MedicalPhysician Q&A

20 Questions: Dr. Yvonne Thornton, MD, MPH

Dr. Yvonne Thornton, author of Something to Prove: A Daughter’s Journey to Fulfill a Father’s Legacy (2010), and the e-book Inside Information for Women: Answers to the Mysteries of the Female Body and Her Health (2011), has broken down gender and race barriers, and in the process become an inspiration to millions.
In Dr. Thornton’s first book, the Pulitzer-prize nominated best-selling memoir The Ditch Digger’s Daughters (1995), she describes her upbringing, detailing how her parents, a maid and a manual laborer, brought her and her four sisters from the projects to possibility, with four of the girls eventually pursuing careers in medicine at the behest of their father.
Dr. Thornton graduated from Monmouth University in 1969, then headed to the College of Physicians and Surgeons at Columbia University in 1970, at a time when just five percent of specialists in obstetrics and gynecology were women.
In 1979, Dr. Thornton, along with her husband, Shearwood McClelland, volunteered for active duty in the United States Navy stationed at the National Naval Medical Center in Bethesda, MD, where she served as Lieutenant Commander in the Medical Corps.
Double board-certified in obstetrics-gynecology and maternal-fetal medicine, Dr. Thornton began her career as an assistant professor in obstetrics-gynecology and clinic director at New York Hospital/Cornell Medical Center, where she established and developed the program for a new form of early prenatal diagnostic testing known as chorionic villus sampling. She went on to work at both Morristown Memorial Hospital in New Jersey and St. Luke’s-Roosevelt Hospital Medical Center in New York.
In 1996, Dr. Thornton received a master’s in public health in health policy and management from the Columbia University School of Public Health. In 2003, she received academic appointment as a full professor of clinical obstetrics and gynecology at Weill-Cornell University Medical College.
Dr. Thornton has been married for 36 years to Shearwood, an orthopedic surgeon, and she is the mother of two children. Her daughter is a graduate of Stanford University currently in her first year of medical school, studying to be a pediatric reconstructive surgeon. Her son, also a physician, was a cum laude graduate of Harvard University, a recent graduate of Columbia University College of Physicians and Surgeons, and is now a resident in neurosurgery.
Recently, Dr. Thornton took time out of her busy schedule to share her insights with SDN.
Why did you choose to become a physician?
My father always wanted all of us (his daughters) to become physicians. I always wanted to be an obstetrician and deliver babies, so it was a confluence of my father’s wishes and my own desires.
Why did you choose your specialty?
I don’t know why, but I always wanted to deliver babies.
Did you plan to enter your current specialty prior to med school?
I did—always wanted to deliver babies. I just didn’t know that obstetrics included all the other elements as well.
If you had it to do all over again, would you still become a physician? (Why or why not? What would you have done instead?)
Yes! I find this career very fulfilling and very satisfying. It’s a very noble career to help another person.
What were some of the challenges you faced en route to becoming the first African-American woman board certified in maternal-fetal medicine?
I am the era of one foot in the future one foot in the past. I didn’t have any role models. Old folks like me broke the barriers–for women over 50, the choice was be a mother or have a career, not both. I’d been a doctor for many years before I became a mother.
My challenge was that people didn’t want me there. As I was reaching for the brass ring, I saw the rock wall…racism, male chauvinism, misogyny. I had more problems being a woman than being black. I turned stumbling blocks into stepping stones. Excellence is the only antidote–they may not want to come see you, but if you’re the best they will have to.
What do you like most and least about being a physician and interacting with patients?
I like being able to heal people. As for what I like least, I don’t know what that could be—I took a Hippocratic oath, so there is no least.
Describe a typical day at work.
It’s joy. I’m at the twilight of my career. There is no typical day dealing with pregnant women, I teach, preceptor, do perinatal consults, etc. I have been in academic medicine for my entire career, so I have always been teaching. I want to pass along the craft, skills, though processes, medical intelligence. It’s like being a surrogate parent.
How many hours a week do you work?
In the old days, I worked 120 hours a week. Until recently, I worked full time. Now it’s about 20 hours. They call us the diurnal obstetricians. We get a call from an O.B. at 3 a.m. and we tell them it’s time to deliver the baby, and then hang up and roll over and go back to sleep.
