Category: Women Surgeons

A Leading Woman Surgeon Speaks the Truth about Women in the Profession 

Originally published on heelskicksscalpel.com

Any one who follows this blog on the nuanced life and career of a woman surgeon  should watch this. In its entirety.

http://academicsurgicalcongress.org/aas-2017-president-address-caprice-greenberg-md-mph/

It is the Presidential address delivered recently by Dr Caprice Greenberg to end her term as President of the Association of Academic Surgery. She speaks with clarity and conviction on a topic of importance to both men and women across generations of surgeons. She provides data, vivid examples, and eye opening analyses about how and why women are professionally held back, not just in surgery but across specialties and other professional roles.

An Open Letter to Young Women Considering a Career in Surgery

Originally posted at heelskicksscalpel.com

Dear Young Woman Considering a Career in Surgery,

It was lovely to meet you the other day. Many times a month, a young woman just like you comes to me with similar interests and concerns. “I really love surgery,” she says, ” But I am afraid of the lifestyle and I really want to have a family.”

Oh, and thank you for also inviting me to speak at your seminar the other day on Women in Traditionally Male Dominated Fields. I have been speaking at similar panel sessions since 2005 when I was a bit of a novelty at my training program as a clinical PGY-4 with an infant daughter. Your collective curiosity on what my life must be like is of great interest to me because to me it’s just my life. It’s the only reality that I know because, like you, I was young (just a few days into my 25th year, just 5 days into my first ever surgical rotation) when it occurred to me that I really loved surgery. It was unexpected; but every day since then (from the remainder of that MS3 rotation, to my sub-internships, to my years in residency, to research and clinical fellowships, and to these past 6 years on staff) I have crafted a reality, as tenuous as it is, that works for me and my family in any given moment in time.

And I am here to tell you that you can do the same too if you, in your heart of hearts, can think of nothing more exciting than surgery as your professional passion.

People outside of surgery will tell you that it’s a career that is too hard to integrate with family life. They are correct that it is generally harder than other fields in medicine; but, ask yourself if you truly want a career in general pediatrics, or dermatology, or invasive cardiology or anything in between. If the answer for whatever alternate field(s) you are considering is no, then no matter how many fewer hours your profession requires, no matter how much more flexible those hours may be, your family will be left with a present, well-rested, yet bitter wife and mother.

[NB: I use the word integrate very purposefully here. Anyone from a demanding profession, surgery or otherwise, who tells you that work-life balance is possible is conning you. Your life will never be in balance. Something will always have to give: your work, your family, or yourself. It’s in how you integrate these things in a shifting, fluid professional and personal lifetime that you will craft your own reality.]

 

The same can be said of those who encourage you to enter surgery training but then offer that you may consider a career in breast surgery or start an exclusive vein clinic or choose some other presumably less time sensitive and/or less time consuming surgical practice to balance your professional work with your desire to have a family. Again, ask yourself  if you can truly be happy in such a practice. (I personally would be bored with only a few kinds of procedures in my armamentarium and the absence of physiologic chaos; but everyone is different.) You may not know the answer until you are well into your training; but, choosing a medical specialty in the first place, or a surgical subspecialty in the second, simply because you presume it will be easier for family life is fraught with potential for professional dissatisfaction. I promise you that professional dissatisfaction will always stand in the way of overall family life satisfaction. Always. Forever.

Finally, as hard as it might be to envision yourself as a surgeon who wants hobbies, and a spouse, and a smoking hot body, and children of your own someday,  remind yourself that divorced parents, widowed parents, disabled parents, parents with deployed military spouses, and parents with far fewer socio-economic resources than practicing surgeons, and trainees for that matter, somehow get it done. Every life has it’s particular challenges when it comes to parenting but surely being a surgeon is not the most insurmountable of them all.

