AWS BLOG

For When the Pipe Bursts

By Shree Agrawal

Approximately half of matriculated medical students identify as female with numbers in surgical training steadily increasing to potentially also account for half of postgraduate trainees. Unfortunately, these figures are still dismal for underrepresented minorities, who at the medical school level may, at best, represent one in twelve students. I can only hope this changes for my underrepresented peers in my lifetime as we continue to redefine the culture of medicine.

Within AWS and in medical training, the metaphor of “building a pipeline” represents creating greater access and entry to medicine among women and underrepresented minorities. In this context, I often wonder about the students and trainees who currently have the courage to enter fields in which the majority is homogenous. Advances in gender equality and diversity representation within other fields of medicine, such as pediatrics, OB/GYN, psychiatry, and geriatrics, has not yet translated to inclusion in leadership and academic positions. I believe mentorship is key to addressing this paucity of diverse role models.

This brings me to some of the great posts I have recently seen on Twitter about mentorship within academic surgery. My feed has been populated with retweeted clips, links, or visual abstracts from Dr. Caprice Greenberg’s address, “Sticky Floors and Glass Ceilings”, Dr. Keith Lillemoe’s address, “Surgical Mentorship: A Great Tradition, But Can We Do Better for the Next Generation?”, and “Characteristics of Effective Mentorship for Academic Surgeons: A Grounded Theory Model,” by Drs. Amalia Cochran, William B. Elder, and Leigh A. Neumayer. In 2017, I view these pieces to be the first sign of preparation for when the pipeline to surgery eventually bursts.

As more diverse medical students develop interest in surgery, dynamic and supportive mentorship becomes even more essential. From Drs. Cochran, Elder, and Neumayer’s work, four major themes for effective mentorship emerged: the need for multiple mentors at different points in a professional lifetime, mentors who provide strategic advising, who are unselfish in their attitude, and engage with diverse mentees. In addition to these basic principles, self-awareness of implicit bias and efforts to reduce its effect, as stated in Dr. Greenberg’s talk, is paramount in effective mentoring, especially of non-traditional mentees.

In medical school, this may translate to finding a mentor who is willing to meet often and create plans for successfully matching or perhaps engaging in academic research. An unselfish attitude may be a sincere interest in helping achieve one’s potential, regardless of institutional interests or personal/professional gains for the mentor. Finding mentors who engage with diverse mentees does not mean identifying faculty members who represent similar backgrounds, but finding someone who understands distinct challenges faced by students from wide-ranging backgrounds. A single mentor may not be able to espouse all of these characteristics, but finding individuals who can contribute in each area facilitates personal and professional development.

What are your strategies for identifying and establishing effective mentee-mentor relationships in your medical training?


Shree is a fourth year medical student at Case Western Reserve University, where she also completed her bachelors of science degree in biology. Currently, she is completing a clinical research fellowship in genitourinary reconstruction at the Glickman Urological and Kidney Institute at Cleveland Clinic and serving as the Chair of the AWS National Medical Student Committee. Shree is passionate about research surrounding patient decision-making and medical education. In her free time, she enjoys blogging for AWS, practicing yoga, and boxing.

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.

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.

Knocking on the Door of Disparity

By Danielle Henry, MD

Before the end of National Minority Health Month, I am compelled to take the opportunity to talk about how a disease I’m passionate about affects black women – breast cancer. National Minority Health Month gives us another chance, outside of October, to focus on breast cancer’s impact on the black community.

After being introduced to the Sisters Network by one of my patients, I gained a greater understanding of breast cancer’s impact on the black community. During one of the events I attended, “Stop the Silence”, there were women who traveled from near and far who were currently battling breast cancer, survivors of breast cancer, loved ones of those who previously passed away from breast cancer and simply supporters coming together to raise awareness. Many admitted that cancer was a taboo topic growing up, and went on to share personal stories of struggles, triumphs, and loss due to breast cancer. As a part of the event, we also walked door to door asking to speak with the women of the household to share breast cancer facts and invite them back to the event site for free mammograms. This part of the event stood out the most, as it took an active role of going into the community instead of passively waiting for them to present to the clinic.

