Healing with Steel – meet Dr Nikki Stamp, cardiothoracic surgeon
If you or anybody you know had surgery for a heart condition, it’s almost a certainty that the person behind the surgical mask was a man. You are going to meet someone who is pretty rare in Australia, there’s only 8 others like her. How she got there, and what she did, makes her exceptional.
Dr Nikki Stamp is one of the 9 female cardiothoracic surgeons in the Australia. Nikki, like Steel Heels, is passionate about being a role model for young women, saying, “Women and girls need strong, smart and real role models and deserve to be encouraged in to areas traditionally dominated by men”. Nikki posts her observations, experiences and tips on her blog.
Historically, there have always been more male than female doctors. In 1986, 25% of GPs and 16% of specialists were women. The gap is closing. By 2011, 43% of GPs and 34% of specialists were women.However when we delve into the 2011 data, surgeons were still predominately male. 94% of orthopaedic surgeons, 89% of vascular surgeons and 88% of cardiothoracic surgeons are men.
A 2012 study of 41 junior doctors, 27 of whom were women, were asked which specialties they would not take up, and why. 30 of the interns nominated surgery, with reasons for not wanting to pursue a surgical career being the lifestyle associated with surgery (66%), the culture within the surgical work environment (53%), a lack of interest in performing surgical work (36%), and the training requirements associated with surgery (33%). Both sexes had similar reasons for not wanting to choose a surgical career; but additionally, women referred to the male-domination of surgery, and the difficulty and inflexibility of the training program as deterrents.
Tell me a little about your background – was this your high school dream job?
As an 8 year-old, I wanted to be a heart surgeon. I wanted to finish the work of Dr Victor Chang, who was pioneering mechanical hearts and transplantation when I was small. In primary school I read anatomy textbooks so often that the teachers and librarians were concerned I was not reading age appropriate fiction. My high school dream job was to be a singer and actor. I never thought I had the aptitude to study and perform well at school so I studied music, English, French, drama. Because I wasn’t sure I could do ‘difficult’ subjects like physics, chemistry or maths, I didn’t apply myself as much as I could. My year ten maths teacher told my parents that I would never be a doctor or a lawyer because I was rubbish at maths. Turned out that was very, very wrong because I’ve now studied university level maths, chemistry and physics!
As I was considering the performing arts, my Dad (a civil engineer) insisted I get a ‘real’ degree. I considered studying accounting and business but my heart wasn’t in it. So he asked me what I would do if I could do anything and I immediately told him I wanted to be a Doctor. I then set out working out how to get into medicine without the ‘right’ subjects from high school.
How did your career start? Who influenced your decision?
I knew I wanted to be a surgeon pretty early on. I loved anatomy and doing things with my hands. I think I recognised early on that those factors really suited a surgical career.
I chose cardiac surgery after doing a rotation as a junior doctor. I was fortunate enough to work for three surgeons who were inspiring and took an interest in teaching me. I did that rotation by accident, but I loved it so much, I never left. The moment I knew I wanted to do this was when I asked a patient who had just had a lung transplant how he felt. He told me ‘You have no idea how good it feels to be able to breathe.’ And that resonated with me. It’s those inspirational mentors and inspirational patients that made me want to do this job.
Any problems you have encountered (challenges/barriers)…?
Being a surgeon is hard work, regardless of who you are. It has not been an easy pathway at all. But it has definitely been worth it. A number of people said that I could never do this. I wasn’t smart enough, I didn’t do the right subjects at school, I was a woman, and it’s too hard. I have to be honest and say that I have gotten some enjoyment and satisfaction in proving every single one of them wrong!
The recent 4 Corners episode which highlighted bullying in medicine was quite dramatic – what other barriers are there in medicine?
Unfortunately, I think that being a woman in surgery can be tricky. I often get asked if I’m the nurse or device representative and not the surgeon who has performed the surgery. It seems that society still has a very strong perception that surgeons are middle-aged men. Some days, it’s frustrating. There are still a number of people who work with me who really don’t have much respect for women, especially ones senior to them, but that is their issue, not mine.
Even as medical students, women will notice that they have to work twice as hard to gain respect from other doctors, nurses or patients. It is slowly changing as we have more women doctors but we have a long way to go. The profession has come under intense scrutiny recently for bullying and harassment and the Royal Australasian College of Surgeons (RACS) has taken some positive steps so far to manage this problem. I don’t really know any young doctors who haven’t seen or experienced bullying which is a real shame. It does make your day absolutely miserable, destroys confidence and careers and could even put patients at risk. Some of the preliminary work for the College suggests that female trainee surgeons are particularly prone to bullying and harassment which is disturbing. I’m pretty happy with how things have been managed so far by RACS and I hope that we as a profession make a positive change in this matter.
What is a typical day at the ‘office’ for you?
Most days start at 7am with a ward round of intensive care and the ward where we see all the patients who have had surgery or are waiting for surgery. The day’s operating starts at around 8am and we usually do two or three operations a day. A typical heart operation takes around 3 or 4 hours. Some more complex ones take 6 or more hours. On a good day, I leave the hospital between 6-7pm. If it’s really good, I can leave around 5pm. We are on call every few days – that’s basically code for being inseparable from your telephone in case you need to do something unexpectedly.
