Shattering Glass Ceilings One Surgery at a Time

Introduction and Dr. Monacou2019s Background 0:00

As we finish out Women's History Month, I am thrilled to bring you this interview with Dr. Joanne Monaco. This was an interview from May of 2022, but the message and the themes ring just as true as ever. A little bit about Dr. Monaco. She is a native New Yorker trained in plastic and reconstructive surgery with an advanced fellowship training in aesthetic surgery. Her practice focuses on facial, breast, and body rejuvenation. She's also served as the program director of the prestigious Manhattan Eye, Ear, and Throat Hospital Aesthetic Surgery Fellowship for seven years and trained up-and-coming plastic surgeons in all sorts of different procedures.

She graduated magna cum laude from Lehigh University, where she completed a master's of science degree in neurobiology She earned her medical degree from University of Vermont College of Medicine and was the first female to graduate from the prestigious Integrated Plastic Surgery Residency at University of Kansas Medical Center. I loved this conversation because Dr. Monaco is a real trailblazer. She went through surgical residency and fellowship at a time that was very challenging and excelled, was highlighted many, many times throughout her career for her compassion, her professionalism, her teaching and commitment to patient care.

So without further ado, enjoy today's episode. Welcome to Heartline, conversations with healthcare changemakers following their heartline. I'm your host, Dr. Andrea Austin. I'm an emergency medicine physician, coach, and educator. I believe that healthcare needs to improve the quality care that patients receive and that supporting the workers is at the heart of this transformation. I am so excited today because we're actually recording this podcast in person at the Women in White Coats Conference.

How She Chose Plastic Surgery 2:06

So welcome to the pod. Thank you so much for having me, Dr. Austin. This is so exciting. So I'd really like to learn more about your story. Plastic surgery, well, like most surgical specialties are really male dominated. So how did you come upon plastics? I guess when I started to learn a little bit about plastic surgery, what I found most interesting was the diversity within plastic surgery. So plastic surgery can consist of the cowboys who are transplanting faces and hands. I wish I had that ability, I do not.

The people who are fixing birth defects such as cleft lips and cleft palates. The plastic surgeons who are reconstructing breasts after breast cancer. the ones who are doing lacerations and fixing playground injuries on children. and the cosmetic surgeons and aesthetic surgeons. So what I really appreciated about plastic surgery was just how incredibly diverse plastic surgery can be. And so that's what attracted me to applying for a plastic surgery residency. And I just, I found myself, when I was a medical student, I scrubbed on a jaw cancer case where the otolaryngologists came in and resected a tremendous amount of a man's face.

And then the plastic surgeons came in and used his scapula to reconstruct a jaw. And he pulled up all of the muscles from around his neck and chest to reconstruct the man's face. And I was in the operating room for 18 hours. And for that time period, I think I was maybe two hours into that surgery when I knew at that point that I didn't, I knew I wanted to be a surgeon from a young age, but it was that surgery that made me decide that I wanted to become a plastic surgeon. I think that that level of bravado in the operating room is just what attracted me to plastic surgery.

And then I just found my niche within plastic surgery as I went through my six year residency program. Wow. 18 hours in the operating room. So for, for some of our listeners out there that might be thinking about surgery, that was definitely a barrier for me. I was like, I can't stand in the operating room for this, this long. And I do recall that you mentioned that you're a marathon runner. Do you think, were you already a runner when you went into medical school and maybe had kind of that muscle base built up that you could stand for a long time, or was that something you had to work on?

It was actually happening at the same time.

Balancing Surgery, Family, and Marathon Running 4:46

I think I ran my first marathon in medical school. So I think that that was just sort of happening all at the same time. So it was just a nice coincidence, actually. And most of my surgeries now are much shorter. I can't think of a time where I've been in the operating room longer than six hours because You know, with what I do, everything is elective. And so we know that longer surgeries can lead to complications. So I will only do surgeries that are done in parts. So I will not do like those old shows that were on where every tip head to toe was, was reconstructed and made gorgeous.

Those things we know are just a little bit unsafe now to keep a patient on the operating room table that long. And for that 18 hour surgery, that patient had a medical need. He needed to be reconstructed. So. it's very different compared to what I do, which is everything elective. So tell us about your current roles and what you enjoy most about your professional mix. Well, I'm in solo practice in New York City. So I have control of my schedule, which is great. I'm able to balance my family life and my work life, which is great.

And I think maybe that's why I have such high job satisfaction. I am able to be where I need to be for my children when they need me to be there. And I really appreciate that because I'm watching them change and grow and achieve great things already, and it's going by so quickly. So I can balance being a surgeon, being a mother, being the wife of a surgeon, all with many balls in the air at one time. So I appreciate the fact that I can control my practice being in solo practice, which is the way most of us are in New York City.

