June 27, 2018
Tessa Balach, MD, always knew she would be a surgeon. She felt it in her bones. “I’m relatively headstrong, as most surgeons are: ‘This is what I want to do and this is what I am going to do,’” she said.
Her game plan got a boost when she worked as a student athletic trainer during her undergraduate days at the University of Chicago. Balach taped ankles for football and basketball players and monitored their rehabilitation. She met orthopaedic surgeon Bruce Reider, MD, the legendary team physician for the Maroons.
“I got to know him and his sports medicine fellows and thought, ‘Hey, this is pretty cool. I can be a surgeon and restore people to function,'” Balach said. She completed her orthopaedic residency and fellowship here, joining the UChicago Medicine staff as an orthopaedic oncologist.
A changing playing field
Men have long dominated the field of orthopaedic surgery and outnumber female colleagues at a higher percentage than in any other specialty. Though more medical students today are women, they account for just 6 percent of orthopaedic surgeons and 14 percent of orthopaedic residents, according to the American Association of Orthopaedic Surgeons.
Fortunately, the playing field is more even at UChicago Medicine. Balach and three other female surgeons constitute nearly 20 percent of the orthopaedic team and are blazing trails in medicine and mentorship.
Some patients say they prefer having a woman surgeon, said renowned hand surgeon-researcher Jennifer Moriatis Wolf, MD. But gender is a non-issue at the table. “The quality of your work stands on its own, and people respect that, and people respect you,” she said. “You prove yourself with your work.”
Megan Conti Mica, MD, joined the Department of Orthopaedic Surgery and Rehabilitation Medicine in 2015 after a hand fellowship at the Mayo Clinic and training in shoulder and elbow surgery in France and Belgium. Wolf, recruited from the University of Connecticut, arrived in July 2016.
Balach started a month later, followed by foot and ankle specialist Kelly Hynes, MD, who had completed a fellowship at the University of British Columbia.
Factor in Holly Benjamin, MD, director of primary care sports medicine — and the first female sports medicine pediatrician in the country to become a full professor in an orthopaedics department — and Mary Lawler, MD, an expert in rehabilitation medicine, and UChicago Medicine has six full-time female physicians on the ortho staff.
Five advanced practice nurses, two physician assistants, and two part-time physicians narrow the gender gap even further.
“I set out in 2013 to recruit the best orthopaedic surgeons to create an interdisciplinary program that spanned patient needs,” said Douglas Dirschl, MD, chair of orthopaedic surgery and rehabilitation medicine. “This I did, and four were women.”
A diverse faculty reflects the patient population, facilitating a more inclusive culture “where beneficial change can more readily occur,” Dirschl said.
These women also hold high-ranking posts such as vice chair, residency program director, ambulatory director and fellowship director, he added. “All have outstanding leadership potential and our patients, staff and students all benefit from their perspectives,” Dirschl said.
Some perspectives this tight-knit band of female surgeons share: The art and science of restoring humans to function is highly satisfying. They hope more women follow their examples. And they debunk the myth that women lack the strength to retract a scapula or rotate a femur.
“The old joke was that you had to look like a football player to be an ortho surgeon,” said Wolf, in practice for 15 years. “You don’t need brute strength. You just need to be smart. And know how to use a lever arm to get things done.”
“It’s technique,” Conti Mica agreed.
Hynes may not be able to bench-press 50 pounds, but she can drill out a fibula. “You do have to be manually and mechanically inclined,” she said. “You have to use power tools.”
Though the majority of their teachers and classmates were men, Hynes and Wolf had female mentors, and all four future surgeons were treated the same as male students by their professors, a right denied to the first female board-certified orthopaedic surgeon. Ruth Jackson, MD, who died in 1994, spent six decades defeating gender barriers in her practice.
At the same time, each woman remembers patients mistaking her for a nurse, a tech or a janitor during rounding. Each shrugged it off; but, like Jackson, worked harder to dispel any doubts about their competence.
Balach and Conti Mica acknowledge Wolf as their first female mentor. Balach met Wolf when they were faculty at the University of Connecticut, and Conti Mica met her at UChicago Medicine.
Conti Mica’s take is that mentorship can and should be gender neutral, an equal-opportunity process that inspires junior faculty to advance in their academic medical careers.
She was taken aback when classmates urged her to seek out a female mentor in medical school. “It was almost like ‘nice discrimination.’ They thought they were being helpful, but they were hurtful,” she said. “I didn’t have a female mentor until I met Jennifer Wolf.”
Nor do first-time patients look surprised when they see their surgeon is a woman. “They Google me in advance,” she said, laughing.
That’s not the case for Balach, who has a stock response up her sleeve. “People look at me and say, ‘Who’s my surgeon?’ I say, ‘That’s me!’,” she said.
“Not everyone comments on it. I had some women say, `I wanted to see a woman.’ I’ve also has both male and female patients say, ‘Your approach is different than the other guy I saw.’ I don’t know how much of that pertains to being a woman or being me.”
Better engagement, better outcomes
According to a British Medical Journal study last year, women surgeons even have a slight edge over male counterparts. The study found that female surgeons had better outcomes, with their patients having fewer complications and lower readmission rates. The authors attributed the favorable outcomes to the female doctors’ communication skills and for engaging their patients about post-op therapy and medication.
Wolf, who studies the gender gap in orthopaedics, believes that a lack of role models and early exposure to the field contribute to the scarcity of female trainees. In a self-empowering, proactive strike, she and her female surgical colleagues formed their own support group. The quartet meets once a month at a restaurant to discuss cases, academic research and grant opportunities over dinner.
“We go over all the things we are doing, bounce things off each other,” Wolf said. “We talk about our successes, we talk about our challenges. We mentor each other.”
“Our main goal is to keep each other on track,” Hynes said. “It fosters our relationships and helps us professionally advance. We’re very close and friends and colleagues.”
As more women surgeons join the team, the circle will expand. “The takeaway is women supporting women, something that should always happen,” Wolf said.
When injury or illness affects the musculoskeletal system, the experienced and skilled orthopaedic team at the University of Chicago Medicine offers the full spectrum of nonsurgical and surgical care.Read about our orthopaedic services