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Women in Surgery: Are You Ready for A Woman in Charge?

Women in Surgery: Are You Ready for A Woman in Charge?. Julie A. Freischlag, M.D. The William Stewart Halsted Professor Chair of Surgery, Johns Hopkins Medical Institutions Surgeon-in-Chief The Johns Hopkins Hospital. Elizabeth D.A. Magnus Cohen, M.D. 1820-1921.

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Women in Surgery: Are You Ready for A Woman in Charge?

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  1. Women in Surgery:Are You Ready for A Woman in Charge? Julie A. Freischlag, M.D. The William Stewart Halsted Professor Chair of Surgery, Johns Hopkins Medical Institutions Surgeon-in-Chief The Johns Hopkins Hospital

  2. Elizabeth D.A. Magnus Cohen, M.D. 1820-1921 • Female Medical College of Pennsylvania • First woman physician licensed to practice medicine in Louisiana – 1857

  3. Cared for the people of the French Quarter from 1857-1887 (yellow fever & smallpox)

  4. Born in New York city • Married Aaron Cohen • 5 children – only 1 into adulthood • Husband went to New Orleans to study surgery – she enrolled in Medical School in 1854 • Did she graduate?

  5. Began her practice 1857 • Listed in directory as a midwife in 1867-1868 • In 1869 – listed as a “Doctress” • 1876 – Mrs. Elizabeth Cohen – physician • She reports no “discrimination” while training

  6. 1853 New Orleans Bee – female physician treating a male patient as incongruous and improper • 1898 JAMA – blamed women for the decline in salaries and prestige of the medical profession • Medical schools began refusing to admit women

  7. Did not lose a patient in 30 years • Nickname – “lucky hand” • Retired from practice in 1887 • Ran sewing and linen room at Touro Infirmary until she died 1921 –age 101

  8. Margaret D. Craighill, M.D. 1898-1977 • The Johns Hopkins University School of Medicine • Maryland – Connecticut • Surgery – Obstetrics and Gynecology

  9. 1898 Born – Southport, North Carolina • 1921 graduated Phi Beta Kappa University of Wisconsin – followed by a M.S. degree • Physiologist in the chemical warfare department at the Army’s Edgewood (Maryland) Arsenal • Post graduate positions in gynecology, surgery and pathology at Johns Hopkins and Yale.

  10. 1943 1st woman physician to become a commissioned officer in the United States Army • Served as Dean of the Woman’s Medical College of Pennsylvania

  11. 1928-37 private assistant in general surgery to Dr. J.A. McCreery at Bellevue Hospital, NY • Also had a private practice in OB/GYN in Greenwich, Connecticut and assistant surgeon and attending gynecologist at Greenwich Hospital • 1940 acting Dean Women's Medical College of Pennsylvania • 1941 WWII went into active service

  12. 1943 Sparkman – Johnson bill – allowing women to enter Army and Navy Medical Corps • One month later, she was the 1st woman doctor to receive an Army Commission • WAC (160,000) – challenged the position that women were unsuited to a military role • Awarded Legion of Merit

  13. 1945 – consultant on women veteran’s medical care • Returned to Women’s Medical College and became a Psychiatrist. • Named Chief Psychiatrist at Connecticut College for Women in New London • Died at age 78 in Southbury, Connecticut

  14. Benjy Frances Brooks, M.D. 1918-1998 • University of Texas Medical Branch, Texas • Pediatric Surgery • 1960 first woman pediatric surgeon in Texas

  15. 1918 – born in Lewisville, Texas • Performed operations on her sister’s dolls with manicure scissors at age 4 • B.S. degree from North Texas State Teacher’s College at age of 19 – M.S. 2 years later • Taught high school for 4 years • 1944 – entered University of Texas Medical Branch in Galveston • Residencies at Penn & Children’s Medical Center in Boston • Became one of the 1st women surgeons at Harvard

  16. 1957 – Glasgow, Scotland – Pediatric Surgery at Royal Hospital for Sick Children • Back to Boston – 1960 – back to Galveston – join 2 other male pediatric surgeons • Studied congenital defects, burn treatment, spleen reparation and the prevention of hepatitis • Benjy Brooks Foundation for Children – by parents of one of her patients. In Texas “you can go as far as you can push yourself.”

