Women Surgeon Leaders for the 21st Century Part II: Profiles in Leadership

By: SreyRam Kuy, MD, MHS

Introduction

We had the privilege of interviewing several influential women surgeon leaders.  Patricia Numann, MD, FACS, Barbara Lee Bass, MD, FACS and Susan Moffatt-Bruce, MD, FACS shared their wisdom, their experiences, and their inspiration with us.   Spanning a spectrum of specialties, roles and backgrounds, these women leaders have changed the face of surgery in America. We thank Drs. Numann, Bass and Moffat-Bruce for their generous time and their invaluably candid answers.  Hopefully, these stories will inspire the next generation of women surgeons to continue this incredible legacy of strength, courage and resilience.  We salute the Women Surgeon Leaders who have defied obstacles, made their own path on their own terms, and paved the way for generations of women and men to come.  We are indebted to these surgeons who have been leaders, educators and mentors to so many young surgeons.  And, we are indebted for their courage in sharing their journey in taking the roads less traveled.       

Interviews

Dr. Patricia Numann

Dr. Patricia Numann is an endocrine surgeon and the Lloyd S. Rogers Professor of Surgery Emeritus at SUNY Upstate Medical University in Syracuse, New York.  She earned her medical degree from SUNY Upstate Medical University in 1965.  She then did a combined medicine and surgery internship, and then stayed to complete her surgery residency there in 1970.  Dr. Numann started as an Assistant Professor of Surgery at SUNY, and then quickly rose through the academic ranks at SUNY Upstate, serving as Associate Dean of the College of Medicine and Medical Director of the University Hospital.  Dr. Numann founded the Association of Women Surgeons in 1981 when she invited as many female surgeons as she could identify to a breakfast at the October meeting of the American College of Surgeons in the San Francisco Hilton Hotel. Up until this point there was no formal organization serving specifically the needs of women surgeons.  Since that first breakfast in 1981 the Association of Women Surgeons has grown into a powerful national organization serving the needs of women medical students, residents and surgeons.  Dr. Numann was the first woman to serve as Chair of the American Board of Surgeons, Founder and President of the Association for Surgical Education, and a President of the Association of Women Surgeons.  In 2011 Dr. Numann became the 92nd president of the American College of Surgeons and its second woman president.

Interviewer:  What do you see as the greatest skills need to be successful as a leader in academic surgery and in surgical organizations?

Dr. Numann:  Optimism, Integrity, Thick Skin, Moral Courage.  The ability to give more.

Good listening skills. Curiosity and diverse interests.  Pride in other’s success.  High Standards

Interviewer:  What are the biggest challenges and obstacles you yourself faced in your career? What are challenges you saw your female colleagues in surgery facing in their careers? What do you see as the challenges women surgeons face today in advancing as surgical leaders in academic institutions and in national surgical organizations?

Dr. Numann:  I guess if I had viewed things as obstacles or problems, I do not think I would have done well.  [Instead], I would think "Now isn't that a silly thing to think or say." I would then decide whether I wanted to deal with any of it or ignore it. Most could just be ignored. I then found a statement by Dawn Steel who was the first woman executive of Paramount studios. "Never try to teach a pig to sing, you waste your time and annoy the pig." I kept it taped to the side of my desk. When people were outrageous or intractable I would think "Pig" and change the topic and strategy to solve the problem. You cannot want to win every battle or convert every person to your way of thinking.

[Rather], I found being useful to whoever or whatever got me through many a tough spot.  No one would accept my application for a surgical residency in 1964.  So I made a deal with my chair to do [an internship] with 6 months of Medicine and 6 months of Surgery.  If I did not want Medicine and had done well enough in Surgery, I could have a spot in our pyramidal program.  In those days prejudice was very open.  I think in some ways that is easier than now where much is unconscious bias that diminishes women's contributions.

I think women still face unconscious bias [in that people assume] that they are not fiscally as wise, that they are too conflicted when they are mothers, that they are not physically or mentally as strong as men.  I also think that they are not put on the list for promotion as commonly as men.  In several cases I have seen women have a great deal of trouble when a child had problems or when they faced divorce. The part time position is still viewed very negatively.  It is hard to get back after a period of part time work. [Research] granting agencies are fairer, but still I think when [reviewers are] unblinded to gender [they] favor male applicants.  I think more objective data is needed to prove women’s equality is some of these issues.

The old boy's network is still in good standing in many, if not most surgical organizations.  Even when women get to be represented in good numbers the leadership positions more frequently go to men.

Interviewer:  What are ways that you overcame those obstacles? Can you give concrete examples? What did you learn from these obstacles?

