Women in Medicine: Nancy Dickey

At Texas A&M, we celebrate the American Medical Association’s Women in Medicine Month this September by highlighting a few of our extraordinary female researchers, scientists, physicians and students who are making meaningful contributions to medicine every day on our campuses and across the globe.

Nancy Dickey, MD, is one of these remarkable women. She was the first female president of the American Medical Association and the first female head of the Texas A&M Health Science Center. She now serves as its president emeritus, head of the Primary Care Medicine Department and executive director of the A&M Rural and Community Health Institute. To help mark Women in Medicine Month, she answers some questions about the profession and her life.

Q: Why did you become a physician?

A: I liked science, people, challenge and variety. I found all of those in medicine, though not without some discouraging words along the way. I had worked as a nurse’s aide during high school and college and loved the hospital atmosphere but was more drawn to the physician’s role. But my high school counselor assured me that while I could certainly become a physician, I likely could not be a wife, mother AND physician. So, believing he knew of what he spoke, I went to college and majored in psychology and sociology. I truly loved the clinical psychology and even pursued a master’s degree in that field. But working in the hospital kept the possibility of being a physician alive. I decided to apply to medical school and see what happened…and I got in. It has been all that I sought: challenging, ever-changing, people-focused and centered in science.

Q: For you, what is the greatest aspect of being a physician?

A: There is so much that I love about being a physician. I embrace the immense variety of roles that a physician can pursue—academic, private practice, research, clinical, big group practice, solo practice—I could go on and on. However, I believe that one of the greatest aspects of being a physician is the role of trusted adviser and confidant that we play in the lives of our patients. Patients seek us out and trust us with secrets large and small, trust us to invade their very body and believe that we will do all that we can to alleviate their suffering. It is my interaction with and relationships with patients that is the greatest aspect of being a physician.

Q: What do you enjoy about being at Texas A&M?

A: My time at Texas A&M has been a substantial trip in a different direction. I had been in private practice and in medical organizational politics. Academics was a significant change. I have enjoyed the challenge, the teamwork. I have also enjoyed the opportunity to build—first the family medicine residency and then the Health Science Center. From a personal perspective, I have enjoyed being part of a college town—the university-related activities like sports and OPAS, lectures and expositions. I have enjoyed the many wonderful relationships that have been a part of being at Texas A&M.

Q: What do you consider your most significant accomplishments to date?

A: I have been blessed in many, many ways. Certainly, my family is my most significant “accomplishment” but I suspect you mean professionally. I was lucky enough to happen into a role at the American Medical Association (AMA) when I was a resident. Over the course of the next 20 years, I served in a variety of roles, both appointed and elected. And ultimately I was honored to be elected as and serve as the president of the American Medical Association—the voice of the breadth and depth of American medicine. Upon my return to College Station (I never really left though I spent far more time NOT in College Station than at home), I was asked to serve as interim dean for the College of Medicine and then selected to serve as president of the Health Science Center. Both of those roles are more often filled by people who have long histories in academic medicine, and I could not have been successful without the many, many people who helped me learn a great deal in a very short time. I have been honored by colleagues by being elected to the National Academy of Medicine (aka Institute of Medicine) and by my fellow Texans by being named to the Texas Women’s Hall of Fame. I have been honored by my universities (Outstanding Young Alumnus, Stephen F Austin State University and Distinguished Alumnus, University of Texas Medical School at Houston). And across the timespan, I have been honored to care for many, many patients, some of whom have traveled long distances to continue to use my services—this is a wonderful accolade in my book—who perceive I am their doctor and they are my patients. This is perhaps the truest accomplishment for a physician.

Q: How are you advocating for women’s health?

A: I have spent most of my career clarifying that I am a physician who happens to be a woman. I like to think that I have advocated for health for Americans or for the world. However, as Ginni Rometty, CEO of IBM, said in a recent interview, it is nearly impossible not to advocate for and be a role model for women, women’s health and women health professionals. Women tend to be the decision makers for their families—including their spouses—in terms of health care. I have spent a good bit of energy trying to provide education for women about how to make good decisions for themselves and their families. I have been involved in two clinics providing low-income women with prenatal care, as this is a proven expenditure that improves the health of both the mother and the infant. And I have advocated for women to have improved opportunities to be involved in research regarding their health.

Q: Who are some women in medicine, past or present, who inspired you?

A: There have been many who have been friends, colleagues and inspirations. Ruth Bains was a president of the Texas Medical Association (TMA) while I was working my way through leadership of TMA and AMA. She was the quintessential lady—always dressed properly, soft spoken and very busy. But like that investment ad on television, when Ruth spoke, doctors and legislators listened. Betty Stephenson was another president of the TMA and nearly the opposite of Ruth. She was a bit raucous, drove a Corvette until she was 80 and didn’t mind raising her voice if that is what it took to get things done.

Vivian Pinn is nearly a legend in medicine, and if any of us thought we had it hard, we needed only listen to her tell of her first day at medical school when she was not only the only woman but was also the only African American in her class to graduate. She went on to become the first African-American woman to chair an academic pathology department in the United States and was the first full time director of the Office of Research on Women’s Health at the National Institutes of Health. She was a strong mentor and a powerful voice for women in medicine.

There are so many more—and one must never assume that all of my mentors were women. In fact, I suspect more were men—there were far more men than women to watch, learn from and be led by.

Q: What obstacles did you personally face?

