Analysis:
Women in surgery: M.D. faculty members at U.S. Medical Schools

Closing the gender gap

Once an exclusively male bastion, surgery is beginning to resemble the rest of academic medicine as more women join its faculty ranks.

Stories by Cathy Shufro
Photographs by Terry Dagradi

When Barbara K. Kinder, M.D. ’71, HS ’77, trained at Yale three decades ago, surgical residents were just that: resident surgeons who virtually lived at the hospital. They worked grueling 128-hour weeks, and overnight call alternated with “short” days that ended at 10 p.m. or later. This went on for five years. If the residents of that era ever felt worn down or resentful, or if they ever longed for a schedule change to attend a wedding or hit the ski slopes, they kept it to themselves.

“In my day, nobody complained about anything. Nobody ever uttered a word,” says Kinder, an endocrine specialist who is now the William H. Carmalt Professor of Surgery. “We basically did as we were told and kept our eye on the goal: getting excellent surgical training and finishing the residency.” In fact, the odds were good that a resident who began training at Yale would not finish here. After the second year, the Yale group was cut from 12 residents to four. In those days, it was “survival of the fittest, a Darwinian approach to surgical training,” says Kinder, who in 1977 was one of the first two women to complete the general surgery training at Yale.

Things have changed. For one thing, the hours of training are much shorter. In July 2003, new rules limited residents’ time on duty to 80 hours per week, and effectively changed the way surgeons learn their craft from an immersion experience to one that is more diffuse. The new limits are in part a response to lawsuits claiming medical errors from fatigue, but they also reflect changes in societal attitudes about family life. Across all medical disciplines, women, in particular, have pushed for greater flexibility, making it somewhat easier for physicians to combine career and family.

Early in her career, Kinder sensed that Yale was committed to making room for the increasing number of women choosing to become doctors. (Her enthusiasm for the school was such that she turned down a chance for a job at another high-powered program.) Yale’s commitment led to the establishment in 1975 of the Office for Women in Medicine. Through informal get-togethers and by matching students with mentors, the office fosters ties among female students, residents and faculty members. “Over the years,” says Director Merle Waxman, M.A., associate dean for academic development, “there’s been a strong base built here, a strong support center.”

The above-average number of women on the surgery faculty attracts more women in turn. Women applying for faculty positions interview with both male and female surgeons, including high-ranking women like Kinder. Candidates for residency get a similar picture. First-year resident Lemi Luu, M.D., says she chose Yale from among other competitive programs in part because the department’s chair, Robert Udelsman, M.D., M.B.A., emphasized the strong presence of women on the faculty.

“That gave me a certain impression about the program, that it was forward-thinking,” says Luu, who graduated from Emory School of Medicine. “I felt that having an opportunity to interact with other female surgery attendings and to use them as role models was very important in my training and development.”

The numbers do suggest that Yale has made significant headway toward increasing the proportion of female surgeons on its faculty. According to an analysis of 2002 faculty roster data by the Association of American Medical Colleges (AAMC), Yale ranked 14th out of 126 medical schools in the percentage of women among its surgeons. (See complete list.) The analysis showed that 17 percent of full-time faculty members holding M.D. degrees in Yale’s Department of Surgery were female, compared with a national average of 11.2 percent, as of December 31, 2002. (Of 52 Yale faculty members with medical degrees who perform surgery, 9 were women.) The numbers are likely to climb as more women choose surgery; at Yale, about 30 percent of residents in general surgery have been women over the past decade, according to John H. Seashore, M.D. ’65, HS ’70, the residency program director. Nationally, 25 percent of general surgery residents are women, according to the AAMC.

Udelsman saw the relatively high percentage of women in the department as a plus when he was recruited from Johns Hopkins in June 2001. He expects that the number of women in surgery at Yale and nationally will increase. Nonetheless, he does recognize that the surgery “lifestyle” puts off some prospective surgeons; women and men alike worry that they won’t have time for family and leisure if they choose the field. But he says that medical students have found the prospects less intimidating since the national Accreditation Council for Graduate Medical Education capped the workweek for residents at 80 hours. “People who in their heart of hearts wanted to be surgeons, and were dissuaded from it, are now considering surgery.”