We're all solo practitioners for the most part in plastic surgery. And then you also do some work in medical education as well. Right now I'm starting to work more and more with medical students, particularly female medical students who are interested in going into surgery. So it's really very fortunate that the pandemic brought us the use of Zoom. is i'm able to connect with female medical students across the united states and just work as a sort of a lunch time series where we can have invited speakers and talk about different areas of surgery bring energy and bring in an anesthesiologist bring in a neurosurgeon a urologist just so that female medical

Pregnancy During Surgical Training 7:10

students can connect with somebody who can answer their questions and can answer the idea of, can I do this? Can I become a mother? Can I become chairman of my department? Can I achieve all that I want to achieve? And it's really nice to have a name and a face and somebody who can sort of answer some of those questions, which can be daunting as a third or fourth year medical student. So we're here at the Women in White Coats Conference. And yesterday you were recognized for being one of our Women in White Coats heroes for leadership and service.

And you told a story about your time being pregnant. I believe it was during residency or maybe it was fellowship. Would you mind sharing that about what that experience was like being pregnant as a surgical trainee? I had my first pregnancy during my aesthetic surgery fellowship and it really was, I think I was one of the first females to come through. I certainly, I was the first female to graduate from my integrated plastic surgery residency. So, you know, there were a lot of barriers that I had to overcome with being in that role.

And then again, as a fellow in aesthetic surgery, there aren't that many women who are doing aesthetic surgery fellowships. And I think it's because the length of training is already so long that by the time people are done with residency, it's time to get out and get started and become a grownup, I guess. But I decided to do the aesthetic surgery fellowship and I kept my pregnancy hidden as long as I possibly could because I just didn't want the bias, the bias that I knew that I sensed and being the first female to come through.

I did not take a maternity leave for any of my three pregnancies. I did not take really any time off after three C-sections. And even with my third C-section, my little guy was put in the NICU for a little while. And I just came right back to work because I figured I didn't even have an infant at home to take care of. So it was the perfect time to get things done. And I would leave when I was allowed to go and visit him. So this is something that I hope is actually going to change and get a little bit better.

There were no dedicated days for. leaving for pregnancy or for giving giving birth or being home with your baby. Those were vacation days. And if you wanted to take more than that, then you made them up afterwards, which just doesn't work timing wise. So I'm, I'm hoping it's better for trainees now just, just was, it was not conducive to having a family as a plastic surgeon in training. And, you know, now we have 54% of medical students are female. The, the The tides are changing. The times are changing.

We are achieving more equity in the workplace. And it's very exciting for female medical students and female physicians because there is more protected time for family. Yeah. So now with the ACGME, which would cover residency, there's four weeks of time off for maternity leave. And depending on how much time you miss.

Learning the Business of Medicine 10:21

I can't remember the number of weeks overall, but you may have to make up some time or extend residency. But you know, in the great, great scheme of things, I've been involved in residency education for years and I've watched many women go through this process. And one of my close friends extended her residency by a month and she was supposed to start a fellowship and she did. And she started it a month late and I don't think she would take that time back at all. You know, my advice would be for for our listeners out there that, you know, if you need to take the time off, you know, a lot of people pave the road like Dr.

Monaco for you to have those four weeks off. So take it. That's great advice. So with the aesthetics fellowship, was that ACGME accredited or is that like an independent or a non accredited fellowship? It's different than the ACGME. It's accredited by the American Society of Plastic Surgeons. So the rules were changing at the time. And, you know, even it's very different in the surgical world, though, whether the rules are there or not, it's just the way you're made to feel if you're taking time away from the call schedule and those types of things.

So I'm sure I could have taken time off. It just would not have been a welcoming environment coming back to and not by my co-fellows. The guys who I trained with were amazing. It's just the overall sentiment. So things are changing and it's exciting. I'm very, very happy to see this change. So I want to go back a little bit and talk about being in independent practice because at least in my medical school and emergency medicine residency, very different most. Well, it's also changing. There are people that own freestanding emergency departments, but there was no business training.

So how did you even start? Like when you started your own practice, do you have to get like a business loan in order to start because I think it's important with the changing medical landscape and one of the things we talk about a lot. is how do you have more autonomy and agency? And I do think we have to start improving our business acumen earlier in the process. I think that's definitely one of the deficits that exists in training today. We are not taught to be business people, and we really need to be taught how to be smart business people as independent practitioners.

And so I tell all of the aesthetic surgery fellows to spend as much time learning the procedures as talking to the other plastic surgeons. Learn from our mistakes. Learn things like when should you get your website set up? How to apply for the best business loan? What interest rates should you be looking at? What equipment should you invest in and what equipment should you wait on? How do you hire your front desk person? What music should play when your patients are on hold? Should your patients ever be on hold?

