Blog: Coronavirus and Shifting Responsibilities for Women in Surgery

Erin M. Corsini, MD1, Jessica G. Y. Luc, MD2, Erin A. Gillaspie, MD3, Mara B. Antonoff, MD1

Author Affiliations: 1Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; 2Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada; 3Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA

published April 13, 2020

[click here for downloadable PDF of this blog]

In the hospital, our roles and responsibilities as surgeons are typically clear-cut: safely complete the operation, talk to the patient’s family, dictate notes and enter orders, and offer educational moments for the junior members of the team, and so on.  At home and with our extended friends and family, though, our responsibilities are sometimes not as straightforward, and are often fluid, evolving as situations change. 

Amidst the COVID pandemic, our lives and usual routines have been disrupted in myriad ways.  For some, this means changing workloads or setting up a home office. Caring for and protecting ill or aged family members has been the sole focus for others.  And the unfortunate reality for many is the loss of employment, which can result in significant financial and emotional challenges.  

For women in the workforce, a disproportionate number of those job losses were suffered by women, as the Labor Department announced over 700,000 jobs had been eliminated in the initial rounds of pandemic layoffs.1  Hit most hard have been the service industries–restaurants, hotels, and salons–where the majority of the workforce is comprised of women.2  Not only does this financial strain pose a great challenge for women and their families, but responsibilities at home have furthermore shifted dramatically as schools and daycares are shuttered.

When so many are struggling, we in medicine are fortunate to feel some reassurance from the reality of job security while we have the privilege of continuing to help so many.  Though the operative case volume has been severely cut, our individual sum total obligations do not necessarily reflect this reduction. However, despite the high demands of a career in surgery, women often bear the majority of household and parenting responsibilities, which, for some, has been further emphasized amidst COVID-related work and school changes.3

Many efforts – some of them purposeful, some organic, and some simply a side-effect of changing times – have been successful in attracting young women to careers in cardiothoracic surgery and other surgical specialties.4-6  In this highly unusual time, though, we pause to reflect on the ways in which our duties have shifted, with some taking on responsibilities more reflective of traditional gender roles.  Together, we represent women at various stages of training and careers with unique responsibilities outside of work.  All of us have been required to make tremendous adaptations in the face of the epidemic, though our experiences and daily considerations are vastly different. 

Dr. Corsini: I still recall the moment I told my husband what had been obvious to me about parenting duties for quite a while.  Our son was not yet one year old, but had already required several pediatrician appointments for recurrent ear infections.  I was, and still am, in a unique phase of my training–at the tail end of a two-year clinical research fellowship in the middle of my general surgery residency.  Sick visits, holidays, and daycare/school vacations meant I was the obvious choice to skip work, as my husband is also a surgical resident. I told him, “You know, when we’re both on clinical rotations again, we’re going to have to take turns to leaving the OR when he has a fever and requires early pickup or a trip to the doctor.”  There was a long pause before he said, “Yeah, I know.” I am sure of two things. First, on principle, he never expected me to bear the sole responsibility (or even majority) of parenting, including the inevitable pickup from daycare when a fever erupted or a trip to the pediatrician was necessary. But secondly, the reality of this had never actually crossed his mind. 

Now, amidst COVID, I have been working from home for over a month.  Daycare has been closed, and once again, I am the obvious choice to miss work.  This requires no conversation; it is just understood between us, and I am in full agreement with this.  I have transitioned my sleep schedule to wake up with my husband, our alarms going off at 4AM, so I can start work before our son is up for the day.  If my work is “nonessential,” it is impossible for me to justify that a babysitter put him/herself in harm’s way to help out. Working from home has required innovative modifications to my routine and has posed new challenges, particularly as I consider my own health, now pregnant with our second child.  I am appreciative of the willingness of my faculty mentors in this trying period, never doubting my work ethic and continuously seeking ways to support me through this rapidly developing situation.

Dr. Luc: Speaking on the collective perspectives of multiple trainees, COVID has in many ways shifted our perspective from our careers to also include a reflection of what matters to us in our lives. Whether that is our own mortality but also the lives, safety and wellbeing of our colleagues, friends and family. In addition, it is also a time of reflection and experiencing in real-time how systems undergo large-scale transformation—from government, businesses, schools, cities, and communities adapt and make fundamental changes to the existing ways in which our society functions.The virus does not discriminate and affects all aspects of our lives for those in all walks of life, from the young to the elderly. 

