It’s lonely at the top

Some of you may be aware that I’m about three years into a two year project** examining barriers to careers in academic surgery; in its current form, the project focuses on women in academic surgery.  In what isn’t likely to be a spoiler alert, while some gender-specific factors are identified, the preponderance of what we’re seeing is both systemic and cultural, therefore impacting the pipeline in general, not just for women.

The major gap in the information that we have to date involves hearing the stories of those who choose to leave academic surgery. I’m aware of this limitation and have plans to address it, which means that this Sunday Review from the New York Times struck a special chord with me. The glass ceiling is real in business and in academia, and while the need to fix it is widely acknowledged, we still don’t entirely understand its etiology. What we do know is that theoretically it should be less of a pipeline problem than it was 20 years ago. In spite of more women entering surgical training, a recent study shows that gender parity in academic surgery will not happen in my lifetime.

Advice on how to get ahead, while well-meaning, doesn’t serve to fix the deeply embedded cultural issues. Preaching to already high-achieving women about how to fix themselves is likely too little, too late, and engages to a degree in the “victim blaming” I’ve been known to rail against when discussing burnout.

Interestingly, there’s a tie between the loneliness described by the high-achieving women in the Sunday Review and burnout. While the basis for loneliness is complex and is only in part attributable to a sense of “other-ness” in those who aren’t historically represented in leadership roles, it quickly becomes obvious that it plays a substantial role in burnout…burnout can result in exit…exit results in loss of (diverse) talent…you can see the downstream effects here.

I’m offering myself some thought challenges that I want to extend to each of you (yes, you, as you say, “I’m not a leader!”).

  • What if today you tried today to bring more compassion to your team through a kind word or supportive act? Hint: “Thank you” counts as a kind word. If you can be specific in that thanks, it’s doubly valuable.
  • What if today you worked to get someone connected into a network of some sort? Confession: being a “connector” is one of my FAVORITE things to do!
  • What if today you helped someone celebrate a “win,” no matter how small that win feels- or if you celebrated your own? If you’re on Twitter, please share your own with #WednesdayWins.  We need for this to become a “thing” to remind ourselves of what’s going well.


**Not actually joking about the time line.  Anyone who has experienced the joy and misery of qualitative research and grounded theory understands exactly what’s going on here. 

What if it’s not our fault?

“If we are to achieve a richer culture, rich in contrasting values, we must recognize the whole gamut of human potentialities, and so weave a less arbitrary social fabric, one in which each diverse human gift will find a fitting place.” – Margaret Mead

In the last week I have found myself in the midst of two interesting Twitter conversations, both with a similar underlying theme regarding the impact of culture and how we seem to underestimate its impact on the individual.

Here’s conversation #1 (remember to start reading at the bottom):

I particularly loved the empathy behind the idea that the term burnout implies that it’s a personal choice. While we’re getting smarter about identifying organizational factors that drive burnout (ahem…my group’s call schedule), there still seems to be this idea that if you’re struggling with burnout, you’re simply not resilient enough. Reality check: I’ve witnessed some people who are remarkably resilient struggle with burnout, and without exception they have been in a work environment in which they had little to no control. Yes, I understand that individual characteristics may predispose people to burnout or may limit the impact of a dysfunctional system upon the individual…but at the end of the day, victim blaming and pretending it’s ALL about resilience?  That’s simply feeding the dragon.  It’s not helpful.

On to Twitter conversation #2:

(The link that you can’t see from here is this recent piece in the Atlantic.)

So, maybe it’s not about biological clocks or because we’re not ambitious enough.  Maybe, just maybe that ambition is situational…and that if we’re in an environment where we see other women hitting their heads repeatedly against the glass ceiling,  or we experience that ourselves, we adjust our expectations accordingly. Or we leave when we realize that we shouldn’t have to adjust those expectations because there isn’t anything wrong with them.

It’s time to stop telling us to try harder, or telling us that we can’t be mothers and academic surgeons, or telling us that we don’t measure up because we don’t know the 100 extra double-secret and unwritten criteria that you’re using to evaluate us. Most importantly, it’s time to create a culture in which we feel valued and supported, not because you tell us that we should, but because we actually are.

What if it’s really not our fault?

Rule Number 5: Everyone’s an equal fighter

PSA: It’s Women in Medicine month.  I would be completely remiss if I didn’t have at least one feminist post this month.

