Orthopaedic mother-daughter duo Alexis Pilato, MD, and Carolyn “Sis” Engle, MD, recently started workingtogether at Heritage Valley Health System in Beaver, Pa.
Courtesy of Alexis Pilato, MD

AAOS Now

Published 12/1/2019
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Kerri Fitzgerald

All in the Family

Mother-daughter duos bond while working together in orthopaedics

Jennifer M. Weiss, MD, FAAOS, is the daughter of an orthopaedist and, as a second-generation orthopaedic surgeon, was well aware of all the women and men who come from orthopaedic families. Until recently, she knew of only father-daughter and father-son orthopaedic pairs. She took to social media hoping to find a mother-daughter dyad and found two: one American and one Canadian.

Mentors who advocate for women in orthopaedics

First, she spoke with Alexis Pilato, MD, and her mother, Carolyn “Sis” Engle, MD, FAAOS, both orthopaedic surgeons working at Heritage Valley Health System in Beaver, Pa. They discussed their mentors and how the female orthopaedic community impacted their careers.

Dr. Weiss: Were you aware that mother-daughter orthopaedic surgeon duos are rare?

Dr. Pilato: I wasn’t aware until recently. I recognized that there are relatively few women in orthopaedics in general. I have come to learn that, as far as I know, we are the only pair in the United States.

Dr. Engle: I was not aware until we were approached about this interview. My mother was a very dedicated nurse, and that is the closest anyone came to being in the medical profession in my family.

You work together in practice?

Dr. Engle: Yes, Dr. Pilato just finished her fellowship in July and joined our practice in September.

Dr. Pilato: Yes, I recently completed a fellowship in hand and upper extremity at the University of Pittsburgh and joined the group.

Dr. Engle: I did not do a fellowship. At the University of Pittsburgh, I was required to do a year as a “super chief.” This allowed me to focus on any subspecialty I wanted, while taking trauma call as an attending. I chose elective time in adult reconstruction. I have a true general orthopaedic practice, but I would say that a lot of my practice favors total joint arthroplasty and trauma.

That is a perfect match. What does your practice look like?

Dr. Engle: We were a private practice, but within the last year we have become part of the Heritage Valley Beaver Multispecialty Group, so we are just recently hospital employed. Our practice provides the whole spectrum of orthopaedic services to our community.

Dr. Pilato: We are part of a group of five orthopaedic surgeons, all having our own niche within the scope of orthopaedic practice. My mother and I are the only female physicians in our group. The group has not had a hand surgeon in several years, and the community has needed one, so it is a very exciting time for me to join the team.

Did you accompany your mom to work when you were little?

Dr. Engle: My husband, Mike, and I have four kids. He is a pilot, so there were many times I had to take them on rounds. My family and husband played an intricate role in getting me through this crazy time, particularly during training. Our kids could not have played sports or been involved in extra activities without the help of my parents hauling them to and from practices and lending a hand.

Dr. Pilato: I remember we would go to church on Sunday mornings and then stop at the hospital so she could make rounds. As a patient, it’s hard to be in a grumpy mood when you have little kids coming in to say hello. It kind of humanizes the physician and makes the scenario more pleasant. I very vividly remember that growing up, and it was definitely impactful. Patients were so grateful, and I recall being so proud of my mother in that role.

Have you talked about any changes in your experiences as women in orthopaedics?

Dr. Engle: There have been many changes for women in orthopaedics. When I interviewed, the orthopaedic workforce was less than 2 percent women. In my third year of medical school, I did an orthopaedic rotation, and Eric Jones, MD, initially piqued my interest. I had zero male and certainly no female mentors pushing me toward orthopaedics until I did a fourth-year medical school rotation at the University of Pittsburgh with Freddie Fu, MD, FAAOS. Dr. Fu was way ahead of his time in advocating for women in orthopaedics. He took an active interest in making sure I pursued this career. He pushed me and never let me give up, even when I heard it would be very difficult for a woman. He is the reason I ended up at the University of Pittsburgh, and I could never thank him enough.

Dr. Pilato: In terms of what has changed—the implementation of work-hour restrictions and more oversight with somewhat less autonomy are examples of bigger changes, for better or for worse. There is more focus on graduated independence throughout training, which is not a bad thing. I think the representation of women in orthopaedics has definitely increased over the years, which is nice. While they are more common, finding a female mentor is still a challenge. There is a lot more advocacy for women than there was during my mom’s time in training. I think she had to continually prove herself, and there wasn’t as much support for women, perhaps even more so resistance.

Dr. Engle: I always felt like I had to be smarter, tougher, and work harder back then to prove myself as a woman among men. Most of my colleagues did not make me feel that way. I think I had a little chip on my shoulder because I am female. I feel that times have changed for the better, and we all must take an active role as mentors to advocate for women in orthopaedics.

