Since its beginnings, surgery - like soldiering, car repair, sports and carpentry - was considered a male domain - a "boys' club," as one UMMC physician put it.
History even records a time when women who wanted to train as surgeons had to masquerade as men.
Those days are long past. Still, even by 2014, the American Medical Association reported, only 19 percent of surgeons are women, although one-third of all physicians are females.
The percentage of women who chaired surgery departments in 2014: 1, according to the AMA.
Residency applications reveal that women are more likely to choose certain fields, especially OB-GYN, as well as pediatrics, family medicine and psychiatry. But a surgery resident is much more likely to be a man: The 2015 Match List at UMMC shows that four women, compared to eight men, chose to train as surgeons.
Female medical students reject careers in surgery for many reasons, research reveals; among them: they are not encouraged, they lack role models, they believe it is not family-friendly and demands too much time.
To combat those barriers and perceptions, the Association of Women's Surgeons surfaced in 1981, which was also the year it published its first Pocket Mentor to help women surmount the "unique challenges" they face during surgical training. The texts of later, updated versions of the Pocket Mentor suggest that, while some of those problems aren't as pervasive today, others persist.
Permitting the Pocket Mentor to frame those issues, more or less, we asked six women in various stages of their careers, most of them at UMMC, to describe what it means to be a female surgeon - what it takes to survive it, and why they love it.
Meet the surgeons:
: Dr. Kate N. Aseme
: In 1977, she became the first black female surgeon in Mississippi. Today, she is the medical director for surgical and trauma services at Forrest General Hospital in Hattiesburg. A native of Nigeria, Aseme earned her medical degree at Howard University in Washington, D.C., in 1970 before doing general surgery residency training at Harlem Hospital Center and Columbia Presbyterian Hospital, both in New York. She plans to retire at the end of the year.
JB: Dr. Jennifer S. Barr: An assistant professor of orthopaedic oncology at UMMC, she is the sole provider of orthopaedic oncology for children and adults in Mississippi. Barr, whose M.D. is from Louisiana State University in Shreveport, completed her internship and residency at UMMC in 2010 before finishing two fellowships, including one in Chur, Switzerland.
SB: Dr. Shuntaye D. Batson: An assistant professor of surgery at UMMC, she earned her M.D. in 2007 from Howard University, where she also did her general surgery residency before completing a surgical critical care fellowship at Georgia Health Sciences University in Augusta. She grew up in Gulfport, where she played basketball for Harrison Central High School.
TH: Dr. Tara G. Hughes: A general surgery resident, she had matched at UMMC three days before she was interviewed for this article. She is only one of four women from the 2015 graduating class to apply for a residency in surgery and only one of two to remain at the Medical Center. She received her M.D. from UMMC on May 22. Hughes, who was married in June 2014, grew up in Madison.
TL: Dr. Tracye J. Lawyer: A graduate of the Ohio State University College of Medicine, she is scheduled to complete her orthopaedic surgery residency at UMMC in two years. A native of Santa Barbara, Calif., she was selected PAC-10 soccer player of the year as an undergraduate at Stanford University, where she was inducted into the Hall of Fame for Track and Field. The NCAA heptathlon champion in 1999, Lawyer was an alternate on the U.S. Olympic team in Athens, Greece, in 2004.
LV: Dr. Laura R. Vick: An assistant professor of surgery, Vick completed her M.D. at the Medical Center in 2011. Her areas of practice include breast cancer and cancer. She is the current student clerkship director for the Department of Surgery. A Jackson native, she was a track-and-field athlete at Mississippi College in Clinton, where she also played basketball. During the time she was interviewed for this article, in March and April, she was expecting her fourth child.
How do I know if surgery is right for me?
… (M)edicine remains a calling, and this is no less true of surgery. There are certainly easier ways to make money, but very few that are as personally rewarding. - Association of Women Surgeons (AWS) Pocket Mentor, 2013, Fifth Edition
LV: I was a tomboy. One day in college I was throwing the football with a guy I was dating. Someone saw me and said, "Here, try this." It was a javelin. So I threw the javelin for the track team while I was at Mississippi College. I also ran the hurdles and played basketball. It never occurred to me: "No, a girl can't do this." Whatever it was. Because of my love of sports, I thought about being an NBA doctor. But I always wanted to do surgery. I like taking a problem and fixing it with your hands. Instant gratification.
KA: When I was 10, I took a Red Cross course in Nigeria so I could help deliver the baby for my mother. We were in a very remote area of Nigeria. I did indeed help deliver. I decided then to be a surgeon [and not a pediatrician]. I didn't want babies crying."
SB: I played basketball in high school and tore my ACL. It was one of my first experiences with the medical community, and it was transformative, in spite of the physician who treated me. I didn't like him. And he was an orthopaedic surgeon. In medical school, my first clinical rotation was in surgery. I enjoyed the team work and atmosphere. From then on I was committed to surgery.
JB: It is a privilege to be a surgeon and a physician. It is an honor to have the trust and respect of a patient. However, it is a great burden at times and not a decision to be taken lightly. I tell students to follow their hearts. Male or female, they need to make a list of wants and desires for their futures and then decide whether or not a career in surgery will allow them to be happy.
