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SALT LAKE CITY — When Dr. Annalise Deane was applying to general surgical residencies, she was advised not to wear her wedding ring and avoid being pregnant at all costs during interviews. She was told that if people knew she was recently married, they would rank her lower because of the chance that she could get pregnant during the five-year residency.
She refused to heed the advice. Instead, during the interviews she openly asked questions about how the programs supported families. Given the responses, the University of Utah was her top choice, in part because she wants to start a family someday, and in part because the atmosphere seemed to allow women surgeons to thrive.
"A ton of women residents have children and families. It was the only place that I felt like I didn't have to sacrifice liking the people I worked with, the quality of the training and still having a family life outside of work," Deane said.
Five out of the six general surgical residencies at the University of Utah Health were awarded to women this July — increasing the percentage of women in the program to 70%. The incoming residents are Drs. Deane, Cecilia Im, Jessica Smith, Hannah Wilcox and Megan Wojick.
Although medicine has historically been a male-dominated field, there has more recently been a national increase in faculty members in academic medicine who are women. Deane refers to these women as the "first generation" who paved the way and serve as role models for the increased number of women currently pursuing medical degrees and careers.
Women now make up 51.5% of total enrollment at U.S. medical schools, according to data from the Association of American Medical Colleges.
At the University of Utah School of Medicine, in particular, there has been an increase in women working in the Department of Surgery. Fifty percent of the faculty in general surgery are women. Women also currently head the general surgery residency program, and are the second-in-command at both the surgery department and surgical education at the U.
"The fact that more women now apply for surgery residencies is a hopeful sign that the current generation of medical students is no longer influenced by gender expectations that may still exist. While I consider myself lucky to have never experienced gender bias in medicine or surgery, there are certainly those who grew up with the cultural expectations that women should not go into medicine, and specifically not surgery," general surgery residency program director Dr. Laura Lambert wrote on the "Good Notes" University of Utah Health blog.
The majority of students in Deane's class in medical school at Oregon Health and Science University were women, and she said it helped her to be surrounded by strong, bright women who were dealing with a lot of the same issues — including being mistaken for a nurse, patients deferring to a man in the room no matter his seniority, or being told that they should go into a specialty like gynecology or pediatrics.
During the residency matching process, applicants are "holistically reviewed and selected for residency interviews based on their accomplishments in and out of medical school, including their grades, life and work experience, volunteerism and research. If selected for an interview, they are then assessed for their aptitude to be a surgeon," wrote Lambert.
The schools and the students then rank their top choices, putting future residents in a sort of limbo until they find out where they are matched through an email that is sent to everyone at the same time. Students are then expected to move to those places quickly.
"A lot of people don't realize that it's legally binding. You go to where you match or you cannot practice medicine in the United States," Deane said.
Historically, there has been more precedent for heterosexual couples to move to wherever the man's job takes them. Even though Deane had her partner's and family's support, she felt a lot of internal pressure and a feeling of needing to meet obligations as a woman to make sure her partner was going to be happy with the move. When she was talking to her female friends at medical school, they all expressed a similar feeling of pressure.
Upon reflection, she asked her friends, "Do you feel like our male classmates feel this same pressure?" They guessed that they probably didn't.
When Deane was matched with University of Utah Health general surgical residency, she was thrilled. But she was even more excited when she saw an Instagram picture of the rest of her cohorts that include four other women.
"It made me really happy. It reflected on my experience in interview season. This is a program that puts their money where their mouth is when it comes to diversity. A lot of places will say things and then match an all-male, white class. I feel like I couldn't have gotten luckier," Deane said.
It's still not all rosy. The bias doesn't naturally go away, especially among patients with "old school beliefs," but "it just helps having people you can talk to," she said.
Surgery, in particular, "gets a very scary rap" and has a fair amount of stereotypes attached to it, like being cold and impersonal or even having a God complex, Deane added.
"We still hear about women medical students facing lingering cultural expectations within medicine. For example, women medical students being told by faculty and residents (both men and women) that they 'do not look (or act) like a surgeon,' or are asked, 'why would you want to be a surgeon? They are all mean,'" wrote Lambert.
"Thankfully, the increasing number of women in surgery now provides students who face these attitudes and perspectives with more opportunities to see what is really possible and to connect with women who have defied these expectations. Through the current generation of driven and amazing women surgeons — and the rising generation of women medical students who choose to become surgeons — conscious and unconscious gender biases will eventually disappear, making it even easier for women who want to be surgeons to make the choice," Lambert said.
For someone as bubbly and outgoing as Deane, it was sometimes hard to feel like she was being pushed more toward pediatrics or into a specialty that was more centered on connecting with patients. Though it took her a little while to figure out she wanted to go into medicine, her interest in surgery was immediate. As soon as she saw a vascular surgery performed, she thought it was the "coolest job anyone could have."
As a woman from a small town in Wyoming, Deane plans on pursuing rural surgery and bringing her expertise to her community to improve accessibility.
This, Lambert wrote, is the main point of medicine: to help people.
"Every specialty in medicine offers the opportunity for a satisfying career and finding tremendous purpose and meaning in life. If it so happens that surgery is the right path for you, regardless of gender, you can do it and make it your own, like those of us who have come before you. Surgery has changed dramatically in so many ways over the past 20 years, and women in surgery have played a major role in many of these changes," Lambert continued.
Deane said that having to overcome these kinds of challenges can help patients relate more to doctors, as well as doctors to relate more with their patients, gradually breaking down the biases and hesitancies that are still common.
"With this shift, there's been no change in the inherent capabilities of women. When the barriers start coming down, you see that it's a very natural thing for a woman to be in medicine and surgery," Deane said. "Give us the opportunity and we will rise to it."