So think long and hard about alternatives to surgery; but choose one only if it speaks to your professional soul. No matter what career you choose, you will likely spend more time at work than on any other aspect of your life be it parenting, self-care, love-making, you name it. Therefore, it is critically important that your choice of career light the fire in your belly to show up every day leaving behind, at least temporarily, everything else including your children. Because one thing is for sure: when you are practicing surgery, your head needs to be in the game. You cannot be distracted by guilt about not being with  your family or about delegating some of the more mundane aspects of childrearing or homemaking to others. You must love the work enough to drop the guilt and create practical solutions to raise your children and provide them with a safe and loving space in which to grow while reimagining whatever stereotypes you hold about being the perfect parent.

Because you know what: There is no such thing as a perfect parent, surgeon or otherwise. So there will never be any point in beating yourself up about it. Know that you will love your children more than you could have ever imagined loving anything, including surgery, but that you will still be a great surgeon. The two are not incompatible, but it takes some effort and creativity.

So, now that I have convinced you to choose the career of your dreams here are some thoughts on the effort and creativity it will require.

Do not underestimate the importance of choosing a life partner who gets the soul inspiring nature of your career choice. He/She may be another surgeon, or physician in another specialty, or a non-medical professional, or a skilled laborer; it doesn’t matter as long as your life partner understands that, when you are tired from the long days and nights, or sorrowful for the lost lives, or otherwise distracted, it is not because you love work more than you love them. Bottom line: as awesome as any career may be there is something messed up about your priorities if you really would choose work over loved ones. So your life partner needs to get that you aren’t messed up; you just have a demanding career.

With the demands of that career comes the need for a real partnership in planning life. That doesn’t mean a 50:50 split or a 80:20 split or anything conscribed; it means a constant openness to splitting however it needs to be split or not splitting at all to ensure that life outside of work happens. It means making the most of precious few waking moments together through physical contact and communication. It means having a very user friendly calendar/shared to-do system. It means providing feedback without judgment for the practical things in life and making space for shared emotional and spiritual needs. If you find yourself paired up with someone who can’t work with you on life this way, then consider dumping him/her. Seriously, it’s not worth trying to make them happy if they just don’t get this hugely important part of what makes you whole.

[NB: If a life partner is not your thing or things just don’t work out, that’s okay. The same principles of reimagining, outsourcing, and dropping the guilt apply. It’s just that your village, or metropolis as may be the case for some surgeons, has a different population structure.]

 

Choose your job based on both professional and personal needs. Training is finite and there is always an end from which to take on a new direction. However, even though many surgeons change jobs, think of your job as your forever job so you don’t accept a situation which will turn out to be toxic for you. Choose partners who will have your back, and you, in turn need to be willing to have theirs. Choose geography that at least satisfies some of your desires for commute time, distance from extended family, lifestyle, weather, etc. and makes life easier. You can’t blame surgery if your long commute destroys your soul, or if having your parents thousands of miles away makes you sad, or if humidity, piles of snow, or whatever your most dreaded weather phenomenon is drives you crazy, or if it takes a flight to get to your favorite past time of hiking, biking, skiing, etc. That’s on you and the choices you have made as a surgeon and not on the profession itself. Finally, choose a practice type and setting that will make you excited to show up every day (for me it was research, teaching, and a level 1 trauma center in a university based system).

If you do have a life partner and working is important to him/her, don’t pick a location that will railroad his/her career. As much as being a surgeon defines you, your soul mate is similarly defined. Please don’t create a situation where he/she will be susceptible to resentment about having his/her professional goals squashed. (I’ve been there. It puts a real strain on a marriage. It sucks.) It’s already hard enough to be paired up with you, a surgeon. Both your jobs may be equally demanding, or one may be more demanding; it doesn’t matter as long as together you negotiate a mutually satisfying life-long give and take about who prioritizes what and when depending on the stages of your respective careers and the ever evolving needs of your family.

