Year | Female percentage | Female/Male | Total Membership |
1970 | 3.9% | 2/49 | 51 |
1994 | 5.5% | 18/309 | 327 |
2019 | 18.6% | 154/674 | 830 |
During WWII, female employment jumped from 27% to 37%. These women were paid 55% less than their male counterparts. With America's WWII factories, civilian population, and electrical supply lines under no risk of aerial bombardment, the US tapped the female labor pool so as to ramp up military-industrial production. At the same time, European countries were busy bombing and sabotaging each other’s infrastructure and industrial capacity. Some things never change. The US emerged as the victorious superpower capable of projecting kinetic force anywhere on the planet.
Women’s entry into the workforce naturally spurred an interest in higher-paid professions. However, the female path to higher education was a bumpy ride. Since college tuition was expensive, many families in the 1950s only sent the boys to college. Women who attended college were often offered two options; nursing or teaching. Upon graduation, women received a lower salary than men for the same work, the argument being that men were supporting a family, but women would get pregnant and quit. "The pill" and declining fertility rates helped women pursue their goals of equal pay and legal protections. Fast-forward to the Women's Movement of the 70's and 80's which favored women in career roles. Workplace female figures such as Mary Tyler Moore appeared routinely on TV and in movies. This encouraged even more women to enter into the educated workforce, where they demanded equal treatment. The net effect was a gradual acceptance of women in the workplace as co-equal to men (Traditional roles still play an equally strong and often fulfilling role in many women's lives). As a result, college-educated women in American society have achieved remarkable progress in creating a path into the once-hostile workplace, similar to the achievements of minorities and gays. Nonetheless, the gender-based pay gap still persists. As well institutional racism and sexism are still present, but they are no longer omnipresent and unchallengeable. Troubling and destabilizing class, gender, and race-based wealth inequalities are widening.
My medical class of 1982 was 45% female. OR signage back then indicated Doctors' Changing Room and Nurses' Changing Room. It didn't seem that big a deal to me at the time; it took decades for me to understand the institutionalized nature of sexism. It was against this background that I first attended an ASOPRS meeting in the late 1980’s. Though women were common in medical school, it was rare to see women in Presidency or upper leadership positions, but I remember many notable and esteemed exceptions such as Barbara Beatty and Eva Hewes of Hewes flap fame, charter member Virginia Lubkin, and of course, Bernice Brown. My interaction with Dr. Bernice Brown concerned my OPRS journal manuscript entitled "Does Decompression Diminish Dysthyroid Discomfort?" I was jazzed that every word in the title began with the letter "D."
Editorial by Jemshed Khan
In the eighties ASOPRS was smaller, more like a family. Spouses volunteered to assist with meeting registration. Children frolicked poolside at Spring Meetings, splashing and laughing and running. Over decades one watched them grow. Some of the generations of ASOPRS physicians that I observed included the Buergers, Schaefers, Epsteins, Rootmans, Katowitzes, Tses, Gavarises, Hollstens, Perrys, Solls, Stephensons, and Stasiors.
Studies of children who follow a parent into medicine reveal several common factors at play. The children recall visits to the medical workplace where enthusiastic coworkers asked if they planned on becoming a doctor too. The seed was planted. Inevitably, odd medical artifacts made their appearance in the home: a specimen in formalin, a bag full of sheep eyes, a glass prosthetic eye. These bizarre occurrences seemed normal in medical families.
Nature and nurture influence career choice in physician offspring. Physicians are often competitive and intelligent: both traits favor a career that demands much sacrifice and effort, but also provides ample rewards. Physician households can bankroll tuition costs that would bankrupt middle class families; Ivy League tuition can exceed $90k/year. The intellectual and emotional challenge, altruism, income, and social status associated with being a physician all motivate career choices in multigenerational physician families.
Following a parent into Oculoplastics was easier when medicine was mostly solo or small group private practice. Back then, after residency one either "hung out a shingle," or went on to a fellowship. Most preceptors were private practitioners who helped at the University. Private practice was a small business enterprise built upon personal excellence, local relationships, and patient care. The physician of that era was a highly autonomous being whose expertise spanned several domains, whose level of education often exceeded that of other health care workers, and whose judgement and skill would routinely make the difference between life and death.
