Coming clean…

Obvious confession:

The blog has been a bit of a ghost town for the last few months.  You’re aware, I’m aware. Twitter hasn’t been an echo chamber, but I’ve not been as present there either.

Not-so-obvious confession to most:

Professional life has been messy and hard, and I’ve struggled with how to process that. Heart and Brain provide a near-perfect summary of what it’s been like (though I’m not sure the brown stuff would have been quicksand had I drawn them).

Personal life has been fine, great even. I have professional friends whom I’ve entrusted with what has been going on and who have been amazing advocates and supporters. I have other professional friends who haven’t been in the loop on things but who have consistently reached out with a kind word when I’ve needed it most (serendipity, FTW!). I have running  friends who have stuck with me when I’ve stopped for an ugly cry in the middle of a 10K. I have friends who have been around seemingly forever who are simply there and constant and kind. While you might not think that in your late 40s your sorority sisters would provide a life raft for you, they have done precisely that. As I told one of them a few weeks ago, “ADPi has saved my sanity the last 18 months.” Mom is great and healthy.  Dad is navigating the indignities of Parkinson’s with grace. Other than Belle!’s anxiety (maybe she’s channeling for me?), the animal support team is awesome. If you look at the ledger strictly from this side, I’m incredibly fortunate, and I won’t deny that. I am grateful for all of these things every day.

Then there’s the professional side.  Lots of things on the “good” side of the ledger there too. I work with the best team that anyone could ask for.  I take care of the most remarkable and resilient people that I could ask to be entrusted to care for. It’s a rare day for me to walk through clinic or the burn unit without getting a hug from a patient, family member, or both. Outside of my clinical work, I’ve been entrusted with leadership roles that I consider both a privilege and an honor. Again, these are the things that keep me going and for which I am grateful.

And yet…there’s this body of literature (which I am in the process of contributing to) that describes why women leave academic surgery and academic medicine. That literature has become intensely personal over the last 6-9 months for me. I’ve found incredible irony that the system that I’m trying to help fix, to make more equitable, has nearly chewed me up and spit me out. While I always found it tragic that many talented women were exiting academic surgery, even 10 years or more into what should have been remarkable careers, I now “get” how this happens. I would be a liar if I didn’t say I’ve thought about walking off. I don’t do disappointment and disillusionment well.

So what?

I’m still working on the answer to this question. What I do know is that I’ve moved past taking it all personally and simply being hurt. If anything, I’m realizing how important some of the intellectual work that I started out to do a few years ago truly is and that it’s time for me to double down on those efforts. I’m focusing more on my core mission(s) and doing the things that are the most meaningful to me. And I’m reminding myself at the close of every single day of those things I am grateful for; there are plenty of them, and they help maintain that sense of purpose that I need.

If you’ll excuse me now, I’m off to tilt at some windmills.  Thanks for joining me.

Ladies, get yourself a Girl Gang

I admit that I usually try to give you food for thought then let you draw you own conclusions and applications.

Tonight, on the eve of International Women’s Day, I’m making an exception.  I’m dispensing some invaluable career advice for my women readers, particularly those in surgery:

Get yourself a “Girl Gang.” If you are somewhere where one is already in place, find out how to become a contributing member. At all costs, though, find yourself a group of women who share your commitment to excellence.

This article examining mentor-mentee sponsorship and gender came to my attention over the weekend (HT: Susan Pitt).  She astutely pointed out that this gives us an “action item” for women in surgery- to do a better job with sponsorship as more of us move into leadership roles.

This came on the heels of my friend Harriet Hopf mentioning during a breakout session last Friday that she appreciated being asked to join a “girl gang” that we already had in place at Utah with the expressed goal of promoting one another for leadership opportunities and awards. She came here from an institution with plenty of women in her department and in leadership roles, so this wasn’t something instinctive for them to do. For those of us in departments and places with a paucity of women leaders, it’s critical.

