A Family Affair: Mother-Daughter Surgeons Reflect on Relationships and the Changing Face of Surgery

The demographics of surgeons are changing. Whereas surgery was once a field almost entirely dominated by men, today women represent a growing part of the surgical workforce. And that growth makes possible a relationship that would have been difficult to find within the field not long ago—mothers and daughters who both are active or aspiring surgeons. This unique, relatively new professional and personal relationship is one that five pairs of skilled, trailblazing women reflect upon in this article.

Drs. Debra Ford and Courtney Ford

Despite the challenges that women and people of color face when they decide to become involved in surgery, determination to achieve goals and support from family can help clear obstacles. Debra Ford, MD, FACS, associate professor of surgery and colon and rectal surgery, Howard University Hospital, and senior associate dean for academic affairs, Howard University College of Medicine, Washington, DC, and her daughter Courtney Ford, MD, postgraduate year (PGY)-1 resident in obstetrics and gynecology (OB/GYN), MedStar Georgetown University Hospital, Washington, DC, spoke about the challenges and their relationship.

“‘Do what you’re supposed to do.’ This is a family motto around the home,” the elder Dr. Ford said, noting that her husband and the younger Dr. Ford’s father also is a physician. Dr. Ford says the best advice she gave her daughter was to be herself and to work hard—and recognize that with effort, she could achieve success in her field no matter what.

“I would say to Courtney, ‘Excellence of performance transcends all barriers created by men,’” the elder Dr. Ford said, borrowing a phrase from Charles R. Drew, MD, FACS. “As a woman and an African-American woman in medicine, there are all of these outside factors that may impact success. However, you need to look beyond all of that, do your best, and you can perform like you know you are able.”

The supportive words and actions from her mother have been apparent to the younger Dr. Ford since she was a child. Even as a busy surgeon, the elder Dr. Ford made time to be with her. “When people think about women in surgery and about having a surgeon as a parent, a lot of them think their children would never see them, but I didn’t experience that,” Dr. Courtney Ford said. “[My mother] came to every sports game, every science fair. I saw that it was possible for someone in medicine also to be a great parent.”

Much of their time spent together allowed the younger Dr. Ford to see what the realities of being a woman in medicine were like before beginning her medical education and training. “When my mom was on call at the hospital, I would hang around there. I got a perspective on medicine from an early age that most people don’t get,” she said. “I saw how hard the work was. Sometimes you’re up all night, and you need to take trauma calls or respond to trauma codes. But I also saw that you can do everything you want to do if you set your mind to it. I feel like I got something from that experience that I’ve taken going into being an OB/GYN.”

The elder Dr. Ford is well-acquainted with meeting and exceeding the challenges that come with being a female person of color in surgery. In 1995, she became the first Black woman to be board certified in colorectal surgery in the US and has used what she learned from that achievement to help her daughter and others find success.

“Being a trailblazer has kept me focused on doing the best that I can and being someone who is mentoring and bringing others along,” the elder Dr. Ford said. “There are so many people I’ve been able to guide, including my daughter, into the field of surgery, and I’m very proud of that.”

And the younger Dr. Ford has benefited greatly from having a mother so familiar with the profession she is just entering. “One thing that is great, is that I can go into work at 5:00 am, and I call [my mom], and we talk about our days and things I’m excited about,” she said. “She gives me advice all the time about navigating the world of medicine. Going from being a medical student and intern into the work environment [as a resident] is a different experience, but being able to talk with someone I’m so close with, who has experienced that and gone through all of the different stages, is invaluable.”

Drs. Leigh Neumayer and Ashleigh Bull

Even when the family has a lineage of surgeons across generations, the relationship that forms between a mother and daughter involved in the field is unique, as Leigh Neumayer, MD, MS, MBA, FACS, MAMSE, professor and chair of surgery, University of Florida Jacksonville, and her daughter Ashleigh Bull, MD, PGY-1 general surgery resident, University of Iowa Health Care, Iowa City, explained.

Dr. Neumayer, Past-Chair, American College of Surgeons (ACS) Board of Regents, noted that her father was a surgeon and an ACS Fellow, as is her husband, David Bull, MD, FACS, professor of surgery, University of Arizona Tucson College of Medicine. Dr. Neumayer’s father-in-law was an OB/GYN himself and an ACS Fellow. “So [my daughter and I] have a long history of surgery in the family,” Dr. Neumayer said. While family history did not necessarily prompt Dr. Ashleigh Bull’s interest in surgery, it did help to shape her attitude about the fields in which it was possible for a woman to find success.