As more women choose the field, Udelsman says, surgery programs will be forced to acknowledge “the fundamental biological difference that you can’t ignore: the issues of childbearing and family. We accept the fact that residents and faculty members who become pregnant will have special needs that in the past have not been major issues in surgery programs, because there have not been many women.” For instance, if complications require a pregnant resident to take a few months off, how will she accrue enough cases to meet certification requirements? “I don’t have the answers,” says Udelsman.

He adds that the Yale surgery program will resolve those dilemmas to ensure that talented and dedicated women continue to choose surgery. In the final analysis, Udelsman is not interested in strong female candidates any more than strong male candidates: he just wants good surgeons. “I’m interested in having the best surgery department in the country, period.”

That focus on skill, not gender, originated in the 1970s. “There’s such a strong tradition of female surgeons, starting with Barbara Kinder,” says vascular surgeon Lynne Henderson Kelley, M.D., who joined the faculty last February. “There’s no distinction. We’re allowed to be surgeons, not women surgeons.” YM

Cathy Shufro is a contributing editor of Yale Medicine. Terry Dagradi is a photographer with the MedMedia Group at the School of Medicine.

A place for women in surgery to network, compare notes

Attending a meeting of the Association of Women Surgeons (AWS) was a revelation for Vivian Gahtan, M.D. As a chief resident at the University of South Florida in 1987, Gahtan was one of only two women among two dozen general surgery residents. At the meeting, she discovered a wider world. “I had never been around 100 surgical women before,” says Gahtan, until recently an associate professor of surgery at Yale and now chief of surgery at the State University of New York-Syracuse. “For the first time, I didn’t feel quite so isolated.”

Now president of the 1,600-member organization, Gahtan says the AWS hopes to attract female medical students into surgery, to make the profession more attractive for them and to provide a structure for networking.

Gahtan believes that women constitute a largely untapped resource for the profession. Women account for about half of medical students but only 12 percent of the nation’s 32,600 general surgeons, according to statistics for 2000 from the American Medical Association. General surgery ranked third in popularity as a specialty for men, but 10th for women.

“Women are becoming a higher percentage of the total physician pool, and if you aren’t attractive to women, it’s going to be a problem,” says Gahtan. “We have to change with the times.”

One major change has been the institution of an 80-hour workweek for surgical residents. Other options that need to be explored, she says, include consolidating the standard training time for individuals in surgery subspecialties; incorporating a standard family leave policy for men and women; and considering part-time practice. Gahtan notes that obstetrics and gynecology has adapted to the demands of the new generation: many physicians in that field practice part time, but surgeons rarely do.

AWS offers a free handbook, Pocket Mentor, that gives practical advice to residents. The group helps its members find mentors by gathering every fall before the annual meeting of the American College of Surgeons. Its website (www.womensurgeons.org) provides a place to ask about issues ranging from how to resolve a dispute over a call schedule to how to take a baby to a scientific meeting. “It’s networking, online,” says Gahtan. The changes advocated by the group should improve the lives of all surgeons, male and female, she adds. “The ultimate goal should be fellowship.”

Profiles

Heidi Frankel
From a trauma surgeon’s perspective, “every day is precious.”

The emergency department serves as a socioeconomic barometer for trauma surgeon Heidi Lee Frankel, M.D. When the economy slips and community morale declines, shootings and stabbings increase.

Although violence is not as frequent now as it was in the 1980s when she began her training, Frankel has seen the relationship between poverty and violence from the vantage point of the trauma service in inner-city hospitals in Baltimore, Washington, D.C., Philadelphia and now New Haven. Guns are commonplace, and young people are “living their whole lives saturated with violence in movies and on television. Violent behavior therefore becomes an acceptable way to interact with others.”

For Frankel and her colleagues, caring for victims of that violence, or of an accident, is guided by a protocol that is “burned into your brain.” It goes like this: ABCDE, or Airway, Bleeding, Circulation, Disability (check for neurological signs) and Exposure (undress the patient to uncover undetected problems).

Frankel, 41, did not expect to thrive in the trauma ward. Early in surgery training, during her residency at Sinai Hospital in Baltimore, she was required to work for a month in shock and trauma medicine. She remembers telling herself: “Thank God it’s a short month. I’ll be done with this soon, and I’ll never have to do this again.” By the end of that short month, “I knew what I was going to do for the rest of my life.” She’d discovered that she loved the pressure. It’s not that she’s normally an “adrenaline person.” She laughs, saying, “I have a tame life outside of the OR.”