Dr. Numann:  I think hard work and being useful helped overcome many obstacles.  I had one chairman who fired me regularly.  Fortunately I had tenure and many colleagues who supported me and respected me professionally.  I decided to mostly ignore him and continue to work, participate in organizations, and be sure that my quality was excellent. I was always a bean counter. I would count cases, publications, abstracts, requests for presentations and keep track of my quality so I knew I was as good as anyone around me. It made it hard for him to get rid of me. He never did.  I felt very vindicated when he left and [also by the knowledge that] other really terrific people also had trouble with him. I wanted to start a Breast Center when he was chair. He refused to fund it so I went to the Hospital Auxiliary and they had a fund raiser to begin the program, then we became self-sufficient. [This would later become the Patricia J. Numann Center for Breast, Endocrine & Plastic Surgery at SUNY Upstate].  There is always a way around an obstacle. Only if you are stubborn and want it just one way will you fail.

Interviewer:  What are the greatest rewards you believe you've gotten from being a leader in a surgical organization?

Dr. Numann:  I could not put one as greatest. I always loved taking care of patients, whether for trivial problems or great ones. I loved the technical aspects of surgery. Doing a complex operation perfectly is such a joy. I loved teaching essentially everyone, patients, nurses, med students, residents and peers.  If I got a complicated referral, I would offer the referring surgeon the opportunity to come to the surgery. I loved administration, planning new things, resolving problems. I think the only thing I never really liked was writing.  I never considered it something I did well.

The greatest rewards have been the things that I have helped develop or facilitate that made life better for individuals.  Whether it was that they had more fulfilling careers, went through difficult problems more easily or actually impacted the well-being of masses of people.  I have gotten great recognition from organizations in the form of awards and election to office but what gives me the greatest pleasure is when I run into someone and they tell me what a difference I made for them.

Interviewer:  What do you see as your greatest achievement as a surgeon? And what is your greatest achievement as a leader?

Dr. Numann:  As a surgeon, I believe I changed the standard of breast and endocrine surgical care in my area, by not only being a good surgeon but also by teaching many surgeons to be good as well.  I would always follow the literature and scientific developments and bring them to the care of patients in our area.

As a leader, I think through AWS and my advocacy for women I have made it easier for women to become surgeons and to be treated as equals.  I believe in my role on the Council of Scientific Affairs of the AMA, I saw that standards for mammography were implemented.  As President of the American College of Surgeons I helped raise awareness and facilitate support for the WHO to include surgical care in its public health mission.  As associate dean of our medical school, I helped improve the logistics of navigating our curriculum for our students.  I began the Women in Medicine Committee.  As Medical Director [of our hospital], I took a hard stance on bad behavior but I always listened to both sides.  I always tried to allow people to save face.

Interviewer:  Do you have any regrets from your experiences as a surgeon leader, or would you do anything differently?

Dr. Numann:  I have no real regrets.  If I would do anything differently, I may have chosen to look at being a chair and should have written more.

Interviewer:  What mistakes would you advise mid-career women in surgery to avoid in order to be successful in pursuing leadership roles in academic surgery and national organizations? What mistakes would you advise young women in surgery to avoid?

Dr. Numann:  Keep Calm and Never Give Up.  I think many young men and women want too much too quickly.  I think many do not respect those before them who have made so much possible for them.  I think some do not deal well with adversity and give up.  When this Chair was firing me regularly, I was talking with a patient who was a successful business man about my difficulty and my interest in leaving. He said, "I would help you do whatever you wish to do, but let me tell you, I wouldn’t respect you much for letting one rotten SOB run you out of your home."  I must say that changed my thinking - probably forever.  No one ever ran me off.

Interviewer:  What additional words of wisdom do you have for mid-career women in surgery? For young women surgeons just entering practice? For residents in training?

Dr. Numann:  I believe it is important to try and make things work but if they will not, [then] look to change the situation.  There is no best time to have children so do it when you want to. Do not be afraid to be a single parent if you want a child and do not want a spouse.  Choose your spouse carefully.  Do not be afraid to stick your neck out.  For residents in training, I think it is very important to have a local support system.  Sometimes you really need to be fed a good meal, taken away from the work or have a shoulder to cry on.  [You need someone] who loves you unconditionally and will not judge you.  I found most of them outside medicine.  I also think throughout life it is important not to be an elitist. You learn so much by having friends of all kinds.  For all, I think it is important to have interests beyond medicine.  I have found that people whose only identity is their professional self are often not as successful or happy in the long run.

Interviewer:  Are there specific leadership courses or organizational training resources you'd recommend to women surgeons interested in pursuing a leadership role in academic surgery or national organizations?

