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Join Carmen Fong, a colorectal surgeon, as she shares her journey through the world of medicine. Carmen’s experiences highlight the challenges women face in academic medicine, from gender disparities to work-life balance. We delve into her decision to transition to private practice, explore the impact of the pandemic on her career, and discuss the broader issues of gender equity within the medical field.

Carmen Fong is a colorectal surgeon.

She discusses the KevinMD article, “I am one of those women who left academic medicine.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Carmen Fong. She is a colorectal surgeon. Her KevinMD article is titled “I am one of those women who left academic medicine.” Carmen, welcome to the show.

Carmen Fong: Thank you for having me. I’m so excited to be here.

Kevin Pho: All right, let’s start by briefly sharing your story and journey to where you are today.

Carmen Fong: I always give the 30-second spiel. I was born in Hong Kong. My parents are immigrants; we immigrated to Canada when I was five, and then we moved back to Hong Kong for high school, and then I came back here to the U.S. by myself for college and medical school. So I’ve actually been here over half my life now. I decided pretty early on that I was eventually going to go to medical school, so I went to medical school in Michigan and became a surgeon, and that’s where I’m at.

Kevin Pho: Perfect. And you’re a colorectal surgeon, so tell us about some typical cases you would see, and a typical day in your life.

Carmen Fong: When I was in New York City, I actually did a lot of robotic surgery, for both benign and malignant diseases, abdominal and pelvic cases. Right now I’m primarily doing a lot of anorectal pathology, which I love. It’s a lot of office-based patients and office-based procedures. I find that everybody has a lot of anorectal issues they hate to discuss, but once they come see me and find somebody who’s rather open and maybe has a sense of humor about it, they’re a lot more at ease.

Kevin Pho: All right, so let’s talk about your KevinMD article. It’s titled “I am one of those women who left academic medicine.” So tell us, how did your article come together?

Carmen Fong: I was a young attending in New York City right after COVID, and a lot of it came about because there were a lot of pressures. As we all know, COVID magnified all of the disparities among health care workers and in our profession. I was expected to take COVID call in addition to maintaining my practice, and that was difficult to begin with. I felt a little bit of a lack of respect from colleagues and administration, so I’d be on call even when I wasn’t on call, under the guise of building my practice.

As time went on, I looked around and realized that a lot of my male counterparts possibly had more resources than I did. Sometimes institutions give the optics of workplace equality by saying, “Well, everybody has the same starting salary. You’re all paid the same.” But in reality, women have a lot fewer resources, and not for lack of asking. They sometimes have to justify a lot more for the same resources, and then they’re expected to meet the same productivity benchmarks as their male counterparts with fewer resources. So it led me almost to an awakening, and then I felt that I had to write this.

Kevin Pho: So you mentioned that women physicians often get fewer resources. Give us an example of what that would look like.

Carmen Fong: This is across all fields, but in surgery in particular, there’s a lack of OR block time, or having the worst OR time, like Friday afternoons, when everybody wants to be home for the weekend, but that’s the time they want you to operate. In the office, for example, it’s having to justify pieces of machinery or devices, like getting a new colonoscope or a flexible sigmoidoscope, and even office staff: having an adequate number of receptionists and MAs. Whereas your male counterpart might have two or three MAs and a PA, I had one MA, and I ran around to three or four offices.

Kevin Pho: And did you bring this up to the administration? And if you did, what was their response?

Carmen Fong: It’s always a valid question. Absolutely, I did, and generally the answer was, “Well, you’re a young surgeon. You have to meet such-and-such a benchmark to justify more resources, more staff and more equipment.” And then it becomes this vicious cycle: You don’t have the resources to reach that benchmark, but you can’t get the resources unless you reach the benchmark.

Kevin Pho: Right. Now, they were giving your youth as an excuse for not giving you the resources. From your observations, what about young male physicians? Did they also lack resources?

Carmen Fong: That’s also a fair question. I would say yes and no. There were some who had the same complaints, but the ones I saw, even ones who joined the practice after me, did not have the same problem. They had more office hours, better OR block time and a few more staff, actually.

Kevin Pho: And did you feel this was a conscious decision made by the administration, or was it more implicit? Tell us what you think some of the motivations were that led to this scenario.

Carmen Fong: I actually think it’s not conscious. I think it’s systemic, almost like an innate bias: “Well, she’s super friendly and super nice,” in my specific scenario, “so maybe she’s not going to ask for much, she’s not going to need that much, and she’ll still work really hard for us.” Whereas sometimes the squeaky wheel gets the oil, and I wasn’t the squeaky wheel in that case.

Kevin Pho: And did you talk to some of your fellow women surgeons? Did they experience similar stories?