When is comes to family, do not waste too much mental effort over-thinking when you should start it. Fertility, along with finding the right person with whom to test your fertility, is a complex and unpredictable thing. No pregnancy is guaranteed to proceed smoothly. Given these inherent limitations and unknowns, along with the demands of a surgical career, there is no perfect time to start a family. This is about as certain as death and taxes. I will spare you the perceived pros and cons to having children during training compared to while in practice. Just know that every time period poses challenges and every passing year makes infertility more likely; so if you are ready in your personal life to try to get pregnant go for it; because, if you choose to wait for a perfect time, you will be waiting for a very, very long time.

And, if having children in a traditional sense is not possible for whatever reason, there is also no perfect time for assisted reproduction, adoption, or surrogacy either even though the salary increase a staff surgeon or faculty job may be necessary for these options. In the end, whatever approach to becoming a parent will be required,  you will figure out a way to get through the challenges because you will have mentally and emotionally committed yourself to the idea of being a mother who also happens to be a surgeon.

[NB: If you choose to not have children-by this I really mean choose as there are myriad other mishaps of life and physiology that prevent women who want to be mothers from becoming mothers-, please do not make that choice simply because you want to succeed as a surgeon. You will never forgive yourself. Not ever.]

 

When it comes to family there are various options to manage childrearing and homemaking. A nanny, two nannies, an au pair, daycare, a nearby grandparent, a neighbor who is a stay-at-home parent, or various combinations of these may be required to keep your children loved and safe. It’s different for every family and I promise you that you will find what works for  you. It will be a source of stress but it is doable. And, no matter how much time others spend rearing your children on your behalf, those kids somehow know that your are their mother, that you love them in a way beyond any other love, that you would give your own life if it would save them, and that you also happen to be a busy surgeon. Trust me. They will. And, they will be really proud of the uniqueness of their surgeon mom. They really will.

When it comes to your home, be it your 600 sqft rental in residency or your 2500 sqft grown up home in a cul de sac, outsource any jobs you and/or your partner simply do not enjoy. I cannot emphasize this enough. You will, in fact, have precious little time with your family. Ask yourself how you want to spend that time. Do you want to being cleaning and doing laundry? Or do you want to plan a family outing? If hopping on your John Deere and showing your lawn whose boss on your Saturday off is a fun activity for you, then by all means go for it, otherwise someone else will be happy to mow your lawn for a fee. If you love cooking, knock yourself out planning, shopping for, and preparing gourmet meals along with the associated clean up, but if you don’t then find a meal service. You get the point. If you don’t love it and it can be done by someone else outsource it. Even on a trainee’s budget you should strive to rid yourself of any household obligations you abhor. (For me the $55 spent every other week during residency for cleaning was well worth never having to spend a day off cleaning a toilet and now the extra hours we pay our nanny to do all of our laundry has spared me a monthly power weekend of washing and folding 10 loads of laundry because we just could not get to it all with the many kids’ activities, call nights, etc. that prevent daily washing.)

Remember: as little time as you will have at home to spend with family, you must also prioritize time for yourself. Don’t expect it to just happen. Just as you schedule elective OR cases, you must schedule elective you time. It may not happen very often but if you don’t take the time for self care in the midst of the stresses of the job and the stresses of parenting you will be cranky and miserable to be around. How you spend time away from family when you have so little time with them will change over time and you may even develop hobbies incorporating your family (we have taken to family bike rides and kayaking trips as the kids have gotten older to combine wellness with family time) but remember to schedule things that feel completely selfish to you. A girls’ night, date night, a pedicure, reading a trashy novel, going to a Zumba class during bath/bedtime, or whatever you enjoy is totally not selfish but you will feel that way; so a good barometer for whether or not you are making time for self care is how selfish it feels. My advice is feel selfish at least once a month.

[NB: If your selfish thing is not a fitness thing then you have to also figure out how to fit that in because your patients and your family need you to be healthy.]

