Seeking Gender Equity in Aesthetic Medicine

Participants

Lynn Jeffers, MD, MBA, Chief Medical Officer, St. John’s Pleasant Valley Hospital; Medical Director, Integrated Breast Center, St. John’s; Plastic Surgeon, Ventura County, CA.; President, the American Society of Plastic Surgeons (ASPS)

Kseniya Kobets, MD, Dermatologist, Skin Laser & Surgery Specialists of NY
and NJ

Wendy W. Lee, MD, Professor, Clinical Ophthalmology and Dermatology, Oculofacial Plastic & Reconstructive Surgery, Orbit and Oncology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL

Mary P. Lupo, MD, Clinical Professor, Dermatology, Tulane University School of Medicine, New Orleans; dermatologist, Lupo Center for Aesthetic & General Dermatology, New Orleans

Mary Lynn Moran, MD, Assistant Clinical Professor, Department of Otolaryngology, Vanderbilt University School of Medicine, Nashville; President, American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)

Jennifer Walden, MD, Plastic Surgeon, New York City and Austin, TX; Member, Board of Directors and Commissioner of Communications, American Society for Aesthetic Plastic Surgery (ASAPS)

Susan H. Weinkle, MD Assistant Clinical Professor, Dermatology, University of South Florida, Tampa, FL; Dermatologist, Bradenton, FL

Julie Woodward, MD, Chief, Oculofacial Surgery, Duke University, Durham, NC

Just one in four practicing doctors is female, but this will soon change. Women now comprise close to 50 percent of all medical students, according to data from the US Department of Health and Human Services, and women enrolling in medical schools outnumber men. As older, predominantly male phycians retire, the gender distribution will shift. Panelists are already noticing the shift in practice and on podiums.

Dr. Kobets: As our society evolves with gender equality, it’s great to see more female leaders in our field who inspire me to be a leader myself. I think it’s very important that women leaders encourage other women to excel, but we must also ask our male leaders and mentors to support the gender diversity movement. Older luminary male dermatologists lecturing at society meetings will slowly retire, opening the field for a new generation of younger female dermatologists (and young male dermatologists) to have an opportunity to become luminaries at the podium.

Dr. Weinkle: Things have changed by 180 degrees. When I started in dermatology in 1979, I think we were about five percent women, and now I think the classes are at least 50-50. The overall practice is not 50-50, because we still have to wait for my class to retire and the younger ones to come along.

Dr. Moran: Things are changing dramatically. We now have a woman president for the first time in several surgical specialty organizations as well as in the American Medical Association. Women now make up more than half of the population of medical students, so it is important that their needs are represented at the leadership level. Within the AAFPRS, women are completely supportive of one another and lift each other up. I have yet to see an example of the cattiness and competitiveness that is often cast as a stereotype for women when they organize. There is so much synergy when members of a group contribute to and celebrate each other’s success.

Dr. Jeffers: When I was in training for plastic surgery, I could count on one hand the number of women plastic surgeons who had trained before me at my program. Since then, the number of women residents has greatly increased, and I think this trend will continue in the coming years as I see more women in residency programs across the country. Additionally, as the number of women plastic surgeons increases, more and more of us are in leadership.

While all panelists are pleased to say that there has been a seismic shift in the workforce as it relates to gender, not everyone is sure that there is equal pay for equal work…yet. In fact, male specialists make 33 percent more on average than female specialists: $372,000 per year versus $280,000, according to the 2019 Medscape Physician Wealth and Debt Report. That said, it seems that dermatology is closing the gender pay gap more quickly than other specialties in the aesthetic space. Furthermore, panelists emphasize career fulfillment and opportunity but acknowledged the need to seek help when needed.

Dr. Kobets: There has been a huge positive culture shift over the last several years since pay discrimination has become illegal, but there is obviously still a gap. I watched the Netflix show “Explained: Why Women Are Paid Less” that argued that gender pay inequality is not solely attributed to pay discrimination, but is also due to the fact that women bear children. Women with children tend to give up work opportunities to be more present at home and thus make less. This seems like a choice that women make, some very happily. A very interesting study in Iceland showed that giving mandatory paternity leave for male employees had resulted in a narrowed pay gap, which I thought was very promising. Hopefully in dermatology, the gender pay gap is less, because we do have an opportunity to use this “lifestyle” profession to our benefit.

