P&S Journal: Spring 1995, Vol.15, No.2
Women in Non-Traditional Residencies
By Kristen Watson
Some people tell Karen Moody'95 they think it's wonderful that she has decided to pursue a career in medicine, but maybe she should try a specialty less demanding than general surgery.
This way, they coax, she would not have to work as hard or expose herself to the same degree of illness. These same people often ask her whether she intends to have children and, if so, what she plans to do about her career when the time comes to start a family.
It's a common scenario.
Female medical students say they face these questions regularly, still having to prove themselves capable of handling demanding careers and offering assurances that their personal lives won't interfere with their work. These questions intensify for women who choose surgical specialties.
Approximately one-third of P&S's Class of 1995 is female: 57 of 166. Some of the women in the class are planning careers in fields not traditionally pursued by women-neurosurgery, general surgery, orthopedics, and urology.
Almost two decades have passed since Dr. Nancy Epstein, a neurosurgeon, graduated from P&S in 1976, but she says the attitude toward women in medicine is basically the same as it was when she was a student. "Not enough has changed," she says.
Dr. Epstein was the 12th woman in the United States to become a board-certified neurosurgeon. After 14 years of working in a private group practice on Long Island, Dr. Epstein is glad to be-finally-a senior member of the group, handling more than 300 cases each year.
But Dr. Epstein's climb to the top wasn't easy, and she faced her share of discrimination along the way. Some professors actively discouraged her and, along with some of her male colleagues, teased her about needing power tools to handle the same workload. But Dr. Epstein combated this negativity by winning over each of her colleagues one at a time by proving her abilities.
A sizable gap remains between the number of men and the number of women in medicine, especially in surgical specialties. Even though several women in the Class of 1995 plan to enter non-traditional residencies, Dr. Epstein says "wait and see" if the numbers remain the same by the time they have finished their residencies.
But the women planning careers in fields that are traditionally considered "male territory" are more optimistic. The only woman in the class to match for a residency in neurosurgery, Judy Huang'95 found the intellectual challenge and stimulation provided by the specialty irresistible. She says the need for attention to detail, concentration, and dedication required led her to apply for Columbia-Presbyterian's neurosurgery residency program. She also credits an interest she has had in neuroscience and the nervous system since she was an undergraduate. She considered pursuing a career in either general surgery or neurology but found neurosurgery a career that would satisfy her interest in both specialties.
According to the Association of American Medical Colleges, only 23 out of 588 neurosurgery residents in 1994 were female (3.9 percent). Ms. Huang will be the third female neurosurgery resident in the history of the medical center. Dr. Robert Solomon, associate professor of clinical neurological surgery and director of the neurosurgery residency program, says some female P&S alumni have done neurosurgery residencies elsewhere, but not many. "Only one has done so in the 15 years that I've been here," he says.
Although not as rare a choice for women as neurosurgery, general surgery is also considered a "new frontier" for women, who represented only 232 (7.2 percent) of the 3,204 general surgery residents in 1994.
To some, a general surgery residency is just the first step toward a career that requires further training. Simona Pautler'95 has applied for a residency in general surgery with hopes of later pursuing a career in plastic surgery. "Plastic surgery can be very creative," she explains. "It allows you to restore and repair what nature has given as well as what chance or misfortune has taken away. Plus, you can go back years later and readily see the results of your work."
An interest in medicine should have been second nature to Ms. Pautler, the daughter of an anesthesiologist. But she says her father's career did not have an immediate influence on her. "I took the long route," she says. After earning an undergraduate degree in international relations, and considering law school, she decided to switch career paths and pursue medicine. She expresses confidence in her choice. "I often speak with my friends in law school, and I realize, although they seem quite happy, law was not for me."
The levels of encouragement and discouragement for her from friends and family vary. Her father is very supportive, yet his colleagues often ask him, "Why does your daughter want to become a surgeon? She's going to run into so many stumbling blocks." But that kind of talk doesn't discourage her. "I'm looking forward to working with physicians who will accept me for my abilities," she says. "Probably the biggest 'stumbling block' will be combining family life with career life. I'm sure I'll encounter many difficulties, but with a supportive husband and outside help, it should all work out."
In the residency interviewing process, Ms. Pautler has found interviewers generally very accepting of women in medicine. "Only once I was interviewed by an older physician who took one look at me and said, 'This isn't pediatrics or radiology, are you sure you want to do this?' After the interview, when I held out my hand, he shrugged his shoulders and reluctantly shook it."
