AWS BLOG

Golden August

By Camila R. Guetter

Created in 1992 by the World Alliance for Breastfeeding Action (WABA), the World Breastfeeding Week completed its 25th edition this year. During the first week of August, campaigns and partnerships take place in order to support and raise awareness on the importance of breastfeeding. It is an international effort that currently involves 150 countries.

This year, to celebrate World Breastfeeding Week’s 25th anniversary, the Brazilian government announced the expansion of this campaign from a single week to a whole month dedicated to the cause, the Golden August. Initiatives include public talks and events, community meetings, advertising on the media, and illuminating monuments and buildings with golden lights. All in an effort to spread even more knowledge and awareness about breastfeeding in Brazil.

The name “Golden August” relates to the fact that breastfeeding is the gold standard for newborn feeding. Compared to Pink October initiatives for Breast Cancer, it intends to make society aware that breastfeeding is a primary preventive measure for many diseases, for both mom and child.

As I  go through my OB/GYN rotation in medical school, I now understand the extent and importance of the benefits of breastfeeding. For mothers, breastfeeding contributes to postpartum weight loss [2,3]. It has also demonstrated risk reduction on ovarian cancer [4], endometrial cancer [5,6], and aggressive inflammatory and invasive forms of breast cancer [7,8].

When it comes to the newborn, breastfeeding plays an important role in the development of the dental arches [9,10], speech, and breathing. It is also a protective factor for allergies [11], infections [12,13,14], gastrointestinal illnesses [13] such as gluten intolerance, obesity [15], and reduces neonatal mortality [16]. Last but not least, it contributes to the effective bond between mother and child. Another recent blog by Nickey Jafari highlights more the benefits of breastfeeding.

Given all the well-known benefits of breastfeeding to both mother and newborn, the WHO recommends exclusive breastfeeding for at least the first six months after the birth of the newborn. Nevertheless, this practice still encounters many barriers worldwide, mainly due to lack of information. Globally, only 38% of newborns receive breast milk until six months of age. The goal set by WHO is to increase this number to 50% by 2025.

Discrimination and criticism over breastfeeding in public is still a major issue in Brazil. In this regard, the Golden August has partnered with public and private companies to empower their employees who are new mothers. Some companies now offer special rooms for breastfeeding, showing recognition of its importance. They offer private and adequate environments for mother-infant interactions and bonding as well as for pumping breast milk, if needed, during work hours. These conditions may lead to less work absenteeism as they improve the ability for women to return to their work routine more easily. They also maintain breastfeeding as a unique and special experience, as it should be.

Happy Golden August to all parents out there!


Camila Guetter is a fifth year medical student at Universidade Federal do Paraná, Brazil. In her third year, Camila received a scholarship to study at UCLA. Subsequently she became a research student at Beth Israel Deaconess Medical Center (Boston, MA) on pancreatic cancer, HPB surgery outcomes, and patient education materials. Camila is passionate about pursuing a career in academic surgery and is currently a Teaching Assistant for Principles and Practice of Clinical Research, a Harvard T.H. Chan School of Public Health course. She currently serves as International Representative for the 2017/2018 AWS Medical Student Committee. Outside of medicine, Camila enjoys playing tennis, playing the piano, and traveling.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

 

 

Breast is Best, Supporting Mothers Is Better

By Nickey Jafari

My rotation in obstetrics & gynecology (OB/GYN) was full of emotional moments, and the first time I witnessed a mom breastfeed her baby was one of my favorites; in a culture that so overtly sexualizes women’s bodies, it reminded me that breasts had evolved for the purpose of nurturing a new human life. Of course, breastfeeding is not always easy, and the decision to breastfeed is a deeply personal one for a woman. Mothers who are unable or unwilling to breastfeed should never be shamed for it. However, the health benefits for both mom and baby are plentiful. We should seek to strike a balance between educating people on the myriad of reasons to breastfeed, while not making women feel pressured to do so.

The World Health Organization recommends exclusive breastfeeding for at least 6 months and reiterates well-known benefits, such as reduction in gastrointestinal illnesses for baby, increased neonatal immunity to infections, and reduced newborn mortality. For mothers, the WHO states the reduction in risks of both breast and ovarian cancers as other reasons to breastfeed. Some of the contraindications to breastfeeding can be found here, and include galactosemia and untreated, active tuberculosis.

Given all its benefits, breastfeeding is a public health priority. The CDC Breastfeeding Report Card 2016 shows that most mothers do want to breastfeed, but rates of exclusive breastfeeding through 6 months are as low as 22.3% throughout the U.S. Barriers to Breastfeeding in the United States frames the issue of expectations on breastfeeding very well – “even though breastfeeding is often described as “natural,” it is also an art that has to be learned by both the mother and the newborn”. Thus, education on breastfeeding techniques, such as the best way to achieve a proper latch, should be provided to moms. Empathy and encouragement go a long way, too. I remember on my pediatrics rotation, when we would check in on our new babies, a lot of moms would get frustrated if the process was not going smoothly because of this societal expectation that breastfeeding is an easy and innate process from the get-go. I noticed some moms who gave up because they felt like, since it was not going well, they were failing at being a mom, and others who switched to formula soon after because they were worried about their baby getting enough nutrition. Their decision did not come from any selfishness, but genuine concern for what is best for their child, and thus I always get upset, as someone who does enthusiastically promote breastfeeding and its benefits, when I see someone judge a woman who does not; we have no idea what her journey was. A little encouragement from clinicians to new moms that it is also “natural” for it to take some work, that they are doing a great job and should keep trying, that their milk amount will continue to increase after the first few days of colostrum, can make a world of difference.

Overall, there are far too many impediments to breastfeeding to address in a single blog post, but in addition to better education to new moms by their clinicians, they include changing societal norms and expectations, increasing social and family support, and creating work policies that allow women to breastfeed. Grace DeHoff wrote about her journey into motherhood as a medical student and touches on breast feeding time commitments. A great post about experiences pumping as a surgeon mom can be found here. The fact of the matter is that “many women face barriers to breastfeeding; poor breastfeeding environments where women work, live, and obtain health care are among the biggest barriers” (read more here). One critical policy area where the U.S. lags far behind other developed nations is the issue of maternity leave. The Family and Medical Leave Act only allows for up to 12 weeks of unpaid leave. The AWS maternity policy for surgeons in practice can be found here.

