Carol Scott-Conner

"There's a Niche for Every Nuthatch"
 
When I speak with medical students about choice of specialty, I often invoke an ecological analogy. A healthy forest has myriad ecologic niches. The great horned owl and the nuthatch happily coexist because each is adapted to its own niche and stays in that niche. The nuthatch doesn't try to swoop down and grab a mouse in its talons, nor does the great horned owl try to creep up or down a tree trunk. They are good at what they do, and they don't try to wander outside the part of the microenvironment for which nature has created them. Medicine is like that. There are many specialties, and the trick is to find the one that fits you.

 

Here are some of the questions I ask them. Do you enjoy spending time with patients? Not everyone does. Most people who go into medicine think they will like direct patient care, with the attendant demands upon time, emotional energy, and empathy. Some find that it is more than they bargained for. If you like direct patient care, then Family Medicine, Internal Medicine, OB/GYN, Pediatrics, General Surgery, Psychiatry and various subspecialties such as Oncology are great choices. If you don't like direct patient care, there's no shame to admit it. Don't let yourself get boxed into one of those specialties. We need pathologists, radiologists, and medical researchers too.

 

Are you the kind of person who likes to know something about everything, or the kind who wants to know everything possible about a narrowly focused field? If you are curious and interested in everything, then become a generalist (such as General Surgery, to take an example from my area of medicine). If you yearn for complete mastery of your field, go into a subspecialty (such as Endocrine Surgery).

 

Do you want an academic career (such as mine) or one in private practice? Academics nowadays requires specialization. Private practice in heavily populated areas does too.

 

Where do you (and your family if you have one) want to live? If you want to return to a rural part of the state, you need to think strategically about what specialties are needed in that area. Even a small rural hospital needs a good pathologist, but it needs a general surgeon more than it needs a surgical oncologist.

 

There used to be a half-humorous algorithm that we shared with medical students. If I find it, I'll post a link. If memory serves me correctly, it had things like: Do you like to work in the dark (Radiology) or not in the dark (anything else). If you went down the entire algorithm it matched you pretty accurately with a specialty.

 

Oh yeah, I should add, I try not to call the med students "nuthatches" – unless you are a bird-watcher, that might be taken the wrong way…
 
 

 

 

When I joined the faculty of Marshall University as an Assistant Professor, fresh out of residency, I was assigned my first committee. It was the so-called "Human Experimentation Committee" – a precursor of today's Institutional Review Board (IRB). As my career unfolded, committee participation became a large part of my responsibilities. Some of these committees, such as the "Human Experimentation Committee," provided a service function for the institution (the review and oversight of clinical trials) and a learning opportunity for me. Others provided true leadership opportunities. 

 

As a young surgeon, you should expect to participate in some committees. Sure, they take time, but they give you experience and visibility. If you are not at the table, someone else will be – why shouldn't it be you?

 

Service-oriented committees such as the IRB, the Medical Records Committee, Blood Bank Committee, and

so on, provide an easy way to get involved early and to get a window into how the institution operates. Over the long run, they tend to require more time commitment than they are worth, possibly because very little influence is wielded by an individual committee member.

 

More powerful institutional committees, such as the Surgical Services or Medical Executive committees, give members more visibility and a voice in how things are done. Committee members can actually influence institutional policies, even if only on a small scale. Membership in these leadership committees may be limited to Department Chairs, but some committees include a few seats for elected members. Check the bylaws.

 

Some institutional committees, such as the Admissions Committee (for a College of Medicine) require a significant input of time. Carefully consider whether it is worth it.

 

At the national level, committee involvement is a great way to gain visibility within an organization. Look at the roster of committees and study the bylaws to see how committees appoint members. Many organizations have a call for nominations (including self-nominations) annually. There are always committees that everybody wants to be part of (for example, the membership or program committees) and others that are less popular (for example, the bylaws committee). Unless you have already established an extraordinary reputation for yourself, be prepared to start with a less-popular committee and work your way up. There is frequently an Executive Committee or Council, which wields the most power. Membership is comprised of chairs of various committees and the organization's leadership. Sometimes a couple of at-large seats are reserved for the general membership.

 

Here are some factors to consider as you evaluate various committee opportunities:

1. Do I have special expertise or interest in this area?
2. Can I learn from this committee appointment?
3. Will it contribute to my own professional growth?
4. Will I be a strong contributor to the committee?

 

As for me, I'm still an IRB member, and I'm still on committees for several national organizations.

When I retired from the regular faculty of the University of Iowa, I became a member of the Emeritus Faculty. That much is clear. What is not totally clear is whether I am now a Professor Emeritus, a Professor Emerita, or even – it's been suggested – a Professora Emerita. 

 

It turns out, it's up to me.

 

I first considered this question a couple of months before retirement, when my department put through the necessary paperwork in support of my new position. Once granted, I would become a Professor Emeritus. If I wanted to use the title Professor Emerita, there was another application process – a minor hassle, but if I did the paperwork, the University would so list me.  

 

The most immediate problem was what to put on my new business cards. After years in male-dominated fields of first engineering and then surgery, the female adjective was very appealing. Then, too, a close friend, also a surgeon, had chosen Professor Emerita. Inertia won out and I took the easy route, remaining (by default) a Professor Emeritus. Reversing the order, Emeritus Professor, seems to give it more gravitas and I must admit that I sometimes sign e-mails this way when communicating with similarly pompous individuals at other institutions – particularly those in the medical Ivy League.

 

The question surfaced again from an unexpected quarter. The University of Iowa has an Emeritus association, and I had agreed to give an Emeritus Lecture. The organizer sent me a mock-up of the poster he planned to electronically circulate and asked what title I wanted to use. He introduced a third possibility, Professora Emerita, explaining that some women used that form.

