Women surgeons--still in a male-dominated world.

“There are two ways to live your life. One is as though nothing is a miracle. The other is as though everything is a miracle.” — Albert Einstein My approach, as I reflect on the 32 years since I first began medical school at Rush in Chicago, has been according to the second part of Einstein’s quotation. It has always seemed a bit of a miracle to see my patients survive incredible ordeals, to have my family and friends continue to support me and my occupational choices, and to have my career take a frequently serendipitous path. I went to college with the goal of becoming a high school biology teacher, but the education program had closed because of a glut of students who wanted to be teachers. So my love of science led me to the pre-med program. In medical school, my ambition was to become a pediatrician. However, I did my surgery clerkship first, just to get it out of the way because I was convinced I wouldn’t like it. That clerkship changed everything. I went to UCLA to train to be the best academic vascular surgeon. My career path led me to taking on leadership roles as Chief of Vascular Surgery at the West Los Angeles VA, Chief of Surgery at Zablocki VA Medical Center in Milwaukee, Chief of Vascular Surgery at UCLA, and currently Chair of Surgery at Johns Hopkins, Baltimore. Initially in one’s career, one wants to do it all, accomplish much in a short time, and for women in surgery, I think we can blaze ahead and just do it. It is like most surgical emergencies — get the data, make the diagnosis, and go for it. It is our nature. Monica McGrath describes this as the first phase of women’s careers, not only in medicine or surgery. In the middle portion of our careers, we obtain a symbiosis with work and life accomplishments. Perhaps it is because we then have families and need space and time to be many places, seemingly at once. Life can get complicated with divorce, health issues, child issues, and parent issues, yet most women find this to be part of what we need (must? want?) to do. McGrath describes a third phase — sort of where I am now — that asks, “Now what?” Inner meaning is essential to women’s careers all along the way. Perhaps for men’s, too, but men do not usually talk about it as vibrantly as women. In these three phases of career development, what women see as obstacles and concerns change, too. In 1980, when I entered General Surgery, three women were in my intern class and the first woman Chief Resident finished at UCLA. However, women were in the minority in the field. In one particular interview, the Chair said in his remarks, “Gentleman and, uh, one lady,” when he saw me sitting in the audience in a green dress. At that time, I did not care what the ratio or odds were. I just wanted to be a surgeon so badly that I forged ahead. Years later, I found out that at one place I interviewed they had removed all women from their rank list — including me. I was the sixth woman to finish General Surgery at UCLA in 1986, the second woman vascular fellow there in 1987, the fourth woman to receive her vascular boards, the first woman faculty on staff at UCSD in 1987 and UCLA in 1989, and the only woman in the country serving as a Vascular Surgery Division Chief from 1998 to 2003. I was told by one Dean who interviewed me for his Department Chair of Surgery that he just couldn’t give that surgery job to a woman. And he didn’t. That was in 2002. I am now one of only three women Department Chairs in Surgery in the country — and one of only six ever. The field of surgery is still male dominated. Medical school enrollments, on the other hand, are 50 percent women. When I began my career, the percentage was 15 to 20 percent. My class at Rush was 42 percent women, which was unusual. Norma Wagoner, PhD, Dean of Students, was a marvelous recruiter of women. Surgery programs today are attracting about one-third women. We need to do better. Most professions change when more than a third of their constituents become different in nature — age, ethnicity, gender, or other background. However, in order to attract more women to surgery and see a change, we need to actively pursue it. Over the past 25 years, the increase in the number of women in surgery has followed a natural selection process of sorts. I love Darwin and find his observations fascinating. However, I feel now we need to alter the environment and actively make raising the number of women in surgery one of our priorities. How should one do that? Women faculty members and partners should be asked what they want and need to progress in their careers and practices to make them enjoyable, tolerable, and durable. Most women need and want flexibility and can tell you how they want to work their day. We, as leaders, should not react as if their requests are not appropriate, condemn their requests, or talk about them among others. The environment must be made more amenable for women. We also need to actively recruit female medical students into residency programs and subsequently into our departments or practices. Only then will the numbers increase. And lastly, we must provide avenues and opportunities so the women we work with can lead. We cannot rely on serendipity to increase the number of women in surgery or the number of women who will lead. There are those who feel only a miracle will allow women to reach their equal representation, not only in surgery but in other fields such as politics and business. But we create our own miracles with a bit of help from our leaders. And our leaders are you and me.