An interview with Dr Sarah Gray, a woman's perspective to surgical training

 Despite the Australian population composing a greater percentage of females compared to males, the Australian National Health Registry notes that there is 96% of Australian orthopaedic surgeons are male and only 3.9% are actually female. Today we're going to hear from one of those who are trying to improve this disparity and pursue a career in surgery. I'm looking forward to hearing her experiences as a female surgeon in training and as a young mother.

Good day and welcome to Aussie Med Ed, the Australian Medical Education Podcast, a program born during COVID times to emulate that general chit-chat and banter around the hospital with the idea of educating the medical student and GP alike. I'm Gavin Nimon, an orthopaedic surgeon based in Adelaide and it's my pleasure to bring Aussie Med Ed to you.

And today we're speaking to Dr. Sarah Gray, an orthopaedic service registrar in Adelaide who is pursuing a career down the path of orthopaedics. She's a single mum of a toddler, a tattoo studio owner and she describes herself as a colourful alternative doctor who likes to advocate for diversity within medicine and surgery by actively encouraging creative self-expression. With this background, I'm looking forward to hearing about her experiences in surgical and orthopaedic training. I'd like to start by acknowledging the traditional owners of the land on which this podcast has been produced, the Kaurna people and pay my respect to the elders both past, present and emerging.

It is my pleasure now to introduce Dr. Sarah Gray. Sarah is an orthopaedic service registrar working with us at the Queen Elizabeth Hospital and she's going to talk a bit about her experiences in orthopaedics and surgical training. Welcome Sarah Gray. Thank you for having me on here Gavin. Good to chat to you. It's great to have you on. It's good to hear your experience as a female going through the surgical pathway. I'd like to ask you to start off by outlining a little bit about yourself, about what got you into medicine and how you've headed down the path of surgery.

Sarah:

Sure. So I'm 34 years old. I'm a single mother to a two and a half year old toddler who owns my heart. He's my world. I'm a orthopaedic service registrar, as you mentioned. So I'm a PGY5 doctor, but this is my second and a half year in orthopaedic service. Outside of medicine, I'm quite heavily involved in the arts scene. So I own a tattoo studio, which I've owned for the last five years. I'm going to like to do quite a bit on the tattoo scene, traveling around Australia, talking about diversity. So that's a little bit about me. I guess I grew up in a country town called Ardrossan, which is on the York Peninsula. A small town, about a thousand people where I did all my schooling through an area school. So reception to year 12, some of my year 12 subjects through open access, because we don't have the capacity to get teachers and all subjects out in the country. So I grew up there. My family is still on York Peninsula. My dad was one of the local GPs. He's now retired. So I guess looking up to my dad, he was one of the reasons why I wanted to get into the medical industry, but it took me quite a bit of time after finishing year 12 before I went to Adelaide Uni. I finished my schooling in 2006 and had a bit of a hiatus until 2013 was when I started medical school. So did a few things before I found my feet, did some work in hospitality management, ran a local pub, did some dental assisting, some clinical court murder type stuff, tattoo modeling, and today trying to get on the pathway of being a bone surgeon. So that's a bit about me so far. And obviously, you explained why you've headed down the surgical path. What do you think about this idea of where you hear female medical students say that orthopaedics is not really a job for them? They consider it as involves a lot of manual duties and it's more of a male area. I disagree with this statement completely. But what are your thoughts when you hear these sort of thoughts? Yeah, well, I guess, you know, when you hear people talk about surgical training, a lot of people think that it's, you know, an old boys club and that, you know, some people think women necessarily don't belong there. I agree with everything you've just said. I entirely disagree with that statement. I think it's a discipline that requires, you know, concentration, eye for detail, a bit of perfectionism and also, you know, having good work ethic, which I certainly don't think that just belong to men. I think women do that very well as well. And it's not brute force that makes you a good orthopaedic surgeon, it's technique. So yeah, I think anyone who's too scared of doing orthopaedics, thinking that it's a male area should reassess things and come and have a bit of a look at things because it's a really great industry and a really good career to follow. I totally agree with that statement. I'm very proud to say that my first two registrars when I was an intern many years ago were two female orthopaedic registrars and they are still mentors to me as well. So I still look up to them.