How much should you be spending on social media and promoting yourself that way when you could potentially be opening yourself up for patients that are, you know, somewhat litigants. So, you know, there are so many questions that need to be asked and answered during training for the next generation of doctors because we're not taught this. So the business of medicine is just a remarkable field and to try to master that while learning all of the information that you have to learn and as surgeons all the surgeries that we have to understand the techniques and the post-operative care, it can be overwhelming.

So just the gift of talk is actually remarkable for teaching so much when you have the opportunity to talk to people who have done it and people who have made those mistakes and who can just talk to you about timelines and funding and those kinds of opportunities and malpractice insurance and you know so spend as much time talking to established doctors as you possibly can because they know and they've learned and they Doctors love talking about themselves.

Building a Strong Practice Team 14:27

I mean, let's just face it. So getting somebody to talk about a specific area of where they've made mistakes or where, where they learned how to avoid lawsuits or staff who have stolen from them or things, you know, whatever the topic may be, they're just, just get a doctor talking and you will learn so, so much. So since you own your own practice, you do have to hire people. What are your tips for finding quality people, keeping quality people? It seems again, something we're not taught. It's, I think so much of that has to do with how you treat the people around you.

How you treat your staff can make such a difference in your happiness in your office. It's just a human trait to treat people well and expect that and receive that in return and not expect anything, honestly. It's just, that can really be a challenge. It really can be a challenge. I don't know where I'm going with all this. No, I think that was good because what and I'll follow it up. So what you're saying is you could hire somebody that you could take the same person and depending on the culture that you create in that office is going to determine the quality of work that that person does.

Absolutely. I think that investing in your staff really helps in terms of getting people to work harder or work longer or what you need them to do. I mean, the worst thing that any office would be hurt by somebody who's always looking at the clock waiting to punch out. And I can't think of anybody in my office who's waiting to punch out. Everybody is dedicated and invested in wanting to take the best possible care of our patients. And that's just remarkable. And also what helps is that Depending on where you are, you may need people with other language skills or some people who are just meant to answer the phone and they're not meant to be face to face with patients.

So you have to know what your needs are before you start staffing your practice. I like that. And so what you're also saying is you have to be attuned to what people's strengths are and kind of be flexible with moving people around to get what you

Navigating COVID in New York City 16:58

ultimately need. Absolutely. And you also have to have somebody in the office who has some kind of a business sense, who is willing to run to Staples when you run out of office paper or paper towels. And I like that flexibility. It's just so important. running a business and just even myself being flexible with my hours or I'm about to walk out and the next thing I know I'm getting called for a kid who has a laceration and that needs to be fixed. So there has to be some level of flexibility with everyone you work with for the team to succeed.

So we're still in a pandemic. It's been a really rough couple of years and you had to navigate owning a business, having a staff, uncharted territory. Oh, and by the way, you were in New York, the epicenter of the initial wave and certainly had subsequent waves that were very intense in New York and your mom with three kids. So I guess I don't even know how to ask the question, but how have you been navigating this storm and do you have any pearls out there for women trying to juggle their practice and COVID and trying to take care of their kids?

Initially in New York City the plastic surgeons were considered non-essential and so we were not allowed to see patients. And that seemed to, felt like an eternity actually, but honestly it didn't matter because we didn't have that many caregivers that were running around in New York City. So with the children home from school we had to be the the teacher, the AV technician, the snack provider, the housekeeper, the student. I don't know. We had to juggle many different hats. And that was just a remarkably, remarkably difficult time.

So when the schools opened up for in-person learning again, I could not have been more grateful that my children were in the classroom, being engaged, being around students at their own age, even if it was in the mask. That's really what the entire family needed. to succeed was to get the schools back open. And patients then were able to come back to the doctor's offices because most of my patients have children. And most of them were busy doing their exact same thing that I had to do, which was being the AV technician for the Zoom and cleaning up after snacks, providing a million snacks during the course of a day.

I had no idea how many snacks a child could possibly need when sitting in front of a computer screen. And so that balance, it was not there and it was not there for a very long time. But now, thankfully for in New York City, we've figured things out and the schools are in person and the children are happy again and practices are thriving and masks are coming off. So patients are running in for their procedures. And that's just exciting for me because people are finally back on track with self care.

And it wasn't just about making their eyes and their foreheads look great because they were That's the only part that you could see on somebody when they were in a mask. But now it's about the whole, the whole body again. So all of the elective procedures are back. We're doing all of the breast lifts and liposuctions and tummy tucks and all that kind of stuff. Cause patients are able to care for themselves again. They're getting to the gym, getting outside, exercising during the pandemic at the initial stages, the parks were closed.