Below is a list of statistics shared during the walk, in addition to a few others, which resonated with me on the topic of breast cancer:

  1. Among black women, breast cancer is the most commonly diagnosed cancer and the second most common cause of cancer deaths.
  2. Although the incidence of breast cancer is lower in black women, they have a 42% higher mortality than white women.
  3. Only 52% of breast cancers are diagnosed at a local stage in minority women.
  4. Twenty-two percent of breast cancers among black women are triple negative (loss of receptors for estrogen, progesterone, her-2-neu), which behave more aggressively, have a poorer prognosis and lack targeted therapy.

I am motivated both by my experience with this grassroots event, as well as the overwhelming data that shows disparity in black women, to address and shed light on this disparity. With National Minority Health Month and this blog offering a prime opportunity to bring awareness, the rest of the months can be spent “Bridging Health Equity Across Communities”. Through the Office of Minority Health, you can find many resources for working with minority populations related to education, prevention and treatment strategies.

Resources:
www.cancer.org
https://minorityhealth.hhs.gov

#NMHM17


Danielle Henry is a chief resident at Orlando Health General Surgery Residency Program and currently serves as the administrative chief resident. She is planning to pursue her passion with a career in breast oncology after residency. She completed her medical degree at Florida State University and undergraduate degree in Applied Physiology and Kinesiology at the University of Florida. She enjoys playing soccer, a good game of scrabble and time at the beach. She also enjoys community service projects and mentoring medical students.

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.

Grey’s Anatomy: 5 Reasons to Aspire to be Like Seattle Grace Hospital

By Sristi Sharma MD, MPH

I confess–there are days when I like to unwind and binge watch Grey’s Anatomy. I revel at the personal drama, root for certain characters (Jackson!), cringe at medical atrocities and then spend (my precious) hours on the internet looking up this mythical hospital, that I can assure you, does not exist in the United States.

All real-life medical doctors, especially surgeons, have several issues with Grey’s Anatomy: the medical science in the program is all wrong, interns in the show have an impossible life, the attendings have a severe I-need-to-do-it-all complex-and don’t even get me started on the hair! However, what Grey’s Anatomy does get right is the alternate reality of gender roles in the field of surgery. Here are 5 things that Seattle Grace Hospital Department of Surgery can teach the real-life surgical community:

  1. The number of female surgery residents: As per AAMC 2016 residents report there are a whopping 163.4% more male surgery residents than female ones. This reflects the general surgery residency application figures which during the ERAS 2016 cycle had around 4870 males vs 2600 females. That is 187.3% more male applicants to these programs. The female heavy residency program at Seattle Grace Hospital does not reflect residency programs in the US. All programs in the country should make a better effort to recruit qualified women surgical residents.
  2. Miranda Bailey as the Chief of Surgery is an outlier. There are 271 general surgery residency programs in the United States. Of these only 16 programs are headed by women. That number was 1 in 2014. So although it looks like we are headed the right way, a lot still needs to be done. The ACS recently hosted a webinar on Principles of Leadership for the Young Surgeon. The fact that it was presented by an advocate for gender equity in general surgery was a great step in the right direction.
  3. In Seattle Grace Hospital the chiefs of cardiothoracic surgery, neurosurgery, orthopedic surgery AND pediatric surgery are all women. Time and again, the show reiterates the high degree of technical skill these women have in their respective fields. So clearly, Seattle Grace Hospital is promoting people based on their qualifications and not on their gender. In the real world however, there exists a glass ceiling that is quite difficult to break, particularly in fields like surgery.There are many reasons why there is a scarcity of women in surgical leadership roles, however inherent systemic biases are some of the most unaddressed reasons that hold women surgeons back. We need to address these biases one at a time and do away with the barriers that prevent women surgeons from achieving their fullest potential.
  4. This year during the International Day of Women and Girls in Science, the UN deplored the bias and stereotyping against women in science and went on to make a bold statement “The world needs science and science needs women”. Melinda Gates has made it a personal mission to increase the number of women in science. Now here is a list of research studies that the women surgeons of Seattle Grace Hospital do: Cristina Yang’s Conduit Trial, Meredith Grey’s Alzheimer’s drug trial, Miranda Bailey’s diabetes research, and Callie Torres’ limb simulation trial, to name a few. Clearly, this hospital has great policies that support research activities among these surgeons. This in turn makes them great academic surgeons, which in turn explains their promotion as department heads. It is a cycle that keeps on going and growing.
  5. Mentoring opportunities: The mentoring relationships portrayed in Grey’s Anatomy is what we all hope to have and give at some points in our careers. The deep bonds (although sometimes over-the-top) that every mentor has with their juniors explains why it seems every surgeon in the show is so successful. The show demonstrates men mentoring the women to rise to the top. A report published recently by Harvard Business School showed that male champions can change the workplace culture so that women actually get what they deserve. The women in turn mentor not just other women but also men (Arizona and Alex anyone?) and the entire system self-propagates. The report shows that companies which adopt gender diversity did better than others,which then kind of explains why Seattle Grace Hospital would be one of the ‘top choices’ for competitive residents.

