How I Make It Work

by Danielle Walsh, MD

December is the time of year when the constant struggle between the needs of work and the commitment to family become most strained. Holiday performances at school, parties for kids sports and other organizations pop up, work-related celebrations occur, and both of my children celebrate birthdays within a week of Christmas Day. After a long day of operating you try and shop online or in crowded stores before heading home to make dinner, ensure homework is done, and then proceed to whatever holiday event is scheduled for that night. It’s exhausting. But I can’t imagine it any other way.

People always ask how to make it all work. Lately, my response is more refined than in the past and it utilizes the tried and true analogy of the full bucket. You have to start with the biggest rocks. My kids’ birthdays, gymnastics meets, the annual AWS conference and a few other events are rocks. They are unmovable, non-negotiable events on my calendar. These are my biggest rocks. My OR days are Monday and Friday. My clinic days are Tuesday afternoon and Thursday morning. They are not movable and are the next size down rocks. I schedule a date night with my husband at least twice a month. Still a rock, but can fit around the other stuff. Then everything else gets filled in order of priority like the AWS, work on a grant, student and resident teaching – gravel, then sand, then water. Most of the time I try to leave pockets in “reserve” – an hour in my schedule for the gym, prayer, or just walking through a store undisturbed (my husband calls this retail therapy, even if I don’t buy anything). Often this is when I can review what the priorities are for that day or week to determine what goes in the bucket.

Sometimes the bucket overflows. I try to do too much at the same time or something unexpected causes the balance to tip. Then I call in the backup buckets – my husband, my parents, my partners, or some hired hand to take on what I can’t handle. Occasionally it means a paper is late (not unlike this blog, which I had hoped to write last week), emails get left in the inbox, and phone messages are not promptly returned. These times never feel good. I hate not being able to do it all on time. Some of the dislike is frustration of leaving others hanging, waiting for me to take action. Some of the issue is realizing that I made an error in taking on so much. But it serves a purpose – a reminder to be patient with others, accept imperfection, and continue trying to do better.

I always schedule at least some vacation time in December when the kids are off. The first day is set aside to clear out all the late assignments from work (like this blog) that will keep me giving my family my full focus. And then I sign out to my partners, turn off the beeper, set up the auto-reply for work email, and be just a mom, wife, and daughter to family for a while. It always feels good.

So as 2013 draws to a close, take a look at your bucket. What are the rocks, the stones, the pebbles, sand, and water? What can fit where and when? Find your time for work, time for family or friends, and time for yourself. May your bucket be full and satisfying.

Peace to all.

Danielle Walsh

P.S. – Didn’t get around to Christmas cards yet. Might still try to do them, but don’t hold it against me if they arrive a little late.

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Dr. Danielle Walsh is an Associate Professor of Surgery at East Carolina University in the Division of Pediatric Surgery. After obtaining her undergraduate degree at Columbia College and her medical degree from the University of South Florida College of Medicine, she trained in general surgery at Massachusetts General Hospital in Boston. She also completed a fellowship in fetal surgery and research at Children’s Hospital of Philadelphia and a fellowship in pediatric surgery at Children’s National Medical Center in Washington, D.C. She practiced in Jacksonville, FL holding faculty appointments at the Mayo Medical Center and University of Florida before moving to her current position in North Carolina. She is the 2013-14 President of the Association of Women Surgeons and mother of 2 children.

Pregnancy during Medical School & Residency

by Callie Thompson, MD

I have read a lot of discussions about “the right time” to have a baby during a career in medicine and most of them come to the conclusion that there is no right time. I don’t think that is really accurate. The more correct answer would be that the right time is entirely dependent on you and your situation. I feel well prepared to write this blog and give this advice because I have been pregnant during both medical school and residency (twice).

In chronological order, I will start with pregnancy during medical school. The first two years of medical school are typically spent listening to a lot of lectures and studying almost all of the time. The third year is usually heavy with clinical work and spending a lot of time in the hospital. And the fourth year is usually a few sub-internships and a lot of light rotations at your home institution. So, where would a pregnancy, birth, and caring for an infant fit in there? Again, it really depends on your situation. You have to weigh the physically demanding state of gravidity with what you will need to be doing at that time. If you are concerned about being on your feet all day, then maybe being pregnant in the first two years would work best for you. You also have to take into account the demands of a newborn/infant. If you need a lot of time to study or are not great at multitasking, then having a newborn prior to taking your USMLE Step 1 might not be the best idea for you. No matter what you decide, you must have a viable option for childcare in mind. I suggest that you do this prior to even becoming pregnant because you will need help.

