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.
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.
-----------------------------------------------------------------------------------------------------------
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.
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