judeo-Christian faith in which I am raising my family or in any other form. I am grateful however, that God (in whatever form you believe in Her) is patient with me. I found myself more than 15 years ago traveling with my friend Dr. Shelly Stelzer, who now resides in Potsdam New York, to the Omega Institute for a week long yoga and meditation retreat. I had no idea where I was going with her, or what this all meant. I never got to spend much time with her, and it was an opportunity for another adventure. I found myself immersed in a weeklong instruction with Sharon Salzberg from the Insight Meditation Society regarding meditative practice and John Friend studying Anusara Yoga. To say it was a transformative week, is an understatement. It was a week that changed my life for the better although the bar was set pretty high for my next week away with my friend. It was a challenge for me to incorporate what I had learned into my daily life (and certainly, my surgical colleagues at that time were a little wary of my experiences. However, they were my experiences and I kept them to myself unless you asked me about them). Being more aware and having that invaluable instruction lead me to attend several other courses with Sharon Salzberg and inviting her to Duke for a weekend retreat regarding Meditative Practice as a prevention of Compassion Fatigue. We sold out tickets 2 days after we posted the conference. She is a Buddhist trained meditation teacher, and her training was in the classic Buddhist tradition.

There are 4 noble truths in Buddhism which make a nice context in which to discuss meditative practice, its goals and the benefits for those of us who spend energy on many people, and often have little left for ourselves.

The first noble truth of Buddhism is that life is about suffering; suffering loss, instability, dissatisfaction that things just haven’t turned out right for us, our friends or family, and our patients. The second noble truth suggests that suffering is related to attachment and ignorance-attachment to things that are not permanent and are not really that important in the big picture or things that are in constant flux, and ignorance about who we really are. Most of us have this ideal of who we “should be” – certainly I do, and more times than not, I fall short of who I think I should be. My suffering comes from my lack of awareness of who I really am and the acknowledgement that I am “good” and usually, doing the best I can at whatever moment in time. I hold myself up to an ideal that if I do not meet, I am afraid of being “less than” in this culture of high achievers and for me, that I may not really “belong” or “deserve” to be here (wherever here might be). When I am tired, or sleep deprived or had a busy day, I am often ignorant of my inner light. Of course most days, I know that I belong and deserve to be “here”. Like most, if not all the women surgeons I know, I have worked hard to be where I am and care for the patients I care for and teach the students and residents for whom I am responsible.  Sometimes the struggle with work and family and other issues can be overwhelming. Sometimes, I just need a little reminder of who I really am underneath the superficial layers of wear and tear and underneath all the work and responsibilities. Really all suffering is, is the practiced art of denial- denial to our real situation, denial to who we are and denial about what we can or cannot do. 

The third noble truth is about the possibility of the cessation of suffering and the fourth noble truth is about the path to take to relieve suffering.  In Buddhist teachings, the relief of suffering is through the noble eightfold path, but basically it is about the “right view, right intention, right speech, right mindfulness and concentration”. All of this sounds like Surgery to me- being where you are at the moment and “doing the right thing”. Staying focused on the task at hand, and solving the problem for your patient. Finding your “rightness” or center, and enhancing your courage can be enhanced by having a practice of quieting the mind and just being aware, learning to step back, and observe. It really doesn’t take a lot of time and the benefits to you and those around you are priceless.

There are several community forums and meditation centers that can help one develop a practice; however for most of us, that is impractical to fit one more thing into our already crowded schedule. From a practical standpoint, for busy surgeons, you can practice the “stepping out’ of your busy schedule and just focus on your breath. What follows is certainly not a complete description of a meditative practice, just a simple way to start; references are added at the end for your perusal. The key to the practice is making time, and space for it in your daily life. The simplest form of meditation is to focus on your breath. Taking a comfortable seat, closing your eyes (and turning off the radio, TV to make where you are quiet) and feeling your breath moving in and out is a simple way to start. Take 5 minutes in the morning at the breakfast table, to sit and just breathe -bringing your attention to the in and then out breath. Let the distracting thoughts about what the day requires come and go. The practice of meditation is the letting go and returning to the breath. You can sit in a chair, cross legged on the floor or use a meditation bench- it doesn’t matter. Just be comfortable and quiet the mind. There are many type of practices that you can pursue and both formal and informal instruction, however the one that I am most familiar with and what I use in my own practice is that of “Metta” meditation. 

