EP159: Trailblazing in Orthopedics: Dr. Deepa Bose on Breaking Barriers

Breaking Stereotypes in Orthopedic Surgery: A Conversation with Ms. Deepa Bose

In this episode of The Girl Doc Survival Guide, Christine interviews Ms. Deepa Bose, a consultant in Orthopedic Trauma and Limb Reconstruction at the Queen Elizabeth Hospital Birmingham, UK. With over 13 years of experience, Ms. Bose shares her journey in the traditionally male-dominated field of orthopedics. She discusses her upbringing in Guyana and India, her training and career in the UK, and the challenges and triumphs she faced as a woman in surgery. The conversation includes insights on gender stereotypes, the importance of mentorship, work-life balance, and recent changes in the work culture to support female surgeons. Ms. Bose also emphasizes internal resilience and the rewards of pursuing a career in surgery despite its demands.

00:00 Introduction

00:03 Meet Ms. Deepa Bose: A Trailblazer in Orthopedic Trauma

00:40 Understanding the Title 'Ms.' in UK Surgery

01:17 Ms. Bose's Journey: From Guyana to the UK

02:28 Choosing Orthopedics: A Personal Insight

03:17 Gender Challenges in Orthopedic Training

07:52 Balancing Career and Family in Surgery

23:49 The Importance of Mentorship in Medicine

27:12 Final Thoughts and Advice for Aspiring Surgeons

Transcript

Christine Ko: [00:00:00] Welcome to today's episode of The Girl Doc Survival Guide. We're joined by Ms. Deepa Bose, a consultant in Orthopedic Trauma and Limb Reconstruction at the Queen Elizabeth Hospital Birmingham in the UK. With over 13 years as a consultant in this traditionally male dominated specialty, she brings valuable insights on navigating surgical training as a woman, balancing career demands with family life, and the importance of mentorship. Beyond her clinical work, she chairs the Specialist Advisory Committee for Trauma and Orthopedics and leads humanitarian efforts in developing nations.

Welcome to Ms. Bose.

Deepa Bose: Thank you. Thank you for having me. 

Christine Ko: I just want to clarify because a lot of listeners are in the U. S. You go by Ms. Physicians in the UK who are surgeons go by Mr. and Ms. is what I've been told. 

Deepa Bose: Yes, that's right. Because traditionally surgeons in the UK were not doctors, they were barbers. So they were [00:01:00] called barber surgeons. So we keep that tradition. When we qualify as surgeons we revert from Dr. Back to Mr. or Ms. 

Christine Ko: Yes. That's what I've been told. It's very interesting. So in the U. S. you would be Dr. Bose, but in the U. K. you're Ms. Bose.

Could you first share a personal anecdote or something just so that people can get to know you a little bit on a personal level? 

Deepa Bose: Sure. I was born and I grew up in a country called Guyana in South America. It used to be a British colony, so it's the only English speaking country in South America. I was there until I was 16, and then I went to India, where my father was from, so I spent 10 years in India. I did my medical training there, and then I came to the UK, and I did my orthopedic training in the UK, and then I did a fellowship in bone infection and limb reconstruction. Limb reconstruction [00:02:00] means different things to different people, but in the UK, when we say that, what we mean is all the sequelae of trauma, like infection, osteomyelitis, nonunion, malunion. Those are the conditions that we treat, and we also do complex trauma and polytrauma. It's a whole sort of range of conditions that we treat.

I became a consultant in 2009, and I've been in Birmingham since then.

Christine Ko: Yes. How did you decide to go into orthopedics? 

Deepa Bose: I always knew I wanted to be in a surgical field since I was a medical student. I just really enjoyed the atmosphere and the environment. Surgery very much aligned with my personality because I like to do things. I'm practical minded. So I knew I wanted to do surgery. I did general surgery initially, and then I did a stint in orthopedics, and I just really enjoyed it. I'm quite mechanical minded. I liked that side of [00:03:00] it, and it was very logical. Everything made more or less sense. It was very gratifying because most trauma patients, you operate on them, and then they get better. That's like an instant gratification. So yeah, I enjoy those things.

Christine Ko: Thank you for sharing all of that. Orthopedics is changing, but in the U. S., it's traditionally been male dominated. I assume it's like that in the United Kingdom as well. Can you share a pivotal moment when you faced gender related challenges in your training and how you overcame them?

