Breaking Barriers, Shattering Glass: Women in Medicine Month

As the only academic medical center in the region, the mission of UC San Diego Health is to deliver outstanding patient care through commitment to the community, groundbreaking research and inspired teaching. In this Q&A, three inspiring women physicians share their personal experiences in the field that reflect the vision of the hospital system and highlight the inspirational path they have carved for themselves and the next generation of doctors.

What inspired you to go into medicine and what are you most proud of from your experiences in the field?

Diane M. Simeone, MD, director, Moores Cancer Center at UC San Diego Health

I grew up in a tightly knit family in the seaside town of North Kingstown, Rhode Island, with four other siblings. It’s a town of around 30,000 people. My father was the chair of economics at Providence College and my mom was initially a homemaker, but later went back to get her degree as a nutritionist. Education was always a priority in our family.

I’ve always been fascinated by the inner workings of human biology and knew I wanted to pursue a career in health or medicine, but I was also an athlete — my other passion was basketball. I helped lead my high school basketball team to win the state championship and was later inducted into the Rhode Island Heritage Hall of Fame. Being an active participant in sports was important for learning how to work with a team through thick and thin and set high standards for what we wanted to accomplish.

I continued to play basketball while studying neuroscience at Brown University, but I ultimately knew I wanted to become a physician. Being a doctor is a wonderful marriage of understanding how things work, but also advancing new treatments and approaches to help people get better.

I was passionate about studying pancreatic cancer because it is a tough, unsolved problem that has not had enough attention or investment. When I was a surgical resident, it struck me as an area that was a significant unmet need. It was an almost uniformly lethal disease. Most patients had advanced disease at the time of diagnosis, and the number of patients we could help surgically was low. Even the minority of patient cases where we were able to surgically remove the tumor, had a high recurrence rate. I was an energetic young physician at the time, and I felt I could make a difference.

I am incredibly proud that my career has led me to be the director of Moores Cancer Center at UC San Diego Health, the region’s only NCI-designated Comprehensive Cancer Center. It is among the top 4% of approximately 1,500 cancer centers in the United States, and one of only 57 Comprehensive Cancer Centers in the nation.

The opportunity to be able to help guide clinical and scientific innovation, increase access to early therapeutics through clinical trials and train the next generation of clinicians and researchers is a lifetime opportunity. We want to build upon these strengths to create and test the next generation of novel therapeutics to treat cancer in more effective ways. We are expanding our clinical trial operations to do this faster and better and offer clinical trials at multiple sites across our community.

I want our cancer program to serve as a model for how to implement strategies for early detection and prevention.

Crystal Wiley Cené, MD, MPH, chief administrative officer for health justice, equity, diversity and inclusion (JEDI) at UC San Diego Health

I’ve wanted to be a doctor since I was in third grade. I think I came to this decision because of several experiences I had in my childhood. 

I was raised by my grandfather who had a lot of serious, chronic medical conditions, so I saw the toll that had on him and the entire family, and I wanted to do something to prevent other kids/families from having to go through this experience. That time in my life instilled a deep sense of empathy and compassion that I always try to lead with in my personal and professional life.

My mother went to nursing school during my upper elementary/early middle school days, and I would go with her to the hospital. I was drawn to the sense of duty and the compassion that I saw exhibited by my mom and her nurse colleagues and witnessed first-hand the empathy and compassion shown from health care professionals, specifically nurses.

I got exposure to medicine while in high school. I worked at a doctor’s office, the only black OB/GYN in my town. I filed and prepared charts for patients’ upcoming visits.

The doctor I worked for was not only a physician, but a community leader and activist. He mentored and encouraged me. He helped me to catalyze my innate sense of empathy and compassion for individuals and families experiencing chronic illness. He helped me believe that I had the intelligence and skills to be successful.

Cynthia Gyamfi-Bannerman, MD, MS, chair for the Department of Obstetrics, Gynecology, and Reproductive Sciences at UC San Diego School of Medicine and perinatologist at UC San Diego Health

My father positively inspired me to go into medicine. I observed his career from the time I was a young child, listening to his nightly phone calls from someone referred to as a “resident,” who would present a case while our family gathered around the dinner table.

My father’s approach to science and medicine as a transplant anesthesiologist at the University of Miami was truly inspirational, and it was incredible to witness the respect he received from his colleagues and trainees. Everyone in the operating room just loved working with him. He embodied, for me, the idea that kindness goes a long way in medicine, as well as in life.

What brings me the most pride is the list of mentees I’ve supported and the people I’ve been able to inspire in this field. I still keep in touch with medical students, residents and fellows that I worked with as a junior faculty member, many of whom are now division chiefs and vice chairs at some of the world’s most prestigious universities. It warms my heart to know that I’ve touched the lives and careers of so many individuals who are now making a difference in medicine and a positive impact on the lives of patients.

What challenges have you faced in your career and what advice would you give to other women aspiring to follow on the same path?