From your perspective, what is the biggest problem in health care today?
The term healthcare industry is an oxymoron. The downfall of medicine is that it patterns itself after a business model. It’s the main reason I studied for my master’s in public health, to try to understand HMOs. I still don’t understand HMOs.
From your perspective, what is the biggest problem in your specialty?
Obesity–it’s an insidious and subtle killer. You can’t call anyone fat or obese. It’s the scourge of obstetrics. Twenty percent of pregnant women are obese, but people are hush hush about it. Obesity is benign neglect. Nobody wants to manage overweight patients. We as obstetricians contribute to obesity. In 1986, we were told that regardless of a woman’s weight before pregnancy, she needed to gain 26 to 35 pound or else the pregnancy would end in fetal death. We need to be looking at overall health and how much the mother weighs to begin with. It’s no longer “eating for two.”
(Dr. Thornton did a seminal study on pregnancy weight gain in which she determined pregnant women may not need to gain weight, but should instead focus on healthy eating. Her findings were published in Journal of the National Medical Association.)
Do you agree with the rules changes regarding resident work hours?  If not, what concerns do you have about the changes?
This is not shift work. People not in medicine are dictating to those who are. I have residents who never see the full continuum of illness–they just don’t have the hours. Especially surgeons–they need to be there to observe before, during, after. Residents come in at 9 and leave at 5. This is not an office job. I wouldn’t want a doctor trained that way.
What do you find inspiring about the medical profession today?  What about current medical students, residents, and new doctors?
When you deliver a difficult pregnancy and both patients are alive. I’ve delivered 5,542 babies and oversaw 12,000 deliveries. I get to touch immortality.
If you had unlimited funding, what sort of research would you like to conduct?
Reproductive women’s health. The only thing ever really studied has been the pill, but I’d like to study endometriosis, ovarian cancer, etc.
Your children are currently in the midst of their own medical education process as a student and resident.  How is their experience different from that of you and your husband?
It was very paramilitary when I was in medical school. Now it’s softened—everybody’s a friend. And no one wears a wristwatch anymore!
What advice did you give your children as they considered pursing medicine as a career?
Never give up. They are the children of two physicians, so they are privileged with focus and structure. We raised them lovingly strict—they weren’t at the mall. We knew where they were.
What helped you pass your exams?  Any study tricks or tips?
Know the material! It’s not about passing the exam.
Now it’s all about the numbers (MCAT scores). There’s nothing about bedside manner or spirit or a humanitarian approach, and patient gets lost in the middle of it all.  It’s all about taking tests instead of taking care of patients. It’s the deterioration of the profession–it’s just a job now.
What types of outreach/volunteer work do you do, if any? Any international work?
I’m on the board of trustees of the Fair Housing Council in northern New Jersey. Your future is based on where you live. I was denied housing in 1982 in Bergen County, and the Fair Housing Council fought for me.
What do you like to do for relaxation or stress relief? Can you share any advice on finding a balance between work and life?
I needle point—it relaxes me. I’m also a championship competitive ballroom dancer, a musician (saxophone) and vocalist. I’m 60 years old, and I don’t take many breaks. My greatest accomplishment is being the mother of two great kids.

About the Ads
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I appreciate Dr. Thornton comments and recognize the struggles she must have experienced when breaking into the field. Definitely planning to read her book.
However, I'm a little surprised by her comments on work hours. It's true that more programs are moving toward a nightfloat system, but "residents come in at 9 and leave at 5"? Not what I saw on my OB & surgical rotations, or any rotation, for that matter.
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    Yvonne S. Thornton, M. D., M. P. H., FACOG, FACS
  • March 3, 2011
The reference to work hours of "9 to 5" was a metaphor with respect to residency hours. The 80-hour work week (compared to the 110 to 120 hours per week thirty years ago) is in force now for residents and, in my opinion, there is just too little time to understand and be comfortable in knowing the nuances of a disease process, especially in a surgical specialty or subspecialty. One needs time to perfect the skill of surgery and residency programs today are not giving the postgraduate physicians enough time. One could increase the years in a program but there is not enough money or resources to do so. Consequently, the residents leave programs with less experience than their predecessors of years past. It's just a fact.
