00:00–00:30
Hello. I’m Dr. Shlomit Schaal and I'm the Chief Physician Executive here at Houston Methodist. Welcome to our webcast. Women in Surgery. Today, I have the honor to host here Dr. Le, welcome. Thank you. Thank you for having me here on your show. It's been, a great getting to know you, actually, this year. We'll talk about it a little bit later. But first, tell me about yourself.

00:30–01:00
Tell me and the audience. Who are you, Dr. Linda Le? so I have been a vascular surgeon here for nine years. and it was my first and only job out of fellowship a long time ago. It's been a great experience. I'm originally from New Orleans, born and raised. And so I love those traditions. But I also have now I consider myself a Texan, but have been... I also consider myself a Texan. Yeah, it definitely grows on you for sure.

01:00–01:30
And so I've been very happy here. Love, love, we have a residency and a fellowship. And excited to be here to talk more about what it's like to be a woman surgeon. So, what is vascular surgery? What do you actually do? So, that's a great question, because many people, even in med school, do not know what we do. I, when I was a third year, just got placed on the vascular rotation as an elective.

01:30–02:00
I had no idea what vascular surgeons do, and not until I was on the rotation did I realize what it was truly about. And to me, I look at it as we're the fire men and women of the hospital. So we do, not only, you know, carotid disease, peripheral arterial disease, but we also stop emergency bleeding if there's clotting, aneurysms. It's a vast array of vascular diseases, mostly affecting older patients. And this field found you or you found the field?

02:00–02:30
How did you come about to be a vascular surgeon? I think it found me, really. So in med school, I had great mentors. They were a husband and wife team. They were both vascular surgeons. And then the Chief of Vascular surgery over there. Dr. Batson, who's... Where is there? At LSU. Okay. And now he's retired.

02:30–03:00
But they were just great mentors to me. They let me do so much in the operating room. It was right after Hurricane Katrina. So talk about an experience that probably most people would never get, Just the independence. The, the severity of illness, sort of like a Covid just, you know, patients presenting later, in their, stages of disease. And so it was a great experience. And then I went into general surgery residency, which, again, the vascular surgeons found me.

03:00–03:30
Again, they were my mentors. And so in my head I went through many rotations, but in the end it was always vascular surgery. So many people who are watching, some of them are in med school and they're thinking, can I even be a surgeon? And we're talking specifically about women. There are not many role models, especially in vascular surgery. I know the numbers nationally are 15% women. Yeah. So it means 85% are not women. Not women. But, you know, we are one of the specialties

03:30–04:00
that have made innumerous strides recently in the last years. We have almost, we are now 50/50 in terms of integrative vascular. And so even though traditionally it's been mostly men in the next coming generations, it's going to probably be more women. So you're talking about fellows who are now in training? Yes. Young faculty, med students going in an integrative residency. So we actually see more female candidates than we do male.

04:00–04:30
And it's really now 50/50 in terms of trainees. So how did that happen from a field that is clearly male dominated? Now you're saying the trainees are now 50/50. Yeah. How did you make that happen in your field and how can we make it happen in other fields? You know, I wish I knew the simple answer to that. It really happened pretty recently, I would say. There's probably multiple reasons. Our first female president of The Society of Vascular Surgery was,

04:30–05:00
I think, in either 2013, around that, that, time period. But, you know, I don't think it was just her. I think also, many of us have had many male mentors that have been extremely supportive, have really given us the opportunity to become better leaders in the field. So I think it's just an overall community, like the all the vascular surgeons,

05:00–05:30
everyone's effort to make it more diverse. And this diversity in that profession, has it made the profession better, and in what ways if it did? I think it definitely has. It definitely has highlighted not only in clinical trials. The inequality of clinical trials, both in, in cardiology, vascular surgery that, you know, your best your best is 30% female enrollment. Oh, wow! But that's that's not what the disease process is.

