The Changing Face of Medicine

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?

This article was originally posted on the Healthcare Leadership Blog on May 7, 2014. 

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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

A place of our own

by Amalia Cochran, MD

Apparently there are a number of men who, upon hearing about a women surgeon’s activity will state, “We don’t get to have a men in surgery group!”

This statement is both true and untrue.

While it would probably be considered politically incorrect to have a formal “men in surgery organization”, it can easily be argued that academic surgery remains the “men in surgery” club. Between 2001 and 2011, the number of women in surgery residencies increased from 24% to 37% of trainees, breaking that 33% number often associated with achieving “critical mass” for any non-majority group. However, in the ranks of academic surgery in 2012, women constituted 21% of surgery faculty, and women are apparently stalled as 9% of full professors in surgery. This paucity of women in academic surgery does matter, both in terms of availability of role models for our residents and students, and in terms of how women are seen and perceived in academic surgery. If you were to ask most (if not all) of my male colleagues if they have walked into a room at a surgical meeting and felt out of place, the vast majority would tell you no, and many would look at you like you were crazy for asking. In contrast, I know experientially from speaking to many of my female colleagues that we’ve walked into any number of surgical settings and felt fairly certain we didn’t belong there. My first experience of this nature came during my fourth year of medical school while on the interview trail- I was one of 40 interviewees at a program that shall remain unnamed on a given date, and I was the only woman in the interview group. While I knew I deserved the interview, I inferred that being a resident there had the potential for me to have to fight lots of battles that involved being judged not on my work, but on my gender. I didn’t have an interest in that. I still occasionally make jokes about it when I find myself seated in a room of surgeons in which I am the only woman- and yes, this does still happen in 2014.

My support for and involvement in organizations like the Association of Women Surgeons, is predicated on this idea that as women we do need a place where we are exclusively looked at for our body of work and where we aren’t judged for being any of the stereotypes associated with single/ married/ divorced/ childless/ childed women surgeons. For me, and for many others, it’s been a “safe” environment to expand our leadership skills and to experiment with authentic engagement with colleagues. My experience in a social sorority in college was similar, in terms of it being a place where my leadership skills were cultivated and I learned to collaborate with people who were very different from I. While I recognize that many horror stories exist about the collegiate Greek system, I remain passionate about the benefits of sorority life when it’s done “right.”

Would I have the leadership and team skills that I have today without Alpha Delta Pi and without the Association of Women Surgeons? Maybe. Would I be where I am in my career without the support of some wonderful men who focused on who I was as a student, then as a surgeon? Absolutely not. Did opportunities in these women’s-only organizations change my life for the better? No doubt, and I am absolutely certain that they helped make me into who I am today. For me, and for many women leaders in varied professions (particularly historically male professions), this idea of having a “place of our own” is critical to our professional and personal development.

This post originally appeared March 11, 2014 on Dr. Cochran's blog Life in the Wild West

~~~

Dr. Amalia Cochran is Associate Professor of Surgery at the University of Utah.  She is heavily involved in undergraduate medical education, serving as the Surgery Clerkship Director and the Director for the Applied Anatomy track for 4th year medical students at the University of Utah.  Her research interests lie in surgical education and in clinical outcomes in burns.  She is completing her term as Vice President for the Association of Women Surgeons.

A Recipe for Success: One Surgeon's Story

 by Minerva Romero Arenas, MD, MPH

 

There are two questions that students frequently ask me about becoming a doctor. One is, “What did you do to become a doctor?” and “How did you stay motivated?” I often tell students attending the Tour 4 Diversity in Medicine (T4D) that becoming a doctor is like running a marathon. The pathway to medicine is long and challenging; I jumped through a lot of “hoops” (prerequisite courses, examinations, extracurricular activities, letters of recommendation, interviewing, etc.) just to get to medical school. At this point, I swear if their eyes get any wider they will come out of their socket. Then I tell them about the time I have spent in residency, research, and fellowships – and overwhelming is probably a gross understatement.

There are many factors that contribute to a person’s success – especially the success of a doctor. In my own personal path, I credit my success to at least four essential factors.

My family has been one of the main sources of strength and motivation. Like many immigrant families, we moved to the United States to pursue the American Dream. I was 8 years old when we moved, but since that young age I knew that my family (yes, I mean my parents, tías and tíos and abuelita) wanted better opportunities for our family. While my family never pushed me to be anything in particular, they always supported and encouraged me to pursue higher education – an opportunity they did not have. When a situation challenges me, I think back to how fortunate I am to have a loving and supportive family and any doubt is erased from my mind.

I also credit my mentors – yes, more than one – with a large part of helping me succeed. Some of them were professors who helped me stay on track and grow academically. Others were instrumental in helping me develop leadership and life skills. Yet others were research mentors or clinical mentors who helped figure out my interest in these fields. Even now as I am in my surgical training, I continue to keep in touch with some of these mentors and have even gained new mentors who are helping me grow and develop as a surgeon-in-training and future leader in healthcare.

I also found motivation in programs that helped me remember why I wanted to be a doctor. In college it was when I worked in certain clinics or doctors. In medical school, student-run clinics, organizations that connected me with other students and doctors who shared similar backgrounds or interests such as ending health disparities. In fact, even now that I have become a doctor and am completing my surgical training I still find it refreshing to remember why I chose this career in the first place. This is part of the reason I joined Tour 4 Diversity in Medicine. Talking to students about my love of surgery, or helping patients, or my research – it always help make me feel more
motivated.

Lastly, I tell students the most important factor in achieving success is the one that nobody else can help you with: hard work. There have been many people who have provided guidance, support, and opportunities that helped me achieve my dream of becoming a doctor. However, I know that my own effort helped me earn the respect and time of my mentors and make the most of the opportunities that were provided. Most importantly it has given me a source of pride and confidence that will continue to make me a successful person and surgeon.

This article was originally posted on February 5, 2014 on the Tour 4 Diversity website under the title "#T4DWest Day 2: A Recipe for Success – One Surgeon’s Story"

