Interview
VOL.10Dr. Carrie Y. Inwards, M.D.
《Profile》
Consultant- Division of Anatomic Pathology, Department ofLaboratory Medicine and Pathology, Mayo Clinic, Rochester,
Minnesota
Consultant (Joint Appointment) - Department of Orthopedic
Surgery, Mayo Clinic, Rochester, Minnesota
Associate Professor of Laboratory Med/Pathology- Collegeof Medicine, Mayo Clinic
Teaching/Examining Privileges in Clinical & Translational
Science - Mayo Graduate School, College of Medicine, Mayo
Clinic

平成 24 年 7 月 17 日、本学病理部でご講演をいただいたミネソタ州ロチェスター市メイヨークリニ
ックの Inwards 医学博士にインタビューをお願いしました。
外園千恵眼科学教室講師と田邊智子非常勤講師がお話しをお伺いしました。

Q1: The first question is: I understand you went to university and medical school inNorth Dakota. How did you envision yourself in the future as a physician when you
were a medical student?

When I started medical school, I really didn’t have a clear vision of what my life as aphysician would be. When I started college I wanted to be a medical technologist in a
lab and had no intention of going to medical school. Things began to change after I
took a class called “histology” during my second year in college. I loved the class somuch that I tried to figure out if I could do this kind of work as a career. I learned thatthe closest job to being a “histologist” was to be a pathologist, and to do that you needto go to medical school. It was very difficult trying to figure out whether I should stayon course to be a medical technologist or change direction and try to get into medical
school. A medical technology degree would guarantee a job that would allow me to be
independent and take care of myself. If I took a gamble and tried to get into medical

school, I had to drop my medical technology course and get a degree that qualified me
to apply to medical school. Unfortunately that degree would not assure me of a job if I
didn’t get into medical school.
I was in college a long time ago during the years of 1976 to 1980. When I was thinking
about applying to medical school, the biggest concern I had about being a doctor waswhether I could successfully combine my career and family. Unfortunately, I didn’tknow any female doctors because there was only one, or maybe two, in our entire
state, making it impossible to see if or how it could be done. I decided to apply anyway
and was fortunate to get accepted into medical school. I thought I would end up inpathology, but I had never really seen what a pathologist did on a daily basis. I wasquite naive.

Q2: What kind of experiences during medical school helped you shape into who you
are now, combining a family and career?
During medical school, the first two years were classroom work so we didn’t see any
patients until the second two years. My third year was spent in a large city,(Minneapolis, MN) where I did clinical rotations at different hospitals. Therefore, I
didn’t have any one person that was a mentor, because I was going to all sorts ofdifferent places. Probably one of the biggest factors that influenced me was an elective
rotation that I did at the Mayo Clinic during my third year as a medical student. It was avery good experience that motivated me and confirmed my decision to apply for apathology residency, hopefully at the Mayo Clinic. In retrospect, it was a good decision
to seek out another place that offered different experiences from my medical school
training. It was very helpful in making my career choice and getting the residency that I
wanted. I certainly recommend that medical students and residents try to get exposed
to as many different people and places as possible, because there are so many options
out there that are hard to realize if you don’t reach beyond the books and immediatesurroundings.
Q3: Did you meet any female pathologists at Mayo while you were a medical student?

Well, when I did the medical school rotation, there was one more senior female
pathologist at Mayo, but I didn’t meet her. When I started my pathology residency, Ididn’t know any female pathologists. There weren’t any female role models, so I
couldn’t see what it was like to be a female physician. I really wanted to talk to
somebody about my concerns, but that wasn’t possible.

Q4: How many female students were there in your medical school class?

The percentage of female students was pretty high for that era. I don’t remember
exactly, but it was at least 30 percent. It was during my generation when the number offemale students in medical school really started to go up. The percentage of female
and male pathology residents at Mayo Clinic was about the same. But when I started
there on staff, by that I mean after my residency, the total percentage of female
physicians in all specialties was about 14 percent, so it was small. And there were only
two females in pathology, one of whom was only one year ahead of me.