How does our Girl Gang work?  It’s remarkably easy.  We watch out for leadership positions or awards (both within and outside of our institution) that align with one other’s skills and accomplishments, and we nominate each another. Also, if there is a recognition that one of us really wants, we have an understanding that self-nomination to another group member is encouraged, and they’ll take care of the actual nomination.

Certainly our effort focuses on a group of women who are at a certain stage of their career, and those people definitely comprise the active members of our Girl Gang. However, once you start doing these things for your peers, you realize that it’s easy enough to extend your influence beyond that core group. I suspect I’m becoming a bit notorious with some of our female faculty in particular for my “nudge” emails (“You are incredibly qualified for this…you should apply…how can I help?”). My basis for doing this is two-fold, and both are factual.  First, as women we tend not to apply for things until we’re overqualified.  Sometimes we just need someone to tell us that yes, we really are worthy.  Second, it helps take the stigma away of tooting your own horn– again, something that women are penalized far more heavily for than are men.

(Closing note: While our Girl Gang has focused heavily on promoting the careers of women, we are not exclusionary and we welcome allies. I solemnly promise that I’ve put men forward for awards, leadership roles, opportunities, etc…I just focus on it less because we’re nowhere near having a critical mass of prominent women in academic surgery.  Yet.)

Greater than, less than

“Who and what do societal and cultural institutions tell you that you are?” HT: Desiree Adaway

This question came across my Facebook feed this morning; in truth, Desiree Adaway posts provocative thoughts on a daily basis. The timing of it mattered because my thoughts have been marinating about a social media storm that happened last weekend and they have finally (mostly) become coherent enough to share.

I’m going to give the short version of what happened last weekend without any screen shots, mostly in the interest of not resurrecting the whole thing AGAIN.  Here are the key points:

  • White cis male surgeon posts an irrelevant and incredibly sexist response to an article on Doximity; he apparently thinks that his response constitutes “humor”.
  • Outrage follows from many women surgeons and male allies. Outrage includes LOTS of Twitter bandwidth and screenshots being shared of his comment with his identity. Outrage also includes people identifying his Twitter accounts and putting comments/ ratings on his practice social media sites.
  • Questioning of the level of outrage occurs with concern expressed that “this could ruin his practice”. Response from those involved is essentially that he earned the judgment.

Other than expressing my horror at his remark,  I largely stayed out of the fray because I couldn’t get entirely comfortable with what any further response should be.  Some of my colleagues provided thoughtful and eloquent responses on Doximity on the thread in question.  One colleague with a significant social media presence actually tried to reach out to him (I don’t know if she was successful or not). A colleague who pled for those who were publicly sharing his information to be thoughtful seemed mystified by the backlash.

And, towards the end of all of this social media hurricane, I hope I was able to crystallize many of the issues into one thing:

The comment implied to women surgeons that we are “less than” in some way.  It’s an experience that has happened to nearly all (if not all) of us at some point in our career-  we have been told, either implicitly or explicitly, that we aren’t as good, aren’t as qualified, aren’t all that merely because of our gender. For our women colleagues who are racial and ethnic minorities, they often are told that they are “less than” twice- once for their gender, and again for their skin color.

The truth is that unless you’ve been told that you are “less than” it’s hard to internalize what that experience is like.  The truth is that when you’ve fought your entire career to not be “less than” (which has often required being “greater than”), that yes, you are going to be outraged when someone publicly indicates that simply by virtue of your chromosomal makeup that you are “less than.” The truth is that many of us are tired of those messages of being “less than,” and we’re simply not willing to put up with it anymore- either for ourselves or for those around us. It’s not cute, it’s not funny, and it’s simply not okay.

Lest you think I’m trying to justify the public shaming that occurred, I’m not, because I’m still ambivalent about parts of it.  What I am trying to provide is a window on why the response was so furious for those who don’t get it. It’s only partially about the one statement, which reflects anywhere from years to a lifetime of messaging that we’re simply not willing to tolerate anymore.  Neither should you.


