Longtime WVSOM faculty member and Class of 1988 alumna Deborah Schmidt, D.O., realized she was interested in medicine as a young girl while seeing a military physician in the early 1960s. “I was 8 years old and sick with pneumonia, and the doctor was doing a chest X-ray and drawing blood,” she said. “I’d always been a curious person who enjoyed taking things apart and investigating, and I said, ‘I think I might like to do this someday.’ He said, ‘You can’t. You’re a girl.’ I looked at him and said, ‘I’m as smart as you are, and I think I can.’” Schmidt’s account is far from unique. Women across the medical profession have stories of not being taken as seriously as their male colleagues. Zinaida Pelkey, D.O., a retired physician and former president of the Osteopathic Cranial Academy, also was told she couldn’t be a doctor. Pelkey was a guest speaker during WVSOM’s Celebrate Osteopathic Medicine (COM) Week in April. In her presentation, Pelkey discussed the influences that led her to a career in the osteopathic profession, as well as the teachings of Andrew Taylor Still, D.O., M.D., the founder of osteopathic medicine, and William Garner Sutherland, D.O., who developed techniques used in cranial osteopathy. “I wanted to be a psychiatrist, but it was the 1950s and all the adults in my life told me I couldn’t be a doctor because I was a girl,” Pelkey said. “I later owned a bakery, and one day I injured my back lifting heavy sacks and decided to try the chiropractor across the street. It worked, and I thought it was nice one-on-one work that I could learn to do. So I went back to finish my bachelor’s degree, and one day the head of biology hauled me into his office and said, ‘You’re aiming too low. Apply to medical school.’” THEN VS. NOW A.T. Still was an advocate for female physicians from the time he founded his profession in the mid-to-late 1800s. In 1892, the osteopathic medical school he created admitted six women into its first class. He also hired women as faculty members at the American School of Osteopathy, now known as A.T. Still University, in Kirksville, Mo. Still’s acceptance of females is highlighted in a PBS documentary that aired in 2017 called The Feminine Touch, based on the book The Feminine Touch: Women in Osteopathic Medicine, by Thomas Quinn, D.O., a professor at Lake Erie College of Osteopathic Medicine in Bradenton, Fla. The documentary showcases the women who rose above adversity to become osteopathic physicians in the profession’s early years. “It is the policy of the school that there shall be no distinction as to sex and that all should have the same opportunities and be held to the same requirements,” Still was quoted as saying in the documentary. The Feminine Touch explores how female physicians found success in the late 1800s and early 1900s, but during the years between World War I and Word War II, and leading up to the 1950s, women in the medical profession were rare — less than 2 percent — due to the glorification of domesticity and the social status of being a “homemaker.” Another shift began in the 1970s, but women still faced an uphill battle. “Every day was a challenge because it was exploring new territory for me and, in most instances, for the institutions where I was training. I was in hospitals that had never had a female medical student. They had no facilities for female medical students. I had to use the nurses’ dressing room,” said Barbara Ross-Lee, D.O., the first black female to serve as dean of a U.S. medical school and president of the American Osteopathic Foundation, who was featured in the documentary. Eighty-six years after Still’s osteopathic medical school opened, in 1978, WVSOM celebrated its first graduating class. A total of 33 students received Doctor of Osteopathy degrees, only five of whom were female. Andrea Nazar, D.O., has worked at WVSOM since 1991. She graduated from the New York College of Osteopathic Medicine, now known as the New York Institute of Technology, in 1983 and remembers a time during her residency when women were underrepresented. “I graduated in a class of 65 students, and 10 were women,” she said. “In my internship year — everybody had to do an internship at that time — there were 22 interns, and I was the only female.” She recounted a story about a patient she had cared for many nights in the intensive care unit with whom she had been communicating during her first year in a family medicine residency at Phoenix General Hospital in Arizona. When the patient finally started feeling better and the patient’s sister came to visit her in the hospital, “she introduced me as her doctor’s daughter,” Nazar said. It’s not uncommon for female physicians to be mistaken for nurses. That has happened a handful of times to Emily Thomas, D.O., a 2008 WVSOM alumna and the school’s medical director of clinical evaluation and simulation. She was a clinical sciences faculty member from 2011 to 2020 at WVSOM, then worked at a veteran’s hospital before returning to WVSOM in her current role. “When I walked in the room I always made sure I had the name badge that said ‘physician.’ Even with that clear marking, the white coat and the introduction, patients would say, ‘Are you my nurse? Who are you?’ Or I’d hear patients talking on the phone about how they have seen their nurse but hadn’t seen their doctor yet. It happens frequently, even now,” Thomas, an internal medicine physician, said. WVSOM’s demographics of male and female students have hovered around the 50 percent mark, give or take a few percentage points, for years. But that wasn’t always the case. Thomas recalls stories from her mentors that differed from her own experience. “When I attended medical school it didn’t strike me as being very lopsided,” she said. “But some of my mentors in school and during residency, as women, were trailblazers because they graduated in classes with only about 10 percent women or were the only females in their residency.” Patricia Lally, D.O., a 1993 WVSOM graduate, was Thomas’ main mentor. Other notable WVSOM faculty members such as Schmidt and Nazar, as well as Marlene Wager, D.O., who championed out-of-state students through scholarship funding, and Karen Steele, D.O., a professor emerita who was the first registered osteopathic physician in South Africa about a decade ago — helped pave the way for future female medical students. “I have a hard time considering myself a trailblazer, but I hope I have had a positive impact on many students,” Nazar said of the mentorship she has strived to provide during her 30-plus years as a WVSOM educator. While women seem to have always had a place at the osteopathic table, their numbers have grown since the turn of the 21st century. More women than ever are choosing to become D.O.s. According to a 2021 report by the American Association of Colleges of Osteopathic Medicine, 54 percent of that year’s first-year osteopathic medical school matriculants were female. Alexis Mbakwe, a WVSOM Class of 2024 student who is the first in her family to pursue a career in medicine, said she is grateful for women trailblazers like Schmidt and Ross-Lee. “Although there is still progress to be made for women, especially women of color, their efforts are much of the reason I can attend medical school today,” Mbakwe said. “It takes grit and confidence to bring your own seat to the table. I hope to continue making progress so their efforts don’t go to waste.” Ross-Lee noted in the documentary that even though more than 50 percent of students entering osteopathic medical school are female, progress should not be taken for granted. “That’s a wonderful thing, but it’s worth nothing if they don’t appreciate the battles and sacrifices that got them there, because we can easily go back,” she said. Another WVSOM Class of 2024 student, Olivia Giambra, is also the first in her family to attend medical school. She recognizes that it’s important for younger generations to see women physicians. “Years ago it was difficult for women to even enter medical school. Those women paved the way for us to have a more equal opportunity to be doctors,” Giambra said. “Now, the baton has been passed to us to pave the way for more female physicians to enter more male-dominated specialties such as orthopedics, general surgery or urology. In the era of social media, it’s amazing to see and follow so many strong females who are in these fields, own their own practices and are doing well.” Micaela Weaver, D.O., FACS, is a breast surgical oncologist at the Care New England Health System in Rhode Island and a nationally recognized surgeon. The WVSOM Class of 2014 alumna agrees that many women in medical school are reluctant to pursue careers in general surgery, in part because the specialty has a reputation for discouraging women. “I certainly had my fair share of ups and downs during training. For example, throughout my five years of residency, surgical gloves were rarely ordered in my size and I was rebuked for not having the grip strength to operate the surgical stapler with one hand,” Weaver said. “The impact of having those experiences feeds into imposter syndrome, doubt and lack of self-confidence. As I progressed in my training and my career, I have been fortunate to find incredible mentors and peers who have supported me, encouraged me, and helped to do away with those feelings.” SUPPORT IS ESSENTIAL While more women are entering the osteopathic profession, as a whole, there has been a slower but steady rise in women who in the nation’s physician workforce — from 28.3 percent in 2007 to 36.3 percent in 2019, according to the Association of American Medical Colleges’ Physician Specialty Data Reports. There is still some work to do to evolve the acceptance of females in the medical profession. Thomas said one way for health care leaders to encourage more women to pursue careers as doctors would be to improve work-life balance, as it is one of the biggest barriers. “The preponderance of housework and child care often falls to the female, so if we want to keep female physicians in the workforce, we need to have more flexible scheduling and we need to have child care opportunities. Some people just take years off from practice. We need to be more flexible in scheduling and more imaginative with benefits,” she said. As a woman in her 20s, Giambra agreed that more support for child care and better work-life balance — along with increased pay for residents — could help encourage women to pursue medical careers. “The average age of medical school entry is between 24 and 28 years old. The median age of women having children is between 27 and 30, which means most women who will have children will most likely have them some time in their medical training — whether that’s during medical school, residency or fellowship,” Giambra said. “To have residents who are pregnant or parents working 80-hour work weeks, getting paid around $60,000 a year while paying back student loans at the same time is absurd.” Melinda Ratini, D.O., a graduate of WVSOM’s Class of 1984, created a work-life balance in the medical profession that has worked for her. She works as an online medical editor for WebMD four days a week and a practicing physician one day each week. “I try to mentor residents and tell them about the different types of opportunities that are out there. I have three children, and working with medical information gave me flexibility when they were young. There is a need in health care, especially for women, for options that will allow them to raise families and still fulfill their professional goals of becoming physicians and helping patients,” she said. Ross-Lee stated in the documentary that many women face challenges related to spouses who add tasks to their plates rather than