As I read the article, "Fewer Surgeons on Call: Places Patients at Risk," in this issue of Connections, it made me reflect on some recent events in my career. I am one of the many surgeons who still take emergency room call. As more surgeons opt out, at what, if any point, is it okay for me to say enough? How much should I compromise my life for my patients? It's not an easy question for any of us to answer, at least honestly. It is, however, an issue that most of us are going to have to face. I would be interested in hearing your thoughts and how you have dealt with this in your practice.

I would like to encourage all of you to sign up for the AWS Ambassador Program at this fall's ACS conference. Remember your first meeting and how nice it was to see a friendly face!

Sincerely,

Rosemary Kozar
Rosemary.A.Kozar@uth.tmc.edu

In this issue. . .

• Doctors Diagnose Doctors in Two Bestsellers

• Couples Matching

• Fewer Surgeons on Call: Places Patients at Risk

• Women on the Move

• Olga Jonasson Remembered

• News from the Academic Practice Committee

• News from the Virginia Chapter

• Job Announcements

• Women in Ophthalmology' s Leadership Summit

• Save the Dates

Doctors Diagnose Doctors in Two Bestsellers

Judging by their bestseller status, two recent books about how doctors think, interact, and strive to improve, appeal to readers far beyond the field of medicine.

The books, by Harvard clinicians and New Yorker columnists Jerome Groopman MD and Atul Gawande MD, are being applauded as compelling, candid and inspiring.

Dr. Groopman's most recent book, How Doctors Think, ranked seventh on the New York Times list of nonfiction hardcovers in mid-May. In an interview, Dr. Groopman said he wrote the book "because I was dissatisfied. In general, there's a high level of dissatisfaction among physicians. Some doctors look to systems analysis to fix things. Maybe I'm a dinosaur; I go for narrative instead."

Michael Crichton MD, one of the world's most prolific physician-authors, reviewed How Doctors Think for the New York Times.

"This elegant, tough-minded book recounts stories about how doctors and patients interact with one another. These clinical episodes make absorbing reading and are often deeply affecting.
At the same time, the author is commenting on some of the most profound problems facing modern medicine."

Crichton concludes that "Groopman powerfully conveys the complexity of the physician's role, the anxiety and uncertainty that dog his every step, the difficulties that arise in understanding patients, eliciting their stories, making a diagnosis."

Gawande's new book is titled Better: A Surgeon's Notes on Performance. In mid-May, it ranked 20th on the New York Times list of nonfiction hardcovers.

When the New York Times critiqued this book, reviewer Pauline Chen, MD (who wrote Final Exam: A Surgeon's Reflections on Mortality) said, "Gawande manages to capture medicine in all of its complex and chaotic glory, and to put it, still squirming with life, down on the page.

Gawande's meditation on performance is not only an absorbing collection of essays on how some doctors manage to do better but also an exhilarating call for the rest of us to do the same."

After reading the book, Chen said she found herself "being a little more persistent, weighing consequences more purposefully and pushing my middle-aged mind to wrap itself around old problems in new ways. I even found myself reaching for hand-washing alcohol gel more often. With this book, Gawande inspires all of us, doctor or not, to be better."     [ top ]

Couples Matching
By: Carolyn Kwak, MS4, AWS Student Member

Life is always full of surprises. When I met my soon-to-be-husband during my third year of medical school, I didn't know we were about to embark on an emotional rollercoaster together during the match process (a.k.a. "couples match"). I wrote this article after the match, so in retrospect I can easily say "everything will work out fine." However, prior to March 15th, the words
"what if. . ." were the only two that resonated in my mind.

My fiance' was a PGY1 while I was a MS4. I was not very flexible with my residency locations as I was applying for an integrated vascular surgery program (which was new starting in 2007) and offered in only four institutions. General surgery was my contingency plan. He was a categorical internal medicine resident considering a fellowship in cardiology or re-entering the match for radiology.

I write in hopes that the following guidelines from my personal experience will assist you in positive ways.

Ten Tips to Consider:

1) Know your commitment level toward your significant other (e.g. are you planning a wedding or just dating?). Anticipate compromise and possibly sacrifice, depending on how competitive both applicants are.

2) Communicate honestly where you can and cannot live for the next 3-6+ years. Make a list so you don't forget each other's preferences. If you become flexible with location, communicate this to your significant other immediately!

3) NRMP advises to make individual rank lists of programs, and a separate couples rank list. This is a great idea, and really helps administratively when you are ranking in February.

4) Unless you're both set on residency programs in rural areas, look into larger cities; there are usually more programs per area (e.g. upstate or New York city, Los Angeles, Chicago, Houston, Philadelphia, Detroit, SF/northern CA, just to name a few).

5) FREIDA is your best friend for locating programs in the same proximity. You will have more choices if you are willing to rank programs in the same city, and not just programs in the same institution.

6) When your significant other receives an interview offer, be proactive and call or email the program director where the interview was offered and let them know you're significant other was offered an interview. Request if they could expedite a review of your application for a possible interview as well. By this time, you would have already applied to that program, but they may get back to you earlier if they want to interview you. This will help your scheduling. If they do not offer an interview, you'll know this earlier, which will save your significant other a trip to that university/institution (from experience this could save up to $500!).