Simeone: While on a rotation in medical school, I was exposed to surgery, and it was the perfect fit for me. So, I decided to apply for residency in general surgery, however, back then, women were not strongly supported in that field.

I had surgical residents tell me, “Although you are fully capable of doing it, it would be too hard of a life for you as a woman to be a surgeon.” I decided to ignore them. I didn’t think someone else should set boundaries for what I could accomplish.

I have relished the opportunity to pursue my career passion to meld clinical care and research, to improve paradigms for how we treat, detection and prevent cancer.

When I did encounter obstacles along the way, I found that persistence and belief in one’s own abilities were critical in navigating to accomplish your goals, along with the support of a mentorship team who had your best interests at heart.  As my career evolved, I have made sure to create environments where all members of my team have equal opportunity to succeed and thrive.

To create an equal playing field, change needs to come from the top. In environments where there are women leaders, there is usually more equity and opportunity for all. I have been so impressed with UC San Diego Health in this regard. It is far advanced in the diversity of its leadership compared to many peer institutions.

Cene: I faced a few profound challenges that have made me the person and physician I am today.

I felt true disappointment when I did not get into medical school the first time I applied. However, I got a full, four-year scholarship the next time I applied. This experience helped me to understand the importance of timing, persistence and maintaining a belief in oneself despite obstacles.

I have experienced others trying to pigeon holed me into what they think I should or should not do or be. One of the biggest pieces of advice I would give others is to identify and stay clear on who you are and what you want to do and contribute to the world. Don’t take a “no” from others who really aren’t empowered to give you a “yes” in the first place.

Over my career, I have had moments of not receiving the respect of other leaders because of others’ expectations of how women leaders should talk, act, etc. I have experienced people feeling like they can interrupt me or calling me by my first name versus Dr. Cene while they will call others by their title.

It is important to stay true to who you are. To be authentic and not change who you are for other people. Being myself and remaining humble yet approachable has served me well throughout my career. I lead by compassion and humanism.

I would say, however, that while it is important to be authentic, it is also good to understand where and how your personal characteristics or defaults might be making you less effective or going against your goals and then make the necessary changes to better align.

Gyamfi-Bannerman: A lesson that my parents reinforced for me from a young age is that my intellectual abilities would be underestimated in life because of my demographics. Whether factual or just an excellent parenting technique, it resulted in my constant desire to be the best at what I do. Further, my sense of accomplishment has always been short-lived; I’m always considering my next step as I reach for the proverbial subsequent goal.

My medical school and residency training introduced me to clinical research in obstetrics, so I chose my post-fellowship training faculty position in an institution and department where clinical trials flourished. Early in my time at Columbia University, it became clear to me that I needed additional training to become a true clinical trialist. Despite contrary advice from some of my mentors at the time, I advocated for myself to get a Master’s Degree in Biostatistics in the Clinical Research Methods Track. As a junior faculty member, this additional education gave me the tools to become a clinician scientist.

I have now designed several clinical trials, all of which have been published in top specialty and subspecialty journals, including the New England Journal of Medicine and JAMA, identifying novel treatment strategies that have impacted numerous lives and changed obstetric practice. I don’t think this would have happened had I not pursued my master’s degree.

What I would say to women aspiring to follow my path is that paramount to your success is a firm belief in yourself. Include multiple mentors and partner with people who have your best interest in heart. Your success is aided by building up your toolkit, helping people along the way, and thanking those who have helped you. Even in a field that is dominated by women, there are times when there is an assumption that one doesn’t carry their true worth. It’s nice to be able to lead on and utilize expertise rooted in evidence-based data, as well as credentials. This helps with imposter syndrome, which is so common in women entering leadership positions.

How have you seen the medical field and opportunities evolve since you went to medical school?

Simeone: The medical field has evolved significantly since I started my training. There has been an explosion of information and many ways in which one can develop and define their career.

The field is becoming more inclusive of diversity, even in what has been considered traditionally more “male-centric” specialties. We are not quite where we need to be yet, where senior leadership opportunities are shared equally between men and women. For example, only 7% of directors of comprehensive cancer centers in the United States are women. In this position, I hope to provide mentorship and advocacy to mitigate this imbalance.

Cene: I have seen more appreciation for and concrete steps to diversify the face of leadership within medicine, including more diversity (especially by gender and race/ethnicity) in specialties and sub-specialties that have traditionally been held by cis-gendered white men.

At the same time, I think we still have a ways to go, especially for certain groups.

Gyamfi-Bannerman: Medical school today is completely different than medical school 30 years ago. The way people learn is different, too. Now medical students are learning by case-based instruction and using multi-modal techniques. We’re also looking at artificial intelligence (AI) and different models of training as we reassess and modernize our medical schools.

One of the interesting evolutions that I’ve observed is that the medical field has evolved away from being disease-focused and toward being patient-focused, which I believe is a good thing. Patient-centered care reminds us of why we do what we do, from bench to bedside.

Has there been a past patient interaction that impacted how you practice medicine?