~~~

 

Dr. Minerva Romero Arenas is a general surgery resident at Sinai Hospital of Baltimore and is completing a research fellowship at The University of Texas MD Anderson Cancer Center in Houston, TX. She obtained her MD and MPH from The University of Arizona, and studied Cellular Biology & French at Arizona State University. She is also involved in mentoring and public policy. On her personal time she enjoys spending time with friends and family, especially when it involves good food.

Changing the paradigm

by Robert Swendiman

Whether I am at Grand Rounds, a department meeting, or the American College of Surgeons Clinical Congress, it is often like looking into a mirror. I cannot help noticing the abundance of white men – especially at “the top.” While I meet numerous female and minority surgical residents and junior faculty, most of the chairs, program directors, and full professors are men.

Outside of the medical profession, surgery has an “old boys club” reputation. But I come from a school of leadership where difference and diversity are more than just opportunities for social progress – they are requirements. So I was disappointed when I perceived the stereotype affirmed. The more I look around, the more men I see.

Constant inquiry (or “quality assessment and quality improvement” in medical terminology) is an important component of leadership. Without it, we fail to analyze, understand, and improve the systems in which we are a part. Thus, I began my investigation, and what I found was shocking. Despite the increasing number of women entering general surgery residency programs – from 10% in 1980 to 36% in 2011 – as of last year, women only represent 9% of all full professors, 17% of associate professors, and 25% of assistant professors in surgery. 1, 2 While these numbers are obviously disproportionate, what is perhaps more concerning is that they also remain stagnate. In the last 15 years, these percentages have not changed. 3

Despite the fact that men and women enter academic medicine at equal rates, the rate promotion is uneven. 4-6 Though men and women start at similar ages, the mean age of attaining “Professor” status in approximately five years younger for men. 4 “Even after adjusting for number of publications, amount of grant support, tenure versus other career track, number of hours worked, and specialty, women [remain] substantially less likely than men to be promoted.” 4

Thus, female surgeons remain impressively underrepresented in the ranks of surgical faculty at 21% of the workforce (the average across all medical departments is 37%). 2 Of all academic departments in the basic and clinical sciences, surgery ranks second to last in percentage of total female faculty members (orthopedics, 15%). 2 However, in other specialties, women hold more than half of all faculty positions (obstetrics and gynecology, pediatrics, and public health and preventive medicine). 2

The famous surgeon, Dr. William Halsted, once quipped that the issue with surgeons taking call every other night was that residents would miss half of the cases. In the same manner, when we exclude 51% of the population from top leadership positions, we are missing out on half of the talent. If fewer than 10% of professors of surgery are women – and that figure has not changed in more than a decade – I wonder, “Is our academic community really moving surgery forward?”

Fellow colleague, Sophia McKinley, wrote about her own early lessons in leadership. She states, “Individuals at every position in a hierarchy can exhibit leadership.” I agree, and I see this lack of diversity as an urgent opportunity for real-time leadership at every level. As a white male, I think it is my job to participate in changing this paradigm – chipping away at the explicit and implicit barriers that male surgeons still espouse in surgery, advocating for and leveraging diversity, and staying curious about surgery’s present and future challenges. As an inspiring academic surgeon, this also meant research, which is why I joined a multi-institutional team from UNC, Harvard, and Stanford to better understand how we can change the status quo. I know it’s not enough, and change will not happen overnight, but doing nothing is not a viable option.

I was often asked on the interview trail, “Can an intern or a medical student really be a leader?”

