It wasn’t until their senior retreat this past January that the surgical residency class at Saint Louis University (SLU) School of Medicine realized just how special their unit was. Individually, they were each remarkable. Together, they made up the first all-female graduating class of surgeons in the school’s 184-year history.
From left to right: Laura Peck, DO; Annie Mooser, MD; Jennifer Keller, MD; Jennifer Lobb, MD; and Faidah Badru, MD.
Because their different subspecialties usually kept them apart, they hadn’t recognized how unique their group was. “But when we were all together, we just kind of all realized, oh, gosh, it’s all ladies here. Well, that’s awesome,” says Jennifer Lobb, MD. Less awesome were the hurdles they faced as women in medicine, including pervasive stereotypes and bullying.
Gender-based discrimination is reported in most specialties, but mistreatment may be the worst in surgery. In a recent national survey, 58% of women surgeons reported having experienced sexual harassment, compared with just 25% of men. And the problem is often worse for women of color. “I’ve been called a janitor because I’m Black,” says classmate Faidah Badru, MD.
The experiences of this all-female class highlight both the growing pains and triumphs of the surgical field as it slowly advances toward gender parity and equity. About 40% of US general surgery residents in 2017 were women, compared with only 14% in 2001.
Reflecting on their training, the recent SLU graduates recall how they pushed past and disproved restrictive misperceptions — like the idea that motherhood is incompatible with residency, especially in surgery, and that women don’t “belong” in male-dominated fields like trauma.
The newly minted surgeons hope their success helps dispel these negative beliefs and encourages others. Their message to the women following in their footsteps: “Whatever you want to do, you should do it and know that you can do it,” says Badru.
Although the five women each have individual accomplishments to celebrate, most point to Badru — now in a pediatric surgery fellowship at the University of Florida College of Medicine — as the exemplar of their class. Badru didn’t want to pause her training to have a family, so she didn’t.
She gave birth to her first child during her second year of residency. She had her second during her fourth year, as she was conducting research in pediatric surgery. During her chief year of residency, she had her third. All the while, she was the only Black woman in SLU’s entire general surgery program. “It was sort of like, ‘Wow, not only are you female, you’re Black, you’re married, and you want kids — I don’t know how it’s going to work out for you,’ ” Badru says.
Many assume that the long hours of surgery make motherhood impossible and discourage women who want to have a family from pursuing it as their specialty, say members of the SLU class. Yet, with the support of her husband, Badru has been able to raise three children and simultaneously complete residency. She has no regrets. “I pretty much have everything I want in life.”
Her classmates say Badru’s ability to juggle motherhood and her training responsibilities makes her a role model. “There are still quite a few women who don’t feel comfortable going into surgery or are told not to because of the lifestyle,” says classmate Jennifer Keller, MD. “People like Faidah are a great example of why you can still do this and have everything that you want.”
Badru and Laura Peck, DO, had similar starts to residency: Badru started hers at Harlem Hospital in New York City. When her institution couldn’t provide her the opportunity to perform research in pediatric surgery, she transferred to SLU, taking the place of a man who left the program. Peck made a similar switch, becoming the fifth and final member of the all-female class after a different male doctor left, but her transfer was motivated by factors outside of medicine.
Whereas Badru spent much of her residency welcoming her children into the world, Peck spent hers saying a difficult goodbye. Peck’s father was diagnosed with stage 4 kidney cancer during her medical training. After her third year of residency at the Swedish Medical Center in Denver, Colorado, she transferred to SLU’s program to be closer to him. Closer was better, she says, but still not enough.
“Life did not allow me to both become a surgeon and be with him as much as I wanted to,” Peck says. “I don’t know if I’ll ever forgive life for that.”
By not easily allowing trainees to take leave to care for ill family members, residency programs’ policies have traditionally forced a choice: neglect those obligations or abandon medical training. This has disproportionally affected women, who take on the majority of caregiving duties for sick parents. Those restrictions are finally changing.
The American Board of Medical Specialties recently passed a rule allowing residents to take at least 6 weeks away from their program to be a caregiver — without extending their training. That ruling came too late to help Peck. It passed in July, the same month her father died. Thankfully, she says, her dad saw her finish a challenging residency.
Now, as she starts her fellowship in minimally invasive surgery at Ascension St. John Hospital in Detroit, Michigan, Peck says she knows her father was proud. “He was always so supportive of my pursuit to become a surgeon.”
Lobb says that Peck’s ability to balance demanding family obligations has been an inspiration to her and others. “Watching my colleagues navigate challenges of life while continuing to be present at work and give the most to their patients really inspired me to continue on a daily basis,” she says.