Deepa Bose: You're right. It is still very male dominated in the U. K. At the moment, I think only 12% of orthopedic consultants are female. In the US you call them attendings. When you look at the trainees that we have here, about 20 to 25% of them are female. So that figure is slowly creeping up. When I was in training, it was a lot smaller. There were fewer of [00:04:00] us. 

Generally speaking, the problem happens from outside the specialty rather than inside the specialty. I received a lot of support and encouragement from people who are in the specialty, but people outside the specialty really struggle to to believe that women can do it because they know the stereotypes. So they think, oh, you have to be physically very strong, which just isn't true, but people outside the specialty were like, really, can you really do this? Your listeners can't see me, but I am four feet, 11 inches, and I weigh 47 kilos. So I'm not very big, and I'm not very physically strong. There were a lot of misconceptions about the specialty, and then when people see that you can do it, you can do the job, then it helps people to change their minds.

Christine Ko: That's a key thing you just said that you just have to do it and prove that you're doing it. You are doing it. And that's how you change people's minds. But it's still difficult, right? 

Deepa Bose: [00:05:00] Yeah, it is. It is difficult. I was very lucky. I had a lot of really good consultants who supported me through my training. Mentorship is really key. When I was training, I didn't realize that it had a name, but it is mentorship, and just having people who believe in you and who help you to overcome difficulties. Mentorship is really important.

Christine Ko: When you said it was people outside of the specialty, so outside of orthopedics, was that other physicians ,or patients, or both?

Deepa Bose: It's mostly other physicians, strangely enough. Patients, I've never really faced any kind of discrimination from patients. Most patients are lovely, and they just want someone who can do the job. And if they know that you're capable, that's all that they want.

I have one funny story about a patient when I was a new consultant. In my first year as a consultant, I had a patient who had a fracture. I went [00:06:00] to see him on the morning of surgery, and I introduced myself, and I said, I'm going to be your surgeon. It was a man, and he said, Oh, so I have a woman driver. I was very taken aback. I didn't know what to say. And then I said, okay, so is that going to be a problem? And he thought about it and he said, no.

Christine Ko: I think it's good that you were able to address it head on and just say, is that going to be a problem? And to get the answer back when he answers no, that's nice. Do you think that your international background helped you in navigating a male dominated specialty?

Deepa Bose: That's a good question. I don't know. I think it gives you an insight into talking to different people from different backgrounds, whether it's patients or other colleagues, to have that other perspective. I think it's tough for anyone. I don't know if it particularly helped per se.

Christine Ko: When you said that it was [00:07:00] really a lot of stereotyping from other physicians, actually. I think that physicians all work very hard and care a lot about what we do and our patients. But I think because of that, because we work very hard, we're very time poor. We actually do tend to stereotype in the sense that it's fast thinking, it's System 1 thinking, it's "easy" thinking, so we are just defaulting to easier thinking. Without maybe sometimes realizing, if a specialty is male dominated traditionally, we will have in our mind, Oh the orthopedic surgeon is a big burly man who, looks very strong, and often don't even realize that we're making that kind of stereotype. I'm not trying to put physicians down. 

Deepa Bose: Yeah that's very true.

Christine Ko: Are there unique pressures that women face in surgical fields, for example, when they're considering having children?

Deepa Bose: [00:08:00] Yeah, I think true. My declaration for your listeners is that I myself don't have children. However, in the past 10 years or so, I have been doing a lot of mentorship for female orthopedic surgeons, and so I am in contact with a lot of people who managed to make it work whilst also having a family. It's definitely hard not just for surgery but in any acute specialty. So even if you're doing acute internal medicine or pediatrics or any busy acute specialty, I would say they all face similar problems in that we still have that fairly old fashioned attitude where your work is supposed to come first, and you're expected to always be available. 

