by Minerva A. Romero Arenas
We cannot all succeed if half of us are held back.
– Malala Yousafzai
Elizabeth Blackwell, a teacher and immigrant to the U.S., turned to
medicine after a friend confided on her deathbed that she would have
been spared much suffering had her physician been a woman. She went on
to become the first woman to earn the Medical Doctorate in the U.S. She
was admitted as a prank by the all-male students on the faculty – who
allowed the students to vote on Elizabeth’s admission never thinking
they would allow a woman to become their peer. The face of medicine has
changed significantly in the 160+ years since
Dr. Blackwell graduated from Geneva Medical College (now Hobart and William Smith College/SUNY).
Women are pursuing medical careers in record-breaking numbers. Female applicants to medical schools went from less than
10% in 1965, to approximately 50% in 2005. In 2013,
48 schools had a female majority of the class.
The changes seen in medical schools, however, are not representative of
the currently active physician workforce. Women make up less than
one-third of all physicians, and only
15% of general surgeons,
and 4-6% of neurosurgeons, urologists, and orthopedic surgeons. Data of
gender representation in residency reflect similar trends. In 2011,
nearly half of female residents were training in primary care (pediatrics, internal medicine, family medicine) and less than 10% in surgical specialties.
Why are women doctors more often choosing primary care than surgical fields?
About 5 years ago, I was talking on the phone with one of my lifelong
mentors when she asked me, “Minerva, why not?” I was unable to come up
with an answer. I was nervous about a realization I had just a few weeks
before: I loved surgery. I had just spent 2 months working long hours
with excellent residents and surgeons. They had a great work ethic, were
cool in the face of chaos, showed compassion toward their patients, and
had a passion for their work that I had not seen in any other field.
What should have been an exciting moment actually terrified me. Did I
have what it takes to be a surgeon? And would it be worth making the
sacrifices it would take for possibly 5-10 years of training?
Just days away from starting what we call “audition rotations” in the
fourth year, switching to surgery was also a scheduling nightmare. I
personally called the clerkship directors to apologize for a late
cancellation. Thankfully, they were graceful and encouraged me to
“figure it out,” even offering to allow me back later in the year if I
ultimately decided against surgery.
It was not surprising that they were perhaps a bit skeptical of this
decision. Surgery had crossed my mind during college, but fell off my
list at some point in my first two years of medical school. I had
planned to pursue a residency in internal medicine and eventually
subspecialize in a field like medical oncology or infectious disease.
These fields were friendly to women, and most importantly, I thought
would help me merge my love of medicine and public health. Many of the
mentors and role models I met were primary care physicians.
When I announced my interest in surgery, nobody hesitated at trying
to save me/tell me why it was so hard – after all, surgery programs have
one of the highest percentages of
residents quitting training. “You won’t have a personal life.” “
Do you want to have children?” “What does surgery have to do with public health?” The issue of lifestyle differences for surgeons is serious.
In a 2009 study
(the year I graduated medical school), women surgeons were less likely
to have children and more likely to have their first child later in
life. Male surgeons were more likely have a spouse who was the child’s
primary caretaker. Reassuringly, 82% of women in that study would choose
their profession again.
If I had a nickel, for every time I heard “but I never met a woman surgeon” maybe I would have paid off my student loans by now.
As a member of two key underrepresented groups in medicine (woman and
Latina/Hispanic), I have felt the need to share my story with students
who may have similar doubts about pursuing careers in medicine and
surgery. I am involved in mentoring & leadership through several
organizations (
National Hispanic Medical Association,
Latino Medical Student Association,
Alliance in Mentorship,
Tour for Diversity in Medicine, and
Association of Women Surgeons).
Many of the premedical and medical students I meet at mentoring events
are surprised to meet a 1) surgeon, 2) woman surgeon, or 3) Latina
surgeon. I was too when I met them in medical school.
In fact, many of my patients are too. When making rounds at the
hospital, I have frequently heard patients tell someone on the phone,
“Let me call you back, the nurse just walked in the room.” I have the
utmost respect for my colleagues in nursing and do not take offense to
these innocent remarks – after all, since
9 out of 10 nurses are female it is more likely that a patient will encounter a woman who is a nurse than a woman who is a doctor.
As I continue my training to become a general surgeon, I have come up
with a couple of answers that I was so worried about years ago. More
than halfway through my training, I can confidently say, Yes, I do have
what it takes to be a surgeon. And it
IS worth all the sacrifices.
Please join me on Tuesday May 13, 2014 at 8:30pm Eastern (for your local time click
here) as I guest moderate the weekly #hcldr tweetchat.
- T1: How important/beneficial is diversity in health care (e.g., gender, age, ethnicity, background, etc.)?
- T2: How can we encourage women and other
underrepresented minorities to pursue careers in medicine/surgery, or
any non-traditional field?
- T3: What can we, as healthcare leaders, do to stop
discriminatory comments or behaviors in healthcare, esp. to women
doctors, minorities?
- CT: What’s one thing you learned tonight that you can use to help a patient tomorrow?
~~~
Minerva A. Romero Arenas, MD, MPH is completing a research fellowship in the
Dept. of Surgical Oncology at The University of Texas MD Anderson Cancer
Center in Houston, TX. She is a General Surgery Resident at Sinai
Hospital of Baltimore. She received her MD and her MPH from The
University of Arizona College of Medicine and the Zuckerman College of
Public Health in 2009. She studied Cell Biology and French at Arizona
State University as an undergraduate.
Her interests include surgical oncology & endocrinology, global
health, health disparities, quality improvement, and genomics. A native
of Mexico City, Mexico, Dr. Romero Arenas is passionate about recruiting
the next generation of surgeons and is involved in mentoring through
various organizations.
She enjoys fine arts, films, gastronomy, and sports. She enjoys
jogging, swimming, and kickboxing. Most importantly, Dr. Romero Arenas
treasures spending time with her family and loved ones.
Resources
National Library of Medicine. Dr. Elizabeth Blackwell Biography on “Changing the face of Medicine.” Accessed April 2014. www.nlm.nih.gov/changingthefaceofmedicine/physicians/biography_35.html
American Association of Medical Colleges. Women in Academic Medicine
Statistics and Medical School Benchmarking, 2011-2012. 2012. https://www.aamc.org/members/gwims/statistics/
American Association of Medical Colleges. Table 1: U.S. Medical
School Applications and Matriculants by School, State of Legal
Residence, and Sex, 2013 www.aamc.org/data/facts
American College of Surgeons Health Policy Research Institute. The
Surgical Workforce in the United States: Profile and Recent Trends. http://www.acshpri.org/documents/ACSHPRI_Surgical_Workforce_in_US_apr2010.pdf
Troppmann KM, et al. Women surgeons in the new millennium. Arch Surg. 2009 Jul;144(7):635-42. doi: 10.1001/archsurg.2009.120.
Health Resources and Services Administration. The U.S. Nursing Workforce: Trends in Supply and Education. 2013. http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/nursingworkforcefullreport.pdf
Image Credit
https://www.nlm.nih.gov/hmd/about/exhibition/changingthefaceofmedicine.html