Lobb may not have had the same family-based challenges as Peck and Badru, but she and all of her classmates had another, particularly notable problem: sexist expectations. Peck says these experiences were common. “I’ll go into a room sometimes and say, ‘Hello, my name is Dr Peck,’ and I’ll talk with them about their whole treatment plan and how they’re doing and everything you’d expect in a visit. And then I’ll get ready to leave and they’ll say, ‘Thank you, nurse. When’s the doctor coming in?’ ”
It wasn’t just the patients. Lobb says she was bullied by faculty and nurses as well. She was surprised to find that female practitioners were often more abusive to her than her male colleagues. She clarifies that most of the troubling exchanges were with women she met in passing and that she never experienced such behavior within her residency class. “The girls that I graduated with are like my sisters.”
Despite how some women responded, the female representation on the staff and in leadership roles at SLU was crucial for the residents. “We have a lot of female leaders, and that was one of the reasons that I chose SLU,” Lobb says.
Badru feels similarly. Harlem Hospital didn’t have many female surgeons, so switching residency programs made a huge difference for her. Having many women to look up to — especially women with children — made it easier for her to be a mother and resident simultaneously, she says.
As much as they appreciated the guidance they received, the five soon became leaders themselves. This was particularly the case for Badru, who drew upon her background and culture in ways that directly helped her patients. Instead of feeling isolated as the only Black woman in the surgery program, she says it meant she could “bring something to the table, which I thought was exciting.”
For instance, when a child came in with burns on her back, some members of the team suggested possible child abuse. Badru, however, realized that the burns were caused by something that is common practice in Black hair care: using hot water to meld the ends of braids.
She says this is just one of the ways in which characteristics that may appear to be limiting to some are actually empowering. “You could be a minority, you could have an accent like I do,” she says, but nothing should hold women in surgery back.
When Badru and Peck transferred in, the class finally became all women, something that led others at the school to dub them “The Spice Girls.” The five embraced the moniker. In fact, classmate Annie Mooser, MD, bought the group Spice Girls-inspired track jackets to wear during their trauma training. (Mooser, now a staff surgeon for the Navy aboard the U.S.S. Ronald Reagan Aircraft Carrier, could not be reached for comment.)
From left to right: Annie Mooser, MD; Jennifer Keller, MD; Jennifer Lobb, MD; Laura Peck, DO; and Faidah Badru, MD.
The class agrees that their stint in trauma had a major influence on them. St. Louis has one of the highest homicide rates in the country. “If you look at the numbers, we get as many traumas a year as some of the major trauma centers in the US,” Lobb says. She points to some unique learning opportunities, such as the chance to do an ED thoracotomy, which involves opening up the chest as a last-ditch effort to save a patient with penetrating injury and cardiac arrest. “When I went on the interview trail for fellowship, there were people who had never seen some of the stuff that I did routinely.”
Lobb never expected to fall in love with this particular area — she had planned to specialize in breast oncology. But working in trauma allowed her to save lives in a more immediate way, which is exactly why she became a doctor. Lobb is now in a trauma critical care fellowship at University of Miami Ryder Trauma Center.
She notes that, traditionally, this is a male-heavy subspecialty: Only about 28% of doctors who earn certification in critical care from the American Board of Surgery are women. When the field started, it was flooded with “hardcore military people working out in the field,” Lobb says. “And I think that has changed. You can still be a female and you can still be however you want to be and you can still love trauma.”
Trauma of a different kind dominated in the weeks before the class graduated. As senior residents, the group played a major role in caring for COVID-19 patients at SLU. “Our surgical residents were the first line,” says Grace Montenegro, MD, the associate program director for the general surgery residency program. “There was a COVID team to put in lines…or just to do a lot of invasive procedures, and it was our surgical residents doing it.”
Keller, in particular, stood out. “If I’m in a disaster situation, she’s the woman to be with,” Montenegro says. Before the pandemic, Montenegro took on some of her most challenging cases with Keller by her side. Keller was on the front lines, working with COVID-19 patients more often than the other residents, Montenegro says.
“It was a little unnerving,” Keller says. “It all became real once you have to do the very secure gown and gloving.”
The COVID-19 pandemic continues to affect the class, to greater and lesser degrees, even now. Keller isn’t so concerned about it interfering with her fellowship in surgical oncology at the John Wayne Cancer Institute in Santa Monica, California. Lobb feels similarly about her trauma fellowship. But Peck worries that she may not receive a comprehensive experience in minimally invasive surgery. The types of operations she would perform are mostly elective, meaning some are suspended because of concerns about the coronavirus.
Moving forward, the surgeons plan to keep pushing to make the field even more accessible to women. “Surgery is tough,” Badru says, “but that rigid mindset we always had about [women in] surgery is going to be there, unless we change the narrative.”
The 2020 SLU class is proof of that change. “In the end, we are all stepping stones,” says Peck. “We are here to help the next woman find her place in the field.”
Tara Santora is a freelance science journalist based out of Aurora, Colorado. They are a Contributing Editor at Fatherly and have written for Scientific American, Undark, Business Insider, Psychology Today, and many more. Follow them on Twitter at @Tara_Santora.