Q5: Was it common for female students at the time to do like an externship outside of
medical school?
It was, yes. Actually in my medical school, students were all in the same class at theuniversity for the first two years of medical school. However, after my first year in
medical school, I did a child psychiatry summer externship at Tufts Medical Center in
Boston, Massachusetts. It was a great experience and exposure to an east coast
medical center. Everybody in my medical school class had to transfer to larger
institutions for their third and fourth years. Some people went to medical schools
around the country. About 40 or 45 students, including me, went to Minneapolis, MN alarge city in the adjacent state, where we were exposed to many different hospitalsettings in Minneapolis.
When I was on medical and surgical rotations, I had to follow the first year resident
intern at all times. That meant I was at the hospital for what seemed like 24 hours perday, 7 days a week. That was something I knew I didn’t want for the rest of my life. And
as I recall, even at the main trauma hospital there had only been one female who
finished a surgery residency. It was insane. So, I was disappointed. I knew it was going
to be rough, and I was correct.

接していて非常に気持ちがよかったです。右顧左眄というか媚びがなくて。
Q6:
From the beginning of your medical school, you were very conscious of having afamily and establishing a career and family, at the same time. You wanted to havesome kind of lifestyle that would afford you to have the both. Can you think ofsomeone, among your supervisors and colleagues, who have influenced you as
mentors or in other ways?

As far as my career was concerned, when I started there was only one more senior
female pathologist working in my area, and I didn’t know her very well. My main
professional mentor turned out to be a male who was an expert in the subspecialty
field of pathology that I was asked to study. He was a very good mentor because he
was a great teacher, opened many professional doors that provided me with a lot ofopportunities, and it was fun to work with him. Mentorship is more than just having
somebody teach you how they think something should be done. It is a better fit
when the two personalities get along well together, too. That is why a random pairing
for mentorship doesn’t always work well.
Back when I was in residency and medical school, it was quite uncommon for thefemale students to have babies. Now I see them having children much more frequently
in residency than we did. My husband, who is also a physician, and I were married
during my fellowship year (6th year of residency). We left Mayo for a year after myfellowship and lived in Nebraska. I was in a private practice job while he was at auniversity for one year doing a fellowship. That was the year when we had ourdaughter. When I applied for the job, I wasn’t pregnant but remember wondering
about the issue of “do you dare ask your employer about maternity leave”. I wasinterviewed by the other members in the practice who were both men. I ended up
deciding that I needed to ask the question because if they didn’t like the idea, then I
knew that I wouldn’t want to work there anyway. (Q: You asked before you got
pregnant?) Yes, when I was interviewing for the job, I asked them, “If I had children,what’s your policy on maternity leave?” They said, “We’ve never had a female
colleague who’s been pregnant… in fact we’ve never had a female partner.”
Fortunately they ended up telling me they would be accommodating and supportive,
and that was good. It frustrates me when I still hear female residents worrying about
asking those questions. They need to be confident and strong because if they don’t, it
just perpetuates the problem and does nothing to help change policies. Women haveto work together to make these things happen.

(Q: You said you were in private practice for one year?) For one year.
(Q: Were you considering working in private practice and not seeking academic careerat that time?) When I was in residency, I was not necessarily thinking I was going to beon an academic track. I had written some papers and I liked it, but I wasn’t firmly
convinced I wanted to be on an academic track. It was after I had been in my private
practice job for 6 months that we got a call from Mayo saying “would you be interested
in coming back?” because they had openings for both of us. My husband really wanted
to come back, but I was kind of plus-minus. I was worried about the extra demands ofacademic expectations. Mayo was very busy place with a lot of service case work, no
off service time in the schedule, and you were expected to be academically productive.
Therefore, it was a difficult decision.
(Q: How old was your daughter?) When we decided to take the jobs at Mayo, I was
about 6 months pregnant. It was a complicated pregnancy, too. My daughter is finenow, but she was in the intensive care unit for 6 weeks. We moved to Mayo 2 weeks
after she came home from the hospital. So I was only in private practice for one year. I
started my job at Mayo when my daughter was 4 months old and I started part-time.
Thanks to the efforts of the woman one year ahead of me, they said I could be full-timeor part-time. Part-time physicians at Mayo Clinic were very unusual at the time. It was
just starting to be something they would consider, due in part to a national push or
cultural change to get more women in staff MD positions. The residency and medical
school programs had close to 50% females, but the percentage on staff at large
institutions was far different. Our department chair at the time I came on staff at Mayo
was also influential in hiring women into our division. His wife was a physician, so hecould relate to a duo career family and was supportive of it. He was forward thinking
and interested in trying to get a more balanced distribution of staff members.
When I started my job, they gave me the option working either 100 percent or 50
percent. I was a little bit nervous about part time because I didn’t know what to expect
since no one had done it for any period of time before me. I wondered if I was going toface discrimination because I was part-time, but I decided to do it anyway. When I
started at 50 percent, they didn’t allow me to choose how it would be scheduled. They
scheduled me to fit their needs. Nevertheless, I was happy to get it because if you
add all of the time required outside of regular work hours to do academic pursuits, itwould obviously be challenging combine family and career with a spouse who also
works full time. It is true that when I started at 50 percent there were pros and cons.
It was nice to have some flexibility, but I definitely worked more than 50% and early on,
there were some ill feelings among some of my colleagues about my part time status.