I have had the great fortune to attend several workshops with Sharon Salzberg of the Insight Meditation Institute over the years, and this is her type of practice. Metta refers to “loving kindness” meditation and centers around the heart literally and figuratively. It is about fostering compassion in ourselves for ourselves and those around us. Again, in taking a comfortable seat, take a few breaths and center the breath on the center of the chest. Sitting quietly, in your mind – steadily repeat “ May I be happy, may I be healthy, may I be safe, may I live my life with ease”. Use the intentions of kindness for yourself to restore or enhance your reservoir of energy that you expend on others. I find that by using this kindness mantra focusing on myself, then my family, my friends,  and most importantly, and finally, for the people I don’t like and that challenge me- enhances my ability to keep an open heart, my compassion and equanimity. It also allows me to “see “the challenging people in a light that allows me to deal with them, in fashion that doesn’t drain me and makes me less judgmental of them. When stray thoughts butt into my mind, which they always do, acknowledge them and let them go. Restore  your focus on your mantra.  It really is that simple-set your phone for 5 minutes, and try it.  I reach for this practice daily and whenever I just can’t “find it” (whatever “it “is). There are many mantras available for you to repeat, or you can just focus on your breath, the practice is of quieting the mind. I also find that when I have had a particular challenging day, or am about to face one, and I am busy, I can find 3-5 minutes to listen to a guided meditation or spiritual music in my office or on my iPod driving in. (I know you are not technically supposed to multi-task while meditating, however, you do what you have to do to find the space.) I believe that even if you do not pursue formal instruction or delve into this further, the practice of just making 5 minutes daily for you just to “be”, will be transformative for you. I encourage you to care for yourselves as well as you care for others.

Betsy Tuttle-Newhall, MD, FACS

  1. Insight Meditation Kit: A step by step course on how to develop a meditative practice by Sharon Salzberg. One of my favorite gifts for people who ask me about meditating.
  2. Unplug: Books and Audio by Sharon Salzberg. This is a set of cards, and audio you can use whenever you have time and listen to and from work. It is a set of restorative practices that simply teach you to let go. Included is a guidebook as well.
  3. Voices of Insight, written by the teachers at the Insight Meditation Institute. This is a group of stories about how these regular people found their way from the West to a mostly eastern based meditation practice and guidelines for assistance in developing your own practice.
  4. Any of the following books by Sharon Salzberg: Loving Kindness: The revolutionary art of happiness. Real Happiness at work: meditations for accomplishment, achievement and peace. Faith (my favorite). Quiet Mind: A beginner’s guide to meditation. Love your enemies. Heart as wide as the world.
  5. CDs or iTunes purchase, Don’t bite the hook: findingfreedom from anger, resentment, and other destructive emotions. This is more Buddhist in nature as it is taught by Pema Chodron as a weekend retreat that was in part recorded. Again, easy to listen to in the car or as a Podcast. She teaches about the concept of patience, and focuses on what we can practice to change our habitual response. I find her incredibly funny and very wise.
  6. CD or ITunes purchase: Mantras for Life. Deva Premal. It is a very beautiful rendition of some ancient Hindu Mantras with specific intentions.
  7. For retreats or more focused time :
    1. Omega Institute in located in Rhinebeck, New York and offers multiple type of retreats regarding spiritual practices, yoga, meditation, or leadership development.
    2. Insight Meditation Society, located in Barre, Massachusetts. Their schedule is located on line and the website is a fabulous resource.
    3. Shambala Sun. A predominantly Buddhist magazine , online and by subscription. Great resources for finding good meditation communities where you live.

In Memoriam: Thomas R. Russell, MD, FACS

AWS lost a long time friend and supporter this month. Dr. Russell is remembered fondly by those Council members who had the privilege to interact with him during his visits to the annual Spring Council meeting that was held at ACS headquarters in Chicago. 

