Respect

by Erin W. Gilbert, MD 

“Your job gives you authority. Your behavior gives you respect.”
—Irwin Federman, general partner at U.S. Venture Partners

Throughout my surgical training I blindly accepted that having grey hair (and experience) equaled garnering respect as a surgeon. Now that I am junior faculty at an academic institution (and beginning to grey myself), I’m wondering if there is more to the story. There is a noticeable difference in how residents treat me as compared to how they treat the Department Chair- which is of course OK by me, but I have begun wondering how can I ensure that I will achieve and more importantly maintain the same level of respect?

As a medical student at LSU in New Orleans, we followed a very hierarchical system where the intern was the boss of the students, the junior was the boss of the intern and so on. It seemed to me in this system that the doctor’s role dictated the level of respect they earned from the team, but just because you follow someone’s orders does not mean you respect them. Other misconceptions I have had include believing respect comes from being a good dresser, having large muscles or simply being intimidating in some way. Now that I have matured a bit I am learning that people may admire good looks, muscles, or a power suit, but this does not translate into respect.

Federman’s quote alludes to the real heart of the story. Think about people in your life you respect; who you would follow into battle without question, who you try to emulate… they are kind, generous, caring, and fair. They treat all of those around them with respect - from the hospital CEO to housekeeping staff - without question and without needing a reason to show respect. They value others’ efforts and acknowledge them; they listen, and they are always sincere. I may just be figuring this out for myself now, but thanks to my upbringing, I know that treating all people with respect is the expectation not the exception- I just didn’t realize how much it could influence how others treat me.

Readers, think back to the role models in your life. What behaviors of theirs did you respect? Share with us in the comments below. 
 

~~~

Erin Gilbert is an Assistant Professor at Oregon Health & Sciences University in Portland where she is a member of the Knight Cancer Institute. She received her medical degree from LSU in New Orleans and completed her general surgery residency at the University of Washington in Seattle. She was fellowship trained in Minimally Invasive Surgery at OHSU and specializes in the surgical management of pancreatic disease.

Green Solutions for the Operating Room

In 2013, the Association of Women Surgeons sponsored its second Green Solutions for the Operating Room Contest in a partnership with Practice Greenhealth.  We received many innovative and creative approaches to reducing the environmental impact of the operating room.  Today we are featuring a submission from Michelle Hoadley, a 4^th year medical student at William Carey University College of Osteopathic Medicine.  Many thanks to Michelle and the rest of the contest participants!

The Use of Steam in Preoperative Preparation of the Operating Room

Michelle Hoadley

I became interested in “going green” because it is my parents business. My parents started up their own company that specializes in commissioning and green building services. Because I have worked many summers at my parent’s office, I have gotten an inside look at the green building process. As a result, I began to see things differently and developed a keen eye for evaluating how to make things more environmentally friendly. I also learned that making things environmentally friendly often times involves small changes or changing things most people do not even think about. One of these things includes the way we clean. Most disinfecting agents carry high levels of Volatile Organic Compounds, aka VOC’s. VOC’s are of particular concern because they are a source of indoor air pollution and are known to cause a variety of health issues with exposure. However, as I began my rotations during 3^rd year I noticed that these same harmful chemicals were being used to in not just cleaning the hospital, but also in cleaning the operating room.

Eliminating the toxic chemical exposures in the hospital and the OR is important to the health of everyone involved, from physicians to staff and even patients. So I started to evaluate the best way to clean the OR without unnecessary VOC exposure. The cleaning method would also have to be affordable and easily implementable into a small hospital as well as large university hospital. What came to mind is steam cleaning—maybe  because I recently purchased one for my home and absolutely love how easy it is to use. Cleaning with steam at home also means I minimize the level of VOC’s my family is exposed to. Why not transfer how I clean my home to how we clean the operating room? Especially since steam is far superior in disinfecting and sterilizing then most of those toxic chemicals currently being used. I also incorporated into my steam cleaning proposal a method to the cleaning process. This method includes cleaning top to bottom and then back wall to the door, which would reduce contamination. In order to improve the disinfecting capabilities even more as well as improve efficiency, one could  add a microfiber cloth attachment to the steam cleaning process.

In conclusion, using steam cleaning in the operating room as well as the hospital in general would eliminate the high levels of VOC’s produced by the toxic disinfecting cleaners in current use. As a result, the indoor air quality would improve. With an improvement in the indoor air quality the health risks associated with the now eliminated toxic fumes would also improve. It’s a win-win situation. To take this one step further, paints, floor waxes, and other sources of high VOC release compounds should be switched to low or no VOC alternatives. We often overlook the pollution caused by our everyday chemicals and cleaners, as well as dismiss the health risks associated to their exposure, which includes respiratory issues and even cancer. It is because VOC exposure is so easy to overlook that I wanted to write about it and bring its health risks to the attention of others by submitting my proposal to the “Greening the OR” competition.

