Transcript Are We Ready for a Women in Charge?

Are We Ready for a Woman
in Charge?
Maintaining Leadership in Surgery
Julie Ann Freischlag, M.D.
The William Stewart Halsted Professor
Chair, Department of Surgery
Surgeon – in – Chief
The Johns Hopkins Medical Institutions
Elizabeth D.A. Magnus Cohen, M.D.
1820-1921
 Female Medical College of Pennsylvania
 First woman physician licensed to
practice medicine in Louisiana – 1857
 Cared for the people of
the French Quarter from
1857-1887 (yellow fever
& smallpox)
Born in New York city
Married Aaron Cohen
5 children – only 1 into adulthood
Husband went to New Orleans to study
surgery – she enrolled in Medical School
in 1854
 Did she graduate?
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 Began her practice 1857
 Listed in directory as a midwife in 1867-1868
 In 1869 – listed as a “Doctress”
 1876 – Mrs. Elizabeth Cohen – physician
 She reports no “discrimination” while training
 1853 New Orleans Bee – female
physician treating a male patient as
incongruous and improper
 1898 JAMA – blamed women for the
decline in salaries and prestige of the
medical profession
 Medical schools began refusing to admit
women
 Did not lose a patient in 30 years
 Nickname – “lucky hand”
 Retired from practice in 1887
 Ran sewing and linen room at
Touro Infirmary until she died 1921
– age 101
Margaret D. Craighill, M.D.
1898-1977
 The Johns Hopkins University School of
Medicine
 Maryland – Connecticut
 Surgery – Obstetrics and Gynecology
 1898 Born – Southport, North Carolina
 1921 graduated Phi Beta Kappa University of
Wisconsin – followed by a M.S. degree
 Physiologist in the chemical warfare
department at the Army’s Edgewood
(Maryland) Arsenal
 Post graduate positions in gynecology,
surgery and pathology at Johns Hopkins and
Yale.
 1943 1st woman physician to become a
commissioned officer in the United
States Army
 Served as Dean of the Woman’s Medical
College of Pennsylvania
 1928-37 private assistant in general surgery
to Dr. J.A. McCreery at Bellevue Hospital, NY
 Also had a private practice in OB/GYN in
Greenwich, Connecticut and assistant
surgeon and attending gynecologist at
Greenwich Hospital
 1940 acting Dean Women's Medical College
of Pennsylvania
 1941 WWII went into active service
 1943 Sparkman – Johnson bill – allowing
women to enter Army and Navy Medical Corps
 One month later, she was the 1st woman
doctor to receive an Army Commission
 WAC (160,000) – challenged the position that
women were unsuited to a military role
 Awarded Legion of Merit
 1945 – consultant on women veteran’s
medical care
 Returned to Women’s Medical College and
became a Psychiatrist.
 Named Chief Psychiatrist at Connecticut
College for Women in New London
 Died at age 78 in Southbury, Connecticut
Benjy Frances Brooks, M.D.
1918-1998
 University of Texas Medical Branch, Texas
 Pediatric Surgery
 1960 first woman pediatric surgeon in Texas
 1918 – born in Lewisville, Texas
 Performed operations on her sister’s dolls
with manicure scissors at age 4
 B.S. degree from North Texas State Teacher’s
College at age of 19 – M.S. 2 years later
 Taught high school for 4 years
 1944 – entered University of Texas Medical
Branch in Galveston
 Residencies at Penn & Children’s Medical
Center in Boston
 Became one of the 1st women surgeons at
Harvard
 1957 – Glasgow, Scotland – Pediatric Surgery at
Royal Hospital for Sick Children
 Back to Boston – 1960 – back to Galveston – join 2
other male pediatric surgeons
 Studied congenital defects, burn treatment, spleen
reparation and the prevention of hepatitis
 Benjy Brooks Foundation for Children – by parents
of one of her patients.
In Texas “you can go as far as you can push
yourself.”
Tenley E. Albright, M.D.
1935 Harvard Medical School
 Massachusetts
 General Surgery
 Father was a surgeon
 To be a doctor and an Olympic gold
medalist in figure skating
 Polio age 14
 Won the silver medal in Oslo, Norway
in 1952(5 consecutive US women’s
singles titles in figure skating)
 1953 entered Radcliffe – pre-med left Radcliffe
in 1956
 1955 Olympic Gold Medal winner – Cortina, Italy
 1957 entered Harvard Medical School – 5 women
out of 135
 “there weren’t a lot of women faces, and there
weren’t a lot of women to teach us either.”