So yes, while interns going berserk with LVADS and a gunman roaming around loose in the hallways may not bode well for a successful setup, Seattle Grace Hospital has some great qualities which surgical communities in the country should aspire to if they want to be considered a success overall.


Sristi Sharma MD, MPH is an aspiring surgeon, a clinical researcher at the Brigham and Women’s Hospital, a previous Paul Farmer Global Surgery Research Associate and a proud alum of Manipal University, India. She is an passionate about advocating for global surgery. She was born in the Himalayas and is a Gorkha to the core.
Twitter: @drsristisharma

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.

National Minority Health Month

By Robin Williams, MD, FACS

Despite the vast advancements of modern medicine, significant health disparities remain amongst minority populations. Heart disease, cancer, stroke, diabetes, and unintentional injuries are the top 5 concerns that disproportionately affect minorities. Just to highlight a few disparities:

  • Thirty percent of African Americans are more likely to die from heart disease. Coronary artery disease occurs earlier in life and in higher percentage of Asian Indians than in other ethnic groups.
  • Seventy percent of African Americans and Latinos are more likely to be diagnosed with diabetes compared to non-Hispanic whites. Twenty percent of Asian Americans are more likely to have type 2 diabetes than their non-Hispanic white counterparts.
  • Although the incidence of breast cancer is higher in white women, African American women tend to be diagnosed at an earlier age (58 compared to 63) and have a death rate that is 42% higher. Hispanic women have among the highest rates of cervical and gallbladder cancer.

The above information juxtaposed with the following heightens the need for awareness to be raised regarding minority health.

  • In 2008, approximately 33% or more than 100 million people identified themselves as belonging to a racial or ethnic minority population.
  • The Census Bureau predicts that by 2045, the racial and ethnic minority populations in the United States will grow to become one half of the US population.
  • The potential excess medical care expenditures for African Americans, Asians and Hispanics that were due to health inequalities is 30.6%.

April is National Minority Health Month. Sponsored by the Office of Minority Health (OMH), the theme this year is “Bridging Health Equity Across Communities.” Healthy People 2020 defines health equity as the “attainment of the highest level of health for all people.” This definition incorporates social determinants of health- where we live, work, play- as factors impacting overall health. OMH invites individuals and organizations to engage in their own communities to achieve equity. There will be a Twitter Town Hall on April 12 and a Twitter Chat on April 25. For more information, go to www.minorityhealth.hhhs.gov.

“Without health, and until we reduce the high death rate, it will be impossible for us to have permanent success in business, in property getting, in acquiring education, or to show other evidence of progress”

~Dr. Booker T. Washington

References:
Current Cardiology Reviews 2015 Aug:11(3): 238 – 245

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558355/table/T1/
The National Negro Health Week, 1915 – 1951: A Descriptive Account, Sandra Crouse Quinn, PhD; Stephen B. Thomas, PhD http://health-equity.lib.umd.edu/541/1/National_Negro_Health_Week.pdf
www.cancer.org
www.minorityhealth.hhs.gov


Dr. Williams is board certified in general surgery.  Her clinical interests are diagnosis and treatment of diseases of the breast.  She is currently the Co-Chair for the Association of Women Surgeons Clinical Practice Committee.  She is a member of the Tennessee Medical Association and serves on the Insurance and Constitution and Bylaws Committees.  She is also a delegate for the Nashville Academy of Medicine.  Over the years, Dr. Williams has been an active participant in the Nashville community.  She has served as a board member of the Tennessee Breast Cancer Coalition, the Nashville Affiliate of Susan G. Komen for the Cure, and the MidSouth Division of the American Cancer Society.  From 2000 to 2007, she was president of the Nashville Chapter of the National Black Leadership Initiative on Cancer.  

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.

Negotiating Your Worth

By Melany Hughes

Hiring Entity
“No. That won’t work for us.”
Job-Seeking Physician
“Ok, that’s fine then.”
I’m not going to cry.
I’m not going to cry.
Ugh, are those tears?
Am I crying?
Did they notice?