(Q: Male colleagues?) Yes, because nearly all of my colleagues were men, and the
majority had spouses who did not work outside the home. Some thought part-time
meant “part interested” or “part dedicated”, etc… In addition, part-time is notconvenient for the rest of the group when you have to try to work around it and areshort staffed. Over time, I’ve come to believe that in order for part time to work, it has
to be something that is more about cultural change. In other words, people would
need to focus on how it allows for broader representation rather than how it affects aparticular day. For the most part, part-time has become something that is thought ofas much more of a female issue, and I really hope that will change. It should be more ofa family issue or work life balance issue with men also going part-time to reach thosegoals. Usually if you are part time at work, you’re doing almost full time everything else
at home. My husband has been very supportive of my career. He works full time, whichmakes juggling things tricky. I would say that it’s not particular to medicine but it’s justduo careers in general. If two people work 12 - 14 hours a day and also spend timeworking on weekends, it doesn’t work well when trying to also have a personal life,
with or without children. This is true whether you are a male or female. So it’s amatter of making compromises. If you have a very demanding career that requires a lotof time, then your partner may have to give up some of what he or she is doing to acertain extent. If it is always only women who do so, then it will make it more difficult
to get opportunities to be “at the table” making policy decisions that positively affectwomen in general. Sometimes academic careers can be more demanding; however,that isn’t always the case because sometimes being in private practice means working
very hard because the group cannot hire any more people. So it doesn’t necessary haveto do with academics, but academics sometimes requires more traveling and things
beyond office work.

Q7: You’ve been to Japan several times. Did you meet a lot of married women? In
Japan, many married female physicians are struggling to develop their carrier andbreak the glass ceiling. What do you think of it? How is it in the US?

I think that same thing is happening in the United States. We struggle with that aswell. It really comes back to, as I said, trying to balance relationships, family, career andstill being quite successful. I see the younger generation, men and women, with a bit ofdifferent approach than my generation. Whereas my generation’s attitude towards ouremployer’s demands was to always say, “yes”, it’s somewhat different now. The
younger generation is more conscious about setting some limits. Sometimes the older
generation gets frustrated with that, but I think there have to be some limits if a duo
career family is going to work. In general, many men have developed successful careers
and a family because women have taken care of most family needs at home. If women
are going to break the glass ceiling, they will need support from men and society as awhole. Most of the time people who desire flexibility are doing it so they can combine
children and work. But sometimes people without kids just want to have more time fora life beyond their career. Overall, it is just much healthier for everybody if people try
to lead more balanced lives.
In order for us to break the glass ceiling, we need to have more women in decision
making positions and leadership roles. When that happens, chances are there will be
more decisions made that favor work/life balance for all and avoid changes that hinder
women from becoming successful. Therefore, I encourage younger women to seek out
opportunities to get involved, because it’s very important. That could range frommembership in a small committee to chairman of the board. That is how change ismade, and if we aren’t there we won’t be heard or have an impact on how things are
done. It may not be easy, but I think the alternative is worse. If we don’t get involved insome capacity, it’s going to turn back the clock of time for our daughters. I saw mymother’s generation in a situation where they were largely dependent on men andlacked opportunity to be self-sufficient. My daughter’s generation hasn’t really seenthat so they have a harder time understanding how difficult it is to have very few
options. A lot of progress has been made over the years and we must work to keep itheaded in the right direction. It takes hard work, but the alternative is not easier in thelong run. The changes are like a large ship - it will turn slowly over time, so people haveto be patient.