Dr. Numann:  I think the ELAM course is very good.  I think public speaking courses such as Dale Carnegie’s are good.  The Harvard course for Chairs.  The ACS Surgeons as Leaders and Surgeons as Educators are great.  I have also found it very helpful to serve on Board of Directors where you meet many talented people who look at the world a bit differently than most doctors.

Dr. Barbara Lee Bass

Dr. Barbara Lee Bass, MD, FACS is a gastrointestinal, breast and endocrine surgeon, and the John F. and Carolyn Bookout Distinguished Endowed Chair at Methodist Hospital in Houston Texas and Professor of Surgery at Weill Medical College of Cornell University.  Dr. Bass did her undergraduate studies at Tufts University, attended medical school at the University of Virgina School of Medicine, completed general surgery training at George Washington University Hospital and a fellowship in gastrointestinal physiology at the Walter Reed Army Institute of Research, while serving as a Captain in the US Army Medical Corps.  Dr. Bass has been a fellow in the American College of Surgeons since 1989, and has served in many influential capacities, including the Chair of the ACS Board of Governors, as member of the ACS Board of Regents, and surgeon champion of the ACS NSQIP.  Dr. Bass was honored with the American College of Surgeons’ highest honor, the Board of Regents 2013 Distinguished Service Award, which recognizes Dr. Bass’s commitment to the initiatives and principles embodied by the American College of Surgeons.  Dr. Bass was also a guest speaker at TedMed, one of the premier conferences focusing on thought provoking and novel approaches to health and medicine.  

Interviewer:  What do you see as the greatest skills need to be successful as a leader in academic surgery and in surgical organizations?

Dr. Bass:  There are two sides to that coin.  The first piece is the academic piece.  You have to have academic credibility.  You have to do the hard work of building that academic credibility yourself.  You have to write, you have to network, and you have to have some credibility as a thought leader in that area.  My area of academic credibility was in gastrointestinal cell biology.  I was funded early in my career with VA Merit and Career Development awards.  I had the gastrointestinal surgeons’ career development award and the College’s career development award. 

You have to have some credibility as an academic surgeon and you have to think about what your contribution to that field will be.  It can be in translational research, it can be in educational research, etc.  But you have to demonstrate that you have the chomps to do that piece.  Then people will say, “she’s done the hard work to get there.” 

The other side of that coin, of being a leader in surgery is similar to leadership in any other venue.  You have to have a profound sense of optimism in people; that you are making it better for everyone, not just for you.  Successful leaders can really inspire others with that sense of future and optimism.  A good leader really has a sense of service; you’re there to serve the cause.  And, you’ve got to be able to communicate.  You’ve got to build bonds.  You build bonds by listening to people and gathering people together. 

Interviewer:  What are the biggest challenges and obstacles you yourself faced in your career? What are challenges you saw your female colleagues in surgery facing in their careers? What do you see as the challenges women surgeons face today in advancing as surgical leaders in academic institutions and in national surgical organizations?

Dr. Bass:  I’m old enough that I didn’t have obvious people to look up to, to think “I want to be like that person.”  When I was a medical student at the University of Virginia in the 70‘s there were no women residents or faculty.  The obstacle is not knowing how to do “this”, when there isn’t anyone who looks like you, and you want to do “this”. It was very hard to figure how to get where I wanted to go. 

But here was a transplant surgeon there, Dr. Leslie Rudolph, who helped me.  I didn’t take surgery until the end of my third year.  Then, Boom!  I realized I was a surgeon!  So very late in the game, I went to talk to this guy [Dr. Rudolph], and he was wonderful.  He said, “This is wonderful.  We haven’t had any girls go into surgery.  You must meet Olga Jonasson and Kathy Anderson.”  He managed to get me hooked with one of them.  I actually ended up training where Kathy Anderson was a faculty, and she was kind of a distant guardian angel and was a great source of advice.  It took 8 or 10 years before I met Dr. Jonasson and was “adopted” by her. 

Interviewer:  What are ways that you overcame those obstacles? Can you give concrete examples? What did you learn from these obstacles?

Dr. Bass:  Blossom where you’re planted.  I decided to stay where my family was.  You have to realize that you can’t necessarily have the freedom to go where you want to go, because you need the infrastructure.  There were times where that made me angry, but in the end it preserved me.  I saw my other women colleagues who didn’t have that infrastructure. I was very lucky to have parents and in-laws and a husband who supported me.  And my payback to them was that I never left them. 

