Title:‘Find your yes’: Five alumnae in medicine share their stories and advice

In the early 1990s, a group of five women— Diane Boykin (M’98), Leah Matthews (M’97), Sylvia Morris (M’98), Jessica Osborn (M’97), and Angela Walker (M’97) —developed a friendship as students at Georgetown School of Medicine.

They formed a lasting bond, sharing major life milestones of marriage, childbirth, and loss of parents, as well as the day-to-day joys and frustrations they encountered as practicing physicians. From their first “girls’ trip” to Las Vegas during their residencies to a recent foray to Miami, they have made an intentional practice of meeting annually, a tradition they call “the glue for our continued friendship.”

Out of their conversations grew an idea— to write a book for women contemplating a career in medicine, providing the information and advice they all wished they’d had before entering medical school.

The Game Plan: A Woman’s Guide to Becoming a Doctor and Living a Life in Medicine offers a comprehensive, practical guide for aspiring women physicians, from taking the MCATs and applying to medical school, to choosing a specialty, to making a job change.

The book takes a holistic approach, encompassing both the personal and professional, with frank revelations from each of the authors about the challenges they’ve faced as women in a male-dominated career field.

One especially distinctive feature is “A Day in the Life,” designed to show how extremely busy physicians attempt to achieve work/life balance. The book provides a detailed, hour-by-hour description of each woman’s typical day—seeing patients, performing surgery, being on call, getting kids ready for school, preparing meals, and mundane tasks like doing the laundry.

“The idea was to share the real-life activities that add hours to your day, especially those things you typically don’t talk about, certainly not in medical school or even with mentors,” says Walker, an OB/GYN currently serving as medical director for Humana.

“One mother I spoke with said that she was going to have her daughter, who wasn’t planning to go into medicine, read the book because of the practical advice we offer for professional women in general,” she continues. “That’s a bonus that wasn’t on my radar.”

Progress and trade-offs

When four of the authors met as students in the 1992–1993 academic year, it marked the first time nationally that women made up 40% of incoming medical school classes, up from less than 10% prior to 1970.

Even then, there was little discussion of women’s particular concerns as physicians. “The one time I remember hearing about being a woman in medicine was at a small panel with Dr. [Joan] St. Onge and a group of other women,” says Osborn, an internist in private practice in Washington, DC. “They answered questions for us about their schedules, having children, and other issues. It definitely had an impact.

“Our class did not look like the 1970 class with three women, but we weren’t an overwhelming presence either. It was an acknowledgment that we were there.”

Despite significant progress—the 2023–2024 entering class at Georgetown School of Medicine is 63% female— the authors are candid about the obstacles female physicians still face.

Many people, for example, still envision a white man in the “Marcus Welby” mode as the norm.

“I always wear my long white lab coat that has my name ‘Sylvia Morris, M.D., MPH.’ I introduce myself as Dr. Morris. I’ll sit down and have a long conversation at the bedside with the patient, then go out to write my notes. Later the patient will say, ‘Oh, you know, a nurse came in, but I haven’t seen a doctor,’” says Morris, a hospitalist with Kaiser Permanente in Atlanta.

“Sometimes patients want to call me by my first name or won’t address me as ‘doctor.’ I’m quite certain it’s because I’m a woman, although there may be some racial aspect woven in,” continues Morris, who is Black, as are her four co-authors. “It’s very interesting that even today the perception of what a physician looks like still tends to be male.”

On the personal side, even with a supportive spouse, women physicians often have to make trade-offs in terms of the kind of practice they enter. As Boykin, an OB/GYN with Kaiser Permanente in Baltimore, writes in The Game Plan: “I have a rotating call schedule that ensures when I am not on call, I don’t have to come to the hospital for deliveries. It is very important that my children grow up with a mom who has a predictable work schedule.”

Issues like being on call, long hours, and dealing with life-and-death situations can put significant stress on couples. For those women physicians whose partners are men, the authors also raise a concern that can often be sensitive to discuss: the potential strain on a relationship when a woman earns more than her male partner.