This is the answer I give them.

~~~

References

1. Cochran A, Freischlag JA, Numann P. Women, surgery, and leadership: where we have been, where we are, where we are going. JAMA Surg 2013;148(4):312-3.

2. Association of American Medical Colleges. “Women in Academic Medicine and Science: Statistics and Benchmarking Report 2011-2012.” Table 3: Distribution of full-time faculty by department, rank, and gender, 2012. < https://members.aamc.org/eweb/upload/Women%20in%20U%20S%20%20Academic%20Medicine%20Statistics%20and%20Benchmarking%20Report%202011-20123.pdf>. Accessed November 6, 2013.

3. Sexton KW, Hocking KM, Wise E, et al. Women in academic surgery: the pipeline is busted. J Surg Educ 2012;69(1):84-90.

4. Zhuge Y, Kaufman J, Simeone DM et al. Is there still a glass ceiling for women in academic surgery? Ann Surg 2011;253:637–643.

5. Schroen AT, Brownstein MR, Sheldon GF. Women in academic general surgery. Acad Med 2004;79:310

6. Buckley LM, Sanders K, Shih M, et al. Obstacles to promotion? Values of women faculty about career success and recognition. Acad Med 2000;75:283-8.

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Robert Swendiman is a dual-degree M.D./M.P.P student at UNC School of Medicine and the Harvard Kennedy School of Government. He spent his time at Harvard as a Dubin Fellow for Emerging Leaders at the Center for Public Leadership, researching how leadership principles can be applied to medical education. Robert is participating in the 2014 Match cycle, and is interested in pediatric surgery.

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.

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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.

Pregnancy during Medical School & Residency

by Callie Thompson, MD

I have read a lot of discussions about “the right time” to have a baby during a career in medicine and most of them come to the conclusion that there is no right time. I don’t think that is really accurate. The more correct answer would be that the right time is entirely dependent on you and your situation. I feel well prepared to write this blog and give this advice because I have been pregnant during both medical school and residency (twice).

In chronological order, I will start with pregnancy during medical school. The first two years of medical school are typically spent listening to a lot of lectures and studying almost all of the time. The third year is usually heavy with clinical work and spending a lot of time in the hospital. And the fourth year is usually a few sub-internships and a lot of light rotations at your home institution. So, where would a pregnancy, birth, and caring for an infant fit in there? Again, it really depends on your situation. You have to weigh the physically demanding state of gravidity with what you will need to be doing at that time. If you are concerned about being on your feet all day, then maybe being pregnant in the first two years would work best for you. You also have to take into account the demands of a newborn/infant. If you need a lot of time to study or are not great at multitasking, then having a newborn prior to taking your USMLE Step 1 might not be the best idea for you. No matter what you decide, you must have a viable option for childcare in mind. I suggest that you do this prior to even becoming pregnant because you will need help.

Regarding taking time away from school, there are no universal rules as to how much time can be taken. This will be school dependent. You just need to make sure that you can fulfill the requirements to earn your degree. Some people choose to take an extra year and make medical school a total of five years to allow them to have their child. I do not think this is necessary for everyone and you are going to know your capabilities best. Don’t let someone push you into a 5th year just because others before you have chosen to do that.

Pregnancy in residency is a bit trickier because of the American Board of Surgery requirements for General Surgery Certification. I had a baby during clinical R3 year and another while I was out in the lab. From a time-off perspective, having a baby during your lab years is much easier. If you are NIH funded through a training grant you can have 6-8 weeks, though some lab work can be done from home so the actual time you get to spend with your newborn can actually be longer than that depending on your research. Having a baby during your clinical years requires a good understanding of “the rules.” The ABS states that:

“To be eligible for ABS certification in general surgery, the following must be completed: At least 48 weeks of full-time clinical activity in each residency year, regardless of the amount of operative experience obtained. The 48 weeks may be averaged over the first three years of residency, for a total of 144 weeks required, and over the last two years, for a total of 96 weeks required."

“For documented medical problems or maternity leave, residents may take an additional two weeks off during the first three years of residency, for a total of 142 weeks required in the first three years of training, and an additional two weeks off during the last two years of residency, for a total of 94 weeks required in the last two years of training.”

Translation: You can average your time over the first three years so, in theory, if you didn't take any other time off for three years, you could have a 14 week maternity leave. Similarly, if you didn't take any time off for vacation during your last two years, you could have a 10 week maternity leave.

In actuality, that isn't possible. For instance, you would have to know that you were going to get pregnant and have a baby during third year so that you could forgo a vacation in your first 2 years. And if you did that, you would surely go insane. So if you did take the regular 3 weeks of vacation a year, you could have an 8 week maternity leave during the year you did have the baby—as long as you don’t take any other vacation that year. A baby during the last two years is even more difficult because of the time constraints. Also, keep in mind that none of this accounts for the possibility of medical problems during the pregnancy and any time off that may need to be taken. None of this is meant to dissuade you from pregnancy during residency (see above where I state I did it twice) but knowledge is power and you have to be prepared to extend your training if you are unable to meet the ABS requirements. This is most important during the last 2 years because they have to be done in succession so if you were to get pregnant, become ill, and need extra time off during your 4th or 5th year, you may be required to start over at year 4.

This blog could end up being very long so the last topic that I will include for today is when/how to tell people when you become pregnant. I advocate telling people when you feel comfortable. For some people that is the minute you find out, for others it is after the first trimester. However, I would not wait much beyond the first trimester because arrangements will need to be made, either to your schedule if you are a student or for coverage from your co-residents if you are a resident. I also would also advise you not to tell anyone else before you tell your Dean or medical school adviser (for students) or your program director (for residents). It is best to give big, personal news yourself, and in person.

~~~ 

Callie is a resident in general surgery at the University of Washington. She completed a two-year research fellowship and is now in her fourth clinical year.  Callie aspires to be a burn and trauma surgeon and a translational scientist. Her research interests include genetic variations and their associations with the development and outcomes of disease and illness. Callie is married to an internist and has three children under the age of 7.
 

There’s Something In the Water

by AWS writer, Denise Harrigan

Often-invisible but highly influential, second-generation gender bias often impedes women’s ascent to top levels of leadership. The Harvard Business Review intends to expose it.

Fifty years after women were first admitted into Harvard’s MBA program, the September 2013 issue of The Harvard Business Review (HBR) examines the status of women in the business world. The cover alone – with a silhouetted female profile and the words “Emotional – Bossy - Too Nice ” -- reveals that women are floundering, not flourishing.

