Women in Surgery Interviews

| September 1, 2019 | 0 Comments

Rachel L. Moore, MD, FACS, ABOM

Metabolic Surgeon and Obesity Medicine Specialist in New Orleans, Louisiana

Teresa L. LaMasters, MD, FACS, FASMBS, DABOM

ASMBS Executive Council; Medical Director, Bariatric Surgery, UnityPoint Clinic Weight Loss Specialists, Des Moines, Iowa

Marina S. Kurian, MD, FACS, FASMBS, DABOM

Medical Director, Department of Surgery, Bariatric Division at New York University (NYU) Langone Medical Center, New York, New York

In this special feature, the clinical editor of Bariatric Times—Dr. John M. Morton—interviewed three of the premier female bariatric surgeons in the United States to hear their unique perspectives on the growing field of bariatric and metabolic surgery. These three women discuss professional challenges they’ve faced, offer advice to future female leaders in the field, and share their thoughts on mentorship and other aspects of being a bariatric surgeon.

Doctors, given that the majority of people who undergo bariatric surgery (82%) are women, is obesity a women’s health concern?

Dr. Moore: The prevalence of obesity should be everyone’s concern. In other states they are lobbying for reduced wait times and lower BMI access to treatment, whereas here in Louisiana millions do not have access to care. Blue Cross of LA does not cover treatment and none of the Louisiana state employees have coverage. Furthermore, more than 35 percent of the population has obesity in Louisiana.

Dr. LaMasters: I don’t believe the health concerns of obesity are gender specific. I do believe that a higher percentage of women seek treatment for obesity. Women may be more sensitive and acutely aware of the impact of obesity on their personal lives and as a barrier to achieving personal goals. Obesity can have a substantial impact on a woman’s family, home life, reproductive ability, and workplace or professional advancement—these are separate issues from the substantial impact obesity can have on health and longevity. Obesity certainly impacts these areas for men, as well. However, there is currently more societal stigma toward women with obesity, compared to their male counterparts, especially in the workplace or professional arenas. Men with obesity still feel this stigma, but usually when they are at a more advanced stage of the disease. Men tend to present for surgical treatment of the disease when they recognize it as a serious risk to health and shortened lifespan rather than as a barrier to reaching professional or life goals. This might occur following a new diagnosis of diabetes or after a heart attack that was linked to the health risks and mortality seen with obesity. In my experience, women typically act as the initial researcher or seeker of information regarding treatment options in a family. I believe that women play an important role in seeking treatment for obesity for both sexes.

Dr. Kurian: Obesity is a global health concern that affects everyone. While it is true the majority of patients who undergo surgery are female, entire families are affected by obesity in their loved ones. Significant and sustained weight loss improves mood and mobility, and it results in patients making better lifestyle choices. These types of changes affect families and friend groups.

How do we get more women in bariatric surgery?

Dr. Moore: We have such a great job that it sells itself! It is gratifying to see so many talented young women choosing our field.

Dr. LaMasters: As with many other specialties, early exposure to the field with positive experiences and mentorship are keys to attracting new bariatric surgeons, including women. The stigma against people who suffer with the disease of obesity is apparent even among the healthcare community. It is important for young surgeons in training, and even surgeons early in their careers, to have exposure to the life-saving and life transformation impact of bariatric surgery. A current barrier to women becoming surgeons in bariatric medicine might be the lack of bariatric surgeons who are chairs of surgery or residency program directors.

Increasing the exposure of young male and female surgeons to the clinical care outside of the operating room, in addition to the technical aspects of bariatric surgery is also important. Allowing surgeons to witness the dramatic improvement in health and the gratitude of a patient who has undergone a life transformation can have tremendous impact.

