Part two of a three-part series exploring issues affecting the otolaryngology workforce
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March 2010Diana C. Ponsky, MD, assistant professor of otolaryngology-facial plastic and reconstructive surgery at Case Medical Center in Cleveland, Ohio, went to medical school wanting to be a pediatrician. She happened upon otolaryngology “by accident, by scrubbing into a very fascinating cancer case. I was hooked,” she now recalls.
Dr. Ponsky is among a minority of women in the specialty. Compared to the burgeoning of women medical school graduates (who comprised 50 percent of last year’s matriculating classes, according to the Association of American Medical Colleges [AAMC]), the representation of women in otolaryngology has been more incremental. Still, the number of women in otolaryngology is “growing in a meaningful way,” said Carol R. Bradford, MD, FACS, professor and chair of otolaryngology at the University of Michigan in Ann Arbor.
In fact, while only 8 percent of residents entering otolaryngology in 1980 were women, that number nearly doubled in 1993—to 15.7 percent—and rose to 21 percent in 2003 (Curr Opin Otolaryngol Head Neck Surg. 2006;14(3):159-63). Figures from AAMC’s 2008 Physician Specialty Data show the percentage of female otolaryngology residents and fellows at 27 percent.
Like other residency programs, the department of otolaryngology at the University of Cincinnati Academic Health Center, where Myles Pensak, MD, FACS, is H.B. Broidy Professor and Chair, has seen an increase in the number of women applicants, and has increasingly ranked more women in their top 10 residency choices per year.
Still, Dr. Pensak and others agree that new strategies could help academic and private practices incorporate more women into the otolaryngology workforce.
There is extra time that has to be invested sometimes in women earlier in their careers, and I think that is daunting to people.—Gayle E. Woodson, MD
Exposure to the Specialty
Encouraging the best otolaryngology candidates requires early involvement with medical students, said Katherine Kendall, MD, FACS, associate professor of otolaryngology at the University of Minnesota. During a recent interview cycle for the UMN otolaryngology residency, applicants reported that they had been unaware of otolaryngology until their one-week rotations. At her institution, Dr. Kendall has urged the dean of the medical school program curriculum to allow surgeons to teach anatomy courses. This not only makes the courses more interesting but piques the interest of medical students in the surgical subspecialties.
Dr. Bradford addresses pipeline issues by ensuring that women from otolaryngology participate in medical students’ career seminars. She and Gayle E. Woodson, MD, professor and chair of otolaryngology–head and neck surgery at Southern Illinois University School of Medicine in Springfield, both members of the Women in Otolaryngology Committee of the AAO-HNS, often present in panels at annual AAO-HNS meetings.
James E. Arnold, MD, Julius W. McCall Professor and chair of otolaryngology-head and neck surgery and professor of pediatrics at University Hospitals Case Medical Center in Cleveland, Ohio, said his department has done “nothing special” to cultivate more women residency applicants “other than to emphasize that we want really bright, smart, talented people in our specialty and our department. And if we’re not going to consider women, we’re missing too much of the population!” Currently, women comprise one-third of the department at his institution.
Only 8 percent of residents entering the specialty in 1980 were women; that number rose to 15.7 percent in 1993 and 21 percent in 2003.Mentoring Future Leaders
Outreach must be intentional and ongoing in order to develop future leaders in otolaryngology, said Gavin Setzen, MD, FACS, FAAOA, president of the New York State Society of Otolaryngology-Head & Neck Surgery, clinical associate professor of otolaryngology at Albany Medical College and president of Albany ENT & Allergy Services, PC, in Albany, N.Y. He said the AAO-HNS Board of Governors, of which he is chair, has asked the Women in Otolaryngology Committee to join with full committee status and representation so that young female physicians can maintain a greater role in organized otolaryngology.
Mentoring becomes even more important as women enter academia, said Dr. Kendall, who believes mentoring is lacking for female otolaryngology faculty. “I’m not advocating preference,” she said, “but women residents and junior faculty should be encouraged by senior faculty by including them in research projects, suggesting them for committees, and the like.”
Dr. Bradford’s institution sponsored her participation in the one-year Executive Leadership in Academic Medicine (ELAM), a core program of the Institute for Women’s Health and Leadership at Drexel University College of Medicine in Philadelphia. She is currently one of four female chairs there and one of two female chairs of surgical departments at Ann Arbor.