Dr. Bull said that seeing Dr. Neumayer be a surgeon and engineer strong in STEM (science, technology, engineering, and math) helped steer her interest in academic science and medicine. “I spent a lot of time trying to be good at math and trying to be good at science because my mom told me that people would not expect that of me, but that I could do it. And so that started me thinking about opportunities that aren’t typically expected of girls,” Dr. Bull said.

Dr. Neumayer encouraged her daughter to take on the challenges associated with STEM classes and medicine when she showed interest, which she thinks provided Dr. Bull with a firm foundation for progressing through medical school and surgical training. “I told Ashleigh that the most important thing is that you just work hard. I think she went into medical school and then into her surgery residency with a fairly grounded sense of how much work it really is,” Dr. Neumayer said.

Dr. Bull saw firsthand how difficult it could be to be a surgeon. “I remember, as a kid, watching my mom climb on top of trauma patients who were belligerent and wouldn’t stay still and needing to go into the hospital in the middle of the night when she was on call,” she said. “Most children don’t have that experience or feel comfortable talking about potentially gross things at the dinner table, but that was not a problem for me and actually helped grow my interest.” She also said it was inspiring to see how Dr. Neumayer has been able to use her influence and connections to help people gain access to healthcare that otherwise may have been difficult to attain. For example, she once helped a young friend of Dr. Bull’s get a necessary neurosurgical procedure.

To Dr. Neumayer, her daughter’s interest in helping people and being a good person are reasons to be exceptionally proud. “Ashleigh has done so many amazing things in her life and career already, and I know one of the things that Ashleigh has is a real passion for doing the right thing and helping others,” she said. “She will be one of those people who will always be doing well beyond what her work responsibilities are.”

And for Dr. Neumayer, being able to speak to her daughter at a similar level about work or a career, especially as women surgeons, has been useful to both. “It’s nice to have other people who understand your frustrations, who get that you’re anxious when something hasn’t gone the way you wanted or the way that everybody wanted. To have people to talk to who can really understand—that, I think, is very important,” Dr. Neumayer said.

That the relatively recent growth and success for women in surgery is largely built upon women supporting one another in an historically male-dominated field has not been lost on Dr. Bull, even at the beginning of her career.

“I think that having a mother in surgery made me appreciate how far women have come in surgery a lot more,” Dr. Bull said. “I matched into an all-female categorical class of residents [at the University of Iowa], and I think that a lot of people see that as interesting, but I saw it as an important development and felt very lucky to have been a part of it.”

Drs. Yana Hadzhieva and Maria Altieri

Although both mother and daughter may share a profession, their respective journeys toward surgery often take different paths, sometimes in both a figurative sense and in a more literal, geographic sense. These differences can be seen in the careers of Yana Hadzhieva, MD, a retired general surgeon in Sofia, Bulgaria, and her daughter Maria Altieri, MD, MS, assistant professor, East Carolina University Brody School of Medicine, Greenville, NC.*

Dr. Hadzhieva traveled widely to learn and train, from her birthplace in a small town on the border of Bulgaria and Greece to Sofia, Bulgaria’s capital, to Libya, to work. “I was actually born in Libya, and I spent close to 2 years there. My mother brought me back [to Bulgaria], where my grandparents took care of me for a couple of years while she was working in Libya,” Dr. Altieri said. Dr. Hadzhieva was a single mother balancing her career with parenting. “She came back to Bulgaria when I was about 4 years old. She was the first female surgeon hired at the Medical Institute of Ministry of Internal Affairs in Sofia, one of the largest hospitals in the capital of Bulgaria,” Dr. Altieri said of her mother.

Dr. Altieri came to the US as an exchange student at 17 years old and chose to stay. Watching her mother navigate a difficult career and life path influenced Dr. Altieri’s decision to pursue medicine, even in the face of opposition. “I had a lot of advisors who used to tell me, ‘You’ll never get into medicine.’ It wasn’t even about surgery; they said you’ll never even get into medical school because you’re a foreigner,” she said. “But again, listening to my mom’s story… [I said to myself that] somebody who was in a little village ascending to that level, I’ve got this drive to not accept ‘No,’ basically,” Dr. Altieri explained.