Things are slowly changing. In the U. K. we have brought in a lot of different initiatives. For example you can work less than full time. It's what we used to call part time working, but we don't use that phrase [00:09:00] anymore because it's seen as being very judgmental, very derogatory. We say less than full time and you can train less than full time. If you're a registrar or a resident, you can do that less than full time, and you don't necessarily have to give a reason. And the same for consultants. We could work less than full time, so that helps. But that's only the starting point. There are so many other things that require support. For example, if you have a period of parental leave, and you come back, coming back is hard. We've introduced initiatives about keeping in touch when you're not working and then supported return to work. Those initiatives have been put in place. We have a lot of information now about pregnancy when you're working, and what to do when you come back and you're still lactating. So you're right. It's still a very tough environment for women who want to have families or who have caring [00:10:00] responsibilities. It is very tough, but I feel that slowly we are starting to make a change, and it's no longer something out of the ordinary. Initially it used to be something quite strange where people would work less than full time or people would go off on maternity leave. It used to be seen as something quite strange, but it's more acceptable now. And in fact, on our rotation now, on our program, we have a couple of male residents who share the parental responsibilities. So they take paternity leave. And in the UK, paternity leave is now a statutory right as well. So you can book paternity leave or you can share it with your partner, however you want to do it. So I feel like things are slowly changing. 

Christine Ko: Okay. And those changes, when did they happen? 

Deepa Bose: They've been changing. Being able to work less than full time has been around [00:11:00] for, I would say about 20 years, but people didn't really take advantage of it because it was seen as not being particularly acceptable, but it's become more acceptable now. So I would say in the last 10 years, yes, all those things are becoming more acceptable. Things like shared parental leave has become more acceptable. 

Christine Ko: You don't have to answer this if you don't want, but may I ask why you chose to not have children, if it was a choice?

Deepa Bose: It wasn't directly a choice. It just didn't happen for me. So I would have had them. It wasn't a deliberate choice to say I wouldn't have them. But sadly, it just didn't happen. 

Christine Ko: Thank you for answering that. Apologies if it was too...

Deepa Bose: Not at all.

Christine Ko: Is there maybe an estimate of an average age that someone would be starting their orthopedics training there? In the U S, if you go straight through medical school, college, medical school and don't really take any time off to do something else, then generally people are finished with medical school around age [00:12:00] 25 and then orthopedics training is usually at least five years.

Deepa Bose: Ours is later because if we are, let's say 28, 29, by the time we start, we finish six years later. We do actually tend to finish a lot later than people in America.

Christine Ko: That even makes it harder, right? Because I learned in medical school, peak fertility is like 27. So if you choose to wait to try to have children till you're finished with training, you don't know how difficult it's going to be. That is a challenge that training happens around the time when you should maybe be having children in the sense of data on fertility.

Deepa Bose: That's quite correct. It is very challenging. 

Christine Ko: I've also found now, reflecting back, because I don't think I had the time to think when I was in training and being a young mom, but there is a culture in the US, and it sounds like in the UK as well from what you said, of workaholism, not [00:13:00] even 100 percent like 1000 percent commitment to being a physician or surgeon is what is normal, actually. Anything "less than that" is seen as then you are less than someone who is working 1000 plus percent. I say that because of your comments on the part time work, which is a term which was seen as derogatory there. We still use that here in the US, and I don't know that it's considered derogatory, but I did hear a comment from a female physician maybe like 10 years ago. She's now full time, but when her children were younger, her children are now past college, she said that she went to be part time as a physician when her kids were younger because she wanted to be able to raise them a certain way, and be present for them, and that was her choice to be part time. She said she was part time and she was probably working like 70, 80 percent [00:14:00] of a normal work week. She was 50 percent, but she was working way more than that. But no one would give her credit. People would just be like, Oh you're not here. Or, you're not here then. Or, you're never really here. And she's, what do you mean? I'm here almost as much as someone who's working full time, but being paid nothing compared to...

Deepa Bose: I think that's true. We had the same thing here as well, that just because you're not there, people think that you're not working, or you're not serious. The message that I always try to send out is less than full time doesn't mean less than committed. 

Christine Ko: That's really important. That's just another way that like, physicians were stereotyping each other, that, oh, if you are not here all the time, then you must not be committed or serious. It's actually not true. It sounds like it's a lot of good things are happening in the UK for female and male surgical trainees, because even though it's still women who become pregnant [00:15:00] and physically have children men have personal private lives too.

Deepa Bose: Definitely. The change in thinking, and the change in the way that people view these things, it's very slow change. The pace of change is glacial. It's not quick. And I wouldn't say that we're there yet. I think we still have a long way to go in how we support pregnancy and how we support people when they come back from leave. Although a lot of things are written down in policy, the challenge is how we implement them, how we actually make them work. A lot of things are written down in policy. So if I were to go to the policy of our hospital, I would see many things that actually are not implemented. So I think the real challenge is how we make it work on a practical level. We still have a lot of work to do. 

