Dr. Sandra L. Wong, Chair of Surgery and the William N. and Bessie Allyn Professor of Surgery at the Geisel School of Medicine at Dartmouth, recently sat down with Justice Goodwin Liu, Associate Justice of the California Supreme Court and senior research fellow at the Harvard Law School Center on the Legal Profession, for a conversation on Asian Americans across the medical and legal professions.
Justice Goodwin Liu: First of all, Dr. Wong, thank you so much for doing this. What a terrific opportunity.
Dr. Sandra L. Wong: Thank you. Happy to be here.
Liu: The lead article for this issue of The Practice looks at the research that a group of students and I did on the progress of Asian Americans in the legal profession. The report that we ultimately produced was the first comprehensive look, I think, that there has ever been at how Asian Americans are doing in law. As an accomplished surgeon, department chair, and professor at Dartmouth’s medical school, I am delighted to get your insight on how Asian Americans are doing in medicine.
Despite tremendous growth, Asian Americans have faced very significant challenges penetrating the very top leadership ranks in every sector of the legal profession.Justice Goodwin Liu, Associate Justice of the California Supreme Court and senior research fellow at the HLS Center on the Legal Profession
As background, Asian Americans have easily been the fastest-growing group in the legal profession for the past 25 years or so. The number has grown from around 10,000 in 1990 to over 55,000 today. That’s more than a fivefold increase in one generation. That’s been amazing to see. Yet, despite this tremendous growth, Asian Americans have faced very significant challenges penetrating the very top leadership ranks in every sector of the legal profession, whether public, private, law firms, in-house, or government.
Moreover, since the recession in 2009, there’s been a very significant drop-off of Asian Americans going to law school, and that drop-off continues even to this day. While numbers have dropped off across the board because of the constricting legal market, Asian Americans have dropped off more than any other group. And we’ve actually been wondering whether Asian Americans have migrated more to medicine or engineering or other fields in order to better understand this phenomenon.
Having said that, do you see any analogous or contrasting observations for how Asian Americans are doing in medicine?
Asians were poorly represented in medical schools in the 1980s—probably in the low single-digit percentages. Fast-forward to today and it’s in the mid- to low twenties. It’s been a phenomenal leap.Dr. Sandra L. Wong, Chair of Surgery and the William N. and Bessie Allyn Professor of Surgery at the Geisel School of Medicine at Dartmouth
Wong: Well, I really enjoyed looking at your Portrait Project—I thought it was very interesting data. Anytime you look outside of your own little snapshot of the world, it does get you thinking. As for medicine, I will say that intersectionality comes to mind. But before I get to that, I have to say that I think the fields of law and medicine are very different. One key difference is the training, where the cycle takes longer in medicine. It takes four years to get through medical school, and then, even the shortest residency takes three years. Then, there are a lot of subspecialties, and once you combine a residency program with a fellowship program, it’s actually a lot longer.
Just taking myself as an example: By the time I finished my four years of medical school and five years of residency program—not to mention the years of research and fellowship training in between them—I was well into 12 years of training. That’s pretty scary if you think about it. I say all that to illustrate it’s a long time before you even get your proverbial first job. There is that lag because it takes so much longer to go from being a first-year medical student to being a first-year practicing physician. I think that plays a lot into the timeline.
And then, when I think about intersectionality, I also think about the different specialties. I know there are different specialties in law, but in medicine it’s much more pronounced because of the specialization component of medical training and practice. I’m a surgeon, and I can tell you that I think the proportion of Asian Americans in surgery is a lot lower than in other fields. And as an Asian American woman, I can tell you that’s proportionally a lot lower, because surgery has historically been a very male-dominated field. And once you start segmenting and you start getting to the intersections, you start facing a lot more problems with data interpretation.
Liu: What have you seen in terms of overall enrollment? Have Asian Americans increased or decreased in the last, say, couple of decades?