Things are rarely typical. Some days, we spend 24 hours or more in the hospital, operating on emergency patients. It’s can be tiring but you just need to get the job done, someone’s life depends on it.
What are some of the personal requirements required for your career?
There is this funny thing called the ‘surgical personality’, which is not a flattering term. It’s meant to describe someone who is a little bit arrogant, tenacious, confident and extroverted. I’m not sure that’s a prerequisite anymore. To be a surgeon, you do need a degree of tenacity, and a willingness to grind on when things get tough because one thing that is for sure, is that they will at some point.
There’s a lot of standing and physical work and it helps to be healthy yourself. You also need to have good dexterity. But being keen and willing to learn will get you a long way.
What are the educational requirements needed to become a cardiothoracic surgeon?
Once you complete a medical degree, all doctors start as interns which is the first year after your complete medical school. From here, you move up to be a resident where you start to stream into areas you’re interested in. A registrar is a doctor who is streaming into a particular specialty area like surgery.
Surgical training in Australia and New Zealand is managed by the Royal Australasian College of Surgeons. Junior doctors apply to the College to get accepted onto a surgical training program in one of the nine surgical specialties. It’s very competitive – some years, only three doctors get selected for the whole of Australia & New Zealand! Surgical training takes around 5-6 years, depending on the specialty. There are a number of exams during training, culminating in one big and important one at the end of training. At the end of training, you are awarded a qualification of Fellow of the Royal Australasian College of Surgeons (FRACS). All in all, it takes around 8-10 years after medical school to qualify as a specialist. It is a pretty long and hard road. The day that I passed my final specialist exam was one of the best days of my life!
Are there any reasons women may not be able to engage in a career as a cardiothoracic surgeon?
Absolutely not. We desperately need more women surgeons so go for it!
Have you ever had a moment of hesitation – the thought “Why am I doing this? Is it really what I love?”
Most definitely. I had some tough times during my training and I came close to quitting at the end of my penultimate year of training. I reflected on why I was feeling that way and I’m glad that I did, because it can be difficult to see light at the end of the tunnel. It would have been terrible if I had made a quick decision based on one bad time.
Who was your role model when you were growing up?
That is a tough question! Especially considering my childhood career aspirations are very different to what I’ve actually done! My parents have always been role models for me. They’re both determined, hard-working and moral people who taught me that I can achieve great things if I put my mind to it and did the work. My dad certainly raised me to be a feminist. I think he got more than he bargained for! I’ve also had a number of mentors over the years and I’ve taken away lots of good points from all of them. Interestingly, most of my mentors have been men. That’s surgery for you.
How have your experiences shaped you? What were some of the greatest lessons learnt?
The difficult times have shaped me the most. I worked hard to get better and regain my life and my career. As tough as it was, I’m glad that I had the opportunity to remind myself that I am resilient. It also taught me a huge lesson about the importance of work-life balance and self-care.
What would you do differently in your life knowing earlier what you know now?
I definitely would have paid more attention in maths! And realised that I could actually do the ‘hard’ subjects. Other than that, even though I didn’t take the usual pathway to get where I am, I wouldn’t change a thing. It’s all shaped me to who I am today.
What are your future plans?
I’m going to head overseas to North America to gain some new skills and see how their hospitals work, especially for heart and lung transplantation. I’ll also keep up with medical education by teaching and examining junior surgeons. I love teaching because it keeps me sharp and I really enjoy being able to help someone else learn.
I volunteer this year for Operation Open Heart. They do overseas trips to developing countries in the Pacific and Africa to perform heart surgery on children and adults. I was in Fiji recently and it was such an amazing, rewarding experience. I can’t wait to be a play a further role with them in the future.
What advice would you give for other women considering a career as a surgeon?
Work hard and go for it. It won’t be smooth sailing, but if you really love it, it will be its own reward. And keep a toothbrush in your locker.
What do you feel needs to be done in order to see an increase in females pursuing careers in surgery?
It’s important to mentor young women into surgery. It’s somewhat unchartered territory still and it’s lovely to give advice from the lessons we have already learned. It’s important for women surgeons to be more visible as mentors, as clinicians and in leadership positions in surgery to say to the younger generation ‘I’ve done it so you can too!’.
We also need to address some of the main obstacles for women entering a surgical career which includes looking at ways to offer interrupted and part time training (especially if a family factors into their plans) and by continuing to stamp out bullying and harassment.
What advice would you give to women starting their careers?
Women in professions should be themselves. What you have is what makes you different and an asset. And being yourself is how you get the best out of you. I love this quote from the film Working Girl – “You’re the first woman I’ve seen at one of these things that dresses like a woman, not like a woman thinks a man would dress if he was a woman.”
Other than that – I say go for it! Work hard, learn a lot and kick ass.
Steel Heels note:
A recurring theme in the interviews in this series so far: there are doubters out there – who seem to enjoy telling people why they can’t – rather than supporting and encouraging them. All interviewees have thumbed their noses at them. The message being to have faith in your abilities and capabilities; and not measure yourself by the standards of other people.
 4102.0 – Australian Social Trends, April 2013 – Doctors and Nurses
 What junior doctors think about choosing a surgical career http://www98.griffith.edu.au/dspace/bitstream/handle/10072/47209/79288_1.pdf?sequence=1