 Spent 23 years in private practice of surgery
 3 grown daughters and lives in
Brookline, MA and practices General
Surgery
 Consultant to National Library of
Medicine’s Board of Regents
 1988 US Figure Skating Associations
Hall of Fame
 “I was surprised to admit to myself
that I liked surgery so much.”
Kathryn Dorothy Duncan Anderson, M.D.
1939 Harvard Medical School
 Wash. DC/California
 Pediatric Surgeon
 2005 President, American College of Surgeons
 1999 President, American Pediatric Surgery
Association
 1992 Chief of Surgery and VP of Surgery Children's
Hospital Los Angeles
 Born 1939 Lancashire, England
 1958 Cambridge University – Bachelor and Master of Arts
degrees with honors
 1964 applied to surgical residency at Harvard “women are
too weak to be surgeons” – refused her
 Boston Children’s – internship in pediatric medicine
 1964 Georgetown – general surgery residency – 7 cases in 2
years
 Community Hospitals – 700 cases / 12months
 Children’s National Medical Center Washington, DC –
2 year fellowship in pediatric surgery
 “My biggest obstacle was my gender”
“There are risks and costs to a
program of action but they are far
less than the long – range risks
and costs of comfortable
inaction.”
John F. Kennedy
Society
Total
American College of Surgeons 54,761
American Surgical Association 1093
Society of University Surgeons 1388
#Women
Officers
2431(4.4) 4
25(2.2)
0
46(3.3)
0
(2000 – 01)
Jonasson Surg 2002;131:672-5
Are there women in
the pipeline?
Women Enrollment and
Graduates U.S. Medical Schools
Enrollment
1961 – 62
1971 – 72
1981 – 82
1991 – 92
2001 – 02
Total
31,078
43,650
66,298
65,602
65,626
Women
1970 (6.3%)
4755 (10.9%)
18505 (27.9%)
24962 (38.1%)
29969 (45.7%)
Graduates
Total
7168
9558
16012
15356
15648
Women
391(5.5%0)
861(9.0%)
3991(24.9%)
5543 (36.1%)
6911 (44.1%)
U.S. Seniors Matched to PGY1
by Specialty
General Surgery
2002
782(5.8%)
2003
2004
2005
867(6.5%) 885(6.5%) 845(6.1%)
Specialty Certification Plans of
Graduating Medical Students
1985
Neurologic Surgery 1.0
Opthalmology
3.6
Orthopedic/Hand
5.7
Otolaryngology
2.4
Plastic Surgery
1.4
General Surgery
6.2
Thoracic Surgery
0.9
Urology
2.0
Surgical Specialties 30.6
2000
1.0
3.0
4.5
1.9
1.0
5.7
0.3
1.6
26.3
2004
1.1
3.0
5.4
2.0
1.4
6.1
0.3
1.6
27.9
Women Residents
2002 – 03
Total Women
Neuro Surgery
778
Ophthalmology 1290
Orthopedic
3002
Otolaryngology 1093
Plastic Surgery
531
General Surgery 7412
Thoracic Surgery 310
Urology
1009
2003 – 04
Total Women
77 (9.9%)
775
434 (33.6%) 1260
271 (9.0%)
3024
218 (19.9%) 1071
139 (26.2%) 556
1853 (25%)
7623
25 ( 8.1%)
303
140 (13.9%) 1038
93
(12%)
424 (33.7%)
285 (9.4%)
229 (21.4%)
117
(21.%)
1939 (25.4%)
31
(10.2%)
158 (15.2%)
GENERAL SURGERY COHORT GROUPS by
GENDER 1977 - 2002
Year
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
CERTIFICATION
Total # of
#
Diplomates Male
921
908 (98.6%)
1168 1141 (97.7%)
1025
999 (97.5%)
968
936 (96.7%)
1047 1003 (95.8%)
965
922 (95.5%)
856
795 (92.9%)
921
841 (91.3%)
926
858 (92.7%)
858
775 (90.3%)
957
885 (92.5%)
1007
923 (91.7%)
RECERTIFICATION
#
# Male
# Female
Female
Recertified
Recertified
13 (1.4%)
554 (61.0%)
7 (53.8%)
27 (2.3%)
742 (65.0%)
13 (48.1%)
26 (2.5%)
694 (69.5%)
17 (65.4%)
32 (3.3%)
682 (72.9%)
24 (75.0%)
44 (4.2%)
738 (73.6%)
37 (84.1%)
43 (4.5%)
709 (76.9%)
31 (72.1%)
61 (7.1%)
617 (77.6%)
50 (82.0%)
80 (8.7%)
635 (75.5%)
55 (68.8%)
68 (7.3%)
655 (76.3%)
51 (75.0%)
83 (9.7%)
611 (78.8%)
62 (74.7%)
72 (7.5%)
715 (80.8%)