For women in surgery, COVID acts to enforce gendered norms for women in the caregiver duty (for family members—young, elderly, and sick), due to the loss of supportive modalities through closure / infections in daycare, babysitters, and long-term care facilities. However, COVID has also been a force that has catalyzed and paved the way for innovative modalities to work from home for all—potentially democratizing opportunities for women. 

Regardless of when or how we emerge from this pandemic, COVID will forever alter the way society operates from telemedicine, e-learning, telecommuting, work-from-home modalities, home-testing, and the growing emphasis on hygiene, compassion, cooperation and the information revolution. In that sense, pandemics are equalizers, allowing us to pinpoint what’s not working and also serving as a starting point to scale and innovate to solve the problems of yesterday, today, and tomorrow. 

Dr. Gillaspie:  My daily life, just like all of you, has completely changed.  I arrive in the morning to start rounds only to find myself shuffled through one of only three entry points to the hospital.  After a screening temperature and being outfitted with my latest “I Have Been Screened” sticker I head up to the floor where I scour the unit trying to recognize my team in their newest caps and masks.  While my routine in the operating room has been relatively unchanged, with the exception of now wearing an N95 mask and having a slower case volume; my clinic on the other hand has shifted to nearly 100% telemedicine which I perform from home.  Research meetings likewise no longer take place in person, rather on Zoom with us all filling squares like the opening sequence of the Brady Bunch.  

Despite these changes I consider myself incredibly fortunate.  I have a job that I love and the opportunity to continue helping others.

I have also found myself supplied with extra time—time that I used to spend attending hockey games, the symphony, volunteering at the local women’s shelter, or working out at my favorite boxing club.  I have filled this with online courses, reading, developing new hobbies (Ukulele anyone?), and writing blogs. Like most people, I also spend time watching or reading the news for pandemic updates.   

Recent articles highlighting gender differences have particularly captured my attention of late. 

While COVID-19 seems to disproportionately affect men medically with increased mortality, women seem to be more impacted socially and financially.  As noted above, 70% of the global workforce in the health and social sectors are women. The risk of exposure is certainly higher. Women are also more likely to lose their jobs.  Women make up a majority of part-time and service industry positions within the labor market—groups expected to bear the heaviest brunt of job losses.7  Women’s unpaid work is also projected to be increasing—in many cases women already assume the responsibility for domestic duties and during the pandemic are also tasked with educating children who are now at home.  

Perhaps the statistic that struck me the most, probably in part because of the volunteer work that I do, was a report by the World Health Organization and United Nations documenting a significant increase in domestic violence.  Heartbreaking stories are pouring in from around the world detailing instances of violent abuse with victims often trapped and assistive resources completely overwhelmed.8  The UN chief Antonio Guterres has called for action to address the “horrifying global surge in domestic violence” directed towards women and girls.9

While we must all fight the COVID-19 virus together, a swift and comprehensive program must also be instituted with gender-specific, global considerations to help support restoration of community.  

Dr. Antonoff: In my everyday life, many have witnessed my affirmation in my belief that being a cardiothoracic surgeon makes me a much better daughter, friend, wife, and mother; likewise, I am certain that being a mother of four makes me a more patient, compassionate, and flexible clinician.  I’ve been overheard in small talk and on conference podiums, stating how I cannot imagine my surgical career without my kids, nor can I imagine parenthood without my identity as a surgeon. “It’s all about time management and work-life integration,” I said. “Four kids can be the same amount of work as one kid,” I said.  My, how quickly perspectives can shift. Fast forward to the worldwide pandemic, when this surgeon-mother-of-four has now been overheard saying, “If you need more than 3 squares of toilet paper, you take a shower.” 

Certainly, we have come a long way for women in cardiothoracic surgery.5  Life for us is very different than for the early female pioneers in the field, and it was through their strength and fortitude, along with the support of male sponsors and our national societies, that women in our specialty have grown and prospered. That being said, I think we all recognize that, despite enormous change for the better, there still exist challenges for women and underrepresented minorities in a field that has traditionally been comprised of a fairly homogeneous demographic.  

