A roundtable discussion on leadership skills, work-life balance, and more

In October 2012, the Women’s Professional Development Symposium for Emerging Leaders in Orthopaedics, sponsored by the nonprofit Nth Dimensions Educational Solutions, explored strategies female orthopaedists use to nurture their careers, improve their leadership skills, and maintain work-life balance. Afterward, the following orthopaedists who served as symposium faculty members took part in an AAOS Now-sponsored roundtable discussion:

• Bonnie Simpson Mason, MD, founder of Nth Dimensions Educational Solutions; clinical assistant professor of orthopaedic surgery, University of Texas Medical Branch, Galveston, Texas, roundtable moderator
• Surrenthia Parker, MD, chief, division of orthopedic surgery, Jackson Park Hospital, Chicago
• Donna Phillips, MD, chief, pediatric orthopaedic surgery, Bellevue Hospital Center, New York; clinical associate professor, departments of pediatrics and orthopaedic surgery, NYU Langone Medical Center, New York
• Carole S. Vetter, MD, associate professor of orthopaedic surgery, Medical College of Wisconsin, Milwaukee, Wis.
• Kimberly J. Templeton, MD, professor of orthopaedic surgery and orthopaedic surgery residency program director, University of Kansas Medical Center, Kansas City, Kan.; president, U.S. Bone and Joint Initiative
• Mary I. O’Connor, MD, professor of orthopaedic surgery and chair of the orthopaedic surgery department, Mayo Clinic, Jacksonville, Fla.
• Vani J. Sabesan, MD, assistant professor, department of orthopaedic surgery, Western Michigan University School of Medicine
• Naomi N. Shields, MD, clinical professor, University of Kansas School of Medicine–Wichita; private practice orthopaedic surgeon, Wichita, Kan.

Dr. Mason: Although the number of female orthopaedists continues to climb, only 14 percent of current orthopaedic surgery residents are women. Why is the percentage still so low?

Dr. O’Connor: Of all specialties, orthopaedics has the lowest percentage of female residents. This is not good for our patients or our profession. Orthopaedics never had a high percentage of women, but now every other surgical specialty has surpassed us, according to recent data from the Association of American Medical Colleges.

Charles S. Day, MD, MBA, recently surveyed students at Harvard Medical School. His data suggest that negative perceptions of the specialty, including concerns that the culture is not welcoming to women, discourage female medical students from considering a career in orthopaedics.

Dr. Templeton: Early presentation of musculoskeletal topics in medical school is frequently the first exposure that many students, especially women, have to this area of medicine. However, many medical schools do not include musculoskeletal medicine as a part of their curriculum.

Anecdotally, I have noted while interviewing residency candidates that men are more likely to have had sports injuries and to have been encouraged to consider a career in orthopaedics. Women may have had the same sports exposure and the same sorts of injuries, but I have not often seen the same degree of early mentoring of female candidates as I have with males.

Dr. Phillips: The percentage of orthopaedic residency applications received from women is equal to the percentage of female applicants accepted to orthopaedic residency programs. So, it is not that women are not being accepted into programs—it is that they are not applying.

I think some stereotypes still exist; for example, that you have to be strong and athletic to pursue orthopaedics and that it is very difficult to get accepted to an orthopaedic residency program. I also think there is a stereotype that it is not possible to have a family and be an orthopaedic surgeon.

Dr. Vetter: I agree. As an orthopaedic residency program director, I talk with many female medical students whose top concern is whether they can have families and be orthopaedic surgeons. The perception is that balancing a family and a career in orthopaedics is more difficult than it would be in other surgical specialties.

Dr. Mason: I work with many young medical students and college students, many of whom have never met a female orthopaedic surgeon. When we, as orthopaedic surgeons, address groups of female medical students, it can encourage them to consider a future in orthopaedics. That’s important because women bring different strengths and attributes to the field.

Dr. O’Connor: Definitely. By cultural upbringing, many women are more socialized to interact as part of a team. As medicine becomes more team-driven and team-oriented, a physician’s ability to serve as a leader—but also embrace and support the team—becomes even more important.

Dr. Phillips: Clearly, not all women are alike, just as all men are not alike. But having a nice mix of people in an orthopaedic residency, practice, or academic department creates a balance for the surgeons, as well as for patients and students.

Dr. Mason: Do you think younger women believe they face the same kinds of challenges we faced?

Dr. Templeton: I think younger women assume things are equal. I think we are heading toward that, but we are not there yet. Women in orthopaedic surgery are perceived differently—and that fact can’t be ignored.

We need to continue to talk with younger women about what some of the issues have been and what some of the current issues are so they understand what they may face in their careers.

Dr. Mason: Based on what I am hearing, it is important for younger female orthopaedists to reach out to more experienced surgeons and to take advantage of resources for ensuring career success.

