“The world will be
saved by a Western Woman.” - His Holiness, the 14th Dalai Lama at the
Vancouver Peace Summit, 2010
His holiness
stated this on stage with three Nobel peace laureates: Mairead Maguire, Jody
Williams and Betty Williams. Also at the table was Mary Robinson, most beloved
of all Irish presidents and a tireless human rights activist. Susan Davis was
there too. Her humanitarian work has impacted the lives of millions in Haiti,
Bangladesh, Afghanistan and several African countries.
Women, it is well
known in the developing world, are less a credit risk and take monies made in a
small business and invest in their families, their communities and their countries.
Women do not start wars (with the exception of Catherine the Great and Margaret
Thatcher). Women, in the Dalai Lama’s opinion, have more compassion and care
for those who suffer. That is why he believes that Western Women, highly
educated and motivated for change, will save the world. In this era of
healthcare, I believe that Women, have a unique role to play in caring for our
patients, our trainees and our colleagues as the environment changes. I believe
that we have a very unique opportunity to steward our profession during “these “uncertain
and changing times.
In academics, how
does one start a “traditional academic career?” You go to the “right” medical
school, then the “right” residency, followed by the prestigious fellowship. At
some point along the journey, you obtain a mentor in the focus of your field of
study – clinical, scientific, or academic. As a woman, your mentor doesn’t have
to be gender specific. In fact, my first (and current) mentor is Dr. Jesse Meredith
at Wake Forest University – not to be confused with his son, J. Wayne Meredith,
MD, the Chair of Surgery at Wake Forest. Dr. Meredith Sr. is one of the
surgeons who trained and performed surgeries in the day of portal hypertension
decompressive surgeries. When TIPS (transjugular intrahepatic portal caval
shunts) do not work or are not possible, those with “open” surgical experience
in those types of surgeries are few and far between. Sometimes, in my line of work, I need someone
to talk to about these types of problems. He has always been there for me with advice,
before I was a transplant surgeon and afterwards. He is who set the tone for my
career: patient first.
The mentor can
certainly help direct your career, and the relationship with the mentor
certainly does not have to be formal. I believe that we are always training and
there are always lessons to learn from whoever is around you if you are aware
and take the time to notice.
Having said that,
where does one go from formal training? First: job, grants, clinical
experience, promotion, tenure, and then perhaps, leadership? This is where the
“glass ceiling,” or perhaps lack of opportunity,
becomes a reality for most mid-level to senior women, not only in surgery,
but medicine.
When you review
the 2012 AAMC report Women in US AcademicMedicine and Science: Statistics and Benchmarking Report, it is clear that
despite women being greater than 50% of all medical school students, we have
not progressed in numbers statistically equivalent in progression in academic
rank or leadership positions. Currently, there are only three sitting chairs of
surgery that are women in the United States, with the departure of Dr. Julie
Freischlag and Dr. Nancy Ascher from their respective chairs.
Why have women not
progressed in similar achievements in the academic hierarchy in similar numbers
occurs for many reasons. I am certainly no sociologist, and a full discussion
of the many pressures that women face in academics is beyond my talk, however, I
can only speak from my own experiences and observations over the past twenty years
in academic surgery.
Medicine as we
know it is undergoing a significant number of changes with the Accountable Care
Act and the call for “value” in healthcare from patients, payers and CMS, as
well as many other changes in the fundamental way we as healthcare
providers perform the business of Medicine. For-profit healthcare, loss of private
practices, hospital ownership of physician’s time and effort, vertically
integrated healthcare systems, are all new and frightening for medical leaders
on all levels. I believe that the instability in the current healthcare
environment leads Healthcare Leadership to choose leaders with whom they are
“comfortable “ and “ familiar” with, as opposed to leaders who don’t look like
them and perhaps possess demographic characteristics they have never worked
with in an executive environment.
I know that there
are other factors in these choices: variations in experience, additional training,
women not understanding the “language of leadership”, opportunities, and
mentorship, and frankly, women’s choices. Leadership in academic medicine is
different than leadership as defined by business, in my opinion. Whether it is
the day-to-day operations of caring for patients, the pressures of working for
organizations that often have conflicting agendas (research, patient care, teaching,
administration and making enough money to support the missions), the politics
of being in academic medicine – leadership, as defined in business, is
different than that observed and defined in medicine. I do not believe that
this should be the case, and leadership should be just that- Leadership.