Wong: That number has increased a lot. Asians were actually poorly represented in medical schools in the 1980s—I would say probably in the low single-digit percentages. If you fast-forward to today, it’s in the mid- to low twenties. So, it’s been a phenomenal leap in terms of the proportion of Asian American medical students. I think in terms of the time lag, though, between me seeing people in medical school to when people are actually out in practice, that increase probably won’t be reflected if you just look at people in the profession itself.
Liu: I want to ask you about leadership and getting to leadership levels. You mentioned that there is already a long kind of runway in medicine, and you are now the chief of the department in a major hospital, so you’ve walked the length of that runway in many ways. That’s very significant, but I assume that you’re pretty rare.
Wong: It’s very interesting. There are, at last count, about 22 women chairs of surgery in the United States. We represent just shy of about 10 percent of all chairs in surgery. Of this small group, I was number 10 or 11, and that was three years ago. So, it’s a very quick lift in terms of these positions. Now, you have to take into account that positions only open up intermittently, and (in your profession) depending on your state or your district, there might be terms, and if there are, they might be of varying lengths. But in our group of women chairs, there are four Asian American women. So in that sense, we are sort of overrepresented. I think if you look at the number of Asian men who are chairs, it’s not that many more than four. I would still say that these are small numbers, and this is just surgery and not all the other fields, so you have to take it for what it is. And, again, this is all at that intersection of racial and ethnic identity and then gender.
There are, at last count, about 22 women chairs of surgery in the United States—10 percent of all chairs in surgery.Dr. Sandra L. Wong
Liu: I’m curious to unpack that a little bit. How do you think advancement plays out in terms of the intersection of race and gender? It would seem that Asian Americans are now, in medical school at least, at the beginning of the pipeline in fairly significant numbers. But how does that play out when people get out into their careers? And what kind of challenges do they face?
Wong: That’s a really interesting question. Surgery has historically just been a cult of old white guys, and it’s been hard, even for white women, to break into surgery because it’s been such an old boys’ club. For a lot of women in surgery, during their training or even as an attending physician, there is that whole conception that you walk into a room and does the patient see you as a physician or as a nurse? And I think that happens quite a bit, which has consequences on the leadership component of it, because if people see you in the gender-defined role of nurse, it makes it that much harder to be viewed as a leader in your field.
Liu: That’s so interesting, and I can say that this is not unique to medicine. In our report, we found through survey responses and focus groups that this actually happens a lot in particular to Asian American women in law as well. They step into a courtroom and they are thought of as the translator or the paralegal or the client or anyone except the lawyer. Do you think the stereotyped perceptions you described are particular to Asian Americans in your field? Or is this a more general, gendered phenomenon?
Wong: Probably both. In large cities, especially in areas where in the past they would just ship in huge numbers of Filipino nurses, the perception is, “Well, of course, you’re a nurse.” I do think that there’s some contextual bias in some of that. And as a surgeon, a lot of times we wear scrubs around and that, by the costume you’re wearing at work, does make people think, “Oh, well, you’re wearing scrubs and you’re a woman. You must be a nurse.” Whereas any man walking around in scrubs would immediately be thought of as the surgeon or the emergency room physician. So, I do think there’s probably some parallels with the legal profession in that regard.
And if you actually dive deeper into what you would characterize as perceptions of hard skills or soft skills, a lot of times because medicine is considered akin to other STEM fields, there is certainly that expectation of a “technically competent physician” with all the hard skills that come with that. When it comes to perceptions of soft skills, however, we’re seeing that play out in this whole Harvard admissions case where Asians may be rated slightly differently, or more poorly, in their social skills. Some of that you can see in medicine too, where the thinking might be, “Sure, that Asian American got the best scores at the best medical school but maybe doesn’t have that ability to have those patient relationships.” This thinking leads to Asian Americans being viewed as less-skilled physicians, because that’s obviously an important part of the job.
