August 2002 Bulletin

Profiles in diversity Women and minorities can and do thrive in orthopaedics Real-life success stories

By Carolyn Rogers

"Diversification and qualifications can and should be successful partners."

That belief—stated by AAOS President Vernon T. Tolo, MD, in his inaugural speech at the 69th Annual Meeting in Dallas this past February—underscores the Academy’s conviction that diversity in orthopaedics is a worthy and attainable goal.

"It is important to our patients, as well as to the world of orthopaedics, to find the way and the means to insist that qualified women and minorities become an integral part of the Academy and of orthopaedics," he added.

Troubled by the scarcity of women and minority medical students choosing orthopaedics as a career, Dr. Tolo called for leadership among academic members, more role models for women students, and greater visibility in early years so that both women and minorities receive an understanding and appreciation of orthopaedics as a career.

To meet these challenges and to advance the goal of a truly diverse orthopaedic community, the Academy’s Diversity Committee has developed a number of programs that address cultural and ethnic disparities in health care, recruiting women and minorities into orthopaedics, including musculoskeletal education in medical school curricula, and other issues relating to diversity.

The AAOS, along with the Ruth Jackson Orthopaedic Society, is expanding its mentoring program targeting minority medical students interested in orthopaedics, and a new AAOS "Diversity Award" has just been announced (see pg. 54).

As Dr. Tolo noted, just 7.2 percent of current orthopaedic surgery residents are women, despite the fact that women now comprise nearly 50 percent of the medical school graduating classes in the United States.

The breakdown for minority residents in orthopaedics isn’t much more encouraging: 11 percent Asian Americans; 5 percent African Americans; 3 percent Hispanic Americans; and 1 percent Native Americans, according to statistics for the year 2000 from American Association of Medical Colleges.

Although the percentages can be disheartening, real-life "success stories" involving women and minorities thriving in orthopaedics are plentiful. Such stories can serve not only to inspire young medical students and residents, but also to encourage potential mentors and supporters of diversity Academy-wide.

Four members of the AAOS Diversity Committee—Fernando A. Ravessoud, MD; Clarence L. Shields, MD; Claudia L. Thomas, MD; and Michele M. Zembo, MD—agreed to look back 20-plus years to share their experiences as young women and minorities just breaking into orthopaedics. These remarkably positive "Profiles in Diversity" tell of successes, struggles, challenges faced with humor and grace, and mentors who made a difference. All four doctors share a love of orthopaedics and a sincere desire to see more women and minorities serve the profession and share in its rewards.

Profile in Diversity: Claudia L. Thomas, MD Excellence, "revolutionary spirit" drives first African-American woman orthopaedist

A background in sculpting and painting—and a belief instilled by her parents that she could do anything—prompted Claudia L. Thomas, MD, to set her sights on a career in surgery.

"I figured surgery would give me an opportunity to use my manual skills as well as my intellect," she says.

But a rotation in general surgery during medical school nearly brought an end to that dream. "The general surgeons didn’t seem to be happy, they didn’t like what they were doing," she recalls.

Not surprisingly, this made her question her career goals.

Then she met an orthopaedic surgeon.

"His attitude was totally different," she recalls. "He seemed pleased with his choice of profession." When given the chance to do an orthopaedic rotation in her third year of medical school, she grabbed it.

"Orthopaedic surgery was fascinating to me," she says. "I seemed to have a natural ability for it and I picked up the language very easily."

The orthopaedic surgeons she met—all white males—were consistently pleasant, loved what they did and were eager to share their knowledge because she was interested in learning. Two orthopaedic residents in particular—Kenneth A. Krackow, MD, and Andrew F. Brooker, MD— encouraged her as a medical student.

"I just fell more and more in love with orthopaedics," she said. But her main concern was "where are the women?"

At the time Dr. Thomas was ready to apply for a residency—1975—there were only 25 women practicing orthopaedics in the country. She spoke to her chief resident about her concerns, and he said, "There’s no reason you can’t do this."

That was the only thing she needed to hear.

Dr. Thomas applied to a number of orthopaedic residency programs, none of which had ever had a woman resident. She chose Yale.