He is seen in this photograph accepting the AWS Nina Starr Braunwald award on behalf of the ACS in 2006. He worked hard to support women in surgery. Read more about Dr. Russell here.

Some thoughts from AWS members are included here.  Please comment below or visit our Facebook page and share your stories about Dr. Russell or comment on this story.

"Dr. Russell was very accessible, even to the resident. He came to speak at our institution, and in his answers, he discussed how he attempted to answer as many inquiries or problems as possible in his position as executive director of the ACS. He understood that medicine was changing, and tried to make sure that no surgeon was left behind. He acted as both guardian and muse."

“[Dr. Russell’s first interaction with the AWS as Executive Director of the ACS came at a Spring Council meeting in Chicago.] When he had the politically sensitive task of mending the fence [after a prior meeting of the AWS with a colleague had not gone as well as expected]. The look on his face as he entered the room was not unlike the ones I've seen on residents walking into an operating room to discuss a difficult situation with an edgy attending. It was clear he was trying so hard to let the AWS know he really felt bad about what happened, that all is defenses fell away and he spoke from the heart. He talked about how his own daughter wanted to be a surgeon and how he really and sincerely wanted the AWS and ACS to work together to make things better for all women surgeons. He was so genuine and earnest in his talk that no one had the heart to re-hash the hurt feelings. We thanked him for his sincerity and have appreciated his efforts on the part of the AWS ever since.”

“I have been fortunate to mentor and train Katie Russell, Tom Russell’s daughter, as a general surgery resident for the last 6 years. Katie is truly her father’s daughter, someone who approaches every situation with kindness and enthusiasm, and someone whom you can unequivocally depend upon. Although I peripherally knew Tom before Katie joined us at Utah, I got to know him better during her time here, which was a genuine privilege. Every time I would run into Tom at a meeting, I would get a warm hug and he would express his gratitude for my mentorship of Katie. What I couldn’t ever explain to Tom was that Katie is one of those superstars for whom I feel like I have had to do relatively little - I’ve simply encouraged, provided opportunities, and enjoyed being within her orbit. I see his grace and humility in all of my interactions with her, and I am better for knowing them both. Tom will be deeply missed. I’m grateful that another generation of the Russell family is part of our wonderful profession. He leaves us an amazing legacy in many ways.”

We look forward to reading more memories from our members.  Please respond of below or on our Facebook page.

Tuesday, August 12, 2014

Book Review: Success Under Stress

The AWS Clinical Practice Committee reviews Success Under Stress: Powerful tools for staying calm, confident, and productive when the pressure’s on by Sharon Melnick, Ph.D.

“The best time to plant a tree was 20 years ago. The second best time is now.” – Chinese proverb

We recently reviewed the book Success Under Stress, by Sharon Melnick, Ph.D., a business psychologist affiliated with Harvard medical school that works with leading business professionals nationwide.  The subtitle of the book sums up the reasons to read it: “Powerful tools for staying calm, confident and productive when the pressure’s on”.  While her examples are very business oriented and may be difficult to apply directly to our daily lives, the principles and ideas behind her examples are very applicable and resounded with many of us on the committee.  One of the key points she makes early on, is that we cannot control (or be responsible for) everything in our lives.  We must focus on the things over which we can influence the outcome, and do those well.  Take ownership of your contribution, and don’t stress over portions not within your control. 

A key to succeeding in stressful situations is in understanding the source of the stress.  She defines stress as an internal response “when the demands of a situation exceed your perceived ability to control them”.  When she describes the average business professional as having 30-100 ongoing projects, being interrupted 7 times an hour, and facing communication from multiple technologies 24h a day, suddenly their lives seem a little more similar to ours!  She also emphasizes that you cannot give 100% of your effort for 24h all day every day. Your mind and body need recovery time.  Planning “off-button” activities not only decreases your level of stress, but makes you more productive when you are “on”.  The key to surviving, and succeeding, is in how you perceive your role, how you exert control over your day, and what you consider to be success.

