The year 2023 may be remembered as the year of the woman in otolaryngology. There have already been a number of firsts, including the first female physician editor of ENTtoday, Robin Lindsay, MD; the first female president of the American Board of Otolaryngology–Head and Neck Surgery, Kathleen C.Y. Sie, MD; and the first female president of the Association of Academic Departments of Otolaryngology–Head & Neck Surgery (AADO), Cherie-Ann Nathan, MD.
Explore This IssueJanuary 2023
This shift to having more women assume leadership roles in otolaryngology has been a slow build. In 1973, the first annual meeting of the newly formed American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) was held in New Orleans, La. “Although women had been placed on the ballot previously to run for president, when they ran against a male candidate, they were unsuccessful,” said Kathleen Yaremchuk, MD, current president of the AAO-HNS.
In 2004, Jenifer Derebery, MD, was elected as the first female president of the AAO-HNS. Two qualified women were on the ballot that year. “Since that time Gayle Woodson, MD , Sujana Chandrasekhar, MD , Carol Bradford, MD , and I  have been elected to serve as president,” said Dr. Yaremchuk, chair of the department of otolaryngology–head and neck surgery at Henry Ford Health Systems in Detroit. “Over the last seven years, four women have been elected.”
Dr. Yaremchuk sees the establishment of the Women In Otolaryngology (WIO) section of AAO-HNS in 2011 as a turning point. “The WIO Section gave women in AAO-HNS an outlet for having their voices heard and advocating for gender-specific issues,” she said.
For Dr. Nathan, who is the Jack Pou Endowed Professor and chair of the department of otolaryngology–head and neck surgery at Louisiana State University Health–Shreveport, being elected president of AADO “is a significant honor and responsibility. It is definitely a major advance [for women] although there’s a long way to go in terms of gender equity. When I graduated in 1994, I was the first female otolaryngology resident at the University of California, San Diego. Hopefully, women in otolaryngology are on the way to a critical mass that will propel them forward.”
As an example, Dr. Nathan noted that, for a number of years, there were only four women chairs in U.S. otolaryngology. “However, in the last two to three years we have added seven more chairs—almost doubled—making a total of 11 chairs, or 9% of the 113 programs,” she said.
In addition to Drs. Woodson, Chandrasekhar, and Bradford, Gaelyn Garrett, MD, MMHC, became the first woman president of the Triological Society (TRIO). She served two terms from 2019 to 2021 during the height of the COVID-19 pandemic. “I know that each of these women has dialed the clock forward for the rest of us,” Dr. Nathan said.
Throughout her career, Dr. Garrett hasn’t looked at herself as a trailblazer. “When I look back at my residency [1989 to 1994], I was the only woman resident. I wasn’t the first, but during my entire tenure I was the only woman [in that position]. Clearly, that has changed,” said Dr. Garrett, who is the Guy M. Maness Chair of laryngology and voice in the department of otolaryngology– head and neck surgery at Vanderbilt University Medical Center in Nashville.
Dr. Garrett was first elected vice president of the Southern section of TRIO in 2012. “That was the first stepping stone to becoming president of TRIO and my foray into leadership [only section VPs can be elected president],” she said. The first woman vice president was actually Margaret Kenna, MD, MPH, who was elected the vice president of the Eastern section in 2007. “I was the third VP after Dr. Kenna and Margaretha L. Casselbrant, MD, PhD, who was also elected VP of the Eastern section.”
Dr. Garrett credits the women who came before her as the true trailblazers in otolaryngology. “They were the ones that faced the most obstacles getting through the [operating room] door,” she said.
Gender-Related Barriers Still Persist
Women in medicine face additional challenges and barriers due to gender bias and discrimination. Some of the specific challenges that female physicians often face include:
- Unequal pay and opportunities. Women are often paid less than their male counterparts, take roles that are perceived as less valued, and may have fewer opportunities for leadership positions and other forms of advancement. There is also often a reluctance to make waves or speak up about gender equity.
- Bias and discrimination. Like other women in male-dominated fields, female otolaryngologists may face bias and discrimination from colleagues and patients, which can make it difficult for them to succeed and advance in their careers.
- Social pressures. Women are still the main caretakers when it comes to family, whether that is childcare or eldercare.