"I made the right choice," she says. "Being a woman was enough of a stigma, but as a black woman, I was an enigma. The program at Yale was a ‘kinder, gentler’ one, and it had a diversity I didn’t see in other programs."

At Yale she saw African-American faculty, African-American residents in the orthopaedics program and female residents in general surgery.

Another factor was Yale’s chief of orthopaedics, Wayne Southwick, MD.

"Dr. Southwick was a very warm person and he clearly wanted to have me on board," she says. "He was like a father figure, just as concerned about our well-being, our welfare and our families as he was about academics."

Augustus A. White, III, MD, chair of the AAOS Diversity Committee, also was on the faculty at Yale at the time Dr. Thomas interviewed.

"He ended up becoming a mentor and was responsible for my getting a couple papers published during my residency," she says.

Although she describes her residency experience as relatively benign, "there was the challenge of being unique and therefore being watched like a hawk," she says. "People expected you to stumble at some point. So I had to be always vigilant and prove myself through my excellence."

She handled the rough times by speaking up, and once walked out of a surgery when the surgeon was disrespectful and rude. She told him she refused to work under such conditions.

"My experience with racism, being an African-American in America, helped me handle the sexism and racism inherent in medicine," she says. "I was a trained soldier in the struggle and I had a revolutionary spirit. I’m not easily intimidated."

Dr. Thomas displayed some of that revolutionary spirit when she first arrived at Yale. "When I got to the New Haven V.A., I was assigned a cubbyhole in the nurses’ locker room that would barely hold a pair of shoes," she recalls. "There was literally no place to put my clothes! I asked where I was supposed to keep my shoes and the head nurse gestured toward a nearby broken shower stall, saying, ‘You can use that.’ Meanwhile, the doctors had this palatial spread."

So she found a postcard and drew the female symbol on it.

"I stuck that sign on the doctors’ locker room door, barged in and claimed a locker," she recalls with a laugh. "I continued to do that until they gave me a decent locker in the nurses’ room."

The low number of minorities and women in orthopaedics greatly concerns Dr. Thomas. "The numbers remain pitifully low," she says. "Women are still discouraged from the specialty, and African Americans are dropping out of American society in general. They’ve dropped out of society in huge numbers that are not yet appreciated. So we don’t have the pipeline feeding into the specialty, the numbers just aren’t there."

Now an assistant professor at Johns Hopkins Medical School Department of Orthopaedics, Dr. Thomas regularly counsels young medical students of all backgrounds and specialty interests.

"If they’re curious about orthopaedics, I tell them it’s a wonderful career, a wonderful specialty that helps people improve their quality of life," she says. "It is more demanding than other specialties on your time and your physical energies. For those women who are counting on family and marriage, it could be a little more challenging, but certainly not impossible. It’s definitely not a field that women should shy away from."

Dr. Thomas advises medical students who want to pursue an orthopaedic residency to spend some time in the specialty by doing a sub-internship, preferably at a location where they have an interest in training.

"Research is very helpful these days, too," she adds. "It’s important to have your name on some papers. The specialty has become very competitive."

Dr. Thomas has mentored more medical students—women in particular—than she can count. One of her mentoring "success stories" is the first African-American woman to do a residency at Johns Hopkins.

"She approached me when she was a medical student at Harvard University," Dr. Thomas recalls. "She ended up doing her residency here at Hopkins during a year when no white males matched in the program; it was a very diverse class. She stayed on for a spine fellowship, and is now in private practice in California."

Dr. Thomas takes her role as a mentor to women and minorities seriously.

"I always wanted to make sure that although I was the first African-American woman in orthopaedic surgery, that I would not be the last. I never wanted to be the one and only."

Profile in Diversity: Fernando A. Ravessoud, MD Hispanic orthopaedist finds ethnicity a help not a hindrance "You would do well in orthopaedics."

Fernando A. Ravessoud, MD, recalls that comment—spoken 25 years ago by an orthopaedic attending surgeon—as the catalyst that eventually led to his current 20-plus year career as an orthopaedic surgeon.

That attending surgeon—Edgar G. Dawson, MD, now a professor of surgery/ orthopaedics at UCLA—continued to encourage and guide Dr. Ravessoud, advising him early on to take a couple of his externships at hospitals that had an orthopaedics program.

