Saturday, June 18, 2011

Divine Secrets of the Surgical Sisterhood

When you choose to go into medicine as a woman, one phrase that you hear a lot is "old boys' club".  It's a reference to the fact that medicine, for centuries, was one practiced by men alone, a fact that was sharpened during the 1950's when the advances made by women were repressed in favor of a return to old time values.  It also references the fact that men, for centuries, have always formed fraternities in one way or another, a way to bond and speak as equals on subjects of substance and importance, and to form friendships, connections and networks for the benefit of all members.  Nowadays, the phrase "old boys' club" infers, due to negative connotation, a professional or social group into which women could be belong based on credentials but cannot because they are not male and therefore not welcome in the fraternity order.

It is a sad fact that women don't seem to have the same natural propensity towards fraternity as men, especially in fields that men have historically dominated.  Of course, the concept of sorority and womens' groups is an old one, but they typically form naturally for the benefit of social friendship, not professional advancement.  Those that exist for professional advancement often have a forced feeling to them, and the ones that have persisted through time exist only in reaction to a negative situation (such as being shut out of male groups).  One would think that, as a minority in certain professional circles, women would band together, help each other out, and act as mentors for each other.  One would especially expect that of the kind of women who have acted as groundbreakers, plowing a path for the rest of us to follow.  But it is not so.  

Dr. Karen Sibert is an anesthesiologist practicing in West Hollywood, CA.  She wrote a well-publicized editorial to the NY Times bemoaning the groves of women training in medicine, only to leave to devote time to family and lifestyle balance.  She includes a number of factual flaws in her argument (ex: she claims that residents don't pay tuition and instead receive a salary, but neglects to mention that repayment of medical school tuition starts in residency while being paid less than minimum wage for a 90 hour work week), and criticizes a pre-med college student for wanting to know about anesthesia as a specialty with regards to work-life balance.  She essentially argues that to be a doctor, one must commit to it to the exclusion of all else, as all men do, or society at large suffers the consequence.  She argues that women are selfish to enter the field and expect such things as time off, end of shifts or part time work, because they suck the precious national resources going into training doctors.

The undercurrent of this editorial is that women must suck it up, not complain, and not ask for anything different in terms of equity.  I am sure that, as a women who graduated medical school 30 years ago and had no other women to band with, this method worked for her.  She has become hard core and old school.  And, truly, I admire her for it.  I've met (heck, we've all met) tough-as-nails female physicians who trained when they had no other companions mentors or encouragement and threw themselves in head first to learn medicine for a higher cause.  It's something I could never do, and have undying respect for.  But there's a broader issue of humanity in medicine - I myself have encountered more than a few older female surgeons who do fantastic work but are a nightmare to be around.  They are, nearly as a rule, nicer to boys than they are to girls.  I never wanted to believe it, but I have encountered more manipulation, lying, sexist and judgmental attitudes at the hands of female surgeons than I ever have at the hands of my male surgical attendings (why by and large have been nothing but encouraging, patient and kind).  

The reason I feel that it's a time-related issue is that, when I look at my senior surgical residents, I don't see any of these traits at all.  I belong to a residency which is at least 50% female, and most of the other programs I applied to were similarly stocked.  The girls I work with are tough and smart, but also look out for me.  I don't get treated any differently than the boys, which is how I know that I am being treated the best I can be.  When I go outside of my residency cradle, I am always shocked at the slightest hint of gender discrimination because it's simply not how I was raised.  At the risk of putting all older female attendings in a box, I argue that the act of training in an all-male world has created a certain type of creature.  Brilliant, tough, smart, but also unable to trust anybody but men.  I believe that the female attending throws younger female doctors under the bus because she forgets her obligation to them.  She is jealous that so many things she had to fight for, her residents can take for granted.  The ability to even consider part time work as a doctor to be with her children?  That was a pipe dream in her day.  Having to be a thousand times better just to be considered at all?  It's the exception rather than the rule now. When she works with men, she's back on familiar territory, she knows how they will behave and react.  On some level, it probably even makes her feel special inside, to be above so many men who were once above her.  But female residents, they throw a wrench in that calculation.  And she forgets her obligation to mentor, guide and protect because she never had those things herself.

Like gay marriage and outdoor smoking bans, changes in this behavior will only come with time.  The female attendings like Dr. Sibert won't change their attitudes, they'll just retire at some point soon and be replaced by many more females who trained under more balanced circumstances, with respect and concern for each other.  Our network will come because we all worked with each other, remember our seniors with fondness and respect, and bond over a common experience.  As much as Dr. Sibert wants to flap her arms about the change in priorities in medicine, the fact is that, very soon, she'll be under our care and not over our heads, and we'll all be able to form the sorority we deserve without her stopping us.


  1. I suspect you're right (at least in many cases) in your impression that older female attendings give young women in medicine a difficult time because they're jealous of how much easier it is for women these days. I can only imagine how bitter I would be if I made many sacrifices in my personal life and then the people coming after me didn't have to do the same. It's unfortunate though that they can't just be pleased with the change and supportive of everyone who wants better life-work balance.

  2. Found your blog via Table for One over at!

    This post makes me really, really thankful that I haven't encountered doctors like Dr. Sibert (I'm only pre-med, though). My female medical director at my workplace is in Dr. Sibert's generation but the COMPLETE opposite - aware of the sexism inherent during her days of training and willing to nurture and support young people in ANY career. Thank goodness for docs like her!

    Coming from a family with two working parents (40 hours each), I am not really an advocate for any male or female cutting down to say, 30 hours just for child-rearing. But I also recognize that a resident living on a shoe-string budget can't afford a nanny or have grandparents that can help. I do think there is a solution somewhere in the middle that a young MD/mother can reach.

  3. Yeah, I think the issue only comes up because medical residents work 90 hour weeks, and we make a lot of sacrifices to do that so it's impossible to not think about what kind of lifestyle you want when you finish training so that you can be with your kids on SOME level. The way she talks about it, women are entering medicine in droves only to want to leave so they can drive their kids to soccer practice at 3 every day. I don't know who she's been talking to, but most girls I know in medicine don't have a burning passion to be that kind of mom. (Personally, I take the attitude that this is what grandparents and husbands were invented for =P) I think if you're picking medicine and you meant it, you understood there was a major sacrifice in the first place, and you are asking about lifestyle just as a way to understand balance.