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. 2023 Mar 29;36(5):299–302. doi: 10.1055/s-0043-1763517

The History of Women Leaders in Colon and Rectal Surgery

Ann C Lowry 1,
PMCID: PMC10411059  PMID: 37564347

Abstract

Women started to enter the specialty of colon and rectal surgery in the early 1970s. However, it was rare for a woman to hold a leadership position in the specialty before 2000. Since then, considerable progress has been made, although the percentage of women leaders does not yet approach the percentage of women in the field. This article focuses on the history of women in leadership positions in the American Board of Colon and Rectal Surgery, the American Society of Colon and Rectal Surgeons, the American Society of Colon and Rectal Surgeons Research Foundation, and the Association of Program Directors in Colon and Rectal Surgery as well the Diseases of the Colon and Rectum and academic departments. Early women leaders shared some common attributes that have contributed to their success. This article reviews some barriers to increasing the number of women in leadership positions; most will be reviewed in other sections in this issue.

Keywords: colorectal surgery, leadership, women


The history of women surgeons is long and storied. In 4000 BCE in Egypt, both men and women practiced surgery. Detailed pictures of surgical instruments and women surgeons are visible in ancient tombs. Over the intervening years, medical schools admitted or denied women admission at various times. This article will focus on the history of women colorectal surgery leaders in the United States, as limited data exist for the rest of the world, at least in English. However, a recent narrative review shared information about the impressive contributions of individual women leaders in the field internationally. 1

In the United States, Dr. Mary Edwards Walker is credited with being the first American woman surgeon; she served in the Union Army during the Civil War. For the next 30 years, women's medical schools educated most women physicians until 1893 when Johns Hopkins Medical School began to admit women. At the end of the 19th century, 25% of medical students were women. By 1930, the Flexner Report, World War I, and the depression caused most of women's medical schools to close; the percentage of women medical students dropped to 4.5% of medical students. That percentage was only 10% by 1970, so it is not surprising that there were very few women surgeons trained between 1930 and 1970.

Colorectal surgery was no exception to that trend. The American Proctologic Society (later the American Society of Colon and Rectal Surgeons) elected the first woman member, Dr. Mary Spears, in 1933. Two more women were admitted in 1944, and by 1951, there were five women members. The American Board of Proctology (later American Board of Colon and Rectal Surgery [ABCRS]) was established in 1940; however, none of these women were board certified. Dr. Ernestine Hambrick, the first woman trained in an approved colon and rectal surgery residency program, became board certified in 1973. Two more women were certified before 1980 and 20 women entered the specialty in the following decade. Currently, there are 508 women board-certified colorectal surgeons ( Table 1 ) (written communication from ABCRS, April 2022) and 40% of colorectal surgery residents are women, which are both significant increases particularly in the past 20 years ( Fig. 1 ). 2

Table 1. Number of board-certified colon and rectal surgery by gender over time.

Year Colorectal surgeons Men Women
1973 590 589 1
1989 873 850 23
2000 1,069 1,000 69
2021 2,414 1,906 508

Fig. 1.

Fig. 1

Colorectal surgery trainees by gender.

Surgery offers many opportunities for leadership roles: residency program directors, professorships, and chiefs or chairs of divisions or departments, as well as chairs of committees, certifying board members, and officers in national colorectal clinical and research organizations. In colorectal surgery, there are historical data available for most of these positions, but not all.

The leading organizations in the field of colon and rectal surgery are the American Society of Colorectal Surgeons (ASCRS), the ABCRS, the ASCRS Research Foundation (ASCRS RF), and the Association of Program Directors in Colorectal Surgery (APDCRS). This article will review the history of women in leadership in those organizations as well as academic surgery.

Committee chairs and members of governance are the primary leadership roles in ASCRS. The Executive Council members-at-large and its officers govern ASCRS. In 1973, the Executive Council numbered four members-at-large. The Executive Council membership increased to six in 2003 and to the current nine members in 2013. In 1973, the officers included the President, President-elect, Vice President, Secretary, and Treasurer. The office of the Past President position was added in 1984. The officers are not necessarily elected from the current membership of the Executive Council. However, most served on the Council before being an officer. Until 2012, there was not a specified progression from one officer position to the next so that Vice Presidents, Treasurers, or Secretaries did not necessarily become President-elects. In fact, between 1973 and 2015, only two Vice Presidents became ASCRS presidents. In 2016, an approved bylaw amendment changed the Vice President's role so that the person in that position would be elevated to President-elect.

Not surprisingly, Dr. Hambrick became the first woman member of the Executive Council in 1979. Her recollection of that is “I did not think of my role there as one of a woman; I thought my role was a colorectal surgeon. I assumed that I had the right to be there.” (personal communication Dr. Hambrick June 2022) Dr. Hambrick became the first woman Vice President in 1992. Dr. Ann Lowry became Treasurer of ASCRS in 2000. Other than those two officer positions, there was not another woman member-at-large or officer of the Executive Council until Dr. Judith Trudel joined as a member-at-large in 2003. Twenty-four years elapsed between the first and second women members of the Executive Council. Progress is occurring slowly, since 2013, 13 women have been members of the Executive Council.