The bottom line is that only four percent of Fortune 500 companies have female CEOs, and 50 of those companies have no female board members. According to Adi Ignatius, editor-in-chief of HBR, women remain “distressingly underrepresented at the top levels of institutions.”

The HBR focus is not on the numbers -- those numbers, in recent years, have been documented to death. The goal, according to Ignatius, is “finding practical new solutions to a seemingly intractable situation. Closing the leadership gap is a formidable challenge. But there’s no excuse for accepting the status quo.”

The issue, part of the Harvard Business School’s global effort to accelerate the advancement of women leaders, features major articles on persistent gender bias and inclusiveness as a mission and moral imperative.

Unfortunate Legacy

The article “Women Rising: The Unseen Barriers,” by Herminia Ibarra, Robin Ely and Deborah Kolb, examines undercurrents that impede women’s progress and identifies second-generation gender bias as a major but rarely acknowledged impediment.

Where first-generation gender bias involved the deliberate exclusion of women, the second generation “erects powerful but often subtle and invisible barriers for women that… inadvertently benefit men while putting women at a disadvantage.”

Insidious

As a result of second-generation gender bias, unspoken cultural perceptions about women often carry more weight than job performance. Perhaps the most insidious belief is that men are natural leaders, and women are followers.

“In most cultures, masculinity and leadership are closely linked,” the authors report. “The ideal leader, like the ideal man, is decisive, assertive and independent. In contrast, women are expected to be nice, caretaking and unselfish.”

Linking leadership with common male behaviors suggests that women are not cut out to be leaders. It can also create a double standard. Assertive men, for example, are admired – and promoted. Assertive women are advised to “soften their sharp elbows.”

As a result, many women waste professional energy trying to project the perfect image -- not too pushy, not too nice. According to the authors, some employ voice coaches, image consultants, and branding experts “to manage the competence-likability trade-off— the seeming choice between being respected and being liked.”

“But the time and energy spent on managing these perceptions can ultimately be self-defeating. Overinvestment in one’s image diminishes the emotional and motivational resources available for larger purposes. People who focus on how others perceive them are less clear about their goals, less open to learning from failure, and less capable of self-regulation.”

Leaders Are Made, Not Born

Leadership is not an innate gift – it’s a skill that requires practice. More often than not, men are given opportunities to practice this skill. The workplace, still predominantly led by men, instinctively grooms men for leadership positions, creating stepping stones where men can practice leadership skills.

According to the authors, “Women have fewer opportunities to develop leadership skills and seem less inclined to create these opportunities for themselves.” By nature or nurture, women often gravitate to behind-the-scenes positions, and their efforts fade into the blur of teamwork.

Internalizing Leadership

“People become leaders by internalizing a leadership identity and developing a sense of purpose,” the authors observe. “Internalizing a sense of oneself as a leader is an iterative process. A person asserts leadership by taking purposeful action—such as convening a meeting to revive a dormant project. Others affirm or resist the action, thus encouraging or discouraging subsequent assertions. These interactions inform the person’s sense of self as a leader.”

In the wake of positive affirmation, “a person’s leadership capabilities grow. Opportunities to demonstrate them expand. High-profile, challenging assignments …. become more likely. Such affirmation gives the person the fortitude to step out-side a comfort zone and experiment with unfamiliar behaviors and new ways of exercising leadership.”

Well-Meaning but Off Center

The authors of “Women Rising” acknowledge that many companies attempt to level the playing field for women. “Many CEOs make gender diversity a priority, set aspirational goals for the proportion of women in leadership roles”…. and invest in building “a more robust pipeline of upwardly mobile women.

“But then, not much happens,” according to the authors. “The solutions to the pipeline problem are very different from what companies currently employ. Mentoring and leadership education programs are necessary but not sufficient.”

Deeply Conflicted Culture

“These approaches don’t address the often fragile process of coming to see oneself, and to be seen by others, as a leader. Integrating leadership into one’s core identity is particularly challenging for women, who must establish credibility in a culture that is deeply conflicted about whether, when, and how they should exercise authority.”

Call It by Name

Since second-generation gender bias “can be subtle, subconscious, assumed but not articulated by both men and women,” the authors recommend that employers begin to address it by simply naming it.

“Second-generation bias does not require an intent to exclude; nor does it necessarily produce direct, immediate harm to any individual. Rather, it creates a context—akin to ‘something in the water’—in which women fail to thrive or reach their full potential.

“Without an understanding of second-generation bias, people are left with stereotypes to explain why women as a group have failed to achieve parity with men: If they can’t reach the top, it’s their own fault for failing to be sufficiently aggressive or committed to the job.”

Alternative Reality

By identifying and addressing second-generation bias, however, companies can finally move toward gender equity – and an executive suite that “doesn’t look or behave like the current generation of senior executives.”

“When women recognize the subtle and pervasive effects of second-generation bias, they feel empowered, not victimized, because they can take action to counter those effects,” the authors promise. “They can put themselves forward for leadership roles when they are qualified but have been overlooked. They can seek out sponsors and others to support and develop them in those roles. They can negotiate for work arrangements that fit both their lives and their organizations’ performance requirements.

“Such understanding,” the authors conclude, “makes it easier for women to ‘lean in.’”

