Lessons From Stanford: How to Make the Future More Female

When Stanford's department of surgery tweeted a photo of their incoming residency class, it was hard not to notice its female skew: All but one incoming resident is a woman. I sent the tweet to my roommate, who is applying to general surgery residency herself.

"The future is female!!" She responded via text. We briefly celebrated female representation in an overwhelmingly male field. In 2021, less than 23% of general surgeons were women.

Then, the tweet went viral. It received over 16 million views, tens of thousands of likes, and thousands of retweets. Some of the attention was positive; some was blatantly sexist and racist. Backlash erupted and twitter users questioned the Stanford surgery department's choice to accept so many women.

"Congrats to the future residents getting a spot based on diversity quotas instead of merit!! You must be so proud!!" one person tweeted.

I don't question why Stanford's surgery department selected so many women in its new class. Countless studies have already demonstrated the benefits of having female clinicians. But match lists are a two-way street. The more fruitful question to ask is why did so many women choose Stanford to complete their surgical residency? This should be a guiding question for residency programs as they consider the changes that they need to make to recruit more women.

First, it's important to understand why certain specialties have their scales tipped so far in favor of men. The temporal demands of these specialties make attaining the already elusive work-life balance in medicine even harder. For women who plan to have children, this is a huge barrier to entry. I recall when a resident whom I worked with during my surgery rotation told me her 6-month-old baby self-weaned from breastfeeding because he didn't recognize her anymore.

Stanford is one of a handful of hospitals that offers to cover fertility preservation and infertility care for its residents. Female physicians face infertility at twice the rate of the general public, largely due to the stressful demands of training and the time required to complete it.

By covering fertility care, Stanford has demonstrated that it is aware of and willing to address this disparity. And when former Stanford general surgery resident Ioana Baiu penned an op-ed about her egg-freezing journey, she highlighted the support of her colleagues and supervising physicians during the arduous process.

But there's still room to improve. Offering to cover fertility preservation is applaudable, but it ultimately feels like symptom management rather than disease prevention. Women should also be supported in having children whenever they want to, even if that means in the throes of residency, rather than just being supported in delaying their decision. An even greater cultural shift must happen so that women don't feel like their fertility is a price to pay to become a physician.

While on a team consisting of three female residents who were new moms and a male attending, I watched our attending devise a plan for each resident to rotate through surgeries while the others pumped breastmilk. The ailments of motherhood were no longer unspoken realities but rather were embraced and publicly accommodated. "My boobs are hurting," one of the residents would loudly declare before scrubbing out of surgery to pump.

I am not convinced that every operating room would be so welcoming to new mothers, and that shouldn't be dependent on one attending's attitudes. For that to happen, residencies would need to make structural changes, such as in the form of extended parental leave. Currently, the American Board of Medical Specialties requires that residencies provide only a minimum of 6 weeks paid leave for new parents, not including vacation allowances. To provide residents more time, Stanford's pediatrics residency program has cleverly created a "New Parent" elective rotation that teaches residents about newborn care from home.

Residents may feel dissuaded from taking additional time because of the burden that can fall on co-residents who provide coverage while residents are on parental leave. Residencies could instead consider hiring mid-level clinicians to relieve some of the tasks of covering residents. Lactation spaces and subsidized childcare are additional benefits that should become the norm.

Some of the cultural shift at Stanford may be due in part to the fact that its department of surgery leadership features so many women. Dr Mary Hawn is the chair of surgery at Stanford, where five out of eight vice-chairs are women. (Though all division chiefs for surgical subspecialties are men.)

Female leaders are more likely to pay attention to women's issues, and the presence of female role models is one of the major factors that influence women to go into surgery. Feeling welcomed in male-dominated spaces therefore becomes a numbers game: The more women trainees see in a department, the more they can feel rest assured they will be respected.

Despite the many merits of Stanford's surgery program that make it an appealing and supportive environment for women to train, Stanford is not immune to gender biases. Somewhere between being mistaken for a nurse for the umpteenth time while my male student peers were mistaken for attending physicians and witnessing female doctors' entire presence ignored, I realized that sexism would be a battle I'd have to fight at every level of my training.

As I went through my own application process for internal medicine residency, it was encouraging to see other hospitals, such as Weill Cornell and University of California hospitals, also make a concerted effort to provide family planning benefits for its trainees. But they comprise a minority of programs that do so. As residency programs across the country organize to form residency unions, I hope these are some of the changes they push for. But even more so, I hope that the necessary changes don't hinge on female residents having to advocate for themselves but rather come from program leaders recognizing the merits of making a future more female.

Tasnim Ahmed (@TasnimMAhmed) is a graduate of Stanford University School of Medicine.

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