The business of dermatology is unique in the fact that in most practices, regardless of whether you are a female or male provider, you are given the same contract compensation terms (percentage of net collections) so the playing field is even. In fact, in the practices where I have worked, the female employees often made more money than the male providers because they were more likely to relate to the female perspective of beauty with regard to skincare, skincare products, and body image.

Dr. Lupo: Female dermatologists can make more, because they are often perceived as being more attuned to aesthetic issues.

Dr. Woodward. I think the gender pay gap is closing. At Duke, our current chairman is completely fair and has a pay structure that treats everyone equally.

Dr. Moran: Despite all of the progress made, there is still deeply embedded discrimination. As women rise to the level of leadership in more organizations, I expect this to change.

Dr. Jeffers: There will always be room for monitoring and working on this issue. It’s all about the work-life balance. By and large, most of the female doctors and surgeons chose their specialty because of the lifestyle it comes with.

Dr. Weinkle: It’s worth considering that it’s overall a very controllable schedule. Most of the work is done during the day and we don’t get a lot of night calls or a huge number or emergencies.

Dr. Lee: I have tremendous passion for what I do. It makes going to work so much better! I try to be efficient with my time, even if it means eating lunch in an elevator or as I’m traveling between places. Efficiency allows me more time to spend on my personal life. I spend quality time and value each moment with family and friends and always remember my priorities. I leave time for myself, as well. I sleep well, try to eat well, exercise, and relax at times.

Dr. Moran: My work fulfills me on so many levels intellectually, artistically, and spiritually. The face is the outward reflection to the world of who a person is. When someone trusts you with their face, it is an honor and a huge responsibility. I get a deep satisfaction knowing that I help empower someone to feel their best.

That’s not to say that plastic surgeons, dermatologists, and other specialists don’t need some help to keep things running smoothly at home and at work.

Dr. Walden: I have a fantastic team of physicians, nurses, aestheticians, and administrative staff, both in Texas and New York City, who I entrust to oversee the day-to-day functions of my practices. That allows me to delegate when it’s appropriate and stay on top of each surgical patient and business matter at hand. I have an amazing practice coordinator; surgeries are scheduled well in advance so that I can plan my travel and family time. Having the freedom to do this helps me to balance work and home life. I have twin nine-year-old boys and live nearby my immediate family, including my mother in Austin, and I love to spend time with them, as well as our pet pug.

Dr. Weinkle: Early on in my career, my father-in-law said I can’t do everything on my own. It takes a village or a good team. I had to have help at home with cooking. We have had someone to do the cooking for the past 36 years because when I am home, I want to spend quality time with my family. I have been very fortunate to have the same employees forever. My nurse has been with me for 32 years and my bookkeeper has been with me for 35 years. You have to treat staff with respect, say “Please” and “Thank you,” and have to let them know that you have their back when they need help. All of my employees are women, because it worked out that way.

Dr. Moran: I don’t believe anyone has it down perfectly, but for me, as long as I am living true to my values and priorities, I can accept the areas where I fall short. This past weekend, I had a to-do list 10 miles long, but I chose to ride bikes with my seven-year-old son. Women have significantly greater pressures placed upon them than men do. We are the primary caregivers for our children, parents, and even spouses, regardless of the load we carry professionally. At many institutions, there is pressure not to get pregnant or not to take time away from work for all the issues that go along with raising children, such as school events and illnesses. This will continue to improve as organizations commit to diversification. Organizations will let go of the outdated precepts that lead to burnout and hinder the overall success of the organization. As we see increasing diversity at the leadership level, we will be able to reshape the norms.