Frankel said seeing the results of violence and accidents affects her in two ways. First, she would never consider endangering others or herself by drinking and driving or neglecting to wear a seat belt. And yet working in trauma reminds her that life “is sometimes capricious. … Every day is precious and every day something can happen to you that can dramatically alter the way you live your life.”

Frankel came to Yale from the University of Pennsylvania three years ago to head the surgical intensive care unit where she spends half her time, and to participate in trauma and emergency general surgery. She works from 50 to 100 hours per week, including one or two overnights. Despite the long hours, her schedule is predictable. “University surgery is very female-friendly because of that lifestyle potential,” says Frankel, who is married and has three stepchildren. She finds time to study jazz dance and to read, particularly contemporary Japanese fiction.

Frankel’s research focuses on improving performance and safety in the intensive care unit. She has found that routinization improves safety. “If we can view our life more in a corporate way, as an assembly line of things we have to do to a patient to get them out of there—not to dehumanize them—but if we can control all the steps in a systematic way, we can minimize errors.”

All is not traumatic in the trauma bay: Frankel met her husband there. Now pastor at Trinity Lutheran Church in Milford, the Rev. John Plessner served as a chaplain at the Hospital of the University of Pennsylvania.

When she witnesses tragedy at work, Frankel discusses it with her husband. “There aren’t always answers: Why was this patient injured? Why did this patient die? … It helps to know that everyone has these questions. There’s comfort in community.”

Amy Friedman
Problem-solving with art, judgment and skills

Transplant surgeon Amy L. Friedman, M.D., brings more than professional knowledge to the room when she checks on a kidney transplant patient or a living donor. Friedman herself came close to donating a kidney to save her mother’s life.

Friedman’s aunt proved to be a better match, donating a kidney that kept Friedman’s mother alive for 17 years following the transplant. “She saw her three daughters married to men they loved and she held seven of her eight grandchildren,” says Friedman, an associate professor of surgery who came to Yale in 1992 from the University of Pennsylvania. Her mother died in 1997 at age 61 from complications of type 1 diabetes.

Friedman, now 44, was in medical school at the time of her mother’s surgery. She had no inkling that she’d become a surgeon herself. “I had never considered it. I thought that I would be unable to deal with the blood-and-guts aspect. To my total shock, I loved surgery. What I liked was the immediate need to be absolutely decisive. … Surgery combines art, judgment and technical skills. It’s possibly the ultimate in problem solving. You can’t find a problem with the abdomen and leave [sew the abdomen closed] without resolving it.”

Decision-making for a transplant surgeon sometimes occurs far from the operating room: Friedman has to move quickly when she gets a call about a kidney or pancreas available for transplantation. Within one hour, she has to evaluate how good the match is with the potential recipient (who is chosen from a centralized list), whether the person needing the organ is strong enough to endure surgery and whether he or she can be reached and hospitalized on short notice. “You have to be decisive even if you’re freezing, sitting outside watching your son’s football game.” Usually the organ comes from an accident victim who has just died. “Not only is it being on call for living people [those awaiting an organ] but also for deceased donor organs … because you can’t postpone.” The chances of success increase if the transplantation is done quickly.

Friedman and her colleague, Marc I. Lorber, M.D., professor of surgery, also remove kidneys from living donors—from a family member or friend of a patient willing to give up a kidney, as Friedman’s aunt did. Since June 2001, Yale has offered laparoscopic donor nephrectomy, a less-invasive surgery for removing a donated kidney. Friedman removes a living donor’s kidney by making only small incisions, inserting a miniature camera in one opening and watching their work on a video monitor. Patients recover faster and have smaller scars, so many who qualify for the new technique choose it.

Because of her demanding schedule, Friedman counts on her husband, engineer Simon Meguira, to “fill in the gaps” in raising their three children. Photos of her two sons and her daughter, ages 15, 9 and 11, fill a shelf in her crowded office. Friedman decided to have her first child during residency, an unusual decision in the 1980s. She’s glad that she started relatively young, at 29, because she later encountered some fertility problems. She is grateful to the surgeon who guided her in deciding whether to have children during residency. She still remembers the woman’s words: “ ‘Amy, 20 years from now, when you look back, are you going to be sorry you didn’t have the kids or that you didn’t have the ultimate academic career?’ The answer was I needed to have the children.”

