Mentor Spotlight: An Interview with Dr. J.E. “Betsy” Tuttle
Friday, May 29, 2020
Dr. J.E. “Betsy” Tuttle is an abdominal transplant surgeon at the Brody School of Medicine at East Carolina University in Greenville, NC. She received her undergraduate and medical degrees from Wake Forest University. She completed general surgery residency training at the New England Deaconess Hospital of Harvard Medical School in Boston, MA. She then went on to complete a surgical critical care fellowship at the University of North Carolina and a fellowship in abdominal transplant surgery at Duke University Medical Center.
Dr. Tuttle is currently serving as the Department Chair of Surgery at the Brody School of Medicine (BSOM), in addition to her role as a Professor of Surgical Immunology and Transplantation. She has a long history of involvement with the Association of Women Surgeons, notably serving as the 2011-2012 AWS President. She has continued her work with AWS at the Brody School of Medicine, where she serves as the faculty advisor for the medical student chapter. She is currently the NC ACS Governor at Large for the American College of Surgeons, a member of the Legislative/Advocacy Committee for the ACS, and a member of the executive council for the Society of Surgical Chairs. On top of the many hats she wears, Dr. Tuttle is also a mother to two.
Dr. Tuttle is a gem at BSOM and a mentor to many. She makes herself available for students and residents at all levels of training. It was at her recommendation that I became more involved with AWS beyond my institution’s chapter. When I first expressed interest in surgery and reached out to third and fourth-year students at my school, every one of them recommended that I get to know Dr. Tuttle as soon as possible. I am proud to have examples of strong female leadership like Dr. Tuttle at my institution, and I would like to extend my heartfelt gratitude for all of her support.
What was your childhood like?
I grew up in a very small town in rural North Carolina called Madison, which is about thirty miles north of Greensboro and close to the Virginia line. I am the youngest of four children, and I am ten years separated from my closest sister. My father was a Chevrolet dealer, and my mother was a schoolteacher. My sisters and I were the first people in my father’s family to go to college.
How has being a female surgeon impacted your surgical training and career?
There was one woman surgical attending at Wake Forest when I was a medical student. No women in my medical school class of one hundred people wanted to pursue surgery as a career, but I loved it and wanted to pursue general surgery. I applied, but I was naïve in my applications. I did not match coming out of medical school, and I had to complete a journeyman year at Wake Forest. I then went on to the University of West Virginia to do a year as a categorical resident. I was sent to Boston to do a year at Children’s to learn ECMO, and when West Virginia was placed on probation for their general surgery training program, I was fortunate enough to garner a spot at the New England Deaconess to complete my residency.
I think it was there in New England where I saw my first group of female attendings and residents. It was a much different place there than in North Carolina. The program I trained at was probably fifty percent women, and this was in the late 1980s and 1990s, meaning it was well ahead of its time. In Boston, you did not feel like there was any difference between you and anyone else in terms of gender identity. We were all working hard. Drs. Glenn Steele and Al Bothe strategically recruited talented women for their training program. They made a conscious choice to increase the number of women trainees. When I returned to North Carolina, I noticed the tremendous geographical difference in the acceptance of women surgeons. I think that is still true today. Women leaders in general face geographical disparity, in terms of what is locally and culturally acceptable. If you look at all of us, we hear “you are too aggressive” or “you are too bossy.” You’re always too this. You’re always too something. I find those disparities much more obvious in the South, which is strange to me because I grew up here, but I have traveled enough to know that we are lagging behind.
Can you speak to your journey to become a department chair? What, if any, barriers did you face?
I did not set out to be a department chair; I set out to be a division chief. I had a great time in St. Louis as division chief, and I had a lot of freedom. It was Margaret Dunn who talked to me about how in academics, we get wrapped up in the reputation of the place where we are, or where we’re going, or where we’re from. Margaret taught me that it is not where you are that defines you, but who you are. She was instrumental in supporting me when I made the decision to leave Duke. When you are at a smaller place, you are able to change things and move your agendas ahead a lot quicker. I had a great time in St. Louis, where I was able to rebuild their transplant program.
I was then asked to serve as the Interim Chair of Anesthesia at St. Louis University, which I did for eighteen months. I had a great time doing it. I restructured the clinical teams, the teaching and training curriculum, and the residency. I was able to bring the group of transplant researchers and their infrastructure to the department of anesthesia, and we received a couple of grants. I liked being chair. I liked the financial part of it, the faculty development, the stewardship of the residency, and pushing the research agenda. After that, I started looking at chair jobs. I interviewed at multiple places, and I thought that the Brody School of Medicine had a unique opportunity to be at the forefront of population health and rural training. I thought that we had a unique situation in partnership with the state, and we had a population in need. We had a mission, and I liked that.
The group of women who are serving as surgical department chairs is a small club. Can you speak to what it is like being a member of such a group?