Dr. Pilato: In my experience, I have not directly had any female mentors that were faculty, but I’ve had some really supportive and progressive male mentors. In residency, former program director David Koon, MD, and current program director Gregory Grabowski, MD, were wonderful and have always had a consistently above-average number of women in their program. Despite often being the only woman in the room, I have never really noticed or felt singled out. I was always just a member of the team. I always felt supported and encouraged as an “orthopaedic surgeon,” not a “female orthopaedic surgeon.” This is true for all the orthopaedic faculty at the University of South Carolina. In my fellowship, Mark Baratz, MD, was phenomenal. He takes an active role in advocating for women. He inquires about obstacles and adversity in orthopaedics unique to women, particularly during training. He has a genuine interest and capacity for compassion that is truly special.

I have found the social media community of women in orthopaedics and surgery in general to be so impactful. Have either of you had this experience with social media?

Dr. Pilato: My mom does not use much social media, but I think it is really nice to have a supportive network of women readily available. It’s a great forum for inquiries regarding work-life balance and challenges unique to women that most male colleagues do not even realize exist. In general, most orthopaedic surgeons have “type A” personalities, wanting to succeed in life at the highest level, both professionally and personally. There are different barriers and personal considerations, especially being of childbearing age, and how to navigate training, practice, and family life with that sort of responsibility. I really love the Women in Orthopaedics Facebook page. People post cases and share opinions. It seems to be a positive and uplifting space for problem-solving, not griping and whining—just a group of awesome women sharing their experiences. Being a female orthopaedic surgeon, it’s easy to feel like no one will understand your circumstance, and it is incredible to see so many women with similar experiences.

Dr. Engle, how did you feel when your daughter said she wanted to go to medical school?

Dr. Engle: I was very happy that Dr. Pilato chose to go to medical school. She made that decision on her own without any pressure from me. The medical profession has changed, but I still feel that being a physician is the best profession in the world. Regarding her choice of orthopaedics, I remember when she said, “Mom, I think I want to do orthopaedics,” and I looked at her and jokingly said, “You better start lifting weights!”

Dr. Pilato: I’m plenty strong, and I have never had any trouble with the big trauma cases!

Dr. Engle: I was really surprised that she went into orthopaedics; it made me feel really good. I hope that I’ve portrayed the fact that I love my job, and I think that’s one of the reasons she wanted to do it.

Dr. Pilato: When I was young, she never pushed a career in medicine on me or my siblings. We just knew she loved what she did, and I always liked the subject of science in school. She also never really brought work home—she was a mom first, so I never knew all that much specifically about orthopaedics growing up. I was open-minded when I went into medical school, but when I did an orthopaedic surgery rotation as a third-year medical student, I remember saying, “This is so fun. This is the coolest job ever!” Then I looked at my mom and thought, “This is what she does all the time? She’s a total badass.

Orthopaedic mother-daughter duo Alexis Pilato, MD, and Carolyn “Sis” Engle, MD, recently started workingtogether at Heritage Valley Health System in Beaver, Pa.
Courtesy of Alexis Pilato, MD
Mother-daughter duo Alexis Pilato, MD, and Carolyn “Sis” Engle, MD, FAAOS, perform an open reduction internal fixation of an ankle fracture. They removed the protective eyewear for the picture
Courtesy of Alexis Pilato, MD
Caroline Scott, MD, and Christine Young, MD, are another orthopaedic mother-daughter duo who work together at Scarborough Health Network in Ontario, Canada.
Courtesy of Caroline Scott, MD

Dr. Pilato, did you ever feel any pressure following in your mom’s footsteps?

Dr. Pilato: No. People who knew my mom had only great things to say, and they were always blown away by her work ethic and ability, which was really impactful to me. She has always been so well respected by everyone, which always resonated with me, but I never felt any pressure to go into orthopaedics. Now that we’re in practice together, it has been really fun because we are both orthopaedic surgeons, but we do such different things. We trained at different times and in different places, and we sometimes approach problems differently, so we have a lot of fun bouncing ideas back and forth.

Orthopaedics in the era of the #MeToo movement

Next, Dr. Weiss spoke with Caroline Scott, MD, and her mother, Christine Young, MD, who are orthopaedic surgeons working at Scarborough Health Network in Ontario, Canada. They discussed the visibility of women in orthopaedics and weighed in on navigating professional relationships in orthopaedics in the wake of the #MeToo movement.

Were you aware that mother-daughter orthopaedic surgeon duos are rare?

Dr. Scott: It must be a rarity. At least in Canada, we are the only mother-daughter orthopaedic duo we are aware of. There are many examples of sons or daughters following in their fathers’ footsteps.

Have you talked about how your experiences in orthopaedics differed?

Dr. Young: When I was starting out going to conferences, it always seemed that there weren’t many women presenting or on panels. This has somewhat improved, but I still think it is an issue we need to work on as a group. During my training, I was mentored by Robert B. Salter, MD, of the Hospital for Sick Children, who was always a big supporter of me.