Hiring Entity
“Do you need a minute?”
Job-Seeking Physician
Noooooooooooooooooo

In our worst nightmares, this is the scenario we think could unfold if we dare make demands during contract and business negotiations. Of course, in reality, it will never happen but the fear of lacking control and losing dignity can be so strong that it compels contract seekers to make no demands and to agree to everything that is proposed; just because it is easier. Women have a tendency to internalize all the cultural, societal, religious and historical characterizations that define us as the “fairer” sex. But let me make it clear that although there is a time and a place for taking a backseat, meetings with potential employers at the negotiation table should not be one of them.

It may seem hard to make demands when you feel that you are approaching the contract process from a place of inferiority. You may even feel that you lack sufficient knowledge to leverage any control in the process. But you have to muster the confidence to serve as your own advocate.

I attend annual meetings and conferences for medical professionals and the horror stories people tell regarding their contracts and work situations would make your hair stand on end. The situations can be downright criminal when there are special circumstances like visa requirements, malpractice settlements or negative hospital inquiries, etc. I know a very competent practicing female surgeon who makes under $100,000 and was required to cover the hospital surgery call schedule 24 hours a day for 4 months at two 200+bed hospitals all for the promise of a sponsorship for a US green card and permanent residency. It is mind-boggling that this beautiful, brilliant, hard-working woman did not think that she was worth more and even more disturbing that despite all our medical training, we are not provided with more business savvy and insight. Happily, through some back-door nudging that I am proud to say I encouraged, she was able to get her contract renegotiated and is living with a slightly better quality of life. But you cannot trust that contract renegotiation will be an option. Sometimes, it is two years later and you are so burnt out that leaving active practice seems a viable option.

Medical school and residency don’t include business classes. In certain cultures, women in the forefront making demands is frowned upon. It is clear that medical training should include more education that relates to contracts and contract negotiation, reimbursement, incentives, malpractice coverage, billing, etc. It’s preposterous that the first time you hear about a non-compete clause or tail coverage is when you are signing the next few years of your life away.

So how do we do this? How do we even approach this?

  1. You are a trained professional. You are a “hot” commodity! You are doing them and their patient population a favor by working for them. You do want to let them know what you can do for them and their practice. You should approach this process and the contract negotiations from a presumed position of power.
  2. Be sure you understand your own desires and needs (lifestyle, family plans, desired salary range, geographic preferences, career interests, work schedule, paid research hours, tenure options, etc).
  3. As a new graduate/physician, you will need to make some compromises to get more experience. But do not give up everything. Keep your soul! If you need two weekends every month to go river rafting or skiing or want two weeks in summer to travel through southeast Asia, then make sure you negotiate for that.
  4. MAKE A LIST. For first-time negotiations, renegotiation or any changes, do not approach the meeting without a written list of both needs you have and compromises you are willing to make to come to a satisfactory agreement. For my last contract re-up, my current employer just took one look at the list and agreed to every single thing.
  5. Read and Empower Yourself. Here are some suggestions:
    • Women Don’t Ask: Negotiation and the Gender Divide by Linda Babcock and Sara Laschever
    • Getting More: How You Can Negotiate to Succeed in Work and Life by Stuart Diamond
    • AWS Job Negotiations Resource by Dr. Margaret Dunn
    • Read the AWS Navigating Your Surgical Career Guide
  6. Have walkaway terms
  7. Lastly, make sure you have a contract lawyer familiar with physician contracts.

Melany Hughes, MD, MPH is a 2005 graduate of the Howard University College of Medicine. She completed her General Surgery internship and residency in 2010 at Howard University. She received a Master of Public Health Degree in Disaster Management and Emergency Preparedness (MPH) from Tulane University (TU) in 2012. While at TU she received a research appointment with the World Health Organization’s Center for Research on the Epidemiology of Disasters (WHO-CRED) in Brussels, Belgium. Her work focused on the analysis of both man-made and natural disaster-related trauma and injury patterns resulting in contributions to several multi-national collaborative research projects and publications. Following completion of her MPH degree, and with a continuing commitment to public service and humanitarian work, she served as a General Surgeon and Medical Officer with the U.S. Indian Health Service; providing healthcare to the Hopi and Navajo Nations in northwest Arizona. Dr. Hughes strives to practice “socially-conscious” general surgery and is currently employed as a private practice surgeon with Hafa Adai Specialist Group in Guam, USA.

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.