Idiosyncrasies of my generation and my culture (I am from Mexico) made it “normal” for me to be one of very few women in medical school and the only woman in residency and fellowship. Despite being of the generation of “liberated women,” I was often the recipient of derogatory comments from male colleagues that went unaddressed by my superiors. I took the situation in stride, perceiving these obstacles as opportunities that would eventually allow me to achieve my goal of becoming an academic hepatologist. I never harbored any aspirations of becoming a leader in Mexico, as I was born and raised in a household where male privilege abounded.
I was naïve in my beliefs that things would be different in the United States, that everybody was treated equally, and as long as I did my job and did it well, recognition would follow. Over almost 30 years, I did do my job, I did it well, and recognition from my peers has followed. I was not treated equally and I feel, as many of young female faculty still do, that as a woman I had to work triply hard compared to males in my profession to prove myself worthy of recognition.
When I first came to Yale to form part of the faculty at the Digestive Diseases section, I was still one of few women, not only in the section but also in the whole Department of Medicine. As a woman in a predominantly male department, I was disappointed when I perceived that my voice was not being heard and that male fellows and faculty would consult other male faculty to validate my opinion regarding patient care and research. I do have to mention an anecdote that occurred soon after getting to Yale. It concerned a patient that I knew had alcoholic hepatitis (I had seen many in Mexico) but who, despite my recommendations to the male team and my male fellow regarding the inadvisability of cholecystectomy, was being wheeled into the OR to get her gallbladder out. As this was occurring I had my first interaction with a surgical chief resident who was a female. After discussing the case, she agreed with me and the patient was wheeled back to her room. My expressed concerns about the inadvisability of the procedure to my male colleagues had fallen on deaf male ears but not on the ears of this female colleague. This was a momentous episode for me. I came to realize how communication or lack thereof between the genders in my profession was significant and could negatively or positively impact the outcome of treatment. This feeling has been strengthened over time and, as more women have become my colleagues and mentees, I find that interactions with them are particularly valuable, rewarding and comforting.
Back then, I also became aware that more junior (male) members of the faculty were receiving a higher salary than I was and this was even more disappointing to me because I realized that, as had occurred in Mexico, the perception that being female and single justified a lower salary also prevailed in the United States and at Yale University!!
One of the most incredible moments in my career was when I was selected to be president of the American Association for the Study of Liver Diseases, only the second woman to hold this position. My first thought was that I was unworthy and incapable of doing a good job but I accepted the position thanks to the encouragement and support of male colleagues in the society. It turned out to be one of the most inspiring and fulfilling jobs of my academic career and I was proud of what I achieved. Sadly, this has not been the case at Yale, where despite opportunities for leadership positions at the departmental level, females in the section have never been offered even the possibility of such positions.
I would hope that, as more women and more minorities enter the field and with an increased communication among them and an increased awareness in the medical community, the challenges that I have confronted will no longer exist and that a woman will be able to feel comfortable and supported in the medical environment and be given the same opportunities and support for career advancement and promotion to leadership positions as their (white) male counterparts. On the other hand, female leaders should go out of their way to do right by other women and to become role models for the younger generations not only of women but, importantly, also of men.
Guadalupe Garcia-Tsao is professor of medicine (digestive diseases) and chief of digestive diseases at the VA Connecticut Healthcare System