Friday, July 25, 2014

2014 AWS Conference Details - SAVE THE DATE

Sunday, October 26 – Tuesday, October 28, 2014
Complete Brochure COMING SOON!

Registration is now open. Register today!

Sunday, October 26th | 2014 AWS Conference: Transitions – Thriving Amidst Change
Westin St. Francis | 335 Powell Street, San Francisco, CA
6:30 am - 3:00 pm 

AWS thanks our Platinum Sponsors:


Conference Highlights Include:
  • Sunrise Scientific Session
  • Medical Student and Resident Starr Poster Presentations
  • Green Solutions for the Operating Room Presentations  
  • Presentations: 
    • Challenges to Leadership in Surgery, Nancy Ascher, MD, FACS, University of California, San Francisco
    • The Changing Face of US Healthcare: How to Optimize Your Career, John E. Hedstrom, JD, American College of Surgeons
    • The Challenge: Transition to a Healthier YouCarol E.H. Scott-Conner, MD, FACS, University of Iowa Carver College of Medicine
    • Transitions and Resilience: Growing and Thriving Throughout Your Life and Career, Janet Bickel, MA, Janet Bickel & Associates, LLC
    • Directed Networking Sessions: Tools for Personal Success, Topics include: Strategies for Family planning, Work/life Balance; Success under Stress, Financial and Retirement planning, Private Practice: Navigating a successful career, Social Media “How-tos,” Alternate/nontraditional career paths, Successful negotiation strategies, Mentorship and Career advancement

Interested in participating in the 2014 AWS Green Solutions for the OR Contest? Click here for details. Deadline to submit is August 3, 2014.

Monday, October 27th | AWSF Awards Dinner & Reception
Westin St. Francis | 335 Powell Street, San Francisco, CA
6:00 pm - 10:00 pm  

The American College of Surgeons’ Women in Surgery Committee sponsors the reception for women surgeons attending the Clinical Congress and their guests. The AWSF Awards Dinner follows. The reception is complimentary. Individual dinner tickets must be purchased in advance. 

Tuesday, October 28th | AWS Networking Breakfast
Nordstrom Café| 865 Market Street, San Francisco, CA
8:00 am – 10:00 am          

Networking Breakfast for AWS members and non-members. No pre-registration required. The breakfast is complimentary.   

Hotel reservations can be made through the American College of Surgeons' travel agency. 

Stay tuned… a complete brochure is COMING SOON! 
Registration is now open

Women Surgeon Leaders for the 21st Century

By: SreyRam Kuy, MD, MHS

Part I: The Status of Women in Leadership Roles, Changing Culture and Leadership Training

“If you're offered a seat on a rocket ship, don't ask what seat! Just get on.” -Sheryl Sandberg, Chief Operating Officer of Facebook, from Lean in: Women, Work, and the Will to Lead

“When you ask women, they do want these things [leadership roles] and they want them as much as men do.” - Patricia Numann, MD, Former President of the American College of Surgeons and Association of Women Surgeons Founder

“I used to walk down the street like I was a super star… I want people to walk around delusional about how great they can be – and then to fight so hard for it every day that the lie becomes the truth.” -Stefani Germanotta, entertainer known as “Lady Gaga”


A century ago Orison Marden published, “How They Succeeded: Life Stories of Successful Men Told by Themselves,” describing the leadership and career success stories of prominent late nineteenth century US leaders such as Alexander Graham Bell and John D. Rockefeller.  Among these profiled nineteenth century leaders was Helen Gould, an heiress, philanthropist and a law school graduate.  Ms. Gould remarked upon the confines of nineteenth century America upon opportunities for upward mobility available to women, “I do not see, for my part, how any child from the poorest tenements could ever grow up and develop into strong, successful men or women…  And it is harder on the girls than the boys!  The boys can go forth into the world and probably secure a position… but the poor girls have so few opportunities.”  And yet, she had the prescient foresight to say, “But I don’t think it matters much what a girl does so long as she is active, and doesn’t allow herself to stagnate.  There’s nothing, to my mind, as pathetic as a girl who thinks she can’t do anything.”  A century later, the first woman to be inducted as president of the American College of Surgeons proved that “girls” can indeed do anything. 