Lynne Henderson Kelley
“Every day there’s something to learn and see”

Vascular surgeon Lynne Henderson Kelley, M.D., began surgery training only a decade ago, and yet, already, the way she works has changed radically.

Kelley entered vascular surgery at a time of transformation, when practitioners were increasingly using less-invasive techniques for treating patients with clogged or weakened blood vessels. No sooner had she finished her fellowship at Mass General a year and a half ago than she flew to France to develop her expertise in endovascular surgery. Practicing these techniques, in turn, has led her to collaborate more and more with interventional radiologists, who not only help diagnose vascular problems but also work side by side with vascular surgeons in the operating suite, supplying what amounts to X-ray vision during surgery. Kelly holds a joint appointment with the Department of Radiology and spends two days a week in the angiography suites performing both diagnostic and therapeutic interventions.

“Vascular surgery is an entirely different specialty now compared to when I entered residency,” says Kelley, who joined the Yale faculty as an assistant professor last February.

Kelley both embraces both the new and traditional approaches while maintaining a healthy degree of skepticism. “You have to have a critical eye,” she says. “Just because we have the new technology, it is not necessarily the better technology.”

Indeed, although surgeons and patients alike are interested in the less-invasive techniques made available by endovascular surgery, its long-term effectiveness has not been methodically compared with that of time-tested open surgery techniques. And so, on the one hand, Kelley is building her skills in endovascular surgery and brainstorming with product engineers to fine-tune the design of implantable grafts (tubes that reconstruct damaged or blocked vessels from within), while on the other hand, she and her colleagues are preparing to join a major study to find out how well one of the new, minimally invasive techniques really works. Yale has applied to participate in a large nationwide trial of carotid stenting, which involves balloon angioplasty and placement of a metal stent into the carotid artery. That study will randomly assign 2,500 patients either to carotid artery stenting, performed through a small incision, or to conventional surgery, in which surgeons open the neck, incise and unclog the artery and then sew it closed. The key question: does stenting prevent stroke as well as open surgery does?

Kelley laid the groundwork for surgical research during medical school at Dartmouth and during a two-year research fellowship at Brigham and Women’s Hospital in Boston. (There she met her husband, independent publisher Charles Kelley, while training for the Boston Marathon, which she completed in four hours and two minutes.)

New techniques, she says, require not only manual skill but also the analytical skills to evaluate them. “Each new advance has to be put in the context of proven treatments,” she says, adding that she enjoys the fast pace of change. “Every day there’s something to learn and see.”

Barbara Kinder
“The changes that have taken place mirror social changes.”

Barbara K. Kinder, M.D. ’71, HS ’77, says that when she trained in surgery at Yale in the mid-1970s, the attending surgeons—all of them men—never questioned her aptitude. Chief surgeons William F. Collins Jr., M.D. ’47 and later C. Elton Cahow, M.D., “were both men who thought women could do anything. It was a matter-of-fact thing for them, not any kind of a crusade. Their attitude was, ‘Why couldn’t they do it?’ ”

Nonetheless, the culture of surgery has changed, shifting from a military model to one that accommodates give-and-take. “The changes that have taken place mirror social changes,” says Kinder, an endocrine surgeon and senior faculty member. Women have brought “a very different management style, a consensus-building style. I think men have become more this way, too. ... The throwing of instruments doesn’t happen any more.”

Kinder and fellow resident Mary Alice Helikson, M.D., HS ’77, who is now a pediatric surgeon in Oregon, were the first two women to complete general surgery training at Yale. Kinder says she tolerated five years without playing tennis, spending time with friends or reading anything except medical journals because, “I rotated into surgery and fell in love with it. It was an epiphany.”

As for the long hours, “I think by and large everyone functioned pretty well doing the 128-hour workweek. On the other hand, I don’t think it made for a rich life outside of medicine,” Kinder says, and she laughs.

Today, women and men alike want to take part in family life. “I think that’s probably healthy,” says Kinder, whose daughter, Caitlin, was born in 1985 when Kinder was 40. Once she became a mother, Kinder says, career became less important. “Could I be doing some more things in surgery nationally? Yes, I probably could, but that’s been my choice. From the day she was born, my daughter has been my first priority.”