The elective timing of procedures in bariatric surgery allows for increased focus on presurgical optimization and continuous quality improvement process. Bariatric surgery is well positioned to have reproducible, high-quality outcomes. One of the most exciting aspects of bariatric surgery is our rapidly expanding understanding of the obesity disease and the innovative treatment options that are now available. Additionally, the field is open, with many opportunities for young surgeons to contribute. These features make bariatric surgery a good fit for many surgeons. Increasing awareness of these factors is an important part of attracting new surgeons to the field, especially women surgeons.

Dr. Kurian: As Mahatma Gandhi said, “Be the change you wish to see in the world.”  Women physicians are entering the bariatric surgery  profession in greater numbers than when I was a fellow. Part of this is because the field of bariatric surgery is so rewarding—we can appreciate and participate in the positive changes we see in our patients’  health and quality of life  following bariatric surgery. Female surgeons are often balancing a busy professional career with a busy family life, which helps us empathize with our patients who are often seeking treatment of their obesity to not only improve their health, but to improve their own professional careers and family life. I believe many of our male residents also appreciate seeing that someone can be successful and busy, while remaining committed to family. Having female role models and mentors with whom they can identify encourages women to enter the field of bariatric surgery.

What has been your greatest challenge?

Dr. Moore: I have at least three “full-time” jobs, and performing all of them at a high level is something toward which I am constantly working. I self-describe as a surgeon, wife, and mother of three (that is chronologic, not in order of importance).

Dr. LaMasters: In many ways, we are still in the adolescence of our field. The general public and the majority of healthcare providers do not understand the severity of the obesity disease, nor do they understand the effective treatments that are available. I am in a position where I can make a dramatic impact on the health and lives of many people. There are many barriers, however, to accessing the resources to care for patients with obesity. Obesity is a chronic, progressive disease and requires a comprehensive model of care for successful treatment. I find myself constantly advocating for the resources needed to accomplish successful treatment of this disease. This job is never finished. There are some days when I feel like public perceptions are too slow to change, which can be exhausting. There are days when I feel like I am in the movie “Groundhog Day,” where the main character lives the same day over and over, and it is frustrating to need to constantly re-explain what we do in bariatric surgery and why we do it.

There are also days when I struggle with self-doubt. Those are the days I really lean on others who are truly committed to the field and help me continue to push forward.

And finally, finding the right level of work–life balance can be difficult. A high degree of passion in my life is tied to my work, so I struggle at times to give my family and other personal goals the time and space they need to be healthy. I try to take the advice of wise mentors and set boundaries to protect these areas, but it is still a work in progress.

Dr. Kurian: I have moved from community, to academic, and now to private practice. I have worried about maintaining my patient flow and staying relevant. When my kids were smaller, it was much harder to find time to publish and present. Now that they are (much) older, I find time in the late evenings to attend to my commitments to committees and societies. That is a long answer to “time management is my challenge.” Making sure I accomplish what I want at work and being present for my family is important. It is a balancing act that constantly shifts, and I give myself the grace to know that is OK.

What has been your greatest joy?

Dr. Moore: Like any parent, my children are my greatest joy. Being a mother is like having your heart walk around outside your body. It’s an amazing experience, and I’m grateful. If you had asked what makes me happy, the list gets longer. My husband, who is a homebody, does a great job of holding my kite string while I fly, and he’s a wonderful father. I love my job, and it is a delight to look after each patient as they become healthier and happier. My brilliant friends are each important to me, too.

Dr. LaMasters: Professionally, my greatest joy has always been to experience the life transformation with my patients that occurs after bariatric surgery. Following that, my greatest joy is seeing the progress of the field of metabolic and bariatric surgery. We stand on the shoulders of courageous innovators who were committed to finding an effective treatment for this life-threatening disease. We have been able to move forward into an era of consistently reliable and safe outcomes with bariatric surgery. We have been able to lead the way in key areas, such as collaboration and care coordination, working with dedicated multidisciplinary teams, close monitoring of data with regular risk-adjusted reporting, and continuous quality improvement. I have seen the needle move dramatically regarding safety and quality outcomes over the past 10 years.