We can and should promote breastfeeding while not making women feel less than as mothers if it is not the best choice for them. We should be especially careful about promoting “breast is best” if we are not simultaneously working to create more flexible work policies, change societal expectations for new moms, and provide the tools that can allow women the chance to successfully breastfeed!


Nickey Jafari finished her third year of medical school at the University of Kansas this past spring and is currently pursuing her Master of Public Health at the Johns Hopkins Bloomberg School of Public Health.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

Success is a Journey

By Jaime D. Lewis, MD

Advancement up the academic ladder from grade school through college and medical school was measured by meeting well-defined milestones along a smooth and narrow pathway. Residency and fellowship introduced some variability but were accompanied by a similarly transparent structure of progression. The end of formal training felt as if I had embarked on a journey along a rocky, winding trail through dark fog aided variably by an old compass that occasionally pointed northward, or at least somewhere in the general vicinity. When I became faculty, this experience and the loss of an unambiguous measuring stick was quite disorienting leading me to feel as if I had I lost my ability to gauge my progress and my achievement of success or descent towards failure.

Through time, work, self-reflection, and connection, I am once again on a trail that I know is moving onward and upward. And as part of my plan for progress and career development, I have had the fantastic opportunity to spend the last four days as a participant in the AAMC Early Career Women Faculty Leadership Seminar. This seminar has provided me with the time, space, and tools to really consider what I want to achieve in surgery and academic medicine. I have started to let go of what is not success for me and stopped comparing myself to colleagues and mentor. Determination of success is ultimately a very personal measure.

I do know that my success requires that I understand and acknowledge what motivates and inspires me and what is core to my being. Central to my success is a commitment to my husband and children that they will always be my first priorities, a choice which is not negotiable. There is nothing in this world of greater importance and I will always be there when they need me.

I better understand those components of my work that motivate me to continue my career in academic medicine. I am motivated to cultivate and expand my mentorship network and will continue to pursue strategic relationships with those who can provide guidance along the way. And I am committed to support and educate those who will succeed me as my biggest accomplishments always evolve from meaningful relationships.

Finally, success requires that I have a strong sense of self and that I am true to that self. I will endorse my talents and opportunities and pursue those activities that fuel my passions. And I will continue to take the time I need for reflection, recovery, and growth on a regular basis.

You only live once, but if you do it right, once is enough.
-Mae West


Jaime D. Lewis MD is an Assistant Professor of Surgery and Assistant Medical Student Clerkship Director at the University of Cincinnati where she also completed her general surgery residency. After residency, she completed a fellowship in breast surgical oncology at the Moffitt Cancer Center. Her clinical interests include malignant breast diseases, oncofertility. Her research interests are ever developing. Outside of the hospital, she enjoys running, yoga, and time with her family.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

My First Delivery Was My Own: A Medical Student’s Journey into Motherhood

By Grace K DeHoff, MS III

I had my first child in November of my 2nd year of medical school. My husband and I tried to plan for a winter break baby but were surprised a little earlier. With plenty of open communication with my school, an unbelievable support system in my husband and my classmates, and more multitasking than I ever knew was possible, I had my child and was able to return to school full time after two weeks off. I was able to make up the missed work over Christmas break. The experience taught me a lot about why so few women decide to have children during medical school. Unfortunately, the alternative to waiting until after residency leaves many women delaying pregnancy to their their late 30s to 40s. Complication rates, infertility and genetic disorders all increase with increasing maternal age. This leaves female physicians with a difficult decision in terms of attempting to balance a career as a physician and the desire to have a family. This piece is meant to highlight this struggle and my own journey with my decision to have a baby in the thick of medical school.

Challenges women in medicine face with family life
My mentor, a male neurosurgeon, once told me I needed to have my children while in medical school. When I asked him why I needed to have kids in medical school he explained that as a woman I would face a challenge that none of my male colleagues would face, especially in the field of neurosurgery. I would most likely be in the minority as a female in the program. In addition, if I had a child during residency, when I left for the labor and recovery, my colleagues would be faced with picking up my workload and shifts, resulting in probable resentment from them. They would be working while I was home with my baby. They would be getting more hours in the OR, seeing more cases, honing their skills as surgeons, and adding to their resumes by further expanding their experiences. Meanwhile, I would be at home, knowing that I was falling behind in my program, which would drive me to return to work to get back on track sooner than when most new mothers usually return to work. He posited I’d then face continuous guilt over leaving my child and missing out on the joys of being a mother. The thought of motherhood in medical school still terrified me, how would I have the time?!

Though he drew a very simplified scenario with many assumptions, I took it to heart and did constantly wonder about how I would manage to have both a family and a career I loved. Even if I do not end up in neurosurgery, I knew any residency, particularly a surgical one would pose a significant challenge on creating a family. Regardless of the residency, there is only a finite amount of time any resident can take off in a calendar year before they are considered to have missed too much to graduate on time and are required to repeat a year or complete a research year. In the best scenario, it is quite possible for a woman to have a baby and get back to work in only a matter of days or weeks. From our experiences in medicine, unfortunately we know that best case scenarios don’t always happen. For those women who do not have the optimal pregnancies, deliveries and recoveries, they face the very real possibility of sacrificing their medical education and accepting that they have fallen behind and must take time off to graduate later than expected. This can have longer term consequences affecting finances, future job offers and marital stress.

Medical school policies for time off
Most medical schools have no official maternity leave policy in place, owing to the changing curriculum throughout medical schools. In the vast majority of US osteopathic and allopathic schools, the first two years are didactic years requiring lecture attendance and regular exams. It is challenging to have a child during this time because of the rigorous schedule and lack of time available to make up missed work. Some schools will allow a certain amount of time off–usually no more than 2 weeks before requiring an official Leave of Absence. Others require students to either take a full year off or to complete a research project during their postpartum period without an option for attempting to keep up with the required schoolwork. My school, Pacific Northwest University of Health Sciences, was more lenient in their policy. The time off that I took for my postpartum period was excused as an “illness” would be and the coursework was understood to be made up at the end of the academic year before I would be eligible to take my board exams.

The clinical years in the last half of medical school are out of the classroom and occur on the wards with variable schedules and hours. Again, each school is different in how they handle requests for time off during this period. Some schools have established electives appropriate for time needed both pre and post partum. Certain medical schools schools permit a breastfeeding elective to support a pregnancy. My school allows up to 6 weeks of a newborn elective (available to both mothers and fathers) as long as the student’s child is less than 1-year-old. In the absence of any of these options, many students will save vacation time, taken as a maternity leave; others will pack their schedules with light rotations, like research rotations to allow flexibility and less clinical responsibilities and to create more time during the newborn period. In general, there seems to be more flexibility for having a child in the last two years of school when compared to the first two.

