Standing My Ground: Memoir of a Woman Physician

Based on the title of this book, Standing My Ground: Memoir of a Woman Physician, I expected a description of the challenges facing women in medicine in the mid to late 1900s. Rather than that, the book describes the remarkable accomplishments of a woman who had completed her medical training in Dublin in 1963, in spite of the constraints posed by being a full-time homemaker and mother.

Claire Callan describes herself as reluctant to enter the field of anesthesiology. Her mother was an anesthesiologist and while able to financially provide for her growing family, Dr. Callan remembers her as being constantly on call and frequently unavailable for family dinners and events. It was only during her internship that Dr. Callan found herself increasingly “drawn” to anesthesiology and applied for a residency in the specialty. In many ways, the course of her training and early adulthood were determined by her children and her husband’s professional development. Several months after beginning training in Ireland, she moved with her husband to Connecticut so that he could further his career as a psychiatrist. Once in the United States, they moved several times with their growing family. Eager to re-engage in medicine, she worked as a medical director at a summer camp once her oldest child was 3 yr old. For a period of time after that, she worked as a part-time physician at Connecticut Valley Hospital. Seeking greater opportunities, she obtained her license to practice medicine in Connecticut in 1969 and then took a position as an anesthesiologist in North Hartford, Connecticut. The hours were long and unwilling to make the same choices as her mother, she chose to leave the position to spend more time with her family. Shortly after making this decision, her husband was drafted and they moved again, this time to Missouri. Dr. Callan attributes the early development of her leadership skills to her experiences during her early adulthood when she was a volunteer in many community organizations and had to adapt to several different living and work situations, exercises that allowed her to become increasingly confident as she managed each issue that developed.

Dr. Callan’s first foray into organized medicine occurred after they moved back to Connecticut from Missouri and she became a delegate of the Auxiliary of the American Medical Association. This role taught her that much could be achieved with a small staff—a lesson to which she would refer on several occasions in the future. With increasing exposure to the leadership opportunities provided by this and other volunteer activities, Dr. Callan became increasingly comfortable in management and began to seek out opportunities that would allow her to make a difference.

Dr. Callan’s first professional leadership opportunity came when she obtained a part-time position reviewing claims for Medicaid patients at the Department of Income Maintenance (DIM) of the State of Connecticut. With this, she became one of a small group of people responsible for reviewing the eligibility of applicants to Medicaid. In this role, she also reviewed the practices of physicians accused of submitting fraudulent charges to the state and developed a reputation as a principled reviewer. Just months after beginning her work at the DIM, Dr. Callan became its Medical Director and was responsible for several new programs that are now well established. These programs included the introduction of an electronic payment system for Medicaid claims and the implementation of a gatekeeper system designed to decrease medical costs by requiring Medicaid recipients to see a general practitioner before they could see a specialist. With changes in the politics of Connecticut, funding for the DIM and its programs was decreased and, with that, leadership was changed. Dr. Callan left the DIM and was free to seek other leadership opportunities—of which she has had many, including President elect of the Institute of Medicine of Chicago, Chief Executive Officer and Founder of Millfield Press, Vice President of the American College of Physician Executives, Board Member of the American College of Medical Quality, Vice President of Science, Quality and Public Health of the American Medical Association, President of the Illinois State Medical Society, President of the American Medical Women’s Association, and Vice President of Medical and Regulatory Affairs and Advance Research of Abbott Laboratories.

Rather than being gender specific, Dr. Callan’s experience is largely applicable to both men and women who have aspirational goals and the motivation to seek opportunities to advance. There are frequent pearls of advice throughout the book such as

• The importance of volunteerism

• Working effectively with a small staff

• Meeting at least three people at each meeting attended and making significant contact with them as a means of networking

• A job can be taken away, regardless of how qualified an employee is

• Monitoring a work environment for change to be able to leave on one’s own terms.

Her experience, though, was not free of discrimination. While providing anesthesia for patients receiving electroconvulsive therapy, the nature of her part-time work was changed, and the male leadership of the department assigned the women members of the staff to cover the services deemed to be less desirable, obstetrics, and the electroconvulsive therapy unit. Although the female staff protested, the staffing was not changed, and Dr. Callan stepped down from her position. Many years later, while on the board of the American Medical Association as the interim Vice President for Scientific Affairs, her male peers had brass nameplates and Dr. Callan had a paper nameplate. For anyone who has not been the focus of discrimination, this vignette may seem petty; for anyone who has lived with discrimination in her day-to-day work experience, it will affirm the sense of having been treated unfairly.

Although the book is an impressive recounting of an individual’s accomplishments, the timeline in the initial portions of the book can be difficult to follow; there are rare errors in terminology that will be noticed by the practicing anesthesiologist; especially toward the end of the text, there is an unfortunate tendency to focus on the shortcomings of the people who had been promoted over her. Standing My Ground: Memoir of a Woman Physician provides an opportunity to glimpse some of the challenges and accomplishments of one of the early pioneers in medicine. The activity at the American Medical Women’s Association meeting in 1985,¹  when Dr. Callan completed her role as President, included contract negotiation workshops, handling dual-physician-couple problems, malpractice issues, and sexual misconduct as an ethical issue. Resolutions passed by the House at that time included recommendations that the American Medical Women’s Association work to eliminate discrimination against lesbian physicians and patients and to support human rights bills and equal rights for all and that further educational efforts and ordinances be enacted against smoking to curb the growing incidence of lung cancer in women. The inaugural address of the incoming president, Constance Battle, “included comments on agreeing to disagree, becoming the best we can be, and taking courage to move boldly forward.”¹  All seem pertinent even now, 30 yr later, and serve as a reminder of the work that still remains to be done to achieve gender equality in anesthesiology, where 37% of anesthesia residency applicants are women,²  13% of departmental chairs are women,³  and fewer than 3% of our society presidents have been women.