Women in Medicine Month: A Conversation with Dr. Mary Hawn

In this special 'Women in Medicine Month' episode of Scrubcast, host Rachel Baker sits down with Dr. Mary Hawn, the Chair of Stanford University's Department of Surgery. Dr. Hawn discusses her multifaceted role overseeing research, education, and clinical care, while still practicing minimally invasive foregut surgery. She shares her journey from basic science research to becoming an acclaimed health services researcher, her thoughts on surgical training reforms, and the complexities of achieving work-life balance in medicine.

The episode also highlights her insights into supporting future surgeon-scientists and celebrates her accomplishments, including the dedication of the Wangensteen Scientific Forum to her at the upcoming American College of Surgeons Clinical Congress.

Rachel Baker: [00:00:00] Welcome to Scrubcast where we take a closer look at the research happening at Stanford University's Department of Surgery. I'm your host, Rachel Baker. This will be our episode for September, also known as Women in Medicine Month. And I thought to myself, who should we interview? Why not the woman in charge herself, Dr. Mary Hawn. Welcome to the show.

Dr. Mary Hawn: Thanks, Rachel. Thanks so much for having me and really thank you for everything you do to make our department shine out there in the universe.

Rachel Baker: Well, it is my pleasure and I love hosting the podcast because I get to ask all of my ridiculous questions to people like you. You are the chair of the Department of Surgery.

I've interviewed a few surgeons so far on the show now, but you are my first chair. So what does a chair do and what does that job title entail? All

Dr. Mary Hawn: right. So a chair is an interesting leadership role. I think it's one of the best leadership roles that we have in academic medicine because the chair is responsible [00:01:00] for all the missions.

It's responsible for research, education, and clinical care. And then the chair is also an institutional leader. So I probably spend a third of my time in institutional meetings, either with the hospitals, with the dean, with my fellow chairs, really trying to advance. It's, you know, not just surgery's platform, but Stanford Medicine's platform.

Rachel Baker: But you still get to do surgery though, right? I

Dr. Mary Hawn: still get to do surgery. Yep. And I love my surgery days. My surgery days are great because I don't try to do anything else on my surgery day. Like maybe I'll try and get through a few emails in between cases. But I have been pretty strict about not trying to have a meeting because I don't want to, you know, rush through a case or do something like, Oh my gosh, I have to make this meeting.

And so it just allows me to focus on the tasks at hand.

Rachel Baker: Absolutely. I love that. Your specialty is Minimally invasive foregut surgery. Minimally invasive, totally get, uh, laparoscopic, robotic, et cetera, but where [00:02:00] exactly is my foregut and what drew you to that part of the anatomy?

Dr. Mary Hawn: Your foregut is your esophagus and stomach.

And so, you know, over the course of my 25 years of practice, my practice has gotten narrower and narrower. Early on in my career was a very broadly practicing GI surgeon, did everything from gynecologist The esophagus down to basically the peritoneal reflection. I didn't do much rectal surgery. Yeah. And so over time, as other commitments have come on, I've kind of honed and only do a couple of different operations now.

Rachel Baker: Got it. Well, you are also an acclaimed health services researcher. You actually started off though, I was reading during my stalking, as a basic science researcher. How and why did you make the switch?

Dr. Mary Hawn: Yeah, so all of my research that I did through undergrad, medical school, residency was basic science research, but colorectal tumor genetics.

And a part of that grant was to [00:03:00] get a master's in public health. And it was pretty unusual to have a master's in public health at that time. Started doing a couple more data science y analyses on some of the research projects that we were doing. And then I was on faculty at Michigan for two years while my husband, Eben, was finishing his residency and had a basic science lab.

And I realized how hard it was to really get that going, even though I was like in the lab of a mentor and your clinical practice going and starting a family and all those things. And then kind of at the end of that two years, we left and we went to Oregon for fellowships. And then when we were looking for jobs, I didn't think I wanted to have my own basic science lab and I just didn't think that I was going to be able to be successful or do a good job at all those things.

So when we took our jobs at UAB, my mentor said, just go around and meet with people at the university, find some research mentors and see what clicks. I found an amazing mentor, this woman, Katerina Kieffa, who is the chief of [00:04:00] preventive medicine, a mathematician. And she basically took me under her wing and was my mentor and helped me develop, you know, my first research project that we got funded.