The children were not even allowed to go to the park to play because the parks were closed. So now we are back in Central Park and running around the reservoir and biking and doing all those amazing things that people are taking care of themselves

Women in Surgery and Advice for Trainees 20:38

and coming to my office for their procedures. So life feels renewed again, thankfully. So what gives you hope about the future of women in surgery? I think that more and more women are going into surgery and going into the various areas of surgery that have been traditionally male dominated. And there are just better protective devices for women in surgery. So we do have like maternity leave, as you had mentioned earlier, and things like that that could protect the work-life balance. And that's really very exciting.

The fact that medical students right now, 54% of them are female. I think that's amazing because Anything is possible when you're a medical student. Anything. I mean, hard work gets you places. And so it's exactly the same way in the surgical disciplines. Hard work will get you whatever it is you are trying to achieve, either as a female or as a male. And that balance is there between the genders, which is exciting. We're really getting there. And I love seeing other women succeed in the surgical subspecialties.

It makes me very excited for the next generation. So as we start to wrap up, we love to ask a few questions of our guests. How do you stay physically fit? That's one thing that tends to fall behind as a mother of three and a business owner. But I have unfortunate that in New York City, most apartment buildings have gyms in their buildings. So I have Peloton bikes available to me and weights and all that kind of great stuff. So when I can carve the time, I love the Peloton. It's just so fun. I love Cody as an instructor.

But I think that soon I'll be back in Central Park training for another marathon. I just haven't carved out the time for the training of it. And if anyone is ever considering running a marathon, the New York City Marathon has to be the best one in the world. It's my favorite. It's great. Wow, I'm just so impressed by that. I can't imagine training for a marathon and all that you do in the operating room on top of that. That's so cool. What's your ideal self-care day? Well, I don't make enough time for sleep and so coming to this conference in Charlotte, North Carolina, I had an amazing night of sleep last night because I was able to turn off the television at nine and not have to worry about anything.

so self care right now for me is figuring out how to be better about sleep i'm great about my skin care that's that's for sure because that's something i'm i'm obsessive about for my patients and i'm always looking for more knowledge on skin care and then i have cut out wheat and dairy from my diet so i think my skin looks actually better gluten-free And just, I don't know, I haven't figured out exactly what self care is when you have all those balls in the air. So sometimes it's just as basic as drinking enough water, getting some sleep.

Well, that's great advice. I think we could all do better on the basics. So we're still in a pandemic, and I think there's been other things happening. The war in Ukraine, it feels like we're going through a rather tumultuous time.

Fitness, Self-Care, and Flexibility 24:10

And even in health care, there's a lot of disruption happening right now. What's your advice as we continue to go through these uncharted waters? I mean, who knows? We might have another variant that shuts things down again. your mental strategy for not kind of cowering in a closet with the latest news coming out and as we go through these disruptions? I think that the amount of adversity that has been thrown at all of us has taught us that we need to have some level of flexibility in the way we handle things.

We have to be flexible about our family life, are flexible about our professional life, And really, that's just the only way to approach it. If the pandemic hasn't taught us anything else, it's just a matter of just we never know what's going to come next. We spend now we spend time raising supplies to send to the Ukraine and teaching children about how to be safe with COVID and their masks. And we're swabbing our children nonstop to stay live in the classroom. It's just all about being flexible right now for us.

And in New York, I think that that's how we are managing and thriving. Our children are starting to thrive again, which is just such a beautiful thing to see. I think that's great advice. We have to be more flexible, adaptable. And that change is the one true constant. Well, this has been so fun. Where can our listeners connect with you? I would love to connect with your listeners. I have a couple of profiles on Instagram, Dr. Joanne Monaco, underscore NYC and Monaco Plastic Surgery, underscore NYC.

I'm also, I have a handle on TikTok and I have a website, Dr. Joanne Monaco, and then just plain old email and telephone. So I'm definitely accessible for anybody who knows how to use the internet for sure. Awesome. Well, thank you again. It's been a true pleasure getting to know you a little bit at the conference. And I would love to have you back and delve more into the business side and pick your brain about social media. You have a TikTok. That's pretty cool. I haven't crossed that bridge yet.

Thank you, Dr. Austin. You are such a wonderful, wonderful podcaster. This is great. I'm excited for your new endeavor. Thank you. Thanks for listening to Heartline, conversations with healthcare changemakers following their heartlines. I'd so appreciate it if you could take a quick moment and hit the like button and also the subscribe button that you'll find within your podcast app or

Where to Connect and Closing Remarks 26:58

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This podcast represents the views of the host and guests. It does not represent the views of any entity we work for or with. It is also for informational use only and does not replace any professional advice including medical or psychological. If you are interested in unlocking your true potential, reach out to me. If you're an organization interested in supporting the well-being of your people, I'd love to connect on innovative solutions. Schedule a strategy session at andreaaustinmd.com. Sound editing services are provided by Better Podcasting Services, and you can find their website at betterpodcastingservices.com.

And I'd also like to thank our future Dr. Caitlin Dinn, who is the production assistant for this podcast.