In 2013, when I interviewed Dr. Alec Patterson, 90th AATS President, in preparation for the AATS Centennial commemorative text, In the Words of the Presidents, I asked him the secret to increasing diversity in our specialty. His response, “We have to make it possible for women to have a successful marriage and a successful family life while successfully training them to do what we do, and it has to seem normal.” I really liked what he said, but when you get right down to it, what do we ever do as cardiothoracic surgeons that is normal? After a decade or more of training beyond medical school we emerge still a novice in our chosen field – is that normal? Or, is it normal to enter the operating room every day not knowing whether our patient will survive through the night? I would challenge that almost nothing we do is normal – nothing we do is routine. But that is what excites me about the field. That is what excites me about the future. People have been predicting the demise of cardiothoracic surgery since before it was even a specialty, but we are not going anywhere – I guarantee it, as long as we continue to evolve as a specialty and become more inclusive of outstanding individuals who, until recent times, have been underrepresented.
I was in a European country last year for a conference and my host was the daughter of the Chief of Cardiac Surgery. She told me how much cardiac surgery excited her when she was young but that she ultimately chose to become a cardiologist. “Why not a cardiac surgeon?” I asked. “Because that is man’s work,” she replied. So often, we find ourselves on the crossroads where self-confidence and vulnerability seem unevenly balanced. A subtle reminder of the nature that begets our own identity. It is not an enigma. A brief repose to refresh the senses through mindfulness, guided self-awareness, or even coffee with a true mentor can reorient the disarray of the jigsaw puzzle fragments that is our daily grind. A proper conversation or two with this young woman from a dedicated mentor might be all it would have taken to impact her life forever.
A recent survey in American Surgeon reported recommendations from faculty mentors to female trainees for surgical specialization. The specialty that ranked at the very bottom, i.e., recommended the least to women mentees, was cardiothoracic surgery – recommended less than even neurosurgery or orthopedics. This has got to change. Cardiothoracic surgery is a great field for anyone and everyone who seeks a challenging, rewarding career, regardless of their gender or race. It is our responsibility as leaders to dispel the myth that certain individuals are not welcome. Les Emmerson’s 1971 hit single, Signs, made reference to a warning that, "Long-haired freaky people need not apply." Those days are gone, at least in cardiothoracic surgery. Long hair, short hair, red hair, or gray – you are all welcome to apply.
I became the Program Director at Washington University in 2003. During the preceding 74 years, only one woman completed training in thoracic surgery and zero underrepresented minorities (URMs). Since 2003, 32% of the 50 graduates have been women or URMs. Since 2014, 50% have been women or URMs, and currently, the diversity ratio among trainees is 55%. Diversity in academic medicine does not occur passively, it requires a concerted effort to change the face of cardiothoracic surgery, both active and continuous. My call to AATS members and the global cardiothoracic community is to put forth that effort – without question, it is time for a change, but it is paramount for us to make it seem normal – at least as normal as we can.
Marc R. Moon, MD
AATS 101st President