AWS BLOG

The Ideal Team Player

By Jean Miner, MD

In all aspects of our lives, we are members of a “team”. We are members of our family “team” first and then head to school at a young age and are paired off on the playground. Many of us joined teams throughout our lives for sports, debate, math, dance, etc… As we get older, we start to value the importance of teamwork to accomplish goals or projects. Think about the college chemistry lab partners or the members of a committee who helped (or hindered) meet deadlines or complete tasks. As surgeons, we are always members of a team- in the operating room, clinic, and patient wards. Ultimately, in life we belong to numerous teams.Recently, the members of the AWS Clinical Practice Committee (CPC) held a book club discussion using The Ideal Team Player by Patrick Lencioni. Our lively discussion quickly turned into a focus on leadership and building the ideal team. Based on the importance of this topic, we will be hosting a tweetchat on November 27th focused on Leadership and The Ideal Team Player. Three virtues, humility, hunger, and people smarts, are what we look for in those alongside of us taking care of patients, in our office, on a committee and even at home.

  • Humility: Characterized by lack of excessive ego or concerns about status. Humble team players share credit and emphasize team over self.
  • Hunger: Defined by self motivation and diligence. Hungry team players are always looking for more things to do and learn.
  • People Smarts: Depicted by possessing common sense about people. Smart team players are intuitive around the subtleties of group dynamics and the impact of their words and actions.

What do we do when we lead a team with members deficient in one, two or maybe all three areas? Should we give up on them? Are we able to teach these qualities or is it nature vs nurture? If we want to be good and effective leaders, we need to try and help our team members before kicking them to the curb. First, we should assess our colleagues to establish where they rank on the three traits. As both team leaders and members, we should do this ourselves. Other key members of the team can (and should) also be included. Next, we meet with the teammate to discuss our findings and develop a game plan. Often when there are deficiencies identified, people are unaware and improvements can be made just by bringing it to their attention. For more challenging situations, we need to set small achievable goals paired with frequent feedback. Finally, after a set period of time, we must reassess the situation and determine if we now have a set of ideal team players. If not, just like in professional sports, we must consider trading members to other teams where they would be a better fit and acquiring new players that fit the project.

Most importantly, we also need to turn the microscope on ourselves. Are we good team players? Most of us would like to think we are, but it is definitely worth a few minutes of self-reflection or use of a self-assessment tool in determining if we are indeed good team members. Or just like we did with our own team, we can ask a leader or mentor to evaluate us. After identifying areas to improve, we need to set our own goals based on the three virtues. If humility or people smarts are issues, we need to make a point to listen and learn more about our team members. This allows us to exercise humility but also gain insight into our counterparts as we take the time to hear their opinions. Hunger can be more difficult to achieve without an interest in the project. If this is a deficient area, we must consider alternative methods for achieving the same outcomes with a process that will motivate us. Or we may need to request off of a project in exchange for one which inspires us to do our best work.

Ultimately, for the development of a high performing team ALL members should embody the virtues of humility, hunger and people smarts and the process of building our team can be as enlightening as what we accomplish together.

Please join the CPC on November 27 at 8pm EST for a tweetchat on “The Ideal Team Player” to discuss your own strategies and experience as a leader and ideal team player.

https://www.tablegroup.com/books/ideal-team-player


Jean Miner is Assistant DIO at Guthrie Hospital in Sayre, PA and a Surgical Attending with Guthrie’s General Surgery Residency. She also has a Masters in Medical Education Leadership from the University of New England. Her work life is in equilibrium with her personal life as a mother of three girls who loves spending time with her husband and family traveling the country and world. In her “spare time” she loves to cook, be outdoors and read as many books as she 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.

So you want to be a Surgeon in the United States? 6 Tips to Succeed as an International Medical Graduate (IMG)

By Sristi Sharma

Congratulations! Your ambition of becoming a surgeon in the United States has finally brought you to this country. You have left your family, your life and everything behind to train in an environment that is completely new to you. You know that you have a steep learning curve ahead of you-be it clinical, personal or social. So how do you navigate this new phase of your career?