 

Being a surgeon is not incompatible with being a good wife, mother, athlete, whatever else; it’s just trickier. But, if young women keep being scared away from surgical careers then these same fears will linger generation after generation; we will never achieve a critical mass of women surgeons in the profession who can set good examples for one another and for future surgeons. With the same focus we apply in the OR and the same organization we bring to rounds and the same compassion we bring to patient encounters, we can create a life strategy that overcomes these perceived barriers for both a happy family life and a successful surgical career. The barriers will change depending on the stage of the career you love so much and the needs, wants, and development of what and who you love outside of work; but, take it from this surgeon mom: they are barriers to be overcome, not shied away from.

I am pretty sure that’s why you showed up at my door and asked me to that seminar, to make what seems impossible to you at the moment seem possible. Let me tell you: if I can do it, you can too. Go forth, be a surgeon, be a wife, be a mom, be good to yourself and craft a reality that works for you. Then, pay it forward so that someday these meetings and seminars might be rendered obsolete.

Sincerely,

@surgeoninheels

Not just a token surgeon-mom-wife-runner

PS. Here is some inspiration. Your potential in surgery is limitless. https://www.womensurgeons.org/in-practice/leaders-in-surgery/

PPS. The Association of Women Surgeons is an invaluable professional organization whose goal is to: ENGAGE current and future women surgeons to realize their professional and personal goals. EMPOWER women to succeed. EXCEL in those aspirations through mentorship, education and a networking community that promotes their contributions and achievements as students, surgeons and leaders. https://www.womensurgeons.org/

PPPS. I have been fortunate for the last 10+ years to be a part of the American College of Surgeons Women in Surgery Committee working towards improved gender parity, opportunities for professional development, and better work life integration in our careers. https://www.facs.org/about-acs/governance/acs-committees/women-in-surgery-committee

Reflections on ‘The Great Work Life Debates’

Originally posted at heelskicksscalpel.com

Last week I, along with nearly 10,000 other surgeons of various specialties, attended our profession’s premier annual meeting, the American College of Surgeons Clinical Congress. Of these, some 50 attended a panel session I chaired called the “Great Work Life Debates.” Embed from Getty Images

Quite honestly, I was so relieved by the turnout.

Every conference needs to have a last day and the desire of attendees to duck out before that day (especially given work life issues such as not spending another night away from your nursing infant or not missing another OR day) is totally understandable. Nevertheless, some sessions will be assigned the dreaded last session of the last day.

So yes, leading up it, I was filled with dread that the co-moderator, six speakers, and I would be the only people in attendance. I was delighted to be wrong.

Embed from Getty ImagesWhy did these hearty surgeons stick around for this session? Why were there so many men (also much to my delight) in the audience? Were they there searching for the right answers to the Great Work Life Debates? Did the panelists even have any answers to provide?

The committee sponsoring the session was the American College of Surgeons Women in Surgery Committee (WiSC). I would posit, however, that in the modern era issues of balancing the demands of work and the demands of life at home (or as I like to think of it, the joys of my profession with the joys of my personal life) are not limited to women surgeons. WiSC just happens to have taken the lead in bringing such issues to a format that I imagine years ago was limited to the best technique for such and such procedure or what’s new with such and such surgical disease.

Just because male surgeons of a particular generation may have propagated a particular stereotype about how they valued or prioritized their work relative to their life outside of work does not mean that the male surgeons of today fit into that stereotype. Just because women are increasingly represented in surgical careers does not mean that socio-cultural norms for women surgeons’ roles outside of work have dissipated. An so, I believe that both men and women sought out this session because more circumscribed professional meetings are less likely to address non-biomedical topics even though concerns for wellness both in and out of work—wholeness as a person inclusive of professional and personal needs—transcend surgical specialties, and yes even gender.