Emotional labor

In addressing the special demands women doctors face, The Game Plan contains a forthright discussion of the cost of “emotional labor.”

A term coined by sociologist Arlie Russell Hochschild, emotional labor refers to the process of regulating emotional expressions as part of one’s professional work role during interactions with clients, customers, co-workers, and managers. For example, flight attendants are expected to smile and be friendly even when a passenger is rude or threatening.

“For me, probably more so in the ’90s and early 2000s, I felt that male physicians could be abrupt and on the rude side, and people would say, ‘Oh, he’s just that way,’” says Osborn. “But a woman has to be nice. It’s almost like being in church on Sunday with your grandmother. There’s a certain way that you have to behave or you’ll be corrected.”

Matthews, a pediatrician practicing with Texas Children’s Pediatrics in Houston, describes a previous experience working for a large organization where administrators without medical backgrounds dictated policy.

“I perceived that my patients had additional expectations of me as a female physician, ones they did not have of the male physicians in my group,” she writes. “Many administrators didn’t understand emotional labor or didn’t care.”

Finally, she says, “I took my reputation, created from my emotional labor, and left.”

With patient satisfaction surveys becoming increasingly important in physician compensation, women doctors may feel even more pressure, the authors note. As Boykin says, “In today’s world, people are more demanding—it takes a lot of emotional energy. Each patient gets a piece of me and a piece of my heart.”

Even when being a woman physician is an advantage, it can be a double-edged sword. “I was working in a big practice where the majority of patients were requesting a female OB,” says Walker. “My numbers kept going up and up.

“On the one hand, it was an ego booster,” she continues, “but because I am an empath and tend to spend more time with patients, it became more of a burden for me. When it got to the point where I came home and felt irritated with my kids, I said, ‘Something’s got to give.’”

Although her salary was based on the number of deliveries she performed, she decided to reduce the number. “It was the best decision I could have ever made.”

In the past several years, with the rise in public awareness of disproportionate Black maternal mortality rates, Walker has faced new demands on her time. “The data showed that women were having better outcomes when they had a Black female physician,” she says.

“That was certainly a different type of burden for me, but I was at a point in my career when I knew I couldn’t go beyond my boundaries.”

The business of medicine

Woven throughout The Game Plan is an emphasis on a neglected aspect of medical education for both women and men: the nuts-and-bolts of finances and business operations.

Although the medical school curriculum is jam-packed, all of the authors agree that financial education should be an essential part of training. “You have to make room for it,” Osborn says.

“I remember my mentor Dr. John Eisenberg [former chair of the department of medicine at Georgetown] telling me, ‘You should get an MBA,’” Morris says. “I was in public health school at the time, and I said, ‘Well, no, I want to be surgeon general.’ Today I wish I had gone to business school.

“I’m not saying that everyone needs an MBA or a master’s in medical management, but you need to know how to save, how to create a spreadsheet for what your Q-tips cost—really practical information that probably could be taught one hour a quarter during the first two years of medical school.”

“Residency programs don’t really talk about finance and money management either,” Boykin adds. “It’s kind of taboo. Doctors really don’t discuss income and share that information. “For physicians who go into private practice, the different models of pay can be challenging if you’ve never been educated on how that system actually works,” she says. Walker notes that newly minted doctors are often far behind their peers in other professions requiring graduate degrees, such as law and business, in terms of earning income and may not make the wisest spending decisions.

Although the authors stress that “the most important thing to do is practice what you love,” medical students and residents must look with a clear eye at the income disparity among different specialties.

At the time she was co-authoring The Game Plan, pediatrician Matthews still had $35,000 in medical school loans— despite participating in a Texas state loan repayment program for treating an underserved population. “While I love pediatrics and my current employer, the stress of paying for my Georgetown education with the lowest compensated specialty is overwhelming,” she notes. “The struggle is real.”

Advice for a new generation

Sharing their collective wisdom for the upcoming generation of women physicians, the authors emphasize the critical importance of mentorship.

