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Dr Mary Ann Hopkins (MAH) is an attending general surgeon and assistant professor of surgery at New York University Medical Center. Dr Susan Pannullo (SP) is an attending neurosurgeon and attending neurologist at Staten Island University Hospital in New York. Dr Jennifer Svahn (JS) is an attending vascular surgeon at New York Hospital Medical Center of Queens.
Q: Why do you think there aren't more women surgeons?
MAH: It's probably because of the long hours and the family sacrifices that you have to make. Since it is such a male-dominated field, it's hard to say, "Well I only want to work 3 days per week or part time." It's simply the hours that are intimidating . . . to anyone, male or female. If you are planning to have a family and children, you may have to commit to a full-time nanny.
JS: First, lay people and many physicians (including surgeons) still believe that surgery is a man's field. Although I think this is changing, this perception can be discouraging and intimidating to a lot of women. Second, the lifestyle does not lend itself easily to the other things that women might want to do, such as having a family and being a wife and mother in the traditional sense. Third, there is still a sort of novelty about women surgeons. Being a "pioneer" or minority in any arena is difficult. Most of us don't have mothers, sisters, or other close female surgical role models to serve as a reference point.
Q: What do you think are the major barriers for female medical students as they consider a career in surgery?
MAH: There is a military ethic in surgery that may not be as appealing to a woman's mentality. There's a lot of yelling and humiliation that goes on with the junior residents, and you have to accept this hierarchical mentality to fit in. Things are slowly changing, but the military mentality may be off-putting to female medical students.
SP: One major barrier is a fear of not being accepted into a surgical program. This may be due to the fact that women receive fewer excellent performance ratings in surgical rotations, partly because they are not mentored or encouraged as much as they are in other specialties. In addition, there are more subtle barriers such as the physical challenge that surgery presents for women who are smaller and often less strong than men. Most surgical instruments were not designed with small operators in mind. Earlier in my career I was counseled by well-meaning male attendings not to go into neurosurgery because I was a woman. Instead, I did a full neurology residency! When I realized that I still loved neurosurgery more than anything else in medicine, I went back and did a neurosurgery residency and fellowship.
Q: Do you have any advice for female medical students who are considering a career in surgery?
MAH: If you want to do surgery, do it! Surgery is so exciting and so dynamic that the hours don't seem that bad after a while. You may not feel like getting up in the middle of the night, but once you're at the hospital saving someone's life it's fantastic. Ironically, women surgeons are highly sought after now both by residency programs and by patients, especially those with breast disease.
SP: I think female medical students should definitely pursue careers in surgery, if that's their gut feeling about what they want to do. They should be very upfront with the people who are training them so that it's clear what their goals and plans are in regard to marriage and children. There's a tendency to hide this information, and residency directors are legally required not to ask these sorts of questions. It's been my experience that it's better to put your cards on the table and discover at the outset whether the residency program is a good match for you.
Q: How do you feel about your career choice? Any regrets?
SP: No regrets. I feel challenged, sometimes almost unbearably so. I think it's important to stress that the career pyramid is inverted for women compared with men. Men often begin their careers relatively unencumbered, without family obligations, and so forth, and then choose to spend less time working later in life. Women, because they bear children at a younger age, receive the brunt of the family commitment early in life and often have fuller careers as they get older. As men are thinking of retirement, women's careers often are taking off.
JS: Knowing everything I do now, I might not choose a medical career. First, I feel there is a lot of public hostility toward physicians. This is difficult and disappointing to encounter when you're one of the doctors getting up at 3 in the morning to take care of people. Second, medical school loans are so large, and you don't make a reasonable salary until after residency. Finally, I think it is important to mention the negative effect that the stress, demands, and narrow-mindedness of surgical residency faculty can have on personal relationships. It is unfortunate, but true, that several women I know (myself included) divorced during their surgical residency, and many more women surgeons I know have never married, despite wanting to. That being said, I can't imagine doing anything else in medicine besides surgery. I love being a surgeon. Being in the operating room is a very heady and powerful experience—there are immediate results and the technical aspects of operating are challenging and unique to our profession. There is an allure to surgery that I don't think I would get from any other field of medicine.
For part 2 of this interview, please see MSJAMA online, http://www.msjama.org.
Jones VA. Why Aren't There More Women Surgeons?. JAMA. 2000;283(5):670. doi:10.1001/jama.283.5.670-JMS0202-5-1