Simeone: I have been shaped by the interactions of many patients over the years, and they have certainly guided how I practice medicine.

As a surgeon, you realize the incredible trust patients put in your hands and the importance of ensuring that you are always focused, do your best and ensure your team functions well together. As an oncologist taking care of a highly lethal disease (pancreatic cancer), where you can see a patient and their family’s world get turned upside down overnight, it has taught me to value every single day and not to take things for granted.

I have also realized that patients count on us to provide high-quality, compassionate care and develop new advances, more effective therapies, less invasive and costly screening strategies and ways to lengthen the quantity and quality of life. It is a privilege to work every day with that mission.

Cene: It is hard to think of just one impactful patient experience as there have been so many. Part of the reason I went into primary care is because I love and value having longitudinal relationships with patients and their families.

I’ve been shaped in various and sundry ways by several of my patients over the years since I started residency (in 2002). I will always remember one patient interaction when I was a resident, when an older white female patient I was taking care of in the intensive care unit told me about a child that she had with a Black man.

Because this was during the time of segregation and her family did not support inter-racial relationships, she gave the child up and never saw them again. She had always carried the guilt and shame of that decision. She stated that I was the only person she had ever told (outside of her parents) about what she did.

I still remember the relief on her face from the grief and shame that she had carried for more than 30 years when I told her that it was not her fault. The decision was made by her parents and she did the best she could at the time. I explained to her that this was an example of how racism hurts everyone.

Gyamfi-Bannerman: There have been so many that I will never forget, but there is one that stands out due to her blatant mistrust of the health care system and our ability to regain her trust. She was an African American patient of mine while I was working in New York City. She originally had envisioned midwifery care, but it became clear early on that her delivery would need to be by cesarean. At each prenatal visit, she’d come prepared with a list of clinical questions but seemed skeptical at each of my responses. To help with this skepticism, I offered that she join one of the monthly hospital tours to become familiar with the inpatient setting. When the pre-specified times did not work with her schedule, I offered a personal tour on my next weekend in-house call. I showed her around the hospital and introduced her to all the nurses and residents. During this tour, I could see the walls she had built up starting to melt away.

Afterwards, she said that she was shocked to observe how well I was treated in the hospital as an African American physician, and the tour gave her the opportunity to open up with me about her fears with the health care system and with her impending delivery. We bonded through that experience. About a year after her beautiful baby was born, she came and participated in an ethics panel for our hospital about the patient experience and about how building trust between provider and patient is so important; it was a really lovely interaction.

I learned that going out of my way to earn this patient’s trust ultimately changed the entire trajectory of her experience.

How can universities, medical schools and hospitals create environments that promote respect, fairness, equity, and work-life integration for women?

Simeone: The most effective environment creates an even playing field for trainees, staff and faculty to thrive and advance based on their contributions and accomplishments. There has been an increased appreciation of some inherent biases in deciding who should be granted such opportunities.

Ideally, you want an environment where everyone is empowered to reach their full potential. It has been refreshing to see over time the recognition that we all benefit from working in an environment that promotes work-life balance and that this is not just a woman issue. The winning formula is putting processes in place to create the proper environment, assessing how well it works and adjusting based on feedback.

Cene: Organizational leadership must be intentional and the process must be continual.

Women need to be invited to share what they need and there needs to be a desire to listen to them. And not listening to respond, but listening to truly hear and then include them in decision-making.

There needs to be an offering of professional and leadership development opportunities for women, including mentorship programs, coaching, etc.

Data needs to be tracked and leaders need to be held accountable for how they are supporting and promoting women.

Gyamfi-Bannerman: Most OB/GYN faculty are women — with 80% female and 20% male, nationwide. However, the majority of OB/GYN department chairs are male. Outdated, traditional gender-specific roles dictate that men focus on their jobs while women multitask, an ability that actually serves women well in leadership roles.

As time goes on, I’ve witnessed a remarkable shift in what is considered appropriate as it relates to wellness and work-life integration, even with specialty and subspecialty meetings. Gone are the days of exotic meetings in hard to reach locations that mandate time away from family. These have been replaced with meetings in easily accessible locations with childcare and breastfeeding space as the norm.

Work-life balance is a focus for women leaders because we live it every day.  While my work as a department chair can be laborious and demanding, I always make sure to carve out time for my children and family, though my children still express surprise when they see me without a computer on my lap.

Our department’s mission is to treat everyone equitably and fairly. This not only includes our patients and community, but also includes our faculty, staff, trainees, students and administrators. Unifying this goal is our desire to provide the best, leading-edge and evidence-based health care to our community and region both clinically and through education and research.

In September 2020, in recognition of our mission and goals, the Department of Obstetrics, Gynecology, and Reproductive Services established the Culture and Justice Quorum to ensure that the care we provide is inclusive and our department is a place where everyone can thrive. I hope that everyone who interacts with our department — from our own team to the patients we serve — feels welcomed, heard and respected. For me, that is what it is all about.