05:30–06:00
You know, I mean, it's so it's never been 50/50. And I would say very few clinical trials have even gotten 30% of female participants. So it's really highlighted that because there's been a big push in vascular surgery of research in gender inequality, not only in this, the field, but also in our patients. You know, in economic disparities in different parts of the country,

06:00–06:30
even, like we've talked about vascular deserts before, where the Midwest has very few vascular surgeon. So I think it's really given us quite a clear picture of what we need to work on and what questions that we haven't answered yet. So you think that female patients, just from your own experience, are they perhaps more comfortable with female surgeons? I think so, I think that goes for any patient. I think patients in general feel comfortable

06:30–07:00
if their doctor looks like them and whatever that is. And also, I think for females, they usually are caregivers, so they may present later in their disease process because, you know, they're taking care of this. They're always worried about somebody else until it really bothers them. And then they come. Right. So, we do notice, that in vascular disease, females tend to present in later stages. Wow!

07:00–07:30
Is there a different anatomical difference between men and women? Obviously there's a difference in size of the blood vessels, Definitely. is it easier or harder to do surgery. First of all, as a surgeon female? And then the second question is as a patient, is it easier to operate on a woman or maybe more difficult because the blood vessels are smaller? Or maybe it doesn't matter? So maybe for open it doesn't. But I think for endovascular it does.

07:30–08:00
There has been research published that actually show Asian Pacific islanders, you know, and females have smaller iliac arteries. And so if you look at that, if you are doing any sort of advanced endovascular procedures, that might be more difficult, which might lead to more complications. In terms of endovascular surgery, that doesn't matter if you're a man or a woman surgeon, right. It shouldn't.

08:00–08:30
It shouldn't, but you know, for example, lead. We have to wear lead for that. That's, pretty, pretty heavy. If you are short, the hybrid tables only go down to a certain a certain height. But then you all, you can't really be on a step stool because you have to press the button. Things, you know, the pedal and everything. And then there was this company, which I won't name, but, you know, there's been some product development like for weightless lead, right?

08:30–09:00
So lead that is weightless so that you don't you don't have that strain from wearing 20 pounds of lead and they literally did not make it for anybody below five foot five. Wow! That was that was literally all the women in our department. So now we couldn't get weightless lead because they didn't, they didn't make those parts to make us the custom lead. That's interesting. That's actually reminded me of, I have a female astronaut friend, and she said they don't make astronaut, suits for women.

09:00–09:30
So they wear the men's suits. Right, right. Which is not that comfortable, especially if you're in space for a long time. Exactly. Yeah. So you have the same, kind of problem. And, are you advocating to change that or is it the if you're going to be 50/50, it's going to be maybe easier to advocate for change in that? Right. Exactly. Absolutely. So we definitely let the company know, they were quite embarrassed. You know, we were not really I mean, I wasn't offended. You don't know what you don't know. Right?

09:30–10:00
So as long as they are open to criticism to comment, like, oh, you know, hey, we didn't think to make parts for shorter individuals, maybe with shorter individuals tends to be women that we should think about, you know, go back to research and development and sort of figure out a way to make this a little bit more equal in terms of body habitus, shall I say, you know. So, as long as, you know, people are open. And that's actually I've noticed that in a lot in vascular surgery

10:00–10:30
is that there are a lot of men and older men in the field, and many times they are so open to you just being honest with them, and they just want to learn. They just like, how do you feel? Like how, you know, they can't say that they've ever been in our perspective. Right? So they don't know what it feels like it. But as long as people are open, to understanding where each other come from, I think that's where, like, growth begins and diversity starts. And so I've always felt that vascular surgery,

10:30–11:00
you know, everybody that does it, I mean we're all different. But we're kind of the same thread that we're all pretty open and very, just compassionate individuals. Fantastic. And you're about ten years into practice. You said nine, ten years. And so this is really the beginning. How difficult it is to start a practice specifically as a female surgeon? You know, I cannot comment on that because when I came here,

11:00–11:30
my partners on my second day of working, gave me ten cases on the O.R. board. I did not even have, scrubs yet or an I.D. And so, you know, the good thing about Houston Methodist is that, you know, people really want, you know, patients who really want to come here. And it's about the name, the quality of the product, right. And so it wasn’t very difficult for me to build the practice. And then I think as long as you are compassionate, you spend time with your patients, you give them a good result,