Regarding taking time away from school, there are no universal rules as to how much time can be taken. This will be school dependent. You just need to make sure that you can fulfill the requirements to earn your degree. Some people choose to take an extra year and make medical school a total of five years to allow them to have their child. I do not think this is necessary for everyone and you are going to know your capabilities best. Don’t let someone push you into a 5th year just because others before you have chosen to do that.

Pregnancy in residency is a bit trickier because of the American Board of Surgery requirements for General Surgery Certification. I had a baby during clinical R3 year and another while I was out in the lab. From a time-off perspective, having a baby during your lab years is much easier. If you are NIH funded through a training grant you can have 6-8 weeks, though some lab work can be done from home so the actual time you get to spend with your newborn can actually be longer than that depending on your research. Having a baby during your clinical years requires a good understanding of “the rules.” The ABS states that:

“To be eligible for ABS certification in general surgery, the following must be completed: At least 48 weeks of full-time clinical activity in each residency year, regardless of the amount of operative experience obtained. The 48 weeks may be averaged over the first three years of residency, for a total of 144 weeks required, and over the last two years, for a total of 96 weeks required."

“For documented medical problems or maternity leave, residents may take an additional two weeks off during the first three years of residency, for a total of 142 weeks required in the first three years of training, and an additional two weeks off during the last two years of residency, for a total of 94 weeks required in the last two years of training.”

Translation: You can average your time over the first three years so, in theory, if you didn't take any other time off for three years, you could have a 14 week maternity leave. Similarly, if you didn't take any time off for vacation during your last two years, you could have a 10 week maternity leave.

In actuality, that isn't possible. For instance, you would have to know that you were going to get pregnant and have a baby during third year so that you could forgo a vacation in your first 2 years. And if you did that, you would surely go insane. So if you did take the regular 3 weeks of vacation a year, you could have an 8 week maternity leave during the year you did have the baby—as long as you don’t take any other vacation that year. A baby during the last two years is even more difficult because of the time constraints. Also, keep in mind that none of this accounts for the possibility of medical problems during the pregnancy and any time off that may need to be taken. None of this is meant to dissuade you from pregnancy during residency (see above where I state I did it twice) but knowledge is power and you have to be prepared to extend your training if you are unable to meet the ABS requirements. This is most important during the last 2 years because they have to be done in succession so if you were to get pregnant, become ill, and need extra time off during your 4th or 5th year, you may be required to start over at year 4.