Dr. Patricia Numann remarked on leadership roles that “When you ask women, they do want these things and they want them as much as men do.”  Clearly, there is a wealth of talent among women surgeons.  What is the status of women in leadership roles in medicine today?  And, what are the resources to assist women medical students, surgical residents and surgeons in advancing in leadership roles in their hospitals, communities, universities, and professional organizations?

The Status of Women in Leadership Roles in Medicine

In 1960, only 5% of medical students were women.[1]  Today, at least half of medical students are women.  Has the advancement of women in leadership roles in medicine kept up with the growth of women entering medicine?  In a cohort study of all US medical school graduates from 1979-1993, women were more likely than men to pursue an academic career (10% more women than would be expected with proportional representation of men and women, with women significantly over-represented among medical school graduates entering academic medicine).[2]  However, the percentage of women who advanced to associate or full professor were significantly lower than their male counterparts.  The percentage of women medical school faculty members holding full professorship has grown slowly over the years, from 7% in 1978 to 15% in 2005.(Nattinger)  This is in contrast to the fact that 30% of male faculty have held the rank of full professor consistently over this time period and that in 2005 only 11% of department chairs were women.  

Some of the factors that have been suggested for this gender disparity in leadership roles in medicine include less preparation for an academic career, fewer resources at the beginning of the career such as salary disparity either due to sexual discrimination or ineffective negotiation, lack of mentoring, less supportive institutional environment, and societal norms dictating home life and child care responsibilities which impact career trajectory.[3],[4],[5]  To close the gender leadership gap, a multifaceted approach is necessary.  A number of strategies have been suggested.  Changing the culture of medicine, disseminating knowledge about resources for leadership training, increasing awareness of promotion criteria, improving mentoring of junior women surgeons and developing negotiation skills are several other avenues that empower women surgeons in emerging as leaders in academic and organized medicine. 

Changing the Culture of Medicine

Valantine and Sandborg describe one institutional model which aims to change the academic culture to allow integration of work-life balance and flexibility policies into the promotion process, such as parental leaves and tenure clock extensions, which would enable institutions to better recruit and retain the best and brightest of both women and men.[6]  Fried et al. describe another multifaceted institutional intervention to address career advancement obstacles faced by women faculty.[7]  By targeting problem identification, leadership involvement, education of faculty, mentoring, reduction of isolation and increased integration of women faculty into the scientific community, they reported a significant increase in the number of women promoted to associate professor rank over a 5 year intervention period.  Other institutional change frameworks emphasize the need to increase the visibility of women and the work they do by tracking and publishing institution specific data on women in leadership positions and valuing women’s relational skills by training deans and other administrators to look for and recognize the value of women’s behind the scenes relational expertise in collaboration.[8]  The National Institute of Medicine (NIH) developed a tool to assess if an institution has a Culture Conducive to Women’s Academic Success (CCWAS).[9]  The CCWAS consists of four elements, equal access, work-life balance, freedom from gender biases and supportive leadership.  This can be a valuable tool for institutions seeking to reinvigorate their culture to enable women to flourish in academic medicine.      

Leadership Training

Sonnino describes valuable resources available for professional development and leadership training, available on the Association of Women Surgeons Website[10] and the American Journal of Surgery.[11]  These opportunities of professional development described include courses provided by the AAMC (Association of American Medical Colleges), the ELAM (Executive Leadership in Academic Medicine) program for women, ACPE (American College of Physician Executives) Leadership Development Program, Harvard University MBA training programs, and the Robert Wood Johnson Foundation Fellowships.  ELAM offers senior women faculty at medical and dental schools a year-long fellowship training experience to enable them to develop the skills need to competitively seek higher level administrative positions at academic medical centers.[12]  Research has demonstrated that women physician who participated in ELAM were more successful than non-ELAM women physicians in attaining department chair or Dean level positions.[13] 