11:30–12:00
then it's just word of mouth. And so that's really how I started a couple years ago. Fantastic. And how about your life at home? How does this work? You know, every time I go to a conference, people say, “Oh, what do you think about life work balance?” And I don't like the word balance. I like the word harmony. So how do you deal with that harmony? I know you have a young, kid at home, so tell us a little bit more about that. You know, I think it's more about a ying and yang

12:00–12:30
kind of maybe similar to how you feel about harmony. Some moments in life require more time at home, and some moments in life require more time at work. I've always been a believer you can't have it all, all at the same time. And so you just have to decide what your priorities are. And those priorities will change depending on, like, what what's going on in your life and what is needed. and so that's sort of how I balance it.

12:30–13:00
Are you worried at all that you're going to be less progressing fast? And, you know, if you compare yourself to your men colleagues? In terms of your professional career, just because you have a young kid and perhaps a lot of duties at home. Yeah, I do, I definitely do. I think, and we were talking about this earlier. Like that mid-career, you know, and actually my webcast talked about that. It's like, you know, during this time, I feel like you're needed the most at home

13:00–13:30
and so somebody, you know, and again, like, it's not like I don't want to do that. I love being a mother. That's like my number one priority, right? Like, if I had to pick, I would pick my family, obviously. But, part of that is obviously you only have 24 hours in a day. And so where does that go to? And I do feel like some women struggle with that mid-career, where they slow down because they're at a vital part of their life where they're needed at home more and by the time they're like, “Okay, I have more time.”,

13:30–14:00
well, a lot of opportunities have passed that they might have, you know, given up or turned down and so then they don't come because there's other people that have fulfilled that job. So I don't really know. I don't have a good answer of how to how to manage that yet or deal with that. I guess it'll just come somehow organically to me. Yes, somebody told me always that you say this is my number one priority, and then you check your schedule and then you see the numbers of hours

14:00–14:30
that you dedicate, and then you realize what's your real number one priority. Do it. That is true! Yeah, yeah! So I don't know I mean, what do you think about that whole like career? You know, for me my kids are grown now. I have four and my little one is 26. Actually, yesterday was 26. So long time has passed, I think. It's not a race and I think everybody has their own path.

14:30–15:00
And like you said, sometimes you're needed in critical points in life at home. And you have to understand that and just give to that. And I think men as well have that. Right! And perhaps now it's more that our society is more forgiving to allow men to be, with their children, with their spouse, with their older parents, and not only put it on women. So I hope that your generation has it better than mine. But just remember that it's not a race.

15:00–15:30
You don't have to. Really? Yes, some people may pass you, but there's not really. You know, you're going to have your opportunities and just make sure you say yes. Yeah. When you have those opportunities. That's great advice. You mentioned you had a webcast. Tell us a little bit about it. Yes, so you were on, you were one of the highlights on our recent shows. It's called Sisterhood in Surgery and it's through the DeBakey CV Education. It's, we've been doing it for three years now, maybe even longer.

15:30–16:00
And we've done topics such as, you know, academic topics, residency, medical student topics, wellness, personal and social topics, even finance, you know, life insurance policies, things like that. It's been a great opportunity to actually meet many vascular surgeons, not only women, but men, across the nation. Especially, and then I also invite, non-vascular surgeons, but wonderful people like you on the show.