Surgeons, irrespective of specialty, gender, or sexual orientation, who haven’t found a life partner, may be prone to wonder whether they should marry another surgeon or seek a non-surgeon with whom to spend the rest of their days outside of the hospital. Those who do have partners, may wonder how to make it work for the long term irrespective of their lifemate’s profession. Surgeons of both genders who do not have children may be experiencing deep inner desire to start a family or may be frustrated by the perception that choosing not to have a family is somehow not acceptable. And, those with children surely have days when inevitable stress of modern day parenting leave them wondering why they did it just as they surely have days when every worry, whether it is about work or home or world peace, is dissipated by boundless giggles of a toddler or the unexpected talkativeness of an otherwise moody teen.  Surgeons whose careers or family situations throw childrearing into chaos must consider the pros and cons of care rendered by nannies in the home or childcare in the diverse, highly regulated environment provided by out-of-home daycare. And, no matter what option or combination of options they choose there will be less than perfect days when both work and child(ren) will be needing you at the exact same moment.

Surgeons—not male surgeons, not female surgeons—but just surgeons sharing similar work life concerns came together to listen to these Great Work Life Debates. These points (and barring time limitations we could have point/counterpointed countless other work life dilemmas) were argued by women with different life experiences, different perspectives, and different debate tactics but both the pros and the cons resonated with the women and the men in the audience who it seems, based of their feedback thus far, simply desired a venue that acknowledged that we surgeons are in fact humans—we have lives outside of work, lives that are made ever more complex by long hours, possible lives at risk while we are working, and myriad other professional demands (which include, by the way, attending such meetings for so many hours/year for continuing medical education credits).

acs

So what was the bottom line for the men and women who stayed for one of the last sessions on the last day of our conference? Not surprisingly there wasn’t one.

Thus, while marriage is challenging no matter what your day job is (if it wasn’t they would just call it dating forever!) you can’t always control who you fall in love with; a loving, supportive spouse will make your work more manageable whether he/she understands to a tee what you go through every day work or has a vague understanding of why you sometimes come home tired or distracted or not at all. But you too have to be loving and supportive in return and that rendering of love and support may take different shapes.

While children come with the stress and anxiety of raising them along with the costs (~250-500k per child up to 18 years before including the costs of college according to one debator) raising them also brings the joy of nurturing, chubby cheeks, Disney World vacations, etc. but choosing to be childfree also brings many joys (e.g. unfettered travel that need not involve animatronics, increased focus on nurturing your relationship with your partner, increased time to pursue personal wellness) that parents often forego or delay.

Finally, both a nanny and daycare can provide a loving, caring environment replete with both educational and emotional growth while you are working but relying on a single individual may limit diversity and back-up options while relying on daycare increases the day to day burden of prepping the child(ren).  Either way, your children will know you are their parent and they will love you back even on the days when things don’t go smoothly.

My hope is that listening to a spirited debate on these issues related to the dilemmas of partnering, parenting, and childcare will have enabled the audience thoughtfully consider what matters to them and various strategies to help alleviate the strain between the joys of work and the joys of personal life. While there are no perfect solutions (and to strive for a vision of perfection is to set yourself up for disillusionment in your choice of life partner, your decision to (or not to) have children, or your childcare preferences), it’s about crafting a reasonable approach to your own great work life debate based on self-reflection and practical needs.

A decade of mommy guilt

Originally posted on heelskicksscalpel.com

My first born turned a decade old the other day. Surely hitting double digits was a huge milestone for her. For me it was a time of reflection on how fast the time has gone by and how much of her childhood I missed in the last 10 years. I want to close my eyes and turn on the reel of memories I have stored away of the day she rolled over for the first time, her first steps, losing her first tooth….. The list goes on and on.

Truth is, I was gone for most of those other milestones in her young life. It wasn’t just the firsts either. There are countless pediatrician visits, parent teacher conferences, sporting/dance events, etc. that I just could not make. Though I know better than to feel guilty anymore about the extra stuff that I might have taken on as a mom like being a coach or a troop leader or a school volunteer, what I wouldn’t give to have been able to console her when she got her shots or to be the one she ran to when she had a nightmare (I am sure she figured “Why bother, Mommy’s side of the bed is empty most nights.”)

