Ann Thorac Surg 2001;71:S19-S21
© 2001 The Society of Thoracic Surgeons
Collective contributions of women to cardiothoracic surgery: a perspective review
Shauna R. Roberts, MDa,
Amy F. Kells, MD, PhDa,
Delos M. Cosgrove, III, MDa
a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Address reprint requests to Dr Cosgrove, The Cleveland Clinic Foundation (F25), 9500 Euclid Ave, Cleveland, OH 44195
e-mail: cosgrod{at}ccf.org
Presented at the Women in Thoracic Surgery Symposium, Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31, 2000.
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Abstract
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Background. Of 5,812 persons boarded by the American Board of Thoracic Surgery (ABTS), 99 (< 2%) are women. This study was designed to collect and report the contributions made by these women in the specialty of cardiothoracic surgery.
Methods. Identification of ABTS board-certified women was obtained from the ABTS. Compilation of data was accomplished through membership databases, medical licensing boards, thoracic surgery residency programs, and residency program attending surgeons. Data were substantiated through hospital medical staff offices, local practitioners, and personal telephone calls. Curricula vitae were requested; practice types (adult, pediatric, cardiac, general thoracic, or transplantation) were established. Data were collated, extrapolated, and tallied. Trends over time were analyzed by logistic regression analyses.
Results. Currently, 84 women are actively practicing: 44 have academic appointments and 40 are in private practice. Of the remaining 15 women, 4 are deceased; 4 are retired; 5 are in other professional fields; and 2 are in an unknown practice setting. Accumulated data confirmed that women surgeons are practicing in every type and subgroup of cardiothoracic surgery (adult, pediatric, cardiac, general thoracic, transplantation, and combinations of these). Collectively, they have published 2,292 articles and book chapters. Manuscripts directly related to cardiac topics number 1,220. Women in cardiothoracic surgical research have been awarded $31.9 million in grant funds. Two trends over time were identified. First, the distribution of practice setting (academic or private) was stable compared with year of board certification. Secondly, a statistically significant rise in the annual percentage of board-certified persons who are women (p < 0.0001) has been established.
Conclusions. The percent of ABTS board-certified women surgeons has increased; more than 50% have academic appointments; and a stable trend for women to choose academic cardiothoracic surgery exists.
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Introduction
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Record of the earliest women surgeons dates back to line drawings on tomb walls of the Egyptian Pharoah, Ramses II. However, it was not until 1931 that the first woman surgeon became a member of the American College of Surgeons [1]. Thirty years later, the first woman surgeon received her board certification in cardiothoracic surgery.
Contributions of women to cardiac surgery includes not only surgeons, but also women who, without ever actively practicing cardiothoracic surgery, left their mark. As early as 1867, Louise Rubinovich discovered the ability to electrically stimulate the heart of a dog and subsequently performed the first human heart pacing. Maude Abbott catalogued and clarified congenital heart defects in 1900. In 1944, Helen Taussig convinced Dr Blalock to build a shunt as a ductus for a cyanotic child. It became the Blalock-Taussig shunt. Mary "Maly" Gibbon was the first perfusionist to perform a cardiopulmonary bypass procedure [2]. In 1961, Nina Starr Braunwald, MD, became the first woman Diplomate of the American Board of Thoracic Surgeons (ABTS). She was followed by Ann S. McKiel, MD, and Nermin D. Tutunji, MD. Doctor Braunwald, however, achieved a permanent place in cardiothoracic history when she headed the operative team that performed the first successful mitral valve replacement in the world [1–3]. Over the ensuing 38 years, 95 women have completed their thoracic surgery boards and make significant contributions in the field.
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Material and methods
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This study was designed to report the collective contributions of women to cardiothoracic surgery. Identification of board-certified women was obtained from the ABTS along with the institution in which the surgeon completed her thoracic residency and the year of board certification. Because no database of demographic information for women in cardiothoracic surgery existed, information was compiled from membership databases including The Society of Thoracic Surgeons, American College of Surgery, American Board of Surgery, American Medical Association, American College of Cardiology, American Board of Medical Specialties, and Women in Thoracic Surgery. Web sites searched included cts.net, web.md, and ancestry.com. Medical licensing boards and hospital medical staff offices were contacted to confirm active practice locations.
Because demographic information obtained was often fragmented or obsolete, thoracic residency programs, attending staff surgeons of these programs, and local community practitioners were contacted to locate women cardiothoracic surgeons and to document their current status.
Methods of collection were telephone or mail. Each surgeon was contacted for a copy of her curriculum vita and confirmation of practice type (adult, pediatric, cardiac, general thoracic, or transplantation).
Of 99 board-certified women, 95 are living. Eighty-eight curricula vitae were available for review. Specifically examined were location of thoracic surgery residency, location of practice, setting of practice (academic or private), academic appointments, type of practice (adult, pediatric, cardiac, general thoracic, or transplantation), number of publications, and grant funding. Because patient care cannot be quantitated respective to contributions, it was not used as a measure.
