The Women Before Me

1. Can you tell me about your career journey?

I come from Peru, and in a country with such poverty, the whole issue of prevention and public health was key. I went to the Harvard School of Public Health first before I studied medicine, so my perspective became a mix of public health, nutrition, disaster response, and physiology. Trauma reactions and their sequelae, especially in children with their developing brain physiology, has been the center of my work for the last 70 years. If you’d like to see some of my work and the educational materials I have written, I have collected it onto my website in English and Spanish [raquelcohendisaster.com].

2. How has your identity shaped your career or been an asset for you?

Being a woman, I do think I was drawn to the care of children. Now, I have three wonderful children of my own. Seeing families so affected when disasters happened, when children are seriously, chronically ill, that really impacted me, and it became my life’s work. [Coming from Peru], I also worked with Hispanic people for all my career, in terms of their healthcare and on various committees for representation in the United States. In every job I had, at every level—federally, nationally, locally—I have always, always included a component of work with Hispanic people. Whether that was in terms of committees, volunteering, or programs, because of my cultural background and my capacity for speaking Spanish, I took every opportunity wherever I could to get myself involved. They always needed people. A key reason I’m living in Miami is actually because the University of Miami received a million-dollar contract to support the new Cuban refugees [in 1980]—this was when thousands of children from Cuba were placed on boats to come to the United States. So, when they found me and discovered my work, they asked me to help... and then I stayed here. That’s just one example of how I’ve tried to advocate for Hispanic people throughout my life.

3. What challenges in your training and career have you faced related to your identity?

As a woman, there were indeed some limitations in how your work was perceived. For instance, I was an Associate Professor at Harvard at the time, and there were two committees in charge of naming full professors who were all men... I was fiery and said “look”—I raised my voice about why men with a similar amount of research and similar number of publications as me in my field had received tenure while I had not. Being a woman in front of committees of men, I did raise my voice about it. [Dr. Cohen ultimately left Harvard and was hired to tenured professorship at the University of Miami Medical School in 1982.]

4. How has the landscape for female physicians changed over the course of your career?

Oh, I think now that’s changed tremendously! Now, women have so many more leadership opportunities than before. I was in Harvard Medical School’s first coeducational class. [Newspaper headlines from the 1940’s crooned, “Señorita from Peru Studies at Harvard to Become M.D.: Plans to Bring Medical Care to Poor Indian Children of Her Land” and “Stork Waits as Wife Wins Harvard Degree.”] We were just twelve [women]; we filled one line of seats in the amphitheater. I had no female teachers; I had no female role models to look up to. Now, I cannot even imagine what it would be like to have 50 or 60 women in a class, how that would look in the amphitheater! You also have female teachers now, which is wonderful.

5. What words of wisdom would you pass on to medical trainees, especially women?

At this time in my life, I have had a lot of time to reflect and look back. I am so grateful. I would tell you to realize that to be a doctor is a wonderful profession. I am at the end of my career and end of my life now; looking back, being a doctor is one of the most satisfying careers you could have...it gives so much meaning to one’s life. Being a female doctor has enriched my life, it has made me a better mother and wife, it has made me more aware of so many issues that I would not have been otherwise. I am very thankful for my career and have fond memories of my years at Harvard. The Harvard label is a fantastic one to open doors in your career, nationally in Washington, D.C. and internationally as well.

1. Can you tell me about your career journey?

My parents didn’t go to college, but they prioritized education for us; they wanted us to have a good life through education. I actually didn’t know a single doctor growing up, but I was always very interested in science and helping people...I had come from a public high school with an average reading level of 8^th grade though, and I wasn’t academically prepared for Stanford. I really struggled academically, actually, the first year. That first year, I decided to become a human biology major but not to go to medical school, because I didn’t think I could. I didn’t think that was still an option for me. But by the time I graduated, I realized, as I had known since middle school, I did really want to go to medical school, and I loved science and medicine and biology. I’m a non-traditional doctor in that regard; my journey took a little longer, an extra four years where I had to work full-time and take premed requirement classes at night half-time. And I love to tell other students of color about my journey and to continue to inspire them to believe in their dreams. I was very grateful to be accepted at Harvard, and while at Harvard, I confirmed my wanting to help people and help the most vulnerable people. That’s why primary care internal medicine is what I do now. I was very sure that’s what I wanted to do.