Much has changed. Especially the decline in solo practice, the increasing expertise of other health care workers, and the loss of status afforded physicians. Most of all, institutional and government policy is now driven by corporate rather than public interest. Let's explore these changes and how they relate to physician families.
For millennia, human offspring worked alongside parents and acquired their skills. This specialization of labor yields profitable efficiencies or "comparative economic advantage" (Ricardo's theory). This advantage was passed down the family tree; offspring would inherit a parent's trade or practice without having to build a business from scratch. As privilege, power, wealth and skill accumulated across generations, they were subject to race and gender-based barriers. Fortunately, those barriers are breaking down. Unfortunately, transfer of business and skills across generations has become difficult because private ownership is being replaced by profit-driven corporate and institutional control. Let's examine the financialization of the medical sector; why it happened: in doing so, we can understand how medicine has changed.
Beginning with Medicare, American medicine became increasingly regulated, specialized, and bureaucratic. The real client was the third-party payor rather than the patient. Physicians responded by forming partnerships and groups to dilute overhead and centralize onerous insurance tasks. This led to formal compensation plans and detailed revenue statements.
Group practice Profit & Loss statements were the beginning of the end because they attracted the attention of venture capitalists (VC). Venture capitalists feed off surplus capital generated by inequitable Federal tax policies and obscene tax favoritism (e.g., carried interest, long term capital gains). VC examined practice profitability and began acquiring practices. They folded practices into publicly traded entities whose stock then traded at multiples of earnings. Most private group practices could not resist the immediate personal wealth generated by selling out to private equity. Thus, between institutionalization, onerous regulation, and financialization, the practice of medicine was forever changed. Given the Federal tax policies at play, physician's taxed at 40% personal rates had zero chance of prevailing against VC on such an uneven playing field.
Some private equity physicians still enjoy practice, but many find the patient load, time demands, and loss of autonomy to be extremely stressful. Many employee-physicians and university physicians have been relegated to line-worker status. They function as relatively powerless and easily replaceable widgets in a profit-driven system that is evolving to provide efficient care at the lowest cost to maximize financial return.
In some places medicine has been dumbed down to the point that the doctor just needs to perform their assigned task. Shift work. This is reflected in Medical School acceptance criteria that no longer prioritize predictors of academic performance such as standardized testing. The knowledge and judgement that physicians once held in their heads is being replaced by AI, practice patterns, and non-physician providers. Diagnosis and treatment are relegated to algorithm. The patient's perception of their encounter and of their provider is often more important than tangible health benefit. Why? Because if the patient doesn't complain, management is free to demand higher productivity and insist that doctors smile through gritted teeth. Fortunately, the pendulum always swings.
In our own field we have seen fellowship oversight outsourced to AUPO. In effect, training has been transferred from a preceptor-centered model to a department-centered model. This reflects the underlying migration of physician practices from solo to group to corporate/institutional. While this is contrary to the autonomy of our specialty, the younger generation faces a different future and seems willing to offload the administrative burden of fellowships to prioritize other unspecified goals.
The next generation of physicians will look at medicine as a less daunting occupation. They will gravitate towards definable hours and life-work balance. Medicine will become more of a nine-to-five job and less of a career. Many will favor institutional and organizational prestige over personal merit and will be required to demonstrate group allegiance rather than exceptional performance. Allegiance will shift from the patient and the profession to the employer. This is an intended and socially managed outcome designed to maximize shareholder wealth.
For sure, earlier times required a different level of commitment, a different mindset. Nowadays a career choice in Medicine is less influenced by family interests. Many young doctors aspire to executive or corporate leadership positions. Direct patient care to them is menial. Despite all of this, I would never discourage a career in medicine. It is a broad enough field that one can still carve a rewarding and challenging personal path while providing excellent personalized care. Old school for sure. But how is this not the highest calling for those who wish to better the lives of others? We are fortunate to have practiced through the best of times. BACK TO Newsletter
Do you know who Bernice Z. Brown was? Well, let me tell you about this woman who left a lasting mark on the field of ophthalmic plastic and reconstructive surgery. Born in Altoona, PA, she headed west and never looked back. After a BA from UCLA, she went across town to USC for her MD and stayed on as the first woman accepted into ophthalmology residency at USC/Doheny Eye Institute. She pursued oculoplastics training with two of the founders of the field: Crowell Beard at UCSF and Alston Callahan in Birmingham, Alabama.