Part of Dr. Altieri’s potential to be a surgeon was apparent to both mother and daughter at a young age. When Dr. Altieri was about 9 years old, she would visit the hospital where Dr. Hadzhieva worked after school so the two could go home together. One time she and an anesthesiologist on staff wanted to play a joke on Dr. Hadzhieva. “The anesthesiologist asked me, ‘What do you want to do [when you’re older]?’ And I said, ‘I want to be a surgeon, just like my mom.’ And he said, ‘Oh, really? Well, let me show you what real surgery is.’” The anesthesiologist gave her scrubs to wear into the operating room (OR), so she could watch her mother perform an operation. “So my mom looked over her shoulder and saw me, and she said, ‘Are you going to faint? Please don’t faint.’ And I said, ‘No, this is fine!’”

That shared willingness to work through uncomfortable situations has allowed mother and daughter to bond and communicate regarding the difficulties of working in a field that is historically dominated by men.

“My mother knows how difficult it is to balance family and work. She retired when my son was born and moved to the US to help me raise my family. She not only inspired me to be a surgeon, but she has helped me achieve my dream so I can be a good surgeon and a good mother,” Dr. Altieri said. “I honestly owe the world to her.”

Drs. Mary McCarthy and Alison Bales

As the next generation of women surgeons begin their careers, those who have surgeon mothers have the benefit of being able to learn intimately just how far women have come in the field. This shared experience is well-known to Mary McCarthy, MD, FACS, professor and previous chair of surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, and daughter Alison Bales, MD, PGY-5 general surgery resident, Indiana University School of Medicine, Indianapolis.

“When I started my surgery residency at Parkland [Memorial Hospital, Dallas, TX], I was the only woman trainee,” said Dr. McCarthy, an ACS Past-Second Vice-President. “I remember a woman who entered training after me, who was already married, was told that if she got pregnant, she would be fired, and she was told this by staff who were otherwise supportive of women entering the program.”

Since then, the profession has become more supportive of women. As Dr. McCarthy notes, “In my last year as chair of surgery at Wright State [Boonshoft School of Medicine], 22% of the medical school class went into surgery, and more than half of those graduates were women.” A significant part of this growth is thanks in part to surgeons like Dr. McCarthy who helped to establish organizations like the Association of Women Surgeons (AWS). “There was a lot of opportunity to collaborate and to share the challenges of being a woman in surgery through the AWS, as well as the ACS.” Dr. McCarthy was the AWS’s third president.

Dr. McCarthy’s role modeling and success meant that Dr. Bales never had to consider whether women could be great surgeons. “When I was growing up, I just thought that was what women did—they become trauma surgeons—because she was my role model and example,” Dr. Bales said. “I had a supportive atmosphere at Duke University [Durham, NC] for premedical education, and then at Wright State where my mom was chair. Our dean was a woman, and I had multiple faculty members whom I could talk with about any challenges.”

Dr. Bales, in her youth, got to personally see her mother working, which offered her invaluable exposure to surgery. “I remember going into the hospital when I was little, starting with hanging out in the doctors’ lounge with my siblings while she rounded on weekend mornings before doing something fun as a family in the afternoon. Then, in high school, I went into the OR for the first couple of times,” she said. When Dr. Bales was in medical school, she and Dr. McCarthy even were able to operate together. “I put in my first chest tube with my mom teaching me—the first of many now that I’m a chief resident. I’ll never forget those experiences. It’s really special to have shared that.”

In addition to professional experience, Dr. Bales is the beneficiary of the work that Dr. McCarthy has done to make a career in surgery more attainable for women. She has had two children during her residency at Indiana University and felt supported by her program to do so. Dr. McCarthy said she is glad that Dr. Bales can feel confident in having a family while coming up in surgery.

“I think it’s wonderful that we are making surgery more doable for women. No question that it was hard before. It really limited the ability of young people to live the rest of their lives,” Dr. McCarthy said. The field is more welcoming now, though work remains to be done to equalize opportunities for all.