Q8: In terms of career goal, what was your original career goal when you moved toMayo Clinic?
Well, when I moved to Mayo Clinic, my goal was to be academically productive andsign out cases. I didn’t have it all planned out, and I wasn’t quite sure all of that wasgoing to happen. Early on, I was paired up with my mentor who was a very famous
person. His wife was a physician who worked part time, so he understood some of thepressures I was under. However, I had more responsibilities outside of work because
my husband worked full time. For a while I was taking care of my young children andalso my grandmother and mother who lived in our town, but not with us. I think thatover time, the combination of my personal life and my work life affected academic
productivity. It certainly didn’t stop it, but I would say that it did slow it down. But
that’s not such a bad thing because I still have been able to accomplish quite a bit. Now
my kids are both living in other cities going to college. (Q: Your kids are out of house,
too?) Yes- for the past year. Overall, it hasn’t been an easy adjustment for me, butthings are getting better.

Q9: I want to know your priority in your life. Has it changed overtime like first when
you started at Mayo which way more your family or your career? Your daughter was so
small, only 2 months, and you had your son, so you had 2 children, and how has itchanged over time, your career goal or like I want to know which one was more
important when your children were so small, you obviously need to take a lot of time
for the family and kind of like just who take care of the family was the most important
thing and then career second, you never thought that way?
My children will always be the most important thing in my life. However, that
doesn’t mean that other things, such as a career, can’t be important to me at the sametime. All along it wasn’t a matter of choosing either or, but rather how to do both at
the same time. There certainly were days, particularly when they were young, when I
worried that I wasn’t spending enough time with them. During those times, I tried tomake myself look at the big picture of life. I felt good about having a rewarding career,
I could support myself and I could be independent. This is role modeling for mychildren. My grandmother always told me that it was very important to be able totake care of myself. Her husband (my grandfather) was away during WWII and hedied at an early age. My parents went through a divorce when I was in college, leaving
my mother in a situation where she had to find a job. Both of these situations mademe realize that my grandmother was right- I need to be able to take care of myself. I
hope my children feel that way, too.
(Q: Did you have a lot of help from your family members?) No. My mother lived in
our town, but she worked full time so didn’t have a lot of time to take care of ourchildren. Unfortunately she passed away when they were in grade school. Therewere no other family members in our town. We hired a wonderful older woman tocome into our home to take care of our children while we were at work. Some of myco-workers had a similar situation, whereas others took their children to a daycare
center. After I was in my job for about 6 years, approximately four more women wereadded to our staff. That lead to what felt like a support group because we would talkabout out how to manage work and kids. Mayo was also starting to develop a
women’s advisory group. This “Women’s Advisory Committee” evolved to what we
now know as the “The Office of Diversity and Inclusion”. However, those who attend
the meetings/functions are almost all women.

Q10: Did you have any in-house day care in hospital or do you still have it now?

No. I remember when I started on a staff and was on the Women’s Advisory
Committee, we were exploring the idea. Overall, Mayo leadership decided it was
something they just could not do. It was too complicated, in part due to the huge
number of employees. They couldn’t get something just for physicians and notinclude the rest of the employees. However, Mayo did set up a daycare for sickchildren that can be used by all employees. The hope was to keep more parents atwork rather than at home with a sick child. This became, and still is, a popular option
for a lot of people.
(Q: We just started the same thing here a year ago.) I am happy to hear that.

Q11: We have only 5 minutes left, you answered most of the questions we want toknow, but how long have you been working as full-time now?
I’m not full-time, (Q: You are not full-time yet?) I’m at 75 percent, but certainly work
more than I did in private practice at full time. While 75 percent seems to work forme, others find full-time or a different percentage works better for them. As I getolder and reflect on my days at 50 percent (but realistically working much more), I see
a clear disadvantage when considering the smaller amount that went into retirement
benefits. For now, I’ve decided not to go full-time because my career already takes up
most of my life. I have a very busy workload and combine it with academic pursuits.

As I near retirement in the future, I suspect I’ll appreciate the time it affords me to be
more involved with family and friends.