Sometimes we get caught up thinking we have to do it the traditional way, and we don’t focus on what keeps us grounded and successful as people in our lives.  Then we get turned upside down. 

There are promising women who started out in surgery, and are no longer in the field.  Maybe they jumped too high, or they got lost.  When I look at my colleagues who have been successful in their careers, they’ve each done it in different ways.  We’ve meandered.  Find the pathway that’s consistent with who you are. 

Other obstacles are the structures that we all have in our institutions.  We all have these structures in our institutions - they have inertia, they don’t have leadership teams that evolve in the way we’d like them to or they don’t share our values.  People automatically look to that more familiar and regular progression.  We see that men get promoted more rapidly than women.  We have to recognize that these structural barriers in our institutions are still in evolution.  But you have to remember, it’s a marathon, not a sprint!  Try to keep your eyes on the big picture.  You have 40 years in this business; don’t prematurely think that you have to jump to the next step or next opportunity.

Interviewer:  What are the greatest rewards you believe you've gained from being a leader in a surgical organization?

Dr. Bass:  My favorite reward is when you go someplace and you run into some med student who you have no recollection of them in your life, and they tell you they are so appreciative of what you’ve done for them.  Then you realize you made an impact on this person’s life.  You make a lasting impact when you didn’t even realize you touched them.  I think being a leader gives you a voice and an impact that goes beyond your title.

It’s nice to see some of the things that you’re demonstrated become the scenery.  See the success you’ve had spill over to those behind you.  I don’t want to hear about how unusual I am; I want this to be very normal.  We want that critical mass.  It’s no longer odd [to be a woman surgeon].  Now it’s becoming normal, even in a demanding surgical field.  I think the most important contribution I’ve made is just being “there” and doing it. 

Interviewer:  What do you see as your greatest achievement?

Dr. Bass:  I’m proud of my boys, of my family, and the incredible relationship I have with my parents.  Having many siblings, I’m the only one that stayed close.    

Interviewer:  What mistakes would you advise mid-career women in surgery to avoid in order to be successful in pursuing leadership roles in academic surgery and national organizations? What mistakes would you advise young women in surgery to avoid?

Dr. Bass:  Don’t be prematurely sensitive or aggressive, or feel that you’re not getting there.  However, occasionally you do feel that you’re up against the wall and you’re not getting where you want to be, whether due to the leadership or the infrastructure. Then you start the slow burn, you start looking.  Sometimes you have to say, this is not working, then move on

Interviewer:  Are there specific leadership courses or organizational training resources you'd recommend to women surgeons interested in pursuing a leadership role in academic surgery or national organizations?

Dr. Bass:  I never took them; I just did it by osmosis and learning from the good people around me. 

Dr. Susan Moffatt-Bruce

Dr. Susan Moffatt-Bruce, BSc, MD, PhD, MBOE, FACS, FRCP is a cardiothoracic surgeon at the Ohio State University Medical Center.  Dr. Moffatt-Bruce completed her undergraduate studies at McGill, her medical school and general surgery residency training at Dalhousie University, a PhD in Transplant Immunology at the University of Cambridge and a Cardiothoracic Surgery fellowship at Stanford University.  Currently, Dr. Moffatt-Bruce is the Associate Dean of Clinical Affairs, Quality and Patient Safety at Ohio State University, where she oversees process improvement at a 6 hospital, 1100 bed academic medical center.  Dr. Moffatt-Bruce is also the Associate Director for the Center for Lean Healthcare Research at the Ohio State University Fisher College of business. 

Interviewer:  What do you see as the greatest skills need to be successful as a leader in academic surgery and in surgical organizations?

Dr. Moffatt-Bruce:  The best trait or most important attribute is the flexibility to be accommodating.  Leaders have to react quickly to many situations and so really being accommodating and flexible is key to the organization.  Also, leaders have to be available.  The people you lead want to have access to you.  The greatest skills needed to be successful as a leader in surgery are being available, accountable, and accommodating.

Interviewer:  What are the biggest challenges and obstacles you yourself faced in your career? What are challenges you saw your female colleagues in surgery facing in their careers? What do you see as the challenges women surgeons face today in advancing as surgical leaders in academic institutions and in national surgical organizations?

Dr. Moffatt-Bruce:  One of the biggest challenges is that if you start going down a pathway that seems reasonable, everyone is happy to help.  However, if you start going down a pathway less traveled, people are less likely to help.  I started as a physician scientist and was doing well.  Then I became a physician administrator and it was difficult to find a mentor who really understood the challenges and what changes I would need to make.  I believe this particular challenge may be specific to women.  Because you’re a woman, they think you’ve changed your mind, that you’re finicky.   Changing paths may be a challenge but it is so worthwhile when you know it is the right choice. Being able to share that with a mentor that understands and embraces change is the challenge. 

