Perspectives From the Women of Wills Eye Hospital

Choosing Ophthalmology as a Profession

Julia A. Haller, MD: Hi. This is Julia Haller. I'm the ophthalmologist-in-chief at Wills Eye Hospital in Philadelphia. I'm joined here by other women from Wills Eye: Carol Shields from our oncology service, Kristin Hammersmith from our cornea service, and Michelle Wilson, who is one of our outstanding second-year residents. This gathering was inspired by an editorial I was asked to write a few months ago for JAMA Ophthalmology entitled "Cherchez La Femme."^[1] It was about the lack of women in leadership positions, particularly editorial positions, in ophthalmology in particular and in medicine in general. We gathered this group of women leaders together to talk a little bit about our backgrounds and share insights on this topic.

Let's start off with you, Carol. How did you get into medicine and ophthalmology?

Carol L. Shields, MD: Back in medical school I had an interest in dermatology, rheumatology, and endocrinology, but I really enjoyed my time in ophthalmology. I thought it was a fast, clean, and efficient profession. I really enjoy taking care of the most important sense of the human body, the sense of sight. I think it can make a profound impact on patients' lives. It's a very important role that we play as ophthalmologists.

Kristin M. Hammersmith, MD: In medical school I also loved everything; I loved the kids, I loved the grownups. It was hard for me to pick an area of specialty. I did an elective rotation in ophthalmology in September of my senior year when I thought I was going down a different path, but the patients were just so grateful [in ophthalmology]. They're so invested. It wasn't like so much of medicine where you say, "You've got to get this blood sugar better and you've got to do this"; patients are coming to you and are interested in their own care.

Dr. Haller: How about you, Michelle? You're closer to the choice than we are.

Michelle E. Wilson, MD: I did not like a lot of the other options, and ophthalmology was one thing that instantly stuck with me. The first day of my ophthalmology rotation I said, "I love this." The second day I said, "I love this." I really wanted to do something that focused on prevention, as opposed to some of the other areas of medicine where it seems like patients come in long after their health has deteriorated. I like that a lot of what we do as ophthalmologists is preventing vision loss. I also wanted to do something where there was a significant opportunity to work on health disparities. We all work with patients who have very large needs, and fighting for their vision is certainly something worth fighting for.

Becoming a Woman Leader in Ophthalmology

Dr Haller: What about being a woman? Do you think that has brought anything special to the table, Kristin?

Dr Hammersmith: I think that being a woman brings something special to the table every day and in every way. As a mother of young kids in my personal life, it has a layer of complexity, but I feel that with patients, women naturally have a very empathetic ear and have the instinct that is very caring, in general. I think that has really helped me to be a better doctor.

Dr Shields: I think women tend to be excellent surgeons. They have really good hand-eye coordination. I've noticed that some of the best fellows on our service have been women. I also agree with Kristin; there is a certain motherly instinct in women that I think patients appreciate. When I first came to Wills Eye in the mid-1980s, it was mostly a male institution, and I've watched over the years how there are more and more women residents and women fellows. I do think that's an added benefit.

Dr Hammersmith: It's interesting that you say that about surgeons, because when I was a resident, [I had heard] that women start out better than men as surgeons but don't end up as better surgeons. I think there are a couple of things to this: Women sometimes don't have the confidence to realize that they are doing a good job, or if they have a bad encounter or have something unfortunate happen, they don't keep up their own confidence. And so much of surgery is confidence.

Dr Shields: I do think it keeps you honest, having a little bit of a conservative approach to your surgery or your approach to patients. Women tend to doubt themselves a little bit more and don't want to move ahead or take on big responsibilities. Again, over the past 20 or 30 years that I've been in ophthalmology, it has been a gradual trend. With Michelle and some of our other residents like Michelle, it's amazing what is happening. We're seeing a lot more leadership from women.

Dr Haller: How about you, Michelle? Do you perceive a barrier at this stage in your career? Does it seem like the path has already been blazed and it's just a piece of cake?

Dr Wilson: There certainly have been trailblazers. It makes a difference being at an institution like this, with you as the head of the organization and with people like Dr Shields here, who are just absolutely the best at what they do. I certainly didn't start with any feelings of challenges to being the absolute best by being a woman. I think that it's unique to be in a place like this. If I was at an institution where it was primarily male-dominated or where there were only men in positions of leadership, it would feel like I was in a boy's club, which I think is common in medicine. Here, in particular, there are such phenomenal women physicians. For the women in my generation, the residents and the fellows who are training, you all have broken the glass ceiling for us; so if anything, the men are questioning whether they can live up to us.

Dr Shields: I think a lot of this goes back even to childhood. I was raised in a large family where everyone was equal and we all could achieve our goals, and that gave me the confidence that I could do whatever my heart desired. A lot of self-esteem is engendered during childhood. You learn how to like yourself, how to trust yourself, and how to manipulate your way through society successfully.