Surgical residencies, in particular, before there were fellowships, the senior or chief resident would get the cases. Now, the fellows are performing the surgery and the senior residents are assisting or observing; which means when they finish the program, they either have to do a fellowship or not have the requisite confidence in performing the surgery. We are in a conundrum.
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    Yvonne S. Thornton, M. D., M. P. H., FACOG, FACS
  • March 3, 2011
Thank you! It took only 36 years of actively practicing medicine (OB/GYN) to get to work 20 hours a week. :) The word "resident" meant just that——you were a resident in the hospital. "Life outside the hospital"? What was THAT? You slept when you could and you ate at the nurses' station. You also developed that special kind of stamina and mindset that would hold you in good stead when you entered the real world, allowing you to manage patients coming at you left and right, office hours, the OR and teaching residents yourself. However, like any "trial by fire", I found myself being a very confident and competent surgeon, physician and diagnostician when I finished the program. As a resident in training, one will never have that kind of supervised oversight by Attendings after they leave the program and he/she should make the best of every minute they have before being thrown out into the real world where litigiousness and uncertainty abound.
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    SPP
  • March 3, 2011
You mentioned working 120 hours in the past but now you only work 20. Im exicted to work in a medical profession, but 120 hours a week sounds insane! How do you find time to eat, sleep, and (god-forbid) enjoy life outside of the hospital??
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    JenD
  • March 3, 2011
Thank you so much for being willing to share your impressive story. I actually saw "The Ditch-Diggers Daughters" movie before I realized the book behind it. I am interested in your viewpoint on raising children in a busy two-physician family. Often there are examples of children who do not turn out quite as well. What are some of the principles you used with your own children that you think contributed to their success?
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    ZackG
  • March 4, 2011
Dr. Thornton,
I am a first year medical student who is very interested in OB/GYN. Your comments about residency hours interested me. A lot of the impetus for the shortened hours came not from a concern that the resident's didn't have enough free time but from concerned patients themselves. I've read magazine and newspaper articles about patients worried that a resident would make dangerous mistakes if they saw new patients after 24 hours on their feet. That a young surgeon in training would have questionable judgement after so many hours without sleep and potentially harm patients. Do you think those are valid concerns and do you think anything should be done to address them?
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    Yvonne S. Thornton, M. D., M. P. H., FACOG, FACS
  • March 5, 2011
Zack:
You need to read more than newspaper and magazine articles. Current studies have shown that shortened residency hours have actually done more harm than good for patients. The reason is that the new (on-service) resident doesn't "know" the patient and fails to ascertain the subtleties and nuances of the disease process. Magazines and newspapers are for the layperson. Medicine is for physicians and patients. If you care about your patient, you will stay up as long as possible to see him/her get the care they need. It is utter hogwash that the patient's safety is at risk because a resident didn't get enough sleep. That's why there are Attendings who are supposed to supervise the residents. Rarely are residents up for 24 hours straight without sleep. Even if they were, we need to stop being so concerned about US and worry more about the patient! In real life, an OB/GYN may have to be up with a delivery all night and then have office hours the next morning, followed by an emergency ectopic in the OR. If one doesn't develop stamina in a residency program, indolence will rule after they leave the program and heaven help them when there is no Attending to bail them out when they are on their own.
