Imaginary Obstacles

August 28, 2010 § Leave a comment

A few months ago I was told that it would be impossible for me to be an interventional cardiologist AND a wife/mother.  What I was really hearing was that it’s impossible to be a woman and live my personal dreams.  Unfortunately I admired the neurologist who told me this far too much otherwise I would have printed this article and stapled it to his forehead….or somewhere else.

NEJM article-

Women in Medicine Force Change in Workforce Dynamics

April 2005

By Bonnie Darves, a Seattle-based freelance health care writer.

Career Resources Editor’s Note: Women are finally gaining equality with their male colleagues in terms of admission to medical school and representation in non-surgical sub-specialties. However, significant disparities remain in surgical sub-specialties, senior academic and leadership positions, as well as in salary. Crucial to the advancement of women in medicine is positive role modeling and mentoring from those who have overcome obstacles and achieved success. The outlook remains bright for women entering medicine and choosing a career path that will bring personal and professional satisfaction.

John A. Fromson, M.D., Vice President for Medical Affairs, Massachusetts Medical Society

In July 2003, when Nancy Nielsen, M.D., Ph.D., was elected speaker of the House of Delegates at the American Medical Association, the Buffalo, New York internist was presented with a box containing glass shards. With becoming the AMA’s first female HOD speaker, Dr. Neilsen had truly broken the glass ceiling.

That story contrasts sharply with what happened 70 years earlier in Dallas, Texas. A year after the country’s first female orthopedic surgeon, Ruth Jackson, M.D., started her practice, the newly founded American Academy of Orthopedic Surgeons (AAOS) opened its membership to all practicing orthopedic surgeons — except Dr. Jackson. It wasn’t until four years later, when Dr. Jackson passed the American Board of Orthopedic Surgery’s newly instituted exam, that she was admitted to the AAOS.

Dr. Jackson’s struggle paled in comparison to the discrimination and ostracism the country’s first female physician, Elizabeth Blackwell, M.D., faced en route to receiving her medical degree in 1849 from Geneva Medical College. Yet it illustrates how little the acceptance environment had changed by the early 20th century.

Perhaps the most telling story about how things have changed in the intervening years for women in medicine — and what the future holds — lies in two statistics that made headlines last November. The Association of American Medical Colleges (AAMC) reported that for the first time in history, women made up the majority of medical school applicants, and that the number of black women applicants exceeded 1,900 — a 10 percent increase over the previous year. And in 2002, 40 percent of all residents were women, a statistic that clearly supports the prediction that by 2010, approximately 40 percent of U.S. physicians will be women.

In certain specialties, especially primary care, women have made large strides. Women comprised only 20 percent of pediatricians in 1970, for example, but accounted for 49 percent in 2002. In obstetrics and gynecology, the growth of women in the field is even more dramatic: from 5 percent in 1970 to more than 70 percent three decades later.

Despite how the overall numbers picture is changing, women in specialties such as orthopedics are still relative rarities — in 2001, less than 9 percent of orthopedic surgery residents were female. Yet times are changing, if slowly, even in this traditionally male-dominated specialty. Sybil Biermann, M.D., associate professor of orthopedics at the University of Michigan in Ann Arbor, who has conducted research on orthopedics work force trends, is buoyed by the changes she has witnessed in the field since she completed her residency in the early 1990s. She is also well aware that much work is needed to increase recruitment in orthopedics and other surgical specialties.

“In my field there is tremendous opportunity for women, and there really are no obstacles in terms of gender bias when you are at the level of being considered for a residency program,” says Dr. Biermann. “The issue is that we’re not recruiting women into the field early enough.”

Dr. Biermann, who joined the University of Michigan faculty 11 years ago, credits the tremendous support she received from the department chair at the University of Iowa as one of the chief factors in her decision to pursue orthopedics. “I was fortunate to be in a program that had trained more women than perhaps any other program at the time, and that really helped to create a supportive environment,” Dr. Biermann recalls.

Orthopedics has been considered one of the last “holdouts” in the surgical specialties, as regards the presence of women in the field. In general surgery, for example, nearly one-fourth of residents are women; and even in neurosurgery, another traditionally male-dominated field, women account for approximately 10 percent of residents, according to the most recent data from the American Medical Association and research conducted by Dr. Biermann for her article published in the December 2003 issue of the Journal of Bone and Joint Surgery. Changes are also occurring in thoracic surgery, where women residents made up nearly 7 percent of the total in 2001, compared to only 0.61 percent in 1970; and in urology, which saw the percentage of female residents increase from 0.27 percent to 12.6 percent over that three-decade period. The most dramatic increase is seen in ophthalmology, in which there has been a tenfold increase — from 3.6 percent in 1970 to 32.4 percent in 2001 — in women in training programs.

The career path of Ellen Raney, M.D., a pediatric orthopedic surgeon in Honolulu, exemplifies the changes that are occurring in the surgical field as a whole and orthopedics in particular. Now chief of staff at Shriners Hospital for Children in Honolulu, Dr. Raney might not have imagined that eventuality when she was the sole woman in her training program 12 years ago. “I was fairly naive to the obstacles in the beginning, and it was hard to be in a program where I had no role model,” Dr. Raney says. “But I loved orthopedics — and I found I had an aptitude for and special love of pediatric orthopedics, so I was determined not to lose sight of my goals. Today, I like to think that my success is making it easier for the next woman.”