Gavin:

Can you describe your experience in surgical training for me?

Sarah:

Yeah, so so far for me, I mean, I'm obviously still very junior and I've got a long way to go. But for me, basically, to get to this point was, you know, you do your internship and you do your residency and I finished my residency early and actually was approached by one of the units that I worked with in the spinal unit to work as a surgical registrar for them because I had such a good term on their unit and was quite interested in orthopaedics, as you know. So I started my service job a little bit early and did six months on the spinal unit. And then this is now my second year of statewide unaccredited service where I've kind of worked my way around the state in the main tertiary hospitals from working at the Flinders Bone Tumour Unit, which I absolutely loved. That was an absolute eye opener and certainly where my passion lies through into, you know, general orthopaedics at the Lyell McEwin I've worked at the Spinal Unit and now over here at the QEH. So I've done a bit of a loop and sweep. I guess the biggest thing for me whilst going through this is being a mum and has made it a bit of a juggling act, but I've still managed to kind of work my way through and tick off the competencies that's required to then take the next step to hopefully apply for set training next year. So biggest thing for me so far was past my surgical primary, the GSSC, which I've just done so can now take the next step hopefully to getting into training. Well, did you encounter any unique challenges as a female going through the pathway in this area? Yeah, well, I think when I came back to work, I came back when my son was eight weeks old full time. Part of that was because there aren't part time training contracts for service registrars that are available. So I guess that's one of the disadvantages being female coming back into the workforce as a new mum meant that I did have to come back a little bit sooner rather than later than I would have liked. A subside to that was the breastfeeding along the way as well. I was really lucky that when I came back, it was for the spinal unit and I was super supportive in offering me time every couple of hours to be able to express and pump and try and continue that journey. But I guess the reality is great in theory to be able to access a time every two hours to do those things. But when you're working as a surgical registrar, it's a very busy job and you haven't always got 20 minutes to take every two hours to sit down and pump. So I think that's something that's certainly a little bit harder being female coming back into surgical training, something that I did find a little bit of a challenge at the start to overcome. I guess another thing for me is also I'm a single mum. So for myself, not having the supports at home from family, that I live two hours away on your peninsula and being by myself, I needed to find a living set up. So I managed to get my thought there. I live in Nanny and I've also got an amazing day in Nanny that makes my life worthwhile. But I guess the challenges that come with that are that the government doesn't support you as a working parent. And I think it's women and men that have the same trouble, but I don't give you any funding towards private childcare. So the majority of my income, in fact, all my income goes to paying Nannies to look after my son so that I can work and pursue my passion to be a surgeon. So that's something that I think is a little bit of a challenge for coming back into the workforce, especially as a female. What about other issues apart from just being a mother? Is there any other issues you've identified even before that scenario as being a female compared to a male in a, probably as a male dominated sort of area? Yeah, well, I guess the thing is in surgery, the numbers are swayed as far as males versus females. I think the last kind of numbers show that about 13% of surgeons in Australia are female compared to males. So furthermore to that, if you look at women of colour and gender diverse people, they're even less representative in surgery.

