The life of a Chinese American female physician executive.

When I was first appointed medical director of medical specialties in a large multispecialty clinic in 1997, I bought a copy of ACPE's Why Physicians Fail. The book taught me what to expect as a physician executive, what pitfalls to avoid.

I had attended many of the management courses at ACPE and thought that I had at least the academic knowledge about what to expect in my new position. However, it was really my life experiences as a first generation Chinese American female that shaped my course.

I was born in Macao, then a Portuguese colony off mainland China and now a bustling special administrative region of the People's Republic of China. My father was a stowaway to New York City during the Great Depression and became an American citizen after serving in the U.S. Army during World War II.

After the war, he brought my mother, a Chinese living in Japan, to America as a war bride. They operated a hand laundry in New York for several years and then moved their growing family back to Macao, where I was born.

When the Cultural Revolution broke out in China, I was five years old. My parents returned to New York, where my father opened a laundry in Spanish Harlem and my mother worked as a seamstress in Chinatown. My first memory of coming to America was being spanked in kindergarten because I couldn't recite the Pledge of Allegiance to the flag.

Although I quickly became Americanized, my parents fought to keep me in contact with my Chinese culture. I had to go to Chinese school in Chinatown every Saturday, and when things quieted down in Macao, they took me back for junior high school. I spent my early teen-age years feeling like an outcast in Macao--looking Chinese but not able to speak Chinese fluently.

On finishing junior high, I was allowed to move back to live with my sister in rural New Jersey.

Academics only

As a child, I was interested in medicine, and in high school I directed my attention single-mindedly to becoming academically prepared. My family certainly fostered that focus.

I was expected to forego all social aspects of high school to ensure that my grades would help me achieve my career goal. Dating was strictly forbidden, particularly since there were no other Chinese in the little town of Long Valley, N.J. It worked! I was accepted to the honors program in medical education at Northwestern University, a program that allowed me to begin medical school after just two years of college.

College in Chicago, away from the intensive oversight of my very strict family, was a real eye opener. I learned that I could do whatever I wanted and that I was responsible for myself. I developed a sense of independence that would not have been allowed if I had stayed close to my family.

Since leaving for college, I have not been able to bring myself to live under my family's roof again, except for short breaks. This has created a certain amount of resentment among my older siblings, who felt that I deserted my parents by not returning to the East coast after my training.

I remember being assigned to a female mentor--a pediatrician on the medical school faculty--during my third year in medical school. Having grown up in the 70s, I took women's liberation for granted and thought that continuing to talk about women's lib was passe. Women were already nearing equal numbers of medical school admissions. What did I need a mentor for? I was not interested in hearing a lot of whining about how hard it is to be a woman in medicine.

However, as my friendship with my mentor grew, I realized the hardships that she had endured as a female medical student in the 60s. The snide comments about how she had taken a man's place in medical school. How she was not good enough. Even her choice of pediatrics was said to reflect how women tended to go into "the softer" more family-oriented specialties.

That was all in the past, I thought. How fortunate I was not to live through that. Ironically, I did not notice that at the same time my boyfriend, a dental student at Northwestern, was complaining about how only half of the female dental students became practicing dentists because the other half got married and had families.

Family matters

As I found myself going through my clinical clerkships, I began to realize how complicated things could be, particularly in the male-dominated rotations like surgery. I found my biggest struggles were not how to learn the material but how to survive the suggestive comments thrown at me, such as a resident's suggestion that my best friend and I join him in a threesome.

An attending doing a breast reduction offered to donate the tissue to me! Of course, by attracting the attention of the male surgeons, I also caught the wrath of the female nurses who felt that I was intruding into their territory. A full three months into my surgical rotation, the OR nurses would still not stock size 5 gloves for me, so that I had to consistently scrub in much later than my male colleagues.

During this same period of time, my parents were pressuring me to get married. I was reminded that I was getting old and if I didn't get married soon, I was going to become an old maid--at the age of 22!

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Fortunately I found someone who was Chinese, didn't smoke, didn't drink and didn't gamble, so my parents quickly established that he was the right man for me. We were married after my internship in Chicago and I moved to Seattle to be with him.

I wanted to do my training in oncology in Chicago and worked hard in the lab of an up and coming oncologist at Northwestern University. That all changed because my fiance wanted to return to Seattle to practice dentistry with his father. I had to find myself a new residency position in Seattle and found a second-year position in neurology, an area in which I had little interest and less aptitude.

As a neurology resident, I found myself in the position of being the only married female resident contemplating having a family. There were certainly many women residents before me, and many of them were married, but none had seriously considered, at least openly, starting a family.

For me, however, having been married out of my internship, the next stage of my life as a good Chinese daughter was expected to unfold. As my husband and I discussed our timelines for having children, our questions were answered by my residency director who informed me, "We have never had a pregnant female resident, and you're not going to be the first!"

I compromised on my plan to become an oncologist by arranging for a neuro-oncology fellowship in Seattle. At the last minute just before the end of my residency, my academic sponsor informed me that he was moving to Baylor, and that I was invited to join him and his lab in Texas. Again. I passed up oncology to stay in Seattle because of my husband's dental practice.

Fortunately, I was invited by a former senior resident to join him in private practice. At my interview with the board of directors, the president of the group turned to me and asked. "So, what are your plans to have a family?" I stammered a response that my husband and I were still discussing this issue. This must have convinced the board that I was not yet seriously considering getting pregnant, because I was hired as a young associate.

Over the ensuing four years I worked hard to build my practice. I was successful in doing so although I was distracted by the deaths of my beloved father and a cousin, and by giving birth to two wonderful children. I also had to find time to study for my board certification exams and was active on the clinical faculty at the medical school.

