Women in orthopedics: Facing the challenges, reaping the rewards

Our panel continues the dialogue on being a successful woman in the orthopedic community.

For close to 80 years, women have played an important role in the history of orthopedics. To open Part 2 of this two-part series, I would like to celebrate some who may not be well known, but are nonetheless extraordinary.

Barbara Stimson, chief of the Fracture Service at New York Orthopaedic Hospital, volunteered to go to England before the United States entered World War II as part of a program to supply American doctors to British hospitals. She served as a commissioned major in the Royal Army Medical Corps in England, North Africa and Italy and was instrumental in convincing her cousin, Secretary of War, Henry Stimson, to commission women nurses and physicians in the U.S. military.

Anna Brady served as a nurse in the Battle of the Bulge, became an orthopedist under the GI Bill and commanded a hospital in Chu Lai during the Vietnam War. She retired from the military as a brigadier general.

As the number of women orthopedic residents rise — it is 11% now, up from 3% just 30 years ago — their participation in the specialty is almost taken for granted as we become accustomed to roles only recently pioneered. However, we still face significant challenges. Women make up over 50% of the student body in most medical schools, but only a fraction of women graduates choose our profession.

During this discussion, I will ask the panelists questions about their decisions to enter orthopedics in an effort to underscore why orthopedics is a terrific career choice for both women and men.

Laura L. Tosi, MD
Moderator

Round Table Participants Virtual Moderator Laura L. Tosi, MD Director, Bone Health Program Children’s National Medical Center Washington, D.C. Sheila E. Brennan, MD Orthopedic Surgeon Veteran’s Brevard Outpatient Clinic Viera, Fla. Laura L. Forese, MD, MPH Senior Vice President Chief Medical Officer Chief Operation Officer New York Presbyterian Medical Center/Weill Cornell Medical Center New York, N.Y. Serena S. Hu, MD Chief, Spine Service University of California San Francisco Medical Center San Francisco, Calif. Valerae O. Lewis, MD Associate Professor, Ad Interim Chief Section of Orthopaedic Oncology MD Anderson Cancer Center Houston, Texas Patricia L. McKay, CDR, MC, USN Residency Program Director Department of Orthopedics National Naval Medical Center Bethesda, Md. Peggy L. Naas, RN, MD, MBA Vice President of Clinical Supply Chain Solutions Physician Preference Management, VHA Inc. St. Paul, Minn. Robin V. West, MD Assistant Professor University of Pittsburgh Department of Orthopedics Pittsburgh, Pa.

Laura L. Tosi, MD: How did you choose medicine as a career?

Sheila E. Brennan, MD: I don’t remember the exact moment, but I do remember that when I was very young — maybe 6th or 7th grade — I read the biography of Elizabeth Blackwell, MD, the first woman physician in the United States and being impressed by her persistence and commitment to becoming a doctor. I think after reading that, I believed that medicine was a real option for women.

Robin V. West, MD: I decided at an earlier age that I wanted to be a physician, even though neither of my parents were physicians. My pediatrician was probably my biggest influence. He had excellent bedside manners, and his enthusiasm about his profession was contagious. I actually asked for a copy of Gray’s Anatomy for Christmas when I was 5 years old (I still have the copy).

Laura L. Forese, MD, MPH: I decided on medicine as a young girl, highly influenced by my parents. Neither of them were physicians, and I probably didn’t know enough about medicine. I entered medical school immediately after graduation from college and then went on to a time-consuming surgical residency. One of the things I regret about my career is that I didn’t take time off between college and medical school. I believe that would have given me a better perspective on medicine and would have made me appreciate it more. As it was, I went through too quickly and didn’t appreciate the opportunities that were given to me. I feel that I missed out on most of my twenties and early thirties. I was just too tired to enjoy them.

Serena S. Hu, MD: I was encouraged by my parents who, being good Chinese parents, wanted their daughter who was good in science to go into medicine. Since I got interested in orthopedics, there was no looking back or around at other fields.

Valerae O. Lewis, MD: I am one of those boring people who have always wanted to be a physician. My father is an internist and I think at an early age I wanted to emulate him. As I grew older, I saw the satisfaction he derived from treating his patients and the love and admiration that the patients had for him. He always seemed excited to go to work and he emphasized that a good physician is always learning. The continual growth aspect of medicine excited me.

“Being a competitive athlete has influenced my practice and decision to choose sports medicine as a specialty.” — Robin V. West, MD

Patricia L. McKay, CDR, MC, USN: I grew up on a farm and was exposed to lots of animals. The constant preventive, perinatal and injury care required on the farm were an inspiration to pursue medicine — only I wanted to take care of people.

I chose medicine after high school. I went to Villa Julie College in Stevenson, Md., to pursue a bachelor of science in nursing program, but after completing the first 2 years I transferred to the University of Maryland Baltimore County for pre-med. My logic went something like this ... I wasn’t an honors student in high school, mostly A’s and B’s, but thought medical school required more. I always knew I wanted to have children and thought nursing would be more flexible, and it is.