"I remind him periodically it was his fault!" Dr. Ravessoud jokes.

Thanks to Dr. Dawson’s advice, Dr. Ravessoud spent part of his senior year of medical school at a one-month externship in orthopaedics at Ben Taub Hospital in Houston, and another at a Minneapolis hospital.

"Those experiences were very enjoyable and cemented my desire to pursue an orthopaedic residency," Dr. Ravessoud recalls.

After a two-year general surgery internship at UCLA, he applied and was accepted into the San Francisco Orthopaedic Residency Training Program.

As a Hispanic, Dr. Ravessoud says he felt very little bias or any issue pertaining to ethnicity throughout his residency.

"I was fortunate that there was another Hispanic in the program with me, and there had been one previously," he says. "The program only took three residents a year, so we felt we were ‘hand-plucked.’ The funny thing was the director of the program often referred to both of us by the name of the previous Hispanic resident. We used to joke that we got into the program because he thought we were all the same person."

Being Hispanic and speaking Spanish was actually a bonus at times.

"San Francisco is culturally very diverse, so we had an occasional Hispanic patient," he recalls. "It was convenient that we spoke Spanish and could work with those patients."

The program itself was great, according to Dr. Ravessoud, because there were many more attending surgeons than residents. "So we were in huge demand and sought after. And in terms of fairness, we were all disciplined equally, we all had to do the same work."

The only lack of diversity he noticed throughout his training was a lack of women. "I don’t think it was until my senior year in training that the first woman came into the program," he says.

Dr. Ravessoud is now part of a successful orthopaedic group practice in Long Beach, Calif., where he’s been for nearly 20 years. His fluency in Spanish continues to serve him and his patients well.

"I do a lot of workers’ compensation in my practice, and our office has a lot of Hispanic employees," he says. "My Spanish comes in very handy."

Dr. Ravessoud says he’s been very fortunate to have a big support group in the Long Beach community. "I’m always surprised by the number of people who say I took care of their neighbor or friend," he says.

It’s clear that Dr. Ravessoud truly enjoys his profession and he says he would strongly encourage any minority or women students who might be considering a career in orthopaedics.

"I’d tell them that orthopaedics is a great field with academic features that’s still growing, so there’s ample opportunity," he says. "It spans the greatest age range—from newborns to our senior population—and you can practice in either a niche field or you can have a very nice general practice. There’s a huge volume of patients who require treatment for orthopaedic needs."

"Diversity-wise", Dr. Ravessoud says the field still could be better.

"We would welcome a woman associate in our practice," he says, and admits the group has actively tried to recruit a woman surgeon.

"We’ve come close, but it has yet to work out," he says. "But we’ve just recruited an orthopaedic surgeon, Derek Dee, MD, who is of Chinese descent. We’re looking forward to his joining us—he’ll be a real asset to our community."

Dr. Ravessoud is already an asset to his community—both as an orthopaedic surgeon and as a volunteer police officer with the Long Beach Police Department (LBPD). He’s been with the department for nearly seven years.

"If an officer needs the day off, I’ll work his shift," he says. "I usually work two night shifts a week—2 p.m. to midnight—so it doesn’t interfere with my practice. Last year I logged 1,075 hours with the department."

He got into this unusual "sideline" after hearing that a local orthopaedic surgeon had put together a "doc squad" at the LBPD.

After first attending the basic academy for reserve officer training, Dr. Ravessoud enjoyed police work so much that in 1998 he went back and attended the full 10-month Academy. This is the same training regular police officers receive, which gives him full police powers.

"They call me ‘doc’ out there," he laughs. "I take calls like everyone else. I use my Spanish regularly and I like working substance abuse in particular."

Domestic violence calls are also common, Ravessoud says, and he’s taken calls at his patients’ homes. "Unfortunately, I did have to arrest the husband of one of my patients once. But overall, it’s been great," he says. "Currently I’m trying to get trained to work the harbor control."

Dr. Ravessoud’s enthusiasm for police work must be contagious. His nurse-practitioner wife is now a reserve police officer too.