2. How has your identity shaped your career or been an asset for you?

I think my identity has shaped my career entirely! Knowing what it’s like to be from a working class, ethnic neighborhood where people don’t always have the access to the best resources that they need and want, wanting to really help people in those situations—that’s been my whole career. Being a primary care doctor, for me, meant that I could take care of the widest breadth of people. I’m only working at UCSF now because we take Medicare and Medi-Cal patients. Getting my MPH was also because I care about communities and not just people.

I should say, my family did not teach me Spanish growing up. I’m first-generation; my father immigrated from Mexico; my mother is Mexican American. Like so many first-generation families, they taught me English only, so I could do well in school. I started taking Spanish and medical Spanish classes, and even though it was embarrassing at first, I realized people can be so grateful when you try to speak their language. I’m bilingual now, and maybe 25% of my patients are monolingual Spanish-speaking patients. I had to build that skill back in my life. But really, use interpreters, use whatever broken language skills you have, take classes to bring it back. It’s such a good thing.

For 15 years, I was on a grant to take care of African-American and Latino elders in San Francisco. We did a lot of research on what they needed and finding better ways to promote care in their communities. My identity as a woman who is proud of her community informed the research that I did. The other thing I’ve always, always tried to do is social justice. At HMS, I helped to start something called Service Day, so students could share what political advocacy and service work they were doing. I helped to start a Social Justice Committee at my division last December, and now we’re running a food bank in our clinic. So, my career has always included service and social justice activism at every level, and that’s definitely been influenced by my identity and where I’m from, wanting to help the people who need the most support.

3. What challenges in your training and career have you faced related to your identity?

So, this is very—I don’t know if it’s interesting, controversial, or common—but for me, being a primary hands-on mom was more important to me than my job. In the Latino culture, the mom really is the heart of the family. Of course, there is no such thing as one type of family, but in that traditional way, my mother was that for us. I worked part-time from the time my daughter was born until her first year of high school, about fifteen years of part-time work. As a Latina mamá, I consider being a wife and mother my number one job, and keeping that as a value has been challenging both financially and career-wise—even though it was my choice, and I would make it again. The balance of trying to be a primary caretaker and trying to do the work I want to do, that’s always been tough for me, not speaking for all women or all Latinas. Unlike many women, I feel I have found a supportive home, at UCSF. Luckily, I haven’t had the challenges of feeling like as a woman, I’m not being taken seriously. I feel very, very grateful for that.

4. How has the landscape for female physicians changed over the course of your career? What changes would you still wish to see?

Personal and professional balance is a little more of an acceptable lifestyle philosophy here. I don’t know if that’s a geographic thing, or if that has changed [over time]. I certainly feel like, for a number of women and men, the balance of making your family a priority seems like it has gotten better.

I still think the challenges though are the same though (laughs) forever and ever. Women in the top leadership roles--it’s still difficult for women to be the president or CEO of a major hospital or institution. I don’t know that there are as many female researchers who are PIs, as there are men. I don’t know that there are as many, you know, female department chairs. Reaching the very top leadership positions is still very, very difficult. I would love to see that changed.

Both as a woman and a woman of color, I do think that overt acts of racist and sexist behaviors have really diminished. Overt ones. However, microaggressions continue, and people can still have the same racist and sexist ideals and ideas. So, what I would like to see is for people to continue to understand that women, people of different sexual orientations, people of color, people of different religious backgrounds all can work in the same area. I would like women and people of color to feel even more supported in their areas of work. In the everyday workplace, women at every level should feel truly supported, and not made to feel othered, which can still happen in a more subtle way than before.