Peggy L. Naas, RN, MD, MBA: I was a baccalaureate-degree registered nurse working in oncology at the University of Minnesota when Dr. Clara Bloomfield, one of the staff physicians, encouraged me to consider becoming a physician. The opportunity to challenge myself and to make a difference in people’s lives at so fundamental a level such as their health attracted me to medicine. I returned to school full time for 2 years in pre-medicine and biologic sciences while I continued working evenings in a county emergency department.

Tosi: What attracted you specifically to orthopedics?

West: Orthopedics came naturally to me. I always loved science and math. The combination of anatomy, physics and biomechanics were a perfect fit. I also love the diversity that orthopedics offers. I get to perform surgery, have personal interactions with the patients in the office, and treat young and old patients from a variety of socioeconomic backgrounds.

I was an athlete growing up and swam competitively in high school and college. Being a competitive athlete has influenced my practice and decision to choose sports medicine as a specialty. I can better relate to my patients and their desire to return to their preinjury activity level.

Brennan: I went to Georgetown Medical School and became interested in orthopedics during my third-year surgical rotation. Dr. Peter Kenmore ran a busy, tough department, but he and others like Dr. Jack Delahay had a real passion for teaching. During the rotation, they actively engaged each student. They inspired confidence in us by challenging us to think and perform, in and out of the operating room, at levels higher than any of us thought possible.

Forese: I started medical school without really knowing much about different specialties and thought that I would like OB/GYN, probably because that was the specialty that I thought I understood. Ironically, that was one of the only specialties that I didn’t like once I reached my clinical year.

I was immediately taken by how much fun the orthopedic surgeons seemed to be having. All of the residents and the professors appeared to be enjoying enormously their practice of medicine. I was also attracted by the chance to actually make things better and to literally see the results immediately.

Hu: I found that the concepts in orthopedics, unlike those in other fields of medicine, made intuitive sense to me. I liked the hands-on aspect of surgery and I like the directness of the approach: If it’s broken, fix it. Of course, now as a spine surgeon, I find that the subtleties of patient selection, far more complex than I appreciated as a medical student.

Lewis: I enjoyed working with my hands. During my third-year medical school rotation at Massachusetts General Hospital (MGH), the orthopedic residents were a great group of people who seemed to love orthopedics. Orthopedics had a team-like atmosphere which appealed to me as an athlete.

I had great mentors during my orthopedic rotation at MGH, who were orthopedic oncologists, who influenced and encouraged my sub-specialization.

McKay: Orthopedics offers tangible results, and problems you can literally “put-your-hands-on” as well as wonderful colleagues and challenging cases without the constant life-and-death issues present in some other types of surgery. The residents and staff I rotated with as a third-year student probably had the most impact leading me to include orthopedic electives in my fourth year.

Naas: Dr. Jim House, an orthopedic professor at the University of Minnesota Hospitals and Clinics, was a tremendous mentor and role model. He is a wonderful individual with enthusiasm for orthopedics and his patients.

When I was an emergency department nurse, the orthopedic residents seemed to be able to definitively help people by manipulation, reducing and casting fractures, or surgery. I am a concrete thinker who likes action and results.

Tosi: Who influenced you along the way and what did the important people in your life think about your decision to train in orthopedics?

West: My family and friends were very supportive of my decision. My mother was a single parent and always encouraged me to challenge myself and not be deterred by certain barriers. She is a very independent and strong-willed woman who always told me that with perseverance, my aspirations were achievable. I was very lucky to have her as an excellent role-model.

Brennan: Along the way I have been encouraged by some wonderful people. My family has always been very supportive of my decision to train in orthopedics. My husband is my greatest supporter and adviser. Dr. Peter Kenmore, chief of orthopedics at Georgetown, dedicated many hours teaching me about orthopedics and the “art of medicine.”

There were also many nurses who encouraged me. Many would come up to me and quietly whisper, “Hang in there, you’re doing great.” And finally, I have to say that I have been influenced and felt great encouragement from other women doctors. We each have our own story, our triumphs and our tragedies and our own version of the “road less traveled.”

“Orthopedics offers tangible results and problems you can literally ‘put your hands on.’” — Patricia L. McKay, CDR, MC, USN

Forese: I was most strongly influenced along the way by my parents, particularly my father who told me there wasn’t anything that I couldn’t do. In my third year of medical school, I rotated through my specialty services with a team of students all of whom were male.

My orthopedic preceptor clearly thought that he could interest at least one of us in orthopedics and was initially surprised and perhaps a bit disappointed that I was the one student in the group with an interest. To his credit, once he saw that I was really interested, he became a great advocate and mentor for me. I was well-supported during training, and if there was any discrimination toward me during my training, I wasn’t aware of it.

I was the first woman in my department to be pregnant during residency. I needed extra time off due to medical complications in carrying twins. My chairman, Dr. Harold Dick, supported me tremendously and arranged for me to have a paid maternity leave — a rarity at the hospital during that time — and to get independent credit for the time I had to be on bed rest.

Dr. Dick also advised me to get a management degree — that it would always be useful. I almost didn’t pursue this because I had two babies, a full-time job, and no money to pay the tuition.