subtract them. “We tend to add more things to do as women without having somebody else share the burden. Ultimately, our spouses, our partners in life, need to share the same level of burden that women do as it relates to the home front. And they don’t do that yet. They’re getting better, but they don’t do that yet,” she said. Nazar said it’s important for women in professional careers to help and support each other, and thinks that the work-life balance for women has improved. “It’s such a complicated balance, and to do either side well is a full-time job,” she said. “I think it has gotten much better with job sharing and part-time jobs, or taking a break from practice and coming back after taking care of their family’s needs. That is a more encouraging process now.” Some female physicians said they believe women have a natural tendency to be caretakers, often bringing more empathy and better communication to the bedside. A 2020 study in The New England Journal of Medicine found that women primary care physicians spend more time — on average, an additional 2.4 minutes — with their patients than men do. The same study showed that women generated 11 percent less in annual revenue because they offered more direct patient care. These statistics don’t surprise Mbakwe, who said she has personally witnessed women spending more time with patients during her clinical rotations. “I believe that some women physicians have a unique way of connecting with their patients,” she said. The osteopathic philosophy of mind, body, spirit and understanding the body as a whole unit naturally results in physicians who spend more time with their patients. WOMEN LEADERS AT WVSOM The Feminine Touch claims that even though more females are enrolling in medical school, leadership positions are rarer among women who are practicing physicians. Adrienne White-Faines, who was CEO of the American Osteopathic Association when the documentary aired, said she would like to see more women leaders in medicine. “There are still too many boards that are homogenous, that are predominantly male, and the problem with that is that when you lose diverse perspectives, when you aren’t hearing the variety of voices, your solutions are less rich and less impactful,” she said. She stated that she likes to remind physicians “that their impact is more than just in the exam room. That today, to make a difference in health care, we have to put voices at many tables. It’s going to be important to be in the exam room with the patient but also to be at the public policy table — to be able to share your insights about patients and families with others, with administrators, with executives, with legislators.” When it comes to leadership equality, it seems a shift has taken place at WVSOM’s campus in Lewisburg, W.Va. More women are stepping into leadership roles — whether in the form of faculty department chairs or administrators at the vice president level, including Linda Boyd, D.O., WVSOM’s first-ever female vice president for academic affairs and dean. Thomas has noticed the change. “Thinking back to when I was a student, Dr. [Michael] Adelman was our dean, Dr. [Olen] Jones was our president and the department chairs were all men,” she said. “I think there has been a shift. I think there is much better faculty representation at WVSOM. If you don’t see someone like yourself in positions of leadership, it’s hard to imagine yourself in that same position. I feel like we have more visible women in leadership here.” Nazar, chair of WVSOM’s Department of Clinical Sciences since 2017, also has witnessed a shift in the percentage of female leaders at the school. “The number of women in leadership positions has had a large increase, and I think there has been a subtle but consistent, intentional attempt to promote women and foster leadership in women,” she said. ASPIRING FOR MORE Aspiring female physicians aren’t immune to hurdles in health care, but women have continued to advance in the profession. Female physicians from five decades ago carry themselves differently from today’s female students, Giambra said. “It is evident that they are incredibly intelligent and strong-willed females, probably because that type of mindset is what it took to break into a male-dominated field at that time,” she said. “It’s inspiring to have instructors like Dr. Schmidt at our school, along with our other female physician faculty members.” Schmidt’s encounter as a young girl who was told she couldn’t practice medicine wasn’t the last time she experienced discouragement about her professional interest. Schmidt earned a degree in pre-medicine from The Ohio State University and then spent several years traveling the U.S. She worked as a waitress, an exercise instructor, an asparagus-field worker and in a shrimp-processing facility before returning to West Virginia. She then spent several years working on the West Virginia Turnpike as a union-trained heavy equipment operator, but eventually returned to medicine. She was sponsored by a friend, an allopathic internist, in applying to the West Virginia University School of Medicine and a 10-fingered D.O. and radiologist in applying to WVSOM. When she was accepted at both schools and ultimately chose WVSOM because she wanted to continue to work with her hands, the internist told her she was “wasting her life” in pursuing osteopathic medicine. Years later, Schmidt returned to a large family practice in downtown Lewisburg and ended up caring for the family of the internist. She was able to conduct home visits to provide osteopathic manipulative treatment for pain relief for the internist’s wife during the final weeks of her life. Her internist friend admitted that he was proud of Schmidt, who was recognized statewide as a “West Virginia Wonder Woman” by WV Living magazine in 2021, and grateful she had chosen the path of osteopathic medicine.