~~~

Michelle Hoadley is a 4^th year medical student at William Carey University College of Osteopathic Medicine. She holds a Bachelor of Arts from Mercer University in women and gender studies with a minor in chemistry. Michelle also holds a Master’s of Science from Mississippi College in biomedical science. Michelle is a current member of the Association of Women Surgeons, has held leadership positions in the Student Osteopathic Medical Association, and is an active instructor in WCUCOM’s suture clinic.

Join our team

Surgeons, residents, med students: Looking for a leadership opportunity? Get involved with the Association of Women Surgeons through social media! We need tweeters, bloggers, and Facebook fanatics to join our communications team and help make a difference! 

Contact info@womensurgeons.org for more information. 

What I learned about negotiation while getting ready for my first job interview.

by Kaitlyn Kelly, MD
Assistant Professor of Surgery 
UC San Diego, Division of Surgical Oncology


I recently made the transition from fellow to attending. As I was getting ready for my first job interview, I realized that I knew nothing about negotiating. Several friends and mentors asked me what I was planning to ask for and I didn’t know. I also felt very anxious about that thought of asking for any more than what was being offered to me. It just is not in my nature. Then a mentor suggested that I read, Women Don’t Ask, by Linda Babcock and Sara Laschever. I bought the book the next day and read it on the flight to my interview. It was very eye-opening for me because it made me realize that I was not alone. It explained that many women have trouble negotiating and provided an in-depth discussion of personal and social reasons for why that is. The book went on to explain how to effectively ask for what you need in an effective, yet polite, way. I felt much more comfortable and better equipped for my interviews after reading it.

Another thing I learned as the process went on is that at many academic institutions, the salary for an assistant clinical professor is a set rate and is not considered negotiable. It is important to find out what the standard / acceptable salary is in one’s field and in the geographic region where one is applying. This information is published yearly in the AAMC Report on Medical School Faculty Salaries.  Even in cases where starting salary is “non-negotiable”, there are many other things that one can still negotiate for in the academic practice setting. These include office space, a computer, a window in one’s office, tuition for courses and career development opportunities, travel funding, phone expenses, parking, etc.

After the interview process is complete, you receive a letter stating the terms of the position and the salary. If you accept the position and terms, you sign and return the letter. This letter is your final opportunity to negotiate. You may respond and ask that it be amended prior to signing. It is important to make sure you are complete when responding and that you ask for all modifications that you want. I have heard of a situation where an applicant went back and forth several times with the letter and ultimately, the offer was taken away.

To summarize, I recommend the following tips when entering the job negotiation process:

1. Read the books: Women Don’t Ask, and the AAMC Report on Medical School Faculty Salaries.
2. Be organized. Know what salary is reasonable to ask for, and know what non-salary items are important to you that you want to ask for.
3. And be confident. Know what you have to offer the institution where you are interviewing.

       Good luck!

Negotiation, like tying surgical knots, is a learned skill.

by Carol EH Scott-Conner, MD, PhD, MBA

Endocrine and Breast Oncology Surgeon

Professor of Surgery - Surgical Oncology and Endocrine Surgery 

University of Iowa Carver College of Medicine 

What image does the word “negotiation” bring to your mind? Do you think of a buyer and a seller haggling in some bazaar? Do you cringe, remembering a time when you had to go to your supervisor with a request for resources (and maybe got turned down)? Perhaps you envision a mother trying to get a toddler to do something. Do you think of bribery? Of weakness? Of strength? Of imbalance of power?

We negotiate all the time, in matters large and small. Negotiation, like tying surgical knots, is a learned skill. And that means that you can learn how to do it, just like you learned how to tie a secure knot (even though you had been tying your own shoelaces for decades).  