Kind of was on a roll from there.

Rachel Baker: Awesome. Well, so on the topic of HSR, you published two articles just this month in the Annals of Surgery. The first. Was roadmap for research and scholarship in general surgery residency training. Uh, so the first question about that one is what is the research subcommittee of blue ribbon committee two on surgical education and training and could it have a longer name?

Dr. Mary Hawn: Yes. And as many compromises, About probably 20 years ago, there was a Blue Ribbon Committee 1, which was just a Blue Ribbon Committee, looking at general surgery training. And what we recognize is that general surgery, it used to be the skin and its contents. That's general [00:05:00] surgery. And now as we have all these other specialties, and even within general surgery, we are all so specialized, and some of us only operate in this little compartment of the abdomen.

And so I think it's kind of Was reflecting the way that surgery was done. changing and, you know, should we change the surgical paradigm? And it was actually kind of moving toward more of a medicine type format where you would have a core surgery and then spend more time in fellowship. So maybe a four, three or a three, three.

There was some pilots of early specialization with the board where people could kind of get double credit for their chief year. They didn't have less time, but if they was been going to be a thoracic surgeon, they would spend more time in thoracic and some of those would count towards their chief numbers.

So all this was kind of moving in this direction. And then in the context of the 80 hour work week and everything else that had kind of disrupted, kind of. our traditional surgical [00:06:00] training model. And so there was a survey and I still pin it on this one survey of fellowship directors that was presented at the American Surgical.

A fellowship director saying that they didn't think that the training product coming out of surgical training programs today was as ready for independent practice. So then all of a sudden there was this Kind of bias or this frame shift that we can't kind of shorten core training. It actually already isn't robust enough based off what I think is a really poor study, because of course the fellowship directors are going to say, if you have a bias at the 80 hour work week, doesn't produce as good of a product, you know, you're going to say, of course, they're not as good as I was, you know, training in the old system.

So that really put a big stop to this whole thought of a core plus, which In my opinion, I think that's where we should be headed. We should, surgical training is too long. I think we can train people better. I don't think everybody needs to do all [00:07:00] of those high end chief level cases if they're not planning to do them in practice.

We could more direct the volume to the people who are going to be doing them. So that's my bias coming into it. But, so the Blue Ribbon Committee was then brought together to say, We still have issues, we think, with competency coming out of surgical training programs. So how can we change the framework?

And so that's where this entrusted professional activities came in. Could we have a different framework to really see how people are progressing during their training period? So that was the blue ribbon. really look at all the different aspects of surgical training from the learning environment to the evaluation feedback mechanism that we use.

And then I was tasked with Jeff Matthews to co chair the research subcommittee. And so we had a great committee. I think we had probably one of the most aligned committees and what we thought should be the The role of research training going forward, because there's like, I can't remember, [00:08:00] I think maybe 500 surgical training programs, some of them are very small community hospital base.

They don't have the resources or not in the academic environment of a Stanford or, or similar institutions. And so their research training is going to be very different than obviously what it would be at an institution like ours. So we absolutely kind of developed these tiers of a foundation. We thought everybody should have a curriculum that could be developed nationally and delivered online.

So at least everybody got a foundational training in research. And then the most rigorous tier would be like more of a surgeon scientist training program, which also our colleagues in medicine, in pediatrics. and neurosurgery do quite better. They identify these folks early on in training and then integrate research throughout their training.

Rachel Baker: Interesting. Okay. So being a surgeon in and of itself is a time consuming profession. Yes. But being a surgeon scientist adds this whole layer of complexity. So how [00:09:00] can we set up our residents for success?

Dr. Mary Hawn: I think the main thing we have to do is give them the basic foundational skills, because still what they learn today, when they go and take their first academic job five plus years from now, the fields are shifting even so much faster.

So what we really just need to give them the strong foundation of the scientific method, the skills they need to be able to write up their work, to present their work, to be able to respond to criticism, other work and how to make it stronger and how to troubleshoot when experiments don't work and your hypothesis doesn't hold up, then how do you then rethink about it and look at it from a different lens?

Rachel Baker: Well, so the second article that I just finished reading, you wrote with one of our chief residents, Dr. Charlotte Rajasingh. It was titled Equity in Pay, Rethinking the ACGME Funding Model. I think this article is probably going to resonate with Tons of young people in the U. S. today because having [00:10:00] children is very expensive.