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    Yvonne S. Thornton, M. D., M. P. H., FACOG, FACS
  • March 5, 2011
JenD:
You are absolutely correct with respect to raising children and being a female physician in a surgical subspecialty. Therefore, residency and pregnancy do not mix. Pregnant female residents become mediocre residents and mediocre parents. One can't serve two masters. Trust me, motherhood trumps everything else. My approach to child-rearing has never changed——to be consistent, involved and encouraging. Setting goals and helping your children to achieve them is one of the most challenging tasks ot being a parent. I hope you enjoyed reading my first memoir, The Ditchdigger's Daughters. In it you will remember me studying for my Board certification examination, being pregnant and being on active duty in the Navy——all at the same time. My new memoir, SOMETHING TO PROVE, answers those questions you posed about raising children in a two-physician household. My mother always told us (her daughters), "No amount of success in your profession can ever make up for being a failure at home." So many children of professionals (celebrities and corporate tycoons, for that matter) are lost to drug addiction, suicide and emotional disturbances. They have the wealth and resources, but no guidance because the parents are too busy taking care of patients or closing the next business deal. I chose academic medicine because it allowed me to have a more stable life to raise my children. The income was not as high as my private practice counterparts, but I was not subject to the vicissitudes of having to pay malpractice premiums, make a payroll or pay staff each week. On the other hand, being a female surgeon and OB/GYN, I needed a "wife" to do all the things that my male counterparts took for granted because their spouses did all of the domestic-related duties, i.e., social correspondence, measuring draperies, making dinner, buying sneakers for the kids, etc. All-in-all, I think my husband and I did a great job. Both of our children are young adults now: 1) My son--Harvard graduate, MD from Columbia and is studying neurosurgery 2) My daughter--Stanford graduate, MPH from Columbia and is now a first-year medical student. I hope you have a chance to read both books.
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    Mike
  • March 5, 2011
I appreciate your perspective, but old-fashioned, literal Residency is not possible for those of us who already have families. I love my wife and kids and my time outside the hospital, and I am thankful for it.
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    ZackG
  • March 5, 2011
Dr. Thornton,
Thank you for your input. I didn't mean to convey that I am worried about myself as a future resident. I was more wondering if you felt that public perception regarding the dangers of stressed residents has any foundation in reality. I've met many residents who, like yourself, want longer hours and feel that they aren't getting the exposure they need. I just know that magazine and newspaper articles, as unreliable as they are, have more sway on public perception than academic journals do. Thank you so much for your comments Dr. Thornton. I really appreciate physicians taking their time to help us who are just starting.
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    Matt
  • March 5, 2011
Thanks for sharing your story and amazing accomplishment in career and family life. All the best.
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    MikeMD
  • March 5, 2011
Nice interview,
Agree with her thoughts on the art of medicine being replaced by the business of medicine. that being said, her thoughts on residency hours are rather sad and seem more reflective of the "old guard" of medicine instead of what is best for both residents and patients. I've spoken with numerous residency directors and residents and there is no question that residents who work on average far less than 80 hours a week perform better, are happier, and learn just as much if not more. Unfortunately, many older physicians think that since they walked uphill both ways to medical school & residency than todays/tomorrows should too. That being said, surgery may be unique in its need for tremendous exposure/repetition.
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    Joe MS-IV
  • March 6, 2011
Dr. Thornton,
Thank you so much for this interview. We need more doctors like you!!! The 80 hour rule is a death sentence to medicine. As a 4th year medical student, I want to use residency to learn as much as I can and graduate as a competent, confident surgeon.
We shouldn't lower our standards to accomodate those who think that medical school should be a walk in the park.
Thank you
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    Stephanie
  • March 6, 2011
The article mentions that you received a Master’s in Public Health in Health Policy and Management from Columbia. Although my ultimate goal is to go into medicine, I am also very passionate about public health. I feel like people are continuously questioning why I am going to school for my MPH first because they don't think it's an important degree. Do you think that pursing an MPH was helpful for your professional career? Why did you chose to get an MPH after your MD, instead of the other way around?
I honestly believe that having an MPH can only help me in the long run. Knowing myself as a student, I would not be able to handle getting a combined MPH/DO at the same time, so I am just taking a different route and doing one at a time. Do you think this plan is realistic?
You also mentioned that "there’s nothing about...a humanitarian approach, and patient gets lost in the middle of it all". Do you think that having an MPH combined with a medical degree will help me look at medicine from a different perspective? When I consider the traditional medical model, the practice of medicine is focused on the clinical aspects of science, and involves the treatment of each patient on an individual basis. I believe that an MPH allows a medical doctor to expand the individual view to one that is population-based, and treatment would instead be a focus on preventing a person from having a disease in the first place (or at least teaching people how to manage their illness so that they prevent further deterioration due to a disease).
Thus, does having knowledge of public health expand your viewpoint as the clinician to consider things that you may not have considered without knowledge of these principles?