Negotiation involves give and take between two parties. Give and take implies that each party has something to gain and something to lose. A successful negotiation satisfies both; there is a sense of balance.

In Women Don’t Ask, Babcock and Laschever argue that many women are averse to negotiation. They give numerous examples and quantitate the way in which women sacrifice as much as half a million dollars over their working lives by neglecting to negotiate effectively for their first job. The damage extends far beyond monetary compensation. Failure to negotiate may hamper your ability to succeed, if you “low-ball” the resources and/or support needed to achieve a needed goal.

Suppose, for a moment, that you have been asked to take on a major responsibility such as becoming a Division Director. It’s a huge honor. You’ve actually wanted this job for quite some time. The moment has come, and you are in the office of your Department Chair. You’re quite excited, and yet afraid, somehow, that the offer will be withdrawn if you are too demanding. You will need to negotiate for: a raise (commensurate with your additional resources), some protected time for the administrative functions, administrative support, a commitment to recruit and grow your division, resources for your division (such as clinic space, operating room time, research support). 

How should you proceed? First of all, prepare ahead of time. You wouldn’t go into the operating room without preparation. Don’t assume for a moment that you can just “wing it”.

1. Do your research. Get as much information about the division as you can. Hopefully you have been doing this along as you prepared to move into an opportunity like this. Basic statistic such as volume and trends in clinic visits, diagnoses, patient satisfaction, surgical cases, complications, length of stay, salaries, size of division relative to other academic medical centers are easily obtained if you dig around a bit.
2. Do a basic SWOT analysis. What are the division’s strengths, weaknesses, opportunities, and threats? How can you build on strengths, expand into opportunities, correct weaknesses and avoid threats?
3. Put your findings into the broader context of the Department and the hospital (or university) in which you work.
4. What are your priorities and goals for your own career? How will this position advance your career? How will it complicate your life?

Next, take this information and make it into a concise set of needs/wants and rationale for each. Rank these. Consider a menu of options. Consider how factors are interrelated; for example, if growth is a priority for this division, then recruitment will require a commitment for additional clinic space and operating room time. Remember that the negotiation process involves give and take. Additional operating time may simply not be feasible at this point, but analysis might reveal that another division is about to lose personnel, or that some surgeons will be moving their practice to an Ambulatory Surgery Center. You may be able to get a commitment to get newly freed up time in the Main OR or to move a significant fraction of your division’s cases to the ASC.

Rehearse your negotiation with a trusted and experienced person. A network of mentors around the country, including friends in other disciplines, can be invaluable. You might (rightly!) not feel comfortable doing this with a colleague in your own department, or even a colleague at a different university. Seek someone with experience in another discipline if necessary. Use your spouse or partner. Go through the discussion. Have your partner throw objections at you. Use the mirror if you have to. Practice countering objections, resistance, even hostility.

Keep a collaborative focus. Both you and the person you are negotiating with want the division to thrive. If the other person does not, you may want to switch jobs or consider turning it down. Think about the priority of this particular division within the larger organizational structure. How does this division affect the whole? Do you provide a crucial service that no one else can do (for example, pediatric surgery) or do you overlap with other divisions (for example colorectal surgery overlaps with MIS, surgical oncology, and GI surgery)?

Lose the emotion. The best advice I ever got about negotiation was to think in these terms: “I care, but not too much” about the outcome. Don’t personalize it. This is not about friendship, or individual worth. This is about what you can do for the organization and what you need to have to do the job.

Get some distance, if you need to. If all else fails, make a graceful exit and return to continue the negotiation after you have both cooled off and reconsidered.

Remember the value that you bring to the organization. This is about maximizing that value, and continuing to contribute.

Let’s take a simpler example. You need better nursing support in clinic. You suspect that the male physicians are assigned more nursing support because they need to be chaperoned when they examine a female patient. You feel that you need to be chaperoned as well, but that your needs are ignored. Go through the same steps outlined above. Collect the data. Come up with a menu of options. Perhaps you can shift clinic days/times to a less busy slot. Perhaps the problem is that you are in clinic when a particularly busy and demanding male surgeon is also there, and he is sucking up all the resources. Options include tackling the issue head-on or switching.

