Dr. Olga Jonasson: Competency defeats gender bias

"It's absurd." This was the response that Olga Jonasson - a medical student at the University of Illinois at Chicago College of Medicine - received from her chief Dr. Warren Cole when she told him that she wanted to become a surgeon. It was the late 1950s, a time when female surgeons were sparse.

Twenty years later, Dr. Jonasson became the first woman in the United States to be named chief of surgery.

"Olga Jonasson cuts through sexist barriers and takes over surgery at County Cook Hospital," states a headline from an article published in People magazine in 1978, proving that the idea of a female surgeon was not so "absurd" after all.

Ten years on, Dr. Jonasson was announced as the chair of the Department of Surgery at the Ohio State University, becoming the first woman in the U.S. to hold such a position.

Today, there are 16 female chairs of surgical departments across the U.S. and Canada, and women make up around half of surgical residents in the U.S.

"I think this was incredibly important to see a woman who was so competent and professional chosen to lead a department of surgery at a major institution," Dr. Mary Hawn, chair of the Department of Surgery at Stanford University School of Medicine in California, told Medical News Today.

In the second of a series of articles celebrating female role models in medicine, we explore Dr. Jonasson's life and career.

How has Dr. Jonasson helped to shape the current landscape for leadership among female surgeons? What challenges remain for women in surgery?

The 'uphill struggle' to surgical leadership

Up until 1970, women in the U.S. and Canada made up no more than 6 percent of students in medical school, and in 1980, only 2 percent of surgical residents in the U.S. were women.

Dr. Constance Bonbrest - who studied with Dr. Jonasson at UIC - said in 2006 that they were frequently dismissed by male colleagues and patients, who often commented that they "should stay home instead of taking up a job that a man should fill."

'In my mind, she represented all that was admirable about surgeons and doctors,' said friend and colleague Dr. Charles J.H. Stolar.
Image credit: National Library of Medicine

"It was an uphill struggle. It really was," she added. "But Olga was so good at what she did, so skillful that she just amazed them all."

Dr. Jonasson's passion and enthusiasm for surgery could not be denied, and this extended beyond the operating room.

"When a motorcyclist whizzed past and was not wearing a helmet, she gunned her engine, raced alongside him, rolled down her window, and nonchalantly handed him a kidney donor card," recalled her friend Jane Meyer. "It was her way of reminding young bikers that kidneys are obtained for transplant from just such a case and she was always promoting her causes."

Through her spirited personality and exceptional surgical skills, Dr. Jonasson gained much respect in a field that was highly male centric.

"In my mind, she represented all that was admirable about surgeons and doctors [...] and it had absolutely nothing to do with her being a woman. It had only to do with who she was and how she related to those around her," said Dr. Charles J.H. Stolar, who worked alongside Dr. Jonasson at UIC between 1974 and 1980, when she was a general surgery attendant.

"Her intimidating qualities notwithstanding she was held in awe by all of us residents. She represented the quintessential surgeon [...] smart, accurate, adept, clever, direct, compassionate, and honest. We all wanted to be like OJ, and still do," he added.

These enviable characteristics got her far, earning her the title of the first woman in the U.S. to head an academic surgical department - an achievement that inspired a number of female surgeons to follow suit.

A friend, leader, and muse

"Her becoming chair showed us all that it could be you being chair," Dr. Julie A. Freischlag - vice chancellor of human health science at the University of California-Davis, and former chair of the Johns Hopkins Department of Surgery - told MNT.

Dr. Freischlag has never hidden the fact that Dr. Jonasson was a big career influence. In a 2015 lecture on women in academic medicine, she thanked Dr. Jonasson for "inspiring women like me to pursue my passion for surgery."

Echoing Dr. Freischlag's sentiment is Dr. Hawn, who told MNT that Dr. Jonasson inspired her in "both the field of transplantation and as a surgical leader."

Dr. Nancy Ascher, chair of the Department of Surgery at the University of California San Francisco (UCSF), added:

"Dr. Jonasson was the first to ask 'where are all the women?' This question focused our attention on the pipeline, lack of female leadership, and decreased visibility at meetings. It forced us to think about how to attract women in our fields."

However, it is not only Dr. Jonasson's perseverance through gender inequality that makes her an inspiration. Male and female surgeons alike highlight her relationship with patients as a pivotal role in her success.

In her paper, Dr. Freischlag points to an article in the Chicago Tribune from 1981, in which Dr. Jonasson is hailed by a kidney transplant recipient as "the patient's best friend."

"She talks to you like you were a person, a friend," he said. "She's not just a doctor, and you know she really does care. After she gave me my kidney, she helped me find a job. That's a friend, a real friend."

Current challenges for female surgeons

In 1978, Dr. Jonasson said: "The decisions of the surgeon as team leader are final, and men have simply been unwilling to accept women in that role of the all-powerful decision maker."

This statement is a reflection of the challenges Dr. Jonasson faced in order to become a leader in the field of surgery. But is this true almost 40 years on?

"I think this statement is much less true today," Dr. Hawn told us. "Women are taking leading roles in all professions and both men and women are becoming increasingly comfortable with a woman leader."

While progress has been made toward gender equality for female surgeons, disparities remain.

Though this may be the case, there is no doubt that disparities remain. Surgery is still a male-dominated field of medicine. Women account for less than a fifth of the surgical workforce in the U.S. and only 1 percent of surgical department chairs.

As Dr. Freischlag says: "Being the lone woman in a sea of black suits is a great metaphor for the experience of women pursuing careers in medicine and science today, particularly academic leadership roles."

Talking to MNT about current leadership barriers for females surgeons, Dr. Freischlag said that they are similar to what all women in leadership positions face.

"Do people see a woman as able to lead? Can she do it in her own style? And can she balance work and home with support from others in her life?" she asks. "Male chairs are facing similar struggles now, as they, too, have to balance their personal and professional lives."

Another key issue for women in surgery is the disparity in pay. One study published last year found that female surgeons earn approximately $44,000 less than male surgeons.

"Salary equity is still an issue across all disciplines but it is better than it was," Dr. Freischlag told MNT. "Men are known to negotiate harder to get more. Leaders need to be sure that both men and women are paid correctly. Institutions now review salary equity annually so the disparities are less than in the past."

'An icon of excellence'

There is clearly a long way to go before gender equality is achieved in the surgical field, but there is no denying the progress that has been made over the past 4 decades - much of which can be attributed to Dr. Jonasson.

Between 1970 and 2008, the number of female surgeons in the U.S. increased by 7 percent, while the number of female surgical residents in the U.S. rose by 12 percent between 1980 and 2001.

"Dr. Jonasson's 'ascension' to chair was important in 1987, but probably just as important today when we have many more qualified women and we are seeing transition of increasing numbers of women into leadership roles," Dr. Ascher told MNT.

Although her brassy attitude, remarkable surgical talent, and a refusal to succumb to gender bias led her to become a pioneer for transplantation and a leader in surgery, her legacy goes beyond her personal achievements.

Dr. Jonasson showed us the influence that role models and mentors can have on generations. As Dr. Kimberly Ephgrave explained after Dr. Jonasson's passing in 2006:

"Olga was an icon of excellence for my generation. She was a true pioneer whose storming of the gender barricades made it feasible for my generation of female academic surgeons to have satisfying careers as well as families.

Her standards were high, but that made her approval all the more valuable. We will miss her perspective, encouragement, and the pleasure that I believe she was able to derive from the professional impact of all the thousands of women who followed her in academic surgery."