Unfortunately, otolaryngology has one of the largest gender gaps in income, academic appointments, and chair positions, noted Dr. Yaremchuk. Although women have made tremendous gains in the field of otolaryngology, they have not reached parity at the academic level. Currently, 40% of residents in otolaryngology are women, but the number of women attaining full professorship is much lower: around 15%, and only 9% of department chair positions are held by women (Laryngoscope. 2020;130:1664-1669). “One important goal is that half of all full professors are women,” said Dr. Sie, who is director of the Childhood Communication Center at Seattle Children’s Hospital and professor in the department of otolaryngology at the University of Washington School of Medicine.
“The lack of women advancing in academia isn’t unique to otolaryngology, but it is a societal issue. Women are less likely to advance to leadership positions and continue to experience salary inequity for the positions they hold,” said Dr. Yaremchuk.
Gender-related barriers are multifactorial, agreed Dr. Nathan. However, “now that the issue has been brought to the forefront, we are making progress. I am honored to work with our male colleagues who are supportive and making a conscious effort to address the issue,” she said.
There’s no question that women have made gains in academia, said Dr. Garrett. For example, Dr. Bradford was appointed dean of The Ohio State University College of Medicine in Columbus in 2020. “I’m the only full professor in our department, however,” Dr. Garrett noted. “The irony is that I’m actually the chair of the Vanderbilt Promotions Committee for faculty affairs. I see how many women are coming through for all levels of promotion, and it’s close to 50/50 males to females. So, we have women in our department who are clearly going to move up the [leadership] ranks.”
“If you look at the number of women who are elected to the Triological Society, it actually mirrors that number. I think the Triological Society is doing a really good job of attracting diverse members, and women certainly are part of that diverse membership,” Dr. Garrett added.
Dr. Sie agrees that the landscape is changing for women in otolaryngology. The changes associated with gender equity will likely help all otolaryngologists. For example, it’s now more acceptable for men to take paternity leave when they have children.
The Appeal of Otolaryngology for Female Surgeons
When asked what drew her to otolaryngology, Dr. Yaremchuk answered, “When I was a medical student, the resident on the rotation was going into ophthalmology and suggested I look into otolaryngology. We both enjoyed surgery and I knew what rotations I didn’t enjoy. I’ve never had the opportunity to thank him for the advice and tell him how right he was.”
“My first interest in medicine was general surgery,” said Dr. Sie. “During my residency at the University of North Carolina, Amelia F. Drake, MD (the Newton D. Fischer Distinguished Professor of Otolaryngology at the University of North Carolina), took me aside and told me about otolaryngology. In 1990, I began my residency training in otolaryngology in Seattle. I fell in love with pediatric otolaryngology. Through my research in velopharyngeal insufficiency, I began to get some visibility regionally, and then nationally,” she said.
Dr. Nathan knew she wanted to be a cancer surgeon as a young teenager in India. “I was drawn to the field because 40% of malignancies in India are head and neck cancers and recurrence rates were so high,” she said. She applied for a scholarship to come to Johns Hopkins University in Baltimore. “I was extremely fortunate that I got to work with some of the great names in our specialty. The first thing I learned from watching these giants [Michael E. Johns II, MD; Douglas E. Mattox, MD; David W. Kennedy, MD; William J. Richtsmeier, MD] was that they worked hard—really hard. And they loved what they did.
“When I got to Johns Hopkins, I realized cancer recurrence rates were just as high in the U.S. as they were in India; it was the nature of the disease. I also realized the only way to improve survival rates in patients was to conduct research and maybe someday make a difference in our patients’ lives. This has been my passion and the driving force behind my love for research and surgery.”
“Medicine just kind of fit my personality,” said Dr. Garrett. “I knew I wanted to be a surgeon for the same reasons. I got to know all the otolaryngology people at Chapel Hill through Harold Pillsbury III, MD, my mentor and sponsor. The Chapel Hill physicians really seemed to love what they were doing, they were well-liked, and they seemed happy to be at work every day. And otolaryngology has been great because it encompasses surgery, primary care, and all patient ages and genders.
“I developed another mentor in Robert Ossoff, DMD, MD, chair of the department of otolaryngology at Vanderbilt Medical Center. Dr. Ossoff was one of the first true laryngologists in the country. He started a fellowship program and became my fellowship director in 1994,” she added.
Mentorship and sponsorship are important, “but, more importantly, institutions need to acknowledge the disparities and adopt policies and processes to improve the status quo,” said Dr. Yaremchuk. “Whether it’s a broken rung on the ladder, a sludgy pipeline, or a glass ceiling, things need to change to welcome women and promote them accordingly within our specialty.”
Nikki Kean is a freelance medical writer based in New Jersey.