  17. Dorothy Lavinia Brown, M.D. 1919 – 2004 • Meharry Medical College, Tennessee - Surgery • 1948 first African American Surgeon in the south • 1956 first single women in Tennessee to become an adoptive parent • 1966 first African American woman to serve in the Tennessee state legislature.

  18. Spent her childhood in an orphanage (age 5 months – 13 years) • Mother reclaimed her but she ran away 5 times back to the orphanage. • Maid at Wing Sing Chinese Laundry • Ran away to attend Troy High School – age 15 (foster home - Lola and Samuel Wesley Redmon) • 1937 – graduated at the top of her class • Attended Bennett College in Greensboro, NC – on scholarship (top of the class)

  19. Inspector for Army Ordinance Department 1944 – enrolled at Meharry – graduated 1948 • Intern – Harlem Hospital • 5 year residency in surgery Meharry and George W. Hubbard Hospital • 1955 – became an Assistant Professor of surgery and 1st African American woman to be FACS. • 1957-1983 Chief of Surgery, Nashville Riverside Hospital • 1982 Consultant to NIH on health, education and welfare.

  20. Resigned as a legislator when an expanded abortion rights bill was defeated • 1970 Dorothy L. Brown Women’s Residence at Meharry College • 1993 humanitarian award from Carnegie Foundation • 1994 Horatio Alger Award

  21. Proud to be a role model “not because I have done so much, but to say to young people that it can be done”

  22. Nina Starr Braunwald, M.D. 1928-1992 • New York University School of Medicine – Thoracic • 1960 – led the team that implanted a prosthetic mitral heart valve that she also designed (age 32) • First woman to be certified by the American Board of Thoracic Surgery • First woman to be elected to the American Association for Thoracic Surgery

  23. General surgery – Georgetown with a postdoctoral fellowship with Charles Hufnagel, M.D. • Work with Andrew G. Morrow, M.D. at the NIH led to development of the valve • Braunwald – Cutter valve (cloth covered) • Stented Aortic homograft for mitral valve replacement • Surgical treatment of chronic thromboembolic disease • Tissue culture techniques

  24. After she left Morrow, professional opportunities were a struggle • Mother of 3 children, grandmother • Painter, sculptor and horseback riding • “pioneering, determined yet gentle”

  25. Tenley E. Albright, M.D.1935- • Harvard Medical School • Massachusetts • General Surgery

  26. Father was a surgeon • To be a doctor and an Olympic gold medalist in figure skating • Polio age 14 • Won the silver medal in Oslo, Norway in 1952 (5 consecutive US women’s singles titles in figure skating)

  27. 1953 entered Radcliffe – pre-med left Radcliffe in 1956 • 1955 Olympic Gold Medal winner – Cortina, Italy • 1957 entered Harvard Medical School – 5 women out of 135 • “there weren’t a lot of women faces, and there weren’t a lot of women to teach us either.” • Spent 23 years in private practice of surgery

  28. 3 grown daughters and lives in Brookline, MA and practices General Surgery • Consultant to National Library of Medicine’s Board of Regents • 1988 US Figure Skating Associations Hall of Fame • “I was surprised to admit to myself that I liked surgery so much.”

