Leadership in American Surgery: Women Are Rising to the top

Susan E. Pories, MD; Patricia L. Turner, MD; Caprice C. Greenberg, MD, MPH; Maya A. Babu, MD, MBA; Sareh Parangi, MD

Disclosures

Annals of Surgery. 2019;269(2):199-205. 

In This Article

Historical Perspective on Women in Leadership

When the American College of Surgeons published a comprehensive history of the organization in 2012 entitled "A Century of Surgeons and Surgery: The American College of Surgeons 1913–2012," the entirety of the history of women in surgery to that point was summarized in 1 chapter, representing only 7 of the 389 pages.[4] Although the influence of women surgeons was almost a footnote in the first hundred years of the ACS, this is now poised to change dramatically.

Elizabeth Blackwell, MD, the first woman physician in the United States, graduated with honors from Geneva Medical College in upstate New York, in 1849.[5] Although she hoped to be a surgeon, she lost an eye to infection and was not able to realize this dream. Not long afterward, Mary Edwards Walker, MD, graduated from Syracuse Medical College, NY, in 1855 and went on to become the first woman surgeon in the United States.[5] Dr Walker volunteered to serve with the Union Army at the outbreak of the American Civil War and was held as a prisoner of war for 4 months in 1864 after being captured when crossing enemy lines to treat wounded civilians. Dr Walker is the only woman to ever have received the Congressional Medal of Honor—the highest United States Armed Forces decoration for bravery.

Of note, Rebecca Crumpler, MD, was the first African American woman in the United States to earn a medical degree in 1864. Dr Crumpler is known for publishing a book of medical advice for women and children—Book of Medical Discourses—in 1883, one of the first medical publications by an African American physician.[6] Matilda Arabella Evans, MD, who graduated from medical school in 1897, was one of the first African American women to practice surgery.[7] A champion of public health, Evans believed that health care was a right of citizenship and just as important as public education.

Florence West Duckering, MD, a surgeon at the New England Hospital for Women and Children, Boston, MA, and Alice Gertrude Bryant, MD, were among the first women surgeons admitted to the American College of Surgeons in 1913.[8] Almost 40 years later, in 1950, Helen Octavia Dickens, MD, was the first African American woman to become a Fellow of the College.[9]

The first woman certified by the American Board of Surgery was Barbara Bartlett Stimson, MD, in 1940.[10,11] An accomplished orthopedic surgeon, she served with distinction and honor in the Royal Army Medical Corps during World War II, choosing this path due to the US Army Medical Corp's prohibition against woman physicians serving as commissioned officers at the time. The first African American woman to be certified by the American Board of Surgery was Dr Hughenna L. Gauntlett in 1968.[6]

Progress for women in medicine and surgery remained slow until recently. It was over 100 years before all medical schools in the United States were open to women. Harvard Medical School did not admit women until 1945. Jefferson Medical College in Philadelphia, PA, was the last holdout and started to accept women in 1960. Title IX of the Education Amendments of 1972, which required the end of sexual discrimination for any educational program receiving federal financial support, opened the door for considerable progress. Due in part to the Surgeon General's call for training more physicians in 1960 and the changing attitudes about women's professional careers, the number of women in medicine and surgery has grown significantly.[1] Women now compose half of all medical school graduates, a remarkable increase when compared to the 1960s when women comprised 5% to 6% of American physicians and 10% of medical students. The number of women in leadership positions has lagged behind what would be expected from the proportion in the "pipeline."[12] Data from the Association of American Medical Colleges (AAMC) demonstrate that 38% of full time academic faculty in the United States are female; however, only 21% of full professors and 15% of department chairs and deans are women. Less than 10% of full professors of surgery were women as of 2015.[13,14] Only 5.7% of surgical chairs were women as of 2013.[15]

Women who are Under-represented Minorities Face Even Greater Challenges

Progress for women in medicine who are under-represented minorities has been even more difficult (Table 1). It is well-recognized that the numbers of under-represented minorities (URMs) including African American, Hispanic, and Native Americans on US faculty is unacceptably low. Women URMs are doubly under-represented, especially when promotion to the higher ranks of academic faculty is considered.[16]