The truth is that you are constantly negotiating. Shall we have dinner at home or eat out? Should we go to a basketball game or a concert? Does my case go first in our shared OR, or does yours? Will you add this procedure on to your full schedule to accommodate my patient? Once you become aware of how pervasive negotiation is, you will find numerous lesser-stakes opportunities to practice. This practice makes you ready for the high-stakes discussions.

What if you are the person in power? Make sure that all the facts are available. Have a menu of options to achieve a shared vision. Don’t take advantage of a naïve junior surgeon. If you feel that the person with whom you are negotiating is naïve, ask them to take some time to look at the data and come back to you with a list of needs. This is not only the right thing to do, it gives both of you a greater probability of success.

In 1995, I became the second woman in American surgery to Chair an academic department at a medical school. Every year, I would met with each faculty member to discuss salaries. The men came in with demands that were often outrageous, but they were usually also armed with data. Too many of the women came in and began the discussion by saying, “the money isn’t important.” I think that women don’t generally go into surgery without a strong sense of vocation. Money doesn’t taint that vocation, it is a just reward for what you do.

It is how people measure success. When I went to Scotland decades ago to meet with a textbook coauthor, I learned the phrase “good value for money.” It can mean a lot of things, but at the most basic it means that it is okay to spend more money if you get higher quality. You provide “good value for money” every day. Don’t hesitate to make sure you are appropriately rewarded and empowered with the resources you need.

The “c” word. I don’t consider myself a crier. However, when I was young, difficult negotiation, one-on-one, with a supervisor used to bring me to the verge of tears. In informal discussion with other women, I know that this is not a rare problem. The remainder of the session would spiral out of my control as I focused on keeping my emotions in check. We all know that crying on the job is almost never a good idea, particularly when you are up against a male surgeon.

I learned not to cry, and you can too. Incidentally, this is not just a female problem. Men cry, too. Rehearsal will help desensitize you. Taking the emotion out is easier if you think of it as an analytic problem rather than an interpersonal one. If all else fails, make a graceful exit and return in the near future with better armor!

Suggested Readings:

Babcock L, Laschever S. Women Don’t Ask, Bantam books, 2007. Get this book and read it!

Negotiation. Wikipaedia. http://en.wikipedia.org/wiki/Negotiation accessed January 2014. This is a very concise and nice guide to negotiation. It identifies three classic styles.

Creating your own academic timeline

by Christina Cellini, MD, FACS, FASCRS

This topic came to me during a grand rounds given by a well-known surgeon in his mid-career - henceforth will be referred to as “WKS”. I had just returned from my second three-month maternity leave in two years and was looking forward to hearing about what advice he had to give.

That morning WKS gave a talk about how he advanced academically starting from residency to his early attending years that eventually led to his promotion to associate professor. His talk was very informative, and he made a really big deal about being present for your family while trying to achieve your goals. All in all it was a thoughtful presentation. However a few things caught my attention and highlighted how everyone’s situation is unique.

One piece of advice given was that one should constantly “be writing papers” and even to “get up at 4 am before work” to write in order to fulfill that goal.

4am??? I thought back to what I was doing at four A.M. that morning. Oh right… I was nursing an infant. I’m certain that’s not something that ever stood in his way of writing papers. Oh well, no time for paper writing this morning. Maybe tomorrow.

His next piece of advice was to take advantage of all the wonderful scholarships and traveling opportunities that are catered towards young attendings under the age of 45 . He showed lovely pictures of him and his family frolicking around a foreign country that was many time zones away.

I thought- wow! I didn’t know about these awards. I should think of putting something together. Then I thought of the logistics- I don’t think I’ll be able to leave my tiny children away for that amount of time. And since these days I need to plan about an hour in advance to take both kids out to a trip to Target…. maybe in about 5-7 more years. But then I’ll be too old for these scholarships!

Finally he mentioned being involved in society meetings and to bring family along so that you can take advantages of the opportunities there while your spouse and kids go and do fun things in the area. See- you can work and spend time with your family as well! I thought- that might be doable. I did have to skip the last 2 of my society meetings because I was either too pregnant to fly safely or did not have the resources to travel with an infant. Let me ask my husband how he’d feel about watching the girls in a strange place for a week while I do my surgery thing. I texted him- I got back “absolutely not”. Apparently dealing with two cranky, nap-less, off schedule children by himself while I do my own thing most of the day was not my husband’s idea of “family fun”. He encouraged me to go alone. Now don’t get me wrong- my husband is awesome and takes care of the lion’s share of child rearing and is supportive of my career- but I couldn’t blame him for not wanting to sign up for that.