 So I guess they face additional challenges that I can't really comment on. I guess there's this talk about the hidden curriculum where it can still be a bit more geared up towards men other than women. But to be honest, I haven't really faced anything specific. I've been always welcomed with open arms, in particular in orthopaedic training. And that's a big part of why I was really drawn to the specialty at the start of my medical school journey. I really appreciated the, I guess the camaraderie and the community in the banter that was in such a tight knit group. I haven't really had anything negative come along my way. Excellent. What about mentorship? Have you had anyone you've actually turned to for advice, both as a female and also as a mother? Is there someone who you aspire to? Obviously you've mentioned your father's approach to medicine already. Obviously he'll be an inspiration you've said, but other people on the ground in Adelaide? Yeah, when I was in medical school, associate professor Nicole Williams was great at being a mentor for me, being a female as head of the unit over at the Women's and Children's and being so heavily involved in research. She was really able to help steer me towards getting into the research side of things with orthopaedics and also introduced me to the Orthopaedic Women's Group or the AL group, which is another kind of mentor or area that supports women in orthopaedic training. So she's been really helpful for me at the start. And then, you know, my female colleagues, my registrars, Mariana Regio has been an outstanding support. She's one of my seniors. I'm sure you know, Rego, she's been great for me. She's really supported me along the way. And then other colleagues that I work with at a service level, you know, I've got excellent friends. They're almost like family, so we kind of stick together. So mentors within, I guess, Orthopaedics specifically. And then, you know, I mentioned before my father, he's been a big role model to me. I wasn't the best teenager, I must admit. I eventually decided that I wanted to do medicine. I'm glad I did, but he's supported me along the way through my whole journey as has my mother. You know, she's been amazing as well. And I've got a supportive sister in the hills as well. So yeah, they've been great. They've been some real people that I can certainly look up to. Yeah.

Gavin:

 That's brilliant. That's good to hear. What about some significant experiences during surgical training in general? Is there anything particular that's really taking your fancy? You've already mentioned the bone tumour service and also the mentors you've come across. Anything particularly you've really thought that this is for me?

Sarah:

Yeah, so as you mentioned, the bone tumour. I remember there was a particular case that we did on a five-year-old where we did a procedure called a kapana technique where essentially we removed part of the tumour from this young leg's proximal tibia and used part of his fibula to spin it around through a cadaver bone and make like a bone hot dog to continue to him to keep his leg a little savage. So that was a big thing that stood out to me. That was about a 12-hour procedure involving work with our plastic surgical colleagues and as a combined pace. And I really enjoyed working with him and his family throughout the whole journey. Another thing I guess that stood out for me is I did look after a gentleman who I was working on a spinal unit who had a central heart syndrome and he had a two-level ACDF that went really well. And for him, he was a really fit guy at the start and he was really worried that he'd never walk again. But every day I saw him and gave him hope and encouraged him. And he went back to New South Wales for his rehab because he's actually from interstate. But six months later when he left that rehab facility, he actually sent me an email, sent me a video where he said, "This is for you, Dr Gray. I'm leaving." And he walked out of rehab. And that video that he sent me is something that I kind of hold quite dear to myself whenever I'm in a bit of a rut and wondering if the juice is worth a squeeze, I guess. It's stuff like that that keeps you coming back. So that's another, I guess, moment that's kind of stood out to me is something that has told me that I know I'm helping make a difference. So yeah, there are a couple of things. That's absolutely brilliant to hear. And this sort of thing makes it all worthwhile. So that's fantastic. Now, moving on, given that the AOA and the College of Surgeons are doing a lot of work on diversity and trying to incorporate that into their training program and also in surgery itself, do you think the process is heading? Do you think they're heading in the right direction? Yeah, I think, well, you mentioned, you know, the AOA in particular, they developed a strategic diversity plan, I think. I think it was about 2018. And it was only released even this year or last year where they really looked into what they could do to try and advocate for diversity in the orthopaedic area. And I really think that that's a big step in the right direction. You know, it really looks at part time training to make things flexible for a work-life balance. Also looks at, you know, allowing trainees to have interruptions of more than 12 months or more off training to allow them to do things like set up a family. So I think these things are really needed because I think the biggest thing with surgery is that I know that at a medical student level, you know, it's quite a polarizing career option. It tends to be the most loved or most hated option. If you ask a medical student if they want to be a surgeon and in particular, I think there's quite a lot of research that shows that the largest deterrent to pursuing a surgical career are perceptions around lifestyle and training pathways that are often seen as incompatible with a rewarding family life and the lack of female role models and the presence of kind of unconscious gender bias amongst several other themes can sometimes set perceptions that are developed through negative personal experiences. So I think these things are needed. I think it's good to see that they're in the right direction. You know, there's the champions of change. You know, RACS have been talking about diversity quite a lot. And it's just quite interesting when you look at the surgical specialties by gender, because orthopaedics, although, you know, they're being the most proactive by setting up this diversity plan, we're still the most outnumbered in a gender sense. Yeah, I think there's about three and a half percent of female orthopaedic consultants compared to almost, you know, 96 and a half percent or so of men. So it's a big disparity. So I think these things need to happen. And the world is changing. Not everybody is the same. We need to be representing everybody as a whole at every level. And that then that includes in surgery, you know, you want to go and see your doctor and you want to know that you can relate to them. So I think it's certainly important to try and get a diverse group of people in into training at every level. And that's not just when it comes to traditional things like thinking about the traditional gender binary framework. If you think about male or female dichotomy, I also want to acknowledge and respect that, you know, there's transgender and gender diverse members of the community who don't necessarily identify with this particular framework. And I think it's important to also consider them as well. And I think things that we can do and what should continue to happen is, you know, making sure that we're working on using the right language. You know, if you walk past something, you accept it. So if you see something that isn't appropriate, you should call it out, making sure you're being inclusive with all people of ages, races, genders, all the different things. We just need to be inclusive. And that includes people with, like myself, you know, like I've got coloured hair, I've got tattoos and piercings, and there's lots of people out there that look like myself. I think it's important that I can represent that group as well, because it certainly works in my favour and in certain instances. So it's not always, certainly not always a negative. In fact, it's overwhelmingly positive in response I receive for how I look. So yeah, I think it's important that we continue to advocate for different...