The US population is increasingly diverse. Census data from 2016 found that 13.3% of the US population identified as black or African American, 17.8% as Hispanic or Latino, and 5.7% as Asian. Unfortunately, this diversity is not represented in medical school faculty, let alone Departments of Surgery. AAMC data from 2008 showed that while African American people comprised 12.2% of the US population, African American women represented only 1.5% of the medical school faculty and well below 1% of full professors.[16]

More recent data from the AAMC for 2017 shows a very slight improvement in diversity.[17] There are now a total of 173,166 medical school faculty members (including all specialties) in the United States. Of these, there are 3036 African American women faculty (1.7%), of whom 223 are full professors; 1979 Hispanic women faculty, of whom 172 are full professors; and 102 Native American women faculty, of whom 3 are full professors. This slow progress led Yu et al[18] to estimate that at the current rate, it would take nearly 1000 years for the proportion of black physicians to catch up to the percentage of African Americans in the general population.

For surgical faculty, specifically in 2017, AAMC data show a total of 15,667 women surgical faculty.[17] Of these, 12.8% are tenured. There are 550 Asian women surgical faculty, 34 are tenured; 124 African American women surgical faculty, 11 are tenured; 82 Hispanic women surgical faculty, 5 are tenured; 7 Native American women surgical faculty, none are tenured.

Collaboration, Mentorship, and Sponsorship

As pioneering women in surgery entered into surgical careers across the United States, they recognized the need for collaboration, mentorship, and sponsorship. In many cases, male colleagues stepped up as crucial sponsors of women surgeons. The support of men is essential because sponsorship is necessary to advance in academic medicine and surgical societies. In addition, women surgeons have formed organizations dedicated to the advancement of the careers of women in surgery. Although some may have doubted the need for these organizations, there is no doubt that the Association of Women Surgeons and similar subspecialty organizations for women in surgery have served as training grounds for leadership in American surgery.

Association of Women Surgeons

The AWS was founded in 1981 when Dr Patricia Numann posted a sign inviting any woman surgeon to a breakfast at the October meeting of the American College of Surgeons (ACS) in the San Francisco Hilton Hotel.[19] By 1988, there were almost 1000 members and AWS earned a seat on the ACS Board of Governors in 1995. The AWS has afforded many women surgeons support, community, and mentorship, and also leadership experience not available to them elsewhere.[20] The AWS has advocated for better maternity/family leave policies and pay equity.[21] The organization has also published 2 immensely helpful "self-help" guides for women in surgery: The Pocket Mentor, which provides guidance for medical students and residents in surgery; and Navigating Your Surgical Career: the AWS Guide to Success, which provides practical career advice for junior faculty.[20,22,23]

ACS Women in Surgery Committee

The ACS established a Committee on Women's Issues in 1998 in response to a proposal from Dr. Olga Jonasson.[4] A transplant surgeon and Chair of the department of surgery at The Ohio State University, Dr. Jonasson was the first woman to chair a surgery department in the United States. She also was the first woman to be selected as a member of the American Surgical Association, the first woman to hold an executive position with the ACS, and the first woman to serve as director of the American Board of Surgery. The Committee on Women's Issues was later renamed as the Women in Surgery Committee (WiSC). The 4 original areas of focus included College membership recruitment and retention, professional development, society membership, and leadership roles. WiSC subcommittees run a successful formal mentoring program, write letters of support for women candidates for leadership positions and awards, and create presentations designed to address issues of importance to women in surgery for the yearly ACS Clinical Congress The committee also established the annual Olga Jonasson Lecture,which provides a platform for prominent women in surgery to share their insights and provide inspiration.

Efforts by the AWS and WiSC have contributed greatly to the success of women in assuming leadership positions. Table 1, Table 2, Table 3, Table 4, Table 5, Table 6 and Table 7 show the progress of URM women and the incorporation of women surgeons into leadership positions in major surgical organizations around the country to the best of our knowledge.

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