Women in otolaryngology.

"Alice in Wonderland is here to see you." This is what the receptionist announced when I reported for my first medical school admission interview. Talk about a confidence builder. Although embarrassed, I was not surprised by the remark. What was I doing here anyway? The prevailing attitude of society at that time was that women medical students were taking training away from men who would need to support families; and women would probably get pregnant and quit, wasting the educational resources invested in them.

When I entered otolaryngology training, there were only 12 female otolaryngologists in the country. I did not know any of them. Fortunately for me, I was one of the first three women accepted into the otolaryngology program at Baylor, in consecutive years. This was a source of anxiety for some of the faculty. What if the women got into "cat fights"? However, we became great friends. When I was a junior resident, Eugene Meyers came to Baylor as a visiting professor and recommended that we get to know a female resident in his program at Pittsburgh. This was Nancy Snyderman, who has subsequently been so successful at combining motherhood, otolaryngology, and broadcasting that her name has become a household word.

Having colleagues with whom to commiserate was not the same as having a female mentor or role model who had "made it," so when I found myself unexpectedly pregnant near the end of my fellowship, I panicked--coping with morning sickness and wondering how I would ever care for a baby and start a practice and build a research program. I did not know anyone who had done this and began to doubt that it could be done. I called Dr. Bobby Alford and tried to chicken out on my impending faculty position at Baylor; but he matter-of-factly pointed out that I would never know what could be done if I did not try. So I took the plunge and ultimately it did work out. I have a rewarding academic career and three nearly grown children, and I am still happily married to their father.

What a difference 30 years makes! By 1980, 1% of otolaryngologists in this country were female. (1) Women now make up approximately 10% of the otolaryngology workforce. This year, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has its first woman president, Jennifer Derebery. Julie Freischlag is chief of Surgery at Johns Hopkins, and Karen Calhoun is chair of the Otolaryngology Department at the University of Missouri School of Medicine. These are significant milestones--not just holes punched in the proverbial glass ceiling. They are tangible evidence, for young women entering surgical careers, not only that it can be done, but also that they have the potential to excel and be leaders!

Organized medicine also offers women courses, seminars, and opportunities for networking. The Association of Women Surgeons meets twice each year, once in conjunction with the College of Surgeons, and once in a separate retreat. The American Association of Medical Colleges includes special programs for women during its annual meetings and has designed the Mid-Career Women Faculty Professional Development Seminar. During its annual fall meeting, the AAO-HNS sponsors the Women in Otolaryngology Luncheon. This event provides an excellent opportunity for young women in the field to find encouragement and role models.

Although we might have "come a long way," we still have far to go. One female chair from among nearly 100 academic otolaryngology department heads is hardly a proportional representation of the number of women in the field. This under-representation at the top runs throughout medicine. In 2000, 37% of U.S. residents and 27% of fulltime medical school faculty were women. But fewer than 11% of women faculty are full professors, compared to 31% of men. (2) Women physicians tend to have lower job satisfaction and a higher rate of divorce. And there is still a large gender gap in financial compensation. On average, the income of women physicians is approximately two-thirds that of their male colleagues. (3)

A number of factors could contribute to this difference, such as a younger average age among women physicians, greater responsibilities within the home, and the tendency for women to work reduced hours and take maternity leaves. But in a recent study, even after correcting for variables such as years in practice, specialty, and hours practiced per week, women internists in Pennsylvania earned 15% less than men. (3)

To young women beginning or contemplating surgical careers and to the many men who still dominate the residency and partnership selection process: Yes, it can be done. But female otolaryngologists still face significant challenges, and in many ways, it is still an "old boys' club." Hopefully, as more women enter the field and continue to make significant contributions, gender bias will continue to diminish and ultimately fade away.

References

(1.) Fletcher MM. A preliminary report on the woman otolaryngologist. Am J Otolaryngol 1980; 1:211-12.

(2.) Bickel J. Women in academic medicine. J Am Med Womens Assoc 2000 Winter;55(1):10-12, 19.

(3.) Ness RB, Ukoli F, Hunt S, et al. Salary equity among male and female internists in Pennsylvania. Ann Intern Med 2000 Jul 18; 133 (2):104-10.

GAYLE WOODSON, MD, FACS, FRCS(C)

Professor of Surgery

Southern Illinois University School of Medicine

Springfield, Illinois