Christine Ko: I like your comment on it's how we make it work on a practical level because that's real life. How have you integrated work life in your [00:16:00] demanding specialty?

Deepa Bose: Okay, so I'm gonna say that I'm not very good at it. It's a very difficult balance. I also think that at different parts in your life, the balance falls differently. So there are times in your life where, your family, especially if you have young kids, then your family tend to take priority. And then as you get older, you get to my stage, then different things take priority. It may be your health, or it may be things that you do outside medicine. So I think that balance falls differently depending on where you are in your life and where you are in your career. So it's not always going to be a perfect balance. No doubt, it's challenging, and if you're like me, I wear many different hats, then it can be difficult.

I make it a point to do the things that I enjoy. So all the things that I do, whether it is to do with education or mentorship or, humanitarian work, they're things that I do because I want to do it. So that makes it less onerous, as it were. And then [00:17:00] I have become more strict in recent years about carving time out for myself. I make sure that I have at least one day in a week where I don't have any commitments, whether it be in the hospital or clinical or with my other works, my charitable works. I make sure that I have one day in a week that I just keep for myself to do the things that I need to do. Not easy, but you have to be strict with yourself.

Christine Ko: Yeah. And just one day, like just one day a week?

Deepa Bose: That's where my balance is now.

Christine Ko: And what will you do on that day off? 

Deepa Bose: I do all the things that one usually keeps for when you have time, all the household chores and all the other stuff. Or I spend time with friends or make time for family, those things.

Christine Ko: When did you start implementing that?

Deepa Bose: About maybe five years ago.

Christine Ko: Before that, would you work seven days?

Deepa Bose: Yeah, all physicians we have a weekend working, [00:18:00] which is part of our normal job plan. But on the weekends that I'm not working, I would usually always have something, either speaking at a conference, or I'm doing something related to my humanitarian work. And then, during the COVID pandemic, we all had a chance to reassess our lives. We all realized that no one is indispensable, and it's really important to take time for yourself and for your family. So I started to be more strict with myself around then. 

Christine Ko: Yes. So it sounds like you set a boundary, actually, is what I would call it, with yourself. Okay, my boundary is I will work as hard as I need to six days of the week, but on this one day, that's my day, and I cannot, will not, schedule anything. You're saying, be strict with yourself. If I set that boundary, okay, I'm not going to work a certain day each week, then I have to be strict and not allow something to creep into it. [00:19:00] Oh, I really need to schedule this meeting where I really need to talk to this person. So I'll do it on that day. Cause I have it. free, but then it's no longer free. 

How did you learn to set a boundary like that? 

Deepa Bose: I don't know if I learned. During COVID, I realized that it's really important to spend time for yourself, to spend time with family. Also, as I get older, you realize that there are physical limitations of what you can do. When I was younger, I could work all the time, and it wouldn't take me very long to bounce back from a busy on call or something like that. But as I get older, it does get harder. And if you are called in the middle of the night, it takes a lot longer to bounce back. It takes weeks to feel better. So I realized that that time is absolutely necessary if I am to do the best to my ability.

Christine Ko: You've said a couple of things I think are really important. One is the boundary thing, to really figure out what you need. And I think that [00:20:00] is the silver lining of something like COVID, as you mentioned, because I think it did make a lot of people sort of reassess, what am I doing with my life? The system looked at physicians as somewhat dispensible . in terms of lack of personal protective equipment. It was, okay, just go ahead and do your job, sacrifice yourself for your patients. I'm not saying that's what I think, but the culture I think was definitely that, you're a physician, that's what you should be doing. Yet I realized, and I feel silly a little bit saying this still, but I am just human. When I say that, I realize that somewhere along the way, I internalized kind of a sense that a doctor is not supposed to be human.

Deepa Bose: Yes. 

Christine Ko: Earlier in COVID, they would say, oh, health care heroes, like doctors are [00:21:00] superheroes. And no we're not.

Deepa Bose: We're just human. Yeah, absolutely.

Christine Ko: Another thing you said, which I think is really key: that there are different points in our lives, there are ups and downs. It might have been that for me or another physician during COVID, I had the time to give a thousand percent, but it might have been for another physician, say, who has a newborn baby or even a challenging three year old or a challenging teenager or a challenging adult child or challenges with family members- parents- or close friends who are having something going on that you may not be able to give a thousand percent. COVID definitely made me realize that, like you said, each of us at different points in our lives, we may have to shift the way that we balance things out. And I think that was really wise.