Breast feeding time commitments
The American Academy of Pediatrics recommends all infants be breastfed exclusively for the first 6 months of life. For new mothers attempting to breastfeed, this introduces a major time challenge, especially upon returning to work in any field. On average, an infant eats every 2-3 hours around the clock or roughly eight times in a 24-hour period. The amount of time the baby spends actually at the breast varies greatly, but averages to about 20-30 minutes. In addition to the physical time it takes to nurse or pump, a mother in medical training must also factor in her study schedule around her nursing schedule.

I found myself pushing past natural study breaks in my study schedule to wait until I nursed, using the time to nurse as a study break. On long days on the medical school campus, I would take a headset intended for those hard of hearing to use during lecture so that I could continue to listen to the lecture while I pumped in a separate room. This allowed me to still hear the information, but it was impossible to take notes or do any active learning while I pumped since it’s actually a pretty hands-on task. I would often have to be very careful about my exam schedule and change my pumping times to ensure I would not have to leave an exam to pump because that would result in time lost from the exam. Additional factors such as the baggage needed to pump, logistics of storing cold milk and the stress of making sure I produced enough milk every day to send with my son to daycare the next day, were some of the biggest challenges of being a mom in medicine. I know plenty of women who chose not to nurse for long or even at all due to these difficulties. Even so, their time commitment was no less than mine, but without the obstacles to pumping during the day. I think any time saved from the decision to formula feed comes specifically from the pumping time commitment.

Male colleague responses
I was on my first rotation as a third year medical student when I found myself with a male resident who had four children, his last child was born within only a few months of beginning his first year of medical school. He went on to tell me that he “completely” understood how difficult it was to have a baby in medical school. When I hesitantly pointed out the difference between becoming a father in medical school versus a mother in medical school, he scoffed and said that he had taken his fair share of the midnight feedings, enough to understand the difficulties of being a new mother. His response hurt me more than I cared to admit and though I know his attitude is not representative of all fathers, the comment left me feeling resentful and intolerant of my male colleagues. In reflecting on this topic, it is difficult to tell any father that he doesn’t understand what it’s like to be a parent, and to a point, it’s impossible. Fathers are invaluable pieces of the family dynamic and I would never have been successful without my son’s father in our lives. Men often want to be valued for their contribution in parenting, which they justly deserve. Women want the same thing. We want support and recognition for the role that we play in carrying, birthing, and nursing a child. Mothers in medicine keep the same schedules as fathers in medicine, the same workload and the same standards, but the gestational and postpartum part of our parenting journey cannot be ignored or brushed off.

“Statistics” When women have a baby in medicine
In an unofficial Facebook survey taken in a private group of physician moms totaling over 61,000 members, over 2000* women responded to the question “when did you have your first child?”. Of those respondents, only 15% of them had their first child in medical school. 25% of women waited until residency and 25% waited until they were in an attending position. The remaining 35% had their child outside of these time frames. These statistics reflect that women chose to have children all throughout their medical education and career and no one time seems to be better than another. The challenge can significantly affect family planning and many female physicians and students feel that waiting sometimes up to 10+ years after beginning medical school to actually start a family is their best option.

Policy Change
As a whole, medical schools in the US do tend to support women who decide to start a family while in school. There are a variety of options available to help students complete their studies on time and most schools are willing to be flexible so long as there is open communication along the way. The women who choose to take on motherhood and medical school are often some of the most driven and hardest working students, but even so, a little help can go a long way. Schools can encourage and support mothers by providing lactation rooms, providing child support resources and being a child friendly campus. Many schools allow children to be on campus but do not allow them within the lecture halls during class time. Some schools allow the option of following along with lectures remotely, which can be invaluable with a newborn. There are even schools that provide childcare on campus for parents!

As a new mother who is not able to be a stay at home mom, childcare is probably the most important planning point in terms of successfully returning to school after having a baby. Planning early for daycares and inquiring about waitlists as well as the minimum age that the baby must be before they can start is an essential part of your family planning. In medical school the financial burdens often make hiring a nanny or in home child care too expensive but enroll family and friends to help out in the early stages. If you plan on nursing, make inquires early about nursing accommodations at your school. Be sure to see how far away nursing rooms are from classrooms to be factored into your pumping schedule. The combination of a newborn and medical school will definitely cut into dedicated study time so the most honest reflection you must make before embarking on this joint path is whether you are in good academic standing and not struggling to be in good standing. If you are a borderline student, having a baby can easily tip you below the passing line. At the end of the day, every second as both a student and a mother is worth it in my humble opinion.

*Statistics:
Total number of respondents: 2037
** This survey specifically asked only about when women had their first child to attempt to determine when women felt prepared enough to start a family.

 

 

 

 

 


Grace DeHoff is a third year osteopathic medical student at Pacific Northwest University and is interested in pursuing a career in Neurosurgery. She is a Denver, CO native but currently lives in Boise, ID with her husband and one-year-old son. She is the Diversity Chair with the National Medical Student Committee for the Association of Women Surgeons. In her free time, she enjoys running and has completed several half marathons and relay races.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

Barriers to Hispanic Healthcare

By Madeline Torres

Halfway through fourth year of medical school, my mother became acutely ill and was eventually diagnosed with a chronic condition. She was initially hesitant to seek medical care, attributing her symptoms to longer work hours leading to a delay in her diagnosis. Many times I wondered why she delayed seeking medical care, finally concluding that my mother had fallen victim to the common barriers many Hispanics face when accessing healthcare. These barriers include lack of health insurance, immigration status, language and cultural barriers to name a few.

Let’s talk about lack of health insurance. In 2015, the Census Bureau revealed that only 47% of Hispanics reported having private insurance. In 2014, the Pew Hispanic Center reported 25% of Hispanics lacked health insurance that is nearly double compared to the 14% reported by the general population. When we break this number down by immigration status, 60% of undocumented Hispanics reported having no health insurance while 28% of documented Hispanics reported no health insurance according to the 2007 Pew Hispanic Center Survey. The reasons for lack of health insurance among Hispanics are complex, in 2000 Monheit and Vistness1 found that 42% of non-elderly Hispanics had employer-provided insurance compared to the 71% of their non-elderly white counterparts. Similarly, 56% of Hispanic male workers were offered health insurance compared to 62% of their male counterparts. Hispanics are also more common to have jobs in small firms, seasonal jobs and part time all of which have less probability of offering health insurance. The Commonwealth Fund released the findings of focus groups that listed cost of insurance and concern over immigration status as primary reasons for not obtaining coverage.