5. What words of wisdom would you pass on to medical trainees, especially women?

My number one advice is to put yourself as the first priority of your life. Always. Always! Not just, “When I’m an attending, I’ll have more time.” Always. Even now as a medical student! I’ve seen it happen to so many women--our family members and our patients are so important that we forget to put ourselves on the list. It’s a long career, and burnout is a real thing, so to avoid burnout and cynicism, to avoid health issues and toxic relationships and all of those things that we don’t want for our patients, we have to take care of ourselves first. Before you say yes to a project, before you say yes to a favor, find out if you’ve gone to the gym or taken care of yourself. You have to be your number one, in order to give what you have to give to the world.

Number two would be to find great mentors at every level. Both for personal and professional journeys, you really do need good mentors who look out for you, who know the ropes, who know what you’re about and care for you. That is something really important, at every level. The third piece of advice would be to do what is right for you, not what is expected or advised. No matter what that is. Go for it. Don’t let people tell you not to.

1. Can you tell me about your career journey?

I would say my career journey has been unexpected and totally enjoyable. At Harvard Medical School, I met a wonderful faculty member, a woman ophthalmologist named Mathea Allansmith with five kids and a full lab. I thought, this is a great career path, if she can manage a clinical practice, a lab, and a family! So, from a practical standpoint, and because I liked the surgery and the culture, I thought ophthalmology was a great choice for me. I did residency back home in New Orleans, then came back to Boston to do a fellowship in glaucoma, because there were so many unanswered questions from a research perspective, and because [glaucoma] is the leading cause of blindness in vulnerable communities.

I did my first academic job as an assistant professor at the University of Illinois. My department chair, Dr. Goldberg, had also been at HMS, and he was one of the most inclusive leaders I had come across. I had a great launch with him, starting with basic science research as well as clinical experience. I was recruited later to the University of Michigan, where I became an associate professor and Assistant Dean of Faculty Affairs...when the opportunity arose to consider a department chair position at the University of Maryland, I jumped at the chance.

My career continued to grow; I was involved with multi-center clinical trials, I was writing and editing books, I was still writing papers, I was doing small studies as well, industry-related drug studies, and public health screening studies... there was a lot of activity! At this time, I was in my mid-50s, and I recognized I had an opportunity to make a greater impact by becoming a dean. I was hired by David Satcher, a former Surgeon General and director of the CDC, to become Dean of Morehouse School of Medicine. Following that, I was recruited to be the Senior Vice President for Health Sciences at Howard University, an opportunity to have a hospital report to me, and to expand beyond medicine to pharmacy and dentistry. Nationally, my career was expanding at the same time. I started being part of advisory committees, joining the Harvard Board of Overseers and the MIT Corporation. I was on the governance boards of two great institutions at the same time! I don’t know how many people have had that experience!

So, it has been a great journey. I am now on another board for Ascension, which is the second largest faith-based healthcare system in the country. This gives me an opportunity to create more of an impact in terms of treating vulnerable communities. I’m also the Vice Dean of Inclusion and Diversity at the University of Pennsylvania, which allows me to be at a research-intensive institution and create some impact in a very important space. 

2. How has your identity shaped your career or been an asset for you?

Being a woman of color really allows you to connect with segments of our population who are vulnerable and really need a voice. Instead of having to study or do other things to prove oneself, when I walk into a room, I’m immediately a part of that community. I’m immediately a part of it. So, it does give me a bridge to contribute to solutions and discussions. It’s hard to know what’s the chicken or the egg, because I’m sure my core values are shaped from my experiences [Dr. Higginbotham integrated her New Orleans elementary school and grew up during the civil rights era], but social justice is very important to me. Integrity, authenticity, compassion, all those things are important to me. And I think those things are important in particular to vulnerable populations. That certainly has been a plus.

3. What challenges in your training and career have you faced related to your identity?

Obviously, being in a minority group can be challenging. But my personality is such that, if I’m challenged, that just makes me want to try harder. That’s the way I was formed.