Many in our ASOPRS community are familiar with her accomplishments – Inductee of Phi Beta Kappa and Alpha Omega Alpha societies, Lester T. Jones Anatomy Award recipient, co-editor of Ophthalmic Plastic and Reconstructive Surgery, and President of ASOPRS in 1990. She was a Clinical Professor of Ophthalmology at USC and was actively teaching the next generation of oculofacial surgeons until her death in 2004.
ASOPRS JOURNEY IN THE WORLD OF ADVOCACY:
MY QUEST
Commentary by Stuart R.Seiff
Dr. Schaefer is married to Marlene Ann Schaefer, and they have three daughters, Dawn Marie, Jamie Lea, and Alyce Daniela. They enjoy flying single-engine airplanes and motorcycles, scuba diving, snorkeling, traveling, sports, and music.
JAMIE LEA SCHAEFER, M.D.
Crowell Beard, MD |
Crowell Beard is renowned as one of the three major founders of Oculoplastic Surgery. His career accomplishments include helping found ASOPRS, developing Oculoplastics as a specialty, authoring the first definitive textbook on ptosis, training many of the second generation of Oculoplastics preceptors, and developing the eponymously named Cutler-Beard staged bridge flap. Beard was one of three sons of J. Edgar Beard and Mabel Crowell Beard. The Beards were an early pioneer family in the Napa Valley and co-owners of the Thompson, Beard & Sons mercantile store in Napa. Crowell was born in Napa, California, on May 23, 1912. He attended the local schools in Napa for his early education and, as a member of a musically talented family, learned to play the violin. Following his father’s pathway, he attended the University of California at Berkeley, initially studying Chinese, economics, and statistics before changing his major to pre-medicine. At UC-Berkeley Crowell transitioned from playing violin to playing the banjo on a weekly half-hour radio show in Berkeley. |
For the Love of the Game... |
SASOPRS: I understand that you’re a big baseball fan. When did your interest in baseball begin? Richard: My interest in baseball began when I was about seven years old. My first baseball game I attended was in 1963 at the old Polo Grounds. The Mets were playing the Cardinals that day, and, of course, lost. I began collecting baseball cards. In those days, we would put the cards in the spokes of our bicycles, use them to "color", trade, etc. I remember attending about 20-25 NY Met games a year at Shea Stadium with my father who was a Deputy Chief Inspector in the NYPD. My father commanded half the precincts in Brooklyn. We would go on "rounds" after the game and officers in the precinct stood up and saluted him when he entered. We would then go to either Peter Luger Steak House or Crisci's restaurant for dinner. I remember car rides with my dad. We would talk about current events and other topics and really "bond." |
For the Love of the Game... |
SASOPRS: I understand that you’re a big baseball fan. When did your interest in baseball begin? Richard: My interest in baseball began when I was about seven years old. My first baseball game I attended was in 1963 at the old Polo Grounds. The Mets were playing the Cardinals that day, and, of course, lost. I began collecting baseball cards. In those days, we would put the cards in the spokes of our bicycles, use them to "color", trade, etc. I remember attending about 20-25 NY Met games a year at Shea Stadium with my father who was a Deputy Chief Inspector in the NYPD. My father commanded half the precincts in Brooklyn. We would go on "rounds" after the game and officers in the precinct stood up and saluted him when he entered. We would then go to either Peter Luger Steak House or Crisci's restaurant for dinner. I remember car rides with my dad. We would talk about current events and other topics and really "bond." |
Byron Capleese Smith was a renowned pioneer in Oculoplastic Surgery. Born in Tonganoxie, Kansas, in August of 1908, he received his B.A. and M.D. from the University of Kansas in 1931. Early in his career, he trained in psychiatry at Topeka State Hospital from 1931-34. Knowing his personality, I suspect that he quickly realized psychiatry was not his calling. Byron continued on to New Haven Hospital, completing a residency in general surgery in 1938. Finally, he completed a two-year residency in ophthalmology at The New York Eye and Ear Infirmary in 1940. |
SASOPRS: John, I understand that you and your family have faced a major medical challenge. Can you tell us a little about your story?