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    Sha'Nika
  • March 7, 2011
Dr.Thornton,
I want to thank you for taking the time to do this interview. I am an African American young lady with two kids. I am wanting to pursue a career in Pharmacy preferably in the the Medicinal Chemistry area. I know that having kids and pursuing the career that I want will not be the easiest thing. The article did upset me a little in that regards but, I appreciate your honesty. It will not make me give up though and it encourages me to try my hardest to balance the two so that I can give my career and my family both the attention that they deserve. I appreciate also your accomplishments and paving the way for young ladies like myself. We can look up to individuals like yourself and know that it can be done. I also love your little saying. I, myself, will continue to turn stumbling blocks into stepping stones.
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    Austin
  • March 8, 2011
Dr. Thornton,
Thank you for the interview and the willingness to speak with commenters. I am very interested in your remarks about residency time and physician effectiveness. I agree we need to read "more than newspaper and magazine" articles. Can you give an example of a journal article that demonstrates a connection between increased work hours and the effectiveness of the produced physician?
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    Yvonne S. Thornton, M. D., M. P. H., FACOG, FACS
  • March 11, 2011
Good morning, everyone:
I've just read the numerous comments about my interview and thank you for your kind words. I am just trying to be as honest as I can. My comments are based on almost 40 years of being a practicing physician and being in academic medicine where I have trained hundreds of residents. There were some criticisms about my statement regarding being a mother and resident. Having and raising children before or after residency is not the problem. The concerns are when pregnancy is simultaneous with residency in the surgical or surgical subspecialty areas. Being pregnant as a psychiatric, pathology, internal medicine, dermatology, pediatric or public health resident does not carry the same import as being pregnant when you are a surgical, OB-GYN, cardiothoracic, neurosurgical or urological resident. So if MomMD believes my statements are insensitive, that is unfortunate. Ipsi res loquitur: In 2008, 75% of male OB-GYN docs are Board-certified compared to 59% of female OB-GYN docs. You be the judge of mediocrity.
The questions about MPH and MD degrees are fascinating. I didn't want to go back to get an MPH because I was too busy. However, the landscape of medicine was changing and my husband and eventually I, felt we needed to keep current or be left behind with all the new terminology and paradigms for medical care. Either way, MD, then MPH or MPH, then MD gives one a depth of understanding about the world of humanitarian medicine and also a good basic background in statistics in order to read and critically analyze the literature.
The following are some references regarding resident hours. It's just common sense, the more hours you are taking care of patients, the better you become. That goes with anything. Surgical specialities are particularly affected by the reduced hours and that is a pity.
J Am Coll Surg. 2003 Oct;197(4):624-30.
Work hours reform: perceptions and desires of contemporary surgical residents.
Whang EE, Perez A, Ito H, Mello MM, Ashley SW, Zinner MJ.
Ann Intern Med. 2010 Dec 21;153(12):829-42.
Systematic review: association of shift length, protected sleep time, and night float with patient care, residents' health, and education.
Reed DA, Fletcher KE, Arora VM.
N Engl J Med. 1988 Mar 24;318(12):775-782.
The impact of long working hours on resident physicians.
McCall TB.
We all love our families and our time outside of the hospital. However, we also took an oath (The Hippocratic oath) and we need to do the best we can in serving both ourselves and our patients.
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    Naomi
  • June 12, 2011
This interview reads like that of a self-congratulatory, condescending, malignant individual who can only extol her own virtues while criticizing others. You repeatedly say that you are such a devoted physician and mother, but then say that people who desire to do both at the same time are "mediocre." You are clearly very self-congratulatory about your childrens' accomplishments, but I wonder how your daughter would respond to your criticisms of women surgeons having families during residency. You sound like a teenager rather than a grown woman. I find it sad and disturbing that you are touting yourself as a role model for young physicians; you are certainly not my role model, ma'am.
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    Naomi: You obviously missed the entire point. Timing is everything, my dear. My daughter (a third-year medical student) responds the same way as I do. Being a mother and a surgical resident are mutually exclusive for excellence in both. I am not a teenager, but you sound as if you want a family. So, go right ahead, but remember where you heard it first. I don't put myself out as being anyone's "role model". We all have our challenges. Good luck with yours.

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