And then there's this challenge of wanting to be a good parent, but also a good colleague and coworker. So from outward appearances, I think you seem to have succeeded at both. Well done. But I can't imagine it was easy. So what do you think the ACGME and residency programs are? could do to support surgeons in training who want to be surgeons, want to be scientists, but also want to have that work life balance and have a family as well.

Dr. Mary Hawn: You know, I think the first thing we can do is not make it harder. And, uh, so this was actually an editorial in response to a paper that was published looking at living wage for trainees and it was written by a group of neurosurgery residents from Vanderbilt. And then, you know, I was asked to write an editorial on it.

And so this is kind of the response of like, the model that was developed a hundred years ago for the house officer who actually mostly lives in the hospital. It [00:11:00] was given a small stipend and long before we had all this subspecialization with different training demands, different time commitments, different duration of training, all those things.

It was developed in a very different time and we kind of have hung onto it that all trainees should be compensated in the same way. And if you think about it, it's such a weird model because. The trainees are here for their education, right? They are learning so much. I mean, the intensity of the learning is like nothing else at any other time in their education to date.

So they're here really intensely learning, but at the same time, they are basically running the hospital. They are providing an incredible amount of service and care of the patients while they're learning. And they're older. They're more in debt and, and we have a lot more women, okay, true. When this was developed, there was no women, right?

It was just guys. It was just guys. There were no women. There were maybe a few, but, but so it was developed for a very different population. So now we know [00:12:00] that women delaying childbearing can have fertility consequences. It can have pregnancy related complications that can be really dangerous to the mom, to the baby and really disruptive to training.

Most of my. we delayed having kids until we were done with training because it was A, before the 80 hour work week, as if the 80 hour work week is a vacation, right? And if I only had to work 80 hours, I could have twins, whatever. I know we all wish we could just have a wonderful on site 24 hour daycare.

Oh, yeah. Like, if you could redesign the system and build it and figure out how you finance that, how you make that available, and not just for our residents, it's for our young faculty, it's for, you know, our nurses, everybody. There's not enough affordable childcare. anywhere to support the people we need to take care of our population.

So I think we need to think about that. But anyway, so long story short, Charlotte and I kind of bantered [00:13:00] around a little bit of like, what would you do? What would you do differently? And part of it is, I think we need to like reflect that a surgery resident is Working a lot longer hours in a day, a lot more inflexible hours, a lot more nights and weekends and things like that.

And they don't have any opportunity really left over for moonlighting. And we really wouldn't want them to, I mean, they're already working so hard.

Rachel Baker: Exactly.

Dr. Mary Hawn: Or if you do have a family and stuff, so. You know, could we say, should it be a stipend for X hours a week? And then for Y hours, there's some type of additional compensation that really reflects the difference in the service, in the time that they are committing, kind of beyond their education.

It's out there. We'll see if it gets much discussion. It would be a total. Reworking of it and, and even in unionization, so most of the, you know, the larger groups are more shift to workers [00:14:00] in terms of, you know, radiology residents, anesthesia residents, even, you know, our medical and pediatric residents, they've got their outpatient months and at least from the outside looking in at them looks like a much more ability to control a schedule.

So if they're the ones who are sitting at the negotiation tables for the contracts and things like that, they're not going to really. be strongly advocating for this smaller surgical subset of residents who really have a different demand on their time.

Rachel Baker: Well, I look forward to seeing what happens there.

Dr. Mary Hawn: Yeah, yeah.

Rachel Baker: Hopefully we can, we can get our residents the support that they deserve, as well as our junior faculty. Um, good luck. So I recently started telling the Stanford community who I was going to be interviewing next on the show and asking if they had questions that they wanted me to ask my guests.

And so this question comes from one of our staff members in the plastic surgery division, [00:15:00] Christine Reyes Santos. She says, You've accomplished so much in your life and everyone looks up to you. How do you keep yourself humble and treat everyone with kindness and respect?

Dr. Mary Hawn: First, it made me just feel like, oh my gosh, that makes me feel so good because I want to be approachable.

I feel like I'm approachable and I know that, you know, it can be intimidating and things like that. But the bottom line is, I mean, this department is our people. It's not me. And it's our people who really, you know, run the department, who take care of our trainees and are really making sure that, you know, everybody can do their best.