Don’t need a membership to validate the hard work I’ve put in and the dues I’ve paid

I realized last week that I generally spend more time thinking that the “gender thing” in surgery is getting better, that we’re making some slow but steady progress.  As of last month, we have 8 women chairs of surgery in the US (admittedly, I’m still eager for double-digits to happen).  As of 2013-2014, 38% of surgery residents are women (critical mass!).  Surgery is now #5 in terms of proportion of women in academic departments.  In my own department, more than 1/2 of our new hires in the last two years have been women, which has changed the composition of both the division and the department substantially.  I’m proud of that because the women who have joined us are all forces of nature (in a good way) and provide wonderful role models for students and residents who want to see how to “do” academic surgery and life gracefully.

And then…I have a week like last week, a week that I understand is a direct result of being a woman surgeon who has been in practice for a decade and who now has multiple leadership roles.  At one early-morning meeting, I was the only woman at the table.  During a PI meeting for a multicenter trial, the two women surgeons present were the PI (a dear friend from the burn sisterhood) and me.  Then there was the email that went out to a leadership group I’m part of for the American College of Surgeons- and because my antenna were up from these meetings, I realized I was the only woman on the email who wasn’t staff.

Surgery still has the 2nd lowest number of full-time women faculty of any specialty documented by the AAMC at 22%.  Our orthopedic colleagues continue in the cellar with 16%.  And while I revel in those 8 women chairs of surgery I mentioned before, if you look at the number of surgery departments out there that’s not a large proportion of departmental leadership.  I want to be completely clear about the fact that I am happy and honored to be “the” woman surgeon in the room/ on the email because I do not believe I am there as a token placeholder.  I just am still sometimes surprised that in 2015 it can still be a pretty lonely place to be a woman leader in academic surgery, and I’m reminded how much I rely on the women and the men who are ahead of me on this journey to make sure that I am (1) treated equitably and (2) given the opportunities that I earn.

Surgery is less of a man’s world than it was when I started my training 18 years ago, and I am delighted at the deserved recognition that my female and minority- and minority female!- colleagues are receiving.  It’s clear to me, though, that we still have miles to go before we sleep to reach that place when my junior colleagues aren’t faced with being the “only” of a group in the room.  And when we are still faced with those situations, it remains imperative that we carry ourselves with confidence and credibility.  Most importantly, none of us can do this alone.  Hard work and helping each other- that’s how we change the world, isn’t it?

Now listening:  Kacey Musgraves “Good ol’ boys club”


Leadership perceptions and feedback: The Gender Gap

Last week this recent Fortune piece started circulating via email amongst a group of women surgeon colleagues of mine.  Included in the email chain was one friend asking, “Do you think this would be abrasive if I sent it to my Chair?”  and another lamenting about comments during resident evaluations with similar descriptors sneaking in.

For the Fortune article, the author acquired a convenience sample of performance review of men and women in tech; she found that the men were more likely to only receive constructive feedback, and the men were less likely to receive critical feedback.  The key differentiator?  Feedback based upon personality rather than behaviors.  While only 2 men received personality-based feedback, 71 (of 94) women did.  While I’ll blog soon about providing behaviorally oriented feedback, my discussion today is predicated on the previously identified “Double-Bind” dilemma that is faced by women in positions of leadership.

The 2007 Catalyst report that described the Double-Bind identified three main themes about women in leadership roles.    First, women struggle to navigate a narrow middle space between being too soft or too tough.  The bandwidth of “acceptable” behaviors for powerful women is indeed quite narrow.  Second, women leaders face higher demands for competence than their male colleagues.  I’ve said more than once that to truly succeed as a woman in surgery you have to be able to run faster, jump higher, and achieve more; being “average” is not an option for women in surgical training, nor for women in leadership roles.  Finally, women leaders are often perceived as either likable or competent.  We struggle mightily to reconcile these two descriptions, and in many ways it relates directly to being too soft or too tough as a boss.