[Becoming department chair] was a daunting thing to do, because at the time, there were no women who were chairs of university-based departments of ophthalmology. And so, it did worry me that my research would not get the attention it needed, and that was exactly what happened. I ended up giving up my basic science research, but continued to do clinical research, be department chair, see patients... But it could be as little as someone repeating what you just said in a meeting, and everyone else nodding their heads. That happened to me today! I was like, “I just said that!” So that sort of thing still happens. Why is that? It’s hard for women to compete at these highest levels. I’ve had those experiences. Statements have been made. When I was younger, it was harder to address them in the moment. As I get older, I tend to say something right away. I’d like to think we’re still chipping away at these cultural barriers.

4. How has the landscape for female physicians changed over the course of your career? What changes would you still wish to see?

The landscape has changed generally for the positive, but we haven’t changed as much as I think we could have. On the positive side, we have a critical mass! More than half of matriculants to medical schools nowadays are women, so that’s great. You can walk into a room and you don’t have to, you know, count the number of women on one hand. But we still have a paucity of women at the highest leadership positions. Given where we started, we should be further along. I think 16% of deans are women; we should be at least at 35-40% given how many women have gone through. We’ve been fighting this for a very long time. For women, we still have challenges in rising to the highest leadership positions; there’s still bias that exists at levels of promotion. There’s a high turnover of women who are assistant professors at the lower levels of academia; so many women have left at that stage before becoming full professors. Culturally, I think we can benefit from women leaders, so that we can have more policies that are family-friendly for instance, so there’s more support for those who are caregivers, so that the whole culture of this profession can rise.

5. What words of wisdom would you pass on to medical trainees, especially women?

Follow your passions, and be self-aware. By that I mean, know your strengths and weaknesses. Don’t let anyone denigrate your strengths; you own that. And for anything you might perceive as a weakness, there’s a course for everything! You can do some self-reflection and really think, “What do I need to do to address this?”

Second, seek out mentors and sponsors. The mentors are easy because we’re used to that term, we know what mentors do, but the sponsors, they’re the ones in the highest leadership positions who are willing to expend some of their political capital on your behalf. They may say, “You’re ready for this major presentation at this research meeting. You can do this.” And they’ll call up their friend who’s organizing the meeting, and say, “Dr. Chen is going to deliver this lecture on this topic. She’s a great person; I know you’ll enjoy hearing her.” “Okay, Bob, that’s good, we were looking for someone!” That’s the opportunity. Develop a mosaic of mentors and sponsors, and seek out opportunities.

1. Can you tell me about your career journey?

I was born and raised in mainland China, right before the Japanese invaded China in 1937. My older two sisters and myself all got sick during the eight-year war. They got sick and died. I survived. Obviously, my parents knew they needed a doctor in the house. Even when I was young, I knew I had to be a doctor.

I went to the National Taiwanese University, then I had the opportunity to come to America and apply to college again and then medical school. I was washing petri dishes and glassware for a professor of Microbiology to earn money; he actually wanted to make me his PhD candidate, but I said I wanted to do medicine as well as research. He told me that the only school at the time that taught both was Harvard. So, I applied here, and Harvard told me they would look at my qualifications first. Finances were secondary. [Dr. Lee ultimately received significant financial aid to support her medical education.]
            At the end of third year, I happened to see a baby born with-- do you know the condition “gastroschisis”? -- well yes, he had gastroschisis. I even wrote my first paper on that. The family was upset but the surgeon said we could fix it, very simply, with a few stitches. I was so impressed; I decided to switch from the medicine track to surgery. This fit my personality—I got impatient when they would stand in the hallway and debate the differential diagnosis and what tests to order... I like to solve problems, and surgery can solve problems right away!

At that time, Boston never took any female surgical residents. I moved all across the country for my training and became a surgical oncologist at USC. During my sabbatical leave in Hawaii, I saw that they needed doctors to help train surgeons for their military hospital. You could say I saw that opportunity and took it; I liked it so much I stayed. In Hawaii, they also have the Aloha Medical Mission, and they needed specialists. The American College of Surgeons has a “Giving Back” global service group, too. There was an OB-GYN who was doing missions in his home country of Ghana; he found me when looking for a general surgeon to join them every year. I’ve now been on 8 trips to Ghana already! [Dr. Lee has now gone on over 50 medical missions total to established sites in Ghana, Honduras, Vietnam, the Philippines, and China.]