58 (80.6%)
84 (8.3%)
734 (79.5%)
70 (83.3%)
GENERAL SURGERY COHORT GROUPS by
GENDER 1977-1998
Year*
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
CERTIFICATION
Total # of
#
#
Diplomates Male
Female
970
880 (90.7%) 90 (9.3%)
981
881 (89.8%) 100 (10.2%)
991
885 (89.3%) 106 (10.7%)
997
884 (88.7%) 113 (11.3%)
1006
888 (88.3%) 118 (11.7%)
966
849 (87.9%) 117 (12.1%)
971
828 (85.3%) 143 (14.7%)
1019
871 (85.5%) 148 (14.5%)
987
848 (85.9%) 139 (14.1%)
957
807 (84.3%) 150 (15.7%)
RECERTIFICATION
# Male
# Female
Recertified
Recertified
706 (80.2%)
71 (78.9%)
693 (78.7%)
80 (80.0%)
661 (74.7%)
85 (80.2%)
573 (64.8%)
81 (71.7%)
334 (37.6%)
49 (41.5%)
72 (8.5%)
14 (12.0%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
GENERAL SURGERY COHORT GROUPS
by GENDER 1999 - 2004
CERTIFICATION
Total #
#
Diplomates Males
1999
2000
2001
2002
2003
2004
1004
1043
994
995
920
1068
856 (85.3%)
836 (80.2%)
823 (82.8%)
810 (81.4%)
755 (82.1%)
834 (78.1%)
#
Females
148 (14.7%)
207 (19.8%)
171 (17.2%)
185 (18.6%)
165 (17.9%)
234 (21.9%)
RECERTIFICATION
#
#
Males
Females
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
(%)
Vascular Surgery Cohort Groups by
Gender 1982 - 1994
Year
1982
1983
1984
1986
1987
1988
1989
1990
1991
1992
1993
1994
Total # Diplomates
14
388
143
75
79
96
124
125
102
103
89
79
#Male
14 (100.0%)
387 (99.7%)
142 (99.3%)
73 (97.3%)
77 (97.5%)
92 (95.8%)
119 (96.0%)
122 (97.6%)
98 (96.1%)
99 (96.1%)
86 (96.6%)
76 (96.2%)
# Female
0 (0.0%)
1 (0.3%)
1 (0.7%)
2 (2.7%)
2 (2.5%)
4 (4.2%)
5 (4.0%)
3 (2.4%)
4 (3.9%)
4 (3.9%)
3 (3.4%)
3 (3.8%)
Vascular Surgery Cohort Groups
by Gender 1994 - 2005
Year
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Total # Diplomates
110
83
96
79
94
106
70
99
105
106
98
# Male
104 (94.5%)
79 (95.2%)
89 (92.7%)
72 (91.1%)
85 (90.4%)
96 (90.6%)
59 (84.3%)
84 (84.8%)
88 (89.8%)
93 (87.7%)
97(89.8%)
# Female
6 (5.5%)
4 (4.8%)
7 (7.3%)
7 (8.9%)
9 (9.6%)
10 (9.4%)
11 (15.7%)
15 (15.2%)
8 (7.6%)
3(12.3%)
10(10.2%)
Pediatric Surgery Cohort Groups
by Gender 1974 - 1988
Year
1974
1975
1976
1977
1978
1980
1982
1984
1986
1988
Total # of Diplomates # Male
3
3 (100.0%)
226
219 (96.9%)
70
65 (92.9%)
24
22 (91.7%)
17
17 (100.0%)
43
40 (93.0%)
38
38 (100.0%)
33
29 (87.9%)
30
28 (93.3%)
37
31 (83.8%)
# Female
0 (0.0%)
7 (3.1%)
5 (7.1%)
2 (8.3%)
0 (0.0%)
3 (7.0%)
0 (0.0%)
4 (12.1%)
2 (6.7%)
6 (16.2%)
Pediatric Surgery Cohort Groups by
Gender 1990 - 2002
Year Total # of Diplomates
1990
35
1992
39
1994
49
1996
57
1998
63
2000
53
2002
60
# Male
27 (77.1%)
30 (76.9%)
43 (87.8%)
51 (89.5%)
56 (88.9%)
44 (83.0%)
47 (78.3%)
# Female
8 (22.9%)
9 (23.1%)
6 (12.2%)
6 (10.5%)
7 (11.1%)
9 (17.0%)
13 (21.7%)
Surgical Critical Care Cohort Groups by
Gender 1986 - 1994
Year Total # of Diplomates # Male
1986
15
15 (100.0%)
1987
81
77 (95.1%)
1987
172
157 (91.3%)
1988
108
95 (88.0%)
1989
132
118 (89.4%)
1990
166
148 (89.2%)
1991
208
192 (92.3%)
1992
193
171 (88.6%)
1993
259
235 (90.7%)
1994
79
64 (81.0%)
# Female
0 (0.0%)
4 (4.9%)
15 (8.7%)
13 (12.0%)
14 (10.6%)
18 (10.8%)
16 (7.7%)
22 (11.4%)
24 (9.3%)
15 (19.0%)
Surgical Critical Care Cohort
Groups by Gender 1995 - 2001
Year Total # of Diplomates # Male
1995
77
63 (81.8%)
1996
83
70 (84.3%)
1997
74
64 (86.5%)
1998
62
47 (75.8%)
1999
73
61 (83.6%)
2000
78
65 (83.3%)
2001
79
64 (81.0%)
# Female
14 (18.2%)
13 (15.7%)
10 (13.5%)
15 (24.2%)
12 (16.4%)
13 (16.7%)
15 (19.0%)
 “You can let the women
into the specialty of
surgery, but if you do not
let them lead, they will
