Closing the gender gap

When Barbara K. Kinder, M.D. ’71, HS ’77, trained at Yale three decades ago, surgical residents were just that: resident surgeons who virtually lived at the hospital. They worked grueling 128-hour weeks, and overnight call alternated with “short” days that ended at 10 p.m. or later. This went on for five years. If the residents of that era ever felt worn down or resentful, or if they ever longed for a schedule change to attend a wedding or hit the ski slopes, they kept it to themselves.

“In my day, nobody complained about anything. Nobody ever uttered a word,” says Kinder, an endocrine specialist who is now the William H. Carmalt Professor of Surgery. “We basically did as we were told and kept our eye on the goal: getting excellent surgical training and finishing the residency.” In fact, the odds were good that a resident who began training at Yale would not finish here. After the second year, the Yale group was cut from 12 residents to four. In those days, it was “survival of the fittest, a Darwinian approach to surgical training,” says Kinder, who in 1977 was one of the first two women to complete the general surgery training at Yale.

Things have changed. For one thing, the hours of training are much shorter. In July 2003, new rules limited residents’ time on duty to 80 hours per week, and effectively changed the way surgeons learn their craft from an immersion experience to one that is more diffuse. The new limits are in part a response to lawsuits claiming medical errors from fatigue, but they also reflect changes in societal attitudes about family life. Across all medical disciplines, women, in particular, have pushed for greater flexibility, making it somewhat easier for physicians to combine career and family.

Early in her career, Kinder sensed that Yale was committed to making room for the increasing number of women choosing to become doctors. (Her enthusiasm for the school was such that she turned down a chance for a job at another high-powered program.) Yale’s commitment led to the establishment in 1975 of the Office for Women in Medicine. Through informal get-togethers and by matching students with mentors, the office fosters ties among female students, residents and faculty members. “Over the years,” says Director Merle Waxman, M.A., associate dean for academic development, “there’s been a strong base built here, a strong support center.”

The above-average number of women on the surgery faculty attracts more women in turn. Women applying for faculty positions interview with both male and female surgeons, including high-ranking women like Kinder. Candidates for residency get a similar picture. First-year resident Lemi Luu, M.D., says she chose Yale from among other competitive programs in part because the department’s chair, Robert Udelsman, M.D., M.B.A., emphasized the strong presence of women on the faculty.

“That gave me a certain impression about the program, that it was forward-thinking,” says Luu, who graduated from Emory School of Medicine. “I felt that having an opportunity to interact with other female surgery attendings and to use them as role models was very important in my training and development.”

The numbers do suggest that Yale has made significant headway toward increasing the proportion of female surgeons on its faculty. According to an analysis of 2002 faculty roster data by the Association of American Medical Colleges (AAMC), Yale ranked 14th out of 126 medical schools in the percentage of women among its surgeons. (See complete list.) The analysis showed that 17 percent of full-time faculty members holding M.D. degrees in Yale’s Department of Surgery were female, compared with a national average of 11.2 percent, as of December 31, 2002. (Of 52 Yale faculty members with medical degrees who perform surgery, 9 were women.) The numbers are likely to climb as more women choose surgery; at Yale, about 30 percent of residents in general surgery have been women over the past decade, according to John H. Seashore, M.D. ’65, HS ’70, the residency program director. Nationally, 25 percent of general surgery residents are women, according to the AAMC.

Udelsman saw the relatively high percentage of women in the department as a plus when he was recruited from Johns Hopkins in June 2001. He expects that the number of women in surgery at Yale and nationally will increase. Nonetheless, he does recognize that the surgery “lifestyle” puts off some prospective surgeons; women and men alike worry that they won’t have time for family and leisure if they choose the field. But he says that medical students have found the prospects less intimidating since the national Accreditation Council for Graduate Medical Education capped the workweek for residents at 80 hours. “People who in their heart of hearts wanted to be surgeons, and were dissuaded from it, are now considering surgery.”

As more women choose the field, Udelsman says, surgery programs will be forced to acknowledge “the fundamental biological difference that you can’t ignore: the issues of childbearing and family. We accept the fact that residents and faculty members who become pregnant will have special needs that in the past have not been major issues in surgery programs, because there have not been many women.” For instance, if complications require a pregnant resident to take a few months off, how will she accrue enough cases to meet certification requirements? “I don’t have the answers,” says Udelsman.

He adds that the Yale surgery program will resolve those dilemmas to ensure that talented and dedicated women continue to choose surgery. In the final analysis, Udelsman is not interested in strong female candidates any more than strong male candidates: he just wants good surgeons. “I’m interested in having the best surgery department in the country, period.”

That focus on skill, not gender, originated in the 1970s. “There’s such a strong tradition of female surgeons, starting with Barbara Kinder,” says vascular surgeon Lynne Henderson Kelley, M.D., who joined the faculty last February. “There’s no distinction. We’re allowed to be surgeons, not women surgeons.” YM