Making their mark

Female General Surgeons – urban and rural alike – face gender-specific hurdles…but it’s changing

It still happens. Even today.

Dr. Debrah Wirtzfeld is at a patient’s bed during rounds. At the bedside, she updates the patient, perhaps explaining any procedures, risks and benefits. She goes over care and options. And then the patient,  without a hint of irony asks, ‘And when can I speak to the surgeon?’ If Dr. Wirtzfeld’s General Surgery residents are standing at the bedside too, the patient may turn   to one of the male residents and ask him a question, assuming he’s the one in charge. It’s a scenario that Dr. Wirtzfeld has faced many times during her 25-plus years in medicine.

“It definitely is better today but it still happens. And depending on the day, how I’m feeling, how many hours I have worked, I may say ‘I am the surgeon,’ or ‘You’re speaking to the surgeon.’”

It’s not exactly water off a ducks back but Dr. Wirtzfeld has learned to pick her battles as a woman in General Surgery.

Yep,  it’s  2017 but assumptions about women’s  roles in medicine still linger. It’s something that Dr.  Wirtzfeld gently pushes against wherever possible. But it’s  about more than opening patients’ eyes to casual sexism. Dr. Wirtzfeld has a bigger responsibility, she says.

Dr. Wirtzfeld is the Regional Lead of General Surgery for the Winnipeg Regional Health Authority and the University of Manitoba. She feels she has a duty to teach female surgeons-in-training what they face as women in the field, both in rural and urban settings.

“I should be doing more,” she says.

But she’s trying. Dr.  Wirtzfeld has frank conversations with her female charges. Her messages? Female residents should know what to expect in their careers. They should identify their goals (both career and personal) now and “make sure you know what you want,” she says. After goals are set, every decision you make should move you, step-by-step, closer to your goals. Set boundaries and limits; and then push back when those lines are hit or crossed.

“Say no to things that don’t fall within the values of your goals. Always look toward your end goal.”

Dr. Wirtzfeld also bursts any bubbles that might linger. She tells female residents to shake off any notions that they’re going to have the traditional surgeon’s job and their partner or spouse is going to stay home and care for their family.

“A role swap isn’t just going to work,” Dr. Wirtzfeld says. “It may work but they shouldn’t assume that it’s going to work.”

This is the very scenario Dr. Michelle Nostedt is navigating in Portage La Prairie. She is one of two General Surgeons in the community; and she started her first job as a General Surgeon, there in 2014. Her daughter was born in September 2015. Her husband, also a medical professional, has stepped back from his career to become a full-time parent.

“I’m trying to balance between home and work and making myself available for my patients and my family,” Dr. Nostedt says. “It’s not always easy.”

She went back to work three months after her daughter was born. And with only one other local General Surgeon, as fantastic and supportive as he was, it wasn’t possible or realistic to take a full year of maternity leave, Dr. Nostedt says. For parents, especially new moms, the first few months of parenthood are about survival and sleep. Going back to work after three months wasn’t  ideal but it was reality, she says. On the job, finding time and a private place to pump breast milk was a problem,  at times, Dr. Nostedt adds.

Those are just a few bumps in the road for female General Surgeons (and working women in general). But change is inevitable.

“As more and more female surgeons graduate and come into the system, they will drive the changes they want to see,” Dr. Nostedt says. “Things are changing for women, and women are driving that change forward.”

That makes sense. There are more women choosing General Surgery as their field.

Dr. Elizabeth Thompson is one of them. She started as a General Surgeon in 2015. Her Winkler-based practice is located at the C.W. Wiebe Medical Centre. She operates at Boundary Trails Health Centre, also in Winkler.

Dr. Thompson’s path to General Surgery wasn’t a straight shot. She took a year of nursing before switching over to medical school. She realized that making decisions about patient care; figuring out problems; and creating  a care plan was her passion. She discovered a passion for General Surgery while on that service during her residency.

“I was always so intrigued being in the operating room,” Dr.  Thompson says.

Today, she loves, not only being a General Surgeon, but working as a General Surgeon in a rural community.

Being a woman in General Surgery, like other professions, is demanding. Work-life balance is important. She has advice for other women in General Surgery, and those coming into practice.

“You have to do what works for you. It’s going to be hard,” she says. “You have to work hard. You have to be able to draw limits and make separate time for home and family.”

Whatever challenges she has faced in finding the balance, Dr. Thompson has always been firmly fixed on the future. She is focused on her patients, improving patient care overall, and making sure that rural patients have top-notch service and care.

She loves what she does, and where she does it. Being a rural General Surgeon is her life and her passion. She is invested in the community, and the health of her patients, for the long term.

To that end, Dr. Thompson has joined forces with two other surgeons, and that surgical team will be expanding to four in 2018.

While she might not admit it, Dr. Thompson is blazing a trail for upcoming female General Surgeons, just like Dr. Wirtzfeld did before her.

When Dr. Wirtzfeld was a resident in the ‘90s, for example, she was one of two female General Surgery residents in a class of about 20. Today half of her residents are women, she says.

Dr. Wirtzfeld has herself paved the way, in many ways. She is a solo parent of two school-age boys and generally works up to 60 hours a week. She has a full-time, live-in nanny. That said, she is present for her kids’ lives. She is there for the important and everyday moments of her childrens’ lives. But she’s also made adjustments and concessions. Her kids, at some point in their lives, hung out in an OR staff room waiting for their mom.

Dr. Wirtzfeld shies away from the phrase work-life balance. She prefers ‘work-life  integration.’ In other words, there will never be a perfect balance between the two realms. And it’s not about that. It’s about making a life in medicine that works for the surgeon. Otherwise, burn out and stress will win.

Institutionally, Dr. Wirtzfeld would also like to see more changes to benefit everyone. General Surgeons have demanding work schedules. They also spent much of their ‘off the clock’ time, on call. A team approach to patient care is a start. General Surgeons working in teams should be able to hand off patients to other competent surgeons when the primary surgeon is not working. This makes sense in both urban and rural settings, she says.

“This is a model we need to move towards.”

Some General Surgery groups, including hers at the Health Sciences Centre, are already doing this, Dr. Wirtzfeld says. In the context of female General Surgeons, with or wanting families, this approach makes especially good sense.

In rural hospitals, there’s been a distinct pattern over time. Historically, one General Surgeon is hired. They work 24 hours a day, seven days a week for the duration of their professional life. They retire at age 70 and the community struggles to find a  replacement.

“We need to change that to a team of surgeons.”

And — as Drs Wirtzfeld, Thompson, and Nostedt all demonstrate — it is changing.