How do we improve the perception of women as leaders?  The “Ban Bossy” campaign is probably a start, simply because it raises the issue to a level of awareness.  We mandate that evaluation is behaviorally anchored, not personality-based, unless personality issues at hand truly impair someone’s effectiveness in an irretrievable manner (e.g. a personality flaw that results in them yelling and throwing instruments in the OR- ironically, behavior that is disproportionately male). The recognition that cultures, particularly in male-dominated professions, remain conflicted about “whether, when, and how” women should exercise authority is important, but it’s ultimately only half of the battle.  We all need to speak up when we hear those subtle slights being made, and being conscious of them is the first step to generating change.

The truth is that many women ascend into leadership positions because they perceive that they have a responsibility to effect change.  To be an effective change agent, relationships play a tremendous role.  As women leaders, it’s our responsibility to remain purposive in our roles, using those leadership roles as a bully pulpit.  If we’re being placed into roles where we get an audience, we should- and must- use those roles to educate about the need for change.  That’s really the crux of leading, regardless of gender.


(Note:  I would LOVE to figure out a way to study women academic surgeon’s retention/ promotion/ tenure letter content to see if this holds in my own profession.  Anyone want to collaborate?)



Sexism and Surgery: Starting off with a bang

Did you happen to see this great piece from Emily Graslie a couple of weeks ago?

I loved this video for a couple of reasons.  One is obvious if you are familiar with her work- Emily’s video series from The Brain Scoop is a terrific, user-friendly approach to science.  The other was that I honestly empathized with the comments that Emily included in her video, as I suspect many of us do, and I loved her approach to dealing with sexism and science.  She’s no-nonsense about it and addresses the issue head on.

I thought back to my first encounter with sexism in medicine, going back to high school.  Our family’s physician, upon being told that I was leaving for college at the end of my junior year under an early admission program with intent of going to medical school, simply commented, “Well, I guess it’s okay for women to be physicians these days.”  No, he wasn’t joking.  No, he never treated me again (nor my mother).  I’ll admit- this was almost 30 years ago, and with the entry of more women into medical school many things have changed.  Or have they?

Plenty of research shows that female medical students often experience gender discrimination, and that this occurs most commonly on their surgical clerkships.  Women medical students are more likely to experience gender discrimination during their surgical clerkship than are their male counterparts and are more likely to perceive sex discrimination, typically from male attendings and male residents.  My own recent work has shown that female surgeons and residents are more concerned about the presence of sex discrimination in the workplace than are their male colleagues, and that they perceive this discrimination as a barrier to advancement in academic surgery.  Clearly this problem isn’t just one of the 1980s; it persists in modern-day medicine.

Stories of incidents can be gathered easily enough from many sources; in one night on Twitter I was able to acquire stories ranging from colleagues or patients refusing to address a woman physician as “Doctor” to women being told they are “too nice” to be a surgeon, or being told that they are allowed to do more in the OR because of their looks.  While the overt sexism remains, many institutions are starting to consider the role of “implicit bias,” those subtle behaviors and actions that manage to undermine the leadership and credibility of any minority group.  Yes, women surgeons are still a minority group.

So back to where we started, with Emily Graslie’s video.  We have a problem still, and what we need is a solution.  We can start by speaking up when we hear sexist comments- particularly those of us who are a little more senior and are therefore more empowered because of where we are in our careers than our younger colleagues.  We need the buy-in of our “enlightened male” colleagues to support the career development of talented women.  We can also work within our institutions to increase awareness of implicit bias in hopes that this will have a durable impact.  And, as Emily Graslie stated, “We need to make sure we’re making it possible for people of all genders to feel acknowledged for their contributions and not feel held back by something as arbitrary as their genetics or appearance.”  That’s simply wise advice for life.