By Miriam D. Weisberg
As far as female pioneers in the surgical field are concerned, Preeti R. John has traveled the distance in more than one respect. After earning her medical degree at St. John’s Medical College in her native India, she ventured almost ten-thousand miles from home to start surgical residency training at Baltimore’s Johns Hopkins Hospital. Presently, John is a Critical Care surgeon and acting director of the Surgical ICU at the Baltimore VA Medical Center, as well as author of a history-making book.
‘Being a Woman Surgeon- Sixty Women Share Their Stories’ is an anthology of essays, poems, and interviews featuring a selection of surgery’s brave and inspiring female trailblazers. The book is the first of its kind and serves to fill a novel void in role models for women aspiring, or even considering, a career in surgery. John has elegantly illustrated both the obstacles and accomplishments of the progression of women in a male-dominant field, a topic which is sparsely documented.
AWS would like to take this opportunity to celebrate the summer release of “Being a Woman Surgeon” by highlighting the magnitude of Dr. John’s contribution as editor and author. John will be present at a landmark event and book signing hosted by the ACS (at the 2015 ACS Clinical Congress in Chicago, Illinois on October 6th from 1-2pm), featuring a number of current and former leaders in surgery who have contributed their experiences to the book (see below for list of guests).
It was a pleasure to interview John regarding her reflections since the book’s release. In exploring her intentions as editor, John’s powerful message and attention to detail shone clearly. ‘Being a Woman Surgeon’ is a treasure chest of honest, infuriating, and brilliantly inspirational stories that is bound to be a staple on the shelves of medical students, residents, and surgeons alike.
MW: Your anthology of 60 essays, interviews and poems written by pioneers for women in the surgical field is the first of its kind. It has been noted as inspiring for women and men alike. What was the initial spark that inspired you to create this compilation?
PJ: It was a series of sparks initiated by questions from medical students contemplating the field, as well as from residents who sometimes openly wondered whether all the hard work is worth it in the end. There were times during my training when I needed inspiration and I had often thought about how nice it would be to read about what other people experienced during training. There were several books written by men in the field, but very few by women. The books that I found were written by women during an earlier era when gender discrimination was rampant…and were not very inspiring.
MW: Atul Gawande called the book “funny, heartbreaking, flabbergasting, infuriating, and inspiring”. On your journey to a successful career in surgery, what was most infuriating for you and how did you overcome it?
PJ: Surgical training is challenging in many ways. There is very little flexibility with the call schedule and free time, and one has to miss several family functions and special occasions. During the first year, I think I remember having just 2 weeks of vacation with some free days during the December holiday season. Your priority becomes the hospital, your work schedule and patients – and everything else has to be less important.
You have to remain focused and tell yourself that this is a temporary phase in life. Important occasions in your personal life might be missed, but once your goal is achieved, there will be more flexibility, and priorities can be re-shuffled.
Depending on what specialty you choose and where you decide to practice, you can have some control over your schedule once you start practicing, so I had to keep reminding myself of this every time I missed a wedding or a funeral of a close family member.
MW: The book features female trailblazers in the surgical field such as Kathryn D Anderson, the first woman president of ACS, and Patricia J Numann, the founder of our very own AWS. Editing their stories and reflections must have been quite an experience. What did you enjoy most in the process of molding their stories together into the book?
PJ: I went through about 14 versions of the manuscript, with each manuscript changing as more contributions were added over time. Each time I received a contribution, I was thrilled, because I realized that the author had set aside valuable time, recognized the importance of this project and made this a priority.
I felt a tremendous sense of responsibility; each contributor trusted me with their essay/poem/answers to interview questions, and expected that I would bring this project to fruition.
I enjoyed this challenge, but what was even more gratifying was reading different contributions and realizing that no matter what our background, age or race, there were things that we have in common as human beings.
For example Patricia Numann (founder of AWS) writes: ‘I am often asked if I regret not having children or a spouse. I have had a few wonderful men in my life. I am sure I have saved each, and myself, an unpleasant divorce. They remain good friends.’ I can certainly identify with this!