16:00–16:30
And so it's been a great, social network for me. And I think it does help a lot of our viewers just realize they're not the only ones thinking about this topic that may be uncomfortable to talk about. So how did you come up with this idea? It was during Covid and you have a partner as well who is a vascular surgeon partnered in crime for the webcast? Yes. So Palma Shaw is my co-host. It actually started with my chair, Alan Lumsden,

16:30–17:00
who is really into video. Loves, you know, we have all kinds of educational videos on our, doing surgery. And he runs a bunch of bootcamps. And so he said to me, “Okay, well, nobody's followed a pregnant vascular surgeon before, so can the cameras follow you?” And I thought, well... [Laughter] What happens when I'm done being pregnant? Does the show just end? And so then we sort of brainstormed and thought, okay, well, maybe be better if we do, we can do a show about pregnancy, being pregnant during,

17:00–17:30
you know, residency or during being a faculty. But we should do other topics. And so that sort of how it evolved. What was the most fun episode that you hosted? So the most, the most intriguing was the episode on divorce, because I felt like nobody talks about that topic, even though it happens. And we had my chair, Alan Lumdsen, like I said, and his divorce lawyer

17:30–18:00
Who’s like one of the top divorce lawyers in Houston. And so it was just kind of an odd topic to talk about. But we learned a lot. And it was great to hear just things like, I wouldn't even know. I'm happily married, obviously, but to hear the emotional aspect of it, of when a marriage falls apart and to hear it from my chair, who, you know, you see as like the strong male individual. Right.? So it was just a very,

18:00–18:30
a good show on a topic that's really kind of hush hush. That's interesting that you discuss divorce. What are the stressors in cardiovascular surgery and vascular surgery that may lead to a result like that? I would think, you know, for our specialty, it's sort of known for longer hours, due to, you know, lots of emergencies. You know, we we do actually have a lot of emergencies

18:30–19:00
as compared to other surgical fields. and we have a lot of more urgent patients. Our patients are pretty sick. Actually vascular surgery patients have a higher mortality rate than cancer patients, because... Is that right? ...when, when it comes to vascular disease, if you have vascular disease, you usually have other diseases such as diabetes, heart disease, you know, lung disease, end stage renal. So all of those come with vascular disease.

19:00–19:30
So, you know, it's a combination of everything that probably makes it a bit stressful to be a vascular surgeon. And you said a lot of emergencies. What kind of emergencies? Oh, well, let’s start naming them. Mesenteric ischemia, stroke, ruptured triple A, which is a ruptured aortic aneurysm. If you, you know, abruptly lose blood flow to your leg, like a cold leg we call it,

19:30–20:00
Cold arm. Cold really anything! You know? So that’s a rush to go to surgery? Yes! You cannot say tomorrow morning. Exactly. Yeah, because that could result in limb loss. Obviously rupture or mesenteric ischemia can result in death. Stroke can result in death. So there are many, many, innate emergencies for vascular surgery. But then we talk about the iatrogenic injuries like, you know, cardiologist does something, you know, the other specialties might get into bleeding in the operating room.

20:00–20:30
And so that's when we get called for other specialties. So you talk about emergency, but the flip side of this is you really save lives. And there are so many advancements in the field of vascular surgery. What excites you? Oh, there's so many exciting things. So the field of vascular surgery, why I love it is it's so diverse. It's so different. You know, the cases are so different from each other. I mean, you can go from something very elective to something very emergent.

20:30–21:00
Like we talked about, but also the technology. I mean, just in the last couple of years we've had, you know, the hybrid carotid stent, what we call the Silk Road TCAR. What is it? That is, where instead of doing carotid stent from the groin, you can do a small little cut down on the neck instead, that way. And so that’s, you know, another part of our toolbox to treat carotid disease. You know, here at Houston Methodist which, what is very exciting.

21:00–21:30
Is that we are starting a vascular robotics program led by my partner, Dr. Charu Bavare, who has done many, many cases. And so that's something that nobody has done in the country. They do it sparingly in Europe. There's one or two people that do it very well, but other than that, that is something that's very leading edge. You know, in terms of vascular surgery. It's exciting because it can make what is traditionally a very big operation and no way out of.

21:30–22:00
Not getting that big operation into small, little laparoscopic incisions, for example, you know any aortofemoral bypass. So that is, you know, very new and we are, you know, already advancing in that significantly. Our residents and fellows are extremely excited to be a part of that as well. And so we look forward to what that brings. So tell me a little bit about robotics in surgery.