Immigration status is also a barrier to seeking services and obtaining health insurance coverage. It limits access and discourages seeking services. Public health assistance programs for low-income families such as Medicaid and the State Children’s Health Insurance Program (SCHIP) are not available to undocumented families. Furthermore, those same programs are often times unavailable to newly naturalized families or may jeopardize their ability to apply for citizenship2.

Language also plays a major component in access to healthcare. I can remember watching countless times when my mother did not understand the question being asked and the provider struggle to understand her answer. Some Hispanic patients are not fluent in English or would be more comfortable discussing health issues in their primary language. Many fear discrimination because of their accent. The inability to communicate well with their doctor also prevents patients from understanding health care information.

Lastly, Cultural beliefs contribute to the how, when, and where Hispanic seek medical care. Growing up in El Salvador, I recall eating fresh Papaya for breakfast to prevent and even treat GI worms. Even after immigrating to the U.S. my mother would seek home remedies for common ailments such as using oregano for stomachaches and chamomile tea for menstrual cramps. Depression, anxiety and other mental health problems are rarely mentioned due to the associated taboo with mental illness.

By now, you may be wondering what you can do to help facilitate the care of your Hispanic or other minority patients. I encourage you to be cognizant of cost when dealing with this and any patient population. Many patients cannot afford testing and/or imaging. Ask yourself, “How will this test change my management?” In addition, look for ways to minimize prescription drug cost: prescribe generics-NPH insulin is cheaper than brand-name insulin, for example. If you suspect there may be a language barrier, ask your patient if they would like a translator, most hospitals have translator phone services available free of cost to the patient. Provide them with information in their preferred language and ensure they are able to read. Lastly, engage patients in their care. Ask if they would agree to take a prescription medication, don’t assume that prescribing ensures compliance and provide safe alternatives when possible.

1. Monheit AC, Vistnes JP. Race/ethnicity and health insurance status: 1987 and 1996. Medical Care Research and Review. 2000;57(Suppl 1):11–35.
2. Escarce JJ, Kapur K. Access to and Quality of Health Care. In: National Research Council (US) Panel on Hispanics in the United States; Tienda M, Mitchell F, editors. Hispanics and the Future of America. Washington (DC): National Academies Press (US); 2006. 10


Madeline B. Torres, M.D. is a general surgery resident at the Penn State Milton S. Hershey Medical Center in Hershey, PA. She  will start a research fellowship in surgical oncology the National Cancer Institute (NCI) this summer.

Dr. Torres was born and raised in El Salvador and immigrated to the United States with her mother and brother at the age of nine. She then went on to obtain her B.S. in chemistry from the University of Colorado at Denver and earned her MD from the University of Utah School of Medicine. She became involved with AWS during medical school after working with AWS members Amalia Cochran M.D. and Leigh Neumayer M.D. whom she considers mentors.

Her interests include surgical education, surgical oncology, work-life balance and encouraging women and minorities to pursue surgery and other careers in medicine.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

The Greenberg Spike: How speaking out on implicit bias and gender equity in surgery continues to trend

By Marissa A. Boeck

When #ILookLikeASurgeon went viral in August 2015, many expected a short lived hashtag. Yet Dr. Caprice Greenberg, the president of the Association for Academic Surgery (AAS), has shown the conversation on diversity, inclusion, and equity in surgery is far from over. During the recent AAS and Society of University Surgeons (SUS) 12th annual conference in Las Vegas, Nevada around 2,000 medical students, residents, fellows, and attendings gathered to network, mentor, collaborate, and discuss academic surgery. Despite the abundance of stiff competition, the AAS Presidential Address “Sticky Floors and Glass Ceilings” by Dr. Greenberg stole the show.

All those packed into the large event hall immediately knew the focus: women in surgery. This subject continues to be pertinent and necessary to discuss despite many notable advances, such as both the current and incoming presidents of the AAS and SUS being female. Yet Dr. Greenberg steered the conversation away from traditional topics of “women in surgery” as she asked us to rethink what issues actual female surgeons face. She argued the challenges do not boil down to only those associated with parenting. This is especially true since 40.5% of female surgeons do not have children, while 91.8% of male surgeons do, which is why we need to talk about parental challenges and leave versus simply maternity. She then spoke about widespread biases and discriminations against women seen throughout society that also resonate in medicine and surgery, using the Audi #DriveProgess 2017 Super Bowl ad, Huffington Post Pinksourcing video, and The Daily Show’s American Soccer’s Gender Wage Gap video as poignant examples. She showed data from a study of academic science faculty exemplifying hiring gender biases for lab managers based solely on applicant names.

Dr. Greenberg then honed in on specific items most relevant to surgeons: differences in salaries, promotions, and grant funding. The fact that in 2017, based solely on gender, with all other factors held equal or superior in females, women still earn less, fill fewer leadership roles, and have lower grant funding than men is unacceptable.

The impact of Dr. Greenberg’s talk was palpable. From individual goosebumps and frequent murmurs, to occasional outbursts of disbelief and, finally, tears. No one in the room appeared unaffected, women and men alike. An objective measure could be visualized on social media, where metrics for the conference hashtag showed a large spike of almost 750 tweets during the 45-minute talk, greatly overshadowing the other subjects of the day (Figure 1). The diversity-championing hashtag #ILookLikeASurgeon showed a similar increase during the same period (Figure 2), disseminating Dr. Greenberg’s important message to a global community that has likely faced similar challenges in their careers.

Figure 1.


Source: Symplur

Figure 2.

