Woman At the Top

It’s 2014 and there are still only six women surgery chairs in all 141 medical schools in the U.S. Anne Mosenthal is one of them. As the recently named head of the Department of Surgery at Rutgers New Jersey Medical School (NJMS), she is a living, breathing example of the changing face of this specialty. Was her goal to climb the steep ladder to the very top of a male-dominated field? Absolutely not, she says. “I set out to become a trauma, critical care surgeon.” Is she happy to be there? Oh yes, she smiles.

Mosenthal exudes quiet determination and focus, but she’s nothing like the archtypical hospital surgeon of bygone days. “The old ways of a single man at the top of a department or operating room just don’t work anymore,” she says emphatically. “It’s about building a strong team.”

That is exactly what she has set out to do in her leadership role at NJMS and as a member of the highly touted University Hospital Level 1 Trauma Center surgical team that has earned a remarkable reputation for saving those torn up by guns and near-fatal car wrecks. This woman of action, a 1985 graduate of Dartmouth Medical School, says there were just 15 women in her class of 65, and “less than a handful of them chose surgery.”

“Surgery is not for women,” she remembers being told. “Well, maybe plastics.” But plastic surgery did not interest Mosenthal at all. She wanted the pace and demands of “taking care of really sick and critically injured patients” and she wanted an academic career as well.

“When I was a medical student, my sense was that women in surgery were pariahs, that they were taken less seriously than men, but I was determined to defy the stereotypes,” she states.

And defy she did — with eyes wide open. She applied to be a surgery resident but remembers worrying if a “quiet, unassuming person,” like her, would be accepted by “the classic surgical personality of the time — confident, arrogant, never in doubt, usually right.” Lucky for her, the University of Massachusetts Medical Center, where she was accepted into a general surgery residency, “was very tough, but it was very tough for everybody.”

She amends her statement a little: “It wasn’t professionally harder for women, but it was personally harder. Many of the men were married, and some had children, but very few of the women were married and none had children.” With no limits on hours and “on call” required every other night, Mosenthal says a social life was next to impossible.

Three of her fellow female surgery residents dropped out, leaving just two women in her year. “It would have been much harder if we didn’t have each other,” she says. The department had just one female faculty member at the time.

Mosenthal finished her residency in 1990 and fellowships in critical care and surgical endoscopy in 1992, and was recruited to NJMS in that year by founding chair of the Department of Surgery, Benjamin Rush, MD. She describes him as a visionary, ahead of his time in recruiting talented women and minorities into the department long before other medical schools.

Life was busy. Not only were the surgeries long and challenging, and the teaching responsibilities demanding, but by this time Mosenthal, now in her 30s, was married to surgeon Peter Rice, MD, and they were thinking of starting a family.

“It’s hard for women in surgery, particularly in the surgical specialties,” she says. “The training is so long and women are just not ready to give up their childbearing years.” She comments that there is an ongoing perception of surgery being more brutal than the other specialties, but “what is true is that the training for all surgical specialties is more demanding in terms of time.”

When her own children came along in the mid- to late-’90s, the pace of her life became even more dizzying. “There were many times that I was gone from home for 36 hours at a time. If it hadn’t been for my husband, who provided a lot of child care and took care of everything when I wasn’t there, I would not have made it,” she states.

“This kind of partnership is rarely talked about, but it is such a crucial element of success for women in demanding professions,” she says.

Professional camaraderie during the working years is difficult to find for women surgeons, comments Mosenthal. “There are way fewer women than men who are colleagues who have a home life and children.”

Over the years, she developed that camaraderie with fellow trauma surgeons, primarily men. But it was her professional partnership with Patricia Murphy— an advanced practice nurse with a doctorate in ethics and bereavement — and their creation of a palliative and endof-life care program that took her career in a new and personally satisfying direction. Launched in 2000, the program answered a huge unmet need of critically ill patients and their families and helped to define Mosenthal as a pioneer and a surgeon whose humanity would consistently be front and center.

“I have always liked to converse with patients and answer their questions, but I felt unprepared to handle bereavement and the sudden life changes of trauma patients and their families,” she says. “In reality, 13 percent of our trauma patients admitted to the surgical ICU will die, many with unknown pain and suffering at the end of life, and many with families in crisis.”

“Other patients will go on to have significant disability and impaired quality of life,” she continues. “We saw that components of palliative care — such as relief of pain and symptoms, good communication, bereavement support and appropriate withdrawal of life support — are essential to the care of trauma patients.”

“This has become one of the great services we offer here,” Mosenthal says, “and it is one of my greatest contributions.”

The program — adopted in hospitals throughout the country— helped to propel her into a leadership position locally and nationally. In 2011, she was asked by NJMS Dean Robert Johnson to lead the strategic planning process for the medical school, a “very exciting effort” that lasted a year and a half and “taught me the power of building a team. We had a lot of different people on the team and a lot of opinions, and our charge was to bring it all together,” she says.

Whether taking care of patients or working with a health care team, Mosenthal’s style is participative and inclusive, and she strives to be “direct, transparent, honest and fair. ”

This trauma surgeon calls surgery “the most intimate relationship. Patients put all their trust in the surgeon.”

“There have been studies showing that women interact differently with patients — they listen more and it’s better for the patients,” she states. “Women bring that to the practice of surgery.”

“And women are better at relationships,” she says. “The critical mass of women who have gone through medical school in the last number of years has already changed the practice of medicine. Surgery is bound to follow suit.”