Dr. Julie Ann Sosa

Dr. Julie Ann Sosa

Interview Performed by Sophia Hernandez

Question 1: What is one thing you know now that you wish you had known during training?

JAS: When I was a learner, I trained at a program that produced hepatobiliary surgeons, specifically pancreatic surgeons. In the history of the residency program, you could count on one hand the number of trainees who did not go into hepatobiliary surgery. There were good reasons for this. It was a fantastic program in that area, the faculty were the strongest, the science was focused there, the chair was that kind of surgeon. So, you produce people who look like you, and that is what you are comfortable doing, and so you do it. My first job in Connecticut was doing pancreatic surgery. I did it for three years and I woke up every day during those three years thinking, “What is this? I am not  joyful.”  So, three years into my career as an attending and I had to recalibrate and redirect. Eventually, I got where I needed to be. Early on, I did not keep my eye on the prize, which is to do what brings you joy. This is the biggest lesson I would give to my former self so many years ago. You need to know your joy. It sounds very easy, but it is actually very hard. You have to know yourself; you have to understand what brings you joy, what you are passionate about first and foremost, and THAT should drive everything thereafter. I think people get all the stuff thereafter in front of that, and that gets lost sometimes. You have to have self-awareness. That takes time, energy, and focus.

Question 2: Who do you admire?

JAS: One of the most extraordinary people in my life as measured by the impact that they have had on my career is Dr. Neil Powe. He is the Chief of Medicine at San Francisco General Hospital. He is an internist, a health services researcher; I’m a surgeon. He has changed my life in many ways.

Question 3: What impact has mentorship had on your surgical career?

JAS:I have been very blessed in my life to have had extraordinary mentors, but I will call out one. Dr. Powe was my mentor when I was a resident at Johns Hopkins and a Robert Wood Johnson Clinical Scholar.  He does not look like me; he is a man, he is Black, he is an internist, and he has had a totally different life-experience than me. What he taught me has nothing to do with any of those things. What he taught me was how to approach a problem, be evidence based and thoughtful and rigorous at the same time that you are creative. Life is strange and the world is small, but when looking for a mentor you must be open. Don’t think that you know what they will look like, don’t think that they will resemble you in any way. Be open to life experience, and, when you have extraordinary life experiences, cherish them. I would not be who I am or where I am if it were not for Dr. Powe.

Question 4: What are you most proud of personally and/or professionally?

JAS: When I graduated from college, I went to England for two years. I was writing a book focused on labor economics called “Prospects for Faculty in the Arts and Sciences” that was ultimately published by the Princeton University Press.  It is probably, to this day, the greatest scientific contribution that I have ever made - if I have made anything! It has actually won a bunch of awards! No one knows or cares in Surgery, so I never get to talk about this! 

Question 5: If not surgery, then what?

JAS: I would have been a PhD in economics. It was all looking good - I was going to get a PhD in Labor Economics. But in our book, we rendered projections of what the job market was going to look like for PhDs in the Arts and Sciences for the next 25 years, and we concluded that there were not going to be any more jobs (laughing). So, I was in this strange predicament where the book we wrote showed that I was not going to have a job. So, I course-corrected, and thought, well, I have to do something different… this is terrible! My parents are in medicine; they told me, “You should go into medicine. You will always have a job.” I hadn’t taken the MCAT, so I thought, okay, where can I apply? There was one medical school that didn’t require the MCAT at that time, and that was Johns Hopkins. I applied, and got in, thank goodness!

Question 6: How do you think we can increase underrepresented in medicine (URM) interest and mentorship in surgery?

JAS: For me, this is very personal. Maybe it is easier, maybe it is harder when it is personal. I think that when it is personal, it is something you think about every day. When it is not personal, then you must be even more active and intentional. It is not going to happen accidentally - you must be strategic, plan, and recruit collaborators. Many people feel that if you empower some, others maybe disempowered; in other words, it is perceived as a zero-sum game when in fact, it is not a zero-sum game; empowering others empowers you! 

Leading by example means demonstrating that there is opportunity to succeed and then using your leadership to empower others. I think you have a responsibility as a leader to have the courage to speak up and speak out on behalf of those that don’t have that power. You have a responsibility to speak about these issues to compel others and then to live by example.

To compel others, you need to provide evidence that there is a problem. Evidence-based advocacy is important and something that I think is unique to UCSF because we are scientists and evidence-based in everything we do. I have spent over a decade of my life working together with Dr. Heather Yeo performing a 10-year, prospective, nationwide cohort study of general surgery residents measuring  why people drop out of general surgery. We looked at gender and found that women were more challenged, as we residents based on race and ethnicity. What is happening is terrible - there are not enough women, they are not finishing, and they are dropping out (late in their training). So, this is very compelling and demonstrates a large opportunity for improvement. Evidence like this should empower us to make thoughtful, strategic change.

So, for students: speaking, advising, inspiring, mentoring, sponsoring, educating—and the same for our residents.

For our faculty, this is extremely hard. You have to actively find and recruit. Not because they don’t exist, they do. But, they have fewer mentors and sponsors.  Often, they are invisible. You cannot see them unless you go looking. So, it is active recruitment. There has to be accountability to demonstrate that you are making progress, because if you are not, then you have to recalibrate and change what you are doing. Then, there is the problem of retention, and that means looking at salary equity, looking at merits and promotions. The minority tax and the women’s tax can be used to describe so many underrepresented groups where people are tasked to mentor and sponsor, and so they do it, but as a result, you are not operating as much, you’re not generating income, or you are not publishing. The minority and women’s taxes are definitely real. We need to empower URiMs and women as well; that is, they need to be in leadership. It is not enough to have a Department that is 50/50 men and women, if all the leaders are men. That is not just.

You cannot do this all on your own. It requires a lot of discussions, organization, like the MSS, Grand Rounds, guest speakers, editorials, writing about things - you have to be constantly stewarding and curating this. If you let your foot off this pedal, the car is going to come to a stop.

You have to live it and you have to use evidence to support what you are doing, because people will not believe, they will criticize, and they will challenge. You have to get a ton of other people enrolled to help you. Put the proverbial ‘pedal to the metal’ all the time!

Question 7: What is your favorite quote or mantra?

First of all, there is no one quote. I have many, many, many, favorite quotes. Lately, I have been thinking a lot about the concepts of compassion and altruism. I am feeling this quote by the Dalai Lama right now because I feel in the world we really lack compassion and altruism. That is a problem if you are a physician, if you are a leader, or if you are a politician. “If you want others to be happy, practice compassion. If you want to be happy, practice compassion.” I think this is true in any setting.

Question 8: What are your hobbies outside of the hospital? 

My hobby is one word: Twinkie! My pup. She is an avocation. It may even be a profession. It is the thing I love so much, and it is time consuming!