Leadership training needs to begin early, in medical school and residency training.  Taking an active leadership role to enable effective teamwork and patient care during residency medical school is the training grounds the future surgical leaders.[14]  The American College of Surgeons hosts an annual Residents as Teachers and Leaders Course at their national headquarters in Chicago, Illinois at no cost to surgical trainees.[15]  Residents are taught effective teaching skills including learning how to give feedback to learners, establish time for teaching, and seeking teaching opportunities in the operating room and on the wards.  Residents are also taught techniques for successful leading such as conflict resolution, integrating diverse working styles, and leading productive teams.  The American College of Surgeons also has course of practicing surgeons, Surgeons as Leaders: From Operating Room to Boardroom.[16]  This three day course teaches surgeons about consensus building, changing culture, conflict resolution, emotional intelligence in order to have personal insight, and practical translation of leadership principles into daily action.    

By incorporating a multifaceted approach of fundamental change in institutional culture, leadership training, negotiation skills, development of mentoring relationships and awareness of promotion criteria, hopefully we can one day see more women surgeons following in the footsteps of Dr. Numann in leading our hospitals, communities, and professional societies.  Check out next month’s AWS newsletter to learn read the second segment of this two part article, “Women Surgeon Leaders for the 21st Century: Part II – Negotiation Skills, Developing Mentorship Relationships, and Promotion Criteria”.

Parting Thoughts from Women Leaders

“Always aim high, work hard and care deeply about what you believe in.  And when you stumble, keep faith.  And, when you’re knocked down, get right back up and never listen to anyone who says you can’t or shouldn’t go on.” - Hillary Rodham Clinton, Former US Senator, First Lady and Secretary of State

“I always did something I was a little not ready to do.  I think that’s how you grow.  When there’s that moment of ‘Wow, I’m not really sure I can do this,’ and you push through those moments, that’s when you have a breakthrough.” 
–Marissa Mayer, Chief Executive Officer of Yahoo

“As a leader, I am tough on myself and I raise the standard for everybody; however, I am very caring because I want I want people to excel at what they are doing so that they can aspire to be me in the future.” –Indra Nooyi, Chief Executive Officer of PepsiCo

SreyRam Kuy, MD, MHS was born in Cambodia, grew up in Oregon, graduated from Crescent Valley High School as Valedictorian, and attended Oregon State University where she earned dual degrees in Philosophy and Microbiology.  Dr. Kuy’s passions are healthcare policy, physician leadership and health services research.  After college she worked as a Kaiser Family Foundation Barbara Jordan Health Policy Scholar in the Senate, writing speeches and policy briefs for Senator Tom Harkin on women’s health, coverage for breast cancer screening and treatment, and health care instrument safety.  She attended medical school at Oregon Health Science University, then finished general surgery residency in Wisconsin.  She earned her master’s degree in health services research at Yale University School of Medicine as a fellow in the prestigious Robert Wood Johnson Clinical Scholars Program.  She is also a writer.  Her first book, Soul of a Tiger, describes her family’s survival during the Cambodian Genocide known as the Killing Fields.  Her second book, 50 Studies Every Surgeon Should Know, will be released in 2015 by Oxford University Press and describes seminal research in the surgical field.  Dr. Kuy is an assistant professor of surgery at Louisiana State University and the Overton Brooks Veterans Affairs Medical Center.    