Another article in this issue will review issues of intersectionality. It is noteworthy that Black women and women from other underrepresented groups face even larger challenges in attaining leadership roles. Dr. Debra Ford was the first Black woman to become board certified in 1995, almost 20 years after Dr. Hambrick. While women of color have achieved positions of leadership in some areas of the specialty, it was not until 2013 that an Asian woman, Dr. Mika Varma, was elected to the Executive Council. In 2021, Dr. Ford, the first Black woman, joined the Executive Council. Black men had the opportunity slightly earlier, but still in a very delayed fashion. Dr. Charles Littlejohn was the first Black man on the Executive Council in 1999 and became the first Black President of ASCRS in 2015.

In 2005, 106 years after the formation of ASCRS, the first woman, Dr. Ann Lowry, was elected President. Two other women, Dr. Patricia Roberts (2016–2017) and Dr. Tracy Hull (2019–2020), have been Presidents of the ASCRS since then. Of note, a decade passed between the first and second women President's tenure.

Historical data about ASCRS committee chair positions are not available. It is known that Dr. Roberts was the first woman Program Chair for the 1997 convention. Currently, there are 13 women chairs of committees out of 25 committees. 3 Historically, committee chairs are often elected to the Executive Council, so theoretically there will be women members of the Executive Council in the future.

A major component of the ASCRS is the journal, Diseases of the Colon and Rectum ( DCR ). Established in 1957, the editor-in-chief serves two 5-year terms. All Editors-in-Chief were men until Dr. Susan Galandiuk became Editor-in-Chief in 2017. Editorial boards of surgery journals remain predominantly men. In a recent review, 74% of the editorial board members of surgery research journals were men. 4 In the 20 years between 1997 and 2017, the percentage of women on the editorial boards of high-impact surgery journals increased from 5 to 19%. 5 The DCR editorial board was 15% women in 2007 but only increased to 17% during the next decade. Women representation on editorial boards will need to increase if there are to be more women editors-in-chiefs. Efforts to diversify the editorial board have started. Dr. Galandiuk instituted the DCR Reviewer's Guild to train young surgeons to be reviewers for the journal and perhaps ultimately members of the editorial board. The program is training a diverse group of young surgeons.

Established in 1958, the purpose of the ASCRS RF is support of research in the field of colorectal surgery with a Board of Trustees as the governing body. The ASCRS RF Board of Trustees consists of 13 members including 5 officers. The President, President-elect, Past President, and Treasurer of ASCRS are designated members. Women are “felt to be critical to the success of the Foundation.” To that end, a Women's Committee of the Research Foundation was established in 1985. 6 The committee's major responsibility was managing the ASCRS RF booth at the annual meeting. The participation of women surgeon scientists started soon after that. Dr. Heidi Nelson received the first Leon Hirsch Traveling Surgical Fellowship Award in 1989. Dr Hambrick joined the ASCRS RF Board of Trustees in 1992 and was the first woman member. Dr. Nelson followed in 1994 and subsequently became the first woman President in 2000. The second woman President, Dr. Elizabeth Wick, began her term 22 years later in 2022. Ten women have served on the Board of Trustees since 1992 (Dr. Galandiuk served two noncontiguous terms). Currently, 4 of the 13 members of the Board of Trustees are women.

The selection of members of the ABCRS is a different process than the others discussed. Five organizations nominate candidates for membership to the ABCRS (ASCRS, ABCRS, American College of Surgeons, APDCRS, and the American Board of Surgery). The process utilized by each organization to select their nominees is not readily available. From the nominees, the ABCRS members elect its members. Most members become the President in the last year of their second and final term. If there are two people completing their second term in the same year, the Board holds an election. Dr. Patricia Roberts was the first woman selected to be a member of the Board and subsequently became President of the Board in 2009. Since then, three other women have been President: Dr. Jan Rakinic, Dr. Judith Trudel, and Dr. Najjia Mahmoud.

The first official training program in proctology began at the University of Minnesota in 1917. The APDCRS was founded in 1979. The membership includes all the program directors of the colorectal surgery residency programs. By 1996, there were 31 training programs. That year, Dr. Jan Rakinic became the first woman program director for a colorectal surgery program. Today there are 71 programs of which 18 (25%) have women program directors. 7 The leadership, deemed Board of Directors, includes the President, Vice-President, Secretary/Treasurer, and a member-at-large elected by the membership. According to the bylaws, the Vice President is assumed to be the President-elect. 8 In 2002, 23 years after the founding of the organization, Dr. Lowry became President. Since then, two other women, Drs. Rakinic and Jennifer Beaty, have been President.