Powerful Tweets

by Lauren Nosanov

Social media have come to play a growing role at national conferences, serving not only as a convenient vehicle for information dissemination, but also as a forum for idea sharing and discourse. This year’s AWS and ACS meetings featured a significantly increased Twitter presence, with tweets from @AmCollSurgeons and @WomenSurgeons as well as several Twitter correspondents and meeting-goers. A review of content tweeted using hashtags #AWS13 and #ACSCC13 offers a wonderful snapshot of ideas discussed and wisdom shared. (For those unfamiliar with Twitter and associated terminology, see our Twitter 101 from Dr. Heather Logghe (@LoggheMD) and consider checking out Twitter’s FAQ section for new users.)

From Dr. Susan Pories on Networking

• Women are often excluded from networks and from conversations that open doors
• Networking: start small and begin with people you know (friends, family, etc)
• Build 3 networks: operational, strategic, developmental
• Don’t be afraid to take risks!
• Smile, ask a question, listen, have a handy business card, make a point to say the person’s name - Dale Carnegie’s five points
• Always be sure to follow up - it confirms that you are someone who can be trusted
• Moral of the story - you never know what will come of the random connections that you make
• “The way of the world is meeting people through other people”
• Key to networking: “building sincere relationships with mutual generosity"

From Dr. Mary Brandt (@drmlb) on Physician Wellness and Avoiding Burnout

• We talk about “quality of life” but not necessary “quality of work”
• Taking care of ourselves is a key part of taking care of our patients
• > 80% of surgeons experience discomfort or pain while operating
• Crucial to pay attention to ergonomics at work, both on the computer and in the OR
• Try to plan exercise every day and do something you really enjoy - focus on rotational core exercise
• When are you eating, are you eating enough, and what exactly are you eating?
• Call nights are similar to jet lag - stay hydrated, eat q3-q4h, repay the deficit
• Human beings heal by telling stories - communicate frequently, sincerely and with intent
• Spend some time every day being still and contemplating awe
• Down time is not wasted time, it’s essential time
• People at the top love to mentor those who are responsive and show potential for success

Dr. Gretchen Purcell Jackson (@pedssurgery) on Planning for Family

• You cannot plan perfectly or be fully prepared (hard for the Type A personality)
• Important to assess values, goal sand priorities prior to starting a family
• One of the few things you can control is your general state of health
• Think about child care options early on
• Know what your institution’s leave policy is and what you need to do to take advantage of it
• Important message from @LeanInOrg - don’t leave before you leave
• It’s okay to have help, and don’t fuss about things you can’t control

Dr. Hilary Sanfey (@hilarysanfey) on Leadership

• Leadership: the process whereby an individual influences a group of individuals to achieve a common goal
• Effective leaders utilize more than one style of leadership
• Watch leaders around you and decide for yourself what style they are using and whether or not it is effective

Joint AWS (@WomenSurgeons) and AAS (@AcademicSurgery) Panel on the Business of Medicine and Professional Development, Moderated by Dr. Carla Pugh (@CarlaPughMDPhD)

• Seek out those who can provide you with objective advice when you find yourself in a difficult situation - Dr. Andrea Hayes-Jordan
• Jobs are not forever - it is ok to change - Dr. Danielle Walsh (@walshds)
• Mentors are a bit like the Easter bunny or unicorns - they can be quite hard to find - Dr. Julie Ann Sosa
• As with all good relationships, mentee-mentor relationships take work to maintain
• You really have to respect your mentor, like them personally and trust them deeply - Dr. Julie Ann Sosa
• Assigned mentors may or may not work out - Dr. Rebecca Sippel
• Good communication is key to effective mentorship - Dr. Julie Ann Sosa
• Mentorship takes effort on the part of the mentee as well. Change mentors as the need arises
• Societies like AWS and AAS place a big emphasis on networking and mentorship - get involved! - Dr. Julie Ann Sosa
• Don’t lose sight of the fact that mentors also stand to gain something from involvement with mentees, it’s a two-way street - Dr. Danielle Walsh
• It’s ok to be a stalker, it’s ok to be a groupie - Dr. Amalia Cochran (@AmaliaCochranMD)
• Mentor opportunities - You give someone a rope and they hang themselves or make macrame - Dr. Mary Brandt (@drmlb)
• When you are asking for something, be sure you’re being realistic about what you need when negotiating - Dr. Andrea Hayes-Jordan
• Know your own value - Dr. Wei Zhou
• Stick to your values during the negotiation process. You will be respected for that. - Dr. Hayes-Jordan and Dr. Wei Zhou
• Write out a description of what you want from your position and get that into your contract - Dr. Joyce Majure
• If you are in a position where you are hiring/firing, work with your HR department to get guidance - Dr. Sandra Wong
• Negotiation is a long dance. Learn the steps. 

A key theme brought up by a number of speakers was the value of advocating for yourself. Whether this is seeking out the mentor that can best meet your needs, prioritizing your own health and well-being or successfully negotiating a competitive salary, conference goers were repeatedly reminded of a crucial point: you cannot expect to get what you need and/or want unless you speak up and ask for it.

Some food for thought:

• What challenges have you faced in advocating for yourself?
• Do you think women surgeons have more difficulty advocating for themselves than their male colleagues?
• Are you on Twitter? Why or why not?
• If so, how has Twitter (or any other form of social media) enhanced your experience of a professional meeting?
• How can the professional use of Twitter enhance your practice as a surgeon? How might it cause harm?