An interest in anthropology, particularly the effects of healing, sickness, and illness on cross cultures, led Ms. Moody to pursue a career in medicine. The efficiency of surgery and the psychological aspects of patient care appeal most to her. She is especially interested in observing how people help each other and themselves in the face of fear and death.
A violinist, Ms. Moody also believes that her hand-eye coordination will be put to good use in general surgery. "I'll have the opportunity to use all of me in surgery," she says.
Ms. Moody believes her background has contributed to her vision of women being capable of doing anything they set their minds to do. Growing up in the inner city of Boston with her mother acting as the family's breadwinner set forth her beliefs and values. However, Ms. Moody realizes that coming from a home run by a hard-working and determined woman gave her expectations of women that are different from the general population's expectations.
Ms. Huang also comes from a hardworking family. The daughter of a former Chinese diplomat, Ms. Huang moved to the United States with her family in 1974 when she was 4 years old. In search of better opportunity for themselves and their children, her parents chose New York City as the place where they would build a new life. Ms. Huang's parents now own their own business, a Baskin Robbins ice cream store, where they work long hours and are committed to their work. However, Ms. Huang says her accomplishments pale in comparison to her parents' 12-hour workdays and keeping the shop open seven days a week.
According to Ms. Moody, women in medicine are still treated differently at times. "If nothing else, they pick up on little comments from their male colleagues," she says. "It's a sort of women's intuition." But, she insists, "if women continue to focus on these negative comments and attitudes, they will become more intimidated, and these fields will become less attractive to women. It's important for women to be in these fields and make their mark. The women who have come out of P&S have done extremely well and have paved the way for us."
And what about bedside manner and the belief that women are at an advantage when it comes to doctor-patient relationships? Ms. Moody says most women have a special knack for listening and building empathy and picking up not only what's being said, but also what is left unsaid. She says male doctors may not be as willing to connect with patients. But as far as day-to-day patient care, with basic skills and hand-eye coordination, Ms. Moody says there is no difference between genders.
Ms. Pautler says women often have an attention to detail that may enable them to pick up some techniques, like microsurgery, easier and quicker than many men. This may give women something of an advantage early in their training, she says, but in the end the quality of the surgeon depends on the individual.
Twenty years removed from her student days, Dr. Epstein discounts this "kinder, gentler female doctor" sentiment. She says male and female physicians' professional performances are equal and she rejects the notion that female doctors are more sensitive. She describes such sentiments as another form of stereotyping.
"It's stamina and energy level, as well as personality, that are important," she says.
Ms. Huang agrees that a doctor's professional performance depends on the individual's ability and personality, not gender. Her mentors have been both male and female, and she says she has been fortunate to have encountered people who can look beyond her gender and appreciate her abilities.
The daughter of a neurosurgeon, Dr. Epstein claims that following in her father's footsteps was a "congenital defect." Aspiring to be a surgeon since age 4, she made her way into the operating room between the ages of 10 and 13, with her camera in hand, taking photos of her father at work. This was one case where being 6 feet tall at such a young age was a plus instead of a minus. She was never kicked out of the OR; no one could determine her age.
Dr. Epstein says most women in medicine do not pursue academic posts because they are actively discriminated against in the university setting. She also claims that female neurosurgical attendings in university positions are assigned less interesting cases and are given less operating time. "You have to have tremendous determination and work twice as hard for the recognition," Dr. Epstein says. And she does work hard, with more than 80 published works to her credit, some in collaboration with her father.
"We need more women to go into surgery and stay in it," Dr. Epstein says, "women who don't choose the 'mommy track'-working 9 to 5 just three days a week. We need more women in surgery full time." Dr. Epstein says it is not impossible for female doctors to manage both a full-time career and a family, but, like most of her peers, she has no children.
The combination of changing times and the acceptance of women in the workplace has led to increasing numbers of women in medicine. Perhaps, as Ms. Huang suggests, the number of females in the Class of 1995 can be attributed to the gradual increase of female role models.
"Society is waking up in a lot of ways," Ms. Moody says. "Men and women can work together in the workplace and, in some instances, prove themselves to be equally capable." Whatever the cause for the increasing number of women in these non-traditional roles, "all medical students are expected to work hard, and, at baseline, we're all expected to run the same race."