10 secrets to success as a female surgeon

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I bolted through the conference room door on the first day of residency orientation.  The room full of interns shifted in their seats.  All one dozen of the faces looking up at me were male.  I got some crooked, goofy grins.  So began my introduction to the world of surgery.

So, what would I tell my daughter about how to survive and thrive as a young female surgeon?  What would I pass on to any woman entering a traditionally male-dominated career path?

I’ve compiled a quick list of tips for general guidance.  This is my honest take based on my experiences, and I will be blunt.  Pardon some of the language.  It goes with the territory.

1. Don’t actually try to be one of the guys. If you try desperately to fit in, it will seem just that, desperate.  Let your double X chromosomes shine.  You may bring a softer voice, a graceful touch, a unique perspective, and nimble small hands to the table.  My intern year I had a stern, older trauma surgeon tell me, “You are just so refreshing to have on service.”  It can be a positive way to set yourself apart from the rest.

2. No second chance for first impressions. When interviewing for a spot in a surgery residency, there is no chance for a redo interview.  So, you have to nail it like a boss.  If you have a weak spot in your self-esteem, Band-Aid it!  Be clear and speak up.  Know the age and know your audience.  Most older, male surgeons are conservative in nearly every sense of the word.  Have common sense about that.  Clothes, jewelry, and makeup: conservative.  Talking points: conservative.  It’s not the time to do something funky with your hair.  It’s not the time to have visible tattoos out on display.  Think Ronald Reagan the whole time.

3. You have more to prove, so do it. Make no mistake, on your first day, you will quickly be sized up by your male counterparts.  Too emotional?  Too bitchy?  Too pretty?  Not pretty enough?  Weak?  Likely to get pregnant?  Annoying?  Over talkative?  And ultimately, not a good fit for surgery?

The overwhelmingly male specialties were the worst about this (i.e., orthopedics).  You were assumed to be a liability until you proved otherwise.  So, don’t start off on shaky ground.  Be prepared.  Be on time.  Be confident.  Listen.  Be organized.  Do what you’re told.  Work hard.  Don’t cry, don’t whine, and don’t make excuses.  Fall on your sword if a mistake happens on your watch.  Get your respect.

4. Don’t fall into a bad stereotype. Male residents were easy to categorize: Excellent, OK, and worthless.

Females fell into more complex categories.

There is the weird, off her rocker surgeon who never seems to live in the same universe with anyone else.  She probably doesn’t have kids but might treat her cats like soul mates.  The eccentricity and off perception of reality may just be one of her best coping tools.

There is the absolute bitch of a surgeon.  She may have favorites, but she is generally rude and may occasionally destroy an unsuspecting medical student in the operating room.  Chip on her shoulder much.

The confused gal who never should have become a surgeon.  She is more emotionally fragile.  She became a surgeon because she likened it to the sculpting she used to have time for.  Wrong reason.  She gives furtive, yearning side glances to the medicine residents on their long rounds and seems a bit avoidant of the operating room.  Her competence rests somewhere between OK and dreadful.  She may bounce to another specialty if she wises up.

Finally, there is the bright female star of the show.  She is assertive but walks that fine line to keep her work environment pleasant and team oriented.  Words like smart, capable, organized, proactive, efficient, and fine surgical skills show up in reviews of her work.  She seems pretty normal and likable.  This is where you want to be!

5.  You can’t beat ’em, join ’em. The number of women in certain career paths may never equal or exceed the men.  So, enjoy the company of men!  They truly are more simple creatures and easier for me to figure out.  It was back to my life of being raised with brothers.  If you like college football, you are set.

In a professional setting, I have to admit that I often have a preference for a group of men.  They can be more entertaining with less emotional complexity.  In residency, it’s as if they all regressed to a pre-med era when we weren’t working hard.

Yes, I occasionally got tackled into walls while rounding.  There were profoundly ridiculous stories and long trains of expletives shared in the operating room that kept me giggling and made long hours seem shorter.  The list of shenanigans could go on and on.  But, even though it felt like (and sometimes smelled like) a locker room, I enjoyed the experience.

6. Develop a thick skin. You will get yelled at.  It doesn’t matter how good you are, something will fall through the cracks and a mistake will happen.  It also only gets worse as you get near the top.  As a chief resident, you are responsible for everyone.  Does it matter that you were in a 6-hour case while your intern made an ass of himself?  Nope.  It is your responsibility too.  Get used to it.  The further you go, the more fault you bear in any error.

There is no crying in surgery.  Guard against heavy emotional responses.  If you can’t come up with anything else, rely on “Yes, sir,” “No, sir.”  Bear it and move on.