Kinder has reservations about the reduction in residents’ hours. “The 80-hour workweek necessarily diffuses the sense of responsibility that a surgeon-in-training has for his or her patient,” she says. As an attending surgeon, Kinder feels responsible for her patients even when she leaves the hospital. “If it’s a weekend or a night, I expect to hear about my patient,” says Kinder. If younger surgeons “don’t learn it by living it, I’m not sure they’ll have the same sense of that contract with the patient. Maybe we overdid it.”

Kinder says surgeons of her generation are disenchanted and are retiring, on average, at age 58. (She is 59.) “I’m incredibly frustrated with medicine. We need national health care. Interspersed between the physician and patient are layers and layers of bureaucracy and nonsense.”

As a member of the School of Medicine admissions committee she looks for applicants “who have concerns about social justice questions. I think we ought to recruit these people. Hopefully they’ll be part of solving this health care crisis.”

Milissa McKee
For pediatric surgeon, endless variety, “less real estate to cover”

Milissa A. McKee, M.D., M.P.H., is only half joking when she says she has attention deficit disorder. She likes variety, and she likes to finish a job and move on. That’s why pediatric surgery suits her. Pediatric surgeries are shorter than adult surgeries because “there’s less real estate to cover.”

“I like doing technically demanding surgery and I like to take care of kids,” says McKee, 31, herself the oldest of seven. “Pediatric surgery fits me particularly well.”

Pediatric surgery also offers variety. McKee gets to tackle a broad spectrum of cases, everything except cardiac and neurological problems. “That’s very unusual in surgery specialties nowadays. In other specialties, you just do endocrine, or you just do cancer, or you just do gastroenterology.”

Although it’s true that McKee can talk cogently about surgery while also plowing through a stack of paperwork and occasionally glancing at her computer screen, you have to take her claim of having attention deficit disorder with a grain of salt—given that she managed to finish college at age 15. She got her driver’s license that year, moved one state west from her Minnesota home and earned her medical degree at the University of North Dakota at 19. Her nine years of postgraduate training included both research and clinical fellowships at Johns Hopkins and a master’s degree in public health, also at Hopkins. She came to New Haven two years ago.

At Yale, McKee has expanded the use of minimally invasive surgery for young patients. For example, she uses a crib-side procedure to treat gastroschisis, an abdominal wall defect that until fairly recently required major surgery shortly after birth. The intestines of a baby born with gastroschisis protrude outside the abdomen. McKee sidesteps major surgery by protecting the intestines in a silicone sac and, over the course of a day or two, gradually introducing them into the baby’s abdomen.

She has noticed that some female medical students rule out surgery prima facie. They have told McKee that “they’re only doing the rotation because they have to, and that they’d never do surgery because the residency is too hard, it has no lifestyle and they want to have a family.”

This frustrates McKee. “If it fits your personality to be a surgeon, you should be a surgeon.” She says that choosing a career in surgery may mean you can’t have the highest-paying practice, head your department and lead the nation in research and still have time to raise children. But having set priorities, McKee asserts that you can “set up your schedule so you can meet all your goals. I strongly believe you can have a fulfilling career and you can have children, and I intend to.”

Sanziana A. Roman
From the opera to the operating room

She may have left behind an opera career to pursue medicine, but endocrine surgeon Sanziana A. Roman, M.D., HS ’99, retains definite ideas about music. For a long, complicated case, she puts on a CD of Mozart, Brahms or the Romanian composer Enescu. For something quick like an appendectomy, disco works. And when everyone’s exhausted, it’s hip-hop. “Studies have shown that surgeons operate better with music,” says Roman.

While different musical themes suit different cases, one mood runs through all of surgery for Roman: the awe she feels toward the surgeon-patient relationship.

“There is no other specialty that allows you to become so intimate with somebody in such a short time. They entrust their body to you. I think that’s incredible—that you allow somebody to completely anesthetize you and cut you open.”

To gain that profound trust from patients, Roman says, “First and foremost is to listen to your patient. Because if you listen, you will find out what their personal needs are. Do they want someone more aggressive, more direct, or do you have to be more gentle? Are they so scared of the procedure that if you tell them every single complication, they’re going to panic and not hear a thing you say? Or are they very diligent and have done their Internet search and want to hear everything and to quiz you? If you’re able to tailor your approach to every single patient, then they’ll trust you.”