7) When your significant other isn't offered an interview where you really want to go. . .find a friend/family member to confide in and "vent" first. Don't initially complain or whine as this will only make your significant other feel guilty (I unfortunately speak from experience). If you find yourself feeling resentful after sleeping on it for a few days, discuss this with your significant other. Re-think if couples matching is really for you if this becomes a problem.

8) If you're concerned that you will be "ranked lower" because you are couples matching and wish to be considered as an individual, communicate this during the interview process. Most competitive programs stated to me "we will rank you according to how much we want you as an individual applicant, not by how we think you will rank us because we can't accommodate your significant other."

9) If there is a program that you can't give up, then there is always the option of ranking that program alone, or "going unmatched" for that program. There is the possibility of being together if one is willing to do an alternative year of research, transitional or pre-lim year and transfer into the program (the following year) where the significant other matched.

10) COMMUNICATE calmly and rationally what you're really feeling/thinking through the whole process (e.g. don't throw temper tantrums, as I am guilty of this as well). If you're the one listening, don't be judgmental but convey it's okay to be upset or disappointed, as this would be expected in anything we highly desire.

Four Hard Truths:

1) Couples matching is not for the undecided. Ask yourself: are you going to be miserable if you end of with your 5th choice instead of one of your top 3 if you couples match? This may happen. It also may not, but you should know it's a possibility.

2) Couples matching is expensive. The more competitive the field, the more interviews you will need to plan. Even if not in a competitive field, you may interview in more places to increase the chances of matching in the same institution or area. It's good to know this for your budget. You may want to consider an extra loan/financial aid ahead of time. With plane tickets, rental cars and housing accommodations, you could easily spend $5000 between the two of you.

3) It may be an emotional rollercoaster. Know that feeling angry and feeling guilty are normal responses. You're not the first to feel this way. This is when you take a good hard look as to what you're getting in return (e.g. being able to spend time with your significant other on your days off). Several couples who went before me told me this was one of the most challenging times of their relationship.

4) The more competitive you are the better. This depends on the field of interest, but it definitely helps if both applicants are competitive (AOA status, two digit 90+ step 1 score, strong letters). If one is interested in family practice or pediatrics, this may be less relevant. But this is highly dependent on the caliber and location of the program. For example, if one wants to do pediatrics in San Diego, California or family practice at Hopkins, competitive numbers are helpful.

The match process gave me insight as to what was required of me for the rest of my life; balance between my two loves. Whether for a future fellowship position, academic job or future family, I realized this is just the beginning of a long journey. During the tough times, be grateful that you have the choice and opportunity to have the best of both worlds! As with all good things, it's all worthwhile in the end.

(Note: Not all couple matches are "couples" in the traditional sense. While not very common, couples, as discussed above, may represent siblings or other individuals who wish to be matched in pairs.)     [ top ]

Fewer Surgeons on Call: Places Patients at Risk

Surgical specialists, such as neurosurgeons and orthopedic surgeons, are increasingly declining emergency room coverage -- and jeopardizing patients -- according to a recent article in U.S. News and World Report. 

"The Joint Commission, hospitals' major credentialing body, has cited lack of specialists as the cause of 21 percent of emergency departments' ?sentinel events' ? unexpected deaths or serious injuries due to slow treatment," the article states.

Citing a 2006 survey by the American College of Emergency Physicians, the article says that 75 percent of the nation's emergency departments report shortages of surgery specialists -- an increase from 66 percent in its 2004 survey.

Contributing to this decline in coverage is a 26 percent increase in emergency department visits between 1993 and 2003 -- and no corresponding increase in surgeons.

The U.S. News and World Report article, by Josh Fischman, attributes the decline in coverage to the "three modern maladies of American Health: too much work, too little pay and the fear of malpractice lawsuits."

The coverage issues are "likely to get worse before they get better," the article concludes. "The American public has no idea how dangerous it has become to get sick or injured at the wrong time."

To read more, see U.S. News & World Report.     [ top ]

Women on the Move

Betsy Tuttle Newhall, MD, FACS, received both the Thomas D. Kinney Award for Excellence in Fourth Year Medical Student Teaching and the Second Year Award for Professionalism at a special ceremony at Duke University in
May 2007. 

• The AWS Academic Practice Committee would like to invite you to participate in the AWS Ambassador program at the October meeting in New Orleans. An AWS Ambassador is an AWS member who helps to acquaint a new member or new attendee with the AWS organization. If you are a new AWS member or this will be your first AWS meeting, we need you to participate, too. We have eager volunteers waiting to meet you in New Orleans. Interested? Please contact AWS at Info@WomenSurgeons.org or watch for the sign-up in your registration materials for the Annual Meeting.

• There's an article in the May 16th edition of JAMA about academic mentoring entitled "Academic Mentoring: How to Give it and How to Get it." To read the article, see the May 16, 2007 edition of JAMA
  (Vol. 297, No. 19).    [ top ]

Hepatic resections, pancreatic resections and other sorts of surgical oncology are done. Dr. Kemeny is looking for a partner at the center. Any amount of experience is okay, including someone just out of fellowship. There is no bench research at the center, but they do a lot of clinical research. The population the center works with is 92% minorities, with a very multi-cultural background. It is very rewarding working with the patients and contributing to the community. Anyone interested in cancer in minorities or in health systems would enjoy this position. Academic appointment with Mt. Sinai Medical Center.

Please contact: Margaret Kemeny, Professor of Surgery, Director, Queens Cancer Center, (718) 883-4031.

Click here for more job announcements.    [ top ]