John: Sure. I was in my mid-40s with two young kids when I was diagnosed with advanced stomach cancer. Despite aggressive surgery and postop chemo, I developed liver metastases. I failed additional conventional chemo, RF ablation, Phase 2 and 1 clinical trials, and partial hepatectomy prior to responding to last-ditch experimental therapy. I’ve fortunately remained stable for the past 11 years. While, like many cancer patients, I have ongoing medical issues and concerns about recurrent or secondary malignancy, I’m profoundly grateful to be here.
SASOPRS: That’s remarkable. I heard that you and your wife recently published a book about your story. What motivated you to write about your experiences?
John: When I was diagnosed, and especially when my metastatic disease was progressing relentlessly, we wished that there was a step-by-step reference to help guide us. In addition, over the years we’ve shared advice with a soberingly large number of family members and friends (including dear ASOPRS colleagues) who have faced their own challenges with cancer. Several folks asked if we would consider sharing our lessons learned during this process.
Albie Hornblass
|
I had the privilege of knowing Marv Quickert as a mentor and co-director of my ASOPRS fellowship at the University of California, San Francisco (UCSF), as well as a friend and extraordinary human being. He tremendously influenced my life, and I am sure he did all those fortunate enough to know him. Marv was President-Elect of ASOPRS in 1974 when his life ended unexpectedly while scuba diving at the age of 45. His death, after only thirteen years of practice, was a true loss to his family, friends, ASOPRS, and oculoplastics. One of the brightest minds in oculoplastics and a perfectionist, he constantly sought a better understanding of orbital anatomy and eyelid function, thus improving operative techniques and outcomes. The field of oculoplastic surgery has progressed significantly in the last fifty-plus years since his death. Still, man of his ideas were the basis for a better understanding of anatomy and function. Surgical procedures and techniques, especially with lacrimal and eyelid problems, are still influenced today by his understanding and development of knowledge. One can only imagine what additional contributions he would have made to oculoplastics had he lived a longer life. |
The Friday Jerry Popham, MD winner was Benyam Kinde, MD, PhD for his “DNA Damage Checkpoint Kinases and Traumatic Optic Neuropathy” presentation. To be selected for the Bart Frueh Award from a cohort of outstanding projects is a humbling experience. The groundbreaking research presented at the Fall 2023 meeting is inspiring, and I feel deeply honored to be a part of ASOPRS and to be selected for this award. This award underscores the shared commitment to advancing our understanding of complex conditions, such as traumatic optic neuropathy, and seeking innovative solutions to improve patient outcomes. |
ASOPRS Foundation 2023 Michael Hawes Lecture - Patrick Bryne, MD ASOPRS Foundation 2023 Michael J. Hawes lecture was presented by Patrick Bryne, MD, entitled Advances in Facial Reanimation 2023. Dr. Patrick Byrne is a Facial Plastic and Reconstructive Surgeon and the Enterprise Chief of the Cleveland Clinic Surgical Specialties Institute, encompassing Cleveland Clinic’s surgical specialties worldwide. He also serves as the Chairman of Cleveland Clinic’s Head & Neck Institute, which comprises the specialties of Otolaryngology-Head and Neck Surgery, Oral and Maxillofacial Surgery and Dentistry, Audiology, and Speech and Language Sciences. |
|
Senior American Society of Ophthalmic Plastic and Reconstructive Surgery (SASOPRS) is two years old. It was started of a concern for the needs of ASOPRS members who have contributed much over the years to ASOPRS but who are sometimes forgotten as they age or feel they don’t fit in with the active clinicians. “Senior” admittedly is a loaded word. While the dictionary says a senior is one who is “more experienced,” some may equate senior to “senile,” “retired,” or “old and out of touch.” But those of us who are more experienced beg to differ. We still have something to offer! |