There are unique challenges that come with being an IMG in the States. Here are 6 tips that will help you become the best surgical trainee you can be:

  1. Be good…no excellent…at what you do! Know your subject inside out and practice your surgical skills . Challenge yourself to learn more everyday. There is no substitute for hard work, and as a foreign medical graduate you will have to work even harder to prove yourself everyday.
  2. Learn the system: Do everything you can to understand the system you are trying to enter. Surgery is a very fast paced specialty and it is unforgiving to those who are slow to catch up. The goal for foreign medical students intending to start their residency should be to be at the same level as a US 4th year medical students. You are not necessarily behind on the clinical knowledge, however the medical students here know how the system works-right from electronic medical systems to how patient care works. To get upto speed familiarize yourself with the lingo. Observe how everyone behaves in their work environment. It does not matter what country you come from, things are different in the United States. As a trainee, you need to be able to hit the road running when you start. Your preparation will go a long way.
  3. Find a mentor: A common piece of advice you will get right from the beginning is to “find a mentor who can guide you”. I cannot stress this enough. Your life will become much easier if you find someone who has been in the same place as you recently. It may be a student from your country who has successfully matched into a residency program or an attending who now has a successful setup. This person may not necessarily be the mentor you are looking for, but they will be your first step to finding one. Ask questions, ask for help. Many people want to help and will even go out of their way if you just ask them. This is especially helpful as you start talking to your potential mentors. The surgeons you meet are busy people who wear multiple hats in their careers and personal lives. They are open to mentoring you as long as you prove that you are in this for the long haul. You are also not limited to one person. You should work with several mentors to achieve your goals. Your motivation will show through in your actions.
  4. Value your uniqueness: One of the worst pieces of advice I received when I first landed in this country was, “make sure you do not tell people what you went through in India. The clinical community will not appreciate it and will think you are not adequately-trained and incompetent”. For the next 3 months I wallowed in doubt and self-hatred. It showed in my interactions with people. I came across as an under-confident individual who was unsure of herself. Very quickly I realized that my approach was wrong. My experiences were unique, and for the most part doctors and surgeons were curious to hear about how I practiced medicine back home. At institutes such as Hopkins and Harvard, I have been working with and learning from the surgeons who share my goal of making the surgical systems better in my country. At every step they want to learn about my experiences to effectively understand the changes that are needed. This experience has taught me it is very important to find a mentor who will appreciate your unique experiences and will encourage you to learn new things while being yourself.
  5. Speak up and take a risk. While working towards my MPH at Hopkins, I was looking for a job. I had heard that one of my professors was looking for a student to help out with his project. But his requirements for the job were very specific. I didn’t have the technical skills that were needed for the job but I had enrolled in classes to learn them at the very moment the job was being advertised. The fear of not getting the position was crippling and I hesitated even to approach the professor. When one of my friends heard about my dilemma she gave me advice that has completely changed my life. She said to me, “You may not get the job if you ask him, but if you do not ask you will definitely not get the job”. Since then, I have made this my mantra. There have been many moments when I have been turned away, but there have been many more when people have gone out of their way to help me out. All that stood between me and them was my willingness to ask for help. It is by speaking up I have found the best of my mentors. Oh and for those of you still wondering-I did get the job!
  6. Don’t fake it. Insincere stories, praises, gifts and fake accents? Just…no!

Being a foreign medical graduate in the US is tough. Being a foreign medical graduate AND a surgeon in the US is even tougher. So, if you want to be a good resident and a successful surgeon, work hard, reach out for help, be genuine and embrace your uniqueness.


Sristi Sharma MD, MPH is a General Surgery Resident at University of Colorado, Denver. She is a previous Paul Farmer Global Surgery Research Associate, Harvard Medical School, a graduate of Johns Hopkins University and a proud alum of Sikkim 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.

 

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.

AWS Day of Service 9/9/17

By Simin G. Roward

Being a medical student is challenging: between studying, rotations and research, it seems there isn’t enough time for everything. Often, it’s easy to lose track of why we chose this profession in the first place. Community service and engagement are put on hold amidst other pressing responsibilities. The goal of the AWS National Day of Service is to designate a day on which medical students from all over the country would come together with residents and attendings and make service to others a priority.

The members of AWS are compassionate, humanistic leaders, who chose the field of surgery because of the ability to make lasting improvements in people’s health and to provide a vital service to communities. These positive characteristics were exemplified in last year’s AWS National Day of Service event, where students nationwide provided much needed services and donations to their community. These service events differed from state to state- some schools put on educational sessions with high school and middle school girls to talk about medical school or to provide mentorship to students from disadvantaged backgrounds. Other schools organized clothing drives to provide supplies for shelters helping domestic abuse survivors or immigrant .

Each service event was specific to the needs of the community: in Washington, students raised funds for a local non-profit organization after it had been broken into and vandalized. In Arizona funds were raised to provide pre-employment TB testing to refugee women. In Texas, cookies were baked with the residents of the Ronald McDonald house, and students in North Carolina helped girl scouts earn badges by teaching them First Aid. Students in DC spent the day packing meals at a local food shelter and Boston students volunteered at a clinic for the homeless.