On a personal level, my greatest joy is my family.  I am blessed with a truly amazing husband and two wonderful boys. There is no greater joy than to contribute as a wife and mother and to watch my boys grow into amazing young men. It is not easy to be the family of a driven person. My foundation is the love of my family and their forgiveness of my faults. These are the people I know are always on my side.

Dr. Kurian: My kids are my greatest joy. However, my next greatest joy is seeing happy patients achieving their weight loss and health goals. These patients finally feel they have regained control of something they had never been able to wrangle.

What is your advice to future leaders?

Dr. Moore: Take excellent care of each individual patient and feel accomplished at the end of the day. Celebrate the ordinary day because for the patients it was incredibly transformative. Also, be careful who you marry. My surgeon husband is proud of me, rather than annoyed, when I am working.

Dr. LaMasters: Encourage innovation in treatment of this disease while holding steadfast to the safety and quality gains we have been able to achieve. It should be a high priority to increase the public awareness of the seriousness of this disease and the effective treatment options that are available, especially bariatric surgery. We also need to improve the knowledge and understanding of other healthcare providers regarding effective treatment options for this disease using bariatric surgery as a critical piece of that treatment plan.

A key gateway is to increase awareness of the distortion of normal physiology that occurs with obesity and the biochemical changes that we can make through metabolic bariatric surgery. We need to facilitate a broader understanding of the unique ability of metabolic bariatric surgery to alter multiple neurohormonal pathways to restore a healthy physiology. It is important to develop the understanding that improving physiology is the goal, and weight loss is one piece of that goal.

Dr. Kurian: Half the battle is showing up, and the rest of it is identifying a need gap and putting forth the effort to ensure positive change. To lead, you have to think about the future and how you can make positive change for your colleagues.

How valuable is mentorship?

Dr. Moore: Mentorship is like any other great relationship: it can’t be forced, and it takes some mutual effort to grow. In my experience, the leaders in our field have been generous with their time.

Dr. LaMasters: Mentorship and sponsorship are truly critical for professional growth and advancement. It allows more rapid expansion of knowledge and broadens perspective faster than would occur organically on your own. It is important to learn institutional processes and culture. Many opportunities come through traditional networking, mentorship, and sponsorship.

Dr. Kurian: Mentorship is critical because we don’t always know where the next best step is. We might not realize where the different growth opportunities are, and a mentor can help guide you. Mentors should know you well, including where your strengths lie. Mentors are also a great sounding board for your thoughts on career trajectory and what will help the most. You never have one mentor, though. That is the beauty of mentorship: you get input from different sources.

Can men be effective mentors to women in bariatric surgery?

Dr. Moore: I could give dozens of examples! Former president of American Society for Metabolic and Bariatric Surgery (ASMBS), J. Patrick O’Leary, was my first boss (during residency). My partners, Tom Lavin and Michael Thomas, taught me laparoscopic surgery when I joined their practice 18 years ago. Manoel Galvao has been an important mentor in endolumenal treatments. Raul Rosenthal appointed me to the ASMBS Executive Council (a position into which I subsequently had to be elected to keep). I’ve been writing with Chris DuCoin. Erik Wilson, Matt Brengman, Stacy Brethauer, and Jaime Ponce have all given me wise advice. I could go on and on. Women can definitely find trusted male mentors and advisors.

Dr. LaMasters: Absolutely! The majority of my mentors and sponsors have been men. We certainly have more in common than we have different. I have found that, in general, male surgeons are more familiar with the role of sponsorship in the progression of a professional career than female surgeons. Male surgeons tend to view sponsorship as an integral and expected step of career advancement. Many women did not grow up with a model of sponsorship. High-achieving women often went down that path alone and didn’t encounter mentorship and sponsorship until later in their careers. It is also helpful to have women as mentors. There are not as many women available to serve as mentors as there are men. Women can be great mentors, in general, and specifically in some areas that are unique to women. Societal and personal pressures that are unique to women can be easier to navigate through with a woman mentor. I have found, however, that men can be great mentors in many areas outside of a strictly professional capacity. This has included guidance with work–life balance, engaging with family, and understanding the sacrifice that is required, with time away from your practice and family, when contributing in leadership.