Roman says her personality is well suited to surgery. “I couldn’t do anything else. I’m very gregarious. I’m very decisive. I like the fact that surgery eliminates a lot of variables from the equation of healing. It really depends on your skill. It gives you a lot of control.”

Roman, 34, emigrated with her parents from Romania to Rockland County, N.Y., in 1984, for political reasons. She was 15. Roman already knew she wanted to be a doctor—or maybe an opera singer. She eventually decided that medicine offered a clearer path to stability and success but has managed to combine both interests. She majored in music performance at Cornell, and while working toward her medical degree at Columbia she also studied music at Mannes College of Music in Manhattan. During summers she trained at the Aspen Music Festival and once sang the role of Susanna in Mozart’s The Marriage of Figaro at the Graz Music Festival in Austria. It helps that she speaks five languages fluently. These days she sees a lot of theatre and opera in New York and Boston and performs informally from time to time with musical colleagues.

Roman still retains a little of the diva’s flair. She has been known to wear heels in the operating room and she does not own a white coat. Even on a dress-down day when she’s wearing pants and a tracksuit jacket, she sports eye-poppingly bright floral clogs.

Roman said she sees no reason to keep a low profile for the sake of fitting into the male-dominated surgical culture. “I don’t think being a surgeon means giving up your life or who you are. There’s room for a lot of personalities. I think if you’re someone who can be respected, you can be yourself.”

Ronnie Rosenthal
“People here are interested in what you’re thinking”

If an elderly person were brought to your emergency department for delirium, would you think to diagnose appendicitis? It’s a mystery why older people can suffer a perforated appendix but report no pain, says Ronnie A. Rosenthal, M.D., chief of surgery at the VA Connecticut Healthcare System in West Haven. “Why don’t they demonstrate the same kind of response to intra-abdominal inflammation as young people do?”

The puzzles of diagnosing surgical disease in the elderly and the challenges of predicting how older people will fare in surgery fascinate Rosenthal, an associate professor of surgery. In the past, surgeons didn’t recognize the ways in which older people differ from the young. “We applied the same rules we applied to middle-aged people to older people without ever determining if they were appropriate,” she says.

The field of geriatrics came into its own in the early 1980s, about the time that Rosenthal was finishing her vascular surgery fellowship at the State University of New York Downstate Medical Center. Two decades later, a great deal of basic information about surgical care of the aged remains unknown. With funding from the American Geriatrics Society and the John A. Hartford Foundation, Rosenthal is working to articulate the unanswered questions in geriatric surgery. She is assisting David H. Solomon, M.D., a prominent geriatrician and director emeritus of the UCLA Center on Aging, in constructing an agenda for further clinical research in general surgery and the surgical specialties.

One reason for the late maturation of surgical geriatrics, says Rosenthal, is “there haven’t been that many older surgical patients before. Rapid growth of the older population and advances in anesthesia and other technology have allowed us to double the percentage of operations we perform in which the patient is over age 65.” Two decades from now, she says, one person in five in the United States will be over 65. And the fastest growing group is those older than 85.

Rosenthal, 56, didn’t plan on a medical career. She was determined to be a biomedical engineer. After earning a master’s degree in electrical engineering at Columbia in 1970, she almost landed the perfect job: troubleshooting a prototype ultrasonic cataract-emulsifying device in the operating room. At the last minute, the company president withdrew the offer, telling Rosenthal he didn’t think surgeons would view a young woman as an authority. She remembers thinking: “If surgeons won’t believe me, maybe I have to just be one!” She’d already realized that she was more interested in the “bio” in bioengineering than in the engineering. She applied to medical school.

Once she was in medical school, however, she leaned toward what she considered more of a “thinking person’s” specialty—internal medicine or perhaps rheumatology. Her perspective changed during a surgery rotation treating nursing home patients. When patients arrived with seemingly inscrutable patterns of distress, the surgeons with experience treating the elderly amazed Rosenthal with their quick appreciation of the nature of the illness. Clearly, this was a thinking person’s specialty, too.

She likes the way surgeons think—“the logic of their approach, pattern recognition, putting things together, being able to fix things. It all fit with engineering. And surgeons do. They think, but they don’t just think. They also do.”

Rosenthal has balanced the demands of her work with raising her daughter, Lauren, who started college at Northwestern this fall. Rosenthal says the keys to balancing work and family are to find high-quality, flexible childcare and for at least one parent to make career concessions that allow for time at home.