As a surgeon, a lot of times we wear scrubs and it does make people think, ‘Oh, well, you’re wearing scrubs and you’re a woman. You must be a nurse.’ Whereas any man walking around in scrubs would immediately be thought of as the surgeon or the emergency room physician.Dr. Sandra L. Wong
And you can take that to the next level. You can be a competent physician—“I’ll send my patients to you, fine, but I don’t know if you have that skill that it takes to lead a department or to be the head of a practice or to be chief of the medical staff, or whatever it might be.” There certainly are some parallels, but slightly nuanced because medicine is viewed as a little bit more of a traditional field for Asians with that science component. At the same time, I think people would say, “Oh, well, pathology is a great field because you’re in the lab and it’s more comfortable for you,” when, in fact, that’s viewed as a slightly different specialty of medicine than, say, the more patient-facing fields.
Liu: I’m curious about your own story. How did you get to where you are given all these dynamics?
Wong: Thinking about the path into surgery itself, I didn’t view it as that unusual. To me, I went through the same thing that all of my classmates went through, which is: What field excites you the most? Which is the field that you think you could be doing as a career? And so, it didn’t occur to me right away that there are not a lot of women at the upper echelons of surgical departments. There were more than a few women in the field in residency, but there certainly weren’t—again, speaking to the timeline problem—a lot of women attendings or women in leadership at the time. So, as a medical student looking at the field, you did have to get over that. Similarly, depending on where you were at in terms of the representation of Asians in the field, there wasn’t a lot of that either. I went to medical school in Chicago, so just given the demographics, you saw a much more diverse population in the medical school class and among the attending staff. But it was pretty clear that there were a lot more Asians in my medical school class than there were among the attending staff. I ended up training in Louisville, Kentucky, where there weren’t a lot of women or Asian American role models. I got really lucky because, even without that, I had a lot of great mentors. They all just happened to be white men who supported me because they thought I had the talent to do it. I give a lot of credit to people who supported me because of what I could bring to the table and not necessarily because of what I look like.
Do you think that the stereotype of Asians going into medicine—being attracted to medicine—makes people think that there’s no problem?Justice Goodwin Liu
Liu: What kind of mentoring goes on now that is more intentional to cultivate people in our community?
Wong: This, again, is where intersectionality comes into play. In my current role, I get asked to do this a lot more than I did a few years ago. I’m at an intersection where I happen to be a surgeon, who’s a woman and who is also Asian American. I do think it’s important to provide that mentorship, and I mentor a lot of people. I mentor men. I mentor women. But I also recognize that a lot of younger Asian American women look to me, because I think they’re starting to see maybe some of the glass ceilings (or bamboo ceilings) that they’re being presented with. Part of that is because we are now relatively well-represented as surgery chairs—four out of 22 women—and so some of these younger Asian American women may start worrying that now there is a perception working against them that, “Oh, the quota’s been met.” So, I’m sensitive to that.
Liu: That is a really interesting point, and I am glad you touched on it. Sometimes when I’m giving presentations about Asian Americans entering law, I joke that where you see this big rise of Asian Americans in the law from about the mid-1980s to the mid-2000s, it’s as if our parents got the memo that law was now OK to do and not just medicine. In fact, my own personal history is that I went to college as a premed. I went all the way through and I had applied to medical school. When I left college, I deferred at UCSF—I was going to go to medical school. The reason I deferred was because I had a chance to go to graduate school and I was doing a PhD in immunology. That’s when I realized that that wasn’t my passion. And so, I reevaluated. I switched course and decided it really wasn’t for me, though lucky for me, I did have an older brother who became a surgeon. But all that said, do you think that the stereotype of Asians going into medicine—being attracted to medicine—makes people think that there’s no problem?
Wong: Well, I do sense that that is some of it, right? Asians are 5.5 percent of the population, and we’re somewhere in the ballpark of 22 percent of medical school classes. There’s this perception of overrepresentation; that there is no problem because we have a quarter of the medical school class. And more to your point, there remains the problem of ascension to leadership roles. I do think that’s a problem because people don’t see it past this perception of overrepresentation.