Source: Symplur

Besides firing everyone up for action, the most important part of Dr. Greenberg’s talk was the discussion of potential solutions. The global social media community agreed, as this appeared to be the most shared slide from a quick glance of the Twitter feed. Her suggested systemic interventions for surgery included:

  • Transparent, objective compensation plans
  • Blinded manuscript, grant, hiring, and promotion practices
  • Explicit, purposeful, and fair distribution of uncompensated teaching and service workload
  • Equal leave policies and tenure clock extensions
  • Objective measures of success and milestones for promotion that are defined a priori so everyone knows the rules
  • Institute educational programs on implicit bias and its impact

Only through the wide adoption of targeted actions that aim to recognize and address surgical workforce inequities, such as those listed above, can we actually hope to erase them. This includes organizations speaking up, such as the Association of Women Surgeons’ Statement on Gender Equality. Although frequently labeled as women in surgery problems, these issues cast a wider net, encompassing all those affected by implicit bias; in other words, potentially anyone. Yet together we can make surgery a field that accepts and promotes anybody who has the passion, stamina, and drive to succeed within a challenging but rewarding profession, irrespective of personal characteristics that have no bearing on one’s potential or worth.

Photo credit: Dr. Danielle Sutzko @LoupesLoveMD

Dr. Greenberg’s final slide starkly projected #ILookLikeASurgeon and #HeForShe in large white font on a black background, inviting the audience to continue the conversation, both on social media and in real life, until we all receive equal compensation and consideration for opportunities for professional and personal success.

From left: Nelly-Ange Kontchou, Heather Logghe, Caprice Greenberg, Marissa Boeck. Photo credit: Dr. Susan Pitt

Resources:
2017 AAS Presidential Address By Dr. Caprice Greenberg, Introduction by Dr. Rebecca Sippel
Ladies Get Paid (@ladiesgetpaid) – Helping women advocate for themselves to get recognized and rewarded
He For She (@HeforShe) – United Nations Women’s mission for gender equality
Why So Slow? The Advancement of Women by Virginia Valian
Carnes, Devine, Baier Manwell, Byars-Winston, et al. “The Effect of an Intervention to Break the Gender Bias Habit for Faculty at One Institution: A Cluster Randomized, Controlled Trial.” Academic Medicine 2015; 90(2): 221-230. Link


Marissa A. Boeck MD, MPH is a general surgery resident at New York Presbyterian Hospital – Columbia. She is passionate about diversity in the surgical workforce, the power of social media in medicine, and global public health, especially as it relates to injury prevention, emergency response, and trauma and surgical system strengthening in low-resource settings.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

How do you take care of YOU?

By Patricia Martinez Quinones, MD

As over-achieving female physicians we strive for perfection in all aspects of our lives. We are not satisfied with being mothers, wives, daughters, (insert noun here). We aim to be good mothers, good wives, good daughters, etc. Besides the pressure we place on ourselves we also took an oath to take care adequately for the sick, but how can we take care of our patients if we don’t know how to take care of ourselves?

With the demands of general surgery residency, a husband and household, I did not consider my well-being a priority. I slowly found my physical, emotional and mental health starting to deteriorate. I grew up in Puerto Rico, where cardiovascular disease and diabetes are two of the three most common causes of death. All of my grandparents have had complications of heart disease, diabetes and obesity. In an attempt to prevent these complications in myself I changed my lifestyle.

I embarked on a health and well-being journey. I am sharing with you some of what I have learned and done along the way. My first step on this journey was a diet overhaul. I was eating cafeteria food, or fast food at least three to four days a week. I made a commitment to myself that I would only buy lunch once a week. I tried meal subscription delivery services (for more information refer to Dr. Miner’s recent blog post) and learned new recipes that I have now incorporated. Eventually I settled on meal prepping as my go-to. I pick one day a week (my off-day usually) and prepare several vegetables, grains and at least two different protein sources. This change led to improved eating habits, extra free time on weeknights and one less thing to worry about.

Not only did my diet undergo a much-needed overhaul, but so did my non-existent self-care routine. Fearing burnout, as I have seen in some of my colleagues I tried to find ways to cope with stress. I settled on the idea of a “self-care week.” For an entire week, I did one thing a day that would allow me to relax and improve my overall sense of self. The week kicked off with a trip to the salon for a pedicure. During the week I also started reading a fiction novel, had a massage and even a dreaded visit to the dentist, who I must admit I hadn’t been to since starting residency. My “self-care week” felt like a vacation, although I invested about an hour a day. I realized how little emphasis I was placing on me-time and how a few minutes a day could lead to an improved version of me.

My journey of self-care continues. I’ve learned to prioritize my health, along with that of my patients. This has translated into improved relationships with my family and co-workers. Taking an entire “self-care week” often is not plausible for most, but I do hope that my experience inspires you to do something you enjoy and learn to take care of you.


Patricia Martinez Quinones is a general surgery resident at the Medical College of Georgia at Augusta University. She is a wife and doggy-mom who is on a well-being inspired journey to learn self-care. She is interested in trauma and critical care and academic medicine. She hopes to inspire other female residents and medical students to learn how to take care of themselves as well as their patients – and themselves.

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

Dressing Your Best, Inside Out

By: Natalie Tully

Every year after the post-midnight New Year’s celebrations wind down, we each start the all-too familiar process of declaring resolutions for the coming twelve months. In that spirit, I hope to explore ideas (most old, but perhaps a few you haven’t heard) and encourage some of you to put on your best self in 2017- mind, body, and wardrobe.
Dressing your best-literally
Fair warning: most of my clothing is sportswear and I prefer the DMV and the Dentist to going clothes shopping. That said, this is something I struggle with but have found strategies that result in me feeling more confident in professional situations without excessive strain.

  1. Err on the Conservative-Yes, you’ve heard this ad nauseum, but no matter your career stage or if it’s an interview, clinic, or social event, you never want your clothing to distract from you. If you question your outfit’s appropriateness, either change or double check with someone else. You don’t have to wear a Muumuu, but do focus on well-fitting clothes that present a great you.
  2. Comfort adds to Confidence- Feeling comfortable in your clothes can help you feel comfortable in your own skin and contribute to your overall confidence. Finding clothes that fit you and your style comfortably can help you to feel at ease. If you’re not the type to define ‘your style’ (I call mine Gym Clothes Chic), finding a few pieces that you love can be a great way to dip your toes in the water.
  3. Form, but Function- Whether it’s shoes, a skirt, or any other piece of clothing, you should like the way it looks, and looks on you. One caveat to that, however, is that it’s important to balance that form with functionality- probably most notably with shoes.

These are some themes that help me to feel professional and confident without sacrificing my femininity. If you’re looking for more specific fashion advice, particularly for interview apparel there is a great blog post at Love and The Sky covering this topic.
Putting your best foot forward
Putting on your best self goes much deeper than your clothing-and one important facet of dressing your best is taking care of the body wearing the clothes. The demanding schedule of this field can make it challenging and sometimes impossible to maintain a diet and exercise routine-but giving your body a leg up where possible can have wide-ranging benefits.

