What attracted you to medicine in general and dermatology specifically?

Susan Weinkle, MD: I think my original fixation with being a physician was because I watched my grandfather in the hospital. He was repeatedly in the hospital and I used to go see him, and I was inspired that—it seemed to me—the doctors had a really good job.

My grandmother would say, “No, Susan, girls are nurses.” I thought, “I don't think so, Granny, I think it looks like the doctor has a really good job here.”

Then when I was a first-year medical student I read Denton Cooley's book Hearts and I dreamed of being a cardiac surgeon with Mike DeBakey and Denton Cooley in Texas. However, I had not yet encountered the general surgeons. And back in those days there were very few women surgeons or in medical school and they were not very supportive, and so I knew I wanted to be some sort of surgeon but to be a plastic surgeon I had to do five years of general surgery, which I couldn't do, I just decided. It wasn't something that was going to make me a happy person. And then dermatology seemed to be a happy specialty—and surgical. It was blossoming at the right time for me.

Allison Weinkle, MD: Once my brother was out of the house at college, we would have Sunday meetings—dinner/meetings—planning my future career. A lot of it was founded in the fact that I wanted to do something completely different; not medicine at all. I got into a good college, I was studying really hard, and I fell in love with neuroscience. I started doing some research in that and realized that I needed to interact with people—I couldn't be “a lab rat” exclusively.

I got into medical school and knowing what my parents did, I had a good foundation of what it is to be a doctor. Once in medical school, I was experimenting with all the different specialties, doing my different rotations and found that I really loved surgery but didn't think I could necessarily keep up with the lifestyle. Knowing that I wanted to have kids in the future, when I started doing rotations in dermatology I realized it had everything that I had loved—I studied art history and architecture in high school—and I could do surgery. It's aesthetically pleasing, and you have continuity with patients. I realized that all the things that I needed were right there in the specialty of dermatology the whole time.

What do you think makes dermatology attractive to women? Has the “flexibility” of the specialty been over-romanticized or over-stated?

Allison Weinkle, MD: Even other physicians under-estimate the time that goes into becoming a dermatologist, and this could derive from misperceptions in residency. The amount of time that goes into studying the field of dermatology outside the clinic is tremendous, and I think it's underestimated by a lot. I've talked with my husband about family planning and it's not easy to have children during residency; it's a commitment. And, I think it's taken for granted.

Susan Weinkle, MD: I think dermatology offers a more controllable lifestyle than many other aspects of medicine and healthcare. But I do think women still need to recognize they cannot be their mother and their father. Meaning, when Allison was growing up and I was working so hard, we had to have help to do the whole project. I couldn't always go to the grocery store. I had to have a village to help because, even though it is a more controllable lifestyle, it can be a very hard, intense, long working day. And I feel like it's so important for women to recognize they can't do everything. They have to learn to delegate, and they have to appreciate they have to have help.

There is some sentiment that men and women may approach management differently, negotiate differently, delegate differently. Do you think there's any truth to that? What advice would you give those looking to be more effective communicators, delegators, negotiators?

Allison Weinkle, MD: I've seen both of my parents and the way that they manage their offices. They're both in private practice—solo practitioners—and there's definite variability in how females and males communicate in the workplace, not only on the day-to-day but also in terms of contract negotiation. It's a different style. Both can be successful, and both can be unsuccessful. I think women tend to be sometimes more like friends with their staff, which can sometimes complicate things, but also result in having employees for 20, 30 years, when it goes well. A practice where you have a more distant management style might be a little smoother on the day-to-day, not have the ups and downs, but you wouldn't have the same connectedness within the office.

Separately, I have many resident colleagues right now trying to negotiate their contracts. It's the first time they're doing this. And if you're a female interviewing at an all-male practice, you may feel very intimidated and really not able to negotiate. Perhaps we're under-trained in this.

Susan Weinkle, MD: I think that was exactly right. I have had the same nurse practitioner for 30 years. People never leave in my office, it seems. So when women have sometimes emotional strains, you feel those, whereas my husband wouldn't necessarily feel that because he's not as close, he's more distant.

On the other hand, I think we need to help nurture and develop the skills in our female colleagues to be appropriate at negotiating. Women tend to be afraid to ask. You don't ask, you don't get.

Allison Weinkle, MD: I think, unfortunately, one thing that is a negative for women in medicine is that they tend to be such high achievers and are used to having to fight for it. So sometimes they fight each other for it, and, you know, women who are still climbing are not necessarily pulling up those around them.

Certainly some of those who have achieved the most have also helped the most, but there are amazing women all over the country fighting for the same spots.

Susan Weinkle, MD: There's a lot more competition now than there used to be, for women in particular. Back then, I was competing against the men. Because there are so many more women applying, the competition among them is much greater.

Looking at each other's experiences, do you see generational differences?

Allison Weinkle, MD: Just from what I've heard from my mother, my experience has been drastically, just inexplicably different. She has horror stories from her experience in general surgery. I chose to do my internship in general surgery and I don't think I was genuinely, personally offended for being a female. I can't even remember one incident that made me feel uncomfortable as female in general surgery internship.

Susan Weinkle, MD: I think it could have been institutionally variable, because I was a medical student in the University of Florida where things were very challenging to women. Then I went to Stanford for my internship and residency and that was quite a different environment. So, it may have been also different locations as well as different times.

We also have to look at the number of women in academic chairmanships in the country. That speaks for itself, for the fact that women are still somewhat having to break the glass ceiling.

In private practice, I can make as much money and work as hard as I want to work. What I bill, what I get from Medicare or insurance or self-pay patients in private practice doesn't matter if I'm a male or a female. I think unfortunately, the academic environment is still evolving.

Allison Weinkle, MD: I was in a Women in Neuroscience meeting when I was in college and I remember someone saying, “Women are doing great, but the numbers that are actually at those top positions aren't very high.” I think partially it's because women choose to have families and then they kind of slow down a little bit. So that they kind of get to that near-peak position but not the top and I think that's definitely prevalent.

What challenges do you see for younger physicians, especially women, starting in dermatology?

Susan Weinkle, MD: Residents are not trained in running a business. And running an office, in private practice, is running a business. I don't think we have even a fraction of a focus on how to manage efficiently, effectively. My husband and I went to 48 years of school between us. Neither one of us ever took a business course, in any way. And no one ever talked about how to run a business. And so, I think that's been a very challenging part of medicine for men and women to look at.

Allison Weinkle, MD: I think there is a problem in the perception that dermatology will be such a relaxed lifestyle. The number of dermatology residency positions is incredibly tight, and if half of the residents going in think, “Oh it's going to be so easy, I'm only going to work three days a week,” then I think we may have a shortage.