2. How has your identity shaped your career or been an asset for you?

I kept having miscarriages. It turns out I have a small, bicornuate uterus. Nature happens, and nature makes mistakes. I can explain to families now, this is not your fault, this is not your bad luck--this is nature, and nature makes mistakes. Because of my miscarriages though, my residency director at the time wanted me to only do research; he no longer wanted me involved in patient care. So, I had to move to another state to complete my residency and become a board-certified general surgeon. This was a blessing in disguise: I was able to rotate through a cancer center, and that became my fellowship emphasis. I received an NIH Post-Residency Clinical Fellowship, and I had a good chief on surgery to support me.

My body is unique; my brain is essential to me but has nothing to do with my gender or race. Benefits or not, you have to have your confidence first. That’s very simple. When I was a resident at a training hospital, I had to park my car at a distance at the garage, and the parking attendant stopped me said, “Wait a minute, this parking space is only for doctors!” So, I said, “Oh, is there a special place for female doctors to park?” I showed him my ID, and we laughed.

3. What challenges in your training and career have you faced related to your identity?

Even though I had learned how to read English when I was in university at Taiwan, it was still very challenging to adjust. Thankfully, my grades in the sciences and chemistry made up for my lower grades in English class. By the time I was applying to residency, and I had done four years of medical school, I was able to show how much I improved.

When I was applying for residency, the director said very clearly: “I only have one spot left. Women get married and raise children. Would you pick a male or a female for that spot?” I said, “I cannot speak for other people, but I know I will continue working as a surgeon. Even if I marry or have children, I will continue.” Even now at my age, I continue working on medical missions! He did take me as his 12^th intern, though later I had to finish residency elsewhere. And we give our kids, my female colleagues and I joke, quality time, if not quantity time.

Otherwise, there have been three instances that come to mind. One, my boss at the time moved my office without talking to me when I came back from sabbatical. Two, he made a rule that we have to show him the manuscripts of our papers, and then he said to me, “Where’s my name on this paper?” even though these were accepted before he became chair. Three, and this was the worst, was I had a paper already accepted for publication... but they had a “boy’s club” you know, so afterwards the editor sent me a letter saying, “On second thought, we don’t have room to publish your paper.” I knew I had to leave. At the time, they said they needed academicians to train surgeons for the military where I was on sabbatical in Hawaii. I was placed on reserve, then activated as a Lieutenant Colonel. So sometimes, you have to make a hard choice and know what it is that you really want.

4. How has the landscape for female physicians changed over the course of your career? What changes would you still wish to see?

In our class, we started with 6 girls; 4 graduated and 2 dropped out. I switched to the surgical track, and my best friend Tenley Albright [an Olympic gold medalist ice skater] decided she also wanted to be a surgeon. Everyone said, “Uh oh, two girls want to be surgeons.” At the Peter Bent Brigham, they said “We have two female candidates. Why should we pick you?” Tenley ended up not matching to the Brigham either.

With the Equal Opportunity Act and Title IX, I don’t think anyone can openly discriminate anymore in terms of gender. Yes, you probably have had that experience, where the patient thinks you’re the nurse (laughs). And yes, we still have to do 110% compared to male’s 100%. But if you count that 10% every time, it distracts your focus, and it will make you miserable. We just have to keep doing the best we can. There are more women surgeons and female faculty now, so trainees are exposed to that from early on. There are graphs showing the percentage of women in surgery increases every year. It’s not just attitudes changing; it’s laws.

5. What words of wisdom would you pass on to medical trainees who are women?

            When I came to Hawaii, I started running marathons, and I also became a movie buff. When the theater goes dark all around you, your mind can go quiet, and you can just focus on the movie. You have to have a stress-reliever. You will work very hard, so you need a stress-reliever. Whether it’s going to the beach, or tai-chi, or sleep, you need to schedule time for relaxing as well as working. I have my grey hair now, so I can advise (laughs). Life is for living! You have to take care of yourself before taking care of others. Then, know what you want, and be all you can be!