  1. Small Steps to Bigger Change-Whether it’s taking the stairs in the hospital, adding an extra block to your evening walk, or playing tag with your kids or pets-exercise does not have to take place in the gym or on the running trail. What is most important is not the duration, intensity or frequency of your exercise-but simply doing it.
  2. Fuel your Success-3am graham cracker and peanut butter sandwiches washed down with coffee or juice are a reality of this field. Eating better can range from meal prepping on a day off, having one whole-food-only day a week, or even just replacing one candy bar with an apple-little changes add up. Find the modifications that fit in with your life and needs, and you will likely find them more palatable to maintain.
  3. The Pizza and Couch Cleanse-This is the part where you forget those two previous points briefly. When your body needs a break, listen. Everyone gets sick, has sleepless nights, or can even be injured- give your body a chance to heal before making it worse. Additionally, enjoy the foods you love, and when you honestly don’t have the energy to cook, don’t-forcing healthy food and cooking on yourself will make you hate them.

Our bodies are the machines that we use to make our work and lives happen, so it only makes sense to keep them in the best working order possible. This is a time of year when many people are looking to change their bodies, but shooting for improved wellness over a dress size or scale number is a far more important goal.
Your most important look is your outlook
The start of the year is always a little bittersweet for me-it represents the return to work/school and the stress that it and the tasks ahead in the year bring. Battling stress and negativity is a constant challenge-one I struggle with mightily-but the way you see into the mirror is the foundation of how others see everything on the outside.

  1. Breathe, just breathe- Taking even a few seconds at the beginning of the day, during stressful moments, or in the car at home can be profoundly beneficial in dealing with acutely stressful situations as well as dampening general stress. Building this habit into your daily routine is a great change by itself or as part of building a meditation practice.
  2. Check your boxes, fill your buckets-All of us have seemingly endless to-do lists-it’s so important not to feel enslaved or entrapped by them. Give yourself credit for accomplishing each task, and use it to build toward successive tasks in your day (H/T to this speech). Use this momentum to get through your day, but keep track of your mental ‘buckets’ so that you can find ways to replenish your stores.
  3. Small bricks build big buildings-It’s so easy to let little failures chip away at our confidence and spirit, forcing us to put on a defensive front simply to survive. Allow yourself infinitesimally small victories, and use them to reassure yourself in times of doubt and to build a stronger foundation for your own sense of well-being.

A very wise person once told me never to give rent-free space in your head to anyone or anything. Working toward a more positive outlook and sense of self are critical steps to creating a stable framework on which to build a healthy body and perch clothes that add to your positive image and confidence, and contribute to putting on your best, most well self for this new year.

headshotNatalie is a 2nd year MD/MPH student at Texas Tech University Health Sciences Center in Lubbock, TX. Before starting medical school, she received her bachelors of science degree at the University of Texas at Austin followed by two years working in basic science research at Baylor College of Medicine. Natalie hopes to pursue a career in surgery, and has particular interest in applying her dual degree in Pediatric or Trauma Surgery. In her free time, she enjoys running, cooking, and playing with her dog, Sadie.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

An Open Letter to Young Women Considering a Career in Surgery

This post originally appeared in Hot Heels, Cool Kicks, & a Scalpel

 

Dear Young Woman Considering a Career in Surgery,

It was lovely to meet you the other day. Many times a month, a young woman just like you comes to me with similar interests and concerns. “I really love surgery,” she says, ” But I am afraid of the lifestyle and I really want to have a family.”

Oh, and thank you for also inviting me to speak at your seminar the other day on Women in Traditionally Male Dominated Fields. I have been speaking at similar panel sessions since 2005 when I was a bit of a novelty at my training program as a clinical PGY-4 with an infant daughter. Your collective curiosity on what my life must be like is of great interest to me because to me it’s just my life. It’s the only reality that I know because, like you, I was young (just a few days into my 25th year, just 5 days into my first ever surgical rotation) when it occurred to me that I really loved surgery. It was unexpected; but every day since then (from the remainder of that MS3 rotation, to my sub-internships, to my years in residency, to research and clinical fellowships, and to these past 6 years on staff) I have crafted a reality, as tenuous as it is, that works for me and my family in any given moment in time.

And I am here to tell you that you can do the same too if you, in your heart of hearts, can think of nothing more exciting than surgery as your professional passion.

People outside of surgery will tell you that it’s a career that is too hard to integrate with family life. They are correct that it is generally harder than other fields in medicine; but, ask yourself if you truly want a career in general pediatrics, or dermatology, or invasive cardiology or anything in between. If the answer for whatever alternate field(s) you are considering is no, then no matter how many fewer hours your profession requires, no matter how much more flexible those hours may be, your family will be left with a present, well-rested, yet bitter wife and mother.

[NB: I use the word integrate very purposefully here. Anyone from a demanding profession, surgery or otherwise, who tells you that work-life balance is possible is conning you. Your life will never be in balance. Something will always have to give: your work, your family, or yourself. It’s in how you integrate these things in a shifting, fluid professional and personal lifetime that you will craft your own reality.]

The same can be said of those who encourage you to enter surgery training but then offer that you may consider a career in breast surgery or start an exclusive vein clinic or choose some other presumably less time sensitive and/or less time consuming surgical practice to balance your professional work with your desire to have a family. Again, ask yourself  if you can truly be happy in such a practice. (I personally would be bored with only a few kinds of procedures in my armamentarium and the absence of physiologic chaos; but everyone is different.) You may not know the answer until you are well into your training; but, choosing a medical specialty in the first place, or a surgical subspecialty in the second, simply because you presume it will be easier for family life is fraught with potential for professional dissatisfaction. I promise you that professional dissatisfaction will always stand in the way of overall family life satisfaction. Always. Forever.

Finally, as hard as it might be to envision yourself as a surgeon who wants hobbies, and a spouse, and a smoking hot body, and children of your own someday,  remind yourself that divorced parents, widowed parents, disabled parents, parents with deployed military spouses, and parents with far fewer socio-economic resources than practicing surgeons, and trainees for that matter, somehow get it done. Every life has it’s particular challenges when it comes to parenting but surely being a surgeon is not the most insurmountable of them all.