Q12: What does it take for female physicians to get into leadership positions?
First of all, I suggest that women step back and look at how things work. Decide
where you have an interest, where you feel that you can be effective, and discoverwhat you feel could be done to improve upon the work of the group. This should help
create motivation and lead to questions such as, “What committee should I try to join,
who chairs that committee, what do they do, what is the time commitment, and how
will I be involved in networking. Ask a lot of questions. Don’t just wait for things tohappen - make a plan or at least try to get involved. Choose wisely. Don’t get
involved in too many things. Be good at a couple of things rather than getting overcommitted and not very good at anything, something that has always been a challenge
for me. Overall, more opportunities for women will open up if more women are in
leadership positions. It will require sacrifices, but in the end everyone benefits. I’ve
been a member of numerous committees at Mayo Clinic, and held a variety ofleadership roles such as director of our surgical pathology fellowship program anddirector of our frozen section labs. A few years ago, I was Vice Chair of Practice, anupper level leadership position in our anatomic pathology division, for almost 5 years.
It definitely added more time pressures, but our children were older so they didn’t
notice it quite as much. In retrospect, I feel proud that I was able to be in a position
where, in part, I could initiate changes in our division, some of which made it a morefamily friendly place. I also learned a lot about what leadership entails and more about
myself. I also have been involved with national and international pathology societies,
both as a member and in leadership positions. I currently serve on the executive
committee of the International Society of Skeletal Society where I hope to becontribute in meaningful ways over my term. The road to that position included
active membership and committee work, both of which I enjoyed.

Q13: Could you give us, for young female physicians and scientists, and students toinspire them some words?

Well, I would say that I’m very happy with my career path. There have beenchallenges all along, but overall I am very glad I persevered through the rough spots.
My children and my colleagues’ children are doing very well and do not appear toresent their mothers for having a career. In fact, so far all of our daughters say theywant to have a career. It is fulfilling to know I’ve had an impact, hopefully a positive
way, in the lives of many people (patients, residents, colleagues..etc), something I hope
my children will do in some way during their lifetimes. Like many women, particularly
early on, I was afraid I couldn’t do certain things and lacked confidence. Slowly, but
surely, I learned that I could accomplish more than I imagined possible. It took a lot ofwork and patience, but it was worth it. I am certain this is, and will be, the same story
for many more women. We need to not be afraid of failure, a feeling that oftentimes
holds us back. Some of the most important lessons I learned were the result of
failure. Nevertheless, I still have times when I struggle with lack of confidence, but it
has become much less frequent. We need to effect positive changes for women in oursociety that will benefit all women who come after us. I am very grateful to thegenerations of women before me who struggled to make changes that benefited me.

Q14: When you kind of felt lost, did you ever feel lost? (A: Oh year.) Who did you talkto?
Of course there were times when I felt lost. I think during these times women have aneasier time reaching out to others than do men. If the issues were family related, I
would reach out to my closest friends (all women), some at work and a couple outsideof work. While my mom was alive, she was my most important source of comfort. For
work related issues, I would confide in a couple of close female colleagues andsometimes male colleagues. It is important to know who you can trust. Ultimately,
the goal should be to build inner strength so that the lost feelings become less and less.

Q15: May I have a question to your son? How do you feel your mother? How old are11
you?
<son> Nineteen years old. Basically, I never felt it was odd growing up with a mom
who worked. I never felt that I lacked a connection with my mother. We get along
very well and I never felt a lack of care or attention or anything like that. There were afew times when I was a little kid that I kind of wanted mom around when she was atwork, but I never felt really overly upset about it. She always came back at the end of
the day, so it was never really a problem. Now that I am older and look back, mymother’s work was normal for me, and again I didn’t comprehend it as a problem. (Q:That’s a relief for us, too.) Overall, I am proud of her.
<Dr. Inwards> I’m very happy to see you have this kind of (diversity) group here in
Kyoto. I remember that during my first visit to Japan in the mid 1990’s, I was on abreak between lectures and there was a young female who followed me into abathroom. She nervously asked me, “How do you combine career and children?” I
thought “Wow, I certainly can relate to that concern, and unfortunately I don’t have all
the answers!” I also knew that she wasn’t alone, her concerns were shared by womenin the USA, and for that matter around the world. I hoped that we’d have more
answers by now, but at least we’ve made some progress. I encourage the younger
generation to ask questions and learn from those of us who have been through thingsin life that give them concern. Similar to history as a whole, they can learn from our
successes and mistakes.

Thank you very much.