Interviewer:  What are ways that you overcame those obstacles? Can you give concrete examples? What did you learn from these obstacles?

Dr. Moffatt-Bruce:  First off, I didn’t know there would be obstacles. The first part was realizing there were very real obstacles that would have to be overcome.  When I became an academic administrator, I had to go out of my comfort zone and engage with women and men outside the medical profession.  Biophysical engineers, people in health care reform, etc.  That is always perceived as “Why is she here?  You’re a surgeon, why are you here?”  I had to embrace them and assure them that I was there to learn and to collaborate.  By leveraging research opportunities and proposing joint ventures, particularly around Surgical Outcomes Research, I was able to create “Win-Win” situations for them and for me.  How cool is using Google Glasses to train residents!!!

Interviewer:  What are the greatest rewards you believe you've gained from being a leader in a surgical organization?

Dr. Moffatt-Bruce:  Oh gosh, there are many rewards.  Just realizing my potential to not just influence a small cohort of residents and patients, but to touch so many other domains of health care is the reward.  So many people ask me why [be a physician administrator]?  Hands down, its’ because I can influence so many patients and that’s a tremendous privilege.

Interviewer:  What do you see as your greatest achievement as a surgeon? And what is your greatest achievement as a leader?

Dr. Moffatt-Bruce:  My greatest achievement has been in instilling in this large academic medical center a culture of accountability and safety.  As a result, we’re now influencing residents and medical students in a culture of accountability and safety.  And now I’m starting to influence that on a national scale.  Its’ unusual to have a thoracic surgeon willing to be a spokesperson for these things.  We have nationally accepted quality metrics, which are frankly very challenging indicators.  I’m able to sit on these committees and say, “These are not good metrics”.  We as surgeons have that ability to shape what is measured as “quality” but we have to go and engage. The National Quality Forum is the national committee that actually endorses the CMS metrics, and I’m a member of that committee.

Interviewer:  What accomplishments are you personally most proud of in your career or in your personal life?

Dr. Moffatt-Bruce:  My children.  My children now never accept the status quo, they ask about everything.  They make sure that what I’m telling them, what their school teachers tell them, what their music teachers tell them is accurate.  They’re not afraid to question (although it can be quite exhausting!)

Interviewer:  Do you have any regrets from your experiences as a surgeon leader, or would you do anything differently?

Dr. Moffatt-Bruce:  Would I do anything different?  I would have taken the same path.  But, I would have been more appreciative during my residency and during the junior faculty years about what the hospital/academic mission is. I was in a silo during the training just trying to make it through.  I never appreciated what it was to have a mortality index; to not meet a SCIP measure.  I never was inquisitive enough.  Absolutely, there would have been opportunities to be involved as a junior faculty or resident.  You have to make those opportunities. 

Interviewer:  What mistakes would you advise mid-career women in surgery to avoid in order to be successful in pursuing leadership roles in academic surgery and national organizations? What mistakes would you advise young women in surgery to avoid?

Dr. Moffatt-Bruce:  I think that women have to really think what their priorities are.  You have to weigh the pros and cons about what you’re asked to do.  Be thoughtful about what you engage in and what you commit to.

Interviewer:  Are there specific leadership courses or organizational training resources you'd recommend to women surgeons interested in pursuing a leadership role in academic surgery or national organizations?

Dr. Moffatt-Bruce:  Lots of great resources that women can use to improve.  The AAMC early career development courses; they’re really super.  Young women faculty should think about taking that in their first 1-2 years.  In the professional societies, anytime they offer courses on coding, etc., take them, and take them a couple times to really benefit. ELAM is also a great experience when you become an Associate Professor

Interviewer:  What else would you like to share about surgical leadership with members of the AWS?

Dr. Moffatt-Bruce:  I’d want to share with other women that sometimes circumstances and opportunities pose themselves at inopportune times; and our resources have to be used to assess them or embrace them, but not to be anxious.  You have to make choices and there will always be opportunities to seize that.  It all depends on what you make of it. 

Conclusion

We are indebted to Patricia Numann, MD, FACS, Barbara Lee Bass, MD, FACS and Susan Moffatt-Bruce, MD, FACS for having the courage and generosity to share their hard earned wisdom, experiences, and inspiration with us.   As the face of surgical leadership evolves, we know that taking the road less traveled is a challenging feat, but well worth the effort.  And the rewards of the journey enrich not just the intrepid explorer, but also pave the path for every future dreamer to come. 

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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.