  29. Kathryn Dorothy Duncan Anderson, M.D. 1939- • Harvard Medical School • Wash. DC/California • Pediatric Surgeon • 2005 President, American College of Surgeons • 1999 President, American Pediatric Surgery Association • 1992 Chief of Surgery and VP of Surgery Children's Hospital Los Angeles

  30. Born 1939 Lancashire, England • 1958 Cambridge University – Bachelor and Master of Arts degrees with honors • 1964 applied to surgical residency at Harvard “women are too weak to be surgeons” – refused her • Boston Children’s – internship in pediatric medicine • 1964 Georgetown – general surgery residency – 7 cases in 2 years • Community Hospitals – 700 cases / 12months • Children’s National Medical Center Washington, DC – 2 year fellowship in pediatric surgery • “My biggest obstacle was my gender”

  31. “There are risks and costs to a program of action but they are far less than the long – range risks and costs of comfortable inaction.” John F. Kennedy

  32. SocietyTotal#WomenOfficers American College of Surgeons 54,761 2431(4.4) 4 American Surgical Association 1093 25(2.2) 0 Society of University Surgeons 1388 46(3.3) 0 (2000 – 01) Jonasson Surg 131:672-5, 2002

  33. Are there women in the pipeline?

  34. Women Enrollment and Graduates U.S. Medical Schools EnrollmentGraduates TotalWomen Total Women 1961 – 62 31,078 1970 (6.3%) 7168 391(5.5%0) 1971 – 72 43,650 4755 (10.9%) 9558 861(9.0%) 1981 – 82 66,298 18505 (27.9%) 16012 3991(24.9%) 1991 – 92 65,602 24962 (38.1%) 15356 5543 (36.1%) 2001 – 02 65,626 29969 (45.7%) 15648 6911 (44.1%)

  35. U.S. Seniors Matched to PGY1 by Specialty General Surgery 200220032004 2005 782(5.8%) 867(6.5%) 885(6.5%) 845(6.1%)

  36. Specialty Certification Plans of Graduating Medical Students 1985 2000 2004 Neurologic Surgery1.0 1.0 1.1 Opthalmology 3.6 3.0 3.0 Orthopedic/Hand 5.7 4.5 5.4 Otolaryngology 2.4 1.9 2.0 Plastic Surgery 1.4 1.0 1.4 General Surgery 6.2 5.7 6.1 Thoracic Surgery 0.9 0.3 0.3 Urology 2.0 1.6 1.6 Surgical Specialties 30.6 26.3 27.9

  37. Women Residents 2002 – 03 2003 – 04 TotalWomenTotalWomen Neuro Surgery 778 77 (9.9%) 775 93 (12%) Ophthalmology 1290 434 (33.6%) 1260 424 (33.7%) Orthopedic 3002 271 (9.0%) 3024 285 (9.4%) Otolaryngology 1093 218 (19.9%) 1071 229 (21.4%) Plastic Surgery 531 139 (26.2%) 556 117 (21.%) General Surgery 7412 1853 (25%) 7623 1939 (25.4%) Thoracic Surgery 310 25 ( 8.1%) 303 31 (10.2%) Urology 1009 140 (13.9%) 1038 158 (15.2%)

  38. CERTIFICATION Total # of # # Year DiplomatesMaleFemale 1977 921 908 (98.6%) 13 (1.4%) 1978 1168 1141 (97.7%) 27 (2.3%) 1979 1025 999 (97.5%) 26 (2.5%) 1980 968 936 (96.7%) 32 (3.3%) 1981 1047 1003 (95.8%) 44 (4.2%) 1982 965 922 (95.5%) 43 (4.5%) 1983 856 795 (92.9%) 61 (7.1%) 1984 921 841 (91.3%) 80 (8.7%) 1985 926 858 (92.7%) 68 (7.3%) 1986 858 775 (90.3%) 83 (9.7%) 1987 957 885 (92.5%) 72 (7.5%) 1988 1007 923 (91.7%)84 (8.3%) RECERTIFICATION # Male # Female RecertifiedRecertified 554 (61.0%) 7 (53.8%) 742 (65.0%) 13 (48.1%) 694 (69.5%) 17 (65.4%) 682 (72.9%) 24 (75.0%) 738 (73.6%) 37 (84.1%) 709 (76.9%) 31 (72.1%) 617 (77.6%) 50 (82.0%) 635 (75.5%) 55 (68.8%) 655 (76.3%) 51 (75.0%) 611 (78.8%) 62 (74.7%) 715 (80.8%) 58 (80.6%) 734 (79.5%) 70 (83.3%) GENERAL SURGERY COHORT GROUPS byGENDER 1977 - 2002

