Women surgeons and the challenges of “having it all”

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Women surgeons and the challenges of “having it all”

by Nicole Martin on Tuesday, November 17, 2015 - 11:39am
When interviewed about the impact of family commitments on her surgical career, one woman shared a colorful story about practicing surgery while pregnant. Late in her pregnancy, in the middle of performing emergency surgery, she experienced her first contractions. However, rather than stopping the surgery, she continued since the contractions were irregularly timed. In fact, she even came to work the next day, by which point her contractions were persistent and at regular five-minute intervals. 
 
Despite being in labor, she kept working her surgical rounds, and it was only when a nurse realized what was happening that she was finally convinced to go to the hospital. But instead of heading there immediately, she first drove all the way home to change out of her scrubs since she had promised her OB/GYN that she wouldn’t be working and didn’t want her doctor to be angry. As a result, she barely escaped having the baby in the car, delivering it within 20 minutes of walking through the hospital doors. 
 
Cindy Kin, a surgeon and former faculty research fellow at the Clayman Institute, shared this story and many others during a fellows’ lunchtime talk fittingly titled, “ “I'm Just Going to Take this Gallbladder Out, Then I'll Push” and Other Stories of Women Surgeons Raising Families.” Also an assistant professor of surgery at the Stanford Medical Center, Kin’s research explores the unusual demands placed upon women surgeons attempting to “have it all” – both a career and family. 
 
The unique obstacles faced by women surgeons 
 
Like many other careers in the sciences, the field of surgery is heavily male-dominated. While medical school is evenly split between female and male students, only 14 percent of women choose to go into surgical specialties in contrast to 33 percent of men. 
 
While medical school is evenly split between female and male students, only 14 percent of women choose to go into surgical specialties in contrast to 33 percent of men.
 Although they share similar trials as women in other male-dominated fields, Kin’s research has focused on the unique challenges women surgeons’ face daily. These include a dozen years or more of surgical training, an intense physical component, being on call two to three nights per week, unpredictable hours, and a huge workload that regularly results in 60-to-80-hour work weeks. All of these factors make having a family while moving up the surgical career path particularly difficult for any person, whether a man or a woman.
 
However, not surprisingly, Kin found that the exceptional demands of surgery affected women’s careers and family trajectories differently than men’s. Twenty-five percent of female surgeons are single, compared to only 6 percent of male surgeons. Similarly, Kin discovered that 60 percent of female surgeons have children versus 92 percent of male surgeons.  Furthermore, only 25 percent of women choose to have their first child during the rigors of surgical residency, which is half as many as their male colleagues.
 
Women surgeon voices: Guilt, stubbornness, and the double standard
 
In order to understand and contextualize these stark disparities between women and men’s experiences, Kin turned to women surgeons to hear what they had to say. She discovered that women felt an overwhelming pressure to hold off on having children until they had completed their training. Or, if they decided not to wait, felt they needed to hide and suppress their pregnancies or any existing children as much as possible. 
 
The women in Kin’s interviews consistently expressed a deep sense of responsibility to not let their colleagues down, meaning they felt they could not show any differences or “weaknesses” compared to men. This is why so many women worked up until the very moment they are in labor, only to return as little as two to six weeks later. One woman surgeon explained how normative this practice had become, claiming, “Everyone plans on working right up to the minute they deliver. You work until your water breaks.”
 
Kin discerned that this intense desire to uphold women surgeon’s collective reputation comes from all quarters. On the one hand, women surgeons are told at an institutional level, “Couldn’t you have waited?” and “You girls go through all this training and then you go off and have kids and just be moms. It’s a shame. It’s a waste of training.” While many women Kin interviewed emphasized how horrified their colleagues were upon discovering they were trying to start a family, others also pointed out that women surgeons often self-generated “a little bit of machismo” and a lot of stubbornness when trying to prove that being pregnant or having a family would not hamper the quality of their work or extend the length of their training. 
 