Lauren was in middle school when Rosenthal took on the job of chief of surgery at the VA, a multi-specialty service with 20 beds. "Having a VA that is integrated into the intellectual community, as it is at Yale, and having this patient population was a perfect combination. If there were only more women patients, it would be perfect," says.

Rosenthal also appreciates the collegiality at Yale. If I have a new idea for looking at a problem or need someone to help design and teach a program in geriatrics “someone is always willing to talk to me about it and think about how to do it. People here are interested in what you’re thinking. They’re very willing to collaborate.”

Julie Ann Sosa
An abundance of mentors, both men and women

Julie Ann Sosa, M.A., M.D., knows the value of finding a mentor. In fact, though she’d planned to go to medical school, meeting a mentor when she was a senior at Princeton almost landed her in a career as an economist.

It happened when she was editor-in-chief at the Daily Princetonian. Student reporters heard some earthshaking news: Princeton’s president, economist William G. Bowen, was about to resign. The student paper broke the story, beating The New York Times. Annoyed by the premature announcement, Bowen summoned Sosa to his office to scold her—and then surprised her by offering her a summer job. Together, they wrote an award-winning book about the labor economics of academia. Sosa went on to study economics as part of a master’s program at Oxford.

Despite having ultimately chosen medicine, she has carried with her the lesson that a mentor can enrich a person’s life.

Mentorship is part of the reason Sosa, 37, came to Yale—to follow the department’s chair, Robert Udelsman, M.D., M.B.A., north from Johns Hopkins after completing her training there in 2002. And as an assistant professor of surgery, she serves as a potential mentor to others, from Yale undergraduates she meets as a fellow of Jonathan Edwards College to surgical residents beginning their careers.

When she finished eight years of residency training at Hopkins, Sosa was only the seventh woman to complete the full general surgery residency program there. She never felt any discrimination and jokes that “everyone was uniformly punished for wanting to be a surgeon” by the grueling call schedule.

At Yale, three of the five surgeons in her section, oncologic and endocrine surgery, are women. And she says the collegiality of Yale physicians, male and female, helps her do research, since “you can’t do good research in isolation. You need collaborators.” As a core faculty member for the Robert Wood Johnson Clinical Scholars Program, Sosa is working with several colleagues to evaluate the quality of the research reported in peer-reviewed medical and surgical journals. She’s also studying the use of video cameras to record what goes on in the operating room. “Most of the teaching in surgery happens in the operating room, but it’s the thing we know least about.” she says. Yale suits Sosa well. “I’m extremely happy,” she says. “I’m thrilled to be here.”

But Sosa tells a story suggesting that people still picture surgeons as male. Soon after moving into her new house recently, Sosa received some letters addressed to her neighbor. When she brought the misdelivered letters next door, the neighbor looked at Sosa oddly. “You live next door?” she asked. “We’d heard a surgeon bought the house.”
Stereotypes linger, but the prospects for women in surgery seem to be gradually improving. At Hopkins, where no woman had ever headed a large clinical department, there’s a new director of surgery. Her name is Julie A. Freischlag.

Women in Surgery

M.D. faculty members at U.S. Medical Schools

Medical School

Total

Women

No.

No.