Illinois neurosurgeon Gail Rousseau, M.D., a past president of the organization Women in Neurosurgery, was also a “solo act” as a woman in her training program at George Washington University, which she completed in 1992. “I think the environment was fair. I got no breaks for being a woman, but encountered no special difficulties because I was a woman, either,” says Dr. Rousseau. “Neurosurgery is an exacting science and a rigorous residency for anyone who undertakes it — as it should be.” She notes that then department chair, Edward R. Laws Jr., M.D., was supportive during that time, as were her male counterparts in training and the attending physicians. “They were all very supportive and I’ve felt that way, almost without exception, throughout my career,” says Dr. Rousseau, who has held leadership positions for both the American Association of Neurological Surgeons and the Congress of Neurological Surgeons.

Despite the increasing numbers of women in the field — only eight women composed the founding membership of Women in Neurosurgery in 1989, but there are approximately 250 practicing women neurosurgeons in the United States today and 550 internationally — women remain a small minority in the field.

In traditionally male-dominated non-surgical specialties, relative representation of men and women is changing far more rapidly. According to the most recent data published by the AMA, in the September 3, 2003 issue of JAMA, women physicians, in growing numbers, are choosing to go into a broad range of non-primary care specialties. For example, 27 percent of anesthesiology residents are female, 25.7 percent of radiology residents are women, and 49.4 percent of pathologists in training are women.

The successes of pioneers such as Drs. Raney, Biermann, Rousseau, and others who have ventured into surgical specialties are, in fact, figuring in the career decisions medical students are making these days. Catherine Mohr, a California medical student who is in her fourth year of Stanford University’s five-year program, credits several mentors — both men and women — with her decision to go into general surgery. A female friend who is a surgeon has given Mohr an honest picture, she says, of “the pluses and minuses of the field, so I’ve been able to watch her career develop. But one of my strongest supporters is a male surgeon,” says Mohr, referring to Stanford’s chair of surgery, Thomas Krummel, M.D., with whom Mohr consulted even before she decided to go to medical school.

At the time, Mohr already had an established career in engineering, but was wrestling with the growing personal recognition that she had shied away from her true calling. “I shared my interests with him, and he simply said, ‘what will it take to get you to come to Stanford?’ ” she says.

Women figure prominently in medicine’s wave of the future, but challenges remain

Although women physicians are far more common in the OR and the ER than they once were, they are still a minority — if a visible one — in the boardroom, the executive suite, and the upper echelons of academia. Diane Magrane, M.D., associate vice president for faculty development and leadership programs at the American Association of Medical Colleges, notes that there has been a stagnation of sorts in academia, in particular. “Women have been about 30 percent of [medical school] faculty since the 1970s, but what we know is that women are less likely to advance past assistant professor than men are,” Dr. Magrane says.

Further, women physicians continue to earn less than their male counterparts — an estimated 25 percent to 35 percent less, depending on the field. While part-time employment status and the predominance of women in primary care surely contribute to the earning disparity, those likely aren’t the only factors, according to the AMA office of Women and Minorities Services.

Dr. Magrane agrees. “There is still a disparity that can only be attributed to gender. How much that is, we don’t know, but it has been consistent,” she says.

In 2002, for example, only 12 percent of full professors were women, compared to approximately 1 percent 30 years ago, and women comprised only 14 percent of tenured professors, according to the AAMC report “Advancing Women’s Leadership.” “That’s not that much of a shift, considering the number of women in the [academic] field now,” Dr. Magrane says. And while there are now 11 female medical school deans, women clearly remain a small minority given the fact that there are 126 teaching institutions, Dr. Magrane adds.

Responses to a survey regularly conducted by AMA’s Women Physicians Congress support Dr. Magrane’s contention, but indicate that advancement opportunities are improving for female physicians. In 1998, respondents cited “leadership development, education, and training” opportunities as their No. 1 priority, but by the 2003 survey that issue had dropped down the scale considerably. And when asked whether the professional climate, as regards disparities or discrimination, had improved for women since they entered medical school, 44 percent of respondents said “somewhat” and 27 percent said “very much” — and only 6 percent said “not at all.”

Despite the statistics on women in leadership positions, which may be attributable more to women physicians’ lifestyle choices than to actual obstacles in academia or the business side of medicine, the environment is far more “women-welcoming” than it once was, recalls one pioneer, Barbara LeTourneau, M.D., M.B.A., vice president for medical affairs at Regions Hospital in St. Paul, Minnesota. “When I received my MBA in 1987, there weren’t very many women in medicine — and there definitely weren’t any women in management positions,” says Dr. LeTourneau, an emergency medicine physician. “When I was 35, I almost never saw a woman in the role of an elected medical staff position, but that’s changed now.”

For Dr. LeTourneau, the move into management was gradual and, as was the case with many of her female colleagues at the time, the first leadership position came about almost by way of default. After she had been in practice for a few years, the physician group with which she was affiliated discovered that although the number of women in the group was increasing, the board of directors was composed entirely of men.

“I think I was recruited because I was the only female full-time ER physician. But then I discovered that I liked management and had a flair for it,” she says. Even though she experienced occasional roadblocks in the management side of her career, mostly because she was a rare sight at the time, Dr. LeTourneau thinks that opportunities for female physician executives are abundant now, for those who are willing to deal with the minority factor that persists in the business arena.

“Women who are entering the physician executive field now will find the playing field level at the entry level. But I still think that where women have to work harder and outperform men is at the upper levels — because even though you’re not excluded, you have to overcome the difficulty of not being part of the male ‘club,’ ” Dr. LeTourneau says.

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