Dr Wilson: I completely agree with that. I have a professional mother who balanced being a career woman and a wonderful mother and wife all at the same time, so growing up, I saw a female superwoman and I had no doubt that I would—and could—do the same thing. It's been nice coming here and seeing this in ophthalmology. I remember calling my mother and saying that I met my absolute role model: I said that Dr Carol Shields is a phenomenal person, mother, and wife, and she is absolutely the best at what she does. That's what I want to do. I had that example growing up, but I also have examples of women in ophthalmology who are doing what I hope to do. It starts at home, but then you also have to have people who have blazed the trail for you, or who at least give you some evidence that you certainly can be not just a woman in ophthalmology but the chief of Wills Eye Hospital. Or you can be the director of the highest-volume ocular oncology service or lead an incredible cornea service. I really think that the women in my class and my generation are looking to all of you when we consider what we are going to do next in our careers.

Dr Hammersmith: I do think you're right about growing up. My parents told my sister and I that we could do whatever we wanted and be whatever we wanted. Although I have little boys, this is still important to me. A partner [in my practice], who has daughters, says that as a woman she wants to be a professional physician to show her daughters that they can do this too. Unfortunately, there are people who do the training and feel like it's too much, and don't practice medicine or don't practice medicine at the level that they wish they were practicing. For my little boys, I want them to know that they would want to be with someone who can be both a professional and a good parent.

Achieving Work-Life Balance in Medicine

Dr Haller: That brings up an interesting point. I've noticed a change since my days of training. You now hear men talking about work-life balance, which used to be a female topic. I had a very unusual experience as a visiting professor at Columbia University where, at dinner, all of the male retina fellows were asking me about my childcare arrangements when the children were growing up. I thought that was a real change. They were curious about live-in nannies and how things worked out. I think part of the change we're seeing in women is also driven by supportive men and also by men thinking about having a part in the home too.

Speaking of work-life balance, Carol, you've probably had more experience with childraising and family life. Do you have any tips for the Medscape audience?

Dr Shields: I'm glad you brought that up. It's not just women who think about work-life balance; it's men too. My husband equally wants to be with our children and wants to go to the birthday parties and attend the lacrosse games as much as I want to, so all of us have this certain delicate balance we want to achieve. When our kids were young, we tried to balance as best as we could. I have to admit that I couldn't attend every meeting that I wanted to attend, nor could I write papers like I can now, but I'm not sad about that. I enjoyed every step along the way, but it does require a good, happy household; good, safe homecare for the children; and, believe it or not, a really good environment at work for it to be worth going to work. Your work partners are the people you basically live with during the day. You really want to have all fronts covered in a good way.

Dr Hammersmith: Marlene Moster [a glaucoma specialist at Wills Eye] always said that you have to get the right people to help you make it happen. We've been really lucky for many years that we've had wonderful people to help us with the children. Having that kind of supportive person to whom you can entrust the emotional and physical well-being of your children is super-important.

Dr Haller: At the resident level, it seems like the men as well as the women are talking about how they balance things with leading a healthy lifestyle and having outside interests.

Dr Wilson: I agree. Traditionally for women residents, the challenge has always been when to start a family. What you said is correct in that men are starting to have a larger role in the family, and male residents are trying to time these things as well.

You all can speak to this as mothers in ways that I can't, as someone who does not have children yet, but I do think it's a challenge trying to figure out how to plan starting your family around your career. There's never a right time. Medical school is so challenging, residency is challenging, as is fellowship; you want to learn as much as you can early in your career. It just seems like there is never a perfect time. One thing people are doing is just saying that they'll make it work. How did you all find that balance?

Dr Shields: You can, to a certain extent, craft your career. You can design what you want to do and where you want to go. I think it's nearly impossible to craft your family, like to find your partner and a time when you have children. When people ask me how to do it, you just let the happiness and love of a relationship happen and the children happen. That's what I did. You can focus on what you can control and that is your career. When people ask me, I tell them to build their career how they want it and when that right person comes along, things will happen.

Dr Hammersmith: I think it also depends on your age when you're going into medicine. For me personally, I was really interested in trying to get through the bulk of the training because I didn't want to feel like I was not getting everything I had wanted and not pulling my weight for the other residents. I think there are people who do a great job with having a family whenever they can, but having a lot of help is very important.

Work-life balance is hard every single day. My husband always says nobody can win every day; home life and work life can't win every day. He'll sometimes say that work really won this week, but next week he's going to make all of the baseball games. I'm lucky I have a husband who's a professional but who also really tries to help out to make things good for all of us.

Dr Haller: Some people make lists, like reminding yourself to talk to your spouse for at least 10 minutes every day. It seems so mechanical, but it actually works if you have lists of things that you don't just let go at the end of the day.

Dr Hammersmith: What I've been trying lately is doing something for one of my friends each week. I feel like my girlfriends have really taken a backseat to the kids and professional life. They are people who, when things aren't going well, support you so well. For example, if it's someone's birthday, I'm going to go out with the girls and try to keep up some of those friendships that will support me in a good way.