How do things change during a pandemic? I remain fortunate to have a superhero of a spouse, a phenomenal clinical team, supportive surgical partners, and a village in my neighborhood of friends who care very much about us. But things can look a little different when we are all nervous, scared, and worried about so many things with so little knowledge to guide us.  I don’t know how many non-physician women are discussing with their partners their current life insurance policies and at which hospital they think they’d be most likely to receive ECMO if needed. Within a clinical team, individuals have strong opinions regarding issues such as N95 use, preoperative COVID testing, social distancing within the clinic, rounding on inpatients–and while we all prioritize patient safety, it is also imperative to consider safety of the workforce and our families.  We each have different comorbidities, different family scenarios, and we are all learning to have new conversations in productive and successful ways. And the amazing village of friends, neighbors, teachers, and coaches—their support can look different in a pandemic, as well—given the need for social distancing. And, like it or not, we, as surgeons who continue to provide clinical care, along with our families who live with us, are likely the most risky contacts to our friends and neighbors.  

It has been very clearly shown in previous investigations that for women who lack same-sex networking within their same institution, that remote relationships facilitated via social media or otherwise are highly beneficial.10  In this time, more than ever, as we are isolated from just about everyone, one thing is very clear: we still need to connect with those who understand our plight.11  At times, I find myself overwhelmed with fear—fear for my parents’ frailty, fear of orphaning my children, fear of financial devastation, fear of missing my 4 year-old’s zoom meeting in the middle of my clinic, fear of running out of toilet paper, fear of my 10 year-old failing to complete his library (!) assignment in time.  Some of these fears are very heavy, some are very silly, but they are all real. And wewomen CT surgeonsneed each other more than ever right now.  Perhaps we don’t have annual meetings to see one another, and we cannot share hugs or even air-hugs.  But please, look out for one another and stay connected. Check in on each other, mentor from afar, and feel open to share your fears and listen to those of others. We are in this together. 


Disclosures: The views expressed herein are the authors’ own and do not represent those of their institutions. 

REFERENCES

  1. Horsley S. U.S. Lost 701,000 Jobs In March; Much Worse To Come:Radio NP 2020 [Available from: https://www.npr.org/sections/coronavirus-live-updates/2020/04/03/826096581/jobs-data-will-be-from-way-back-when-things-were-normal-3-weeks-ago.
  2. Horsley S. Women Are Losing More Jobs In Coronavirus Shutdowns:Radio NP 2020 [Available from: https://www.npr.org/2020/04/08/829141182/women-are-losing-more-jobs-in-coronavirus-shutdowns.
  3. Greenberg CC. Association for Academic Surgery presidential address: sticky floors and glass ceilings. J Surg Res. 2017;219:ix-xviii.
  4. Bass BL. Our lives as surgeons: finding a sense of place and purpose. J Am Coll Surg. 2015;220:790-6.
  5. Antonoff MB, David EA, Donington JS, Colson YL, Litle VR, Lawton JS, et al. Women in Thoracic Surgery: 30 Years of History. Ann Thorac Surg. 2016;101:399-409.
  6. Corsini EM, Boeck M, Hughes KA, Logghe HJ, Pitt SC, Stamp N, et al. Global Impact of Social Media on Women in Surgery. Am Surg. 2020;86:152-7.
  7. Durant I. COVID-19 requires gender-equal responses to save economies.  United Nations Conference on Trade and Development. April 1, 2020. https://unctad.org/en/pages/newsdetails.aspx?OriginalVersionID=2319  
  8. Taub, A. A New COVID-19 Crisis: Domestic Abuse Rises Worldwide.  April 6, 2020. https://www.nytimes.com/2020/04/06/world/coronavirus-domestic-violence.html
  9. UN chief calls for domestic violence ‘ceasefire’ amid ‘horrifying global surge’.  April 6, 2020. https://news.un.org/en/story/2020/04/1061052
  10. Luc JGY, Stamp NL, Antonoff MB. Social Media as a Means of Networking and Mentorship: Role for Women in Cardiothoracic Surgery.  Semin Thorac Cardiovasc Surg. 2018 Winter;30(4):487-495. 
  11. Blackmon SH. Blackmon COVID 19 04 02 2008. Available on YouTube. https://youtu.be/a3W6R2-KduQ