Profile in Diversity: Michele M. Zembo, MD "Team" mind-set, supportive mentors ease the way for woman orthopaedist

Michele M. Zembo, MD, felt little bias as a woman resident during her orthopaedic residency days in the early 1980s. Her visibility as a woman, however, presented its own challenges.

Dr. Zembo was in the middle of her residency at the University of Michigan when she and her best friend in the program, Jack B. Perlmutter, MD, decided to visit New Orleans for a weekend.

"We always had Saturday rounds, so we arranged to have our shifts covered, " she recalls. "When we returned on Monday, nobody had missed Jack, but I got called in and chewed out. . . As a woman if you weren’t there, they always knew it!"

In general though, Dr. Zembo feels fortunate that her experience as a woman in orthopaedics has been a relatively smooth one. Men have said to her, "You seem to fit in more so than a lot of other women, why do you think that is?"

"In many ways I’ve attributed that to the fact that I played team sports, and I learned to think in that manner," she explains. "Unless you’ve been involved in sports, you may not be used to winning and losing and the idea that even if you lose you’re still friends. Team sports in particular give you some of that perspective."

Dr. Zembo gained much of that team mind-set through her participation in high school and college basketball. Her love of sports—and her experience as the first woman athletic trainer at Renssalaer Polytechnic Institute in 1974—led to her seek a career in orthopaedic surgery.

Those aspirations were nourished by Robert B. Greer, III, MD, a professor at the Pennsylvania State University College of Medicine.

"Dr. Greer was always very encouraging and positive," she says. "For my fourth year rotation in medical school, he sent me to spend time with a woman orthopaedist he’d trained with when he was a resident in Pittsburgh," she says. "He wanted me to see this was something I could do."

Later it was Robert N. Hensinger, MD, at the University of Michigan who took on the role of mentor. "It was because of Dr. Hensinger—his influence—that I went into pediatric orthopaedics rather than sports medicine," she says.

Dr. Zembo feels fortunate that out of 30 orthopedic residents in her program, at one time six were women. "It really helped that I wasn’t in the residency situation by myself," she says. "There were a number of women in other surgical specialties, as well, so we had a support group. Sure, things happened, but by and large the residency was fair and I got equal training".

In responding to the challenges that did arise, Dr. Zembo says, "You have to pick your battles." But she always made sure to stand up for herself with the other residents.

"There was always a rivalry between orthopaedics and general surgery, so it was more likely for the general surgeons to try to take advantage in some way," she recalls. "I learned to stand up for myself, so it wasn’t a big issue."

In one instance, being a woman actually worked in her favor, she recalls.

"It’s funny," she says. "When I was president of the residents’ union another woman resident and I went to ask the department chair if we could go to the AMA meeting in Hawaii."

The department chair never allowed people to attend meetings in resort areas, so they were a little apprehensive.

"As it turned out, though, he was afraid we wanted to talk about sexual harassment in the sports medicine service," she says. "He was so relieved that we just wanted to go to a meeting in Hawaii, he asked ‘Is that all?’ and let us go!"

Dr. Zembo, now an associate professor of orthopaedics at Louisiana State University Medical Center in New Orleans, attributes the dearth of minorities and women in orthopaedics to a lack of exposure to the specialty. By the time they think of orthopaedics, she says, it’s often too late to do the extra things in medical school that are required.

"We’re celebrating 30 years of Title IX, though, so maybe as more and more women are exposed to orthopaedics through sports, the numbers will go up," she says.

Another problem, however, is a lack of role models.

To illustrate her point, she refers to a recent study published in the February 2002 issue of The American Journal of Surgery.

"The study shows a direct association between women medical students’ choice of surgery as a career and a higher proportion of women on the surgical faculty,’" she says. "That tells you a lot right there."

There are still those subtle ‘glass ceiling’ limits, Dr. Zembo admits. "You’re not ‘one of the guys’ all the time. An opportunity comes up and sometimes your colleagues assume that you wouldn’t be interested or be the best candidate. They immediately think of a guy."

Dr. Zembo says she’s fortunate to have felt "very supported" in the places she’s been in medicine, but she knows other women who have not had the same experience.