And I value that so much, and I hope it shows that we're all one big team.

Rachel Baker: Well, we are at that point in the episode where we ask each of our guests that same two questions. And the first one is, who is a surgeon you admire and why?

Dr. Mary Hawn: Wow. There's so many [00:16:00] surgeons I admire and I admire them for different qualities and characteristics.

So kind of starting early, one of my mentors from my residency is Mike Mulholland. Mike Mulholland is very talented surgeon, very efficient, very precise, uh, and really values that. Being like a really good surgeon. He was an amazing scientist and leader and everything else But the other thing I value about Mike is he didn't mince words Like if he thought you were doing a good job, he lets you know you're doing a good job If he thought you could do better he'd tell you you could do better And if you were really disappointing him, he would let you know and he There are not many people who will do that for you.

So he's one of these people, whenever I'm at some, you know, thinking of some opportunity or something coming along that I, I asked for advice because I know he'll be honest. He'll be, you know, like, no, you shouldn't do that. Or no, you know, you're not, that's not the right thing for you. So he'll be super honest.

Another person who I really admire was then my, my [00:17:00] mentor at UAB, Selwyn Vickers, and Selwyn has just. an amazing, expansive, visionary look at the world. And yet is also real and will joke around with people. But is his kind of big vision, I think drives all the people underneath him crazy. Because he's not a detail guy.

He's not a detail guy. He's like the vision guy. So it's fun to kind of see how he does it and look at what he does. And then I think the third person who is really been an incredibly inspiring mentor and colleague and friend is Lee Neumeier and I met her early on in my career and she's been kind of a distance mentor and, and just the, Support that she gives others and takes more pride and joy in their successes than any of her own successes.

It's just, you know, something that I try to lift up and help other people in the way that I feel like she lifted [00:18:00] up and helped

Rachel Baker: me. The second question is, what is the best advice you have received in 10 words or less?

Dr. Mary Hawn: Hmm. Everybody has a boss. Make sure you do your day job, .

Rachel Baker: Okay. Explain.

Dr. Mary Hawn: First, I think it's important to know everybody has a boss.

There is somebody who everybody reports to. And I've been called on and had the opportunity and privilege to do a lot of things nationally, like very high level leadership roles that have taken a lot of my time, but I'm like, they're not my boss. So I have to make sure, you know, always remind myself, make sure I'm taking care of my department and my day job first.

And then I can do these other things. Did

Rachel Baker: you hear that Dean Lloyd Minor?

Dr. Mary Hawn: And of course, you know, getting back to the last comment, I mean, I've had so many, you know, we have such great division chiefs, such great departmental [00:19:00] leaders and staff and things like that, that the department, Does not need a lot, a lot of my attention, but I always want to make sure that people know that I am there, that I'm not too busy, that we're all working together to keep things moving forward.

Rachel Baker: Fantastic. Well, so I always try to end my interviews by looking into the future. Next month, the American College of Surgeons annual clinical Congress will be held in San Francisco. And the ACS has chosen to dedicate the ONH Wangensteen Scientific Forum to you. How cool is that?

Dr. Mary Hawn: That's very cool. That's very, it's incredibly meaningful because the scientific form is.

Well, first it's a committee I worked on for a decade, which so did Mike Longaker. He also had a dedication to him. So maybe if you give them a decade, they'll ultimately dedicate it to you. But it's really, it's a setting. I think the college is such an incredible organization. It is big and it is diffuse, but at the same time, it really has that [00:20:00] mission to mentor our youngest.

trainees, both in their clinical practice, but also in their academic endeavors. And so that's what the scientific forum really is a place where young faculty or trainees can present their research in an incredibly supportive environment. So it is, it's an honor to have it, have it dedicated for sure.

Rachel Baker: Well, it is one of my favorite events of the year. I'm definitely looking forward to it. Thank you so much for coming on the show. I want to wish you and all of our female physicians a very happy women in medicine month. Thanks, Rachel. And that brings us to the end of another episode. If you like Scrubcast, we hope you'll tell your friends and subscribe wherever you get your podcasts.

Scrubcast is a production of Stanford University's Department of Surgery. Today's episode was produced by Rachel Baker. The music is by Midnight Rounds and our chair is Dr. Mary [00:21:00] Hawn.