“One of the things that we address in the book, and hopefully we continue to improve on, is encouraging women at the beginning of their career to identify mentors,” Boykin says. Although she recognizes that it is a lofty ideal, she recommends that medical schools institute programs to match incoming women students with women mentors in leadership positions.

Another key piece of advice is practicing self-care. “Continue to foster your relationships and don’t put them on hold,” Walker says. “Start to practice mindfulness behavior at the beginning, because the stress of medicine does not stop after medical school and residency— it’s a continuum.”

Morris and Osborn both recommend that aspiring and current medical students get broad exposure to different types of specialties, both by taking electives and by shadowing practicing physicians. “You may think you want to do x, but you don’t know that you’d be good at y and z unless you have some type of experience with that,” Morris says.

“There was a female cardiothoracic surgeon I knew whose father was a psychiatrist, and she was exposed to different fields of medicine as a kid,” Osborn says. “For me, cardiothoracic surgery was reaching for the stars, but she knew she could do it. That’s why I recommend shadowing, to find out the reality and what really interests you.”

Morris adds another helpful piece of guidance based on her own experience. “You’re going to hear no. But sometimes that voice within says, ‘I think I can.’ So you have to find your yes.

“When I was considering my residency, I went to my clerkship director and showed him my list. He said, ‘Well … have you considered these other schools?’ I knew with my heart that I’d rather have the schools I wanted to apply to tell me no, instead of my own voice telling me no. I ended up matching with the University of Washington, and the rest is history.”

A beautiful friendship

With a first published book out in the world, the group has no immediate plans to write a follow-up—although as Morris says, “Only time will tell.”

“One of our counselors at Georgetown, Dean Emerita Joy Williams, read the book and told us, ‘I’m ready for the sequel on how to manage from the peak of your career towards retirement,’” Osborn notes.

The friendship that gave birth to the book will continue to remain central to all the women’s lives, however, serving as a model for physicians of all genders, young and old.

“The best thing that came from the book was really learning that having a community of people around is extremely important,” Morris says. “That not only applies to us as physicians and professional women, but to everyone.

“There’s something about bearing witness to each other’s lives, starting back in our 20s and continuing through. We may not see each other every day, but I know I can pick up the phone or text, and these women will show up for me.”

Walker echoes that sentiment: “I have a spouse, I have a best friend from high school, but when it comes to medicine, they never understand when I’m complaining about something that happened during my day because they haven’t lived it. But these ladies have lived it.

“We have fellowship, we have fun, we laugh, we cry. I have complete understanding and empathy from them.”

Loyal Hoyas

All five women express appreciation for both the enduring values that define Georgetown medicine and the changes— particularly in the composition of the faculty and student body—that have occurred since they attended the School of Medicine, with particular thanks to the Georgetown Experimental Medical Studies, or GEMS, program of which Boykin, Morris, Osborn and Walker were beneficiaries, and which they hope serves students well into the future.

“I’m very impressed by the selection of Dean Jones,” says Morris, referring to Lee Jones, dean for medical education and professor of psychiatry, who joined the Georgetown faculty in 2021.

Jones, a national leader in efforts to advance equity and inclusion in medical schools in the U.S., currently serves as chair of the Association of American Medical Colleges Board of Directors. “He’s a wonderful human being and a fantastic addition to the Georgetown family,” Morris adds.

“The mention of cura personalis has come up so much recently wherever I go,” Walker says. “People who have experience with Georgetown know that we truly care about the community that we’re serving, and I treasure that. It bodes well for Georgetown, and we feel it in our group.”

“I’m in DC, and my family has chosen to have our care at Georgetown—that’s for a reason,” Osborn says. While the commitment to cura personalis remains the same, she notes that today’s MedStar Georgetown University Hospital is far more diverse than when she trained there in the 1990s, a much-welcomed change.

“Walking the halls of the hospital—the sounds, the languages, the makeup of the people—is very different from when I was a student,” she says.

“Georgetown brought us together, so I’m forever grateful that Georgetown said yes to me,” Morris says. “Clearly the universe aligned such that I could meet these four other wonderful women that helped me get through. Because I wouldn’t be the woman that I am now without them.”