This post can also be found on the blog page of the Association of Academic Surgery.

~~~

Lauren Nosanov is a fourth year medical student at the University of Southern California Keck School of Medicine. She has spent the last year as a Dean’s Research Scholar, dedicating her time to clinical research in the field of Trauma and Critical Care. Having loved surgery from the very beginning, she is excited to embark upon the process of applying to General Surgery residency this fall. She is passionate about issues surrounding surgical education, mentorship and finding a balance between motherhood and medicine. Outside of medicine she enjoys practicing Taekwondo and spending time with her husband and son.

Lean In: Book Review & Discussion (Part Three)

 by Sophia Kim McKinley, Callie Thompson, MD, and Minerva Romero Arenas, MD, MPH

Chapter 8: Make your partner a real partner (Callie)

By nature, women are charged with carrying the child, birthing the child, and feeding the child (if one so chooses), resulting in an uneven distribution of work between a couple from conception. This chapter discusses some of the author’s personal struggles with being a new parent and the division of labor and responsibility in her relationship. Data show that in heterosexual couples, when both work outside the home, the women does 30-40% more of the childcare and housework, and as recently as 2009, only 9% of dual-earner marriages said they split the work evenly.

As a surgeon, I would suggest that this needs to be acknowledged and discussed prior to starting a family with a spouse/significant other. When a couple is discussing having children, there can be a lot of debate and negotiations about the vision for that child with regard to religion, discipline, schooling, extracurricular activities, and on and on. One thing should not be a negotiation; both parents must contribute equally to the care and development of the child, and if that is not okay with your partner, I strongly suggest reconsidering him for that role. This does not mean that each task needs to be done by each parent equally, just that the division of labor overall needs to be as close to 50/50 as possible. If you feed the child, your partner can bathe the child, and if you clean the dishes after dinner, your partner can vacuum the floor, etc . . . .

If that was it, things would be easy, but you also have to deal with society. You have to realize that society is going to set out to make your male partner feel emasculated because he is sharing household and child-rearing tasks with you. Believe it or not, even in 2013, men are still harassed for staying at home with their kids. Lighthearted comments and snide remarks can be hurtful to our male partners. The easiest way to counteract those actions is to let them know how appreciated they are, not because they are doing things FOR you but because they are doing them WITH you. Society will also try to make you feel badly for working outside of the home. People will tell you how wonderful it is or how lucky you are that your husband “watches” your kids for you. When this takes place, you should feel free to inform these people that the father of your children is fathering them. Nothing more, nothing less. But overall, my best advice is to ignore, ignore, ignore. If it works for you and your family, the rest does not really matter.

Do you have a family? Is your partner in medicine or surgery? Are couples in similar fields more likely to succeed or fail?

Chapter 9: The myth of doing it all (Callie)

In this chapter, “having it all” is called “the greatest trap ever set for women,” “antiquated rhetoric,” “a myth,” and a “recipe for disappointment.” I think we can all agree that this phrase should leave the vocabulary of our society and never return. Sandberg quotes some amazing women in this chapter: Gloria Steinem, Nora Ephron, Tina Fey. All of it is to say that being a working parent is hard work, and it doesn’t always (read: almost never) go according to plan, but the best way to manage is to cut yourself some slack, be willing to compromise, be honest with yourself about your own goals/desires, and be willing to change the plan. Admittedly, some of these things are much easier to do in other lines of work and at different points in our surgical careers. For instance, it would be great to be able to work the hours that worked best for my family, but those aren’t the hours that are best for my patients, my attendings, my co-residents, or my hospital system, so as a resident, I work the hours I work, and when it comes time to choose a job, I may want to take that into consideration in my choice.

Another important point is that we need to manage our guilt. This is a hard one because, no matter how many times you hear people say that your kid(s) will be okay even though you don’t stay home with them, the one time someone insinuates the opposite, it will stick with you and that one thought can fester and cause a lot of damage to your psyche. However, as lovers of science and evidence-based practice, we should rely on the data. As the author points out, data show that kids who are cared for by their mom vs. those also cared for by others develop the same, build the same relationships, and still bond with their moms. Also, having an involved dad, a mom who gives you independence, and parents with emotional intimacy are much more influential on a child’s development than having their mom care for them exclusively.

Full disclosure: despite this data, I still feel guilty quite frequently. I was irrationally crushed just last week when we missed my son’s 12 -month check-up because my husband and I both forgot. Other than reminding myself that the kid is fine, the appointment was rescheduled, and nothing bad actually happened because of this. Conclusion? I do not have a good solution to these thoughts.

How do you “do it all?” Is it really a myth?

Chapter 10: Let’s Start Talking About It (Sophia)

Sandberg encourages a conversation about the influence of gender in the workplace—the whole point of her book is to start talking about it. I’ve heard from more senior women in surgery that the attitude in the past has been one of “play along to get along.” That is, you don’t bring up the fact that you are a woman because you don’t want to bring any more attention to your obvious minority identity. While “play along to get along” may be useful for an individual to minimize any associated penalty for being a woman, Sandberg would challenge this strategy as one that would win in the long run. She encourages naming hidden biases and the micro-aggressions against women as a way to move forward toward gender equality.

Once, when I told a faculty member that I was going into general surgery, the first thing she said was “Are you planning on having children?” I highly doubt she would have asked the same question to a male medical student, which means that my gender was a strong determinant in her attitude toward my chosen career. I shared her comments with other faculty as a way to shed light on the ways in which women who pursue surgery continue to be treated differently, even by other women. Knowing precisely how and when to raise the topic of gender requires thoughtfulness and discretion, but I am hoping that forums such as the AWS Blog will continue the conversation about gender and surgery in a way that is rigorous yet respectful.

Have you encountered gender discrimination in or out of surgery? How have you addressed it? 

Chapter 11: Working together towards equality (Callie)

“Today, despite all of the gains we have made, neither men nor women have real choice. Until women have supportive employers and colleagues as well as partners who share family responsibilities, they don’t have real choice.” This is where the AWS and each of us at our institutions across the country can make a big impact. We can be those colleagues and mentors. We can encourage our fellow women surgeons to make their partners real partners. We can speak out when we see or hear a male medical student or resident praised for their outgoing spirit while a female who behaves the same is chastised for her aggressiveness. If we do not point out the inequities of such thoughts and perceptions, they will never end.

As Deborah Gruenfeld is quoted to have said, “Working together, we are fifty percent of the population and therefore have real power.”

How can we move toward equality? How can we engage the men in these initiatives?

Let’s Keep Talking

We have truly enjoyed reading and discussing our thoughts on this book and the parallels drawn in the surgical world. Please join our discussion below and share your input on how we can improve personally, as a discipline, and as leaders.

Part One of the discussion can be found here. Part Two, here.