  39. CERTIFICATION Total # of # # Year* DiplomatesMaleFemale 970 880 (90.7%) 90 (9.3%) 981 881 (89.8%) 100 (10.2%) 991 885 (89.3%) 106 (10.7%) 997 884 (88.7%) 113 (11.3%) 1006 888 (88.3%) 118 (11.7%) 966 849 (87.9%) 117 (12.1%) 971 828 (85.3%) 143 (14.7%) 1019 871 (85.5%) 148 (14.5%) 987 848 (85.9%) 139 (14.1%) 957 807 (84.3%) 150 (15.7%) RECERTIFICATION # Male # Female RecertifiedRecertified 706 (80.2%) 71 (78.9%) 693 (78.7%) 80 (80.0%) 661 (74.7%) 85 (80.2%) 573 (64.8%) 81 (71.7%) 334 (37.6%) 49 (41.5%) 72 (8.5%) 14 (12.0%) (%) (%) (%) (%) (%) (%) (%) (%) GENERAL SURGERY COHORT GROUPS byGENDER 1977-1998

  40. GENERAL SURGERY COHORT GROUPS by GENDER 1999 - 2004 CERTIFICATIONRECERTIFICATION Total # # # # # Diplomates Males Females Males Females 1999 1004 856 (85.3%) 148 (14.7%) (%) (%) • 1043 836 (80.2%) 207 (19.8%) (%) (%) • 994 823 (82.8%) 171 (17.2%) (%) (%) 2002 995 810 (81.4%) 185 (18.6%) (%) (%) • 920 755 (82.1%) 165 (17.9%) (%) (%) 2004 1068 834 (78.1%) 234 (21.9%) (%) (%)

  41. Vascular Surgery Cohort Groups by Gender 1982 - 1994 YearTotal # Diplomates#Male# Female 1982 14 14 (100.0%) 0 (0.0%) 1983 388 387 (99.7%) 1 (0.3%) 1984 143 142 (99.3%) 1 (0.7%) 1986 75 73 (97.3%) 2 (2.7%) 1987 79 77 (97.5%) 2 (2.5%) • 96 92 (95.8%) 4 (4.2%) 1989 124 119 (96.0%) 5 (4.0%) 1990 125 122 (97.6%) 3 (2.4%) 1991 102 98 (96.1%) 4 (3.9%) 1992 103 99 (96.1%) 4 (3.9%) 1993 89 86 (96.6%) 3 (3.4%) 1994 79 76 (96.2%) 3 (3.8%)

  42. Vascular Surgery Cohort Groups by Gender 1995 - 2005 YearTotal # Diplomates # Male# Female 1995 110 104 (94.5%) 6 (5.5%) 1996 83 79 (95.2%) 4 (4.8%) 1997 96 89 (92.7%) 7 (7.3%) 1998 79 72 (91.1%) 7 (8.9%) 1999 94 85 (90.4%) 9 (9.6%) 2000 106 96 (90.6%) 10 (9.4%) 2001 70 59 (84.3%) 11 (15.7%) • 99 84 (84.8%) 15 (15.2%) • 105 88 (89.8%) 8 (7.6%) 2004 106 93 (87.7%) 3(12.3%) 2005 98 97(89.8%) 10(10.2%)

  43. Pediatric Surgery Cohort Groups by Gender 1974 - 1988 YearTotal # of Diplomates# Male# Female 1974 3 3 (100.0%) 0 (0.0%) 1975 226 219 (96.9%) 7 (3.1%) 1976 70 65 (92.9%) 5 (7.1%) 1977 24 22 (91.7%) 2 (8.3%) 1978 17 17 (100.0%) 0 (0.0%) 1980 43 40 (93.0%) 3 (7.0%) 1982 38 38 (100.0%) 0 (0.0%) 1984 33 29 (87.9%) 4 (12.1%) • 30 28 (93.3%) 2 (6.7%) 1988 37 31 (83.8%) 6 (16.2%)

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