It is funny you ask that. I have been writing a lot of letters of promotion lately, which is one of the many ways that the Association of Women Surgeons is beneficial for all of us – by connecting all of us to support and assist in the promotion of women surgeons. There is an organization in the American College of Surgeons called the Society of Surgical Chairs, and we have created a women’s subcommittee of that organization. We usually meet at the College before the Society of Surgical Chairs. The women’s subcommittee is always in flux, but we are very close. Currently, we seem to be stuck at twenty members; however, now with the addition of Dr. Sareh Parengi as chair at the Newton Wellesley Hospital in Boston, we are up to 21 women chairs. This total includes two women chairs from Canada. There are at least two hundred and fifty surgery departments, depending on how you count, in the United States alone. If you have seen one medical center, you have seen just that. We each have our own unique institutional issues, but there are some shared experiences between us. We are all very supportive of each other and communicate frequently, as individuals and as a group. We depend on the support and guidance from our liaison to the ACS, Ms. Ellen Waller.
It takes a village to raise a child, or I guess to raise a chair. I have depended a lot on my support system, including my sister chairs, family, and friends. I have good mentors. There are so many great women who are a little in front of me, in terms of their longevity, who did a lot of the heavy lifting for women in surgery. We all stand on the shoulder of giants – Drs. Dunn, Freischlag, Jonasson, McCarthy, Ephgrave, Bass, and so many more. They have certainly contributed to making the playing field more level for us all.
In the past, I have heard you say that there is a difference between a mentor, supporter, and promoter. Could you elaborate on that?
To me, a mentor advises you as you go through the early years and even late years of your career. They give you advice about decisions and steps you are about to make. A supporter is someone who supports you in your current role (i.e. my Division Chiefs and my allies within the hospital). In my mind, being a promoter is when people call me and ask who their next dean should be, and I say someone’s name. I promote my faculty out there to say, “yes, he or she would be a great division chief at this stage in their career.” I promote them into positions where people ask me for my advice. That, I think, is a significant difference. You can have mentors who do not support you, and supporters who do not promote you. As a chairman, my role is to be a supporter, as well as a promoter of my faculty, residents, and students.
Dr. R.R. Bollinger, one of my early mentors and supporters in transplant surgery at Duke, said, “When I’m dead and gone, it doesn’t matter how many papers I’ve written or how many grants I’ve gotten. It matters how many people I’ve helped along the way.”
Being a department chair means you are in a position of leadership. How do you approach your leadership style?
People always assume that doctors can be leaders because of our socioeconomic position and the fact that we have received so much education. For them, it is not necessarily about leadership and management skills when they see a physician – it is about education level. Somehow a medical education is supposed to translate in ability to lead others. When I decided to look at being a chairman, I decided I would go back to school and get a master’s degree in health administration. I think that when you look at leadership characteristics, it is easy to put people in boxes. What you hope you can do is craft a leadership style in which you have clear and present missions, and you serve those missions. One of the first things I did when I came here was create a mission and vision statement. Our mission is to take care of the patients of eastern NC. It is broad, yet specific enough to be achievable. Our next mission is to educate the upcoming generation of care providers, and our third mission is to conduct research into the conditions that affect the patients we serve. When you define why you do what you do, it is easier to craft your leadership style around that. My role as chair is to support my faculty in what they need to do in terms of taking care of our patients, educating residents and students, and conducting research.
How can students and residents develop their leadership skills in a meaningful way?
I think you have to treat developing your leadership style like you treat everything else in medical school. When they teach you how a dendritic cell presents an antigen to the immune system, you go home and read about it. I think you have to read about leadership so that you can recognize it when you see it. You have to recognize the type and model your own style after those characteristics you admire and believe you can achieve. You have to read, be observational, and conduct case studies of the people you work with who you want to emulate. I think that people have intrinsic leadership traits, but I believe that leaders are ultimately created. I think you have to study for this like you do for everything else – it doesn’t just come to you.
Do you have any recommended books for surgeons wanting to develop their leadership style?
The 15 Commitments of Conscious Leadership, by Jim Dethmer, Diana Chapman, and Kaley Warner Klemp
Reframing Organizations, by Lee G. Bolman and Terrence E. Deal
Positive Academic Leadership: How to Stop Putting Out Fires and Start Making a Difference, by Jeffrey L. Buller
Influencer: The Power to Change Anything, by Kerry Patterson, Joseph Grenny, David Maxfield, Ron McMillan, and Al Switzler
The No Asshole Rule: Building a Civilized Workplace and Surviving One That Isn’t, by Robert I. Sutton
Do you have any parting advice to give to women pursuing surgery?
Do what serves you. If you love it, you have to do it.
Amber Priester is a third-year medical student at East Carolina University’s Brody School of Medicine. Originally from southeastern North Carolina, she attended UNC Chapel Hill, where she double majored in biology and anthropology. While in Chapel Hill, she conducted research in the field of cardiac electrophysiology. She is a member of her institution’s Medical Education and Teaching Distinction Track, through which she is conducting research and outreach education in pediatric trauma imaging. She is considering a career in academic surgery, which she feels will allow her to engage in her passion for teaching and mentorship. In her free time, Amber enjoys reading, traveling, and exploring the outdoors with her beloved puppy, Vagus.