~~~  

Sophia Kim McKinley is a dual-degree M.D./Ed.M. student at Harvard Medical School and the Harvard Graduate School of Education. She received the 2012 Association of Women Surgeons Patricia Numann Medical Student Award and spent a year as a Zuckerman fellow at the Center for Public Leadership at Harvard Kennedy School. Sophia is passionate about medical education and she hopes to be an academic surgeon who brings educationally-sound innovations to surgical training. Her clinical interests are gastrointestinal and minimally invasive surgery. Sophia will be applying for general surgery residency during the 2014 Match cycle.  

Dr. Callie Thompson is a resident in general surgery at the University of Washington. She recently completed a two year research fellowship and is now in her fourth clinical year. Callie aspires to be a burn and trauma surgeon and a translational scientist. Her research interests include genetic variations and their associations with the development and outcomes of disease and illness. Callie is married to an internist and has three children under the age of 7.

Dr. Minerva Romero Arenas is a general surgery resident at Sinai Hospital of Baltimore and is completing a research fellowship at The University of Texas MD Anderson Cancer Center in Houston, TX. She obtained her MD and MPH from The University of Arizona, and studied Cellular Biology & French at Arizona State University. She is also involved in mentoring and public policy. On her personal time she enjoys spending time with friends and family, especially when it involves good food.

 

Lean In: Book Review & Discussion (Part Two)

by Sophia Kim McKinley, Callie Thompson, MD, and Minerva Romero Arenas, MD, MPH

Chapter 4: It’s a Jungle Gym, not a Ladder (Sophia)

Sandberg reveals that she did not have a master plan at the outset or her career. Instead, she took opportunities as they arose or created her own opportunities. Again, business is a different context than surgery, in which the progression up the totem pole happens in a very particular and prescribed order. Still, there are elements of uncertainty, risk, and surprise when making decisions about a career in medicine.

Even as a 4th year medical student, I can describe junctions and branch points in my medical career where, instead of taking the safe or planned route, I pursued something else and wound up in a wonderful situation. I entered a lottery to be one of a dozen students in a novel, integrated third year and found myself having yearlong relationships with patients. It was there that I abandoned my plan of becoming a dermatologist in the operating room of a surgeon who would become one of my greatest mentors. And because of the effect of this new rotation system, I developed an interest in surgical education and ended up taking a year off to complete a Master of Education. It’s easy to look at someone successful or admirable and imagine him or her climbing a ladder straight to that position. Long-term goal setting and planning are critical to achieving ambition dreams, but Sandberg reminds her readers that there is likely more to the story, including a willingness to pursue unanticipated opportunities because of the potential for growth, whether that be taking a job in a new part of the country, starting a new research project, or taking on additional responsibilities in one’s current practice setting.

Have you taken alternative routes in your career?

Chapter 5: Are you my mentor? (Minerva)

“It should be a badge of honor for men to sponsor women.”

This chapter is full of practical advice that can easily be applied into any field, and in my opinion, can help both the mentee and the mentor. Through anecdotes of Sandberg’s own mentors and the people she has mentored herself (whether officially or not), her message becomes clear: mentoring relationships have to develop naturally and grow. As such, having ground rules for these relationships is important.

Things to consider:

1. Be mindful of the mentor’s time – mentees cannot expect to spend hours of a mentor’s time each week. As Sandberg points out “That’s not a mentor – that’s a therapist.” In my personal experience, setting up short meetings of 15-20 minutes with focused questions or goals are more effective for both the mentor and mentee. On a similar note, Sandberg suggests avoiding complaining “excessively” to a mentor and instead, ask for specific advice about how to move forward.
2. Strangers can be mentors – Just do not seek a mentor by asking a stranger cold-turkey “Can you be my mentor?” Successful mentees have approached Sandberg in a different form – a simple introduction with a well-thought out question. These individuals sparked her interest through their own success and she eventually filled that mentor role.
3. “Excel and you will get a mentor” – In surgery, strangers are frequently referred to each other by a common colleague or friend. This is how I landed with my current research mentor. The key is engaging potential mentors so they may take an interest in you and your success (via your CV or a strong referral) and following through afterwards with hard work (the mentoring relationship will naturally develop through your hard work).