This blog could end up being very long so the last topic that I will include for today is when/how to tell people when you become pregnant. I advocate telling people when you feel comfortable. For some people that is the minute you find out, for others it is after the first trimester. However, I would not wait much beyond the first trimester because arrangements will need to be made, either to your schedule if you are a student or for coverage from your co-residents if you are a resident. I also would also advise you not to tell anyone else before you tell your Dean or medical school adviser (for students) or your program director (for residents). It is best to give big, personal news yourself, and in person.

~~~ 

Callie is a resident in general surgery at the University of Washington. She completed a two-year research fellowship and is now in her fourth clinical year.  Callie aspires to be a burn and trauma surgeon and a translational scientist. Her research interests include genetic variations and their associations with the development and outcomes of disease and illness. Callie is married to an internist and has three children under the age of 7.
 

“The Advice Less Given”

by Stephanie Bonne, MD

As a relatively new mother (I have 2 boys, ages 3 and 1), I’m usually anti-advice. I often feel as if each person’s situation is unique and resources and priorities are variable, so it’s hard for anyone to give meaningful advice that fully applies to me. If you have a young family or are contemplating having a family, you have no doubt been inundated with advice from lots of very well-meaning people. Some advice is trivial (“Jen is the best Gymboree instructor!”) and some is not (“if you are going to have more than one, make sure you have them as close together/far apart as possible”), but much of it we hear over and over again. “There is no good time,” “make sure you have lots of help,” “remember to take time for yourself,” are all well-meaning, but tend to be a little vague and can mean vastly different things to different people. However, in recent months, I’ve gotten 3 pieces of parenting advice that were a bit different than the usual advice and pretty adaptable to most woman surgeons, so I thought I’d take the opportunity to share them here.

1. “Learn to let go of some stuff, but not ALL stuff.” This is a comment on balance. As a surgeon, I’m used to being in control of almost everything, but as a parent, I can’t be. This first became apparent to me when my son came home from daycare one day in a mismatched outfit my husband had put him in that morning after I had left for work. I suppressed the urge to say “You let him go to school wearing THAT?!” Having meticulously dressed children is just something I have to let go of, along with the occasional glass of non-organic milk, or extra half hour of cartoons. My first advice to young moms: Throw away the Pottery Barn Kids catalog the minute it enters your house. No four year old boy spends an afternoon quietly reclining in his sailboat-decorated bedroom, reading a Caldecott-winning book while snacking on a perfectly balanced meal from his personalized bento box (seriously, when did preschoolers start carrying bento boxes?). Now, that last statement might sound remarkably reminiscent of some jaded-but-funny suburban parenting blogs. My second bit of advice: unsubscribe from these too. True, there may be humor in highlighting all your first-world failings as a parent, or brazenly point out that your kids are still alive, in spite of your best efforts and constant feelings of failure. These blogs, however, in an attempt to use intellect to deescalate the “Pottery Barn” ideal of a perfect mom, somehow miss the mark and instead validate the very thing they are trying to dismiss. You are a surgeon; you don’t have time to get involved in the mommy wars. This means letting go of the things that don’t matter, but realizing that not everything can be marginalized, and recognizing which things do matter. Your kids need to be fed, clothed, washed, and most of all loved, but that’s just the start – they DO need intellectual stimulation, bedtime stories, play time, social interaction, and swimming lessons. You can’t cast these things off as insignificant in the life of a child, but you also don’t have the time to place too much importance on each of your child’s experiences being perfectly orchestrated to be both stimulating and meaningful. Balance.
2. “Teach your kids, right from the start, about what you do and why it is important.” My experience with this has been short so far, but I do tell my son when I leave for call that I have to go to the hospital to help take care of sick people. Naturally, after a few times, he mustered a fake little cough and said “but I’m sick too.” I think every doctor-parent has a story like this, and yes, it is heartbreaking. But my husband and I reinforce what I do and why it is important and I think my son does understand. He will ask me when I come home the next day if I fixed the hole in someone’s tummy, and burst out an encouraging “great job, mommy!” when I say yes. When I recently went to DC for the AWS and ACS meetings, he asked me if people in Washington DC have holes in their tummies too. I’m sure the day is coming when I will miss a big soccer game or first music recital, but knowing that they understand what I do will help them. Sometimes, reminding myself of the importance of my work helps me too. 
3. “Take time for you and your partner, and do it guilt-free.” This is a variation on the date-night advice, but the key here is doing it guilt-free. This came up last spring after my parents were graciously willing to watch the kids for a few days so my husband and I could have a little getaway. Afterwards, I was recounting our trip on two separate occasions to some older, wiser women when they pointed out that I was making excuses for why we didn’t take the kids on our trip. Both encouraged me to never feel guilty for the time I spend away from the kids, pointing out that having two parents who live together, and furthermore, love each other, is far more important to them than the couple of days spent away from us. I think there is balance here too – we can’t jet away together every weekend, but we can do it within reason and should do it from time to time. For different couples, this will look different – to some, it’s going on long walks or runs together, for others it’s a monthly date night, for others it’s a weekend away once a year. Whatever it is, it’s helping you stay together, so make it a priority, but the real point is - don’t feel bad about it.

Props to the awesome women who gave me this advice – some of you will be reading this, and you know who you are. For the rest of us, take the advice that is given to you gracefully – remember, advice is rarely given in a malicious spirit, and most of your advice-givers really do have your best interest at heart. But take each piece and either toss it later, or process it and make it fit for you, and if it’s really good, pass it on later.

~~~

Stephanie Bonne is an Assistant Professor in Trauma, Acute, and Critical Care Surgery at Washington University in St. Louis. Her husband, Jeremy, is a trademark attorney for Anheuser-Busch. She has two sons, Evan, 3, and Colin, 1.

Family Life

by Jennifer Knight, MD, FACS

I picked this topic because for me, Family Life is a work in progress and sometimes putting thought into something you are working on often allows for enlightenment. As a surgeon, the idea of work life balance is a moving target. I struggle with it most days, but recently a colleague of mine told me that they wished that they could master the work life balance like I had. Master seemed a strong word!  There are things I have mastered; work life balance is not one of them. But I think because I do “try” perhaps that’s as close to mastering, as I will get. I though maybe I’d list a few things that I do as my attempt to try.