The participating schools should be proud of the events they organized and the important contributions they have made to their communities. The spirit of volunteering and community service are well aligned with the mission of the Association of Women Surgeons. As the AWS day of service will become an annual event, each year will build on the strengths of the previous year. This year’s AWS National Day of Service is September 9th, 2017, please contact us for additional resources or questions about participating!

Pictures:

 

 

 

 

 

 

 

 

USUHS put together bags of food donations at Food for ALL

 

 

 

 

 

 

 

University of Texas Medical Branch  hosted a Valentines cookie baking event at Ronald McDonald house

 

 

 

 

 

 

 

Paul L Foster School of Medicine (Texas Tech-El Paso)-organized a clothing drive for Anunciation house, a migrant shelter

 

 

 

 

 

 

 

 

 

University of Arizona- Fundraising for pre-employment TB testing for Syrian refugees

 

 

 

 

 

 

 

Boston Chapter-Hosted a game night with patients from their clinic


Simin G. Roward is a recent graduate of University of Arizona college of medicine.  She is currently a general surgery intern at University of Texas at San Antonio and she is planning to pursue a career in pediatric surgery.  She served as the community service chair for the Association of Women Surgeons during the 2016 school year and began the AWS day of service event. Her interests include global health, running marathons, traveling and participating in community service.   

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.

Perception of Personal Success in Burnout

By Shree Agrawal

In the preclinical years of medical school, the idea of burnout among healthcare workers is more of an abstract concept. The unique environment of healthcare, regardless of specialty or academic/private practice settings, has been shown to make all healthcare providers vulnerable to burnout.(1)(2) In my observations on clinical rotations, it seems highly successful peers, trainees, and faculty, who may have multiple publications, excellent clinical skills, and a strong work ethic, can also be the same individuals who unexpectedly experience burnout. Interactions with someone who does not realize they may actually be experiencing burnout are challenging, even for individuals who are at the fray of most clinical situations.

Some of the key manifestations of burnout include emotional exhaustion, cynicism, depersonalization or isolation, feelings of ineffectiveness, and lack of accomplishment, as shown in Figure 1.(3) Some of these features are difficult to fully notice in brief professional interactions with peers and superiors. Instead, common outward defining behaviors in burnout may be a focus on professional survival, fewer reflective practices, reduced desire to be at work, and/or a diminishing appeal of clinical and non-clinical activities.(4)

Figure 1: Factors contributing to and subsequent manifestations of burnout

For all the successes visible to the outsider, the relevance of personal and professional accomplishments to the person, who may be burned out, appear less significant. A component of this perception could be individual focus on future goals and milestones. Regardless, I am curious. Does the perception of personal success change in the process of burnout? Do achievements seem less worthy in the face of factors contributing to burnout?

Even though I would posit my observations are a multifactorial outcome, studies would imply this is not an uncommon phenomenon. Research within healthcare settings demonstrated insufficient recognition of employee contributions corresponded to healthcare providers feeling less respected and valuable to their organizations. This belief alone can cause providers to experience higher levels of emotional exhaustion, feelings of ineffectiveness, and subsequent burnout.(5) Another study suggests individuals who identify as a minority in society may receive less recognition and credibility for their accomplishments/capabilities when compared to their counterparts. Many minority participants in this study expressed already feeling burned out in their training. They stated their role on the team was not viewed as meaningful, or worse, unsatisfactory. Alarmingly, some minority participants not only revealed their feelings of inferiority to their peers but also doubted their own accomplishments, abilities, and personalities.(6) The infrequency or lack of recognition in healthcare both contributes to burnout and reduces individual perceptions of professional competencies and capabilities.

On the blog, we have talked about practicing gratitude and cultivating resilience in the face of burnout.(7,8,9,10) While these are important tools, I wonder if we should also encourage the practice of acknowledging both our own success ladders and those of the people working alongside us.

Outward recognition, while not common within medicine, is crucial to defining individual success. It facilitates finding value in our professional responsibilities, validates personal efforts for growth, and positively changes the perception of personal success. Recognition ultimately nurtures essential skills, traits, and resilience required in the practice of medicine.


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.