"So we still have to keep pushing," she says. "We’ve made lots of progress but there’s still a little more to go."

Profile in Diversity: Clarence L. Shields Jr., MD African-American orthopaedist credits vision, hard work, good timing for success

Sports are analogous to life, as Clarence L. Shields Jr., MD, former team physician to the Los Angeles Rams, sees it.

"As an athlete, you have to stay focused on what you’re trying to accomplish," Dr. Shields says. "You have to put on your ‘game face’ and be very serious."

You also have to be prepared.

"These athletes don’t just show up for the games," he says. "They practice, and they study a lot of films. Then they try to produce their best effort when it’s important to do so."

The same is true of orthopaedic surgeons.

"You have to be focused about the field of medicine, put your ‘game face’ on in the operating room and be very serious about taking care of your patients," he says.

Orthopaedists prepare for their own version of "game day"—the time spent treating patients—with years of training and study.

Dr. Shields has learned a great deal through his involvement with collegiate and professional athletes, he says, a line of work he fell into by chance.

"I was an intern at UCLA, and the team physician asked me to join him to cover some of the UCLA games," he recalls. "That did it!"

The internship solidified Dr. Shields’ interest in sports medicine, but the Vietnam War intervened and he was soon drafted. Dr. Shields was serving in the military when he decided to apply for an orthopaedic residency.

The UCLA team physician, Martin E. Blazina, MD, again played a role in guiding Dr. Shields.

"Dr. Blazina was very instrumental at this time because I was planning to go back to UCLA for my residency," Dr. Shields says. "But he encouraged me to go to USC, so I did. It was there that I met Dr. Frank Jobe and Dr. Robert Kerlan, with whom I later became a partner. And I got more involved with athletics at USC. So it was the right choice."

Dr. Shields joined the same orthopaedic group as Dr. Blazina—the Kerlan-Jobe Orthopaedic Clinic in Los Angeles—where Dr. Blazina (now deceased) served as his "ongoing mentor."

Dr. Shields, an African American, doesn’t recall his race presenting any special challenges during his residency.

"I didn’t run into many problems then because my residency was at a large county hospital," he says. "Race was not a major issue."

One race-related issue Dr. Shields encountered occurred during his early days as the team physician for the L.A. Rams.

"It was challenging because the trainers would never identify me to the athletes," he says, "so it usually was assumed that I was not the doctor."

Although he found that experience frustrating, the athletes eventually came to know him as the physician, and he greatly enjoyed his time with the team.

Dr. Shields credits "good timing" for his becoming the Ram’s physician.

"A lot of things in life have to do with timing," he says. "When I joined the group, we simultaneously became the team physicians for the Rams. The others in the group already had teams, so I was the only one available. It helped that I had a very strong interest in football."

Dr. Shields says he’s been fortunate to learn "a great deal" from the athletes he treats.

"You have to listen to the patient," he says. "That’s the biggest thing I’ve learned from treating athletes. You have to listen to know what it is the athletes do, how hard that is and how important it is that they return to the sport."

Dr. Shields, 2001–2002 president of the American Orthopaedic Sports Medicine Society, makes a point of sharing his enthusiasm for orthopaedics by serving as a role model and mentor for minority students and residents.

At his invitation, a number of minority residents—primarily from the orthopaedic training program at the Charles R. Drew College of Medicine in L.A.—have come to his office and spent three months working alongside him.

"I’ve actually convinced two or three of them to go into sports medicine," he’s pleased to report.

Dr. Shields advises minority and women students to believe in themselves. "You need to have the vision that you’re going to be successful," he says.

One of the reasons there are so few minorities and women in orthopaedics is a lack of exposure, according to Dr. Shields. "Because of the focus on primary care, orthopaedists are not able to have interaction with the medical students. Unless the students get to know an orthopaedist as a person or as a patient, there is no contact," he points out.

Once that hurdle has been overcome, Dr. Shields says, "The chairman of the residency program has to realize that diversity in the program is beneficial because American society is diverse."

This is a multi-level task, he says. "The key thing is that everyone in orthopaedics can make a difference in achieving the goal of diversity. But you have to want to do that and be willing to become a stakeholder in diversity—not just agree that it’s a good idea."