Curricula vitae were obtained from 81 of 84 practicing surgeons, 2 of 4 retired surgeons, 4 of 5 working in other professional fields, and 1 of 4 deceased. Eleven curricula vitae were unavailable: 3 practicing surgeons, 3 deceased, 2 retired, 1 in another field, and 2 from unknown practices. Some publications were obtained from Medline searches including the 11 surgeons whose curricula vitae were unavailable. Publications bearing the boarded surgeon’s name and the institution from which the surgeon was affiliated were included in the publication totals.
The number of women surgeons board certified each year between 1961 and 1999 was evaluated by 5- and 10-year intervals. A surgeon was assigned to an academic practice setting if she held any academic appointments; otherwise, she was assigned to private practice. Distribution of current practice settings (academic or private) was compared with the year in which the surgeons were board certified. Trends over time were analyzed with logistic regression analyses.
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Results
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Currently, 95 women living are Diplomates of the ABTS. Trend across time showed a statistically significant increase in the number of women boarded per decade (p < 0.0001) (Fig 1). Figure 2 shows the known location for 96 of 99 thoracic residencies. Sixty-two of 98 women were the first to train at their respective programs. Of these, 40 are the only women cardiothoracic surgeons trained at that institution to date.
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Fig 1. The greatest increase in the number of women cardiothoracic surgeons did not occur until the 1980s.
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Current status of 99 women boarded by the ABTS is illustrated in Figure 3. Two are MD/PhDs; one is MD/JD. Eighty-four women are currently in practice; 5 have sought other professions: 1 chief executive officer of a company, 1 in law school, 1 in managed care, 1 in private industry, and 1 in the priesthood. Sixty-seven women practice both adult cardiac and thoracic surgery; 10 practice exclusively in adult thoracic surgery; 6 practice in pediatric cardiac and/or thoracic surgery; and 1 practices in general surgery (Fig 4). Forty women are in private practice and 44 in academics (affiliated with a teaching hospital or hold an academic appointment). Eighteen women have achieved tenure with 7 attaining the rank of full professor of surgery (4 cardiac, 3 thoracic). Distribution of practice setting (private or academic) was found to be stable over time compared with the year of board certification (Fig 5).
Women currently comprise 30% to 50% of medical school graduates [4], 24% of surgical residency graduates [5], and 26% full-time academic faculty, 10% as full professors [6]. Thirty-two women cardiothoracic surgeons are in full-time academics and 7 (22%) are full professors. Nineteen surgeons are involved with ongoing research in either cardiac or thoracic surgery and are responsible for securing $32 million of funding at both the local and national levels. Of 2,292 articles and book chapters contributed to the literature, 1,220 are exclusive to cardiac surgery. Women specializing in general thoracic surgery and thoracic organ transplantation are especially notable in the academic arena as assessed by tenure, publications, and grant funding.
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Comment
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Several reports have been written on the subject of women in cardiothoracic surgery. None to date has included this size database and none has examined the group for specific and collective contributions. Though small in number, women are choosing to practice in all subspecialties of cardiothoracic surgery. With more than 50% of all women in academic surgery, they are directly impacting the field and influencing future generations of surgeons. Women continue to contribute to the field through active ongoing research projects and at the clinical level. Three women have been appointed to National Institutes of Health study sessions. As members of this influential group, they have an active voice in the selection of investigators to receive National Institutes of Health funding. Women have gained recognition from their peers, lecturing by invitation at both national and international seminars and meetings and being actively involved in organized governing bodies and committees.
The percent of board-certified women cardiothoracic surgeons has increased and shows a stable trend for women choosing an academic practice setting. A greater percentage of women in cardiothoracic surgery hold full professorships than in the general population of women physician faculty. As a result, the number of potential role models has expanded. Overall, women are approaching 50% of medical school graduates and 24% of surgical residency graduates. It is easy to speculate that more women will pursue this field and that contributions from women will continue to impact the future of cardiothoracic surgery.
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Acknowledgments
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We thank Renee Hartz, MD, for providing information, Bonnie Davis for assisting with and editing this manuscript, and Nancy Poirier, MD, for assistance in reviewing curricula vitae.
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References
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Kemeny M.M. Johasson, Braunwald, and Morani. Three firsts in American surgery. Arch Surg 1993;128:643-646.[Abstract/Free Full Text]
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Kohman LJ. Contributions of women to cardiothoracic surgery. Unpublished manuscript, 1999.
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Waldhausen J.A. In memoriam: Nina S. Braunwald, 1928–1992. Ann Thorac Surg 1993;55:1055-1056.[Medline]
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Dresler C.M., Padgett D.L., Mackinnon S.E., Patterson G.A. Experiences of women in cardiothoracic surgery: a gender comparison. Arch Surg 1996;131:1128-1135.[Abstract/Free Full Text]
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Kwakwa F., Jonasson O. The longitudinal study of surgical residents, 1994 to 1996. J Am Coll Surg 1999;188:575-585.[Medline]
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Scott R.P. Women in thoracic surgery: an ancient tradition and a new milestone. Ann Thorac Surg 2000;69:11.[Free Full Text]
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Abstract
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