WKS had a number of great ideas that worked for him to achieve academic success so quickly in his career. I am certain there are many young surgeons - both men and women- who can achieve that as well. However, WKS had a personal situation that allowed him to flourish early on. He was able to follow the typical academic timeline that usually consists of publishing 2-3 papers/year, obtaining some sort of early career development grant or funding in the first 5 years as a means for future funding, active involvement in the ACS and specialty societies - all in addition to growing one’s clinical practice at the expected pace. With this timeline one can usually expect promotion to associate professor within five years or so. I know that I will not be able to keep up with that timeline. My path to promotion will likely take a few (or more) years longer than others. Occasionally I get antsy about it when I perceive that my peers are advancing faster than me or that I am in some way “behind”. However, I have been lucky to have colleagues and mentors that understand my need to slow down for my family and are supportive of an “extended” academic timeline to academic advancement.

Now, if you can breastfeed and write scientific papers at the same time go for it! If not, I suggest the following:

1) Take some time to really think about what your future academic goals are. Make them very discrete, not ambiguous. Also, take the time to write them down.

2) Prioritize the goals and create a timeline to go with them. Give some real thought as to how you might go about achieving these goals. Again, the more specific you are, the more likely you are to realize them.

3) Share your academic timeline with a more senior colleague or mentor. Doing so may help you identify potential opportunities or pitfalls in your strategy that you may not have considered. As always AWS members are available to help- and have likely been in your shoes at one time or another!

4) Periodically look back on what you have written and adjust as necessary. Do not feel bad or guilty if it takes longer than you thought. Try not to fall into the “keeping up with the Jones’s” trap that can be prevalent in surgery (I know I have on more than one occasion). Take the time to write down and reflect on everything that you have accomplished up to that point. Remember no accomplishment is too small! As long as you remember what’s important to you and keep your eye on the prize you will no doubt be able to balance your personal and professional life and accomplish what you have set out to do.