leave.”
Haile Debas, M.D.
President, American Surgical Association 2002
Top 5 Reasons Surgery is
Ready for Women in Charge
1. Future Oriented Department Chair
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Emotional Competence
Develops others
Able to build and lead a team
Resilience
Strong Communication Skills
Grigsby et al
Acad Med 2004;79:571-77
Core Values – Department of Surgery
Johns Hopkins Medical Institutions
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Integrity *
Teamwork*
Communication
Trust*
Respect*
* of the top 6 leadership
skills rated by Deans
Souba et al Acad Med 2006;81:20-26
2. “Lucy – I’m home!”
Ricky Ricardo
There are women in the pipeline to
be available for leadership
positions and women are needed
in leadership positions to mentor
those in the pipeline…. And so
on….
3. Lessons Learned from Business
We have moved from the “clan” – (parent
figure, loyalty #1, internal flexibility) to
“the market” – (competitive marketplace,
measurements of success). To do that
we need a diverse leadership Shuck JM, AJS. 2002;183(4):345-348
4. The Daughter Theory
There is nothing more powerful than
powerful men surgeons raising brilliant and
motivated daughters – who are out in the
workplace – and experiencing the good, the
bad and the ugly.
My professors look at me and understand
my issues, my style and my talents because
they look at their daughters and see the
same.
Thank you to all the daughters in the world!
5. Diversity Can be Spoken Aloud
We now have retreats, mission
statements, search committees and
recognition of our diversity – can be
gender, race, where one is born, where
one went to school, height, weight, etc
– even though we all have prejudices –
by verbalizing them they become less
critical for exclusion and more critical
for inclusion.
5 Reasons Women are not ready
to be in charge
1. Perception and reality that women
surgeons remain single and childless as
compared to men in surgery and other
women in medicine. To get to the top,
one has to give up too much personally.
2. Perception and reality
that women surgeons (other
women physicians as well)
get paid less. It is better to
“count your money while
sitting at the table.”
3. Perception and reality that women are
discriminated against and are
harassed in surgery.
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To get to the top, you will have to put
up with too much hostility (?clan)
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There are not enough women in
leadership positions.
4. Perception and reality that
the job is not ok – requirements
to succeed are too demanding,
the rules are wrong, the time
spent is not rewarding and it is
not “fun.”
5. Perception and reality that
the Deans, Presidents and
CEO’s have not “bought in” –
that they really don’t want a
woman in charge; but they
have to.
Lessons Learned
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Need a flexible pace
Need to admit you’re wrong
Never can listen too much
*Be yourself ASAP
Keep your sense of humor
Enjoy it along the way – Wilson
50% of the day is fine – Stabile
Those complaining - that’s your job - (Youkey)
Keep your family in the loop
Respond to crisis with your heart and mind – (Passaro).
We need to recognize that
diversity – managing and
leading across differences – is
not an initiative or a program; it
should be a competency that
anyone who manages people
must learn if he or she is to be an
effective leader.