So think long and hard about alternatives to surgery; but choose one only if it speaks to your professional soul. No matter what career you choose, you will likely spend more time at work than on any other aspect of your life be it parenting, self-care, love-making, you name it. Therefore, it is critically important that your choice of career light the fire in your belly to show up every day leaving behind, at least temporarily, everything else including your children. Because one thing is for sure: when you are practicing surgery, your head needs to be in the game. You cannot be distracted by guilt about not being with  your family or about delegating some of the more mundane aspects of childrearing or homemaking to others. You must love the work enough to drop the guilt and create practical solutions to raise your children and provide them with a safe and loving space in which to grow while reimagining whatever stereotypes you hold about being the perfect parent.

Because you know what: There is no such thing as a perfect parent, surgeon or otherwise. So there will never be any point in beating yourself up about it. Know that you will love your children more than you could have ever imagined loving anything, including surgery, but that you will still be a great surgeon. The two are not incompatible, but it takes some effort and creativity.

So, now that I have convinced you to choose the career of your dreams here are some thoughts on the effort and creativity it will require.

Do not underestimate the importance of choosing a life partner who gets the soul inspiring nature of your career choice. He/She may be another surgeon, or physician in another specialty, or a non-medical professional, or a skilled laborer; it doesn’t matter as long as your life partner understands that, when you are tired from the long days and nights, or sorrowful for the lost lives, or otherwise distracted, it is not because you love work more than you love them. Bottom line: as awesome as any career may be there is something messed up about your priorities if you really would choose work over loved ones. So your life partner needs to get that you aren’t messed up; you just have a demanding career.

With the demands of that career comes the need for a real partnership in planning life. That doesn’t mean a 50:50 split or a 80:20 split or anything conscribed; it means a constant openness to splitting however it needs to be split or not splitting at all to ensure that life outside of work happens. It means making the most of precious few waking moments together through physical contact and communication. It means having a very user friendly calendar/shared to-do system. It means providing feedback without judgment for the practical things in life and making space for shared emotional and spiritual needs. If you find yourself paired up with someone who can’t work with you on life this way, then consider dumping him/her. Seriously, it’s not worth trying to make them happy if they just don’t get this hugely important part of what makes you whole.

[NB: If a life partner is not your thing or things just don’t work out, that’s okay. The same principles of reimagining, outsourcing, and dropping the guilt apply. It’s just that your village, or metropolis as may be the case for some surgeons, has a different population structure.]

Choose your job based on both professional and personal needs. Training is finite and there is always an end from which to take on a new direction. However, even though many surgeons change jobs, think of your job as your forever job so you don’t accept a situation which will turn out to be toxic for you. Choose partners who will have your back, and you, in turn need to be willing to have theirs. Choose geography that at least satisfies some of your desires for commute time, distance from extended family, lifestyle, weather, etc. and makes life easier. You can’t blame surgery if your long commute destroys your soul, or if having your parents thousands of miles away makes you sad, or if humidity, piles of snow, or whatever your most dreaded weather phenomenon is drives you crazy, or if it takes a flight to get to your favorite past time of hiking, biking, skiing, etc. That’s on you and the choices you have made as a surgeon and not on the profession itself. Finally, choose a practice type and setting that will make you excited to show up every day (for me it was research, teaching, and a level 1 trauma center in a university based system).

If you do have a life partner and working is important to him/her, don’t pick a location that will railroad his/her career. As much as being a surgeon defines you, your soul mate is similarly defined. Please don’t create a situation where he/she will be susceptible to resentment about having his/her professional goals squashed. (I’ve been there. It puts a real strain on a marriage. It sucks.) It’s already hard enough to be paired up with you, a surgeon. Both your jobs may be equally demanding, or one may be more demanding; it doesn’t matter as long as together you negotiate a mutually satisfying life-long give and take about who prioritizes what and when depending on the stages of your respective careers and the ever evolving needs of your family.

When is comes to family, do not waste too much mental effort over-thinking when you should start it. Fertility, along with finding the right person with whom to test your fertility, is a complex and unpredictable thing. No pregnancy is guaranteed to proceed smoothly. Given these inherent limitations and unknowns, along with the demands of a surgical career, there is no perfect time to start a family. This is about as certain as death and taxes. I will spare you the perceived pros and cons to having children during training compared to while in practice. Just know that every time period poses challenges and every passing year makes infertility more likely; so if you are ready in your personal life to try to get pregnant go for it; because, if you choose to wait for a perfect time, you will be waiting for a very, very long time.

And, if having children in a traditional sense is not possible for whatever reason, there is also no perfect time for assisted reproduction, adoption, or surrogacy either even though the salary increase a staff surgeon or faculty job may be necessary for these options. In the end, whatever approach to becoming a parent will be required,  you will figure out a way to get through the challenges because you will have mentally and emotionally committed yourself to the idea of being a mother who also happens to be a surgeon.

[NB: If you choose to not have children-by this I really mean choose as there are myriad other mishaps of life and physiology that prevent women who want to be mothers from becoming mothers-, please do not make that choice simply because you want to succeed as a surgeon. You will never forgive yourself. Not ever.]

When it comes to family there are various options to manage childrearing and homemaking. A nanny, two nannies, an au pair, daycare, a nearby grandparent, a neighbor who is a stay-at-home parent, or various combinations of these may be required to keep your children loved and safe. It’s different for every family and I promise you that you will find what works for  you. It will be a source of stress but it is doable. And, no matter how much time others spend rearing your children on your behalf, those kids somehow know that your are their mother, that you love them in a way beyond any other love, that you would give your own life if it would save them, and that you also happen to be a busy surgeon. Trust me. They will. And, they will be really proud of the uniqueness of their surgeon mom. They really will.

When it comes to your home, be it your 600 sqft rental in residency or your 2500 sqft grown up home in a cul de sac, outsource any jobs you and/or your partner simply do not enjoy. I cannot emphasize this enough. You will, in fact, have precious little time with your family. Ask yourself how you want to spend that time. Do you want to being cleaning and doing laundry? Or do you want to plan a family outing? If hopping on your John Deere and showing your lawn whose boss on your Saturday off is a fun activity for you, then by all means go for it, otherwise someone else will be happy to mow your lawn for a fee. If you love cooking, knock yourself out planning, shopping for, and preparing gourmet meals along with the associated clean up, but if you don’t then find a meal service. You get the point. If you don’t love it and it can be done by someone else outsource it. Even on a trainee’s budget you should strive to rid yourself of any household obligations you abhor. (For me the $55 spent every other week during residency for cleaning was well worth never having to spend a day off cleaning a toilet and now the extra hours we pay our nanny to do all of our laundry has spared me a monthly power weekend of washing and folding 10 loads of laundry because we just could not get to it all with the many kids’ activities, call nights, etc. that prevent daily washing.)