Readers, how have you adjusted your own professional timeline to achieve both personal and professional goals in a reasonable manner? Share your thoughts below.
 

~~~

 

Dr. Christina Cellini is an Assistant Professor of Surgery and Oncology at the University of Rochester Medical Center in the Division of Colorectal Surgery. After obtaining her undergraduate and medical school degrees at Cornell University she trained in general surgery at the NewYork Presbyterian Hospital-Weill Cornell Medical Center. Following residency, she completed a fellowship in Colorectal Surgery at Washington University in St. Louis. She recently completed a Masters in Medical Management at the Simon School of Business at the University of Rochester. She lives in Webster, NY with her husband and 2 children and enjoys running and snowshoeing in her free time. Dr. Cellini serves on the AWS communication committee.

Finding Strength in Setbacks

by Jane Zhao

Two months ago, I read a great book, and I’ve been raving about it ever since to whoever will listen. David and Goliath: Underdogs, Misfits, and the Art of Battling Giants by Malcolm Gladwell is a book that stays true to form to Gladwell’s other works. In it, Gladwell challenges readers to look beyond conventional wisdom to reevaluate the way we look at setbacks.

The nonfiction book begins with a vignette from the biblical passage of David and Goliath. Historically, David has always been painted as the underdog and Goliath the giant. But based on what criterion? The fact that David is of significantly smaller stature? Pfft. According to Gladwell, David wasn’t such a weakling. In fact, he had numerous other qualities that made him just as formidable (if not more so) than Goliath.

Gladwell writes early on in the book:

“There is a set of advantages that have to do with material resources, and there is a set that have to do with the absence of material resources—and the reason underdogs win as often as they do is that the latter is sometimes every bit the equal of the former.

“For some reason, this is a very difficult lesson for us to learn. We have, I think, a very rigid and limited definition of what an advantage is. We think of things as helpful that actually aren’t and think of other things as unhelpful that in reality leave us stronger and wiser.”

As I read, I thought bemusedly how his words could be applied to setbacks faced by women in surgery. How often have I heard of the challenges faced by my predecessors described as blessings in disguise? Based on his writing, Gladwell probably wouldn't think of that analogy as far-fetched at all.

So I came up with some examples of surgeons whose pasts as underdogs and misfits shaped them into amazing role models.

• In the 1970s, women were discriminated against from receiving credit in their own name at banks, and if these women were married, they were told to use their husband’s name on the checking account. Finally, in response to the refusal of service, a number of women banded together and formed the first ever women’s bank. Dr. Anita Figueredo was one of them. During the creation of the bank, these women received derision and dismissal from many of their peers. But after the bank’s successful launch, banks all around (even the ones that had previously refused them service) began to open up "women’s departments" and "women's divisions." Lessons learned: when these women didn’t feel welcome, they decided that instead of trying to fit in, they’d start from scratch elsewhere. As a result, they each became successful entrepreneurs with leverage of their own right in the banking community.
• Dr. Frances Conley never really considered herself the victim of sexual harassment. Anytime an off-color joke was directed her way, she’d fire off a snappy retort, and that’d be the end of that. She built an incredibly successful career as a neurosurgeon at one of the most prominent academic institutions in the country. She kept her head down and didn't rock the boat. But then came an incident of misogyny that she simply couldn’t ignore, and she publicly resigned from her tenured position in protest. Her office and lab were ransacked; she was vilified by the media and many of her peers. Thanks to her efforts, numerous medical schools, universities, hospitals, and research labs created or updated their policies regarding sexual harassment. When she finally performed the unsavory deed of “rocking the boat” that she’d spent so long trying to avoid, she became recognized and respected as a leader brave enough to speak the unspeakable.
• Dr. Linda Brodsky serendipitously discovered in 1997 during a residency program review that a recently hired male faculty member in her department with lesser qualifications, responsibilities, and seniority was being compensated by her university at twice her state salary. Upon further investigation, she discovered that this was not an isolated incident. After more than two years of trying to resolve her gender and pay concerns internally, she resorted to filing charges of discrimination by her two employers. As a consequence, she lost her job. She’s since spoken publicly about the innumerable times she became wracked with guilt over putting her family through the tortuous process. Often, she’d lose sight of the light at the end of the tunnel and question whether she’d made the right choice by filing a lawsuit. After ten long years, the lawsuits were finally settled. Because of that grueling period in her life, she is significantly wiser about the laws regarding fair gender compensation, and she has become a fearless leader in the global community by advocating for others who are now in similar situations. 
• And lastly, an orthopedic surgeon I know was teased and called “Token” by her co-residents all throughout residency because she was the token woman their program had taken in that year to meet its quota for diversity and inclusion. Being called by a nickname she hated irked her to no end, but that experience made her aware of just how damaging and alienating such taunts, however slight, can be over time. As a result, she is an infinitely more sensitive caretaker and teacher than she would have been otherwise.

The incidents suffered by these women were awful. They faced difficulties because they were different. The silver lining to all of this is that we wouldn’t know about any of these women and their heroic contributions to society if they hadn’t been pushed to the brink and been forced by their situations to find the inner courage to implement change when change was needed.

Globally, women and underrepresented minorities still have a ways to go before full equality is met. It’s a new year though, and with that as reason enough to celebrate, I’d like to raise a toast to the tremendous progress we’ve made as a society, all thanks to the efforts of underdogs and misfits who saw setbacks not as obstacles that blocked their paths but as walls to be climbed over.

Happy 2014.

Oh, and make sure to read David and Goliath: Underdogs, Misfits, and the Art of Battling Giants by Malcolm Gladwell. It’s a good book.

Do you have an experience where being an outsider made you a stronger individual? Share your story with us in the comments below.

~~~

Jane Zhao is a fourth year medical student at the University of Texas Medical School at Houston. She completed her undergraduate studies in Medicine, Health, & Society at Vanderbilt University. She was the 2012 recipient of the Shohrae Hajibashi Memorial Leadership Award. Her interests include healthcare social media, quality improvement, and public health from a surgical perspective. She chairs the AWS blog subcommittee and can be followed on Twitter. She is in the process of interviewing for General Surgery residency for the 2014 Match.