24 Oct 2020

By Justine Broecker, MD

An Interview with Dr. Toncred Styblo, a surgical oncologist within the Department of Surgery at Emory University for over 30 years, with her daughter, Dr. Justine Broecker, a PGY-4 general surgery resident at Mayo Clinic Florida.

Part 2 of the interview continues below:

What was your hiring process like at Emory? How did you negotiate, how many women were in the department when you started, and how has your career progressed over the past 30 years?

There was one woman in the general surgery department who left and was no longer in the department when I was hired.

Dr. Lawrence had given me some guidelines about how much lab space (sq feet) and how many financial resources to request to start lab work. I would say that my negotiations were fairly simple and I did not demand a lot of resources when I started.

In hindsight, I did not have an office for two years. I had a desk in one of my male partners offices. If I had thought I needed to negotiate for that I would have negotiated.

I think when you are starting out in a practice, and you’re also trying to establish yourself in a laboratory, you need to understand what are the resources and who your  mentors are who can help you initiate your research. In short, you will need to get significant funding and without mentorship it’s not likely for that to be successful.

One of the biggest regrets I have of my professional career was I was not able to get funding to do my laboratory research, and part of it was because there weren’t many people doing basic science cancer research when I started and I was expected to build a productive clinical practice given the way my salary was arranged. I was naïve about what establishing a practice and a laboratory would require and making sure I had all the working blocks I needed before I accepted the position.

The one complexity of interviewing for a job is that at the time I was engaged to a pediatric urologist (who has been my husband for 32 years) who was also looking for a job in the same city. We had interviewed for 6 months across the county. Trying to find two professional jobs that are challenging and tailored for both of us is exponentially more difficult not twice as hard. If there was a position for me there wasn’t for him and vice versa.

We interviewed separately at Emory because people didn’t really interview or hire together at the time. As the only female on the faculty for the department of surgery when I started, they hadn’t really anticipated what my needs were including my fiancé who was a urologist who also was seeking a job.

I was initially hired to do a variety of surgical oncology cases(?). I did all of the thyroids, adrenals and breast at Grady Memorial Hospital downtown for about two years. I did some general surgical oncology at Emory but certainly the majority was at Grady. I had the opportunity at Emory to collaborate with Dr. John Bostwick, a world famous plastic surgeon who had developed many reconstruction techniques, and it was a privilege to be able to develop a practice and we pioneered skin sparing and nipple sparing mastectomy during my first decade at Emory. My basic science interest and the focus of my laboratory work was signal transduction and autocrine factors in cancer progression. I developed a breast cancer in vivo and in vitro model with draining lymphocytes which is part of the reason (in addition to fact I was female) why I think my practice became breast specific compared to HPB/colorectal/endocrine.

How did you balance having a family, being a surgeon, and having a lab?

It was extremely challenging, I won’t say that it wasn’t. I don’t know where to start. I was writing DOD grants when I was on maternity leave for 6 weeks. Trying to sort out child care when you have two parents who are full time academic surgeons was a challenge and extremely stressful initially trying to find someone who was reliable and dependable and acceptable for both of us. And, eventually, once the kids got older they started school it was more manageable. But trying to get the operating room and getting kids to school in the morning was a challenge. It almost takes a personal secretary to figure out two surgeons’ call schedules to make sure they didn’t overlap and make sure that someone could be there every night and not called to the hospital.

How did you manage maternity leave and breastfeeding as a surgeon?

When I got pregnant there was no maternity leave. I was taking call at Emory University Hospital. The call schedule came out a year at a time and you covered both surgical oncology and general surgery. I had a due date in early August. The call schedule came out in January and I was supposed to be on call over labor day which was supposed to be during my maternity leave. When I got into my 2nd trimester and realized that I needed to give them notice that I wasn’t going to be able to take call, I was essentially told this was the way it was done, this is the way it was always done, and I was going to need to get coverage (which I couldn’t find). Eventually, the active chair of the department who was the one who could not accommodate my maternity leave and my call schedule was replaced with a chairman who could.

Regarding breastfeeding, fortunately I lived close enough to the hospital, I came home most days when I was in clinic, and I could arrange my outpatient surgery schedule so that I would come home between 12-1. If I couldn’t, I had to pump. Some nights when I was on call it would be uncomfortable but I would pump. There were no lactation rooms; I pumped in my office.

What do you think the challenges are for women in surgery and how do you suggest that we address them?