At the end of the day, a woman is typically hardwired to take on the responsibility of caretaker but we will be in a position to build in greater flexibility for that in the workplace. Men are increasingly taking on a greater role as caretakers and largely benefiting from the connection that brings. Women are still finding their voice and strength when it comes to rejecting the guilt associated with delegating, but that is an area of great potential and opportunity. Women hold themselves back in the workplace and with respect to their own mental and physical health if they try to take on every role themselves. This is my greatest challenge. I am also learning not to apologize unnecessarily.

Dr. Woodward: You can feel like you are never good enough at work or at home. I have to delegate a lot. When we were younger, we had live-in help. I have a supportive husband and I am lucky that I have family nearby and in a pinch, I could reach out to my parents to help.

Speaking of help, all participants agree on the importance of mentoring and mentorships. (Read this article online at ModernAesthetics.com for more panel insights on mentorship.)

Dr. Jeffers: I am a strong believer in the importance of mentors and mentorship. I have been extremely lucky in that I have had many strong mentors throughout my life and career. As a result, I make a point to try to mentor those around me. I believe that people find their mentorship in many different ways. For some, it will be in-person from people in their personal or work arena. Others will find mentoring in structured programs and in online Facebook groups or other opportunities to learn and receive support from others. As leaders, it is our job to support and encourage these opportunities and to look for ways to offer support and perspective for those who are coming after us. I belong to a number of groups and I have seen incidences where due to the support from the group, women were moved to seek leadership opportunities and advocate on their own behalf. In some of these, I do believe that the support of the others in these groups made a difference as to whether these women would have pursued these activities. I have also seen coordination of activities and inspiring actions due to women coming together around various causes and initiatives. I would also say one of the most incredible things that happens when women support each other is that women come to realize that they are not alone and begin to see the great potential for impact when we come together.

Dr. Moran: I had fantastic mentors during medical school and surgical training that modeled and nurtured in me the traits that I admire most about the medical profession, but they were all men. It is wonderful now to be able to share my experiences with younger women in the field and give them the unique perspective and insight that I was unable to receive from my male mentors. I recently met with a new female colleague and I was able to be very frank about the importance of prioritizing your life goals and needs instead of centering your life around career expectations. Many women surgeons compartmentalize the issue of motherhood for so long, since it is so incompatible with a surgical lifestyle, especially during training.

Dr. Lupo: I received the Mentor of the Year award from the Women’s Dermatologic Society because in one year alone, I had 13 residents shadow me. I regularly mentor residents and peers. My greatest mentor was Dr. Larry Millikan. He allowed me to start the resident’s injection clinic in 1983 at Tulane when I was chief resident. I directed it for 30 years before stepping down in 2014 to do ad hoc.

Dr. Weinkle: I am very blessed. Wilma Bergfeld, MD was such an inspiration to me at each turn in my professional career. Dr. Lynn Drake gave me my first opportunity to direct a large surgical symposium at the American Academy of Dermatology meeting, and I have done it for the last 30 years. They taught me the value of mentoring, especially for my daughter, who now wants to be exactly like me. She will be starting a fellowship in dermatology and wants to do Mohs surgery in the morning and cosmetics in the afternoon.

Dr. Woodward: I love being a mentor. I am the Director of Oculoplastic Surgery at Vegas Cosmetic Surgery and putting together a couple of panels of young oculoplastic surgeons to get these young people on the podium at the upcoming meeting. They are so excited.

Dr. Lee: Many have mentored me along the way—teachers, chairmen, preceptors, and colleagues. I was a teacher before I was a doctor, so mentoring has always been a part of my life. I enjoy mentoring anyone who will let me: my medical students, residents, fellows, and junior faculty, with career and life advice.

Dr. Kobets: I was lucky to have had very encouraging parents early on to motivate me to be the best, and had great mentors (both female and male) shape my career along the way. And looking back on my training, I realize the people who were most enlightening were the ones who probably had gone through their own difficult journeys. I think that we all should try to bring out the best in the people around us by limiting judgment and looking for the best in them. When you have worked so hard in your life to get to where you are, you find that simple things like showing someone how to do a procedure or laser or explaining a concept is very rewarding.

