by Claire Yang, MD
A young colleague called me the other day to ask my advice, having recently finished her fellowship and appointed as junior faculty in our department. She is married, has a new baby, and was wondering about the feasibility of her career choice. I have never been one to push the “woman’s” perspective on anyone, trying to remain gender-neutral in my approach to mentoring. For some reason, this particular call prompted me to think a little more closely about a woman’s perspective in a career called “academic surgery”. This entity has traditionally called for the “triple threat”: someone who can do (and excel at) clinical work, research, and teaching. Note that nowhere is there a mention of family life. It is no secret, though, that meshing family life with a challenging career is a major concern for many women. Despite the obvious challenges, academic surgery is a feasible and rewarding career—but there are a few things to keep in mind as you take the plunge.
The percentage of women surgeon/scientists in medical school faculties is still fairly low, particularly at the associate professor and professor ranks,1 and many of those women are not married or do not have children.2 The explanation for the low numbers in part involves a perennial question: how can a young surgeon fulfill the triple threat and have a family life? There are recognized institutional barriers to success for women in academic surgery.3 These barriers notwithstanding, there are also many personal decisions that a female surgeon needs to bear in mind when considering an academic career. This reflection contains some of my observations from almost 20 years in academia.
For me, a critical component to success is a supportive partner, if you are choosing to be partnered. But that holds true for just about any career that you want to pursue. So let’s assume you have or want a supportive partner, and you envision at least one child in your future. With this scenario, the following are some suggestions for balancing the work/family life juggling act, from a mid-career female surgeon/scientist:
1. Get a mentor. A supportive mentor (or better yet, more than one person) who is well-versed in the machinations of academia, is successful in his or her research, and is willing to commit uncompensated time to the development of your career, is a priceless commodity. The presence or absence of such a person can make or break a career. There are a myriad of reasons why a mentor is necessary, and such a discussion is beyond the scope of this essay. If you are starting out, take my word for it and find a mentor.
2. Be hyper-organized.Time, contrary to the Rolling Stones song, is not on my side, and it will not be on yours, either. A surgeon can never be “off service”, and so the time constraints are even greater than those of colleagues in non-surgical fields of academic medicine. Make the most of your time by constantly prioritizing, getting help for things you do not have time to do, and not procrastinating. Being a good surgeon requires you to be organized in the operating room, so bring that skill into your personal life.
3. Recognize the unexpected influence of a child on your career and worldview. In my observations, the arrival of children into a family has a profound effect on a female academic surgeon’s career. I have seen more than one woman take the fast track toward academic surgery, fully expecting that she will be able to carry out the triple threat, and then get off that track with the arrival of a baby. Whether it’s the hormonal influences, or the recognition that caring for a child and managing a burgeoning career are at odds, or just the joy that motherhood brings – no matter what the reason, many women change their minds about their career at their transition to motherhood. It is hard to know in advance how you are going to feel about it, so reflection about your maternal motivations is important. Realize that your long-held views about yourself and your career may change dramatically.
4. Acknowledge that family cannot always come first, and that you are not indispensible to your children. Bringing a child into the world means a commitment to expend the necessary time and energy to raise that child to his or her full potential. How each person decides what her child needs is highly individualized, and some children need more parental presence than others. If you feel that your frequent or constant presence in your child’s life is necessary, then academic surgery is probably not for you. If you are willing to accept the “it takes a village” view of child-rearing, you may find that there are many people who can love and nurture your little one, just as well (or perhaps even better, as was the case for me) as you and your partner can.
5. Be selfish about your career. This concept is particularly difficult for many women. If you explicitly or implicitly acknowledge your partner’s career to be more important to the family than yours, your career will not advance to your satisfaction. You will then be the one always staying home with your child when the daycare is closed, making arrangements for the plumber to fix the overflowing toilet, etc. You cannot be the primary parent, the primary house manager, AND the academic surgeon, otherwise you will be at high risk for burn out. An equal division of labor with regard to childcare and home management (a service which can also be purchased!) is a must, or, your spouse can be the primary parent and home manager. Selfishness must also be extended to the clinical setting: when you are approached to cover clinical duties when you are on your research time, don’t do it! Your protected research time should remain protected. It is easy to get sucked into the never-ending vortex of uncovered clinical duties, and once that happens, invariably the research suffers.
6. Feel excitement about research. In his book “Better: A Surgeon’s Notes on Performance”, Atul Gawande encouraged physicians to “count something”, which is shorthand for doing research or keeping data for review. I would add to that “Count something, and be excited about it.” Feeling excitement is the only way you can do the counting in the hectic life of a surgeon. It is what will allow you the energy to help your kids with their homework after dinner, get them tucked in bed, and then spend another couple of hours finishing that grant, before getting up at 5 AM to start another day. This kind of crazy schedule is not meant to be in place constantly, but it gets old quickly if there is no personal gratification. The desire to do this can only come from a deep well of curiosity and a drive to convince Mother Nature to relinquish her secrets. As with most things, without the excitement, the effort cannot be sustained.
7. Don’t be afraid to mix work life with home life, and vice versa. Many people try to make their home a sanctuary from work. My husband and I both bring work home when possible and appropriate, because it allows us more time together as a family. I would rather make patient calls or have residents contact me at home during evenings and weekends, than sit in my office during those times, wishing I was home. Also, I have been known to bring the kids to work and to out-of-town meetings, all in the name of familial unity.
8. Set realistic goals and realize you can’t have it all. Although my former chairman says that women who have families require superhuman characteristics to survive and be successful in the academic environment, the reality is that we are only mortals, with many, many limitations, and we need to recognize those limits. By recognizing that I was not omnipotent, I believe I have maintained my family’s integrity and my sanity thus far. The decisions I made definitely slowed my career trajectory compared to that of my colleagues, but I am achieving my career goals -- on my own timeline. As a result, I have thus far avoided burnout, I’m still in academic medicine (and enjoying it), and plan to be in it for the long haul.
Some of these suggestions may sound incongruent, saying on the one hand that family cannot always come first, then emphasizing that raising children requires time and energy, countering with being selfish with your career. Therein lies the conundrum for anyone wrestling with this matter: how to balance the conflicting messages? It is a constant exercise to assess and reassess priorities, and unfortunately, there is no right answer for everyone.
Although faculty positions in academic medicine are evolving to be more “family friendly”, the surgeon/scientist triple-threat skill set is still being demanded in many institutions. The difficulty in balancing career and family life is a known deterrent for many women surgeons considering this line of work. An academic career can be challenging, fulfilling, exciting and fun. It is a worthwhile endeavor, but it is not for everyone. My hope is that those of you who do want this career path will realize the feasibility of such a pursuit, but with awareness that it will require making weighty personal decisions not only as you start out, but at frequent intervals along the way.
1) AAMC Women in U.S. Academic Medicine: Statistics and Benchmarking Report 2009-2010, at
https://www.aamc.org/members/gwims/statistics/ Accessed Sept. 6, 2011.
2) Schroen AT, Brownstein MR, Sheldon GF. Women in academic general surgery. Acad Med. 2004; 79:310-318.
3) Bickel J, Wara D, Atkinson BF, et al. Increasing women’s leadership in academic medicine: report of the AAMC Project Implementation Committee. Acad Med. 2002; 77:1044-61.