Liu: I was surprised to learn that, I think it wasn’t until the appointment of Dr. Vivian Lee to the deanship at the University of Utah that an Asian American became dean of a major medical school in the United States. And that was in 2011. To me, that’s just amazing that it took until this decade to see an Asian American dean, especially given how prevalent this stereotype is of Asians going into medicine. Is it surprising to you that no Asian American ever led a U.S. medical school until this decade?
Wong: It is and it isn’t. It is in the sense of just, “Where did everybody drop off? Where in the pipeline did the leak happen?” But then if you flip it, Vivian was probably in medical school in the late 1980s/early 1990s, and the proportion of Asian medical students at that time was certainly a lot lower than it is now. Part of it is by the time you finish medical school, you do residency training and then you have to establish yourself to the point where you have the credentials that it takes to become a dean. But at what point do you pay attention to that particular denominator? Because if you’re a medical student today, you probably really shouldn’t even be considering a dean’s job for, what, 25 years? It’s very far out.
Liu: I would also be curious about your broader take on not just surgery but the field more generally. What does it take to get to those kinds of positions?
There’s this perception of overrepresentation; that there is no problem because we have a quarter of the medical school class. And yet, there remains the problem of ascension to leadership roles.Dr. Sandra L. Wong
Wong: To be honest, I’m not sure that if you had asked me this same question 10 years ago that I would have said I aspired to be a chair. I was practicing. I was taking good care of patients. I was doing good research. I was in some administrative roles. To me, I had a pretty good job, and, at some point, I thought maybe I would consider moving up. But there certainly wasn’t that intentionality that I know a lot of people have. My thinking was, “Well, I suppose I expect to make full professor within some timeline. And if there’s something that I end up wanting to do, maybe that’s what I do.” For a time, I admit I thought that being a dean was not a good job.
Some of it is just knowing what you personally want out of life. There’s that old adage that not everybody can be a leader. It just doesn’t work that way. For me it was a choice about “What do I want, ultimately? What do I want my legacy in life to be? And how do I bring value to my field and to my profession?” And to me, that was what made me start thinking that I should be a leader in this field. There are certain things I want to accomplish at a departmental level and at a professional level. Fortunately for me a lot of the people who were my mentors were people who were on that track. I had people who were supportive and could mentor me through some of that. Some of it is having the right mentors in place. Some of it is luck. But I will say there wasn’t a huge amount of intentionality around it until later in the game. At the same time, there’s a broader picture of representation. I do think we need to be intentional about things that we do, and we need to be intentional about words that we use when we mentor people and when we sponsor people through their career path.
Liu: I certainly know what you mean, and of course it depends on your perspective personally. I was on a law faculty before I became a judge for a number of years. And post-tenure, I was just enjoying my position and didn’t really think about going into administration or being a dean or anything like that. You’re happy doing what you’re doing, and the last thing you want is to do the administrative work.
Wong: Absolutely. I think the difference is if it’s not for you, then it’s not for you. The problem that we run into is when you decide that it is something you want to do and there are barriers in spite of intentionality—for example, if those barriers are based in bias or other things like that. There are a lot of Asian American men, some of my colleagues who have been looking at chair jobs for a long time, and there’s a feeling that there was some inherent bias from the perspective of being Asian. In having these discussions with my colleagues, we asked, “Well, is it a bias of being Asian?” Or, in my situation, “Could it be a bias of being a woman or both?” There is that perception of what people perceive Asian American men to be, as opposed to Asian American women, which adds another layer of nuance. I think of the Asian American women who are currently sitting in chair positions and the way that we’re perceived is probably a little bit different from how our male colleagues are perceived.
