The session was called “Defeating Impostor Syndrome.” Dr. Marianna Papageorge, a 35-year-old fellow in thoracic surgery at Memorial Sloan Kettering Cancer Center in New York, had a question.
“Impostor syndrome can often be tied to confidence,” she said when she came up to the microphone. “So as an early career surgeon, especially as you’re doing higher-risk cases, if you have complications, how do you sort of parse those apart and move forward?”
The speaker, Dr. Alexandra Kharazi, a San Diego cardiothoracic surgeon, had a swift answer. “The only surgeons that don’t have complications or mortalities are ones that are not operating very much,” she said, or are “cherry-picking their cases.” Focus instead on all your good outcomes, she advised.
Dr. Kharazi recalled how she once told a male surgeon that she planned to ask for operating privileges at his hospital in order to expand her practice. “And he told me, ‘Well, it’s generally not a good idea to go where you’re not invited.’”
The lesson here: “My entire life has essentially consisted of going where I wasn’t invited,” Dr. Kharazi said. If she hadn’t, she said, “I would be nowhere now.”
So went the second annual meeting of Women in Thoracic Surgery, a group for the less than 10 percent of heart and lung surgeons in the United States who are women, one of the smallest percentages of any surgical specialty. Women make up about 30 percent of surgeons in the United States overall, and a little less than 40 percent of all physicians.
The conference, held over a day and a half this month in Amelia Island, Fla., offered a glimpse into how women are trying to change one of the most demanding, stressful and male-dominated fortresses of American medicine, and how far they still have to go. The 233 participants — thoracic surgeons, medical residents, fellows, interns and students — attended scientific presentations like “Sex-based Differences in Transcatheter Aortic Valve Replacement Reinterventions” but also sessions on parental leave policies and “How to Do It All.”
Many of the surgeons in the group, nearly 60 in all, seemed forceful and exacting, fulfilling some of the stereotypes of their field. But several said they had to tone down their personalities at work because women are not rewarded for the same bravado found in male counterparts.
“You have to figure out how to be strong and assertive and minimally threatening,” said Dr. Nora Burgess, 73, who was a cardiovascular surgeon for three decades at Kaiser Permanente’s San Francisco Medical Center until her retirement in 2013. Dr. Burgess was one of eight surgeons who got together for the group’s first meeting, a breakfast in Washington, in 1986. It was the idea of Dr. Leslie Kohman, then a cardiac surgeon at SUNY Upstate University Hospital in Syracuse, N.Y.
“Cardiothoracic surgery had a reputation, which is fading but probably not gone, as the toughest, meanest and the most macho specialty,” said Dr. Kohman, 76, now the hospital’s chief wellness officer.
The women say the good news today is that some 500 women have been certified as thoracic surgeons in the United States, although there are less than that in active practice — still, enough for them to hold a conference. (The terms “thoracic” and “cardiothoracic” are used interchangeably to refer to doctors who operate on the organs in the chest cavity.)
But the women presented surveys showing that on average they still make 20 percent less than men of the same experience, are not promoted at the same rate and lack mentors. They face what they say is persistent sexual harassment on the job and struggle with having children while working 80-hour weeks in their prime childbearing years. Although some 25 percent of cardiothoracic trainees — interns, residents and fellows — are now women, attrition remains high.
In many ways, the gathering dealt with the same work-life issues as any other women’s professional and support group, except that this kind of work can mean the difference between life and death.
“We have a performative art,” said Dr. Leah Backhus, a thoracic surgeon at Stanford. “We have to physically do stuff and we can’t mess it up because the stakes are high. That adds an extra level of stress for the whole situation.” After a bad day, she said, you have to “shove it all down and figure out how to get yourself together enough to go and interact and lead the ship.”
One of the most popular sessions was on negotiating better pay. The speaker presented results of a survey that showed female thoracic surgeons were more likely than their male counterparts to feel unprepared going into such negotiations and were more worried that asking for an increase in pay would reflect badly on them. But salaries, despite the inequities, are high.
After medical school, first-year residents in training programs, both men and women, can make roughly $60,000 to $100,000 or more a year, depending on where in the country they work. Pay for cardiothoracic surgeons ranges from around $500,000 to more than $1 million a year. Surgeons in private practice tend to make more than those at university hospitals, but not always.
“None of us are starving to death,” said Dr. Jane Schwabe, the director of cardiothoracic surgery at Mosaic Life Care, the only hospital in St. Joseph, Mo.
Dr. Mara Antonoff, the group’s president and an associate professor of thoracic and cardiovascular surgery at the MD Anderson Cancer Center in Houston, was determined to use the conference to make some positive points.
“It’s time for us to stop telling everyone, ‘Here are all the reasons why CT surgery is bad for women,’” she said in one session. “It’s time for us to explain why it’s a great field, why it’s a privilege, it’s an honor, why women are wanted and needed.” Recent studies have suggested, for example, that patients of female surgeons have better outcomes than those of male surgeons.