But according to Linda Brodsky, MD, FACS, FAAP, a pediatric otolaryngologist at Pediatric Ear, Nose & Throat Associates in Buffalo, N.Y., mentorship alone will not fully address gender parity. A retired professor of otolaryngology and pediatrics at the State University of New York at Buffalo, Dr. Brodsky sued the university on grounds of gender discrimination. She is currently writing a book on gender discrimination in health care. “The issue is not getting to students early and being mentors to them,” she said. “The issue is: Are they feeling welcome?”
I’m not advocating preference but women residents and junior faculty should be encouraged by senior faculty by including them in research projects, suggesting them for committees, and the like.—Katherine Kendall, MD, FACS
Women and Surgery
Changing ingrained attitudes takes time, Dr. Woodson said, noting that even some of her female surgical colleagues initially believed that surgery was solely a male domain. “We discovered that we had an ‘aha!’ experience during medical school, when we realized that we could be surgeons, even though we’re women,” she said. Her own aha! moment came during her surgical residency, when she was first-assist in a pivotal case. The patient had been admitted to the [emergency department] with a gunshot wound to the heart. “One of my most vivid memories was sitting there, holding the patient’s heart, with the index finger of my right hand in the entry wound and my left hand on the exit wound. It didn’t matter that I was a woman. I was a person with hands who was there and jumped in. (The man recovered and was discharged from the hospital a week later.) Throughout her residency, Dr. Woodson noted that the other surgery residents and attendings—all men—“became very supportive when I was enthusiastic and showed that I could do the work.”
The challenge for institutions is to take a longer view of the arc of women’s careers, Dr. Woodson added. “There is extra time that has to be invested sometimes in women earlier in their careers, and I think that is daunting to people,” she said.
Jo Shapiro, MD, chief of otolaryngology and director of the Center for Professionalism and Peer Support at Brigham and Women’s Hospital in Boston, encourages women interested in surgery to challenge their internal perceptions about the field—that being a surgeon necessitates foregoing a family.
What women can do is vary their career trajectory in concert with their children’s needs, she said. “The first thing is for the professional herself to admit, ‘I do want it all, but perhaps I cannot have it all at the same time,’” she said. “It’s because I’m juggling home and work that I want my work to be deeply engaging and meaningful. I tell students, ‘You better choose work that makes it worth the juggling!’”
Work/Life Balance
While it is often believed that women’s specialty choices are determined by lifestyle factors, one study showed that men are just as likely to choose a specialty with more “controllable lifestyles” such as predictable work schedules, and that, over time, women were slightly more likely to choose an uncontrollable lifestyle specialty than were men (Acad Med. 2005;80(9):797-802).
Nevertheless, women bear the children and the brunt of childcare care often falls to them, especially in a two-career marriage. Careful balancing is required, as are creative solutions. Dr. Bradford emphasized a pragmatic approach to workforce issues. Most important is a department or practice with the willingness to “pitch in” when crises arise.
Some institutions, such as the Johns Hopkins Medical Center, offer on-site infant and child day care for employees and house staff. She also urges all young faculty, men and women alike, to have contingency plans for children’s sick days, snow days and other unexpected family events.
Drs. Woodson and Brodsky, both members of the American College of Surgeons (ACS), said general surgeons are beginning to address fundamental change as part of their strategy to attract and retain women. For instance, Dr. Woodson, who is chair of ACS’ residency education committee, noted that more of her ACS colleagues are discussing maternal leave policies and altering call schedules.
Dr. Brodsky pointed out that more publications addressing women surgeons’ issues have been published in the ACS journal, and specifically noted a recent survey, “Career Satisfaction of Women in Surgery: Perceptions, Factors, and Strategies” (J Am Coll Surg. 2010;210(1):23-28). In partnership with the Association of Women Surgeons, the ACS also funded a 2009 study, “Women Surgeons in the New Millennium,” (Arch Surg. 2009;144(7):635-42) that suggested optimizing maternity leave and child care opportunities as strategies for including more women in surgical specialties.
Balancing a work and family schedule was one attraction for Dr. Ponsky’s career direction. She is one of two female otolaryngologists who have part-time positions in the department at Case Medical Center.
“Because we have all these subspecialties under the general otolaryngology ‘umbrella,’ this enables people to make a variety of career choices—and is a very good field for females seeking a healthy balance of career and family,” Dr. Ponsky added. ENTtoday
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