Dr. Kurian: Both men and women can be role models, mentors, and sponsors. Many of my mentors were and are men. Mentorship is about helping someone to be their best self and maximize the change they can bring to their position and practice. There is no gender restriction when it comes to able mentorship.

What is your best advice for career advancement?

Dr. Moore: Start at the state level with your ASMBS and American College of Surgeons (ACS) chapters. It is easier and faster to ascend into leadership at that level and then build on it.

Dr. LaMasters: You need to be willing to “show up.”  There is no substitute for face time. Commit to being present and then speak up and contribute. Understand you have a unique background and perspective that is valuable. Listen and learn from others. Seek out people who think like you and others who do not think like you. You can and should learn from both sides. Volunteer—do not wait to be asked to contribute. Be willing to do the hard work, even if it is not glamorous.

Dr. Kurian: I tell everyone to show up and give everything they do 110 percent. Give your enthusiasm and energy to the tasks at hand. It will be noted by those around you, and 1) more might be given to you and 2) this will help advance your objectives. Be smart about what you say yes to lest you overload your capacity to deliver. Certainly, in the early years, its easier to say yes and do, and then as your practice gets busier, limit some of your endeavors for maximal yield.

What is the best part of ASMBS?

Dr. Moore: The members are the best part of ASMBS. The surgeons are all smart, independent thinkers, and it is such a fun, dynamic experience when we are together! Social media and other forums have their place, but face-to-face meetings are best. Some of my most pivotal conversations have occurred at ASMBS meetings.

Dr. LaMasters: Finding my people, my tribe. I have the opportunity to contribute and to help develop others. I am passionate about treating people with obesity, providing them with high quality outcomes, and helping to transform their lives. I get to work with people every day who help me expand that mission beyond just my local practice and community out to a national scale and greater impact.

Dr. Kurian: ASMBS is a meritocracy. Please volunteer and be active. It helps you feel part of an incredible community of like-minded souls. Your effort will be noted, and you can advance in the Society. ASMBS needs surgeons at every stage in their career because everyone brings unique perspectives and knowledge to the most rewarding volunteer job there is. Join an ASMBS committee today!

Do you have any final thoughts?

Dr. Moore: My gender is the least interesting thing about me. Ask me what I am reading, the last museum I went to, or where I travel next, and you will get much better answers!

Dr. LaMasters: I encourage everyone to look for ways to grow and strive for excellence. My best advice for those considering leadership is to develop a good team around you and draw from each person’s skills. Look for opportunities to learn from others. No one is successful alone. Develop a network of people who can tell you the truth, even if it is uncomfortable. Take time to invest in the development and growth of others. Take time to read books regarding leadership. Leaders are not born; they are made. Learning any skill takes concerted time and effort to master. Read books from a traditional business perspective to understand how corporations function and to understand gender-related challenges. Don’t be afraid to try different committees and projects even if they don’t seem initially to fit your skill set. Often times the best person for the job is the one who is willing to do the work and learn along the way. Most importantly, have fun. It is about the journey, not the destination.

Dr. Kurian: I think it’s important to note that I have always been supported in my interests throughout my life. No one ever has ever told me, “You can’t do this.” I would not be here without the efforts of my teachers, nonmedical and medical, who encouraged me to do what I wanted and gave me the building blocks and framework to create the career I wanted. I’m not done yet, but I know I have colleagues, mentors, and friends who continue to support and encourage me. ASMBS is the best resource for what we do, and with our social media, we are able to reach a greater number of people. Our ASMBS Facebook groups for active members and private practice groups provide real-time commentary and answers to complicated situations or simple practice concerns.

The interviews have been edited for length and clarity.


Category: Interviews, Past Articles

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