Hail to the Chief: Dr. Carla Pugh

This article is part of a series of interviews with Stanford Surgery faculty who were, are, or will be presidents of surgical societies. Carla Pugh, MD, PhD, is a Professor in the Division of General Surgery and Director of the TECI Center. She was elected President of the Society of Black Academic Surgeons for the 2021-22 term in April.

Rachel Baker: SBAS is the first society we're talking about in this series that isn't based around surgical specialty or region. How is it similar and different?

Carla Pugh: All the specialties are represented in terms of the surgeons that are members of SBAS, and it’s a national group but our annual meeting is still small because it’s for a very focused group. It has two metrics that cut the numbers down significantly: “academic” and “Black.” Most Black surgeons are in private practice or may be in an academic medical center, but their work may be mostly clinical; they may not be surgeon scientists.

SBAS is an amazing organization in what it does and the way that works. I‘ve been a part of it since I was a medical student, so more than 25 years. When I was a medical student and looking for a mentor, I knew that it was a place to be groomed as a surgeon scientist. It’s like signing up for academic surgery bootcamp. It was: “More feedback, please. More feedback, please. Thank you. Thank you!”

The reality is that there weren’t that many Black medical students at that time. SBAS was a chance to meet other people, who had similar dreams and goals and shared experiences. I have friends who I never went to med school or residency with, but I’ve known for years because of SBAS.

RB: You are currently President-elect. How did that process work? Were you nominated? elected?

CP: It’s a nomination process of your own colleagues, who see the work that you’re doing in committees and executive roles. Usually the person who becomes president-elect has been treasurer or secretary or chair of the program committee, and that’s because those positions require a lot of work, and you have a lot of visibility. It’s an opportunity for people to see your commitment and work ethic. It's much the same at lower levels of the organization. 

I started out on the education committee, and then I became secretary. I think I was driven by being goal-oriented and having a high level of confidence that I could achieve those goals. I found that I enjoy collaborating and building a community of people who have an interest in a specific goal, and I learned to modify my personal goals to a similar but different goal that related more to the collective. Once you have that type of success, then other people invite you on their quests to achieve their goals.

If you’re only doing it for the title, then the outcomes you achieve will show it. If you’re doing it because you believe in your heart-of-hearts that you can guide this organization to a destination that is for the benefit of all then you will succeed.

RB: How is the SBAS responding to the death of George Floyd and subsequent resurgence of the BLM movement?

CP: Like everyone else, we put out a statement. But we tried to make it clear that our white coats have never protected us. We’ve lived a double life all of our careers: a white coat has some symbolism in the hospital, but, when we don’t wear our coats, we are targets for racial profiling and misconceptions.

We just did a podcast with Behind the Knife and—just sort of while brainstorming ahead of time‑all of us had the realization that there are two reactions here to deal with: first, the emotions of these events and hurdles that we’ve had to overcome as academic surgeons. The other one is to get together and come up with a plan of action. And you can’t do both at the same time, just because of headspace.

We made it very clear before we did that podcast that you aren’t going to hear painful stories. We focused on how to empower the chairs of surgery to partner with their faculty, staff, researchers, residents to move forward with an agenda and invite people, like how we’ve done in our department, from across campus and from the outside to help lay a foundation, a point of departure in terms of conversation. Realizing that the majority of chairs of surgery are not African American and many of them feel that they have no credibility, we tried to make it very clear to them that everyone is going to make mistakes; you have to make a safe place to plan how to move forward.

There was a lot of great response to the episode, but there’s a lot more work to be done. So, we’re planning a second podcast that is joining hands with The Society of Asian Academic Surgeons. There’s a visual phenotype for Asian Americans just like there is for Black Americans. Our brains quickly cluster and build expectations based on what we see before anyone says anything and that’s why Asian Americans, not just those from China, are facing injustice in this time of COVID. It just shows that when we move fast, people are not thoughtful about their actions.

How do you continue to strive to be the best you can be in this environment? How do you walk around with the fear of expectation that you’re supposed to guide the process? Residents and medical students are taking on a whole new role while they’re supposed to be learning about diseases; now you’re expected to be a leader in racial justice too. It has to be overwhelming—for everybody. How do you protect your family from a virus and how do you move forward as your country goes through this transition?

RB: How has the global pandemic changed operations at SBAS?

CP: Similar to all the other societies, we had to make the hard decision to have an extremely shortened virtual meeting this past April. We were due to have our meeting in Wisconsin (my third home).

We also have our annual executive retreat coming up. That’s the President’s time to get the troops together and set the platform in motion, but that will have to be virtual as well. It makes it really tough. It’s not a real retreat.

RB: How has being a woman affected your career as a surgeon?

CP: You know if you asked me that 10 years ago, I would have had a different answer. Lots of big societies have a separate “women in surgery” event. Seeing the numbers grow tremendously over the past decade, I think was really inspiring. There is light at the end of the tunnel.

Something that I learned in one of the classes I took at [Stanford’s Graduate School of Business] is that globally, until women reach a critical mass in an industry, you will always be working harder to fit into the rules. Because these organizations lacked that diversity at their inception, women are constantly trying to fit in. And it’s extra work.

You hear the stories and you start to see patterns. One that I noticed is that there are a set of things that you can do within academia that traditionally fit on your CV and are counted as awardable effort. Female academics—broadly, not just surgery—had to learn how to put a number of things on our CVs that weren’t the norm. Some of those are education and innovation; 20 years ago, those things were not rewarded. You can either be frustrated by it or find a mentor that can help you find a way around it and win. I was very purposeful in pushing my mentors to help me figure out ways to put things on my CV.

RB: Did it have any impact on your decision to become a leader?

CP: For years I was terrified; I didn’t want to be on public record failing my mentees or colleagues. What am I going to look like on the podium? I initially saw myself as someone who could get something across the finish line. In the back of my mind, I knew that someday there would be a platform for someone like me—an innovator, a collaborator. When I started to see those models, then it became clear that I would succeed in that role, and I didn’t have to fear not meeting expectations. Now, the hardest expectations to meet are my own.

I will be the third female president out of 20 or 30 before me. We haven’t reached a critical mass in SBAS yet, but, for all the members of the Under-Represented in Medicine community, in this new era of cultural competency and racial justice and equality, there’s lots of opportunity.

RB: What advice do you have for other women and people of color (POC) who are getting into surgery?

CP: There’s an external part where you have to be a great detective, a great listener and observer and when you come up with a theory, you have to have a group of friends to test it on. You should spend your career building that inner circle of people who will help guide you and support you. I think women are more self-critical, and that makes it more difficult. Find a group of friends to tell you how ridiculous you are when you say bad things about yourself. Actually, that advice isn’t only for women.

Maybe it’s tough love to say it, but it’s your responsibility to build your brand and have a mission statement that is clear enough that other people understand what you stand for and can help you meet your goals.

Follow your dream and fight hard for it. Reflect. Take a look at how it makes you feel. If it doesn’t make you excited, then you won’t be able to give 120%.