Gavin:

That’s totally brilliant. I totally agree with you. It's important to respect everyone and embrace diversity. Another thought that comes to mind is what do you actually say to medical students who come up to you and ask your opinion about heading down a path for surgery? What's your actual response to them?

Sarah:

I guess the first thing is if a female student comes up to me and says, "Hey, you know, I'm interested in a surgical career," then, you know, firstly, I would acknowledge that it's great that they've been able to voice their feelings with me about that, because, you know, speaking to your seniors can be a bit scary. When you're a student, it can be a bit confronting and overwhelming. But firstly, finding out, you know, what it is that drives them and then how you can help them. So very important for me is if someone does go out of their way to make it known that they're interested in what I'm doing or that they're interested in doing it themselves is to let them feel heard and see how you can help them along their journey. You can, you know, without mentors or without people to look up to, we have to learn along the way what doesn't work so that those behind us can make it work for themselves. So if I can use my experiences in any way, whether they're positive or negative, I'd certainly love to try and help, I guess, guide people into that path. So, yeah, yeah, for me, it's important. I guess I'm a bit of an unofficial mentor for a lot of people out there. I'm quite lucky that in my social media, people will often reach out to me from all around the world even and just say, you know, "Hey, you know, I really wanted to be a doctor or a nurse or, you know, an accountant or something that might be traditionally viewed as, you know, a more conservative role." But they were worried about doing so because of how they looked and then they found me and then they were able to kind of go, "All right, well, if she can do it, then I can do it too." So, you know, that type of stuff is really cool.

Gavin:

Brilliant. Absolutely brilliant to hear.

Sarah:

So you never know, I guess, you never know how big or little what you're doing is for someone's life. So if you can be true to yourself and just keep fighting and just knowing that you're fighting the good fight, then, you know, you're not just helping yourself, you're helping others behind you. So, yeah, important for me to remember that.

Gavin:

Yeah, I think that's a great attitude to have and a good way to live your life. So no wonder people come and ask for your advice. Moving forward, do you have any tips you might suggest to the listener on how to balance, work life balance in this scenario, being a single mum, also running a set to studio and also working as an orthopaedic registrar too?