[1] Hamel M, Ingelfinger J, Phimister E, Solomon C.  Women in Academic Medicine – Progress and Challenges.  NEJM. 2006;355:310-312.
[2] Nonnemaker L.  Women Physicians in Academic Medicine: New Insights from Cohort Studies.  NEJM. 2000;342:399-405.
[3] Nattinger A.  Promoting the Career Development of Women in Academic Medicine.  Arch Intern Med.  2007;167:323-324.
[4] Bickel J, Wara D, Atkinson B, Cohen L, Dunn M, Hostler S, Johnson T, Morahan P, Rubenstein A, Sheldon G, Stokes E.  AAMC Paper:  Increasing Women’s Leadership in Academic Medicine: Report of the AAMC Project Implementation Committee.  Acad Med.  2002;77(10):1043-1058.
[5] Allen I.  Women doctors and their careers: what now?  BMJ. 2005;331:569-572.
[6] Valentine H, Sandborg C.  Changing the Culture of Academic Medicine to Eliminate the Gender Leadership Gap: 50/50 by 2020. Acad Med. 2013;88(10):1411-1413.
[7] Fried L, Francomano C, MacDonald S, Wagner E, Stokes E, Carbone K, Bias W, Newman M, Stobo J.  Career Development for Women in Academic Medicine.  JAMA.  1996;276:898-905.
[8] Morahan P, Rosen S, Richman R, Gleason K.  The Leadership Continuum: A Framework for Organizational and Individual Assessment Relative to the Advancement of Women Physicians and Scientists.  Journal of Women’s Halth.  2011;20(3):1-10.
[9] Westring A, Speck R, Sammel M, Scott P, Tuton L, Grisso J, Abbuhl S.  A Culture Conducive to Women’s Academic Success: Development of a Measure.  Acad Med. 2012;87(11):1622-1631.
[10] Association of Women Surgeons.  Accessed 6/10/2014.
[11] Sonnino R.  Professional development and leadership training opportunities for healthcare professionals.  The American Journal of Surgery.  2013;206:727-731.
[12] Richman R, Morahan P, Cohen D, McDade S.  Advancing Women and Closing the Leadership Gap:  The Executive Leadership in Academic Medicine (ELAM) Program Experience.  Journal of Women’s Health & Gender Based Medicine.  2001;10(3):271-277.
[13] Dannels S, Yamagata H, McDade S, Chuang Y, Gleason K, McLaughlin J, Richman R, Morahan P.  Evaluating a Leadership Program: A Comparative, Longitudinal Study to Assess the Impact of the Executive Leadership in Academic Medicine (ELAM) Program for Women.  Acad Med. 2008;83:488-495.
[14] Kiesewetter J, Schmidt-Humber M, Netzel J, Krohn A, Angstwurm M, Fischer M.  Training of Leadership Skills in Medical Education.  GMS.  2013;30(4).
[15] American College of Surgeons.  Residents as Teachers and Leaders Course.  Accessed 6/10/2014.
[16] American College of Surgeons.  Surgeons as Leaders: From Operating Room to Boardroom.  Accessed 6/10/2014.  

Thursday, July 24, 2014

Running a Multi-Disciplinary Breast Center

by: Holly Mason, MD FACS

One of the great challenges and great accomplishments of my career has been the oversight of the Baystate Breast & Wellness Center. Under one roof, patients can undergo breast imaging, breast surgery consultation, plastic surgery consultation and high risk assessment. Patients with cancer are transitioned to medical and radiation oncology at the Cancer Center at the appropriate time. The sum of all of this is that coordination of care is needed between multiple specialties, providers and staff all while respecting the patients emotional needs and desires. The presence of nurse navigators significantly improves this coordination of care and lowers the anxiety of the patient as they now have a guide to lead them through the care process. Finesse and patience is required when dealing with the specialties; I am a surgeon and may not understand why a specialist has to do things in a certain way or why the process takes a certain amount of time. I simply want things done (that is the surgeon in me). As a surgeon in a leadership position, I need to temper the surgeon part of my personality to give the collaborative part of me a chance to succeed.

We live in a time of change and our practice needs to keep up with that change. The purpose of our clinical steering committee is to delve into the processes of the Breast Center to sort out those that work both for the patient and the institution and those that do not. Our leadership team regularly looks at metrics to ensure that our access rates are appropriate and that our imaging meets or surpasses national standards. It is necessary to look at the financial impact of the choices we make and the tests that we order. No other specialty highlights this challenge quite like breast cancer care. We have advanced technology to evaluate patients but it is necessary to choose wisely what is indicated medically and what is not to keep costs under control. We can’t order a test just because we can. We have the surgical skills to treat the breast in the form of the patients choosing, but, as recent data shows, there is significant cost both to the patient (increased complication rates for patients undergoing bilateral mastectomy and reconstruction, for example) and to the health care system. Most of my hour-long visit with a breast cancer patient is spent trying to find the correct balance for the individual patient that optimizes cancer care and minimizes risk.