Eventually, I found a scholarship and pursued an executive MPH in health care management. He ultimately gave me the role of managing departmental administration and finance.

When Dr. Louis Bigliani, succeeded him, I was able to move into a vice chair role because I had this administrative skill set. He gave me plenty of opportunities and allowed me to make mistakes. When I was ready to move on, he helped me find my next job. To this day, he continues to be a mentor.

Hu: I was lucky to always have people encourage me along the way: attendings, associate deans, and residents. My dean in medical school, Dr. Dean Cruess, was an orthopedic surgeon who was open to my asking about balancing multiple life interests. I don’t think I was ever discouraged about my interest in orthopedics, or if I was I didn’t hear it. I was also lucky to serve on a committee in medical school with a general surgeon, Dr. Joe Meakins, who became a mentor and encouraged me.

When I was a resident, my attendings, particularly Drs. David Levine, Steve Burke, John Healy and numerous others, were supportive as were my fellow senior residents. Among the faculty, Dr. David Bradford has been a key mentor.

Lewis: My parents have been very supportive throughout my life and were very supportive of my choice of medicine as a career goal. I was one of three girls and it was assumed in our household that we would all get advanced degrees.

“We each have our own story, our triumphs and our tragedies and our own version of the ‘road less traveled.” — Shelia E. Brennan, MD

My dad would have loved for me to go into internal medicine but he was supportive (orthopedic jokes aside) of my choice of orthopedic surgery. My mom made sure we were always prepared. She was a great role model on how to juggle a career and still be a full-time mom. Dr. Dempsey Springfield was, and still is, a great influence on me.

He supported my subspecialization choice and has been a great mentor ever since.

Drs. Mark Gebhardt and Henry Mankin were also inspiring. Dr. Mankin made it seem that there was never any doubt that I would find orthopedics, specifically orthopedic oncology, a satisfying and rewarding field, and that I would be welcomed there.

McKay: My mother profoundly influenced me. She was widowed at 34 with two small girls to raise. She has a gift with animals and made a living teaching riding and boarding/training horses. She taught us to be responsible and set the highest standards for us. She did not complain, but made it clear that we had to have a career plan, so we wouldn’t end up in her shoes, without retirement and always a tenant.

My maternal grandfather, a retired Naval officer, showed me the path to the Navy, and Haydee Kimmich, MD, who is now a retired Navy captain and orthopedic hand surgeon, taught, encouraged and reassured me that women have plenty of “strength” to do orthopedics because it isn’t about being powerful, it is about being smart and using gravity, leverage, etc. to your advantage.

Naas: In addition to the mentors I have already mentioned, Roby Thompson, MD, was the head of the orthopedic department at the University of Minnesota Hospitals and Clinics. I admire him for his work in orthopedic surgery, his leadership of the department, the American Academy of Orthopaedic Surgeons (AAOS), and now the university physician practice group. He inspired me to take on leadership and service roles.

My family has been supportive of my goals and I am grateful for their efforts in making it work. My husband is a general surgeon and our two teenaged-children have graciously accommodated their two surgeon-parents and work very hard in their own school accomplishments.

The women of the Ruth Jackson Society are living testament that women could be orthopedic surgeons, professors, wives, mothers, athletes and achieve all the accomplishments and activities that life and our specialty had to offer. Though certainly next to some of those “super women,” I have to understand my limitations by comparison.

For more information:

• Sheila E. Brennan, MD, can be reached at Brevard Veteran’s Outpatient Clinic, 2900 Veteran’s Way, Viera, Fl 32940; 321-637-3788; e-mail: sheila.brennan2@med.va.gov.
• Laura L. Forese, MD,MPH, can be reached at New York Presbyterian Hospital, 525 E. 68th St., P114, New York, NY 10021; 212-746-5563; e-mail: foresel@nyp.org.
• Serena S. Hu, MD, can be reached at UCSF Medical Center, 505 Parnassus Ave., San Francisco, CA 94122: 415-476-1000; e-mail: HuS@orthosurg.ucsf.edu.
• Valerae O. Lewis, MD, can be reached at MD Anderson Cancer Center Orthopedic Oncology Section, P.O. Box 301402, Unit 408, Houston, TX 77210; 713-792-5073; e-mail: volewis@mdanderson.org.
• Patricia L. McKay, MD, can be reached at National Naval Medical Center, 8901 Rockville Pike, Bethesda, MD 20889-5600; 301-295-4611; e-mail PLMcKay@Bethesda.med.navy.mil. She notes that, “The opinions represented by this paper do not reflect the viewpoints of the federal government or of the U.S. Navy.”
• Peggy L. Naas, MD, MBA, can be reached at VHA Clinical Supply Chain Solutions, P.O. Box 140909, Irving, TX 75014; 972-830-0081; e-mail: pnaas@vha.com.
• Laura L. Tosi, MD, can be reached at Children’s Hospital, 111 Michigan Ave. N.W., Washington, DC 20010-2978; 202-884-4152; e-mail: ltosi@cnmc.org.

Reference:

• Part 1 of the discussion appeared in our June issue and can be accessed at www.ORTHOSupersite.com.