In my own experience, it is important to have more than one mentor, something Sandberg alludes to through various anecdotes. For example, I have surgical mentors to whom I can turn to for various aspects of my career: my clinical concerns, career advice, and even task or situation-specific guidance. I have mentors to whom I can turn to for support and life advice. I also have some informal mentors with whom I interact on a less frequent basis (often by email or occasional text messages or calls).

The importance of mentors in surgery (as in other fields) is obvious and many employers and medical organizations, including AWS, have launched their own mentorship programs. Interestingly, Sandberg points out that “official mentorship programs are not sufficient by themselves and work best when combined with other kinds of development and training.”

What has your own mentorship experience been like? Have you been a part of an organized mentorship program?

If you have not downloaded the AWS Pocket Mentor you may do so here. You can also read our AWS blog post for good advice passed down from our mentors.

Chapter 6: Seek and speak your truth (Minerva)

In closing the chapter, Sandberg writes one of the sentences that made me think a lot about my own experience in surgery- “And maybe the compassion and sensitivity that have historically held some women back will make them more natural leaders in the future.”

What I took away from this chapter really was a lesson in effective communication and leadership. By this point in the book it is no doubt that Sandberg has research to back up the inescapable fact that gender strongly influences others’ perceptions of a person. In fact, gender strongly influences our own perceptions of ourselves. Sandberg laments that women hesitate to provide honest feedback, lest they be labeled as whiners or avoid discussing their children at work lest their priorities be questioned. Instead she advocates for honesty and a shift in leadership that strives for “authenticity over perfection.”

I have seen both types of leaders and struggled with the qualities I want to emulate. Slowly I have realized that some situations will call for a different kind of leader in order to be effective. For example, I know a leader who is generally regarded as someone who has high expectations, demands perfection, and may not be the easiest person to please. While this style may aggravate colleagues and subordinates in many situations, in surgery this type of leadership is essential when dealing with decisions that carry serious consequences such as life or death. Ultimately, more diversity in the workforce will translate to changes in leadership and eventually, I hope more equitable roles in the workforce.

Have you ever felt like you could not voice concerns out of fear that you may be labeled as a complainer or not a team-player?

Chapter 7: Don't leave before you leave (Minerva)

Sandberg points out that many women start to end their career before even getting out of the workforce. In an extreme example, Sandberg notes a young employee who worried about raising children before even being in a relationship, pregnant, or anywhere near having to worry about career-personal life balance. She raises a valid point that instead of holding themselves back from success due to being unable to meet demands later – women should aim for success and adjust or scale back as needed later when their success will lend them much more flexibility.

When I read this chapter I immediately thought of one surgery mentor. Having seen many intelligent, bright, and technically gifted female residents quit surgery for their families, he would frequently warn me not to quit surgery “because you want to have kids.” Most of the time I thought he was kidding with me, but in retrospect I feel lucky that someone saw enough promise in me and cared enough to open up a sincerely dialogue with me about career planning.

I must admit that I am guilty of nearly doing this to myself. While I had mentally prepared to make sacrifices for my career, during medical school I realistically started to consider how much of my life I would let my career consume. After my clinical rotations I was convinced in my heart that I wanted to do surgery, but all the warning alarms in my mind were going off. I am thankful that I had the sense to call one of my mentors (and a voice of reason) to help me think through this seemingly enormous decision. “Why not?” she asked during that call –I had no answer –and with that simple question she helped me realized that only I could hold myself back from a fulfilling career in surgery.

Do women really leave before they leave?

We value your opinion. Chime in on the comments below, and be sure to check back tomorrow as we continue our discussion in Part Three. Yesterday's discussion can be found here.

~~~

Sophia Kim McKinley is a dual-degree M.D./Ed.M. student at Harvard Medical School and the Harvard Graduate School of Education. She received the 2012 Association of Women Surgeons Patricia Numann Medical Student Award and spent a year as a Zuckerman fellow at the Center for Public Leadership at Harvard Kennedy School. Sophia is passionate about medical education and she hopes to be an academic surgeon who brings educationally-sound innovations to surgical training. Her clinical interests are gastrointestinal and minimally invasive surgery. Sophia will be applying for general surgery residency during the 2014 Match cycle.






Dr. Callie Thompson is a resident in general surgery at the University of Washington. She recently completed a two year research fellowship and is now in her fourth clinical year. Callie aspires to be a burn and trauma surgeon and a translational scientist. Her research interests include genetic variations and their associations with the development and outcomes of disease and illness. Callie is married to an internist and has three children under the age of 7.



 




Dr. Minerva Romero Arenas is a general surgery resident at Sinai Hospital of Baltimore and is completing a research fellowship at The University of Texas MD Anderson Cancer Center in Houston, TX. She obtained her MD and MPH from The University of Arizona, and studied Cellular Biology & French at Arizona State University. She is also involved in mentoring and public policy. On her personal time she enjoys spending time with friends and family, especially when it involves good food.