Dr. Shields: Absolutely. It is very valuable to volunteer to be on committees of various groups and societies to help develop leadership skills. Participating in different organizations expands your world tremendously by helping you create contacts and develop professional relationships.

Volunteering with groups outside of orthopaedics provides exposure to how leaders work and think. People will not ask you to volunteer if they do not know who you are. Medical students should consider getting involved with programs at their schools or starting an orthopaedic medical student club.

Dr. Parker: I agree. Joining the local orthopaedic society provides the opportunity to interact with colleagues and to meet people who can introduce you to different avenues of leadership. Everyone needs a support network, which includes mentors. Mentors should offer helpful feedback—positive as well as negative—to help you improve the way you do things.

Dr. Sabesan: One resource I found helpful was a leadership course sponsored by the American Orthopaedic Association, which focused on leadership and communication, rather than the practice of orthopaedics.

Dr. Mason: What about negotiation skills? What do women need to know? And what was your reaction to Sara Laschever, author of Women Don’t Ask, who was a presenter at the symposium?

Dr. Templeton: Women and men are socialized differently. Women are taught that hard work will eventually be recognized and compensated accordingly. Men are more accustomed to asking for what they want. Women are not used to negotiating, and many of us tend to undervalue our work. Even when we do negotiate, we do not always do the research to find out what we are worth and then ask for appropriate compensation.

Dr. Mason: One of the take-home points from Sara Laschever’s talk was that women generally do not ask for as much as our male counterparts might. For example, I recently counseled a surgeon who asked whether she should negotiate for a higher salary or for reimbursement for costs related to continuing medical education and professional society dues.

I simply said, “Why don’t you ask for both?” She called me back a month later and said she got everything she wanted. Before I suggested it, it had not occurred to her to ask for both.

Dr. Shields: I think women often try to reach a win-win type solution. When somebody says “no” to us, we back off because we do not want to be seen as troublemakers.

Dr. Mason: What about that stereotype on work-life balance? Is it achievable in orthopaedics?

Dr. Parker: I did not achieve work-life balance in my early career. The pressure was to be as good as I possibly could be. I did not say “no” as much as I should have.

Due to an illness, I had to leave the trauma center where I practiced. I’m now at a community hospital, which enables me to manage my health, to practice orthopaedics on a fulltime basis, and to have a family life. I do not have children, but I have my husband and am involved in the community and my church. I have balance and am very happy.

So, based on my experience, I would stress to residents and those starting a practice to focus on achieving balance.

Dr. Phillips: I have two stepchildren and two sons with my husband. It is very difficult to do it all simultaneously. Planning work priorities out sequentially can be helpful. For example, if you decide to pursue leadership and academics, you might put off having children. Conversely, you might have children early and pursue leadership positions when they are older. In my case, I was able to negotiate a part-time academic position so I could be home more with my children. As my kids got older, I became more involved academically.

Dr. O’Connor: A supportive spouse and family are critical. Many factors make parenting a young child biologically unfair. For example, a sick baby doesn’t care that mom has to perform a sarcoma resection or hip revision the next day.

So, early on, I think it is physically more difficult. If I could do it all again, I would work four days a week when my children were younger. I would try to give myself a little more flexibility so that I could pursue my long-term career goals. All of this hinges on having a pretty good understanding of where you want to be in your career in 10 years or 20 years.

Dr. Sabesan: Dr. Vetter inspired me at the symposium when she talked about being a surgeon and having young children. She said the bottom line is that you have to let go of controlling everything and remember that you can’t do it all.

Dr. Vetter: Yes, you have to be flexible so that you can do what is most important to you, which, in my situation, was to have a career and a family.

Dr. Shields: I think setting life and career goals is very important, as is breaking down the steps involved in achieving those goals. Learning the value of “no” is key in maintaining a work-life balance. And work-life balance is not necessarily about having a family and kids. It can also be about friends and the hobbies and activities that you find fulfilling.

Dr. Mason: Any final thoughts?

Dr. Sabesan: We need more experiences like the Women’s Development Symposium and this roundtable discussion. It is important to raise awareness about the need for more women in orthopaedics. We want to give young people the ­opportunity to learn from our experiences.

Upcoming Opportunities
The 2013 AAOS Annual Meeting will include multiple opportunities for female orthopaedists to network and improve their leadership skills, including the following:

• The Ruth Jackson Orthopaedic Society (RJOS) 2013 Annual Meeting—Tuesday, March 19, 5 p.m.–9 p.m. in the Monroe Room of Chicago’s Palmer House Hilton Hotel.
• Symposium Y: Women as Surgeons and Patients: Obstacles and Solutions for Increasing Diversity and Improving Care—Friday, March 22, 10:30 a.m.–12:30 p.m., McCormick Place, Room S105.