I am fortunate to work with providers as passionate about breast cancer as I am. Our multidisciplinary team meets regularly to review protocols and practices to ensure that we are keeping up with the rapidly changing world that is breast cancer care. Together, we strive to provide high quality efficient care that can work in a changing cost-control environment. As a surgeon in a leadership position, I balance the need to keep a “big picture” view of the impact of our patient care choices with the maintenance of an active clinical practice.  I wouldn’t have it any other way.

Dr. Holly Mason is the Director of Breast Surgical Services at Baystate Medical Center in Springfield, MA.  She is also the Co-Medical Director of the Baystate Breast & Wellness Center.  Besides her specialized work in breast surgery, she enjoys time with her husband and two daughters and tries to remind herself to take a deep breath every now and then to enjoy the world around her.

Wednesday, July 23, 2014

Sisters by choice: A community Woman surgeon leading charity since 1989

A native Georgian, Dr. Rogsbert F. Phillips-Reed is a general surgeon specialized in breast surgery. I had the pleasure to meet her last week and was inspired to write about her great work.When I first mentioned Association of Woman Surgeons (AWS), she smiled mischievously and recalled as being one of the first few AWS resident members.

She graduated from Columbia University School of Physicians and Surgeons in 1977 and in 1982 became the second woman and first African-American woman to successfully complete Emory University's surgical Program. When she started her general surgery practice, majority of her referral was Breast related. She welcomed all patients alike and gave best care possible. Over a period of time she was successful in building a  very broad based general surgery practice. Her caseload ranged from Hernias to Whipple. All that only inspired her to learn more, do better and keep up with new innovations in surgery. While midway in her practice, she trained herself to do complex laparoscopic as well as oncoplastic procedures. Forapproximately 30 years she has practiced medicine in metropolitan Atlanta area, serving a diverse patient population. Today she heads Metro Surgical Associates, a community-based surgical practice with offices in downtown Atlanta and Lithonia.

Georgia ranks 10th in population among the fifty states, but 40th  in physician supply per 100,000 population. In fact, latest figures tell us that 15% of Georgia's population is medically underserved for primary care. Access to more specialized services is even worse. Since majority of  Dr Rogsbert-Phillips's practice was breast related she soon realized the need for programs that would not only increase public awareness of breast cancer but also bridge the gap in care. So, in 1989 she founded Sisters By Choice (SBC). Initially formed as a support group for women diagnosed with breast cancer and their families, SBC has evolved into a multi-faceted organization serving women in Georgia.SBC provides over 800 free mammograms and breast exams to uninsured, unemployed and homeless women each year as well as free educational seminars, workshops, and health fairs to promote breast cancer awareness.

Realizing that there are health care disparities surrounding access to quality breast care in rural Georgia; Dr. Phillips-Reed has started an initiative to address this disparity by developing a Mobile Breast Clinic. This unique mobile breast clinic will facilitate remote screening and diagnostic services. It will provide screenings, diagnostic services, treatment referrals, education and access to clinical trials to medically underserved men and women in rural and urban Georgia. This complete diagnostic care will make this clinic historic. It will be the first of its kind in Georgia, and among the first in the nation.

I was pleasantly surprised to see how much her patients admire her for her care and compassion. One can also see that most of her family and friends either work or volunteer at her practice. Of all the people, her husband Mr Reed and son Kasim Reed Mayor of Atlanta, are one of the biggest supporters of her mission. With pure good intentions, she has not only earned loyalty of her patients but devotion of her family for a cause that is dear to her. She has proved that all it takes is one dedicated woman community surgeon to change the way care is provided to vast section of the community underserved or uninsured.

Bharti Jasra is a Breast Surgical Oncology Fellow at UTSW 2014-2015. She completed General Surgery residency at Saint Louis University Hospital in June 2014.