The Importance of Mentorship

Dr Haller: Are there things we could be doing better? Here we have people who have succeeded at the highest level. We've all done it to a certain extent on our own, but we've all had mentors, too. Are there ways that we could be helping our sisters that we aren't doing now?

Dr Shields: I do think mentoring is very important. I love seeing the new first-year class coming to Wills Eye every year. I try to help both the guys and the girls. I came from a family of guys so I'm very comfortable with guys, but I always look out for the girls. Women nowadays come into Wills Eye very confident. They're not shy. They're not sheepish. They come in confident and I think they come in with a different background from what mine was when I came into Wills Eye. I do think mentoring is very important, even if it's just saying hello or asking how a case went, or "Here's a great case—let's work on it together."

Dr Hammersmith: During [one resident's] ophthalmology residency interview, her husband got asked if he would be willing to delay having kids so that she could finish training. He said, "I'll do whatever she wants," but she had a kid during training. She was so helpful to me personally through the discussion of having kids and a life, but also just to go over cases at the end of the day. I feel like women don't always have the same amount of ego as men, and when things get rough, which they do in medicine, it's nice to have someone who says, "That's happened to me before, and you just move on." [A colleague] tells the story of a very well-regarded ophthalmic surgeon who was a resident and was doing a trephination on a corneal transplant and went right through the cornea and the lens. She said that, luckily, they were doing a triple anyway, but at the end of the case, everything went fine. The resident said that other than the trephination, he thought everything went pretty well.

Dr Haller: That was the male reaction.

Dr Hammersmith: Right, that was the male reaction to it, and he went right ahead and has done great ever since. I think there are a lot of women surgeons who are good but don't keep up with it, or leave leadership roles because someone knocks them down.

Advice for Becoming a Woman Leader

Dr Haller: Michelle, you came from Johns Hopkins. Now you're at Wills Eye. You've been at top places. Do you have some tips? What are some best practices that have given you a little pat on your back along the way?

Dr Wilson: Be sure to support young women in training. You all have done fabulously. I've worked on a couple of projects with Dr Shields. We've worked in clinic together, and you have always pulled me aside and told me that it's your priority for me to learn as much as I can. There's a special feeling—that this person is just pouring their knowledge into me. That matters. I haven't had a chance to work with you, Dr Haller, in the retina service but I will be up there. That's important—just knowing that you have these brilliant women and knowing that they see enough value in you that they are just willing to pour themselves into you.

Dr Haller: How about more formal things, like having women's group meetings or chances to talk about ways to strategize?

One of the things that I've realized only recently is that a lot of the data that are out there are about where women fall behind. For example, it's known that women don't negotiate for better salaries, yet we haven't really talked about that in a gender-specific way with our residents. We haven't said, "You'll accept an offer that's 15% to 25% less than for your male colleagues because you're female." We haven't really told people how to prepare for that.

Dr Shields: Not unless you're working with a woman who's in charge of the finances. If you look at it, even in our practice, there is no gender disparity in regard to pay.

Another pearl that I can give in balancing your life is to carve out a little time for you and the family during the week where you can do all of the doctors' visits or grocery shopping or whatever. Don't try to work 5 full days. It's almost impossible. I used to carve out a Friday afternoon where I could leave work.I think that's important, and most practices will understand it.

Kristin, you said something really important earlier. You have to work a little bit harder as a woman in medicine to pull your weight. If your child's ill and you have to leave, I think it's important to always be there on time and always give 100%, and prove that you're worth it to your practice so that when you need to leave it's acceptable. Also, share those leaves with your husband; your husband has to pitch in.

Dr Hammersmith: In terms of the women's groups, I always think it's a great idea conceptually and then I just don't know where the time comes to have one more meeting. It would be so much better if it somehow worked into the time that you are already at work and not during the evening dinners or that kind of thing that you already feel like you're away from so much.

Dr Shields: I like the informal meetings, like where you see someone in the operating room and you're talking at the scrub sink.

Dr Wilson: We have had some Women in Ophthalmology events that have been really great.

Dr Haller: Sometimes you get a little nugget of information that sticks, something you didn't know. Posture, for example—women tend to be more closed and men tend to have power positions. It makes a difference. Those little things are good tips. I think we can do more in terms of working on some of those.

Dr Shields: I have a question for Julia. What is it like being the chief at Wills Eye? Everyone at Wills Eye admires you so much.

Dr Haller: It's the greatest job in the world. I love it every day. I come to work and I'm so proud to be on your team.

Dr Hammersmith: I trained with Julia at Johns Hopkins, and she was known to be the best retina surgeon. At the time, she would always wear her little scrub dress and her little stocking feet, and she would come in and get on the pedals and operate like crazy. I love that you're able to be who you are as a retina surgeon, which is mostly a male-dominated field. You do it in your own way and very femininely, even though you're very powerful.

Dr Haller: Thank you, and ditto back at you all. I think it's time to finish up. I want to thank my distinguished collaborators, the WOW group—Women of Wills. This is a collaboration between Medscape Ophthalmology and Wills Eye Hospital. I'm Julia Haller, and we look forward to meeting with you again.