Dr. Heidi Nelson still remembers the doubters after she became Mayo Clinic's first female surgeon a quarter century ago. She had to win credibility with colleagues — and find ways to convince patients she was the surgeon.
"I had to develop a strategy where I'd walk into a room with my card, and I would engage them with eye contact and with verbal presence ... I'm Dr. Heidi Nelson, I'm a colorectal surgeon on staff. I'm here to answer questions and care for you. Here's my card,'" she recalled recently.
Questions about who she is or why a woman is a surgeon are ancient history. Two years ago, Mayo named Nelson chair of surgery. Her selection was part of a wave of academic promotions for women at Mayo in fields long-dominated by men. Last year, 70 women won promotions to either associate or full professor, more than quadruple the number a decade before.
For Mayo, it's been a conscious effort to stay competitive and improve the quality of care.
The institution's leaders recognized it trailed other nationally known medical centers when it came to gender equality in academic promotions, said Sharonne Hayes, director of Mayo's Office of Diversity and Inclusion. Diversity in medicine is important because it enriches and improves the way doctors see patients and treat their health problems, and academic promotions are the typical path into leadership roles, she added.
Getting there, though, meant making changes to the typical path to promotion. Hayes says her office was established five years ago with a mandate to clear the obstacles that can hold back women and minorities in the sciences and medical leadership. Among the efforts, Hayes said Mayo has made it easier for women to resume a career after their childbearing years. Academic medicine, she added, is typically "very unforgiving in that regard."
The women now in power at Mayo are helping change that dynamic.
Last summer, Dr. Claudia Lucchinetti became the first woman in Mayo's history to chair the clinic's neurology department. The first thing she did, she says, was to inform department staff of her kids' dance and swim schedules.
"You can move forward along the leadership ranks and it doesn't mean you have to give up or abandon or not prioritize your family," she said. "I think that's an important message."
Lucchinetti, 51, also recalls that the path to leadership wasn't clear when she joined the faculty in 1996. As an undergraduate at Northwestern University, she built ties to several Mayo researchers, including a neuroimmunologist who invited her to do research in Rochester for three consecutive summers.
After medical school, that history helped Lucchinetti land a neurology residency at Mayo. A few years later, she sought one of the world's leading neuropathologists, this time in Austria, sent him a fax and convinced him to let her train with him for six months.
Once on the Mayo staff, she saw patients, published research, and rose through the academic ranks enough to seek a promotion to full professor. But colleagues advised her to wait.
"When I went up for professor of neurology, I did get feedback — 'Well, I think it's too early. I think it's too soon,"" she said. "I'm looking at this and thinking, 'Well, wait a minute, I don't think so.' Yes, I was young and yes I was a woman, so it might have been unconscious bias."
She said she ignored the advice. "I put my letter forward and I was promoted."
Besides surgery and neurology, women are at the helm of Mayo departments in physical medicine and rehabilitation, medical genetics, systems and procedures and the Center for the Science of Health Care Delivery.
Among the ranks of associate professors, women and men are roughly equal as a portion of all faculty members. However, among full professors, women represent only half the share of men.
In 2004, 16 women were promoted to either associate professor or professor at Mayo. By 2010, that number more than doubled to 38. And last year, 70 were promoted.
In all last year, 140 women held associate professors positions, representing 17 percent of the clinic's faculty, compared to 381 men, or 19 percent; 111 women held professor positions, or 14 percent of faculty, compared to 593 men, or 29 percent.
Nelson, 61, says the climate at Mayo has become more welcoming to women in science leadership. Her department is now about one-quarter female — a long way from when she was the only one.
The absence of female role models forced her to develop her own style in working with exclusively male colleagues. She specializes in treating patients with colon or rectal cancer and her medical research on minimally invasive surgical techniques won her professional credibility. But she also found building relationships with male colleagues required researching minimally invasive social techniques, too.
She's still figuring out the social aspects of chairing the Mayo Clinic surgery department.
"I don't golf, fish or watch sports," she said, "so connecting socially with people in leadership positions, whether its Mayo, national, whatever, is sometimes still challenging."