TH: You need to see it for yourself to find out if you can handle it. Otherwise, it's just a nice thought.
TL: I believe women make great surgeons. It's that natural, nurturing part of you. You're very good at showing the soft side of medicine to patients. Women also pay attention to details, which is good in surgery.
Understanding Differences Between Women and Men
… "They Can Kill You ... But They Can't Eat You." (Dawn Steel, Pocket Books, 1993.) (T)his … provides a number of useful insights into how to succeed in a man's world. - AWS Pocket Mentor
KA: Society has brought us up so that I still feel like I have the most responsibility for my children. Some fathers raise their children from newborn. I praise them. But many give up that privilege because many women think they are the only ones who take care of their children. Some of these (surgical) specialties are rigorous, so they're not going to do them if they want a family.
LV: As of today, 12 years after I finished medical school, I know three women who also graduated from the School of Medicine and are now stay-at-home moms. I believe more women make that choice than men. Medicine is hard, no matter what you go into. Surgery has probably been perceived as one of the roughest roads, and that probably turns off more women than men.
JB: When I decided to become a surgeon, orthopaedic surgery and neurosurgery had less than 10 percent females nationwide. There was a reason: It is physically demanding and more of a "boys' club." No one questioned my choice of orthopaedics due to skill. The general surgeons I worked with during medical school tried to talk me into OB-GYN, dermatology or anesthesia. Anything that was more of a "female" sort of field. It's funny now to think back on it.
In your training and in your professional life, you will inevitably encounter attendings, co-workers, and patients with very different cultural, religious, and political beliefs from your own.
LV: I have detected biases occasionally, but I don't pay it much attention. That is a "their problem," not a "my problem."
KA: I was the only black surgeon in town for a year or two. I wanted to go where the need existed; that was what motivated me to come to Hattiesburg. The CEO at Forrest General Hospital was the most progressive man. He said to me, "If you're any good, you'll make it." But another hospital would not give me admitting privileges. There were some problems being accepted, but I don't take "no" for an answer. I fought. It was like a fight. I believe I've opened a lot of doors for people.
TH: I very rarely have any trouble with male patients. The only ones I can really think of at the moment are those drunk trauma patients who come in late at night, and they're just being drunk guys. You pretty quickly learn how to just deflect and keep doing your job. I'm often mistaken for a nurse, but I feel like I get that from girls as much as I do from guys.
TL: Patients think you are the nurse. I get that all the time. It's not a bad thing, because there are excellent nurses. But when they find out you're the doctor, it's, "Oh, wow, congratulations … ." That's something women will face for a while, to be honest, whether it's orthopaedics or something else.
JB: My fellowship director had a positive bias: He thought that because I was a female, I was better than the males. He thought females had better hand-eye coordination and were more intelligent. I certainly have experienced the opposite opinion as well. I believe there is no way to escape all bias, no matter what the situation.
How important is a mentor, and how do I find one?
Mentors serve as role models, and as such, may exhibit some characteristic that helps you particularly to identify with them, such as race or sex. - AWS Pocket Mentor
TL: I didn't know about female mentors until I got into medical school. There are so many men, it's nice for a female to see someone of her gender. The women I know who are in orthopaedics are fabulous. Dr. Jennifer Barr is wonderful. I believe you will see women as chairs of departments of surgery eventually, and more women will choose surgery."
JB: Dr. Jane Eggerstadt was the best female role model I could ask for. Now the dean for academic affairs at LSUHSC Shreveport, she taught me many things, but most importantly: I am a surgeon. Not a female surgeon. Another strong mentor was Dr. George Russell, who is now my chairman. He recognized certain aspects that were more difficult for me during training and recognized my weaknesses and took interest in my academic and surgical skills development.
SB: I was just so impressed by Dr. Debra Ford at Howard University. She demonstrated to me that not only can women do it, they can do it well. In 1981, the Association of Women Surgeons was created as a way to mentor and encourage and educate women in medicine at all levels. I believe this has had an impact.
LV: When women see me, I believe I serve as a role model, especially for women who want to do surgery: "Dr. Vick has kids, so I can do it, too."
TH: Dr. Laura Vick has been an example for me - seeing that she can do it and have three kids and be successful with it.
Expect to work hard
Do not complain about working hard or about being tired. Do not ask to leave early. - AWS Pocket Mentor
LV: It's not for everybody. You have to love it - being in the OR all day and standing up for 12 hours.
JB: It is a physically, mentally and sometimes emotionally demanding job. Also, the "surgeon personality" is not an overly friendly one. The way we teach each other is at times abrasive and very demanding. I liken it to a new recruit going through boot camp. As a female, I noticed that I took some of the criticism more personally than it was intended. It took me many years to learn that it was never personal. They were trying to teach me how to be a responsible and safe surgeon.
SB: When I decided to become a surgeon, male surgeons were very encouraging. If anything, words of discouragement may have come more from non-surgeons: "Are you sure?" Their impression was that surgeons work all the time, they live at the hospital: "Do you want to have a family?"