 

English took root from Latin and German, among other influences. Well, I studied Latin for three years in high school, and taught myself enough German to get through my PhD, so maybe I could figure this all out. From Latin, I grasped the difference between Emerita and Emeritus. From German, I (barely) grasped the principle that some languages assign to every noun a gender which may or may not make sense to the uninitiated. Das Madchen (the young woman) is the example frequently cited for German. To quote Mark Twain, "In German, a young lady has no sex, while a turnip has. Think what overwrought reverence that shows for the turnip, and what callous disrespect for the girl."

 

Unable to resolve the issue from personal knowledge, I went to the source of all knowledge – the Internet and ultimately the Wikipaedia – with my specific concerns about Professor Emeritus. It turns out that the two key concepts to consider are inflection and concord. Inflection occurs when a noun is modified (in this case reflecting the gender of the object to which it refers). Thus, chicken is a generic term which is inflected for gender as hen and cock. Human being, woman, man. But…professor, professor, professor. Professor is not inflected for gender in English.

 

Concord means that the modifier should agree with the noun. So, if professor were inflected, say into Professora and Professorus, then Emerita and Emeritus would be completely appropriate. But English just uses Professor. Professor is not inflected; thus Emeritus is considered appropriate for both men and women. Thus both men and women may correctly use the title Professor Emeritus. That would seem to settle it.

 

But should a woman consider it appropriate? For years, I've been "one of the guys" at work. Was it time to reassert my difference? 

 

I considered the lowly crossword puzzle, that mirror of current culture. It seems like for the past ten years, maybe longer, the correct answer for a woman who appears in the movies is "actor," rather than "actress," the term in common usage during my childhood. Similarly, a woman who writes poetry is a "poet," not a "poetess." A woman who is voted into a position of city leadership is a "mayor," not a "mayoress." Social norms seem to be avoiding modifiers. The gender-inflected forms of these nouns are dying out of popular usage, much like riding side-saddle in long skirts has.

 

So, I asked myself - does reverting to a gender-specific modifier help the cause of women in surgery by emphasizing my difference? Or does it diminish me (and by extension other women) by emphasizing that difference? Beats me.

 

In the end, I stuck with Professor Emeritus. It was just easier. Besides, I earned it.

In 2019, I went back to graduate school for the third time since attaining my MD degree. I began work on a graduate certificate in Narrative Healthcare, and have continued in the Lenoir-Rhyne MFA program. Narrative Healthcare is a more clinician-inclusive name for Narrative Medicine.

 

So, as many people have asked me, "What is Narrative Medicine?"

 

I think of Narrative Medicine in two ways. First of all, if you think of the Medical Humanities as complementary to Scientific Medicine, then Narrative Medicine is that subset of the Medical Humanities that deals with the written word. Our medical school has a Humanities Distinction Track, and over the years most students who complete that track have produced written-word creations. A few have done visual arts or interpretive dance. I suspect that, as physicians, we have spent so much time reading and writing that this particular mode of expression comes most naturally to us.

 

Narrative Medicine is more than that, however. It encompasses a variety of techniques that can be used to build empathy, combat burnout, and build listening skills. It is being widely disseminated through US medical schools. I am particularly interested in extending this into the residency environment. For this, I felt that I needed additional training. 

 

There are two graduate level programs in Narrative Medicine. One is based at Columbia, in New York City, where the discipline originated. The second one is in Asheville, North Carolina, at the Thomas Wolfe Center for Creative Writing at Lenoir-Rhyne University. I enrolled in the Lenoir-Rhyne program because it uses distance learning, and it fits my schedule. Classes are mostly in the evenings, and are held via Zoom. It's an immersive environment, with a small group of students and a charismatic knowledgable instructor.

 

I just completed my first semester and am into the summer term. In addition to providing the formal knowledge base that I need in Narrative Medicine, the coursework is also improving my creative writing. Currently, I'm working on a third short story collection. After that, probably a memoir of my personal experience with breast cancer. 

 

It's invigorating to be back in school! If you are considering devoting your career to surgical education, in addition to obtaining a degree in medical education you might want to consider a certificate-level program in Narrative Medicine such as the one at Lenoir-Rhyne. I'm here to tell you that it is both do-able and potentially highly valuable.

I feel compelled to write about e-mail. At a recent surgical meeting I concluded a two-hour breakfast meeting with a more junior colleague with the words, “You need to start answering your e-mails!” It started me thinking about the topic, and I want to give you some thoughts about e-mail. For academic physicians, e-mail  Read More 

Certain times of year are abstract-deadline-time. A resident or fellow does a super job of analyzing data and drafting an abstract. With fear and trembling, that person sends it out to the group. If the group is doing its job, “track changes” and comments proliferate. It’s easy to come of out this feeling  Read More 

One of our trainees recently asked me for advice finding that first job. She had been combing the Internet for job postings in her area of expertise, and was finding very little that interested her. She had definite preferences as to geographic region, and that additional constraint was, of course, further limiting her options.  Read More 

In the course of my academic career, I made three moves. The first move was from New York University, where I did my residency, to Marshall University in Huntington WV, where I was appointed Assistant Professor. That one almost doesn’t count, because many people leave their residency site for their first job. The  Read More 

Meeting and exchanging ideas with surgeons from other institutions – networking – is one of the major pleasures of academic medicine. Young surgeons sometimes find it hard to know how to get started. Committee activity (see previous post from 11/4/2014) is one sure-fire way. Another important activity is discussing papers at national meetings.

At most meetings, a  Read More 

A recent discussion on one of the American College of Surgeons “communities” brought this topic to mind. I, myself, am in my last year of phased retirement and will be fully retired from clinical practice in less than a year. I thought I would pass some thoughts along to you.

IF YOU ARE A  Read More