Remember: as little time as you will have at home to spend with family, you must also prioritize time for yourself. Don’t expect it to just happen. Just as you schedule elective OR cases, you must schedule elective you time. It may not happen very often but if you don’t take the time for self care in the midst of the stresses of the job and the stresses of parenting you will be cranky and miserable to be around. How you spend time away from family when you have so little time with them will change over time and you may even develop hobbies incorporating your family (we have taken to family bike rides and kayaking trips as the kids have gotten older to combine wellness with family time) but remember to schedule things that feel completely selfish to you. A girls’ night, date night, a pedicure, reading a trashy novel, going to a Zumba class during bath/bedtime, or whatever you enjoy is totally not selfish but you will feel that way; so a good barometer for whether or not you are making time for self care is how selfish it feels. My advice is feel selfish at least once a month.

[NB: If your selfish thing is not a fitness thing then you have to also figure out how to fit that in because your patients and your family need you to be healthy.]

Being a surgeon is not incompatible with being a good wife, mother, athlete, whatever else; it’s just trickier. But, if young women keep being scared away from surgical careers then these same fears will linger generation after generation; we will never achieve a critical mass of women surgeons in the profession who can set good examples for one another and for future surgeons. With the same focus we apply in the OR and the same organization we bring to rounds and the same compassion we bring to patient encounters,we can create a life strategy that overcomes these perceived barriers for both a happy family life and a successful surgical career. The barriers will change depending on the stage of the career you love so much and the needs, wants, and development of what and who you love outside of work; but, take it from this surgeon mom: they are barriers to be overcome, not shied away from.

I am pretty sure that’s why you showed up at my door and asked me to that seminar, to make what seems impossible to you at the moment seem possible. Let me tell you: if I can do it, you can too. Go forth, be a surgeon, be a wife, be a mom, be good to yourself and craft a reality that works for you. Then, pay it forward so that someday these meetings and seminars might be rendered obsolete.

Sincerely,

@surgeoninheels

Not just a token surgeon-mom-wife-runner

PS. Here is some inspiration. Your potential in surgery is limitless. https://www.womensurgeons.org/in-practice/leaders-in-surgery/

PPS. The Association of Women Surgeons is an invaluable professional organization whose goal is to: ENGAGE current and future women surgeons to realize their professional and personal goals. EMPOWER women to succeed. EXCEL in those aspirations through mentorship, education and a networking community that promotes their contributions and achievements as students, surgeons and leaders. https://www.womensurgeons.org/

PPPS. I have been fortunate for the last 10+ years to be a part of the American College of Surgeons Women in Surgery Committee working towards improved gender parity, opportunities for professional development, and better work life integration in our careers.https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee

dg-strappysAbout @surgeoninheels: I am an acute care surgeon specializing in trauma, emergency general surgery, and surgical critical care. I am married to an incredibly supportive husband who is the primary childcare provider, homemaker, and diy’er in our home. I began running with him two years ago and we plan to run many half marathons together. While navigating the abyss between work and our two children and small dog, I also do as much Zumba, Stott Pilates reformer, and shopping as I can.


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.

 

Guilt

By JS

I recently completed a 1-year hospital based fellowship that is designed to provide faculty and staff with the expertise and skills needed to advance academic careers in medical education.  While I originally applied for the fellowship in order to improve my teaching style, I was particularly drawn in by the wellness sessions. I learned about the high prevalence of physician burnout, which is 30-40% amongst American surgeons1 and the many signs to help recognize it in myself and in others.  I also became more aware of the resources  available to help someone who is dealing with burnout.

As the only surgeon in the group, it quickly became obvious to me that many of the solutions to preventing burnout required time and rearranging one’s schedule, for example, to go to a yoga class or meet with a peer support person. Of course, the irony was not lost on the other participants that actually trying to make time to fit in more activities is part of the challenge to using these resources.  One of my co-fellows pointed out how physicians often “can’t make time” for wellness until they are seriously ill.  It is only when a physician has a significant change in their life, like cancer, or a heart attack, that they are able to free up time for daily radiation therapy or cardiac rehab. These stories have always bothered me, they suggest that work-life balance is as simple as getting one’s priorities straight and “making time” for friends, family, and self.

Most of us want to give our patients everything we have because we care about them.  It’s not as simple as choosing between “work” and “life.”  The line is blurred when “work” includes helping people that you have gotten to know well and care about and who have entrusted you with their health/lives.

What limits the time I have for my family and favorite activities is not that I am a workaholic or afraid that a colleague would see me leave for lunch. It is a little voice in my head that, despite it being well after “normal” work hours and knowing my patients are in stable condition with an in-house resident watching over them, still thinks “Why do I get to be out in my garden at 7, enjoying a late summer sunset while those patients are still sitting in the hospital, waiting?” Yes, that’s right, I feel guilty about it.  For me, and I imagine others out there, ever since finishing my surgical training I have had a big component of guilt associated with my free time because there is a human on the other end, not feeling well.  In fact, instead of trying to find more time for wellness I often wonder if I could have spent just a few more minutes with one of my patients or a few extra moments reading the latest journal article.  So where does appropriate responsibility and work ethic cross the line into self-destructing guilt?

 Shortly after my fellowship session where we had discussed wellness, I had one of those life events when I really did need to cancel everything. My grandmother passed away unexpectedly and my mother needed support.  I canceled a very full all day clinic to go to the funeral and stay overnight at my mom’s house the night before.  One of my partners generously picked up a call that night at the last minute.  And I didn’t feel guilty, not even for a second.  I thought back to that fellowship session and again thought about what my non-surgeon colleagues had pointed out during that session and realized that they were right. In some ways, my grandmother’s death was what it took for me to be out of work and not feel guilty about it.   So instead of trying to find ways to “make time” for those priorities I am trying to find a way to be guilt-free while using that time.

Reference

1. Shanafelt, T. Ann Surg Oncol (2008) 15: 400. doi:10.1245/s10434-007-9725-9

JS

 

J.S. is a general surgeon from Boston, MA.

 

 


Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author, and are not necessarily the opinion of the Association of Women Surgeons.