And a warning: Have you heard of Feminist Fight Club (FFC)? No? I’ll warn you that there’s some salty language over there, so if you’re easily offended it may not be for you. That said, it’s a how to guide for fighting sexism with plenty of data.  It’s my current read, and I’m loving it. It’s also providing me with some inspiration.

Before you question if there’s a need in surgery and in medicine for something like FFC, I assure you that there still is. Although women have been half of all medical students for a decade or more, our gains in academia and leadership simply aren’t matching the numbers there- and it’s not simply a time decay phenomenon.  Women enter academics at a lower rate, and our attrition rates are higher.  Even with our equivalent levels of training, we are paid less. These are all simple facts. So, yes, while FFC isn’t written about careers in medicine, it’s no less applicable in our professional world.

Bennett divides her stories and facts into a few key areas:

  • Know the enemy (for the record, it’s patriarchy, not men in general)
  • Know yourself
  • Booby traps (a/k/a “office hospital politics”)
  • Get your speak on
  • F you, Pay me
  • WWJD- What would Josh (a really average white guy) do?

Interestingly, several of these concepts, particularly those around effective communications,  align with key features of Executive Presence, which were published in a more “formal”/ professional  manner.

One of the bits in Feminist Fight Club that resonated the most with me was one of the ground rules for Bennett’s group- no mean girls. We are all in this together, and if we’re busy fighting with you, we can’t get the work done.  You’re a distraction. If you’re a mean girl, we’re still fighting the patriarchy on your behalf.  We’re just not including you in our meetings about how we’re getting it done. Work this important requires a drama-free zone.

I’m going to borrow Bennett’s questions that she includes as discussion topics for a Feminist Fight Club meeting, and I’m going to encourage you (reader) to think about them, to develop your own set of responses.  Note: Men and Women both welcome to play!

  1. Where do you want to be in 5 years?
  2. What’s your biggest pet peeve at work?
  3. What career goals do you have, and who can help you to achieve them (include yourself on the list!)?
  4. When is the last time you were proud at work? Why?
  5. (For those who read the book) Try out a FFC ninja move, keep notes on how it worked, and report back to some like-minded friends.  Guys, you also have FFC ninja moves that start on Page 239. We’re all in this together.

You’re not crazy.  It is real. And being aware of it is the first step to solving the problem.

Apropos of nothing at all: The best piece of advice appears on page 103- Take the nap. 


We can’t wait

Let me start with some simple facts.

Female surgeons have the same training as male surgeons; we go to medical school, we spend the same amount of time in residency, we sit for the same board exams.

However, if you compare the earnings of full-time female surgeons to our male colleagues annually, we make 24% less.

Here’s a question for you: Do you believe that this is right?

The reality is that pay equity is a family issue; when women aren’t paid equitably, over our lifetimes we make anywhere from $700,000 to $2 million less than men.  That’s not ideal for the economy, and it’s definitely not good for families. Pay equity also results in a more engaged workforce.

It’s important to me as the current president of the Association of Women Surgeons to make people aware of this pay equity gap; everyone I have mentioned it to is surprised by it, and since we didn’t train 24% less (or take boards that were 24% less intensive) no one seems to think this is okay.

And while awareness is important, it’s also important to understand what you can do about pay parity.  The AWS will prepare a white paper on this later in the year (stay tuned!) but I didn’t want to leave you without some strategies to get started.  Here are a few ideas, compliments of the AAUW.

  • Ask for, or generate, a workplace pay audit.
  • Encourage policies that support equity
    • Flexibility and family-friendly policies for men and women
  • Seek better benefits
    • Family and medical leave, health insurance, emergency family care, and scheduling meetings that don’t intrude on family activities benefit everyone
  • Write a letter to the editor or op-ed, or ask for a commentary time on local media

Other things you can do:

  • Educate yourself- Catalyst has great information, as does Evelyn Murphy’s WAGE project
  • Sponsor a workshop to educate your mentees and your peers about negotiation techniques
  • Share this blog post!
  • Options are limited only by your imagination!

April 12 is Equal Pay Day in the US; for those not familiar with the idea, it’s the day of the year when women’s pay from the last year plus the first 3 1/2 months of this year equal what men made last year. I hope that you’ll use this week as an opportunity to speak out and to talk about #fairpay. It’s time, and we simply can’t wait.



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”