By Dominique Perkins
When Leigh Neumayer, MD, told her father, a general surgeon in private practice for over 40 years, that she wanted to become a physician, he initially discouraged her.
“He thought the environment was changing so much that it wasn’t going to be as fun or easy to be a doctor,” she said. This was in the late 1970s, and he may have had a point. The landscape of medicine certainly has changed.
From practice guidelines that micro-manage a physician’s care decisions to the constant battle for reimbursement, one could argue there are many aspects of a doctor’s life that are neither fun nor easy. However, Neumayer still finds a great deal of joy in what she does and seeks to pass that along to others.
In addition to her father’s cautions, she had her own reservations to entering the medical field: her nose.
“I have a very sensitive nose,” she said. “My concern was that the smells in medicine might be too much for me. I didn’t like visiting my grandpas in their nursing homes because of the strong smells.”
To be sure she made the right decision for her, Neumayer considered her career options carefully, and put her interests to the test to see how she faired. She studied engineering in college, which allowed her to spend time working in both math and physics, which she thoroughly enjoyed.
She also worked as a phlebotomist, and then began working as a nurse’s aide at a nursing home.
“Figuring the work in a nursing home would expose me to many different and probably unpleasant smells I thought it would be a good test,” she said.
Thoughtfully comparing her experience in working as an engineer with her job as a nurse’s aide, Neumayer found that while she was certainly capable of doing either job, she much preferred the nursing home work, and her decision was made.
She went to Baylor College of Medicine, and enjoyed each of her rotations with a clear preference for surgery. She chose otolaryngology, and matched in a position at the University of California at San Francisco.
While in San Francisco, she met and married her husband, who was also a surgical resident. They transferred together to the University of Arizona to complete residencies in general surgery.
After completing her residency, Neumayer joined the faculty at the University of Arizona while her husband completed a vascular surgery residency, and then moved to the University of Utah in Salt Lake City while he completed a residency in cardiac surgery.
Salt Lake surgery
Neumayer practiced in Salt Lake City for 22 years. She worked at the VA, where she held many positions including staff surgeon, and chief of surgery. As her interests and talents continued to expand, she began to work part time at the VA and part time with the University of Utah, where she started a general surgery practice including trauma care.
Eventually she moved full-time to her work with the university, and focused her elective practice on breast disease, still participating in trauma call and service and staffing a new ICU in the Huntsman cancer hospital, and co-led multidisciplinary breast cancer clinical and research programs.
In 2014, Neumayer was recruited back to the University of Arizona to lead the department of surgery. Beginning Jan 1 of this year, she was appointed interim Senior Vice President for Health Sciences.
“I spend the majority of my time now in administration however try to carve out some time for research and still do one day a week clinical and take one to two nights of call a month,” she said.
As a surgeon, Neumayer entered a field traditionally dominated by men. Currently, less than 20% of our nation’s more than 25,000 general surgeons are women. Neumayer remembers there being very few women in surgery when she completed medical school, but said that the presence or absence of women in the field did not impact her decision to pursue it.
“I chose surgery because I love the field,” she said.
However, once she was completing her residency, Neumayer did begin to notice that there weren’t very many like her.
“By then I was married (to another surgeon) and was wondering if there were women surgeons who were married to other surgeons and whether any of them had kids,” she said.
She helped conduct a survey through the Association of Women Surgeons to find out, and made many contacts through her experience, all of whom she says are great colleagues and friends to this day.
While many more women have joined the ranks of physicians and surgeons since Neumayer graduated from medical school, there are still specialties reported to have fewer than 10% of women in their fields (vascular surgery, interventional radiology, neurosurgery, interventional cardiology, urology, thoracic surgery, and orthopedic surgery). Whereas other specialties, such as OB/GYN and Pediatrics have a clear majority of women in their practice.
We asked Neumayer why she thought this might be the case, and she felt it came mainly down exposure, and the availability of good role models. Because medical students are not required to have rotations in specialties such as vascular surgery and interventional radiology, few pursue them. And frequently only those who have had some exposure to the field before.
The popularity of other practices may also be a question of exposure, Neumayer said, but she also pointed out that once you hit a sort of “critical mass” of women in a specialty, gender becomes a non-issue.
“Interestingly, while the residencies are replete with women in those specialties, the number of women in leadership positions in OB/GYN and peds are still very low,” she said.
As one of only a handful of female surgery department heads at an American medical school, Neumayer admits she does see herself as a role-model for other young female physicians considering a career in a male-dominated field, and tries to make herself available to mentor students, residents and faculty.
“I think this is a very important part of what I do,” she said.
“To me, being happy in what you are doing every day is the most important thing, so I try to empower and enable others to find what it is that makes them happy.”
Neumayer said that in January of 2014 there were 4 departments of surgery at medical schools run by women, and by the end of 2016 that number had grown to 16. These 16 women have actively banded together to promote and support other women surgeons by holding a special leadership forum this spring.
“This is so important to prepare women and give them more exposure to get them into these roles,” she said.
Speaking of her own role as the newly-appointed interim Senior Vice President for Health Sciences at the University of Arizona, Neumayer said she sees the challenges presented by the role to be potential opportunities. As they search for a new university presidency as well as other high-profile positions, she said she hopes to engage all involved to create a shared vision for the university department of health sciences.
She plans to spend a lot of time at both the Tucson and Phoenix campus, serving as a bridge between the two schools. Common programs and centers such as the University of Arizona Cancer Center and the precision grant provide a common thread of research will serve to unite and support them.
There has been much discussion throughout the last year about leadership changes in the Phoenix campus. Neumayer says the first priority will be to secure full accreditation.
“Part and parcel to this is to complete the dean search,” she said. “Dr. Ken Ramos has been serving as the Interim Dean and has done an immense amount of work along with other leaders in the COM-P in preparation for the accreditation site visit.”
Most medical schools have seen female enrollment dramatically increase over the past several decades, and women now make up at least half the student body at most institutions.
Neumayer noted that while there may be more women around than there used to be, the biggest change she has witnessed is the number pf physicians who are currently married to other physicians.
“This presents great problems when recruiting, because both spouses want a good job,” she said.
When it comes to inequalities on the job, she said it all hinges on the beginning negotiations. Recent reports show that female physicians make on average 8% less than their male counterparts, and that first job really makes a difference
“My experience in the last two years is that women ask for less from the get-go,” Neumayer said.
Neumayer referenced Evelyn Murphy, PhD economist and founder of the WAGE Project, who has done extensive research and reports that for physicians starting out a lower salary can add up to as much as $2 million lost income over 20 years.
“We won’t fix this gap until there is absolute attention paid to this both in the public and private sector,” she said.
She also said the only place she has worked where she did not experience a salary gap with male surgeons was the VA, where salaries were lower across the board than at universities or in private practice.
There have been some recent reports in the media noting the correlation between treatment successes of elderly patients when cared for by women physicians. Hospitalized elderly patients treated by female physicians had lower incidences of mortality and reduces readmission rates as compared to those treated by male physicians. When asked about the clinical implications of these findings, Neumayer noted that they seemed similar to studies that have shown improved outcomes when patients are cared for by providers of their same race or ethnicity, and perhaps it is tied to perceptions and comfort-level.
“I believe we should identify best practices and work hard to implement them across diverse settings,” she said.