%

1. Wright State

15

5

33

2. Chicago Med-Finch

7

2

29

3. Hawaii-Burns

7

2

29

4. East Tennessee-Quillen

29

8

28

5. South Alabama

11

3

27

6. Nevada

16

4

25

7. Creighton

32

8

25

8. Marshall-Edwards

13

3

23

9. Stanford

60

11

18

10. Michigan State

11

2

18

11. Southern Illinois

33

6

18

12. UC San Francisco

55

10

18

13. UC San Diego

46

8

17

14. Yale

52

9

17

15. Maryland

104

18

17

16. UT Southwestern

121

20

17

17. Louisville

55

9

16

18. Missouri Columbia

49

8

16

19. UT Houston

49

8

16

20. Loyola-Stritch

80

13

16

21. Boston

62

10

16

22. New York Medical

95

15

16

23. Michigan

142

22

15

24. UT Galveston

39

6

15

25. UMDNJ New Jersey

74

11

15

26. Georgetown

54

8

15

27. Iowa-Carver

54

8

15

28. MC Wisconsin

61

9

15

29. Harvard

324

46

14

30. Tennessee

93

13

14

31. St Louis

43

6

14

32. Florida

73

10

14

33. Northwestern-Feinberg

110

15

14

34. Duke

148

20

14

35. Georgia

52

7

13

36. South Florida

15

2

13

37. Tufts

68

9

13

38. Pittsburgh

167

22

13

39. Colorado

61

8

13

40. Arkansas

39

5

13

41. Puerto Rico

39

5

13

42. Connecticut

47

6

13

43. Cincinnati

63

8

13

44. Missouri Kansas City

24

3

13

45. SUNY Upstate

24

3

13

46. Temple

24

3

13

47. Texas Tech

24

3

13

48. Rush

48

6

13

49. Kentucky

56

7

13

50. LSU Shreveport

56

7

13

51. Indiana

73

9

12

52. Ohio State

33

4

12

53. U Washington

59

7

12

54. Tulane

34

4

12

55. Mount Sinai

70

8

11

56. Wayne State

53

6

11

57. Columbia

115

13

11

58. Pennsylvania

124

14

11

59. Chicago-Pritzker

80

9

11

60. Cornell-Weill

125

14

11

61. Minnesota Twin Cities

72

8

11

62. North Carolina

72

8

11

63. Jefferson

55

6

11

64. New Mexico

46

5

11

65. George Washington

28

3

11

66. Massachusetts

56

6

11

67. Washington U St Louis

103

11

11

68. Emory

123

13

11

69. UCLA-Geffen

107

11

10

70. Stony Brook

59

6

10

71. Dartmouth

79

8

10

72. Oklahoma

30

3

10

73. UMDNJ-RW Johnson

50

5

10

74. Vanderbilt

50

5

10

75. Brown

41

4

10

76. Virginia

52

5

10

77. UC Irvine

42

4

10

78. New York University

84

8

10

79. Johns Hopkins

95

9

9

80. Einstein

159

15

9

81. Case Western

96

9

9

82. Penn State

54

5

9

83. Utah

54

5

9

84. SUNY Downstate

56

5

9

85. Virginia Commonwealth

56

5

9

86. UC Davis

35

3

9

87. Vermont

49

4

8

88. Mayo

147

12

8

89. Uniformed Services-Hebert

151

12

8

90. Morehouse

13

1

8

91. East Carolina-Brody

39

3

8

92. UT San Antonio

53

4

8

93. Nebraska

43

3

7

94. Baylor

115

8

7

95. Buffalo

61

4

7

96. Miami

78

5

6

97. MU South Carolina

47

3

6

98. Rochester

63

4

6

99. Oregon

50

3

6

100. Wake Forest

84

5

6

101. Kansas

34

2

6

102. Mississippi

34

2

6

103. Southern Cal-Keck

68

4

6

104. Albany

53

3

6

105. Howard

19

1

5

106. Loma Linda

58

3

5

107. LSU New Orleans

20

1

5

108. Texas A & M

108

5

5

109. Illinois

44

2

5

110. West Virginia

44

2

5

111. Wisconsin

54

2

4

112. Arizona

31

1

3

113. MC Ohio

32

1

3

114. Drexel

108

3

3

115. North Dakota

2

0

0

116. Ponce

2

0

0

117. Caribe

4

0

0

118. South Dakota

8

0

0

119. South Carolina

12

0

0

120. Meharry

13

0

0

121. Eastern Virginia

14

0

0

122. Northeastern Ohio

15

0

0

123. Mercer

24

0

0

124. Alabama

68

0

0

125. Florida State

n/a

n/a

n/a

126. Minnesota-Duluth

n/a

n/a

n/a

Average percentage women

11.2

This table compares the number of female faculty members holding M.D. degrees in Yale’s Department of Surgery to that of other U.S. medical schools, as of December 31, 2002. For this comparison, only M.D.s in the subspecialties represented in Yale’s Department of Surgery* were counted.

* cardiothoracic surgery, gastroenterology (surgical), oncologic and endocrine surgery, otolaryngology, pediatric surgery, plastic and reconstructive surgery, organ transplantation and immunology, trauma and surgical critical care, urology, and vascular surgery

Source: Association of American Medical Colleges


			Originally published in Yale Medicine, Winter 2004. Copyright © 2004 Yale University School of Medicine. All rights reserved.