While for much of the time I was, as this now wise young lady believes, “taking care of people,” there were plenty of times when I was simply busy doing the other part of my work where people’s lives were not in my hands (e.g. research, education, volunteer efforts for professional societies). While the trickle down effect of each of these efforts will certainly someday improve the care people receive, the guilt of being away from my child–the most amazing thing I have ever accomplished (albeit with some help from my remarkable life partner)–has been heartbreaking at times. Healing the heartbreak has been daunting. I am talking about healing me let alone the lingering effects my absence may have on her. (Luckily she has a great dad and amazing grand parents to counteract my absences.)

TIps for Healing Mommy Guilt found at http://dailymom.com/nurture/beating-back-mommy-guilt/
Tips for Healing Mommy Guilt

I have done more and more, in particular after finally getting my first grown up job in her 7th year of life, to assuage that guilt–to be there as much as I can.  When she was in preschool, everyone assumed that my husband was a single parent. I was that out of the picture. Entering into the picture has meant asking my parents to sacrifice daily contact with their grandkids so that I can have a more favorable commute that theoretically frees up times for the kids (alas most activities, events, and meetings still tend to occur between 6am and 6pm and I remain the forever absent mom). It has meant asking my husband to do every more to sustain our household so that I can get in some mommy time (i.e. he will do the dishes, bang out a few loads of laundry so I can maybe, just maybe be awake enough to read a chapter or two to my child). It has meant allowing myself to fall behind on the things where a life is not on the line or where someone else is not holding me to an expectation (I can’t ignore my billing or my employer gets on me, I can’t not proofread a paper that I told someone I would review for them, I can’t put off a grant that has a prescribed federal deadline but I sure can put off my own internal deadlines). In the end, an extra night or weekend of work will sort everything out. I am hardwired to get the job done, so I will. But every long day, every night, and every weekend of getting it done will come at a cost, another empty reel in the memory bank of my daughter’s childhood and, unless I pay re-calibrate the push and pull between work and family, I will find myself at her 20th birthday still ridden with guilt.

I attended a faculty seminar on work-life balance a couple of years ago. Everyone entered that room with a ton of baggage related to their inability to balance work and life with work seemingly winning every time. The upshot of the seminar was essentially: lose the guilt (if you are at work don’t feel guilty about not being at home and if you are at home don’t feel guilty about not being at work). While I have tried especially hard since then (not that I needed to be told but it was a good reminder at a time when I was really, really buried in my work life) to sneak in quality time with my daughter (and her baby brother but I will get all sappy about him when his birthday rolls around) the problem is that it has felt just like that–sneaking around. When spending time with your child feels like sneaking around, the Mommy Guilt has gotten out of hand.

The decade of Mommy Guilt I have built up won’t dissipate easily and surely my profession can move the dial a bit (both surgery and academics) so both men and women don’t have to “sneak around” so much when they choose life over work. But in the end, rather than letting the Mommy Guilt mount in the years to come, I am resolving to feel Mommy Pride for each of the moments that do make it onto the memory reel in my daughter’s teens. Guilt won’t make the reel amazingly devoid of gaps so why bother. I am better off feeling pride in the moments of parenting I am super savvy enough fit in given the nearly (but not completely) all-consuming career I have chosen (and do deeply enjoy).

So yeah, I am pretty proud that I proactively requested a day off over a year in advance so that I could be at my daughter’s birthday party, and that I might have put off writing a manuscript late one night to brainstorm venues and a guest list with her.  I ended up delegating the evites, the cupcakes, booking the actual venue to my husband (I could blog pages and pages about how amazing this guy is about getting it done at home while I work and work some more) but I wasn’t entirely absent and that is an accomplishment worthy of pride rather than guilt.

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