When Dr. Hambrick became board certified, most academic institutions did not have colon and rectal surgery faculty. The prevailing belief was that colon and rectal surgery procedures fell under the purview of general surgery and subspecialization was not necessary. Today, most academic departments of surgery have colorectal surgery faculty. Promotion of women to full professorships or leadership positions in departments of surgery has been slow despite the growing number of women surgical residents and junior faculty. In recent years, the pace has increased. A study of leadership in academic surgery departments reviewed gender and ethnic diversity in various leadership positions. 9 Overall, in surgery, 74.6% of program directors, 77.3% of vice chairs of education, and 85.3% of department chairs were men. There was a higher percentage of women serving as associate program directors (38.5%). Overall, 10% of division chiefs were women; colorectal surgery was slightly above the mean with 17.6% of the division chiefs being women. Two women colorectal surgeons have been chairs of surgery, Dr. Nelson at the Mayo Clinic Rochester and Dr. Roberts at the Lahey Clinic. While improvement has happened, the percentage of women leading colorectal surgery divisions does not yet reflect the 21% of colon and rectal surgeons who are women nor even approach the 44% of recent graduates from colorectal surgery programs who are women. The percentages are proportionately lower for women from underrepresented groups.

Like the male leaders in colorectal surgery, the early female leaders practiced at large, teaching institutions. Dr. Hambrick practiced at the University of Illinois, Dr. Hull at the Cleveland Clinic, Dr. Galandiuk at the University of Louisville, Dr. Lowry at the University of Minnesota, Dr. Nelson at the Mayo Clinic Rochester, and Dr. Roberts at the Lahey Clinic. It is likely that contacts at those institutions provided sponsorship and afforded those women the opportunities to demonstrate their leadership skills.

For the early women leaders, women surgeons were not available as role models or mentors. In the recent narrative review, several leaders mention that their mothers were mentors for them. 1 Dr. Hambrick's mother returned to school as a widow and rose to a leadership position in nursing administration. Dr. Galandiuk noted “my most important mentor was my mother, who as a young refugee from Eastern Europe, was forced to drop out of medical school during the aftermath of World War II for economic reasons… I would call her every day and tell her of my concerns and my successes. I know of no better mentor or friend.” 1 Dr. Nelson stated that her mother and grandmother “showed her that professional doors would swing open if you chose the right doors.” 1 Dr. Lowry's mother was the first woman to finish the internal medicine program at the University of Minnesota. Her mother practiced while raising a family and showed her that it was possible for women to do both. These women were lucky that women role models and mentors were available in their families. Others found men who were open to mentoring women surgeons. Fortunately, there are now women surgeons available as role models and mentors and more men who are willing to mentor women as exemplified by the HeForShe movement. 10

Departments of surgery and colorectal surgery organizations must address the barriers to advancement for women. Historically, the pipeline was an issue for women. The number of women entering medical school is now approximately equal to the number of men. In addition, women residents in surgery hold 45% of the positions, while women in colorectal surgery represent 40% of residents. The pipeline remains a significant problem for underrepresented groups both at the medical school and residency levels.

One barrier to increasing women as leaders may be the nomination process for ASCRS, ASCRS RF, ABCRS, and APDCRS, since a small group makes the selection. A nominating committee of the three Past Presidents of ASCRS presented a slate of candidates for Executive Council members and officers for approval. Other than the designated members of the ASCRS RF Board of Trustees, the members and officers are nominated by a nominating committee composed of the President and immediate Past President of the ASCRS RF and the President, President-elect, and Past President of ASCRS. APDCRS members submit applications to be an officer to the nominating committee composed of the past three APDCRS Presidents. The nominating committee then presents a ballot of three names to the Board Officers who make the final selection. Multiple organizations submit candidates for the ABCRS; the process of choosing those candidates is not available in documentation that could be accessed. In many of these organizations, effort was made to solicit names broadly but lobbying by other leaders in the field played a role. It would be natural to favor nominees from the group's known professional network. It is known that men are more likely to have professional networks of only men. 11

There are now efforts to make the process more transparent and inclusive. “To increase input from various stakeholders to the nomination process for ASCRS leaders, the Executive Council approved creation of the Nominations Advisory Task Force. Task force members will do the initial vetting of Executive Council nominees and then present their recommendations to ASCRS Nominating Committee. The ASCRS Vice President serves as the task force chair. Other members of the task force include the Young Surgeons Committee Chair or their designee, the Diversity, Equity and Inclusion Committee Chair or their designee, the American Board of Colon and Rectal Surgery (ABCRS) President or their designee, the Association of Program Directors in Colon and Rectal Surgery (APDCRS) President or their designee, and the Diseases of the Colon and Rectum (DCR) Editor-in-Chief or their designee.” 12 The mission is to have more diverse candidates, including more women, emerge from this process.

While there are clearly distinguished women leaders in colon and rectal surgery, the numbers are not comparable to the number of women practicing colon and rectal surgeons. The lack of women role models and the nomination processes likely contribute to the small numbers. However, there are multiple other barriers to career advancement. Those barriers and mitigation methods such as mentorship and policy changes are discussed elsewhere in this issue.

Footnotes

Conflict of Interest Volenteer for American Board of Colon and Rectal Surgery board member, committee chair and American Society of Colon and Rectal Surgeons committee chair.

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