Our students seem to be interested in equity and how we can make sure that we eliminate biases and how we can have men be more of an ally, because we can’t do it without them.Dr. Sandra L. Wong
Liu: What do the young people coming up behind you most typically ask about? And what are the subjects of conversation when they’re looking for guidance and mentorship from you?
Wong: Well, the current topic of conversation is all around #MeToo and #TimesUp. A lot of people are now thinking much more heavily about harassment and about the biases that may occur because of that. I’m very careful to emphasize that there is a big difference between harassment, which is criminal, and issues of equity, which are a lot subtler and not criminal but wrong nevertheless. That seems to be a lot of what’s taking up the conversations with our students these days, especially the concern that that may jeopardize their career. What we’re talking about is the need to have allies; that it can’t be just women looking out for women and that it needs to be more of a community. Our students seem to be interested in equity and how we can make sure that we eliminate biases and how we can have men be more of an ally, because we can’t do it without them. And that seems to be the current context of the conversation. It’s actually very interesting and not necessarily the same conversation we were having five or 10 years ago.
Liu: Do students and younger physicians in the pipeline raise the #MeToo issue because they’ve personally experienced it? Or because it’s all over the news?
Wong: I think it’s probably a little bit of both. Some of the early data we’re seeing is that the amount of #MeToo behavior we’re seeing in medicine is actually shocking to people. I don’t know that people are concerned because they’ve actually experienced it or if there’s a perception that, “Well, if it’s in Hollywood, it’s happened in DC. Is it now medicine’s turn in the #MeToo movement?” So, I don’t how much of it is more discussion versus actual experience. Obviously, I hope it’s the former.
Liu: Are you at all surprised by surveys or data that have shown that this is a prevalent problem in medicine? Or is this something people have long known about?
Wong: I’m not surprised. I’m not surprised because I do think that it has happened. And, of course, it is still happening. I’d be naive to think that it’s not. The question is whether it’s a hot topic of conversation because they were actively experiencing it, meaning our younger generation, or if they’re just hyperaware of it. I think certainly if you take people’s experience from 30 years ago, it’s a different world. There’s just so much to unpack there.
Some of the early data we’re seeing is that the amount of #MeToo behavior we’re seeing in medicine is actually shocking to people.Dr. Sandra L. Wong
Liu: I’m sure there is. I was just at a conference—the National Asian Pacific American Bar Association conference—and there was a big panel devoted to #MeToo. And there were some interesting survey results showing that many men reported that they no longer feel comfortable interacting with women in certain ways; for example, if a male partner is going to take a junior associate on a business trip, the partner feels uncomfortable bringing a female associate. I thought that was startling, but I suppose this is one aspect we haven’t completely dealt with yet.
Wong: You hear similar data points in medicine. There was an editorial in the New England Journal of Medicine that spoke about the same sentiment, and I think there’s grave danger in that in terms of what it means for the mentorship and sponsorship of women coming up in the professions.
Liu: I certainly agree. Well, it has been delightful getting the chance to speak with you on these issues. You obviously have done amazing for yourself in your field and, despite your saying that there are quite a few of you among the women in the ranks of surgery chiefs, you’re still very rare in the wider context of your field.
Wong: Well, at the end of the day, you just have to go to work.
Liu: We all feel that way, certainly, and it’s only actually when you pause when these issues come out. I thought the same thing when I was appointed to this position on the court. I just thought, “Well, I’m just going to work.” But through involvement in our community, I have come to understand about how significant people find the fact of an Asian American occupying a prominent leadership role. And so, that has stimulated my own interest in all of these issues.
Wong: I would definitely share that sentiment.
Liu: Thank you so much for taking the time, Dr. Wong.
Wong: Thank you. This has been great.
Dr. Sandra L. Wong is the Chair of Surgery and the William N. and Bessie Allyn Professor of Surgery at the Geisel School of Medicine at Dartmouth.
Justice Goodwin Liu is an Associate Justice of the California Supreme Court and a senior research fellow at the Harvard Law School Center on the Legal Profession.