Can I do surgery and still have a family/pursue other interests/”have a life”?
Of course! For starters, distinguish in your mind the training years from the rest of your career. - AWS Pocket Mentor
JB: Now that I have a child, I have found this to be a harder task than before. I am very lucky to have a chairman [Dr. George Russell] who supports my desire to have a good work-home life balance and partners who are each striving for the same goal. It is a more difficult task in private practice, I would imagine. But in general, I do believe you can achieve balance. It involves giving up some control - which is hard for us (surgeons) to relinquish.
SB: Surgery does take up a lot of time, but I wouldn't say it's not family-friendly. The younger generation of surgeons, male and female, is looking for a more balanced lifestyle. As more women enter the ranks, I'd say the culture is shifting.
TL: I've always had a supportive family, and my husband Sidney [Robinson] is super supportive. He bathes the kids, gets them fed, takes them to school. He's a saint. But it's still hard. We have no family down here. Without him I wouldn't be able to have that great balance between work and family.
LV: Although it's changing, surgery will remain the least female-dominated field in medicine, I believe. A female is still expected to be wife and mother, and yet you have to leave your family on a Saturday when you're on call. It's hard to balance a home life. I still feel compelled to be a full-time wife, full-time mom and full-time surgeon. That's three full-time jobs in one day.
Each institution has its own policy on maternity leave, so become familiar with it. - AWS Pocket Mentor
LV: I was probably one of the first females here to be pregnant during her surgical residency. I almost felt like I had to work more. I wasn't about to say, "I've got to go home; I'm having contractions." One night, on call, I did have them. But I think now it is more acceptable to take off. And there were no negative comments about me during my pregnancy. I just didn't want to be perceived as not pulling my weight. Medicine is a team sport. You've got to be part of the team.
If you choose to nurse your baby, explore the options available for you to pump and store breast milk at your hospital.
LV: Pregnancy may become an issue when you're breast-feeding or pumping. I have to make arrangements to pump between cases. I once had to scrub out in order to pump because I had underestimated the length of the case.
… (W)e fully recognize that what "jazzes" a surgeon most happens in the Operating Room. - AWS Pocket Mentor
SB: I do acute care surgery, where madness shows up in emergency room: appendectomies, gall bladder surgery. Gun shots.
TL: Before surgery, it's nervous excitement, especially for certain procedures. I like the ACLs, the rotator-cuff repairs. The bread-and-butter of orthopaedics is trauma. So, fixing fractures, that stuff is cool to me.
JB: I was a third-year medical student when the orthopaedic surgery resident allowed me to place a traction pin in the distal femur of a patient. It was a very simple procedure for him, but it meant the world that he allowed me to perform it. I was hooked from that point and never turned back. I realized that in orthopaedics, they use the same tools that I grew up using with my father, who was a carpenter. It was like second nature.
TH: I'm very much a DIY person. I painted and stained my own furniture. I like to fix things. When I was a junior in college, I saw a right-sided craniotomy. The patient had blocked arteries at the base of the brain. It's called moyamoya disease and it means "puff of smoke" in Japanese. It was the first surgery I ever saw, and I knew then that's what I wanted to do. It was very, very cool to make that immediate difference in someone's life.
LV: In contrast to surgery, family medicine is what I call "thinking medicine." A patient comes in with a problem that may have to be treated over time. But, as a surgeon, I take you into an operating room with a problem, and an hour later you don't have it.
(FOR THE MEDICAL STUDENT): So, you want to be a surgeon?
Congratulations! You wouldn't be reading this now if you weren't considering a career in surgery or a surgical subspecialty. Those of us writing this book believe there is no more rewarding specialty choice you could make. - AWS Pocket Mentor
LV: My advice is to work hard, and make your choices based off of your needs and wants, not the perceptions of others. Those people likely won't be around in five or 10 years, when you are dealing with the consequences of your choices.
JB: Don't give them a reason to stereotype you. Don't blame things on gender or race. If you make a mistake, be humble, acknowledge it, and take steps to fix the problem that led to the error. Make at least one ally among your peers. Have each others' backs and work as a team. You will have to work harder to prove yourself, but when you do, it will be worth it.
KA: It was a beautiful day and I was outside on a bench. A man sitting next to me suddenly said, "I think I know you. You took my appendix out when I was 13 years old." He was 45. He gave me his personal phone number. He said he would do anything for me, just let him know; he'd even wash my windows. It's so totally cool, I can't believe it. What do you think I felt when he thanked me over and over? I was on cloud nine; 32 years later, he recognized my face. I'm going to tell that story to every student who wants to become a doctor.
Male-dominated Residency Applications of U.S. Medical Schools, Surgical Specialties, 2014 (Selected Specialties)
TOTAL NUMBER OF APPLICANTS: 5,166
TOTALS BY GENDER:
Women: 1,576 (30.5 percent)
Men: 3,590 (69.5 percent)
Source: Association of American Medical Colleges (AAMC), Nov. 17, 2014