MW: In your program for Women’s History Month, you mentioned how different the experiences were for women in surgery during the 1970s/80s as compared to now. ‘Being a woman surgeon’ features female surgeons over a range of stages in their careers, from residency to retirement. What are some of the major differences you found among the experiences of your colleagues in writing this book?
PJ: Women who trained in an earlier era had to overcome a lot more difficulties than they do today. Overt gender discrimination was rampant and tolerated, which is no longer the case.
Kathryn Anderson, the first woman President of the ACS, wrote in her essay about her experience with the Dean of Harvard Medical School: ‘I did run into overt sexism when I told the Dean of Students that I wanted to do a surgical internship and residency. I was told that women could not be surgeons, and if I even applied, the Dean would make sure I did not get any internship in Boston or elsewhere. So I did a year in Pediatrics at the Boston Children’s Hospital.’
Family support systems were not in place: giving birth to and raising children was a lot more challenging in that environment. Anderson’s essay highlights this:
‘In the 1960s it was very much okay to make sexist remarks and be overtly averse to training a woman. “You’ll only get pregnant and quit, wasting a place which could be better occupied by a man.”‘
Many of today’s surgical residents and young attending surgeons give no thought to the fact that they are women in what was once a male dominated field, simply because there are many more women surgeons around. We live in a society that is much more aware (and less tolerant) of gender discrimination. Most surgical residency training programs will not tolerate overt sexism.
MW: Today only about 21% of surgeons in the United States are woman. In addition, the number of women applying to and graduating from medical school is dropping every year. If you could identify a major turning point in the recent evolution of female physicians, to what would you attribute the decline in interest among young women to enter into surgery?
PJ: Despite the 2003 ACGME restrictions on resident work hours, residency programs in general remain far from family friendly. Residents who become parents and wish to spend a meaningful amount of time with their children, continue to find this challenging.
Not only are residency programs physically demanding, they can also conflict with the peak period of family demands. Many female residents will become mothers… at ‘advanced maternal age’, which contributes to issues with infertility and pregnancy-related complications.
Inadequate maternity leave post-childbirth makes things difficult for couples… Compared to Europe, the US has little time allocated to ‘maternity leave’ and no formal policy regarding maternity leave for surgical residents.
ENT Surgeon and mother of four, Sujana Chandrasekhar, writes in her essay: ‘There is no national US policy on maternity leave per se. There is Family Medical Leave for men and women who need time off for family medical issues, including maternity… Anecdotes reveal that in training women have taken their four to six weeks of vacation time; in the military time taken for maternity leave must be made up by extending the training period. In practice, the woman often has to come up with her own version of maternity leave and any time needed subsequently for child care, and this is often the basis for pay inequity.’
Consideration of a fore mentioned factors has resulted in a low number of females electing a career in surgery, due in part to personal choices that women make during medical school.
MW: In your book, many of the contributors express perseverance, sacrifice, and passion. From your experience, what characteristics are most valuable to the success of a woman in the surgical field?
PJ: Willpower- the desire to train in this specialty. You have to like this more than any other field in medicine in order to be truly happy doing this (practicing surgery) for the rest of your life.
Perseverance and emotional strength– there will always be times when you feel discouraged, when people say things that bring you down. You have to keep at it, and keep pulling yourself up after each failure. There is no-one at work who will keep encouraging you or praising you for working hard.
Physical stamina – the long hours can be challenging, and there are periods when you are standing / on your feet for hours on end. You may not always have the chance to have a full meal during the day, and your body needs to be able to cope with the physical demands of doing long procedures, having very little sleep on certain nights.
Breast Surgeon and former AWS President, Susan Pories, writes in her essay: ‘..Being strong is one of the most important qualities for a career in Surgery. You do need to be physically strong and have a strong ego and work ethic, just to keep going and show up every day without fail – even if the patient is not doing well, even if you don’t feel well, even if you made a mistake, even if you don’t get the promotion you want…’
MW: Many of the contributors emphasized a mentor, role model, or individual who provided them with an opportunity that aided in driving their career forward or supporting them in their pursuit. Who was that person for you and in what way did they impact your career? What traits are most important in a mentor?