Deepa Bose: I like what you said about the fact that you internalized that culture because I think we do. I think it's a very toxic culture. And we do internalize it, and we do [00:22:00] feel that we have to be bulletproof. But as you say, we are human. And in order to give the best of yourself, you need to recharge, and you need to take care of yourself because you can't be the best doctor if you haven't recharged or if you haven't looked after yourself. And I think that we're slowly starting to accept that. 

Christine Ko: Yes. The culture is very toxic. For me, I didn't initially think to question the culture, but also because I was very time poor, I would just default myself to easier thinking, and it's easier to accept it the prevailing culture without even really thinking about it. You mentioned earlier that you grew up in different areas, Guyana, and then India, and the UK, and I'm sure you've traveled all over the world. I've lived in the US and South Korea, mainly just those two countries. But I [00:23:00] think it did give me a perspective of, a lot of times, being an outsider. And so I think initially it made me want to just be integrated and not question the culture, but then I think as I'm older now, it's made it a little bit easier to be like, I feel like an outsider in this type of thinking, but I know what that feels like. It's okay. I'll still survive. I know I'll survive. Not that it's comfortable to feel like I'm on the outside, but I think sometimes it's necessary.

Deepa Bose: Yeah. And I think that sort of physician work culture is prevalent throughout the world. I don't think it's in any one place. I've worked in India too, and I think it was like that there as well. So I think this is something that all physicians everywhere would recognize.

Christine Ko: Yeah. You mentioned mentorship earlier, that you had really great mentors in your specialty, and that helped you. That is very important, that you have [00:24:00] mentors and models that are doing things the way that you can see can work for yourself. Can you talk about that a little bit? 

Deepa Bose: Yeah, sure. As I said, I didn't know the word when I was a registrar, but I had people who believed in me, who thought that I could do it. I also had people who were the opposite, who didn't believe in me, didn't think I could do it. But I was lucky enough that I have enough people who were there to encourage and support me. The great thing about mentors is that they allow you to realize your own potential. It's different from pushing you or coaching you or that kind of thing, but they just allow you to realize your own potential and provide support for you to be what you want to be. I was very lucky because I had enough of those people when I was training to allow me to become who I am today. And so I [00:25:00] like to try and continue that. 

And you said something about visibility as well, having models. There's a phrase that I hear a lot here in the UK, which is that you can't be what you can't see. So if no female medical student can see a person, a female, short, small, being an orthopedic surgeon; if they can't see that, then they think, oh this isn't for me. This is not the right specialty for me. Whereas if they see that there are people who can do the job, who don't fit into those stereotypes of being a big, beefy man who goes to the gym all the time, then they think, okay maybe this is something that I can do. Just having the visibility and having those role models is important in attracting people into the specialty. And then once they enter the specialty, just being able to mentor and support them so that they can find their own path is [00:26:00] really important.

Christine Ko: I like that phrase, you can't be what you can't see. I think it is true overall. And yet, when you are trailblazing, as you have done, it's not true because you didn't really see anyone, I don't think...

Deepa Bose: There were a few. When I started, there were a few women who did orthopedics, not many at all. There were one or two. I did it for six months in India, and I knew that I enjoyed it, but at that time, I didn't think that this is what I was going to do. And then when I came to the UK, and I met other women who were doing it, and they were very few and far between, but I happened to be doing a job with the husband of one of them. And I was saying to him, I really enjoy this, but I don't think I can do it. And he said, Of course you can do it. My wife does it. You can do it too. And so that was really the start of me thinking, Okay, maybe I can do this. Maybe this is the career path for me. 

Christine Ko: That's really important. Like you said, we [00:27:00] need encouragement. Sometimes it is just one short conversation like that, where someone might say something very impactful, even though it just takes a second. Do you have any advice you would give to women, and men, today considering a challenging specialty like orthopedics?

Deepa Bose: The thing about surgery is that it is demanding, and it would be wrong to suggest that it isn't. It is demanding. It is physically demanding. It is mentally demanding and emotionally demanding. So I think you need to have a certain degree of internal resilience to be able to deal with it. If you have that, and if it's something that floats your boat, as they say, then do it. Don't let anyone tell you that you can't do it. Do it. 

Christine Ko: I like that. That's a good way to end as well. Thank you so much for your time and all your insights.

Deepa Bose: Thank you so much for inviting me. It's been a pleasure.