But Dr. Antonoff acknowledged major hurdles. “Is it hard to do a 12-hour case on cardiopulmonary bypass when you’re in the middle of lactating?” she said in an interview before the conference. “Yes. But that’s not what pushes women away by any means. Because these are women who have done really hard things.”
Instead, she said, “people get exhausted from being the only woman in the room.” In short, “it’s just the beat-down of the culture and the expectations and the loneliness, honestly.”
Discouragement Along the Way
Dr. Backhus, 53, was often the only Black woman in the room in a career that led her to the Stanford School of Medicine, where she is co-director of a thoracic surgery clinical research program, and to the Palo Alto VA Medical Center, where she is the chief of thoracic surgery. It was not an easy road.
Raised by a single mother in Southern California, she was good in science and math and propelled by an early ambition. By the time she was in sixth grade, she had already decided she would go to Stanford and into one of the most rarefied fields in medicine.
“I asked someone, ‘What’s the part of the body that we know the least amount about?’” she said in an interview on the sidelines of the conference. “And someone said, ‘The brain.’ I was like, ‘OK, great, I’m going to be a brain surgeon.’” The adults around her, she said, “were really jazzed by that. I got a great reaction from people, so then I just kept going with it.
“Clearly,” she said, “I had no clue what a neurosurgeon was.”
It was still her dream in her second year of medical school at the University of Southern California. But when she first mentioned it to a professor, she did not get the usual reaction. He asked her where she had gone as an undergraduate. Stanford, she said.
His response, she said, was, “We only take people from the Ivy League.”
She didn’t know if that was true, but she was devastated. “He was the pinnacle of his specialty, he’s the only representative that I have in front of me” and he was “this unwelcoming,” she said. For a time she was at a loss about her future in medicine. It was not until another male professor steered her into thoracic surgery that she found a home. Today, the most rewarding part of her job, she said, is working with lung cancer patients.
“Because if you don’t do something,” she said, the patient is “going to die. It’s an opportunity to really help someone when they’re at their most vulnerable or most frightened, and work with them to make them better. You don’t run in there saying you’re some white knight that’s going to cure them, but that’s your goal.”
As one of the very rare Black women in thoracic surgery, she said she had been mostly insulated from issues of race by the “liberal bubble” of Stanford. But there have been times when patients have asked if they can see one of her white male partners instead of her. “And you’re like, ‘OK, but he doesn’t even do this surgery. That doesn’t actually make sense.’”
“That’s when it really hits you,” she said.
The Only Woman in the Room
Sexual harassment is not the issue it once was for Dr. Shanda Blackmon, 55, a thoracic surgeon who is the director of the Lung Cancer Institute at the Baylor College of Medicine in Texas. “Once you become of a certain age, people no longer see you as attractive, and so it becomes less of a problem,” she said in an interview at the conference.
But as often the only woman in the room when she was young and rising in the field, she had to deal with male superiors who had enormous power over her. She said she never felt able to talk about what happened, which she did not describe in the interview.
“You want to be seen as a scientist,” she said. “You want to be seen as a researcher. You want to be seen as someone who does what they do. And the last thing on earth you want is to be seen as sexual, or a victim.”
Dr. Antonoff, the group’s president, addressed sexual harassment in her opening remarks as a “frequent event in surgical arenas.” Like Dr. Blackmon, she mentioned no specifics, and said in an interview after the conference that “a lot of us have trauma that we don’t want to share.”
“We don’t talk to each other about it,” she said, although “we acknowledge that it’s not that everyone is bad, it’s that there are a few bad actors, and there aren’t that many women. And so they’ve all been the victim to a very small number of bad actors.”
Dr. Blackmon said she estimated things would not significantly change for women in thoracic surgery until they made up some 30 to 40 percent of the specialty. That would take “10 more years, at least,” she said.
Seats for the Doctors
Dr. Schwabe, 63, the cardiothoracic surgeon from St. Joseph, Mo., said she didn’t want to be an internist who, she said, would have told her patients, “Here’s a pill, come back and see me in three months and we’ll see if your blood pressure is any better.’”
Yet she never thought she could be in command in an operating room until she was paired in a clinical rotation with a pediatric surgeon who “did this teeny, tiny surgery on babies.”
“He let me do some stitching,” she said. “I’ve always played the piano, and I always was good with my hands. And he said, ‘You have a natural talent. You could do this.’”
Decades later she is still stitching, although she operates on adults. “I do like my old people that I take care of,” she said, “so I’m happy that this is the way things moved.”
She still remembers the first time she went to a medical conference, in January 1998.
“I went into a room with dark suits and men with gray hair,” she said. “And I sat down and somebody came and told me that these were seats for the doctors, and the drug reps needed to go to the back of the room.”
“Oh, I’m sorry, I’m a doctor,” she said she told them. “I’m one of the surgeons.”
Elisabeth Bumiller writes about the people, politics and culture of the nation’s capital, and how decisions made there affect lives across the country and the world.
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