“True leadership
is less of a title or a position, it is more of a state of “being.” It is about
courage and risk taking and not so much about politics and walking a “safe”
line. Leadership is about standing up for what is important to you – patients,
trainees, your research or science, mentorship and having the vision to bring
your Department/Division/group of partners along with you. It is about sacrificing your career for the
forward motion of your organizations and its members – the concept of “servant
leadership.” It is eventually about your legacy and the legacy of the
organization under your direction. Not empire building and certainly not about
money.
So, if this is a
track you want to pursue, the first thing one needs to do is to assess what you
have available to you to make this happen and what you need to acquire. What
resources do you have? What skills do you have and potentially need? What are
your challenges? First, you must learn the language of leadership and have a
vision for what you want to achieve. Think globally not locally.
There are
resources available to you for your leadership training and development. 35% of
AAMC accredited medical schools have monetary support for the standard Group on
Women in Medicine and Science (GWIMS). These monies are intended for women
faculty promotion and provide development opportunities for those selected
faculty members. Departments and Divisions often have funds set aside for
faculty training and development. If there are no monies available at your
institution at that level, the Dean’s office or Hospital may possess funds
available for leadership training. See the table below for some options and
costs for those training opportunities.
Other options for
leadership development include formal mentorship opportunities (if not
available for you locally) in national societies such as the American College
of Surgeons and the Association of Women Surgeons. A searchable mentor database has been developed for AWS members.
I have found
personal coaching and assessment very valuable and now have a relationship with
a psychologist who specializes in helping women find their way to leadership.
Personal coaching is an expensive option. However, it is about you – your skills,
your challenges and your issues and allows you to have an objective ear for
your concerns. I have found this assessment and support, invaluable.
I would suggest
that now is the right time to pursue leadership opportunities. The challenges
that Healthcare Reform presents allows us that opportunity and the business
literature is full of articles and assessments regarding women as leaders.
While it is unfair to all of us to stereotype a “typical” woman leader, Forbes
Magazine at a conference in 2012, published an article regarding women’s leadership
characteristics including: empathy, curiosity, collaboration – as well as – an open,
information sharing style vs. hording of knowledge. Women are also described as
highly adaptable leaders. The perfect skills to have in the changing health
care environment.
While you are
preparing for whatever leadership role you desire (section, division,
department chief or dean role or even a chief medical officer in industry), here
are a few suggestions from lessons I have learned along the way (mostly from mistakes).
1. First, always lead yourself.
Have a routine for
basic self-care (exercise, diet, meditation, yoga, religion, etc.). Practice
finding that work/life balance – whatever that looks like for you. Be extremely
mindful of the resource that is you. Don’t waste your energy on people,
issues or activities that do not “feed you” and only drain you. People depend
on you – family, patients, and colleagues. Preserve yourself for what matters
to you. Become the leader you would like to be. Have unquestionable integrity,
and fairness. Lead by example. Be on time for the OR, keep your charts up to
date, and be on time for clinic. Have a sense of humor, and remember most of
the time, “it” isn’t all that important usually. We, as surgeons, know what is
really important. Never hold a grudge – easier said than done, but work at it.
Be the best surgeon you can be.
2. Have peer credibility.
Possess and
practice the four A’s of Surgery – accountability, availability, affability and
ability (usually in that order of priority). If you are friendly and available,
you will go a long way with garnering the support and, if not admiration, the
respect of your colleagues. Remember, it is your colleagues that you are hoping
to lead in some fashion as you move forward.
Be supportive to the people who work for you: nursing staff, administrative
support staff, and especially trainees. Never be demeaning, hold people
accountable but communicate and educate.
3. Most importantly, fine tune your inter-personal and communication
skills.
Moving forward in
academics is about relationship building. Note, I did not say politics. Learn
people’s names and listen to staff (you usually can find out the “real” story
about any one issue by listening.) Work on building your reputation of being
friendly, approachable and most importantly, effective. Never lose your temper
and if you do, do not say anything that could be repeated out of context that
makes you look worse.
I have observed
over the years, that women in the operating room (for example); do not enjoy
the same level of understanding from the staff when tempers are lost. There is
no room for immaturity or lack of insight into how a tiff in the OR could
potentially ruin or significantly delay your potential promotion into a
leadership position until you have been judged to be “mature.” Most
importantly, never single out an individual with your tirade. It has to be
about the issues.