Dr. Walden: After residency training with my mentor of nearly 25 years, Dr. Linda Phillips, I moved from Texas to New York to pursue my special interest in aesthetic surgery after being selected for the fellowship at Manhattan Eye, Ear and Throat Hospital. During my fellowship and with the guidance of the esteemed Dr. Sherrell Aston, I benefited from his mentorship and the expertise of internationally known leaders in the field. Now I run my own surgical practice with medical spas in both Texas and New York, and I have an ASAPS-endorsed aesthetic surgery fellowship. I mentor young women (and men!) in that role and one of my alum fellows, Dr. Nikki Phillips, who is Harvard Plastic Surgery-trained, will be returning from Australia to be my first junior associate. We are pumped!

Despite their success, things weren’t always easy for participants, and many have overcome adversity and sexism.

Dr. Lupo: As a resident and medical student there was an issue that I had to handle alone. I dealt with it once [with] a punch in the face and usually just a firm “No,” and then I moved on. There were no resources in the late 1970s and no laws. I did not even have maternity leave for my first child! It is much better now.

Dr. Kobets: There have been times in my life and my career when I have been made to feel uncomfortable in situations where I should not have by someone who was my superior. Now with the #MeToo movement this should not happen to others. In my opinion, the #MeToo movement, especially those women who have had the courage to come forward and tell very personal details at considerable risk to their careers, has had a positive impact on the way people live their lives and treat others. If that same event happened to me today, I would have the confidence and personal strength to come forward, all thanks to the #MeToo movement.

Dr. Moran: There is definitely sexual harassment in our field, but it is far less prevalent than it was in the past. When I was coming up in my education and training, sexual harassment and objectification was normalized. Being one of so few women in my field, I didn’t want to stand out or seem weak by complaining to authorities. The way that it was seen is that you don’t ask to join an all-boys club and then complain that the boys are acting like boys. I either told the guy off, gave it back to him, or ignored it, even if it made me extremely uncomfortable. I would never tolerate that behavior toward any of the women coming up in my field now.

When asked what advice they would give their younger self or a female physician starting her career, the panelists were passionate.

Dr. Walden: Go for it. Don’t wait for someone to tell you that you can or can’t, because you will hear both. Believe in yourself and work, seeing your aspirations through and persisting day in and day out. Listen to your mentors and improve your skills wherever and whenever you can. Every day is another opportunity to learn something new, whether it is something new you have encountered handling a patient or surgical case, your own self-improvement, time-management skills, awareness, and so much more. Lastly, ask for help when you need it.

Dr. Weinkle: Choosing the right mentor is important. If you like writing and medical dermatology, you should find a doctor with similar interests. Do a rotation and develop a rapport so he or she can guide you. If you want to be a leader in our field, align yourself with people who can open those doors for you at the major organizations. Sometimes you have to test the waters, too. You may think you want to do cosmetics but may be inspired by a mentor who is a Mohs surgeon and change paths.

Dr. Jeffers: No matter what career you choose, look for opportunities for mentorship. Mentorship can come in many forms. I have had wonderful mentors, both men and women, from multiple spheres in my life.

Dr. Jeffers: As with any career choice, I would recommend that anyone interested in plastic surgery should talk to current plastic surgeons. Understand your options and what the pros and cons are for this career choice. What do you think your life would look like and does this coincide with what your interests and priorities are?

When asked if it’s possible to “have it all,” Dr. Lee provided noted the importance of seeting and seeking one’s personal goals: “What is ‘all’?” she asks. “That answer is different for everyone. If it means a balanced life, happiness, challenges, successes and failures, then maybe. But really none of us should have it ‘all’ because we should always be aspiring to achieve more, whether in your personal or professional life.”

To get a better handle on what is happening in terms of gender equity in the cosmetic specialties, Modern Aesthetics® magazine reached out to a group of female physicians who opened up about all things related to being a woman in medicine today, from gender pay gaps and the importance of mentors and mentoring to the #MeToo movement and how it has affected their career trajectory.