Sarah:

Well, for me, obviously, I'm a very organized person. So controlled chaos, like to call it. I love a diary, I love a list. Communication is obviously very important and that's with all people around you. So, you know, things aren't always going to be easy, but knowing that you don't have to just take it all on yourself, that there's other people around there to help you and just to communicate that with everyone. So, I guess, is trying to get as much sleep as you can, which when you're on call, that's not always possible to get lots of sleep, but making sure that you're eating and hydrating and self-care really important. You can't pull from an empty cup, so you've got to look after yourself before you can look after others. So, that's a little bit of advice. Also, I guess when it comes to being a female in the workforce, if you want to have children, it's a hard thing to say, but there's never really going to be a right time. So you know, you just need to do what's right for you and ultimately, your family always comes first. So, you work as much as you love it. It doesn't tuck you in at night, so it's really important to focus on what's important and knowing that everybody's journey is different. So, you go at your own pace, you know. If it takes me twice as long as my colleague who chose not to have children, then that's fine. Like, it's not a competition. The only one I'm in competition with is myself, not those around me. So, yeah, just do things at your own pace and know that everything is possible if you want it and if you work hard enough, you can do it.

Gavin:

I'd agree. I think it's very important to put your family up front. I also think that when you are distracted by family scenarios or other things going on in your life, it also helps you focus on work too. When you've got all the time in the world to study for an exam, you just need to make distractions for yourself. When you've actually only got limited time to study, it makes your focus at those times you've got.

Sarah:

Well, that's the thing. It's about prioritising your tasks because you can't do everything. You've got to know what's important and what to do first and in what order. So, knowing when to say no to is really important. You can't be available for everybody all the time. You've got to know when enough is enough. In this world of technology, are there any particular apps you rely upon or any particular techniques you use to help you coordinate your life between your child, your work and also the running of the tattoo studio? Yeah, I mean, I don't have any specific apps, but I do use my phone diary and I do put quite a lot of notifications and reminders in there. I also have a whiteboard at home that I use where I write things weekly of upcoming tasks to do. I guess they're things in more of the outside of work situation, but yeah, just using things to help make things work for you. And everybody will have a different way of doing things. It's a bit like how everybody studies differently. Some people study well as a group. Some people study well on their own. Just find what works for you and don't compare yourself or the way you do it to others because that's when you'll get yourself into a spiral. Just because you do something one way doesn't necessarily mean it's right or wrong. As long as you're getting to the end common goal, that's really all that matters. Journey along the way is a bit different. I

Gavin:

 think that's excellent advice. Look, for my final question, I'd just like to ask you, looking at your journey along this pathway to surgical training, would you do anything different in retrospect? Would you have changed anything in any way?

Sarah:

Well, that's a tough question. Anything I would change. Look, I think for me, again, this comes down to self belief. I think it's very easy along the way to get caught up in going at a different pace to those around you and to get down on yourself to self doubt. To know that, I guess, looking back for me, for example, when I first tried to pass my primary, I was studying, I had my last textbook in my hand while I was in labour, which was silly. I should have just taken the time and gone, "Oh, hey, look, maybe this isn't my time to be trying to even pass an exam." In hindsight, I wouldn't have pushed myself so hard to try and perform to a certain unrealistic expectation that we create of ourselves. I think if I had my time again, I would have just realised that it's okay to take time. It's okay to do things for yourself and it's okay to go at a different pace to others. Just know that you don't need to ever give up or you don't need to feel that because you're doing something one way that it's wrong. Just being a bit more proud of myself for what I've ever come along the way is something I would have changed.

Gavin:

That's a great way to finish the interview. It's fantastic speaking to Dr. Sarah Gray. It's excellent to hear your journey along the path of surgical training. Thank you very much for giving your time up to do this interview today.

Sarah:

Yeah, thanks for having me, Gavin. That was really good. It's been great having a chat and I look forward to welcoming those that are listening to this podcast today to know that they can never feel like they can't reach out and ask a question. I'm always available and if I can help in any way, please don't hesitate to ask.

Gavin:

I'd like to thank you very much for listening to our podcast. I'd like to remind you that the information provided today is just for general medical advice and does not pertain to one particular medical condition or one way of treating a particular condition. If you have any concerns about information raised today, please do not hesitate to contact your general practitioner for further information. We hope you've enjoyed the podcast and please don't hesitate to give us a like or tell your friends about it or give us a positive review. We look forward to presenting another podcast to you in the near future on a different topic. Until then, stay safe. Thank you very much.