Kin also investigated women surgeons’ experiences once they had children. She found that most women felt tremendously guilt-ridden, believing they were failing at both their career and motherhood. During her talk, Kin described how women surgeons possess higher rates of work-home conflicts than men, including conflicts associated with depression, emotional exhaustion, lower quality of life, and dissatisfaction with both their spouse and career. One woman summed up the general sentiment about the “superwoman” transformation that surgery demands when she explained, “Academically, I’ve found it impossible. I can’t be a full time clinical surgeon, vaguely [a] full time mom, and full time researcher. I am not one of those women who rise at 3:45 am to write a paper while exercising on a treadmill. I’m never going to be able to do that. When I realized that, I got depressed.” 
 
What made women surgeons’ experiences especially frustrating, Kin discovered, was how men were seemingly not subject to many of the same pressures, despite being more likely to have families. One reason was that 83 percent of women’s partners also worked outside of the home while only 48 percent of men’s partners did. This meant women surgeons were more likely to be tasked with organizing elaborate child care schemes, often involving multiple nannies or the help of extended family members and little-to-no face-time with their partner. 
 
Women are still seen as primarily responsible for child rearing, regardless of whether they work outside the home or not.
 Some women attributed the extra pressure to how women are still seen as primarily responsible for child rearing, regardless of whether they work outside the home or not. Many women surgeons felt like they could not make their families visible in the workplace, because any hint of being a mom was seen as interfering with their work in a way that being a dad would not. Or, conversely, one woman shared, “When my section chief sees me here beyond 6:00 pm, he says, ‘Go home and be with your kids, I don’t want you to be here and burn out.’ He probably wouldn’t say that to any of the guys with kids.” She further explained how her male partners assumed that she would go part time “because I’m the mom” without applying that same expectation to the men with families.  
 
New models, new possibilities
 
Kin concluded her talk by sharing the hope women surgeons had for building a new model of being both a mom and surgeon, including an environment in which not “having it all” doesn’t result in so much guilt and conflict. Some women voiced that they would simply dial down their high career aspirations. Others said they would stop striving to be the type of full-time moms their mothers were, and that this was okay. 
 
In fact, some women expressed that combining motherhood and the practice of surgery could even hold certain advantages. Some have found that they built better relationships with their patients when they disregarded convention and actually acknowledged their status as both mother and surgeon in the workplace. Other women emphasized the importance of breaking new ground and becoming role models for their children as well as future generations of women surgeons. 
 
Concrete solutions, such as greater autonomy in scheduling, job sharing, and child care, need to be instituted in order for women surgeons to maintain a work-life balance.
 Kin also proposed several concrete solutions that would help ease the double standard women surgeons face. These solutions include creating a workplace environment that allows for greater autonomy in scheduling, more room for job sharing and other innovative practice structures, and on-site back-up childcare for non-school days. They hope to accommodate the surgeon’s life choices using innovative problem-solving and without compromising their work. If empowering and practical changes like these are instituted, Kin believes it will be possible for women surgeons to maintain a work-life balance and live life according to priorities that embrace both their professional and personal goals. 
 
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For more information on the experiences of women surgeons, see Claudia Mueller's article.
 
Assistant Professor of Surgery (General Surgery) at the Stanford University Medical Center

Cindy Kin is a Colon & Rectal Surgeon and Assistant Professor of Surgery at Stanford University Medical Center. She received her BA in Government from Harvard University and her MD from Columbia University. She completed her residency in General Surgery at Stanford, followed by a fellowship in Colorectal Surgery at the Cleveland Clinic. She specializes in the surgical management of colorectal cancer,...

Nicole Martin
Graduate Voice & Influence Program Fellow 2015-2016, History

Nicole received her B.A. in gender history from the University of California, Berkeley and her M.St. in Women’s Studies from Oxford University.

Nicole’s focus is in the historical intersections of American imperialism and gender in the American West. Her research investigates the role of the home and alternative domesticities during the Reconstruction...