1. You need a team. A friend, who is not a surgeon, pointed out to me that I need a team of people in the operating room to ensure that my cases go smoothly and efficiently. Why didn’t I have the same type of team for home? Would a team help my home run smoothly and efficiently as well? So I got a team! I already had a nanny but added someone to clean by house, I signed up for after school play dates, and developed an arrangement with a caterer for parties and functions. 
2. Facebook. Everyone has an opinion about personal pages on Facebook. I find that I can use Facebook to stay involved with friends and relatives. I can post pictures of my family and send birthday wishes to friends. When I am able to meet face to face, I don’t need to “catch up” as much.  And while I am a peripheral user, a select “like” or “comment” lets other people know I am still around and care.
3. Plan ahead. I clearly communicate to everyone that if they want me to participate, I need 3-6 months advance notice. I’ve been able to go on class trips with my son, plan weekend get-away with girlfriends, and make most birthday parties. My friends have commented that planning in advance has helped them be more organized as well.
4. Have a good partner. My husband is also a surgeon and has a high level administrative job in our hospital system. We have to have great communication about each other’s schedules. But he is equal parent. He likes doing laundry and I like yard work. We complement each other’s strengths and weaknesses and both give 100%.
5. Mow the grass. Maybe not literally. But I love mowing the grass. And while I have a “team”, the one job around the house that I love is mowing grass. I put on my headphones and put my John Deere into drive and have great personal quiet time attacking the lawn. The point is, make sure you have alone time and if that alone time contributes to the family in some way, even better.
6. Family-friendly and fun-friendly are two different things.  I have friends and work partners who are single. Make sure that your focus on family life doesn’t trump your friends or work partners needs or plans as well.  

This is not a perfect and complete list but each of these things have helped me. Your family life is YOUR family life. Make it what you want it to be.