22:00–22:30
That's, in general, very exciting and it and a relatively recent developments. So when I was trained, you know, as a surgeon, everything was open or laparoscopic but not robotic. And today, a lot of the procedures in different specialties are done by robots. Right. How do you view this evolution and do you embrace it? And what are the pros and cons of it? Yeah. So I definitely embrace it. And many other fields, just like your previous guest like urology, that field, you know, in terms.

22:30–23:00
Of prostatectomy, big operations, they do it robotically. I think robotics brings, you know, a skill set that is much different when I'm talking about vascular surgery. But the visualization of your anatomy and the patient is better than even open, believe it or not. I mean, you can look so close at what's bleeding. It's incredible. And just the fact that you have a 360, you know, rotation.

23:00–23:30
Of what is your hands, which is the robot hands so that you can do things that you couldn't even do with, you know, your real hands. So it's really cool, and patient satisfaction is great because they, they get this operation that otherwise would be a humongous surgery. Lots of post-operative pain, increased length of stay, and they're not in that much pain. They get to go home the next day. Fantastic. This is really, you know, for me it's like the future and it's very exciting for our patients. And I know Houston Methodist is leading the way.

23:30–24:00
And I'm looking forward to to hear more about it. Let me ask you a little bit about, you know, for our viewers what would be your advice, how to make it into a field that is surgical, that is still manly dominated? How do, how to if you had to make some suggestions, let's say you're a medical student and you don't know you want to go to surgery, but you're not sure what, what would be your advice?

24:00–24:30
Definitely find yourself a mentor. Okay. So that's important to kind of get as much viewpoint as you can on the field that you're interested in. And anybody can be your mentor, right? I mean, it doesn't have to just be a vascular surgeon, other surgeons, just so you can see what that field of surgery looks like.

24:30–25:00
You definitely have to put in your time and so if you are interested in that you got to show up, be there, be visible. Ask intelligent questions. Maybe not too many questions. But really read the room that you're in. So, you know, I have one med student who shows up to conference every Thursday.

25:00–25:30
You know, he wants to do vascular surgery. He keeps in touch with me. You know, he's going to be following us this week, so, you know, that makes him like, oh, he's on my radar, right? Like, always keeping in touch and showing his interest.

25:30–26:00
And so that's, those are some of the tips that I would give the audience if they were looking to go into surgery. And would you recommend that field if you had to choose again, would you go again? Vascular surgery? Oh, absolutely. I mean, there's, you know, it can be tiring. It can be, you know, very humbling a lot of days.

26:00–26:30
But then some days you leave and you're like, wow, I really made a difference or I really, you said, save lives. Like, I've really saved a life today. And like, there's nothing better than, like, saying that to yourself, and like, I made a difference, you know, like I made this person's life better. So I would say, absolutely.

26:30–27:00
And tell me about you, how you function as a mentor. So you do many things you have to take care of your patients, have to take care of your home and your husband and little girl. Mm-hmm. How do you make time for your mentees?

27:00–27:30
Well, a lot of it is in the operating room so, you know, just being with them in surgery and then also giving them opportunities. So if there's something that comes up that I can't do, right, or that somebody wants a resident, I always think, okay, what about my mentees? Right?

27:30–28:00
Giving them an opportunity to shine. And also just leading by example, like never doing something that I wouldn't want them to do, so that they can see okay, well, you know, if she's doing it that way that's how I'm going to do it.

28:00–28:30
So you also serve on national societies. Yeah. Tell me a little bit about that service. So there's many vascular societies. There's the major national society and then the regional societies and then, a subspecialty societies like American Venus Forum.

28:30–29:00
So I'm a member of many of them and I serve on certain committees. We rotate every couple of years. They're always looking for volunteers. So that's sort of my part of trying to help nationally push forward, you know, push vascular surgery forward.

29:00–29:30
It's been, you know, great. I've done the public outreach, professional/public outreach committee. I've done postgraduate committees, diversity committees, resident committees. So there's a lot of opportunity out there to help within your society. And you have fellows that you mentor here? Yes, I have fellows and residents.