AAMC Reporter: September 2005

Julia McMurray, M.D., associate professor of medicine, University of Wisconsin School of Medicine

Daughters of the First Women in Medicine Build on Success

Medical education for Julia McMurray, M.D., started during her childhood in western North Carolina in the 1950s. Both of her parents were trained as physicians, and she often followed her father around on Sundays when he would see patients in his office. He even let her answer the telephone, using his pet name for her, "Miss Bird."

From that point on, McMurray, now an associate professor of medicine at the University of Wisconsin School of Medicine, was hooked on becoming a doctor. She enjoyed being around her father's patients and listening to their stories and was proud that the care her father provided could make them feel better.

"I was timid at first," she said. "But I really enjoyed going in to see the little old ladies with blue hair. And I knew being a doctor was important because whenever my dad was on call, the phone would ring almost every 10 minutes at night."

McMurray's mother was also a trained physician—one of three women who graduated in 1945 from the University of Oklahoma College of Medicine. Before starting a family, McMurray's mother worked in a sexually transmitted diseases clinic, but McMurray never saw her practice medicine and wondered why her mother never treated patients. It was not until after she graduated from the University of North Carolina-Chapel Hill School of Medicine that McMurray began to understand that the work-life balance is difficult and requires compromises, especially for women doctors.

The decision to go to medical school was a painless one for McMurray, who had the support of both parents. Her father told her completing medical education was "the easiest thing to do," and in 1975, she was not considered odd for wanting to be a doctor.

"My mother was part of the first era. They were pioneers for women in medicine," she said. "I was part of the second era. We were the settlers—so it wasn't a big deal. There were plenty of women around in medical school."

Still, as a medical student, McMurray struggled with feeling like an impostor. She said that while she reveled in caring for patients and encountering new people on a daily basis, she sometimes had trouble believing the experience was real. But by the time she began her residency in primary care at Montefiore Medical Center in New York City, she was comfortable wearing the white coat.

She worked in the South Bronx and treated African-Americans, as well as patients of Jewish, Italian and Russian decent. As she had done with her father's patients, she enjoyed hearing her own patients' stories—much more than filling out the copious paperwork that was part of their treatment. And despite working with so many different cultures, she never had a patient who did not want a female physician.

McMurray continued as a fast-paced, work-driven doctor who arrived in the office at 7 a.m. and left late in the evening until she had her first child and fully appreciated why her mother never practiced medicine. While she was fortunate enough to have money for childcare, she soon realized she wanted to only work part time. The University of Wisconsin School of Medicine agreed to reduce her workload, and McMurray's husband, also a doctor, gladly shared the child-care responsibilities.

"The big deal today is the balance between work and home," she said. "It's the current buzzword, even for men. We don't talk about children, we talk about 'balance.'"

Diane Wara, M.D., division chief of pediatric immunology/ rheumatology and program director, Pediatric Clinical Research Center, University of California School of Medicine

Marriage and Medical School

Unlike McMurray, Diane Wara, M.D., division chief of pediatric immunology/rheumatology and program director for the Pediatric Clinical Research Center at the University of California San Francisco School of Medicine, earned her medical degree in 1969 not because she specifically wanted to treat patients but because it was an easier path into medical research. Her undergraduate advisor at Stanford University suggested both she and her husband-to-be apply to medical school because few women who earned doctorates in basic science at that time ever went on to conduct research in major universities.

The concept of married couples applying to the same medical school was still new, and her parents were not initially supportive because they believed that the combination of a new marriage and medical school would be too stressful. However, the University of California-Irvine School of Medicine (UCISOM) accepted Wara and her husband, she said, because it had just joined the University of California medical school system and was willing to take risks to get qualified applicants. Over time, her parents became more confident about the arrangement.

"My parents opinion changed rapidly, and they became very supportive," she said. "But, when I was applying at the time of getting married, it just wasn't consistent in their minds."

Even though Wara was only one of eight women in her class, UCISOM faculty encouraged her to aim for a career as a faculty member at a research-oriented medical school. So instead of choosing a career in surgery, as many of her female classmates did, she focused on pediatrics and immunology, which led to her clinical research with children.

Being one of the few women in medicine at the time had its advantages, Wara said. Instead of encountering roadblocks throughout her education, she received accolades and assistance for her hard work.

"When you're one of a few and do a good job, you get all the breaks and the benefits—it's not so in a crowd," she said. "I was singled out because I was different, and getting lots of credit was easier than it is for women students today."

For example, Wara received a scholarship specifically designated for a female medical student who resided in the city and county of Los Angeles. The scholarship covered all her tuition and living expenses, but Wara said she requested only half the money and funded the rest herself. Such generous opportunities, she said, are not available for women students today.

She also received unexpected assistance during the latter parts of her medical education. As a pregnant intern at the University of California Los Angeles School of Medicine, Wara went into labor while she was on call and delivered her baby the same day. The chair of pediatrics took over her duties and insisted she take a week off. When she started her residency at the University of California San Francisco School of Medicine, however, maternity leave and childcare assistance did not exist. Fortunately for her, the pediatrics chair was married to a physician and understood her challenge, so he rented a room in the old nursing quarters so Wara's husband could bring their daughter Anne to her while she was on call.

"I was fortunate to have such wonderful mentors in these two chairs of pediatrics," Wara said. "They saw that I needed assistance, and they were incredibly supportive and helpful."

Achieving Balance

But Wara's success did not initially inspire her daughter Anne to pursue a career in medicine. In fact, Anne Wara, M.D., an obstetrician/gynecologist working for Kaiser Permanente in San Rafael, Calif., was interested in environmental policy when she first matriculated at Stanford University. An internship at a women's needs center refocused her attention on women's health issues, however, and she decided to study obstetrics/gynecology.

Her parents did not try to influence her career choice, Wara said, but they were firmly supportive of her decision to enter women's health because they recognized her dedication to the field. She believes her gender helps her to connect with her patients.

"Definitely in my field, being a women is a huge advantage because it provides you with an insight into the patient's experience," she said. "You can also rely on some personal experience to offer advice, and the patients appreciate that you've been helpful in that way."

It was during her residency at Kaiser Permanente that Wara realized that she wanted to enter clinical practice instead of following her mother into academic medicine. She said she felt working at Kaiser would expose her to a more diverse patient population and a wider range of practicing physicians from whom to learn. Future family plans and obligations were not the sole determining factor in her decision to pursue a full-time career, she said.

"I never had any doubts that I could balance family and work," she said. "My mom worked full time, she did complicated clinical research, she saw a high number of patients, and she was still around for us. She never worked part time, so I knew I could do it."

It is that "can-do" attitude that women bring to medicine that benefits both the patients and other medical colleagues, Anne Wara said. Because women face family and work decisions constantly, they bring flexibility into the workplace and are accustomed to working collaboratively. In addition, women often exhibit nurturing characteristics as physicians, she said.

"Women just have a unique approach to medicine and patient care," she said. "It's just one model for being a physician, and if women practice this way frequently, it's definitely a bonus for everyone involved."

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