That’s a pretty large question. First and foremost, you want to become a well-trained surgeon who at the end of their residency is capable of taking care of patients to the best possible ability that you are capable of. Which means during surgery residency, it certainly was my priority to become the best surgeon I could and everything else was secondary. That’s part of the reason why I didn’t get married during residency so that I didn’t have to feel that there was a conflict between my family(?) and residency. For instance, I saw a lot of co-residents getting divorced by the end of their residency because of the stresses of trying to work that many hours and to keep a marriage and a family going (which can be a huge challenge). So, you have to be realistic and I don’t think it’s just if you’re female, it’s that the person you share your life with understands that he/she will not be your first priority during residency. Education, patients and becoming a surgeon takes priority because you certainly wouldn’t want to finish residency and have a patient depending on you and not being well trained enough to do the best for that patient. So I don’t think that’s a unique female consideration.

I still think that there is not necessarily hidden or overt discrimination, but I worry that female residents do not get the same operative opportunities as male residents. I think that if female residents knew they were falling behind they might have a more aggressive attitude, but right now we don’t have a good way of measuring surgical milestones to measure disparities. Hopefully residency is long enough and there is enough clinical material that those disparities no longer exist by the end of residency, but I think that’s something as faculty within surgery department we need to be aware of and I tell my female residents that they should be talking with their co-residents about what cases, how many cases and what part of the cases they are doing so they know that it is equitable. I think the same thing is true of committee, teaching and research opportunities as you progress from residency to faculty. We need to make things as equitable as possible and  be aware of what is actually going on.

How has the culture of surgery changed during your career? How should it continue to evolve?

There are certainly more female surgery residents in training. There are certainly more women faculty now so that female residents have more mentors which I think is important. I have never had a female mentor in my career. It’s not necessary but I think it would have been very helpful to get guidance about being a mother, surgeon, wife and an educator. There are a lot of hats you have to wear, and trying to navigate those positions can be extremely challenging. Sometimes it’s nice to hear someone’s perspective.

There are still few women in leadership positions. There are female chairs but it is still a male dominated leadership in surgery. Having women in leadership is extremely important. A mentor is one of the most important things in a mentee’s life to inspire them to choose an area of education and profession. Although they can get it from male mentor, seeing women succeed and having women encourage them to succeed is important as well.

What is your advice to female medical students and surgery residents?

That’s a big question. You are going to get out of it what you put into it. You have to be aware of what your male colleagues are doing and what you need to do to succeed.I think the most important thing is to be objective and not take things personally. It’s easy when you are criticized to take it personally, but it’s important that you adopt an attitude that it’s going to be constructive and that you can move forward. If you think you are not getting the same opportunities as your male colleagues, you need to be able to discuss that in a constructive way. And, if you don’t get a constructive response, you need leadership that can guide you and improve that situation. You need to identify mentors. The role of mentors changes as you progress through your professional career but is equally important. That’s why it’s important to have female faculty in different positions and practices so that you can witness different leadership styles and observe what makes them successful. The saying “a truly great teacher considers the best success when their pupils excel beyond them” is incredibly important and those are the kind of mentors you are looking for. Someone you can stand on his/her shoulders so that you can do not only as well as them but excel and exceed what they are able to accomplish.

What is your advice to students and residents that want a family? Or that have co-physician households?

There is no reason you can’t do it, I did it.

You have to have a mate who respects you professionally to be able to do that. You can’t always be the one that’s expected to forego your professional responsibilities to be there for child care. It has to be a partnership. You have to acknowledge it’s not always going to be perfect, it will be frustrating and challenging at times, but you can do it. It’s like Lily Tomlin says, “they say you can have everything, but the part they didn’t tell you, is that you have to do everything too”. And, there are only so many hours in the day. So you need a partner who is willing to work with you and help make all those things happen.

What are you most proud of in your career?

I think all of the patients that I have met and taken care of and have had the privilege of operating on. Also, the collaborations with so many of the people I work with on a daily basis. I feel like I have two families: I have my family at work and my family at home. And I have a great deal of love and affection for both of them

If you had to do it again would you be a surgeon?

Yeah I don’t regret for one minute what I do. I love what I do, I have no regrets.

Did you encourage your daughter to be a surgeon?

I took a lesson from my father. I always encouraged her that there is no reason she can’t do whatever it is she is really passionate about. If she loves it and it brings her joy, then at the end of the day, you spend a lot of hours at work, so you can’t choose something you don’t love to do.” When you find something to do with your life that you have a passion for, absolutely the most fortunate thing in the world is to be able to do that thing. So if you can choose it and you can do that thing, you should absolutely do it.

If you couldn’t be a surgeon what would you be and why?

I would probably be a middle school science teacher. I enjoy teaching and life sciences. I still remember my junior high school teacher. She was one of the reasons I loved science as much as I do. For girls, having a female science teacher is really important.

Justine Broecker, MD, is a PGY-4 general surgery resident at Mayo Clinic in Florida. She is from Atlanta, GA. You can follow her on twitter @jasb805.

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.

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