Carmen Fong: Yes, absolutely. Actually, one of the questions you sent me was what was really surprising about this article. I had such an overwhelming response after writing it. People reached out to me through my social media, my Instagram, my website and LinkedIn to share their stories. A lot of physicians told me they were going through the same thing or similar scenarios, and had either left their practice or were still struggling through it. Just the number of responses, my heart went out to them, and it really made me think that something needs to change.

Kevin Pho: Now, are these issues unique to academic medicine, or are they also pervasive in private practice?

Carmen Fong: I think they’re pervasive in private practice. I actually think they’re pervasive throughout all fields, not just medicine; it might just be that sometimes it’s a little more pronounced in medicine. I’m sure you know this, but just this morning there was a Wall Street Journal article about how female surgeons have better long-term outcomes than their male counterparts. That kind of thing helps, but there still has to be a systemic attitude and cultural shift.

Kevin Pho: So tell us the next part of your story. You were experiencing this lack of resources. What happened next?

Carmen Fong: I struggled through the lack of resources and still did my best. I still did very, very well, I would say, productivity-wise, and I tried to take the best care of my patients I could. In general, I always told myself, “Remember why you’re doing this,” which is a message I would have for most people: We’re in this to take care of people, not to make money. That brought me through. But eventually, it did come to a tipping point. We had an opportunity to move out of state, and it was actually a good time for me as well, since I was also pregnant and had recently experienced a miscarriage, and I just really felt it was a good time to take a break. It was perfect timing. I ended up taking about six months off from clinical work and wrote a book called Constipation Nation, which comes out next year. Now I spend half my time in private practice and half my time writing.

Kevin Pho: And how are the resources afforded to you currently?

Carmen Fong: Really good. I do think that in private practice we have a little more autonomy and a little more control over what’s going on. There are only a couple of us in this practice, so if it’s, “Well, I need these sutures,” or “I need this instrument,” we can get it. At least I know directly who’s above me, the administrator who’s ordering these things, and I can tell her why I need them, rather than going through an entire system meeting justifying why you need another scope or another robot.

Kevin Pho: So tell us about the transition from academic medicine to private practice, because a lot of physicians, of course, are in that academic environment during training. Was it a difficult transition? Tell us about that.

Carmen Fong: Honestly, I don’t think so. When I was in medical school, we used to say that the pendulum was swinging from private to institutionalized medicine, and it feels like people are going the other way again, just because we’re trying to get out from under a lot of this institutionalized administrative stuff. For me, it was an easy transition because, how do I say this, there wasn’t anything holding me back.

Kevin Pho: Now, for other women physicians and surgeons who are going through stories similar to the one you describe, what can they do? What advice and tips can you share with them?

Carmen Fong: I wouldn’t necessarily say, “Leave immediately.” That’s not my advice, and actually I think most people need to stay and want to stay. I’d say two things. One is, like I said, remember why you’re doing this: We’re in this to help people, in whatever capacity needs to be done. The second thing is that I think the shift needs to come from rewarding those of us who are in private practice, and acknowledging that private practice can be academic as well. I know a lot of private practice surgeons and physicians who are involved in teaching, research and different advocacy efforts. So it’s not mutually exclusive; it’s not either-or. You can be both. Rewarding and acknowledging those positions, I think, will make a huge difference. And if you think about it, the majority of people actually aren’t in academics. There are a ton of community physicians out there who just want to do their thing and take care of patients, but also be up to date on the research and the evidence.

Kevin Pho: You mentioned earlier that the squeaky wheel may get more resources. What are some ways physicians can speak up when they see a disparity in resources against them?

Carmen Fong: That’s such a tough one. I always think, “Oh, yeah, if you see something, say something,” and that’s always what we’re taught. But it’s hard to speak up, because you’re afraid of the implications and any kind of backlash. One approach, I think, is that if you can’t speak up for yourself, maybe you can speak up for someone else, and people find that easier. If you see something happening, you can say, “Hey, that doesn’t sound right. Why is she on eight different committees and in committee meetings all day, unable to do her clinical office practice?” Because that’s nonpromotable work, and it’s not rewarded financially. Things like that. So speak up, and if you can’t speak up for yourself, speak up for others.

Kevin Pho: We’re talking to Carmen Fong. She’s a colorectal surgeon. Her KevinMD article is titled “I am one of those women who left academic medicine.” Carmen, tell us some of the take-home messages that you want to leave with the KevinMD audience.

Carmen Fong: I think the main thing is that you really need to assess your own priorities. At this point in my life, I had a baby, and I thought, “You know what? I don’t need to be killing myself over my career, necessarily.” I love my job, I love what I do and I love taking care of patients, but I do need to find that kind of balance. If that’s true for you, listening out there, then I think you can do it too. Everybody can do it. And the second thing, of course, is that constipation is about prevention. I have to tell you that.

Kevin Pho: Carmen, thank you so much for sharing your story and time, and thanks again for coming on the show.