What tips do you have that help balance your work life and your family life? 

~~~

Jennifer Knight, MD, FACS is an Assistant Professor of Surgery at West Virginia University. She serves on the AWS Communications Committee. 

Sexism & Surgery

by Amalia Cochran, MD, MA, FACS, FCCM

How many of you saw this great piece from Emily Graslie a couple of weeks ago? 

 

I loved this video for a couple of reasons. One is obvious if you are familiar with her work- Emily’s video series from The Brain Scoop is a terrific, user-friendly approach to science. The other was that I honestly empathized with the comments that Emily included in her video, as I suspect many of us do, and I loved her approach to dealing with sexism and science. She’s no-nonsense about it and addresses the issue head on.

I thought back to my first encounter with sexism in medicine, going back to high school. Our family’s physician, upon being told that I was leaving for college at the end of my junior year under an early admission program with intent of going to medical school, simply commented, “Well, I guess it’s okay for women to be physicians these days.” No, he wasn’t joking. No, he never treated me again (nor my mother). I’ll admit- this was almost 30 years ago, and with the entry of more women into medical school many things have changed. Or have they?

Plenty of research shows that female medical students often experience gender discrimination, and that this occurs most commonly on their surgical clerkships. Women medical students are more likely to experience gender discrimination during their surgical clerkship than are their male counterparts and are more likely to perceive sex discrimination, typically from male attendings and male residents. My own recent work has shown that female surgeons and residents are more concerned about the presence of sex discrimination in the workplace than are their male colleagues, and that they perceive this discrimination as a barrier to advancement in academic surgery. Clearly this problem isn’t just one of the 1980s; it persists in modern-day medicine.

Stories of incidents can be gathered easily enough from many sources; in one night on Twitter I was able to acquire stories ranging from colleagues or patients refusing to address a woman physician as “Doctor” to women being told they are “too nice” to be a surgeon, or being told that they are allowed to do more in the OR because of their looks. While the overt sexism remains, many institutions are starting to consider the role of “implicit bias,” those subtle behaviors and actions that manage to undermine the leadership and credibility of any minority group. Yes, women surgeons are still a minority group.

So back to where we started, with Emily Graslie’s video. We have a problem still, and what we need is a solution. We can start by speaking up when we hear sexist comments- particularly those of us who are a little more senior and have less to lose than our younger colleagues. We can also work within our institutions to increase awareness of implicit bias in hopes that this will have a durable impact. And, as Emily Graslie stated, “We need to make sure we’re making it possible for people of all genders to feel acknowledged for their contributions and not feel held back by something as arbitrary as their genetics or appearance.”

How have you experienced sexism? And, perhaps more importantly, how have you dealt with it when you have either experienced it or witnessed it?

This post was originally published on Dr. Cochran's blog, Life in the Wild West.

 

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Dr. Amalia Cochran is Associate Professor of Surgery at the University of Utah. She is heavily involved in undergraduate medical education, serving as the Surgery Clerkship Director and the Director for the Applied Anatomy track for 4th year medical students at the University of Utah. Her research interests lie in surgical education and in clinical outcomes in burns. She is Vice President of the Association of Women Surgeons. Follow her on Twitter. Visit her blog. 

Interview with Dr. Julie A. Freischlag

by Bharti Jasra, MD

A while back, there once was a little girl in Illinois who impressed everyone with her extraordinary performance at school. Her grandfather told her that when she grew up, people would tell her what she could or couldn't do. "There is nothing that I can't do," her grandfather said. "Is all you need to tell them all."

That little girl grew up to be the great vascular surgeon whom we know as Dr. Julie A. Freischlag. She is an internationally renowned expert in thoracic outlet syndrome. She became the first woman director of the Department of Surgery at Johns Hopkins in its 110 year history. She served as President of the Society of Vascular Surgery from 2012 to 2013. In 2012 she was elected Chair of the Board of Regents of the American College of Surgeons. In addition, she has held leadership positions in many leading surgical societies and serves on the editorial board of several surgical journals. In February 2014 she will join the University of California, Davis as Vice Chancellor for Human Health Sciences and Dean of the UC Davis School of Medicine.

I had the opportunity to interview this great leader and ask a few questions that I thought might benefit our Association of Women Surgeons members.

Q: What role did AWS play in your career?
A: I was one of the first few resident members of AWS. It was really nice at that time to know that there were other women in the surgical community that I could look up to for guidance. Also in early years of my career it helped me as a forum for networking. It was at AWS meetings that I met Dr. Patricia Numann for the first time, and we became good friends in the next 20 years.

Q: Do administrative positions adversely affect clinical duties?
A: I spend 60% of my time in departmental work and whereas only 40% in teaching and clinical duties. As a department chair one has to work for the department and not just for yourself.

Q: Is it essential to have additional degrees like an MBA to hold a leadership position?
A: It is not required to have additional degree but there are several leadership courses offered by ACS and AAMC which could be useful. I myself benefited from the ELAM course and highly recommend it.

Q: Do you think that you had a different set of challenges being a woman?
A: It's quite lonely up there at that level since there are not many of you. Women are underrepresented not just in medical community but in legal and business communities as well. It's easy to get noticed since there are not many of you at that level. At the same time it gives you a unique opportunity to represent interests of an underrepresented class and most effective use of this opportunity is essential.

Q: Do you wish you had more time to spend with your family?
A: I am blessed with a caring husband and loving children. As surgeons we like to stay busy and I have no regrets as I have been able to find time for my family for the most part. I try to go to my son's sporting events and recitals. Also I try to limit my travel for work as much as possible.

Dr. Fresichlag with her son and husband during Parents Day at the University of Maryland

Q: What is the key to happiness?
A: Staying in touch with yourself and your family is the key to happiness.

Q: What do you do to rejuvenate after work?
A: I am a swimmer and use the pool in our backyard. Also I walk try to walk few miles a day.

Q: What is your opinion on infertility among women in surgery?
A: I believe it has been a problem, but we are heading toward better times. My own residents now are having kids during residency, and it’s only going to get better in the future.

Dr. Freischlag with her family at the Ravens-Packers game   

Q: What challenges do you foresee in this new leadership role at UC Davis?

A: I am very excited to learn more about something other than surgery, especially healthcare delivery and medical education among the Hispanic population.

Q: Any message for AWS members?

A: We are very lucky to be surgeons, and we should enjoy every part of it at all levels, whether we are residents or in practice. 

~~~

Bharti Jasra, M.D. is a medical graduate from India finishing up her General Surgery Residency at Saint Louis University Hospital. She is interested in pursuing Breast Surgical Oncology training in the year 2014.