7. Grow a thicker spine and sophisticated shaming. I’m obviously encouraging a female to behave in a pleasant, respectful manner in the surgery world.  But, you have to come into your own.  If you are a naturally nice person, don’t let yourself get taken advantage of.

Being nice is a double-edged sword.  People like you and feel comfortable approaching you.  They want to work with you.  But, it also generally means that people will call you when they shouldn’t, and your help can be abused.  So, it is important to set limits.  This is a harder concept for women.

Start developing the art of sophisticated shaming.  I’m not talking about passive-aggressive behavior.  I’m talking about saying what you mean without sounding like you’re raging.

For example, “A surgical consult to remove staples.”

The conversation:  “Are you serious?.”  The reply: “Yes.”  Deep breath.

“You know this is a sign of the gross incompetence of your training?  This is not a surgery consult.  I will do this once with you and never again.  Meet me at the patient bedside in 5 minutes with a staple remover.  I will teach you this skill that no one ever taught me.  If you ever call me with something like this again, I will have our attendings speak to one another.  Got it?  All you need is an opposable thumb.”  I call this sophisticated shaming.

8. Don’t be the den mother. Women tend to naturally fall into caregiving roles when it is needed.  That is fine in your home, but don’t do that too much in your professional life.  If you bake, bring some munchies to work from time to time.  Do not do it habitually.  Do not pour glasses of water for the men in a conference or board room.  Do not become the coffee maker or the butt wiper for the group.  Do not frequently offer yourself up for jobs that are too menial for your job title.  If you place yourself in a subservient role, you will lose layers of respect and possibly negotiating power for raises or promotions down the road.  The perception (fair or not) is weakness.

9. You don’t get to be the patient. You need endurance, devotion, and an inherent toughness to succeed in surgery (and other ventures).  Do not be the weak link.  If you completed some military boot camp or ran 70 miles a week as a long distance runner, you have perspective on pain and fatigue.  If you can’t boast an endurance sport in your past, then buckle down and find your inner tough.

I was pregnant for the last four months of my residency training.  I didn’t get any breaks, and I didn’t ask for one.  I clearly remember pulling my car over on the side of the road at just before 6 a.m. one morning to vomit.  It was 4 degrees outside: miserable.  One of the residents pulled up beside me with one of those familiar crooked grins on his face.  “You alright!?” he yelled.  “Yep, I’m just fine.  Just keep driving on.  Nothing to see here.”

You don’t get to be the patient.  Call it unfair, but it is just a truth.  You had to be delivering a baby, admitted to the hospital, or dying to have a legitimate excuse out of work.  Sick days just didn’t and don’t exist for doctors.  In business or the world of medicine, don’t talk too much about your aches, pains, headaches, colds, or PMS.  I promise you, no one wants to hear it.

10. Coping for the mommy physician (or professional). You may not have a family yet and if you do, you will find out someday that there is a secret stay at home mom lurking within you.  Ha!  Isn’t that a controversial comment?  Oh, but it’s true.

You can find that ideal work-life balance as a surgeon.  Right.  It’s like finding the Holy Grail or spotting a unicorn.  It’s one of the great lies you are fed when starting your medical career along with “Money isn’t as good these days, but it’ll take care of itself,” or “You will always feel like you are helping people.”  You must find ways of limiting guilt, coping, and making it all work for you.

Here are my suggestions.

Marry an excellent husband (or significant other).  This is huge, and I cannot stress this enough.

Change your vision of success.  To remain sane, you may not be able to earn the income you were expecting or fill your operating time blocks so that you can pick your kid up from school.  You may need to accept a more mundane existence focusing on more predictable, elective, and mostly outpatient surgery in order to create a consistent presence in your child’s life.

Find the model that works best for you in business and life.  Employment versus private practice/small business owner.  This may take some trial and error.

In my opinion, location is much less important than your family’s quality of life.  Don’t struggle unnecessarily in a city or job that can’t give you what you need.  Be willing to relocate for a better life.

Give yourself a break when your kid(s) are young.  But, if you have an ambitious dream, create a plan to make it happen, or inertia will grab hold and never let you go.

If you can afford it, hire help.  Child care, laundry, cleaning, cooking.  Outsource to survive.  Drive a less fancy car or find other ways to downsize in order to make it happen for you.

Don’t destroy yourself to breast feed.

Take mini-vacations to occasionally get a taste of that SAHM feeling.  Take a day off just to go to the zoo with your kid in the middle of the week.  It’s. Simply. Awesome.

And finally, don’t be the “grass is always greener” girl.  You went to great lengths to get where you are.  Having kids didn’t just radically change who you are at the core.  You can get what you want out of life.

Work it, girl!

Lauren Crawford is a plastic surgeon.

Image credit: Shutterstock.com

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