Dr. Scott: In my training, there was a lot of focus on subspecialty. The technology and techniques my mom and I learned are different. We have a unique shared practice as general community orthopaedic surgeons. I think it enhances our care for our patients, because we bounce ideas off each other. We enhance each other’s skills. We work in a very culturally diverse area of Toronto, which happens to be statistically the most multicultural city in the world. We can provide a unique service, for example, for a very conservative woman who might not want to see a male doctor.

Dr. Young: My point of view for a patient may come from years of experience, while hers comes from recent training and knowledge of new technology. Dr. Scott is definitely better in hip arthroplasty than me. …

Dr. Scott: … And Dr. Young is a shoulder expert, which I have benefited in learning from her. But in terms of changes over the last 30 years, I was at the AAOS 2019 Annual Meeting and heard Kristy L. Weber, MD, FAAOS, speak. I was very inspired by her words about recognizing diversity and harnessing the power of different viewpoints. I don’t think the culture has changed as much as I would like. Hopefully our experience may be highlighted as a unique skill of women working together.

How many other orthopaedic surgeons are in your practice?

Dr. Scott: We have more than 20 now, and we are two of three women.

Dr. Young, from your time in training until now, we’ve seen women in orthopaedics jump from about 2 percent to 6 percent. That’s not as much improvement as I would like.

Dr. Young: I’ve always felt like the token woman in the room, and I don’t think that should be the case. I think our point of view should be listened to. Things are getting better with the younger orthopaedic surgeons—they’re more empathetic.

Dr. Scott: Many of my peers, men and women alike, want to prioritize work-life balance. I’m a vocal member of our orthopaedics group with many supportive and progressive colleagues. My trauma and arthroplasty fellowship at Sunnybrook Health Sciences Centre in Toronto with surgeons like Hans Kreder, MD, MPH; Richard Jenkinson, MD, MSc; Markku Nousiainen, MD, MS, MEd; Diane Nam, MD, MSc; and David Stephen, MD, was an enriching year professionally and personally. Because of my program support and my family background, sometimes I forget I’m the “woman in the room.”

I have learned a lot from my male colleagues about mentoring in the #MeToo movement. Have you found that mentoring has been impacted by this?

Dr. Scott: I did my training before the #MeToo movement, but my approach was to be professional and formal. I didn’t want to cross any lines. If you want to be mentored, you have to actively make that relationship happen. I was lucky that I used my background playing National Collegiate Athletic Association hockey to step on the ice with my orthopaedics mentors and socialize in this way. A very Canadian approach …

Have you been involved in the female orthopaedic community on social media?

Dr. Scott: I just recently joined Twitter at my husband’s encouragement. I was so intrigued that there are many women publicly sharing situations that are common to women surgeons. I also started following this female trauma surgeon who posts X-rays and tips and tricks on fracture reduction. The #orthotwitter community has broadened my horizons—thinking we’re not unicorns; I am part of this amazing movement of women leading other women in surgery.

Dr. Scott, did you always want to go into medicine?

Dr. Scott: I was always interested in math and science. I thought I would go into medicine. I loved the active nature of surgery. I loved orthopaedics—there’s a problem; I have a solution; let’s get it done. My mom is my longstanding inspiration because she loves her job and because many of my teachers at University of Toronto respect her as a skilled and compassionate colleague.

Dr. Young: I was very happy and proud to see her go into orthopaedics. She has a very strong personality, and she’s very confident. I’m amazed at how skilled she is. However, her father and I did question, “Does she know what she’s getting into?” It’s a tough specialty, especially because it’s a male-dominated field. It’s also not easy physically, and your time is not your own. So, it’s important to have a partner who realizes that kind of lifestyle. But I know she loves it, and she’s learning how to separate her work and home life.

Dr. Scott: My mom is a notable trailblazer at University of Toronto, because she was pregnant with me in her residency. …

Dr. Young: I actually operated up until she was born, basically. I remember doing a bipolar hemiarthroplasty, and she was kicking around quite a bit not long before she was delivered. I put a retractor under my belly to help expose the wound. I was like, “Hold this!” I was in the operating room of Allan Gross, MD, who was a strong supporter of women in orthopaedics.

Dr. Scott: I guess I was born to do this. …

Dr. Young: I grew up on a farm with four sisters, and my father had us do all the farm work. I didn’t really know there was a difference in what women and men did, so I was naïve when I went to medical school. When I interviewed for my orthopaedic residency, one of the male fellows said, “I don’t think you’re strong enough to be an orthopaedic surgeon.” I was an athlete; I threw the javelin and had good arms at the time. So, I said, “Well then let’s arm wrestle.” He declined to arm wrestle, but I did get the job.

Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at kefitzgerald@aaos.org.

Jennifer M. Weiss, MD, FAAOS, chair of AAOS’ Communications Cabinet, contributed to the article. Dr. Weiss practices in the Permanente Medical Group in Los Angeles. She specializes in pediatric sports. Learn more about Dr. Weiss at www.jenniferweissmd.com and follow her on Twitter at @mymomthesurgeon.