A: I am never sure how to answer this question. Perhaps the biggest was simply making the decision to go to medical school. From the high school counselor who subtly discouraged me to friends who questioned why anyone would want to “do that,” there were more discouraging voices than encouraging ones. However, I had a lifelong friend, my husband, and a family who were great counter-voices saying, “Go for it!”

Often, I thought that being a woman may have been an advantage. I was admitted to medical school at a time when it was beginning to be discussed that there were too few women in medicine…and I have overheard people say, “She got in because she was a woman,” but, like many of my generation, I want to think I got there on achievement, not gender. And I certainly got out on achievement—not gender. I chose a specialty that welcomed women so I did not have to fight that battle as some entering certain fields, particularly surgical specialties, faced. Being a woman meant that you were likely to be remembered—so if you did well, you were remembered; if you did poorly, you were also likely to be remembered. So there was, of course, some pressure to do well.

I have had perhaps more than my share of “first woman” roles and have sensed that doing well was important to those of my gender who would follow; in fact, the opportunity for a second woman to fill a role may at least somewhat be decided by how well the first woman performed! I hope that I have left more doors open than closed for those who may follow me.

Q: What hurdles do we need to overcome for women in medicine?

A: I think that we need to look at pay equity for women. Whether one is a primary school principal or a brain surgeon, one should be paid by performance NOT by gender. Medicine has not done any better than other arenas in terms of addressing this concern. Pay is one of the measuring sticks of success in this country, and as long as there are measurable differences between genders, women will never be seen as successful as men.

I think women need to look at how to develop practice models that allow them to have families while continuing to demonstrate a commitment to their patients. One of the greatest concerns that I have for medicine today is that medicine seems to be turning into a trade or a technical service not a profession committed to achieving health for the patients we serve. Today’s science is magnificent, but it is too often delivered by a dispassionate, emotionally distant individual who is working a shift, not working in partnership with an individual to diagnose, treat and heal. Generations ago William Osler said that listening to patients would very often give us the diagnosis. Yet today, we rarely listen and even less often hear. In a YouTube video Abraham Verghese tells the audience that if a patient today were to go to the emergency room and tell them he had lost his left leg, he would not be believed until it was confirmed by X-ray or MRI. He then goes on to describe a mentor who demonstrated the power of observation. But if we are not willing to listen to the patient, we are unlikely to be willing to sit still long enough to observe the patient. And, along with missing diagnostic clues, we are likely missing their fear of what is happening to them, their lack of understanding of what is being done to or for them or their confusion about what their role might be. I do not want us to give up any of the extraordinary advances of medicine, but I would like us to find a way to deploy those advances in a compassionate, sincere way. Women are often perceived to be more compassionate and kinder than men; let us then help develop mechanisms and organizations of care that allow us to keep humanity in medicine even as we adopt more and more technology to accompany the caring and to do it in way that allows men and women to commit their lives to medicine even as they have lives outside of medicine.

Q: What advice would you give young women who want to pursue medicine as a career?

A: I am not sure that many women will want to hear my advice. I recognize that I came through medicine at a time when most women felt that we needed to do it the way our male colleagues did it in order to be perceived a success. That often meant long hours, delaying personal life decisions, etc. And I recognize that much has changed so that women today can seek roles in medicine that are somewhat less “all consuming.” However, I believe that choosing to become a physician is a life choice—one that does and should impact the rest of your life. You go to school for a long time (and at great expense). You learn a great deal and most importantly learn how to continuously learn, as medicine is ever changing. Far more important than the facts one learns, one develops judgement and instinct, which along with knowledge, make a physician valuable to patients. And that knowledge and judgement are like fine instruments—they perform best if continuously tuned and used. So, even as a woman—or a man—considers becoming a physician, I encourage that person to evaluate how she or he will weave the demands of being a physician with the life goals they seek to achieve.

I was profoundly lucky in finding the man who has been my help-mate, my friend, my love for the last four and a half decades. He believed as much in my goals and dreams as he did in his own. And together, we achieved many of each of our goals. With such a partner by my side, I was able to defeat the high school counselor’s assumptions and balance being a wife, having a family and being a physician. I have high energy levels and did not need or desire to take long breaks from my practice or training as a result of pregnancy or childbearing. Certainly, for some their health will demand slowing down or even stepping out of medicine for a time. But to plan on a career that includes long breaks from being a physician is problematic in my book.

I think individuals are not well served by taking substantive breaks from “being a physician.” Reducing one’s commitment from “full time” to part time but keeping active in the practice of medicine allows one to seek goals outside of medicine. But studies have shown that absences of even months and certainly absences of years create challenges for the physician who wants to return to medicine. The military has looked at time that physicians are deployed and using very different skill sets than required by their stateside practices and insurance companies, boards of licensure and hospitals are all looking at how long one can be “out of practice” and simply step back in without retraining or at least reassessment.

So, my advice: be sure that the practice of medicine is truly calling you and that you have given serious thought to the implications of answering that call. If you choose to step away from practice for a significant period of time, be prepared to go through a reassessment or even a retraining period. Plan for medicine to be one of your passions and give the time and energy such passion requires…just as our children, our spouses and perhaps some of our outside interests require! Your patients and your profession should expect no less of you. And if you answer the call, it is an amazing journey rewarding intellectually, personally and spiritually.

Q: What is your personal motto?

A: Passion. Compassion. Excellence. Achievement. Honesty.

Passion in all that I do.

Have compassion—not all have been as blessed, as lucky as have I.

Strive for excellence; otherwise, why bother doing the thing?

Make a difference, achieve something, touch someone, leave a legacy.

Be honest, have integrity—live like my father when a handshake was a bond, a promise was kept.