At this time I found myself struggling to meet the demands of a busy career and the needs of my two toddlers. I had help from my mother, who moved in from New Jersey right before the birth of my first child. However, my mother did not think much of the Western lifestyle in which she found our family. She also did not think much of my education.

At this point, I had begun working on the pre-course work for the Masters in Medical Management degree. Despite my work that included training residents and medical students in my position as a clinical associate professor of neurology, my mother frequently informed me that I knew nothing about anything and that my accomplishments meant little.

As a Chinese daughter, I had no choice but to endure. Confucius taught that we honor our elders above ourselves. I found myself juggling patient care, getting my kids to all their activities and driving my mother to get her Chinese groceries and to her mahjongg games.

Changes sought

What served to save me and allowed me to grow and recognize my self-worth was joining the board of directors of the Kin On Chinese Nursing Home Society and the Asian Counseling and Referral Service. My work with these organizations gave me confidence in myself and showed me that I had something to contribute to my community.

I helped build a 100-bed nursing home for the Chinese community and started the seeds of what ultimately became a Chinese home health service organization. In addition, I helped recruit an executive director to the largest Asian American social service organization in the Pacific Northwest at a time when the organization was struggling.

It was this newfound confidence and sense of self worth that helped me realize that I was unhappy and unfulfilled in my marriage. My husband wanted me to quit medicine and become his office manager, as this was what he thought all dentists' wives did--at least in his group of friends. Obviously this did not match my career goals.

The idea of leaving my husband was terrifying. Divorce is certainly not viewed as permissively in Chinese culture as it is in American society and I worried that I would be rejected. Surprisingly, my family, including my mother, was supportive of my decision. With their support, I was able to divorce my husband and start a new life.

It was at this time that I was appointed medical director of medical specialties in the organization I had joined after the birth of my second child. The organization's mission was to take care of the medically underserved. This work was underwritten by a very profitable contract with the U.S. Department of Defense, but poor management and huge overheads were causing the organization to lose a lot of money. It was also encumbered by some physicians who were not willing to sacrifice for the organization to survive.

I embraced the concept of "no money, no mission" passionately and began to dismantle services that were money losers and not capable of changing. Behind my back I was known as "psycho bitch," a name I had previously been given as a senior resident who believed in running a tight clinical service.

I thrived on learning the business side of medicine, working on contracting professional services and playing with financial models to identify what changes needed to be made. I smiled when people called me "a dragon lady" because they perceived me as a strong-willed women who was determined to make a success out of my department. However, I also cried quietly when I had to go through large reductions in force because I knew that ultimately my actions affected people who were working to support their families.

At the same time. I was struggling as a single mom, trying to complete my MMM degree. I used up all my vacation time to attend ACPE seminars and then on to New Orleans for the course work at Tulane. I was the only woman in my MMM cohort, which was the source of some funny stories.

Because of my strong will, there was some suspicion voiced that I was a man-hating lesbian. Alternatively, some spouses became jealous that I was in a strange city with their men, pulling all-nighters and sharing beers after class. The positive side was that I developed friendships with my classmates who understood how unpopular my work was, because they too were in the same boat. We all recognized how lonely we were in our organizations and learned how much we appreciated being with others who could relate to our situation.

Uncharted course

One of the things I realize now was how uncharted my course was, and how I had so few role models to guide me. I made my share of mistakes.

Recently, I joined a major local hospital system. I opened a general neurology clinic. I have a busy clinical practice, with a small but cross-trained staff and my neurology partner of many years. The clinic is a training site for medical students and residents. I am active once again in the community, sitting on the board of directors of the local chapter of the Organization of Chinese Americans.

I serve as the Asian community liaison to the county elections office to ensure compliance with a federally mandated outreach program. I am active with the local MS Society as a clinical advisor. I sit on the legislative committee of the American Academy of Neurology, and have been part of the Academy's advocacy training program.

In 2003, I was asked to give a talk to some Robert Wood Johnson clinical scholars about my experiences as a woman physician executive. I was surprised to find my audience captivated as I shared stories of some of my experiences. They were obviously a lot smarter than I was, because they understood what I had not realized--that mine was an unmapped path. They wanted to learn from my mistakes.

After my talk, a Chinese American physician came up to talk to me. She told me that she belonged to a social group of Chinese American women health care professionals and invited me to talk with them about my experiences. Here's what I shared with them:

1. Persevere. You can't be the best at everything. Sometimes you fail and you have to pick yourself up off the ground and dust yourself off and try again.

2. Be flexible. Sometimes things don't work out like you planned. It's not always a bad thing.

3. Don't take yourself too seriously. See humor in everything.

4. It's not all about you. Think about servant leadership.

5. Prioritize! Be good to yourself; you're no good to anyone else if you are not well.

6. Treat others as you would like to be treated. It makes life a lot easier. Don't burn your bridges. You never know when you're going to need someone you've just teed off. Conversely, don't take sh--from anyone.

7. Mountains are meant to be climbed. Learn where your limits are and push on them. As Lance Armstrong said, "Just because something's never been done isn't an obstacle, it's motivation."

So that's my story, at least up until this point. My life has been enhanced by my choice of careers, my gender, my race and culture, and my passion for life. I've made my share of mistakes, but along the way, I think I've made a difference in the lives of my patients, my staff, my students, my friends and my family.

By Lily Jung, MD, MMM

Lily Jung MD, MMM is medical director of the general neurology clinic at the Swedish Neuroscience Institute in Seattle, Wash. She can be reached at 206-386-2800 or [e-mail].

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