Through it all, Dr. McCarthy has always supported Dr. Bales’s career decisions, including her choice to pursue her passion for basketball. Dr. Bales played basketball in college and was drafted into the Women’s National Basketball Association, where she played for 5 years before returning to school to pursue medicine.

“Now, being a surgery resident and being able to share that bond has benefitted me so much. I can call her and say, ‘You’ll never guess this case I had,’ and she can be just as excited because she had a similar experience when she was training,” Dr. Bales said.

Drs. Shaista Husain and Inna Husain

A shared surgical specialty can help to form a bond between any surgeons, but it can be especially meaningful in an already close relationship, according to Shaista A. Husain, MD, FACS, an otolaryngologist-head and neck surgeon associated with Houston Memorial Hermann Hospital, St. Joseph Medical Center, and Houston Methodist Hospital, TX, and her daughter Inna A. Husain, MD, associate professor, department of otorhinolaryngology; and section head of laryngology, Rush University Medical Center, Chicago, IL.

“I always tell the story of Mom coming home one day, and I had my aunt’s head in my lap, and she was wondering what I was doing,” the younger Dr. Husain said. “And I said I was doing a neck dissection because I had found one of my mom’s training videos. And so, I’m sitting there doing a neck dissection on my aunt,” she said, noting she became very familiar with terms such as tonsils, ear tubes, and otoscope. “It was incredibly familiar. I would say that I kept an open mind when I went into medical school, because we all want to do our own thing, but I just found myself still drawn to the head and neck anatomy and the intricacies of it.”

Despite also being an ear, nose, and throat (ENT) surgeon, the elder Dr. Husain allowed her daughter’s interest to grow naturally. “I tried not to push her into anything, but I was very proud of her,” she said. “I was really very happy that she chose to be a doctor first, and then a surgeon, and then following in my footsteps in ENT,” the elder Dr. Husain said, expressing how proud she was that her daughter was able to further chart her own course in an ENT subspecialty.

The shared work and specialty between mother and daughter also contribute to a strong relationship, based partially on a shared language and ability to support one another professionally. “There’s definitely something, almost like a secret language that we have,” the younger Dr. Husain said. “We have our own secret lingo about things, which is kind of fun.”

The younger Dr. Husain added, “A unique part of our relationship, I would say, is that we can share those types of things. I think if I ever came across something that was unusual, I could go to Mom and say, ‘Have you ever seen this?’ And I think the feeling would be mutual. If she saw unusual laryngeal pathology, she might say, ‘Have you seen this type of thing before?’” she said.

The Drs. Husain also described the time they were able to work together briefly, as well as the prospect of working together in the future. “When Inna was in medical school, doing a rotation in Houston, she worked with me because I was in the faculty [at UT Houston],” the elder Dr. Husain said. “I think we could work well together because we can share different aspects of otolaryngology. I can send all my laryngology cases to her, and she can ask me for sinus surgeries and things like that.”

The younger Dr. Husain added, “I think it would be very interesting to work together because it would be with our two strong surgeon personalities. Because in home life, we’re mom and daughter, and in work life, we’re both formidable surgeons.”

Beyond the advice and words offered on clinical topics, the elder Dr. Husain wanted to pass on her appreciation for being a surgeon in general. “I hope that I have conveyed my passion and love for surgery, and that it is one of the most important aspects of my professional life and career,” she said, adding, “There is nothing better than surgery.”

The younger Dr. Husain absorbed her mother’s advice and worldview, noting how important it was to see a woman in her life achieve so much in the field. However, her mother’s success also may have masked some of the difficulties of being a woman surgeon. “Growing up, having a mom who was a surgeon, I didn’t realize how hard it was being a woman in surgery. I think I had this false sense of security,” she said.

“You come into the field, and you realize that, unfortunately, there is a lot of implicit bias against women in surgery,” she continued. “We still deal with a lot of microaggressions, so I hope the next generation of female surgeons read our account and they’re motivated by it.”

A Unique Bond and the Promise of Equity

The bond shared by the mothers and daughters in surgery is one that is built upon love and support, open communication, and a shared commitment to advance women in the field. As representation of women surgeons grows, mother and daughter pairs like those in this article will likely become more common, but for now, these women and their unique relationship show the promise of a more equitable profession.

*Dr. Altieri helped translate some of Dr. Hadzhieva’s comments for this article.