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 History of the Match and the Perspective From One Medical Student’s Journey

By Hilary McCrary, MPH

Throughout all of medical school, I always looked up to the current fourth year students. They seemed so seasoned and prepared to make the transition from student to doctor. The fourth year of medical school is also highly anticipated, as it is what medical students perceive as the first time they are solely focusing on their chosen career and traveling across the country for either away rotations or interviews. Now that I am towards the end of this process, I have had time to reflect on all of the components that go into the Match and what is takes to get there.

The Match process was created in 1952 as a way to address concerns related to institutions offering a spot for residency training earlier than other competing institutions.1 This previous design put pressure on applicants to accept multiple appointments, as positions were typically offered over the phone with the intent of providing the institution an immediate answer or losing that training spot.1 This process was followed by attempts to make a uniform time for institutions to release intern positions. Ultimately, F.J. Mullin from the University of Chicago School of Medicine suggested that both students and institutions create rank-order lists that would end in a match between that individual and a hospital.2 There were growing pains associated with this transition, but the Boston Pool algorithm created a stable process in which the rank-order lists were updated as each student went through the matching process. This program became known as the National Resident Matching Program (NRMP) and is the program that is still used today.3 The most recent change to this matching algorithm came in 1998, which was aimed at making the outcomes as favorable as possible for the applicant.4 In fact, in 2012 economists Alvin Roth and Lloyd Shapley would go on to win the Nobel Prize in Economics for their contributions to creating a stable match process through their work on match theory.5 While some controversy surrounded the inception of the Match, it does provide applicants and hospitals a sensible system to determine where new physicians will spend several years of training. As attested by several students, even though not all individuals may get their top pick on Match Day, the system has a way of finding the program best suited  for each individual.

While every specialty has its own unique aspects to the Match, there is one piece of advice that I always listened to – apply broadly. As a student applying to Otolaryngology, I knew that I needed to apply to a large number of diverse programs. This serves two purposes. It allows the student to see enough programs to know what aspects of a training program will most suit their needs and it sets you up for success statistically, as the more programs you apply to the higher your odds are of matching. I applied to 70 programs across the nation, which seemed daunting at first. The process of receiving interviews was exciting and stressful. In the fall months, students receive a flurry of interviews via email, and typically must respond within minutes or that interview spot may be taken. As someone who was on a surgical rotation during this time, I found it hard to be in the operating room without worrying about what emails were popping up on my phone.

Then comes the fun part – the traveling. As someone who loves flying and exploring new places, I was most excited for this aspect of applying to residency. In total, I attended 17 interviews, in 13 different states, over the course of three months. What no one prepared me for was how exhausting this process is. There were periods of time where I had four interviews in just five days, often associated with several flight delays and arriving at my destination city in the early hours of the morning. Furthermore, this process was financially difficult as well, as this entire process cost thousands of dollars. While in the thick of the interview trail I felt challenged, however, looking back it was an incredible experience that I felt lucky to partake in. Especially since I was given the opportunity to meet my future colleagues that I will collaborate with in the future, whether this is clinically or on research endeavors.

Now I join thousands of other medical students and wait to see where this process leads me on Match Day – March 17, 2017, which happens to land on St. Patrick’s Day this year. After a lot of thought and reflection, my rank-order list is certified and waiting for processing. What I have learned is there is no right way to navigate the Match and at the end of the day it’s best to go with your gut. Really listen to what your intuition is telling you on an interview day and make sure to ask questions that are important to you. Take risks, as programs you never thought would be what you are looking for or be within your reach might be the perfect fit for you. Finally, seek advice from your mentors who understand your career goals; their insight can be invaluable in helping create your rank-order list. Best of luck to all medical students and future surgeons participating in the Match this year!

 

References:

1)    Roth AE. The Origins, History, and Design of the Resident Match. JAMA. 2003;289(7):909-912.

2)    Mullin FJ. A proposal for supplementing the Cooperative Plan for appointment of interns.  J Assoc Am Med Coll.1950;25:437-442.

3)    Roth AE. The evolution of the labor market for medical interns and residents: a case study in game theory.  J Political Economy.1984;92:991-1016.

4)    Roth AE, Peranson E. The redesign of the matching market for American physicians: some engineering aspects of economic design.  Am Econ Rev.1999;89:748-780.

5)    Rampell C. “2 From U.S. Win Nobel in Economics”. The New York Times. Published October 15, 2012. Accessed on February 11, 2017.

 


 

Hilary McCrary is the Chair of the AWS Medical Student Committee and is a fourth year medical student at the University of Arizona College of Medicine – Tucson. She is currently applying to otolaryngology and hopes to practice in an academic setting where she can operate, teach, and conduct research. hcrees@email.arizona.edu

 

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.