Breaking Through Barriers

In late 2007, Dr. O announced that he would step down as chief. This suddenly provided me with an opportunity to advance my career.

When I was a nurse, I envisioned becoming a physician and so returned to college to prepare. When I became a physician, I envisioned becoming an administrator and so prepared by earning my Certified Physician Executive (CPE) degree. Throughout my career, I continued to take courses to build my resume so I would be ready if or when an opportunity arrived. Simply waiting for an opportunity isn’t enough; it’s important to believe that a different future is possible and to prepare for it.

Essayist Henry David Thoreau was right: “Go confidently in the direction of your dreams. Live the life you have imagined.” The envisioning part is especially important because there are so few women role models or mentors and plenty of male naysayers, as was evident during much of my career. Luckily, some men believed in me. It is always easier if a woman has already achieved the goal you seek because it is a clear sign that success is possible. Although some positions I wanted had never been held by a woman, I was not dissuaded from trying for them. Along the way, I was occasionally disheartened but never defeated. If you can’t be the next, be the first.

I didn’t start out thinking I would be a physician leader. I slowly built up my practice, forging relationships with other physicians and gaining confidence in my abilities. Eventually, I began to consider positions other than direct patient care. The fact that all those jobs were held by men did not dissuade me from applying. The only way to expand the field is to get into the game, and I’m proof that it can pay off.

I had imagined one day becoming chief. Suddenly, the possibility presented itself. In the past, I had witnessed promotions given to favorites or, as happens too often, given to those who remind the boss of his younger self. Women do not generally remind men of their younger selves, so that is an obvious problem. In this case, I knew that I needed to advocate for myself. As the senior member of the group, I had already assumed some of Dr. O’s responsibilities. However, I didn’t want to simply assume I would be given the job though Dr. O recommended me for the position.

I applied and waited for months while Unity conducted a nationwide search. In December 2007, I was proud to have been chosen as the next chief of cardiology at Unity Hospital. “We are fortunate to have a cardiologist and physician of Dr. Thomas’s caliber assume this important role. She is a highly respected cardiologist in Rochester,” announced James M. Haley, MD, chair of the department of medicine at Unity.

I was honored and humbled to be chosen and confident that I had truly earned it. I also knew that luck played a role — I was at the right place at the right time. I was the first woman in New York state to become chief and one of the few female cardiologists in the nation to reach the top position in their departments; I knew only of Dr. Pamela Douglas at Duke University and Dr. Nanette Wenger at Emory University. I was close with Dr. O, who made me aware of the chief’s stipend. I was not going to accept a lesser stipend, so I asked for and received the same amount. Later, as the demands of the position increased, I asked for and received an increase.

On my first day, I stepped into my new office with excitement and a slight twinge of anxiety. The nameplate on the door said Dr. Joan Thomas, Chief of Cardiology. I took a few seconds to remind myself that I was here not only due to my own efforts but those of Blackwell and all the women who had bravely built the rungs on my ladder. I knew that if I looked up at my office ceiling, I would see spongy white tiles and that if I looked down at the floor, I would see vinyl flooring. But on this day, I saw something different. Above me, I imagined the hole I had punched in the glass ceiling. Below me, I imagined jagged shards of glass that had at times wounded me but never defeated me. I set down my coffee mug and got to work.

As expected, the chief’s job was demanding. I was given one-half day each week to focus on my administrative duties, but that, of course, was not enough time to accomplish everything that needed to get done, even though I became more efficient as time went on. But my hours were still long, and I continued to take my regular turn on the call schedule. Bud was patient though our dinners at home were pushed even later. Medicine puts a damper on the personal side of life, but we accept that when we enter the profession. Fortunately, the call schedule became less onerous later in my career as advances in medicine meant that cardiologists needed to make fewer late-night trips into the hospital.

Unfortunately, there is no indication in medical school or during residency that someday you may need administrative skills. I had a mind full of facts from medical school and much clinical experience from my practice, but I had no administrative training. Now, in addition to seeing patients and doing clinical rotations and on-call shifts, I had to attend many meetings, collaborate with other departments, outline a strategy for department growth and innovative research, respond to numerous emails and phone calls, and handle a myriad of human resource issues including recruitment, retention, and performance.

Excerpted from The Heart of the Story: My Improbable Journey as a Cardiologist , by Joan L. Thomas, MD, CPE, FACC.