4.
Have a constructive way to resolve conflict on
any level.
Always start your resolution process with a clear mind and a calm heart
(as hard as that might be). Remember it is about the issue, not the person, even
if it has to do with the person’s behavior. It is about being disruptive, for
example. Always resolve issues face-to-face and refrain from the immediate
email reflex. A short meeting with a published agenda and planned follow up is critical.
Ignore the urge to call someone’s boss. Be deliberate, be about the issue and
follow through.
5.
Set your
priorities.
Refer back to #1. Preserve the resource that is you for the
things and efforts that you think are important. Other people will have an idea
of what they want for you, but you have to be very clear in your own direction
and avoid busy work (i.e. committee that are not important, and do not
accomplish anything for example). Avoid being the token appointment to any
committee or organization unless you feel it is something that you think is
worthy of your time and effort. Be extremely organized using whatever tools
work for you. The personal coach for me has been extremely useful in this
particular issue. Prioritize your office, and time – clinical administrative
and teaching. If research is important to you, set aside protected time for
your efforts. This of course, may require negotiation and follow through. You
cannot do research and have a clinic the same day.
6.
Disarm the
tenure clock and collaborate.
In order to
progress in the hierarchy of Medicine, one must be productive in a research
area and/or publish. Not all of us should be, or can be, an NIH funded basic science
researcher. However, that doesn’t mean that all of us in academic medicine
cannot be productive.
One of the issues in
retaining women faculty is the issue to promotion and tenure. Certainly, some
institutions have more rigorous promotion and tenure requirements than others.
However, all academic programs have some minimum requirement for contribution
to the literature and some have a time limit for application for promotion and
tenure.
If and when you
make the decision to have a child, and you are in the academic setting, know
your own institution’s maternity policy. Apply for leave, in anticipation of
your leave, in an early and timely fashion and do not leave this application to
anyone else. I have had Division Chief’s lose these types of applications on
their desks – never reaching their intended destinations. If you are planning a
child or you are a very busy clinical surgeon, it is critical for your academic
success to collaborate with academically productive people. You as a clinician
can contribute much needed clinical expertise to (as my example) an Outcomes
Research group. By collaborating, instead of being on your own, your work can
continue when you do take leave, or you become very busy.
7.
Hone your
administrative skill set.
Currently, I am in
the throes of a Corporate Finance class as part of a Master’s in Health
Administration Program. Why? As a Division Chief and as the former interim
Chair of Anesthesia at my institution, I was responsible for budgets to the
Dean, determining salaries based on productivity, bonuses and contract negotiations
with Hospital organizations for services provided. I was blessed with a
wonderful business manager; however, I felt that I needed more precise
information about what I was doing, hence my return back to school for the MHA.
It is imperative
if you are to be a leader in academic medicine especially in the current environment
that you understand the finances of what it is that you do. You need to know
diagnostic codes, reimbursements, documentation requirements and your own
regulatory environment. You must have a trustworthy business manager but they
are often hard to find and may have been “institutionalized” meaning they may
not be open to new ideas about how to do your business. You often have to
mentor them as much as your partners and trainees. If you cannot read the P &
L statement or an income statement, take the time to talk to your business
people and learn about how overhead is allocated and what the lines on your P &
L statement mean. It is important. Profitable divisions and departments have
the ability to grow and develop. If you are not comfortable with any of this
perhaps you too will find yourself back in school for an MBA or an MHA. It
isn’t surgery, after all.
In conclusion, I
hope my hard learned lessons have been useful. I have learned over the years,
that keeping one’s own CV is important, make sure you know what you are doing (i.e.
do an executive summary) and look at yourself and your career annually to make
sure you are on the track you want to be. Use your friends to help you on your
way.
I would never be
where I am, or more importantly who I am and how I am, without the Association
of Women Surgeons and my mentors there. To be the 2014 Kim Ephgrave Visiting
Professor is one of the highlights of my career. Thank you again for this
honor.
“I learned all
kinds of things from AWS members and staff about challenges in our various
family and professional situations, and AWS gave meaning to my own hard learned
lessons as a vehicle for sharing them with others.” - Kim Ephgrave, MD
A few references for
your perusal:
Dr. Betsy Tuttle Newhall
Professor of Surgery, and Urology
Division Chief of Abdominal Transplantation
Surgical Director for UNOS, Kidney and Kidney Pancreas Program
Saint Louis University