PJ: Mentors are important in any profession. It is the person that matters, not the age or gender. You need to have good personal rapport with your mentor… and feel comfortable approaching him/her and asking for… advice. (Likewise, a mentor) …has to be genuinely interested in helping you and be willing to set aside time to talk with you.
I have had several mentors at various stages in my surgical training …Dr. Keith Lillemoe, Elliott Haut, and Anne Mosenthal.
I remember Dr. Mosenthal advising me to speak up about problematic issues in the workplace. If you recognize a problem, you have to speak up about it, but with the right person. A good mentor will have your interest in mind, and will advise you about how best to approach the issue/s at hand.
Book contributor, Kristy Weber (Orthopedic Oncologist, Professor of Orthopedic Surgery at University of Pennsylvania), wrote: ‘…I continue to seek out mentors at every stage of my career, even now… I have learned a great deal from my male mentors in the field. It is important to seek out mentors, not wait for them to find us. Now it is my obligation and responsibility to mentor younger women and men in the field.’
MW: What advice do you have to the upcoming generation of physicians whom are considering this career path? What are some important factors you would encourage them to take into account?
PJ: You have to want to do this (a career in surgery) and nothing else. The training period is long and takes up a significant chunk of time during your adult life. There are always exams to study for …you don’t have much control over your schedule and your priorities have to change. Be prepared for sacrifices & adjustments… or else it will make you miserable and bitter.
MW: What steps or changes do you think the healthcare profession can take to make surgery a more welcoming and even playing field for women?
PJ: Flexibility with regard to training period/duration… Child care options and breast pumping rooms on site. More family friendly times for conferences. For example, starting morning conference at 6:30am makes things difficult because most child care and pet care centers open at 7am!
Establishment of a unifying national policy for maternity leave amongst surgical residents… There has to be a complete cultural paradigm shift, and value needs to be placed on a reasonable maternity policy in the US for different professions. This has to be pushed by society, employers and mothers… and put into effect by Legislation.
Wage equality for women in surgery. Ample evidence exists to document inequality in academic Surgery departments. Once more women assume leadership positions, perhaps this will be rectified. Women are beginning to take the helm at different institutions, and differences in pay and expectations between men and women are being brought to light.
MW: Final words about the book. Anything else to share. What is your number one take away?
PJ: Mentors (male or female) are important… Cultivate relationships.
Persevere. You don’t have to be the best at something in order to do it. I knew nothing about the world of book publishing before embarking on this project. I had an idea and kept at it, despite the odds.
For more on ‘Being a Woman Surgeon’:
Review by David Hoyt featured in ACS Bulletin
Available for sale at the American College of Surgeons 2015 Conference: at the ACS Logo and Merchandise Shop near the ACS Resource Center.
Book signing event with editors and contributing authors will be held at the ACS Resource Center, McCormick Place, on Tuesday, October 6th between 1-2pm.
ACS Book Signing Guest Contributors:
Kathy Anderson, First woman President of ACS
Patricia Numann, Second woman President of ACS, Founder of AWS
Julie Freischlag, Chair, Board of Regents, Vascular Surgery, Former Chair of Surgery at Johns Hopkins Hospital
Barbara Bass, Chair of Surgery at Houston Methodist Hospital; Recipient of ACS ‘Distinguished Service Award’
Susan Pories, Breast surgeon, Former President of AWS
Marion Couch, Chair of ENT at Indiana University
Martha Zeiger, Chair of Endocrinology at Johns Hopkins Hospital
Sujana Chandrasekhar, President of American Academy of Head and Neck Surgeons
Carol Scott-Conner, Former Chair of Surgery at Iowa University
Joan Huffman, Critical Care Surgeon
Minerva Romero, Surgical Resident
Sarah Blair, Surgical Oncologist
Deborah Kuhls, Critical Care Surgeon
Helen Cappuccino, Surgical Oncologist
Claire Cronin, Breast Surgeon
Preeti R. John, Critical Care Surgeon, Editor of ‘Being of Woman Surgeon’